Knowledge, Morality and ‘Kastom’: SikAIDS Among Young Yupno People, Finisterre Range, Papua New Guinea

By Keck, Verena

ABSTRACT

This paper investigates the extent of knowledge about HIV/AIDS among young Yupno women and men. Local understanding of sikAIDS is shaped by cultural, moral and religious concepts and processes that are based on social values and practices. Difficulties these young people face in accessing information about HIV/AIDS and using it to implement preventative measures – for example by obtaining condoms – have to be seen in the framework of ‘kastom’ and a moral discourse coined and influenced by the Lutheran Church. As the research shows, there is an urgent need for a broad and contextually sensitive approach to sexual health, including information about conception, family planning methods, and sexually transmitted diseases when planning awareness campaigns for teenagers in rural regions.

Key words: condoms, youth, Christianity, gender, HIV/AIDS, Papua New Guinea.

INTRODUCTION

According to the most recent data, the incidence of confirmed cases of HIV/AIDS in Papua New Guinea has dramatically increased. Nearly two percent of Papua New Guineans are now living with HIV/ AIDS (The National 2005b), it rates as the primary cause of death at Port Moresby General Hospital Medical Ward (The National 2005a), and, as stated by the Chairman of the Parliamentary Committee on HIV/ AIDS, between 120 to 150 new cases are diagnosed daily (The National 2005c; cf. Cullen 2006). A significant feature of the situation is that a high proportion of young people aged 14 to 24 are affected by HIV/AIDS, of which young women and teenage girls constitute a particularly high-risk group (Chen 2001:166).’ In addition, there is the risk associated with unprotected sex among teenagers (Caldwell 2000:14).

The large majority of Papua New Guineans live in rural areas, some of them in remote regions with non-existent, collapsed, ill- equipped or small health centres or aid posts (Duke 1999) where there is little or no testing for HIV; HIV/AIDS-awareness campaigns with programs designed especially for rural lifestyles hardly ever reach the population in these regions (Post Courier 2005). That is why little is known about levels of knowledge of the rural population with regard to HIV/AIDS or the realities of the many people infected with HIV or suffering from AIDS; in addition, there has been only limited anthropological research into the impact of HIV/AIDS in remote rural areas (see for eg. Eves 2003; Haley 2005; McPherson 2005). In view of these facts, the figures collected in urban hospitals like Port Moresby, Lae, Mount Hagen, for example – which are often based on projections and estimates and thus to be interpreted with caution – paint an even more dramatic picture of the epidemic that requires urgent, culturally sensitive and locally adjusted strategies for HIV/AIDS prevention as well as for the care of afflicted relatives and wantoks.

In 2004, when I returned to the Yupno in the village of Gua, it was the seventh visit since the beginning of my fieldwork in 1986, twenty years before. Needless to say, I had developed and maintained close relations with some of the people in Gua and that made fieldwork considerably easier. My first research topic among the Yupno had focussed on their traditional worldview, concept of person, and theories about and measures against illness. Basic questions included what was regarded as being ill, and what does being healthy mean, what do they think about the etiology of an illness and how do they accept biomedical medicine, represented in the form of a small health centre in Teptep. Starting with the results of this earlier research, I began my research on young Yupno’s knowledge about and their dealings with HIV/AIDS or sikAIDS as it is called in Tok Pisin (tp). Most Yupno use the term sikAIDS; sometimes it is referred to as sit tevan in the Yupno language, ‘serious illness’ whereby sit is the generic noun for illness and tevan means strong. This term is also used for all kinds of sexually transmitted diseases, including gonorrhea (Keck 2005:159, 166). In order to develop better and culturally adjusted prevention of sikAIDS for the Yupno as well as people in the many other rural regions in Papua New Guinea, more anthropological research is needed that focuses on how biomedical information about HIV/AIDS is perceived and adopted into local contexts. My aim was to provide useful information for teenagers and younger Yupno who – and this applies more frequently to female Yupno frequently have limited education and little or no information on HIV/AIDS.

THE YUPNO SETTING

The Yupno people live in a steep mountain region in the eastern Finisterre Range of Papua New Guinea, an area that is difficult to reach, right at the border of the Madang and Morobe provinces, which runs through the middle of the upper Yupno region. The dispute about the border lasted many years, until the governments of Madang and Morobe demonstrated their presence with offices and representatives in Teptep in 2000. All that remains today of this double track are two health stations; the Teptep Health Centre (THC) run by Madang and the recently erected Kangulut Health Centre (KHC), which is financed by Morobe. The Upper Yupno live in 14 villages at a height between 1600 and 2200 m, and they form the largest part of the population, approximately 6,000 people according to the census in 2000. They live in a subsistence economy, cultivating sweet potatoes (to a lesser extent also taro), bananas, sugar cane and various local and European vegetables (cabbage, onions, beans, tomatoes, leafy vegetables). Coffee and tobacco are also grown as cash crops. In the 198Os, the Lutheran Church initiated an agricultural development project designed to both provide an income and minimize migration into towns. As a result, Yupno began planting European vegetables and fruits including broccoli, cauliflower, spring onions, silver beet, capsicum, asparagus and strawberries which were then flown to supermarkets and hotels in Madang. Compared with other groups in PNG, few ideas and goods of the western world reached their remote and inaccessible region until late in the 1970s (Keck 1993b, 2005). With the construction of a government station, a school, a small hospital and an airstrip the world of the Yupno has been enlarged and their social space broadened as well: an increasing number of Yupno, mainly younger men, went into town (Lae or Madang) in search of further school education, looking for work and for an income-generating and ‘modern’ urban lifestyle. Some stayed on but many came back and followed a pattern of ‘circular mobility’ (Chapman and Prothero 1985:4) so typical of the rural exodus and the migration into the towns all over Papua New Guinea: one lives in town for some time, then again in the village, then back in town. This form of migration is today increasingly becoming more permanent (Connell 1990:2), and larger groups of Yupno are now living in Madang, Lae and Nadzap.

