In African countries, promoting healthy sexual behavior such as abstinence or consistent condom use can be difficult when that behavior conflicts with cultural beliefs. A study done by Population Services International (PSI) reveals that young Zambian men’s belief in folk explanations, misconceptions and denial impede them from protecting themselves against HIV.

PSI conducted interviews with young men, ages 15-19, in Lusaka, Zambia and found that common beliefs included: that HIV transmission relies on the "strength" of a person’s blood, HIV infection is associated with sorcery, women are able to shed the HIV virus during menstruation and sexually promiscuous looking individuals are the most likely carrier of sexually-transmitted infections (STIs) and HIV. Despite acknowledging that even a healthy-looking person can be infected, respondents reportedly rely on outward appearance as a means of identifying infected individuals.

The PSI working paper "Misconceptions, Folk Beliefs, and Denial: Young Men’s Risk for STIs and HIV/AIDS in Zambia" shows almost all the participants acquired information on STIs and HIV indirectly from friends or family through overheard conversations or gossip. Such hearsay results in the spread of inaccurate information and furthers misconceptions about transmission and risk. Shyness, fear and embarrassment obstruct young men from directly questioning friends and family about HIV.

Denial of possible infection can occur when behaviors that lead to infection, and the infection itself, are highly stigmatized, or if a conflict exists between an individual’s behavior and the values of the local culture. Infection can be viewed as a punishment for moral shortcomings or lack of self control because transmission is associated with deviant sexual behavior. Due to such associations, many participants are hesitant to approach adults for information, not wanting their curiosity to be interpreted as an admission of guilt.

Even though most agreed that sexual abstinence is the most effective method of STI/HIV prevention, the young men surveyed believed it unreasonable to expect youth to abstain. Participants expressed that sex is a fundamental human need, pleasurable and essential for emotional and physical development. Some viewed multiple partners as a means to establish their manhood and demonstrate their prowess.

Most participants avoided unhygienic or promiscuous looking females as an HIV prevention strategy. The importance of consistent condom use was not recognized by participants. They lacked correct information on the effectiveness of condoms as an STI/HIV prevention tool. Young men also failed to realize the benefits of voluntary counseling and testing, or were not aware of the service at all. Others regarded an HIV positive diagnosis as a death sentence.

Young men’s reluctance to adopt effective prevention strategies, such as abstinence or condom use, or to be tested for STIs and HIV, appear to be extensions of their denial. Participants considered monogamous relationships to be risk-free, despite the fact that the majority of their relationships lasted less than six months. None of the participants recognized the link between past sexual encounters and potential risk in current relationships, nor did they see the risk that serial monogamy presents.

PSI researchers concluded that because young people rely heavily upon interpersonal contacts for STI/HIV information, peer-based education programs should be increased to ensure that youth have access to accurate information. Information, education and communication campaigns should correct incomplete knowledge, challenge misconceptions, communicate the availability of HIV and STI testing and stress the importance of knowing one’s HIV serostatus. Campaigns should also target adults, encouraging them to talk openly to their children about sex, STIs and HIV/AIDS. And to decrease the likelihood of denial, PSI proposes that programs work with communities to decrease the stigma associated with STI/HIV infection.

PSI is the world’s leading social marketing organization, with headquarters in Washington, DC and programs in 70 countries in Africa, Asia, the Americas and Europe. PSI provides information, products and services to better enable low-income people to lead healthier lives.

A full copy of Working Paper No. 53 entitled "Misconceptions, Folk Beliefs, and Denial: Young Men’s Risk for STIs and HIV/AIDS in Zambia" can be ordered from PSI by mail or through the web site at www.psi.org. Click on "Research," then "Published Works," then type in the title of the Working Paper.