Discussing Sexual Health with African Refugees
Abdi Osman Muhammed, NRCHC August 08
It can be easy to offend or discourage an African patient when talking about sexual health. There are some cultural differences you must consider.
Culture & beliefs (East Africa)
- Unmarried men and women cannot talk to each other about anything to do with sexuality
- Avoiding sex before marriage is expected by parents and community
- Sex before marriage is 'evil', and killings or forced marriage may happen in the country of origin (even if the offensive behaviour took place elsewhere)
- Boys have less shame to carry than girls
- Gender roles are different in East Africa than in Australia
- Women may require more help from their husbands in Australia, which can cause conflict
- Many teens and young adults are shy about discussing sex openly with their family
- Reluctance towards treatment by a doctor of opposite gender
HIV & AIDS
The rate of HIV/AIDS in East Africa was 3.2% in 2007, but is probably under-reported.
New arrivals often have no one to turn to after diagnosis, and they are unfamiliar with HIV/AIDS service organisations (UNSW report). In fact, they are unfamiliar with a formal health system and western style medicine.
Fear, stigma and misconceptions create barriers to prevention and treatment strategies. Stigma leads to isolation from family and community. It is a common assumption among East Africans that anyone who contracts HIV/AIDS must have committed a sin, and is therefore cursed.
Some common misconceptions:
- HIV is a wrath from God
- HIV is a 'white man disease'
- HIV doesn't affect good practising Muslims
- The virus is implanted in the condom (this belief comes from the fact that western countries introduced the term HIV/AIDS and also developed the condom)
- If you have HIV/AIDS you have done bad things
- Distributing condoms encourages promiscuity
If a member of East African community is diagnosed positive there is limited tolerance and willingness to care for them. Isolation and deliberate discrimination follow, as people are afraid to touch the person's body.
A positive woman is more likely to be divorced and separated from her children.
Denial and stigma is the biggest barrier to seeking medication and counselling.
Talking with patients
Talking about sexuality openly is a challenge. Try to separate fact from cultural beliefs. Work within what is acceptable to your client: for instance, talking about abstinence and faithfulness if parents are present.
Encourage patients to share the cultural and religious beliefs that influence their perception of their illness, and how family members treat them. For instance, Islam is against premarital sex and adultery. In Islam, there are very clear verses (from the Qur'an) that forbid sexual intercourse between unmarried couples.
Encourage negotiation rather than compliance; consider alternate points of view rather than trying to change someone's beliefs.
Questions for patients
The following questions can be used with a patient to encourage discussion about the causes and symptoms of their illness:
- What do you think caused your problem (use patient's words*)
- Why do you think it started when it did?
- What do you think (*) does to you? What are the chief problems it has caused for you?
- How severe is your (*)? What do you fear most about it?
- What kind of treatment/help do you think should receive?
- Within your own culture, how would your (*) be treated?
- How is your family/community helping you with your (*)
- What have you been doing so far for your (*)
- What are the most important results you hope to get from treatment?
This article is available online at http://bddgp.org.au/article/2008/08/african-refugees
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