Patricia Schwärzler: "De nos jours, chacun fait ce qu'il veut"? dynamiques des relations sociales et pratiques sexuelles dans le contexte du VIH/sida à Ouagadougou, Burkina Faso

PhD-thesis, Swiss TPH,  University of Basel (2014)

Although West Africa shows remarkably low prevalence, AIDS remains a burning issue for the population of Ouagadougou. The capital of Burkina Faso has the highest rates in the country with an HIV prevalence in 2010 of 2.1% among adults aged 15-49, compared to 1% at the national level (UNAIDS 2012:19). Indeed, AIDS is a disease that many people associate with socially unacceptable and condemnable sexual behavior. This study aims to better understand and contextualize the dynamics of social relations and sexual practices in Ouagadougou, with a particular focus on adolescent girls and boys.

This research was conducted among residents of a peri-urban and disadvantaged area of the city, the secteur 29, with a population, accrued from rural exodus in recent decades, which is diverse in terms of ethnic, social and religious origin. Focus group discussions and in-depth interviews were conducted with men and women of three classificatory generations: "children", "parents" and "grandparents". For a more robust triangulation, additional qualitative data were collected through interviews with religious leaders, representatives of the traditional and the biomedical health systems and representatives of NGOs working in the field of AIDS, as well as monitoring popular media including newspapers and television and radio broadcasts and, finally, observation and participation in the social life of secteur 29.

Sexual practices are activities shaped by the cultural and social context and are thus subject to social change and negotiations of position between different groups within a community. They reflect the power relations between and within generational and gender groups which drive social relations. In Ouagadougou, different types of relationships and a variety of discourses and practices of sexuality coexist. We observed a marked difference between the generations of grandparents and children. The grandparent generation compares relational and sexual practices of young people growing up today in the city with customary cultural institutions that were once used to control teenage premarital sexuality and to forge matrimonial alliances between different lineages. Old women and men complain about the weakening of these institutions, with most of them attributing the spread of HIV to the decline of family control. They mainly blame the girls.

Young people react against these societal discourses and present a different image of their own practices. These are more complex and dynamic than those represented by the older generation. Girls are uncertain and ambiguous with respect to their sexuality. The polyphonic information they receive poses a dilemma for them on whether to be sexually active or abstinent. In addition to positive images of sexuality, they also represent different risks – in addition to an unplanned pregnancy or infection with STIs or HIV: sexual abstinence could make them sick or infertile, masturbation necessarily leads to uncontrollable sexual urges and infidelity, the onset of sexual activity is recommended only when the body is fully developed, and finally, infidelity is due to masturbation, early sexual initiation or economic needs. The girls complained strongly about being addressed by men of the neighborhood for transactional sex or by teachers for ‘gratificational’ sex.

In general, girls have only fragmented information on sexuality and hence construct 'creative' representations and have a diversity of practices resulting from their context coined by multiple and divergent values and a lack of orientation that leaves them ambiguous. According to both young men and women, their relational and sexual practices are diverse and span a wide range from abstinence to multiple and concurrent relationships. Abstinence, one of the poles of this range, holds a high social value for young people, especially for girls. The other pole of this range, multiple partnerships, does not necessarily imply sex with all, or even with any, partners. In general, young people are not all sexually (over)active as imagined by the older generation. They rather practice a variety of forms of relationships and combinations of them that do not all necessarily involve sexual activity. Young people perceive their adolescence and their relational and sexual practices as an expression of their current life stage before marriage allowing them things they value as unacceptable in their future live as socially respected wives and husbands.

For actors in public health, use of condoms by sexually active people is a crucial element of the combined HIV prevention programs. However, like all technologies, a condom is not viewed in any community as a neutral and value-free object. It actually enters a social context impregnated by a multitude of ideas covering a variety of topics. In Ouagadougou, condom related representations are historical, macro-political, economic, religious, social, sanitary or symbolic. All these aspects affect the appropriation or reluctance, as well as its management. In addition, the burkinabè population perceives negative social and moral consequences with the use of condoms. Those are depreciated on two levels: the devaluation of sexuality, valued as trivial, vulgar and ordinary, and the degradation of basic relational values, through infidelity, adultery, multiple partnerships and the emphasis of sexual pleasure instead of procreation. Our results contradict the reductionist views on African sexuality and promiscuity and give visibility to the current moral debates across and within generational and gender groups.

An understanding of these debates can help to better target culturally sensitive public health efforts in the field of family planning and prevention of sexually transmitted diseases and HIV. To this end, we recommend three activities of application of our results. At the local level, on the one hand, the establishment of discussion forums on sexual and reproductive health for young people, as well as intergenerational forums with girls and boys, with mothers and fathers, on the other hand, would both help to address the lack of accurate information for youth and to initiate communication between parents and children on aspects of education and sexual health. At the national level, we propose the initiation of a community dialogue to counter and weaken representations impeding the use of condoms.

For research, we suggest four new avenues. Firstly, it is important to examine the possibility of transactional sex between young boys and "sugar mummies", or between boys and men, both as sources of revenue for the boys. It would be additionally interesting to see whether new forms of more egalitarian relationships are beginning to develop in Ouagadougou between well-educated and well-off young men and women, involving pleasurable and mutually satisfactory sexuality. Undoubtedly, basic research on lifestyles, social networks and homosexual culture of men who have sex with men and women who have sex with women is also important. Finally, elucidating the differences, on the one hand among believers between religious commands and actual practices, and on the other hand among the representatives of the different religious communities between their preaching and their activities, possibly deviant from official doctrines, would help to better understand the dilemmas of the two religious actors, both believers as well as religious leaders, and to reinforce good practices related to HIV prevention and AIDS. These research avenues could contribute to the development of new culturally appropriate interventions for prevention and sensitization based on the lived experiences of people and on empirical results.


Supervisors: Prof. Dr. Brigit Obrist, Prof. Dr. Elisabeth Zemp, Prof. Dr. Marcel Tanner

Funding: National Centre of Competence in Research North-South (NCCR N-S); private funds and donation; scholarships from the Swiss National Science Foundation, Bern, the Max Geldner Foundation, Basel, and the Graduate School Gender Studies, Baselfileadmin/zasb/redaktion/Dokumente/Forschung/Poster/Schwaerzler_Patricia_Poster_Ausstellung_2012.pdf

Schwärzler Patricia. 2010. Sex and the City: Erzählungen alter Männer und Frauen über jugendliche Sexualität und AIDS in Ouagadougou, Burkina Faso. In: H. Dilger & B. Hadolt, eds., Medizin im Kontext: Krankheit und Gesundheit in einer vernetzten Welt. Frankfurt am Main, Peter Lang: 389-409.
Schwärzler Patricia. 2010. Sexe dans la Cité: Récits des vieilles et des vieux sur la sexualité des jeunes et le sida à Ouagadougou, Burkina Faso. (French translation, available from the author)

Keywords: medical anthropology, urbanization, societal change, gender, sexual and reproductive health (SRH), HIV/AIDS