Introduction of culturally sensitive HIV prevention in the context of female initiation rites: an applied anthropological approach in Mozambique.

In Mozambique, initiation rites represent the most appropriate socio-cultural context for dealing with sexuality for a large part of the population. As the group most vulnerable to HIV exposure, HIV-prevention counselling could be ideally introduced to young women during initiation rites. This article demonstrates how interventions can take advantage of the positive aspects of this tradition. We discuss local notions of social 'contamination' versus biological 'contamination,' and we present a culturally sensitive communication strategy to bridge the divergent paradigms around AIDS-similar symptoms. Because of the emotional importance of the initiation rites, the suggested approach goes far beyond cognitive knowledge. After training, the godmothers in initiation rites became highly motivated to teach novice girls about HIV prevention and they trained other elderly women as well. Thus, the initiation rites turned into a process of empowerment for women in their own communities. A central agenda of the female initiation rites in Mozambique is to inculcate respect towards ancestors, elders, authorities and others; however, this respectful attitude between genders and between generations is disappearing due to factors like warfare and the cash economy. HIV-prevention counselling may be successfully introduced into initiation rites because of the unconscious, emotional impact of the process on the initiates' behaviour. Other studies have shown that cognitive knowledge is not enough to lead to behavioural changes. Without changing the traditional initiation rites for females, which in Mozambique includes no genital cutting, a complementary approach introduces HIV-prevention counselling during ritual counselling moments, thereby motivating godmothers and novice girls and young women to be more aware and take precautions to prevent HIV infection.