Politics, culture and medicine in Malawi: Historical continuities and ruptures with special reference to HIV/AIDS

From reflexive, theoretical, historical and fieldwork perspectives, this multidisciplinary work (using triangulated methodological approaches) challenges and interrogates current viewpoints on health promotion, in the context of HIV/AIDS, in Malawi. The thesis is presented in a number of steps, culminating in the explication of the dynamics of cultural socialisation among primary, secondary and tertiary school students, relevant to HIV/AIDS. First, a culturally based pre-colonial traditional framework of health promotion, medical service delivery and order maintenance is ‘reconstructed‘, using a number of markers, which are later used to show the colonial and postcolonial persistence and continuity of this framework. Second, it is argued that this culturally based medical framework survived and minimised conflict (and epistemological and pragmatic dialogue) with colonial power and medicine by largely retreating into localities. This created localised indigenous communal medicocultural and welfare traditions, which continued to offer services to most Ahcans. Third, it is suggested that the framework’ s postcolonial persistence reflects the limited colonial and postcolonial socio-economic change in Malawi, with elites now, as whites then, controlling limited western medical resources at the expense of the anthu wamba (peasantry). Fourth, a critical history of HIV/AIDS in Malawi shows how, having entered Malawi in this context, the HIV/AIDS epidemic was bound to be viewed through these vibrant localised traditional frameworks of beliefs. The localised beliefs affected the perceptions and responses to, as well as the extent of, the epidemic; some Malawians saw HIV/AIDS as mdulo or kanyela (wasting diseases caused by transgressing sexual taboos). Fifth, political, religious and economic factors also affected the explanations and interpretations of and strategies for dealing with HIV/AIDS, contributing to a donor-dependent National Aids Strategic Framework (2000 - 2004) predicated on assumptions of socio-economic, educational and developmental progress. Six, the fieldwork confirmed the vibrancy of and influential dynamic of indigenous culture towards health beliefs and practices among the general public, and school students in particular, despite a high level of awareness among school students (and the public) about the scientific aspects of HIV/AIDS. Seven, these high awareness levels, even in school contexts coexist with discourses, such as ufiti (witchcraft), which are influenced by localised cultural traditions. Eight, it is argued that, given the socio-economic constraints, these discourses may influence or dilute western HIV/AIDS awareness messages and influence the actual socialisation and social and sexual behaviour of students