The Lutheran Mission of Neuendettelsau began missionizing the Yupno in the 1930s (Wassmann 1992), intensified efforts then followed in the 1950s and particularly in the 1990s, and today the church has an important position among the Yupno. Since almost all the government institutions with their staff as they existed in Teptep 20 years ago, such as a kiap office with a kiap, a post office, a policeman, a small jail and others, no longer exist, their tasks have partly been taken over by the church, whether in education (the tokples schools) or transport: only MAF (Missionary Aviation Fellowship) airplanes fly regularly into Teptep. To date, the Lutheran Church has succeeded in maintaining its Christian monopoly among the Yupno; its sphere of influence includes a series of jobs and positions in the village that have to be supported and partially financed by villagers, from pastors, tokples skul teachers, church leaders as well as youth group leaders, and circuit president (seket presideri). For some years now, over the Christmas and New Year period, a mission team of ‘reborn Lutherans’ from the Western Highlands visit for two to three weeks; in 2004 it consisted of ten younger men who indoctrinated the Yupno during hours of nightly church services with sermons and songs and whose explanatory models, including that for HIV/AIDS, are clearly marked by fundamentalism. An 18-year-old man from Gua, who is in grade 5 at Teptep school, made the point that the young men from the mission team all say, ‘this sickness here comes from God, it does not come from anywhere else. We, the local people from here, we do not get this sickness. It comes into [our country] from Israel’.2

In numerous conversations with younger Yupno, the isolation of the Yupno region and the lack of opportunities to earn money are listed as today’s pressing and interlinked problems. The remoteness of their region and, compared with other parts of the country, late development and change underlie feelings of inferiority and shame vis–vis other, ‘more developed’ groups. As one young man put it, ‘we are bus kanaka tru’, meaning ‘really backwoods men’. The Yupno share this notion with the Rai Coast villagers east of the Finisterre, for whom their place is the ‘last place’ (Engl\und and Leach 2000:230), and with many other people in very remote areas of Papua New Guinea, such as the Duna at Lake Kopiago (Haley 2005). Information from outside filters slowly into the area, as there is no television, very few radios, and hardly any newspapers. For about 15 years – an issue revived during each election campaign – there has been discussion about building a road from Saidor via Teptep to Wantoat and the possible positive and negative effects of such a development; however, the project has never grown beyond planning phases and political rhetoric. Today many Yupno would welcome such a connection to the coast and the towns of Madang and Lae to market their vegetables. Airfares to Lae and Madang are very expensive, due to increased flight costs, for passengers as well as for cargo; in addition, flights from Teptep, the subdistrict headquarters, to Lae and Madang are much less frequent and reliable today than they were 20 years ago, and as a consequence the possibility of making money from the sale of vegetables has decreased dramatically. Other ways to leave the Yupno Valley include a two-day march either to the coast at Malalamai and a boat trip to Madang or an exhausting two- day march to Wantoat where buses leave for Nadzap and Lae. This route is much feared because of suddenly raging rivers and frequent hold-ups, yet many people carry their coffee beans to Wantoat to sell them or their tobacco on the markets in Lae and Madang in order to avoid expensive plane trips.

Today, the Yupno face the impact of the cash economy of modern Papua New Guinea and their increasing poverty is linked to isolation: money is often lacking for the payment of school fees for the community school in Teptep and, especially, for secondary schools, which are all situated outside the Yupno region. Despite their difficulties, many Yupno try to raise money to provide for their children (particularly for their sons) the kind of school education that they deem very important today – in the hope that their children will later on find good jobs and would then be able to support them financially. Compared with the young men, only very few younger women have a grade-10 certificate and although they would like to get higher education, money is often lacking to accomplish that and often when the money is available, it is invested in boys/men. Wilma’s case is exemplary: a talented girl from Gua who just graduated from grade 10 and now is working in the tuna cannery in Madang to enable her brother to attend a secondary school. In the context of the HIV/AIDS epidemic this is a tragic situation as the education of women can be one of the most effective methods of prevention. Many do not have money for everyday items such as soap, salt, rice, clothes and kerosene, and as a result there are only two shops left in Teptep with a very limited range of goods. Money is also needed for travelling and for church matters, such as, for example, the building of a Circuit Offices, for church collections, and for the support of pastors and teachers. Local church representatives with their vehement lectures place heavy financial pressure on the population. Many Yupno, particularly fathers of teenagers attending secondary schools, feel forced to leave the Yupno region in order to make money in town by selling betel nuts, peanuts or tobacco or acting as middlemen for soap or cigarette lighters at the markets in Lae and Madang. Frequently they return to the village after a few months in town. Yet many also live permanently in the cities without jobs or incomes. Women and younger children mostly stay in the village.

Over the past years, the health situation of the Yupno has also changed. Thus the incidence of tuberculosis, according to the officer in charge of the KHC, has markedly increased and today dominates local health problems, and, as a consequence, efforts in awareness campaigns focus largely on the avoidance of tuberculosis. The increase in tuberculosis seems to be a nationwide problem (see Haley 2005 for a similar situation in Kopiago). Tuberculosis, bigpela, strongpela kus, or keaknok in Yupno, was not a prominent health problem in the late 1980s in the Yupno region (Keck 2005:164- 176). The officer in charge of the KHC attributes its dramatic increase to frequent contact with coastal people, climate changes, global warming, and the traditional oval Yupno houses, which are smoke-filled, dark and often overcrowded. In addition to this has been an increased rate of malaria, particularly for those returning from urban areas. Like many other populations in Papua New Guinea, the problems that the Yupno are facing make them vulnerable to HIV/ AIDS (Wardlow 2002). These include the remoteness of their region, male out-migration to urban areas for the generation of an income, increasing poverty, unequal gender relations and new health threats.

