Building on Traditional Assets in Protecting Children Against HIV/STDs in War and Post Conflict Situations

This 68-page report, published by the Canadian International Development Agency (CIDA) through the Child Protection Research Fund, examines the potential of the wayo (paternal aunt) institution to protect young girls and women against sex abuse, HIV/AIDS, and sexually transmitted infections (STIs) in northern Uganda. The report presents an evaluation of a sexual health intervention that focused on the role of the father's sister or wayo, who is the traditional channel of communication on sex and marriage for adolescent females in most ethnic groups in Uganda. Previous research in southwestern Uganda had shown that the wayo's (called also "ssenga" in that region) authority as a mentor is widely accepted, and that her role is essential in a child's life, since parents rarely talk to their children about sex and sexuality.

Prior to the intervention, research was conducted with women and girls about the wayo system and the importance of the role of the grandmother's hut. Women and girls were also interviewed regarding their thoughts about their vulnerability to HIV/AIDS, the impact of war, abductions, and fatalism. Findings from this research were used in consultations with communities around the viability of implementing a sexual health-related intervention derived from the traditional roles and responsibilities of the wayo. Community members were involved in nominating women in their communities who could assume the role of wayo. Young people were also asked to forward the names of women whom they trusted completely. Forty names appearing on both lists from three internally displaced persons (IDP) camps were selected for a training that occurred over a three-week period and included modules on STI training and education, child rights, the relationship between HIV and war, and HIV/AIDS awareness and education.

According to the evaluation, involving the community in the development of the intervention contributed to its success. It enabled organisers to address issues of community concern without going against the grain of cultural sensibilities. Inclusion of traditional aspects of the wayo ensured continuity between the old and new style wayo, and contributed to the acceptability of the modern wayo. Also, because they were community members whom everyone knew (and whom the community had chosen), they could be easily approached. For example, in one month in a single IDP camp, the ten wayo saw an average of 200 people, at least half of whom were girls. Their work also addressed widespread barriers to sexual and reproductive health services by helping to facilitate referrals. According to the report, mothers themselves introduced their daughters to wayo so that they could access sex education in culturally appropriate ways.

In their work, wayo interacted with different social institutions, both traditional and modern, which, according to the report, greatly facilitated community participation in wayo activities. For example, schools and churches appear to be accessing the wayo as a first point of contact in the community for sexual health, marriage, and child protection issues. Through their mentoring processes, the wayo also enhanced the ability of girls to understand the use of condoms and when and how sex happens. One main recommendation from the community was to introduce a male equivalent of the auntie who would focus, among other things, on changing male attitudes and behaviours.

The intervention has, however, not been without its challenges, particularly related to health service delivery and political will. For example, a wayo may help a girl access STI treatment, but the care available in the camps may be restricted or lacking altogether. In one camp, the wayo team encountered resistance and lack of will on the part of the government to deal with the large numbers of girls reporting rape.

The report also lists a number of programme and policy recommendations related to sexual health education in Uganda. These include adding: HIV/AIDS activities within national strategic frameworks; conducting operational research in the context of conflict and post-conflict situations; increasing school enrolment and retention of female learners; providing life skills training for out-of-school girls; strengthening family protection of young girls; and providing psycho-social support for sexual trauma.

One recommendation directly related to the intervention is about the importance of culturally appropriate approaches. The authors say interventions that are built solidly on indigenous knowledge and supported by the community must be evaluated, expanded, and funded. It must be recognised that while HIV/AIDS knowledge and information are critical, information, communication, and education (IEC) campaigns fall short because information alone is not enough. Also, access to services must be increased, for, although the wayo are seen as an important source of referrals to condoms, condom information, voluntary counselling and testing (VCT), STI treatment, and antiviral care, these referrals only work if the services are available. Another recommendation emerging from the report is about ensuring that boys are a focus of intervention as well. In retrospect, not designing the intervention to work with boys was one of the project's biggest methodological limitations. If girls are to achieve the confidence and self-esteem to negotiate things like safer sex, men and boys will have to be involved in exploring socio-sexual norms and behaviours.

Editor's note, June 19 2017: This document is no longer available online.