Courtois R, Mullet E, Malvy D
Service de psychiatrie de l'enfant et de l'adolescent, Château du Clos Saint-Victor, 3 rue de Chantepie, 37300 Joué-lès-Tours, France.
Sante. 2001 Jan-Feb;11(1):43-8.
The pandemic due to the human immunodeficiency virus (HIV) is extensive in Sub-Saharan Africa and especially in Congo. Congo is a small country on the Atlantic coast and characterized by plentiful equatorial forests and low population density (essentially urban). In Congo, there is a high prevalence of HIV. The social and economic consequences of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. These confrontations have led to a massive exodus of the inhabitants of the capital, Brazzaville, to the forests and neighbouring cities, essentially towards Pointe-Noire. Pointe-Noire, chief place of the region of Kouilou, in the South of the country, is the second city of Congo and the economic Capital. It is undoubtedly for this reason that it has been globally saved. In this context, a sanitary policy of prevention of sexual risky behavior can appear as a challenge. While it supposes a better knowledge of the sexual activity of the young people, it cannot be dissociated from the analysis of the other factors. These factors can be of socio-economic political or cultural order. Thus the influence of cultural variables in the field of sexuality is certainly preponderant in African countries, where sexuality is taboo. Sexuality is a private matter (personal intimacy and the couple), but concerns also the family (in the sense of membership in an extended domestic group or in a system of relationship) in its aspects related to procreation and to the social field (power, alliances). Such individual behaviour can be lived as a questioning of the social order. In this article, the authors question the place of sexuality in Congo, particularly based on the work of anthropologists [2, 6, 7, 9]. Research in the field of sexuality at adolescence is rather recent in France and investigations that have been done in Congo these last ten years do not exist. Meetings and exchanges in 1998 with high-school pupils and schoolboys and girls of Pointe-Noire, have shown that they had a high level of knowledge (about contamination by HIV). On the other hand, this has also been associated with a number of beliefs, which are higher than in France: relating to the possibilities of interpersonal contagion by saliva (by kissing), food. but also a contagion by mosquito bites. Some of these pupils (essentially boys) have asked us about the greater risk of contagion when the male sexual partner presents an irritation or a wound in the penis. This recurring question seemingly concerns a point of knowledge. However a more attentive analysis lets us think that there could be various interpretations. First of all, if the penis is healthy, the risk is low, nearly absent. The concern about a friction or about a wound in the penis could be associated with the concept of forbidden sexual positions (similar to animal positions). Proscriptions are explained by their traumatic character for the feminine device and because they are able to induce an infertility or dystocia (difficult) childbirth. Other beliefs have