KNOWLEDGE, MORALITY AND ‘KASTOM’

When I began my research on the extent of knowledge of HIV/AIDS among Yupno teenagers in the village of Gua in late 2004, I anticipated that church officials would be apprehensive about the topic of my research. Yet after preliminary talks with the pastor, the teacher and the circuit president, it became clear that I could count on their tolerance and to an extent their support. This did not mean, however, that my model for explanation and theirs regarding HIV/AIDS coincided. I had also anticipated problems with the teenagers since I knew the embarrassment they would suffer discussing topics around sexuality. Although in the beginning they were somewhat shy and just giggled, they soon relaxed and took a vivid interest in the subject; and frequently asked me a lot more questions than I asked them, about family planning, ways of infection, other sexually transmitted diseases and their symptoms. For instance, several young men wanted to know whether circumcision could prevent HIV infection. In the traditional initiation of young men, which was given up decades ago upon pressure from the Lutheran mission together with the men’s houses, mbema yut, circumcision was unknown. Today, in a kind of revival, parts of this initiation are held ‘undercover’ in small, hidden mbema yut in the bush and strictly out of sight of church functionaries, and a new element is circumcision. This circumcision is linked to knowledge and special power but also with the idea that it protects men from HIV/AIDS – a dangerous assumption that according to Jenkins and Alpers (1996:249) is ‘widespread in all areas and promoted as a substitute for condom use’ (see also Wilde this collection).

I spoke to a total of fourteen young women and ten young men, mostly in separate conversations and semi-structured interviews. In some cases, the young women did not talk Tok Pisin and I used a female translator and sometimes the young woman or man only had the courage to talk in the company of a girl- or boyfriend. The most important criteria I evaluated were: level of education, urban experience, knowledge about the sexual transmission of HIV/AIDS, and their own sexual experience. Other topics included information about other forms of transmitting HIV/AIDS, where knowledge about sikAIDS came from, as well as knowledge about, use of or availability of condoms. The fourteen young women were between 15 and 23 years old, with an average age of 18.9. With the exception of one newly wed 18- year-old, they are all single and living with their parents or kin. The ten young men were between 15 and 30, with an average age of 21.8. Two were married and had children, three of them only stayed in Gua during the school holidays and for the rest of the year lived in Wasu or Wantoat to attend schools there – a pattern typical of many male youths.

More typical are the gender differences regarding the experience of outside worlds, towns or larger government stations, which for the Yupno include Madang, Lae, Nadzap, and Wantoat. Only two (14 percent) of the female teenagers had urban experience, 12 had never left the region or only for a short time as a baby or small child, which contrasts with six (60 percent) of the young men who had been outside the Yupno area and four (40 percent) who had never left the region.

The question regarding general knowledge about HIV/AIDS and sexual transmission brought the same results: all who had ever heard of sikAIDS also knew about the sexual transmission of HIV. Eight young women (58 percent) had heard of HIV/AIDS and knew about the sexual transmission of HIV/AIDS, six (42 percent) didn’t have any knowledge. All of the young men (100 percent) knew about HIV/AIDS and were informed about its sexual transmission. Distinctions between HIV, the infection with the virus, and AIDS, the outcome that results in manifold diseases, were known only by two young men.

Linked to this knowledge about the sexual transmission was a moral judgment known as pamuk pasin or paul pasin which has several connotations: it ranges from promiscuous or extra-martial sexual relations to prostitution or sex work (a term preferred today in social science literature), meaning relations with multiple, serial sexual partners (Wardlow 2004). There are many different forms of and motives for sex work in today’s Papua New Guinea (cf. Hammar 1998a; Wardlow 2004, 2006). Statements like these by two 16-year- old women, ‘this disease comes from all the men and women who sleep around with each other [who have promiscuous sexual relations]‘ can be seen as representative of many comments. From the majority of the younger men’s point of view, women are primarily guilty for it is they who infect men. Particularly dangerous are the women in town – a topic similarly reported from many regions of Papua New Guinea, for instance for the Wampar (Beer 2005) or the Bariai (McPherson 2005). There is agreement that this disease is brought into the Yupno region from outside, from men infected by women in town and returnin\g to the village. A young man said: ‘the men come and go and come and go, into town, to the village, into town, and they bring this disease here into the village. [So far] the disease hardly exists here but the men [who have been infected by women in town] bring it with them’. Similarly, the officer in charge at the KHC commented that,

something that’s very much in my thoughts is this: somebody is roaming around outside [i.e. outside the Yupno valley] and in case he has sex with someone who is HIV positive and he comes here, how are we to know that he has this disease? This really causes us problems, to recognize this, and it would he bad if he were to come back here and spreads this disease here and then leaves the region again. This is a big concern for us.

But another young man does not want to confirm this statement: ‘the men from here are afraid [of sikAIDS] when they are in town. And also they are not great talkers or womanizers when it comes to flirting or picking someone up. We men from here, we think of the market and of making money in town, that’s all. And then we come back. And this desire to commit adultery and to find another woman – we don’t know this here’.

Asked about their sexual experience, four (28.5 percent) of the young women said they had had sex with a man, of the young men eight (80 percent) had sexual experience, in this context meaning heterosexual penetrative sex. Petting does not seem to be popular; a young man explained: ‘we are not satisfied with just holding a woman, that’s not how it works here, we sleep together and we only think of the go up [meaning: to climb atop, to penetrate]‘.’ Another shy young man, 16 years old said: ? heard others [talk about it] and I was excited, in my thoughts, but I have never had sex. How everyone gets excited during sex and so on I don’t understand. And how they do it and how they reach this sexual satisfaction isn’t clear to me either. The men do it and tell about it and I listen … I am very fond of a woman but it is difficult to tell her. This has to do with shame’.* All the eight men’s sexual experience (with the exception of the two married men, most had one or two sexual encounters) took place in the Yupno region, often with a young girl from a neighbouring village that they would meet in the garden house. One young man mentioned having sex once while being in town. None of the teenagers had been told the facts of life by their parents, for instance in talks about sexual behaviour, sexual parts, conception etc., ‘tambu truor taboo, as one of them appropriately put it; the sex education of one young woman consisted of ‘no ken raun na paul’ – ‘don’t roam and fuck around’, and another teenage girl said: ‘my mother and my father said I have to stay decent and gentle, and not roam around’.

