Influences of body and religious representations in the constructs of HIV transmission

Background: There is an urgent need to understand cultural social dynamics related to HIV transmission. This study illustrates how illness representations influence the construct of routes of HIV transmission.  Methods: An ethnographic methodology was used, including semi-structured in-depth interviews with 52 patients (30 male, 22 female), photo-documentation and participant-observation at HIV/AIDS out-patient clinics and in the patients' homes during a period of 2 years. Study sites were comprised of 14 locals in different rural regions. Results: Religion plays a key role in participant's constructs of their illness, with HIV/AIDS essentially perceived as a symbolic-moral disease. Hence, patients believed that AIDS is a consequence of sin and as such, cures occur through religious conversions, where only God has the power to protect people from the disease. There was a strong association between HIV and blood, but not with other bodily fluids. HIV transmission modes are believed to be through river water, soap, towel, toilet seats, injections, insect bites and contaminated objects, like glasses, plates, spoons and through sitting in a “warm place”. Participants, irrespective of gender, indicated that despite knowledge of their sero-positive status, continued to practice sex without use of condoms. There was a strong notion that if an individual was deemed as reliable, use of condoms is unnecessary.  Reliable people are identified as those who come from rural communities. These ideas contributed to the discrimination and stigma experienced by all the patients, at both the community and family levels. Consequently, patients hid their HIV status from the community and from family members. Bodily representations of HIV/AIDS are also a central source of stigma.
Implications: Patients do not perceive themselves at risk for transmitting HIV infections. Illness representations related to transmission are powerful barriers to the uptake of current preventions programs.