connected the origin of AIDS with prohibited sexual practices, committed by foreigners, who passed on them secondarily to the natives of the country. They are clearly blamed in their contributions to the decline of customs and the corruption of tradition. However this unfavourable evolution is not longer only their privilege. Sexual superactivity and "sexual wandering" are also concerned. It is dialectic of the pure and the impure. The rejection or the stigmatisation of foreign values can allow the group to find its led astray identity. Condoms are well known by Congolese pupils, but there is mistrust of their use, notably for the "elders", guarantor for the moral order. This mistrust is probably connected with the beliefs of risks of infertility, infection or weakening of the virile force. Condoms are mechanical barriers, made by foreigners, to protect native people from foreign troubles, which foreigners generate. The investigation of chains of significant from the primary couple "nature/artificial (synthetic)" can establish a bait of understanding. The contraceptive action of condoms is a problem. Reproduction remains family business. Moreover, the place of the "morality", the official speech of condemnation from the Roman Catholic Church and the ambivalent positioning of certain Congolese religious congregations does not encourage condom use. Finally, one should not neglect their cost compared to the standard of living. The religious faith is a source of comfort for many Congolese. AIDS can be lived as a spiritual probation that certain traditional healers would have foreseen. Certain ideologies can be a source of intolerance for people who transgress "ways of life" (alcohol, tobacco, anal sexual intercourse.). The religious congregations have invaded the public space. The medical world and the political institutions cannot ignore them any more. (ABSTRACT TRUNCATED)
人类免疫缺陷病毒（HIV）引发的疫情在撒哈拉以南非洲地区广泛传播，在刚果尤为严重。刚果是一个位于大西洋沿岸的小国，拥有广袤的赤道森林，人口密度较低（主要集中在城市）。在刚果，HIV感染率很高。艾滋病带来的社会和经济后果，又叠加了1997年那场内战的影响。在此期间前后发生了内讧冲突。这些冲突导致首都布拉柴维尔的居民大量逃往森林和周边城市，主要是前往黑角。黑角是该国南部奎卢地区的主要城市，是刚果的第二大城市和经济首都。毫无疑问，正因如此它才得以在整体上幸免于难。在这种背景下，预防性传播危险行为的卫生政策可能会面临挑战。虽然这需要更深入了解年轻人的性行为，但它不能脱离对其他因素的分析。这些因素可能涉及社会经济、政治或文化层面。因此，在非洲国家，文化变量在性领域的影响无疑占主导地位，在这些国家，性是一个禁忌话题。性是一件私事（个人亲密关系和伴侣关系），但在生育以及社会领域（权力、联盟）等方面，它也涉及家庭（指大家庭成员或关系体系中的成员）。这种个人行为可能被视为对社会秩序的一种质疑。在本文中，作者们探讨了性在刚果的地位，特别是基于人类学家的研究成果[2, 6, 7, 9]。在法国，青少年性领域的研究相对较新，而过去十年在刚果尚未开展此类调查。1998年与黑角的高中生及男女学生的会面和交流表明，他们对（HIV感染）有较高的认知水平。另一方面，这也伴随着一些观念，这些观念比法国的更为普遍：涉及唾液（通过亲吻）、食物导致人际传播的可能性，还有蚊虫叮咬传播。一些学生（主要是男生）问我们，当男性性伴侣阴茎有炎症或伤口时，感染风险是否更高。这个反复出现的问题表面上似乎是一个知识问题。然而，更深入的分析让我们认为可能有多种解读。首先，如果阴茎健康，风险就很低，几乎不存在。对阴茎摩擦或伤口的担忧可能与禁止的性行为姿势（类似于动物的姿势）概念有关。这些禁忌的解释是，它们对女性生殖器官具有创伤性，并且可能导致不孕或难产。其他观念将艾滋病的起源与外国人的违禁性行为联系起来，外国人将这些行为传给了该国本地人。他们显然因导致风俗衰败和传统腐化而受到指责。然而，这种不良演变不再只是他们的专利。性活动过度和“性乱”也受到关注。这是纯洁与不纯洁的辩证关系。对外国价值观的排斥或污名化可以让群体找回迷失的身份认同。刚果学生对避孕套很熟悉，但对其使用存在疑虑，特别是对于“长辈”来说，他们是道德秩序的维护者。这种疑虑可能与不孕、感染或性能力减弱的风险观念有关。避孕套是外国人制造的机械屏障，用于保护本地人免受外国人带来的外来麻烦。对“自然/人工（合成）”这一基本二元关系相关意义链的研究可以建立起理解的桥梁。避孕套的避孕作用是一个问题。生育仍然是家庭事务。此外，“道德”的地位、罗马天主教会的官方谴责言论以及某些刚果宗教团体的矛盾立场都不鼓励使用避孕套。最后，与生活水平相比，不能忽视避孕套的成本。宗教信仰是许多刚果人的慰藉之源。艾滋病可以被视为某种传统治疗师可能预见到的一种精神考验。某些意识形态可能会导致对违反“生活方式”（酗酒、吸烟、肛交……）的人产生不容忍。宗教团体已经侵入了公共空间。医学界和政治机构再也不能忽视它们了。（摘要部分截选）