Asked about knowledge regarding other modes of transmitting HIV/ AIDS, three young women (21.4 percent) listed syringe needles; three (30 percent) young men listed blood, razor blades, nails used for tattooing, nails to pierce the earlobes and also syringe needles. For some young men, information regarding the transmission of tuberculosis, known from the tuberculosis campaigns, as well as traditional concepts, have been conflated with those of HIV/AIDS: they mentioned a possible infection through sharing food, plates and cups or from lime for chewing betelnut, cigarettes because of contact with saliva or with left-over food. Similar ideas are presented by Haley (2005), Strathern and Stewart (1999:150) and Dundon (this collection). According to one young man, ‘sikAIDS sticks to you if someone spits on the ground and buries it and you step on it with bare feet; the germ of this man is in his spit and it drops to the ground and you step on it and the disease penetrates the soles of your feet and goes into you’. A slightly different version, without germs contained in saliva but clearly more traditional, was explained by a different male teenager: ‘a man has the disease, sikAIDS, and he walks first and steps on and later you don’t look, and you step on his footprints, in the soggy, swampy ground, and then you will get the disease, it will go into your body through the soles of your feet, that’s what the health worker said’. This idea of the transmission of HIV/AIDS is also entangled with traditional Yupno concepts regarding personhood and sorcery (cf. Keck 1993a, 1999, 2005; Wassmann 1993). Each Yupno person has two spiritual aspects, monan, breath spirit, and wopm, shadow soul. Relevant here is the breath spirit; it is particularly concentrated in the saliva, but also in all other parts of the body, in nails, hair and skin. It has a substantial quality and part of it remains on everything with which it has come into contact -in this case: footprints in the ground, and is used for ‘leaving sorcery’ or poison. To injure another person, one takes a piece of chewed sugarcane, sweet potato or another item that has been in contact with the victim, and gives it to a specialist who will, in a secret ritual, burn this item and the associated particle of monan, breath spirit, and accordingly the victim will become very seriously ill.

Information on HIV/AIDS comes from different sources. The young women who knew about sikAIDS had learned about it through hearsay or from other girlfriends, had seen posters at the THC or had been told by a health worker as part of their school education. A 19-year-old woman commented,

when we were in grade 6 in the school in Teptep, in 2002, the officer in charge from THC came in our classroom and taught us about this disease. He said, ‘you cannot roam around with men. The husbands of other women cannot come and sit down or talk or roam around with you, or sleep with you’. This is what he said. And he said: ‘don’t roam and fornicate around’. This kind of admonition he gave us. All men have to stay with one woman, and all women with one man until they die. He taught us this way.”

The young men listed as an additional source of information radios, teachers, brochures and newspaper articles, and a video. This video was shown at Teptep Community School by Ola, an extremely popular and committed MAF pilot from Finland, to exclusively male teenagers and left a lasting impression on the viewers. In this video, neonatal HIV/AIDS transmission from mother to child is also a topic of which only one single man (grade 10) had ever heard. According to the man,

if a man and a woman have sex, promiscuous sex, and don’t use a condom, if they do it without, then this HIV/AIDS germ the man and the woman have inside of them is very quickly passed on to the other partner with sperm or fluids. It goes inside the other, then it will infect the baby and the woman will not be able to carry the child to term, or the HIV/AIDS germ will harm the child.’2

A topic where there are also considerable gender differences is condoms, called ‘rabba kondom’, “rabba plastik’, or, in Yupno, nyivil yok (nyivil: penis, yok: netbag, bag). Eight young women (57 percent) had heard of condoms or had seen pictures of them on posters, and all of the ten young men (100 percent) were familiar with condoms. Six out of the eight young men with sexual experience used, as they told me, condoms – often obtained from elder friends or relatives – when having sex. A young man said: ‘they pinned up a poster with a man on it holding a condom and an arrow. Above it is written I’m not afraid, and below: I’m protected’. All those who had been informed about the sexual transmission of HIV/AIDS had a very positive attitude towards the use of condoms and welcomed them as a means of contraception as well as a protection against sikAIDS. Especially for younger, unmarried women, hence for women for whom no brideprice had been paid, an illegitimate pregnancy is socially precarious and more often than not linked with vehement, also violent arguments with their own family. As a younger man described the situation, ‘sex without condoms is not good, the woman runs around [and has sex], this goes on for a few months, and after five or six months she is pregnant and then it gets bad when her mother and father and her family are mad at her and beat her’. Another young woman suggested, ‘some women are afraid to ask for condoms, they are afraid because it would be bad if they asked and they are ashamed and so they run around without [condoms] and [have sex], and they become pregnant, some of them are really very young girls, they have a baby … they are afraid to ask the health worker [for condoms]‘.

