Silver bullets, glass beads, and strengthening Africa's HIV response

Hopes for slowing the epidemic were largely pinned on exported models of behaviour change that were based on a constructed idea of human cognitive universality, permitting policy makers and programmers to view the task of changing the sexual behaviour of African people as something akin to changing the smoking habits of New Yorkers. The persistent problem of stigma about HIV in some African communities, for example, or low rates of condom use, testing, disclosure, or treatment adherence--in fact almost everything commonly thought of as major barriers to improved HIV outcomes--are highly related to the value these communities place on social life. A person might hold disparaging views on practices like female circumcision, traditional medicine, or heeding the advice of seers or prophets, but he or she might also partake in these practices out of obligation and social expectation.