Widow cleansing and inheritance practices amongst the Luo limit women’s options to use current HIV prevention methods

 

Widow cleansing and inheritance among the Luo in Kenya: the need for additional women-centred HIV prevention options.  

Perry B, Oluoch L, Agot K, Taylor J, Onyango J, Ouma L, Otieno C, Wong C, Corneli A J Int AIDS Soc. 2014; 17(1): 19010. Epub Jun 26, 2014.  doi:  10.7448/IAS.17.1.19010

Introduction: The customs of widow cleansing and widow inheritance are practiced in several communities throughout sub-Saharan Africa. In the Nyanza Province of Kenya, according to tradition, Luo widows are expected to engage in sexual intercourse with a "cleanser," without the use of a condom, in order to remove the impurity ascribed to her after her husband's death. Luo couples, including widows, are also expected to engage in sex preceding specific agricultural activities, building homes, funerals, weddings, and other significant cultural and social events. Widows who are inherited for the purpose of fulfilling cultural obligation have a higher prevalence of HIV than those who remain un-inherited or are inherited for the purpose of companionship.

Methods: As part of a larger descriptive qualitative study to inform study procedures for FEM-PrEP, an HIV prevention pre-exposure prophylaxis clinical trial, we conducted 15 semi-structured interviews (SSIs) with widows, 15 SSIs with inheritors, and four focus group discussions with widows in the Bondo and Rarieda districts in Nyanza Province to explore the HIV risk context within widow cleansing and inheritance practices. Thematic qualitative analysis was used to analyze the data.

Results: The majority of widows reported in the demographic questionnaire being inherited, and most widows in the SSIs described participating in the cleansing ritual. We identified two main themes related to HIV prevention within the context of widow cleansing and inheritance: 1) widows must balance limiting their risk for HIV infection with meeting cultural expectations and ensuring that their livelihood needs are met, and 2) sexual abstinence undermines cultural expectations in widowhood while the use of condoms is deemed inappropriate in fulfilling culturally prescribed sexual rituals, and is often beyond the widow's ability to negotiate.

Conclusions: Women-controlled HIV prevention methods such as antiretroviral-based oral pre-exposure prophylaxis, vaginal gels, and vaginal rings are needed for HIV-negative widows who engage in sexual rituals related to widowhood.

Abstract  Full-text [free] access  

Editor’s notes: This paper provides an in-depth insight into the practice of widow cleansing and its implications for widows’ vulnerability to contracting HIV. The paper describes the practice of widow cleansing by the Luo in Kenya. This entails the requirement for widows to have sexual intercourse with a non-relative of her deceased husband to “cleanse” the impurity she has acquired from the death of her husband. Following this practice widows are “inherited”, traditionally by an in-law but more recently by a professional inheritor who inherits widows for money. Relationships with professional inheritors commonly entail sexual intercourse and financial and emotional support for the widow. These relationships can be ended if not fulfilled to expectation. Alongside this, there are other expectations for widows to perform sexual intercourse with other men as part of ceremonies.

To understand the sexual risk-taking behaviours of Luo widows and inheritors, in-depth interviews and focus groups were conducted with widows and inheritors. This was part of a larger qualitative study during the FEM-PrEP trial. The findings revealed that widows were aware of their risk of HIV infection through cleansing and inheritance practices, which often entailed sexual intercourse without a condom. However, women’s concerns about this were outweighed by the need to fulfil cultural expectations to avoid being ostracised, and importantly to receive financial support. Whilst some women were able to use condoms with inheritors, this only occurred in new relationships or during menstruation or pregnancy. Widows and inheritors reported that condoms were rarely used during “cleansing” practices as the mixing of semen and vaginal fluids is essential to remove impurities.

Whilst this study reveals similar constraints on condom use for women in long-term relationships it highlights the additional complexity for Luo widows in relation to cleansing and inheritance practices. These practices legitimise multiple concurrent relationships and sex without a condom. Importantly, as a strongly embedded practice this gives widows limited options to use condoms or abstinence to prevent HIV infection. The authors suggest that Luo widows would benefit from access to biomedical HIV prevention methods, including PrEP and microbicides.

Africa
Kenya
  • share