In the Yupno region it is, however, extremely difficult for a teenager to obtain condoms from the health centres in Teptep or Kangulut. A statement of one 18-year-old teenager is representative of many others: ‘the health workers … have taken a new course and that is why they now say: “All married men may come and get condoms. But all the young men and teenagers are not allowed to come and get any.” That is what they say’.” The Health Extension Officer in Kangulut, who is an active churchgoer from the Yupno region, justified his refusal to hand out condoms to teenagers with the kastom of the region:

we have been given the okay from the Health Office in Lae to hand out condoms, we have to hand them out free of charge. They don’t cost anything, but as to the adolescents – I deter them. I tell them: “I can give you [condoms] but you go now and behave in a decent way [decent meaning: not having sex]. If I give them to you, I am at the same time encouraging you [to have sexual relations] and you will roam around”, and I usually tell them all: “I don’t want to give you any … If you look after yourselves, you will be fine and you will save your life” … We are looking carefully at our kastom here, kastom is something very important as well as the ways people in the villages live. This is what we learned and we and our work have to be in line with kastom.

This is a most impressive \example of how different the ideas and instructions of international health planners often are (free handouts of condoms for prevention) from those of the people working in the government health service – here an employee at the KHC, a neighbouring village, exactly those people who are to implement this health policy locally. This may be a single case, but represents the usual practice of health professionals in Papua New Guinea as other authors also show (Karel 1995; Wardlow 2002, 2005). Yupno kastom, mentioned by the health worker, has been influenced and shaped by the Lutheran Church since the 1950s. While many traditions, particularly in the religious and ritual realm (initiations, men’s houses, cosmological knowledge, sorcery, polygynous marriages), were vehemently fought by Lutheran missionaries and evangelists, other traditions, like those associated with sexual practices that are linked with shame and are strictly sanctioned through the brideprice and social norms, fitted the Lutheran ethos well. This conceptualisation of kastom supports Tonkinson’s (1993:599) notion where ‘tradition is most effectively conceptualized as a resource, employed (or not employed) strategically by certain (not all) of a community’s members’.

Into this Lutheran discourse can be placed the idea of HIV/AIDS as the result of moral misdemeanors – a concept that is not specific to the Yupno but shapes many Papua New Guinean’s understandings of HIV/AIDS (see Wilde this collection). Different Christian groups have developed various stances toward sikAIDS, from apocalyptic explanations among the Lelet in New Ireland (Eves 2003) to the concept of divine retribution among the HuIi (Wardlow 2005). Compared to these fundamentalistic versions, Yupno Lutheran Christianity is, so far, ‘moderate’, pragmatic and certainly more tolerant. However, the more fundamentalist version spread by mission teams seems to attract younger people especially who might see in these Christian groups powerful agents for changing their life for the better and for protecting them against all kinds of threats, including sikAIDS. As one young women told me: ? have heard that the faithful and the representatives of the church say: it is a sin God imposes on men and women who roam around and sleep around with each other … God sends this powerful sickness for which there is no medicine. Many are saying: this is the punishment which God sends’.’ This makes the ecclesiastical tenor of many churches in Papua New Guinea more than clear: HIV/AIDS is a punishment, a sin, sent by God for those who misbehave. SikAIDS is linked with morals, with promiscuous sex and prostitution. A teacher and representative of the church explained why information on HIV/AIDS is so important:

because our body is God’s sacred vessel, made by God, and God has determined its time, until it gets old and dies. But if we don’t look after it and care for it, then sikAIDS can kill and destroy this good body God has given us. And then we stand in the face of God and have to explain ourselves: why did we destroy this body? And God will accuse us. And that’s why we have to talk with every single one here in the Teptep region and support the campaign of the health workers, and our health workers can make friends with the church leaders and gather in order to protect the young people from HIV/ AIDS.

In his comment, a threatening, judging God prevails over moral offenders. In all of these perceptions of sikAIDS, an often inadequate understanding of biomdical ways of HIV/AIDS transmission, morality – combined with more or less fundamentalistic Christian explanatory models – and certain selectively chosen traditional concepts of kastom, are conflated.

On the whole, we can state that the young men were better informed about HIV/AIDS than the young women, which can be attributed to a better school education overall and broader outside experience. They clearly had more sexual experience than the young women – yet all this has to be interpreted with a grain of salt. While it is culturally permitted that young men have premarital sexual experiences (as long as they are without consequence and don’t result in the partner’s pregnancy), it is officially taboo for young women. This is closely connected to the concept and practice of brideprice which is so important to the Yupno: only a wife for whom brideprice has been paid is a socially accepted and integrated woman who, however, has then to show her reproductive abilities to the members of her clan and husband’s clan as soon as possible- thus those who have paid the brideprice and therefore also have a right to the ‘product’, the baby. There is a tendency to ascribe to Yupno women in the village a sexually passive role and there are many tales of how men seduce women but never the other way round. Female sexuality is traditionally seen primarily as a means of reproduction – culturally accepted enjoyment or lust experienced through liberally lived sexuality, as it is for instance known among the Trobriand Islanders (Lepani 2005 and Lepani this collection), is foreign to the Yupno. These statements have to be understood against this background. Women in town, in contrast, with all the possible urban and modern connotations and, in particular, Highland women living in town are definitely viewed as sexually active, sometimes as sexual predators. Similar ideas are held by the Wampar (Beer 2005) and the Bariai (McPherson 2005).

So where can we now position sikAIDS in the larger framework of the Yupno indigenous medical system? The Yupno have a system of different levels of illness, ranging from a harmless bodily disorder, the lowest level, to the most serious (Keck 2005). ‘Real illness’ is always caused by a social (voluntary or involuntary) misdemeanor that leads to an oppressing problem, a njtgi in Yupno and a hevi (tp). This concept of burdened social relations is highly emphasized and differentiated among the Yupno and shapes their etiology of illness. For them it can be formulated as follows: a person always falls ill socio-somatically. Social discord, such as anger, arguments and fighting, theft of pigs, seduction of women, and more serious conflicts that might lead to eliminating the opponents with the help of sorcery are disruptions of the ideally cool, balanced social harmony. Its restoration is the main aim and this can be achieved through group discussions among those involved, dream interpretations, finding consensus as well as paying compensation. secondary, accompanying therapies involve traditional plants or the use of western medication. This aspect of being ill as a social sanction is therefore a central aspect of the Yupno’s medical system.

