The Language of Multiple Concurrent Partners, Sex, and HIV and AIDS in Lesotho: Opportunities for Dialogue Promotion

This 38-page report, produced by the United States Agency for International Development (USAID) and prepared by the C-Change (Communication for Change) programme managed by the Academy for Educational Development (AED), analyses formative research carried out by C-Change to understand how culturally-embedded communication about HIV and AIDS and sexual behaviour contributes to sustaining the practice of multiple concurrent partners (MCP) in Lesotho. According to the report, the findings from qualitative research along with a review of existing research is informing message development for a short-term communication campaign in Lesotho focusing on HIV prevention through the promotion of dialogue about MCP. The report suggests that opportunities for intervening in language, promoting dialogue, and community mobilisation should pay attention to the fact that dialogue about sex and MCP using open and direct language runs counter to indigenous concepts of respect and social status and risks provoking a backlash.

The research was based on 24 in-depth interviews with key informants identified in the following six categories: traditional healers, youth leaders, health care workers, volunteers involved in HIV and AIDS and reproductive health work, local area chiefs, and church leaders. It found that a certain amount of dialogue about sex, MCP, and HIV does occur, but in ways that are not immediately apparent to cultural outsiders. This finding contrasts with that of previous research, which has indicated that Basotho are silent, secretive, and non-communicative about sex. This study also provides insight into the type of language that is currently utilised, making the case that silence and secrecy are part of culturally appropriate communication that Basotho use to "talk" about sex, MCP, and HIV.

The report explains that the language of secrecy in the context of this research refers to verbal and non-verbal communication. Verbal communication about sex, MCP, and HIV occur using metaphors, euphemisms, and other indirect references; the direct Sesotho word for "penis" for example, is seldom used. Similarly, sexually transmitted infections (STIs), seen as ritual pollution rather than the result of risky sexual behaviour, are referred to as "dirts" or "a pain in the waist", which usually means genital discomfort due to an STI. Basotho also use symbols to communicate about sex, MCP, and HIV. For example, a broom that is placed in a particular way sends a message to a sexual partner that he or she may visit. As a result, the meaning of this language is not immediately obvious, especially to a cultural outsider. A key finding of the report is that secrecy about sex and MCP is an indicator of respect for oneself, one’s kin, and the community. The language that one uses is an essential part of maintaining this secrecy.

In terms of the meanings and language of MCP, the research found the following:

• Most informants indicated that MCP was culturally entrenched and believed that the practice of MCP was unlikely to change. The practice of having multiple partners, though not necessarily multiple concurrent partners, is viewed as "African" and is particularly linked to the identity of African men.
• Most informants associated MCP with ideas of shame and disrespect. As such, the names used to refer to MCPs are usually derogatory, indicating that the person engaging in MCP lacks self-respect.
• Basotho believe in the power of language to construct sexual and social identity. For example, Basotho do not use direct Sesotho vocabulary to discuss sex with children since this is viewed as encouraging access to inappropriate knowledge that they believe will promote premature sexual development and identity.
• Verbal communication that directly refers to sexual issues, HIV, and particularly MCP is uncommon, for they function as indicators of disrespect for self, children, family, and community. Open discussions about sex provoke negative sanctions from the community.
• The culturally appropriate language of secrecy is designed to keep sexual identity a hidden phenomenon. By this means, sexual identity conforms to indigenous ideas of respect and honour. A key finding is that although common, MCP is also understood as illicit or nearly illicit, especially since it operates in a space outside the kinship structures.
• The meanings in the Basotho "language of secrecy" frequently require insider knowledge to be correctly decoded. Also, such meanings are not always apparent between groups; for example, elders are not always familiar with the language used by youth, and vice versa.
• Terms with negative connotations that are applied to MCPs may present opportunities to promote dialogue that question the value of MCP.

The report proposes that the first level of intervention should possibly be designed to reinvent the meanings of silence and secrecy rather than introducing an alternative form of communication. This could also include exploring ways of using existing cultural resources as communication media. For example, existing traditions, such as when women gather after a funeral to wash the dead person’s clothes may represent promising opportunities for dialogue promotion. According to an informant, gatherings of women prompt freer conversation and enable women to go back to their partners and raise issues around sex and MCP.

The report further mentions that intergenerational dialogue is also clearly problematic among Basotho. Some informants indicated that if families were to educate children about sex and sexual boundaries, children would be better positioned to know how to behave and to detect when such boundaries have been breached.

The report provides a wide range of programming recommendations which include the following:

• Strategies that promote dialogue about sex, MCP, and HIV, and that employ features of the indigenous language, are needed.
• Informants generally agree on the benefits of promoting communication on the risks of MCP. Visuals and graphic images were recommended as compelling formats by which to bring home the reality of HIV and AIDS.
• Education about the "consequences" of MCP was frequently mentioned, and there seems to be a need for content to be reworked and rethought since a number of informants reported that existing educational materials, messages, and efforts are not fully effective in promoting behaviour change. Interpersonal communication and participatory activity-based methods were viewed as among those to which communities are responsive. Print materials were seen as the least effective.
• A gender norms intervention should be considered as an integral component of dialogue promotion since communication between couples is unlikely to change unless existing ideas of gender identity are challenged.
• Dialogue promotion between youth and elders should take cognisance of the rules of respect that underlie social interaction among Basotho.
• Pitsos, or community gatherings, with incentives to participate, such as providing food, were viewed as useful platforms for disseminating messages and engaging community members in knowledge sharing.
• Additional and more focused education about condoms is needed.
• Identify chiefs and other influential community members who have changed this practice due to HIV-related risks and solicit their cooperation as champions who can demonstrate the many benefits of remaining HIV negative.