For the Yupno, sikAIDS is generally understood as a new and imported disease for which no traditional cures exist. It is associated with promiscuous sexual relations and immorality, socially undesirable behaviour. Thus the concept of sikAIDS correlates with the traditional concept of njtgi, the oppressing problems. But unlike traditional problems, sikAIDS cannot be healed with group discussions or dream interpretations and the Yupno are aware that it is a deadly illness for which there is no cure – at least in Papua New Guinea. According to health professionals, to date there are no HIV/AIDS patients in the Yupno region; thus it cannot be predicted with any certainty how actual cases of the disease would be explained and how the Yupno would handle them – if they would thus take care of the diseased or if they would stigmatize them and exclude them from the community. But their social values and practices will certainly be challenged in coping with sikAIDS in the years to come. Some of the younger people suspected possibly diseased persons, all of them younger women, with a reputation as pamuk men (tp), as women who are promiscuous further proof of how consistently sikAIDS is seen as a moral-medical concept.

The results presented here in many respects confirm those of an earlier study on current knowledge, attitudes and practice regarding HIV/AIDS which Karel (1995) conducted in three samples, Lae Town, Coastal Lae and Kaiapit, in age groups ranging from 15 to 45. As among the Yupno, prostitution and promiscuity, pamuk pasin (tp) were listed as primary modes of transmission, followed by having sex with an infected partner. Other modes of transmission such as reusing contaminated needles or syringes or from mother to baby were seldom indicated. In both investigations, a possible method of preventing sikAIDS was seen in a faithful sexual relationship with one partner; in case of premarital or extra-marital sex, condom use was seen as a useful prevention.

THE ABC PROGRAM: RECOMMENDATIONS FOR RURAL PREVENTION STRATEGIES

A young Yupno woman, turning to other young women, said ‘listen, when a man comes back from town and wants to make friends with you, you tell him: you have been in town, you have roamed around with pamuk meris (tp), prostitutes, in town, you go to the hospital first and have yourself checked. Then afterwards you can run around with me’. Another young woman put it in a nutshell while other teenagers wholeheartedly and laughingly agreed with her that: ‘no condoms – no sex’.” However, this so welcome and self-assured attitude does not reflect reality in the Yupno region. In this final section, the Yupno data are presented in relation to the ABC Program and several possibilities for a culturally appropriate prevention of sikAIDS among the Yupno are recommended.

The ABC Program, Abstinence, Being sexually faithful within marriage, using Condoms, is one of the main concepts in national HIV/ AIDS strategies of prevention in Papua New Guinea and many other countries. It is a vehemently criticized program that simplifies or even misses the reality of life for many people. The concept of promoting abstinence as successful prevention of HIV/AIDS among young people is used in \the small health centres in the Yupno region. Handing out condoms is seen as encouragement, particularly for adolescents, to become sexually active. The data – 80 percent of young Yupno men questioned had sexual experience – speak against a successful acceptance of this approach by young people in this region, and I agree with Hammar (1998a) that worldwide there is little ethnographic data that suggest that this approach would work elsewhere.” Studies in many regions of Papua New Guinea (Aeno 2005; Wardlow 2005) show that married women are a particularly vulnerable group for HIV infection, which they contract from their husbands. But often they are not aware of the risk. They frequently have little knowledge about their bodies, they are underprivileged in regard to education and money, and are often hardly given the opportunity to state their own needs, sexual wishes or ideas. For the most part, sexually submissive behaviour vis–vis their husbands is expected. ‘Abstinence and being faithful to one sexual partner in reality is not an option for women in marriages as they simply have no control over their sexual lives within their marriages’ (Aeno 2005:14). In addition, condom use requires the cooperation of men. Hammar (1998b, 1998a:53) criticizes this concept more fundamentally and more clearly:

AIDS prevention messages that admonish people to ‘Go God’s way’, to refrain from ‘going around with pamukus’ [prostitutes], to ‘know your partner’, and to ‘be faithful’, are a threat to public health. They discourage people from thinking about their own and others’ risks in sexual and other relations. They ignore that heterosexual monogamy is often precisely what puts women at risk of sexual violence and pathogenic transfer in the first place. The messages obscure the fact that human beings have sex with and exchange in the process bodily fluids with other human beings, with other bodies, not with moral precepts – ignoring the fact that monogamy is not the most important issue for many women around the world, including Papua New Guinea. Even when they remain monogamous, few women are in a position to compel their partners to become and remain so, much less to know that they are uninfected.

These statements also apply to the Yupno. The main problem for unmarried young people in rural regions is availability of condoms and a reliable distribution system. Health workers often practise restrictions and hand out condoms to married people, which they link to the hope that lack of condoms might keep people from initiating extramarital sex. Here as well, in the use of condoms, there is an inherent moral judgment since ‘faithful partners’ don’t need condoms. It is particularly difficult for young women in more remote areas with strong social control to ask for condoms at the local hospital.

It is well known that the lack of accurate, meaningful and comprehensible information about sikAIDS increases personal and social vulnerability (Karel 1995). Information is especially scarce in rural areas, and there are to date only a few studies on how sikAIDS is locally understood and adopted in existing concepts of Papua New Guinea communities (Eves 2003; Haley 2005; Hammar 1998a; 1998b Lepani 2005; McPherson 2005). What would a more culturally sensitive and locally adapted prevention strategy look like? Three recommendations are proposed. Firstly, many HIV/AIDS-awareness campaigns are designed for people in towns and the posters posit a message for urban middle-class people, which the Yupno and certainly other people living in rural areas find it difficult to identify with. Sexual encounters among the Yupno take place in the garden or in the bush; a full-page campaign (The National, November 10, 2004, p. 13) is a much better reflection of their reality: under the heading ‘ways of infection of HIV/AIDS’ one sees a couple on a narrow path, on their way into the bush, and the text reads: ‘If you have sex with someone who has HIV/AIDS and you don’t use a condom’.22 SikAIDS-campaigns with texts or posters with whose content young people in rural regions can identify are highly recommended.

Secondly, efforts towards better sexual education for teenagers should be undertaken since it is they who are a particularly vulnerable group (Chen 2001:166). Topics such as sexual health, ideas about conception and different methods of family planning, sexual wishes etc. should be part of the curricula in community schools, and presented in groups where young people meet, including youth groups, sport teams, confirmation classes and so on. Although a good medium for teaching younger people about sikAIDS includes theatre groups and videos, none had found its way to Teptep by early 2005. There are some community schools in remote parts of the Finisterre Range where no information at all about HIV/AIDS has been given to the students. Teachers, youth group leaders, and pastors should receive training and be encouraged to talk about these matters, since they themselves are quite often ashamed to address these issues.

Finally, a special effort should be made to improve the position of women and to address unequal gender relations. To counter this, more women should be employed as teachers or health workers in rural regions, since for girls, teenagers and young women it is much less awkward and shameful to discuss topics focussing on sexual and reproductive health with other women. A teenage girl, who was very interested to learn about sexual matters, expressed her dilemma: ‘the women here are all ashamed and afraid. We were all sitting comfortably together with our best girlfriends and talk and listen and talk and chat, and if there were female health workers the health centre, it would be easier to talk about the subject. If there are only male health workers present, we are ashamed’.2′ Today there are some well-educated, female students, living in the villages, who are denied any chance of further education because of lack of money and the practice that gives focuses on the education of boys. Young women’s education, skills and knowledge should be used; they should receive training about sexual health and a financial incentive to stay in the villages and to inform their female wantoks about sikAIDS and related matters, in an open, relaxed and informal way.

ACKNOWLEDGEMENTS

This paper is dedicated to Zuhuke (Juke) Tingneyu from Gua, who passed away suddenly in February 2005. He worked for many years as Aid Post Orderly, first in Teptep, later in Madang, where we became friends, and where he helped me and his elder brother Zaka Tingneyu, my closest friend, numerous times in many ways, with practical issues (as organizing huge amounts of betelnut as gifts for the Gua villagers), as well as with his communicative skills (as go-between for news between me and Yupno people in Madang, in Gua and Lae.) His house in Sisiak was an important meeting point for Gua villagers, and I owe him for lots of information regarding the everyday life of the Yupno in towns and reflexive thoughts about kastom and modernity. In autumn 2004 he encouraged me to do my study about the knowledge of HIV/AIDS among young Yupno people. My cordial thanks for translating this paper from German into English goes to Ingrid Bell. In addition, I want to thank Herick Aeno, Bettina Beer, Richard Eves, Nicole Haley, Katherine Lepani, Naomi McPherson and Holly Wardlow for giving me generous permission to cite from their unpublished manuscripts and an anonymous reviewer for the useful criticism and helpful comments.

NOTES

1. I want to follow Brummelhuis and Herdt ( 1995:ix) who prefer to speak of risks (in the plural) instead of risk (singular), acknowledging the multiple modes of infection; it too helps to avoid the stigmatization of epidemiologically constructed ‘risk groups’, who are too often ‘the others’ and who have received many criticisms in anthropological literature (Herdt 1992; see the other contribution in Herdt and Lindenbaum 1992; Schoepf 2001; Schiller, Crystal and Lewellen 1994).

2. ‘Sik hia i kam long God, i no kam long narapela we. Mipela man long graun i no kisim dispela sik . Em i kam insait long Israel. ‘

3. ‘No school’ also includes attending the confirmation class without formerly attending the community school in Teptep.

4. ‘Ol mani save i go i kam i go i kam namel long taun, na kisim dispela sik i kam insail long pies. Nau long pies i no tumas, tasol ol man i karim i kam long hia. ‘

5. ‘Wanpela samting mi wok long tingim em olsem: man em i raun raun long autsait na sapos em i raun paul wantaim wanpela positive AIDS, na em i kam long hia, how bai mipela save olsem em i gat dispela sik? Dispela kain tasol i givim hevi long mipela long hard long mipela long luksave na nongut em i kam na spreadim dispela na em i got aut long area long mipela. Mipela i gal bigpela concern long dispela.’

6. ‘Ol man long hia ol i prt. Na tu ol i no man bilong toktok na grisim meri long raun wantaim, olsem mipela man long hia, mipela i save tingling long market na painim toea. Em tasol. Na kam bek. Na dispela kain tingling bilong paul na painim meri em mipela i nogat long hia. ‘

7. ‘Mipela les long holim tasol, long hia nogat, slip tasol, tingling long koap tasol. ‘

8. ‘Mi save harim na olsem kisim feelings, long tingling mi save kisim, tasol mi no bin pilim olsem sex. How ol i save kisim feeling na wanem samting em mi no klia. Na how ol i save mekim na dispela laik i save kisim ol, na mekim, mi no klia. Olsem ol man i save mekim na go stori na mi save harim … Olsem mi save putim laik long meri tasol em i hard long tokim em. Samting long sem. ‘

9. ‘Mama na papa tok mi mas stop isi, no ken raun. ‘

10. ‘Na wanpela rot, sik AIDS em i save pas long taim man i spet na ol i karamapim, na yu leg noting na yu krongutim antap, em germ bilong dispela man em i stop insait wantaim saliva, na em i pundaun long hap bai yu krongutim antap, dispela sik bai pas long dispelaskin bilong leg na go insait long yu. ‘ ‘Man i kisim sik pinis i go pas na krongutim leg na bihain yu go na yu no lukim, yu krongutim gen long leg mak bilong en, long graun tais, graun malomalo, em nau bai yu kisim dispela sik, i bai go insait long dispela [he points to the soles of his feets] na go antap, dokta i bin tok olsem. ‘

11. ‘Taim mipela skul grade 6, long skul long Teptep, 2002, na wanpela dokta, OIC bilong Teptep, em i bin tokim course insait long classroom na teachim mipela long we long dispela sik, lainim mipela. Em i bin tok olsem: Yupela i no ken raun nabaut wantaim man. Ol man bilong ol narapela meri ol i no ken kam sindaun wantaim yupela toktok raun nabaut, slip wantaim yupela. Em i bin tokim mipela olsem. Em i bin tok: No ken koap nabaut na raun. Kain toktok em i bin givim mipela. Ol man wantaim wanpela meri, ol meri wantaim wanpela man i mas stap long tupela inap long lupela indai. Em i bin teachim mipela long dispela we. ‘

12. ‘Taim man na meri wokim dispela sex, pasin bilong pamuk, dispela taim em germ bilong taim ol i no yusim kondom wokim noting em germ bilong dispela AIDS is stap insait long man na meri, harriap tru em bai pas i go insait long narapela wantaim ol wara susu nabaut bilong ol. Em i go insait, ok, taim em i stap em bai affectim bebi, na meri bai i no inap karim pikinini o germ bilog AIDS bai bagarapim bebi. ‘

13. ‘Na ol i bin putim wanpela piksa bilong wanpela man i holim wanpela kondom, na holim wanpela spia na sanap. Antap ol i raitim: Mi gat bonis, na daunbilo: mi no prt. ‘

14. ‘Nongut wokim noting [having sex without condom], dispela meri i raun i go, sampela man, faivpela sixpela man, meri i gat bel, na nongut mama na papa na lain bilong en i kros na paitim em. ‘ ‘Sampela ol meri ol i save prt long askim na kisim dispela rabba kondom, ol i save prt, nongut yu askim, ol i save sem, na ol i save raun noting noting, na ol i save kisim bel, sampela liklik meri tasol ol i karim pinis, karim na raun i stap. Ol i save prt long askim dokta. ‘

15. ‘Nau long Kangulut ol dokta i kisim nupela course, olsem na ol i tok olsem: Ol man i gat meri i ken i kam na kism kondom. Na ol manki ol i no inap long kam na na kism. Ol i tok olsem. ‘

16. ‘Kondom mipela kisim tok orait long Health Office long Lae, tok mipela kisim em mipela im mas supplyim free. Nogat pay, tasol wanpela samting long said bilong ol yangpela em mi save stopim ol. Mi tok: Mi ken givim yupela tasol yupela nau go na stap isi. Mi givim yupela na encouragim yupela bai yupela raun raun, na mi save tokim ol: Mi no laik givim yupela … Tasol yupela lukautim yupela yet, yupela stap gut ma yupela savim laif bilong yupela. … Mipela save lukluk tru long kastom bilong mipela, kastam em i bigpela samting na pasin bilong ol manmeri long pies. Em skul mipela kisim em mipela i mas go in lain wantaim ol kastom. ‘

17. ‘Mi bin harim, olgeta ol bilip man na wokman bilong church, ol i save mekim dispela toktok, ol i save tok: Sin God i givim long ol manmeri i save paul nabaut. God i lukim olsem olgeta manmeri ol i no save sindaun gut wantaim meri bilong ol, ol marit manmeri, ol wok long paulim nabaut na God i salim dispela strongpela siknes, nogat marasin bilong ol. Planti i tok olsem: em i punishment God i salim. ‘

18. ‘Long wanem, bodi bilong yumi em i haus holi bilong God na God i wokim na God i makim taim bilong dispela bodi bilong yumi, bai i gat taim bilong en stap i go lapun na indai. Tasol yumi no bosim na lukautim, em dispela sikAlDS bai ken kilim indai na bagarapim dispela gutpela bodi God i givim yumi. Na bihain yumi gat toktok long ai bilong God. Bilong wanem na mipela i bin bagarapim dispela bodi na God i gat tok long kotim yumi tu. Olsem na wan wan manmeri insati long Teptep mipela i gal wok long toktok na sapolim tok bilong ol dokta,ol dokta bilong mipela i ken poroman waintaim church lida na wok bung wantaim long banisim na guidim olgeta yangpela i no ken kisim dispela sik AIDS. ‘

19. In the markets in town all kinds of remedies made of plant material (the noni-tree and numerous other plants) and mixed up together are promoted and sold as miracle cures against HIV/AIDS, tuberculosis, hair loss etc.; among the Yupno this ‘invented’ medicine (cf. Eves 2005) to date is not known or widespread and their herbal medicine is so far not being connected sikAIDS or used against it.

20. ‘Harim: Sapos wanpela man i kam long taun, na em i laik prenim yu, tokim em olsem: yu raun long taun, yu raun wantaim pamuk meri long taun, yu go long haus sik na ol i checkim yu pastaim. Bihain yu kam raun raun wantaim mi. ‘ ‘Nogat kondom, nogat hamamas. ‘

21. Wolf and Dilger (2003:268) cite a study on young women in Uganda who, as members of a Pentecostal congregation, deliberately renounce pre- and extramarital sexual relations – a decision also accepted by the young men.

22. ‘Rot yu inap kisim HIV/AIDS ‘: sapos yu kuap wantaim narapela husat igat HIV/AIDS nayuno usim kondom. ‘

23. Ol meri long hia ol lain long sem, ol lain long prt. Ol i sindaun gut wantaim ol gutpela besti, ol meri, besti bilong ol, ol yet toktok i go i kam. Na sapos i gat dokta meri long haus sik, em bai gutpela long toktok long dispela samting. Sapos dokta man tasol, mipela sem.’

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Verena Keck

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Copyright University of Sydney, Oceania Publications Mar 2007

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