Human Rights Violations: Thousands of babies raped in South Africa because of Virgin AIDS-cleansing myth: expert ethnologist report

Thousands of babies of all races are raped in South Africa because of the 'AIDS-cure witchdoctor myth': expert ethnologist report: http://scnc.ukzn.ac.za/doc/Health/Aids/LeclercMadlala-S_Virgin_cleansing_myth_HIV-AIDS_ethnomedicine.pdf ----------------------- RELATED ARTICLE: Oct 2013: Babies raped and murdered in Diepsloot, South Africa Diepsloot, South Africa (CNN) -- In a country where several rapes are said to occur every minute, in a township where violence is commonplace, this was a crime that shocked the entire community of Diepsloot, South Africa. Two baby cousins, aged two and three, were taken from their doorstep -- kidnapped in broad daylight.And when Yonelisa and Zandile Mali were found a few days later in the township north of Johannesburg, the news only got worse.The two girls had been raped and murdered, their lifeless bodies dumped in a public toilet in Diepsloot.Since that discovery October 15, five men have been accused of kidnapping, raping and killing the two little girls. The suspects appeared briefly in court in Pretoria Thursday but the trial has been adjourned until November 1 while investigations continue, Medupe Simasiku, a spokesman for South Africa's National Prosecuting Authority, told CNN. Investigators are currently analyzing DNA evidence and awaiting official identification of the five men, he said.A confession from one of the suspects was legally obtained and will be used in court, according to Simasiku, but the other suspects have not confessed to the alleged crimes. All five will defend themselves in court.Residents of Diepsloot demonstrated outside Pretoria Magistrate's Court as the men made their appearance, voicing their anger over the killings. The sprawling, densely populated township on the outskirts of Johannesburg is one of the most violent places in the country, making it a challenge for any parent to keep their child safe here.But Yonelisa's mother, Thokozani Mali, tried her best. She was at home with the girls on the day they were taken, checking on them every five minutes as they played together. She discovered they'd vanished after going to check when all went quiet. Family, neighbors and the police joined a frantic hunt for the toddlers.Ten days after their bodies were found, Thokozani finds it hard to talk about the loss of her only child."I am trying to be strong," she told CNN. "When I am sleeping, she always next to me, so when I think of that I feel like crying."A box of the girls' shoes is outside her home, waiting to be given away to those in need. But for the moment, the pain is still too raw.Arrests for rape are rare in South Africa, and only 6% of rape cases lead to convictions.But South Africa has one of the highest rates of 'sexual violence' in the world, with an average of 55,000 reported cases a year.The true figure is likely much higher, though, since many victims stay silent, according to Prof. Rachel Jewkes of the South African Medical Research Council.Surveys of adult women in South Africa's Gauteng province, which encompasses Johannesburg, Diepsloot and Pretoria, suggest that 25 women are raped for each one who reports it to the police, she said. UNDERREPORTED RAPES:"If you take into account that rape is so under-reported, there are several rapes every minute in this country by our estimate," she said. --- FIFTEEN PERCENT OF THE FEMALES RAPED IN SOUTH AFRICA ARE YOUNGER THAN ELEVEN YEARS: -- While some 60% of the women raped in South Africa are adults, about 15% are children under the age of 11, she said."We do see rapes of children of age 3 and 2 every year but obviously not that many," Jewkes said. She has seen a disturbing increase in cases where those attacked are both raped and killed. About a quarter of girl children who are murdered are raped, Jewkes said. The police station in Diepsloot has one of the highest rates of reported rapes in the country, she said. http://edition.cnn.com/2013/10/24/world/africa/south-africa-child-murder-case/ --------------------- CNN video: http://www.cnn.com/video/data/2.0/video/world/2013/10/24/sa-toddler-rape.cnn.html ------------- RELATED ARTICLE FROM TWO CHILD-SPECIALISTS IN SOUTH AFRICA: "Motivation behind infant rape in South Africa"-- Drs Douglas MG Bowley & Graeme J Pitcher: -- "We aimed to highlight infant rape with associated perineal injury. In our practice in Johannesburg, perineal mutilation of infants (hardly an injury that fails to present for medical treatment) has recently emerged as a distinct clinical entity. -- Page 1352, 13 April 2002 " Jewkes and colleagues DISPUTE the assertion that the virgin cleansing myth is an important cause of child sexual abuse. The idea that sex with a virgin will cure men of sexually transmitted infection is not new, nor exclusively African. In renaissance Europe, it was widely believed that syphilis could be cured by intercourse with a virgin. In 1925, Samuel Cameron2 wrote: “The disgusting superstition, surviving amongst ignorant and vicious men, that contact with an immature vulva will cure venereal disease, is still responsible [for transmission of gonorrhoea] in many cases.” In a South African sexual-health workshop, reported by Jewkes herself in 2000, 32·7% of participants believed sex with a virgin could cure HIV infection. After 14 sessions of 2—3 h each, this myth was still believed by 20% of the participants.3 Jewkes believes that a 1% seroconversion rate in raped children from Cape Town disproves the cleansing myth because the "rate is too low". -- This reported rate is falsely low, since HIV testing in the early years of the study was haphazard, and since 1997 all children have received post-exposure prophylaxis (Sebastian van As, personal communication). -- In consensual sex in developed countries, the average risk of transmission per contact for unprotected receptive anal intercourse with an HIV-positive man is around 5%; -- for unprotected receptive vaginal intercourse this risk is less than 1%.5 -- SIXTY THREE PERCENT OF THE TRACED OFFENDERS ARE NOT EVEN TRIED FOR THEIR CRIMES... The risk after rape is much greater and although multiple penetrations by multiple perpetrators, dry sex, the presence of other sexually transmitted infections, and the occurrence of perineal injury increase the risk after rape, a low seroconversion rate is still consistent with a high HIV-positivity rate among perpetrators. -- The fact that few perpetrators "admit that the myth motivated their actions" is hardly surprising given that around 63% of traced offenders are not even tried for their crimes in South Africa and only 7% receive a prison sentence.We agree with Jewkes and colleagues that 'rape in South Africa occurs in the context of a society inured to very high levels of violence', with fractured families and communities and extreme inequality between the sexes. --- "However, the high level of poverty to which they correctly refer as a contributory factor cannot be divorced from high levels of ignorance and illiteracy, which we believe potentiate dangerous beliefs and traditions. --- We concur that the virgin cleansing myth is not the ONLY motivation behind the appalling levels of rape in South Africa, but we believe it is IMPORTANT. We add our voices to that of Charlene Smith, the noted South African rape activist, who has questioned why there is a paucity of research on this practice (of raping infants_ or vociferous advocacy to challenge it." http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2802%2908305-8/fulltext ----- TOP ETHNOLOGIST 'S REPORT AND WARNINGS ABOUT BABY RAPE BEING USED AS AN 'AIDS-CLEANING CURE' IS BEING IGNORED --------- --- "White academics in South Africa are completely silent on 'Ukuthwala', the 'virgin-cleansing myth'. The most authorative paper on this subject was written by Ethnologist Suzanne Leclerk-Madlala who published details of the underlying 'belief-system' explaining this practice in 2002," wrote Afrikaner academic Dr Dan Roodt. He writes: "South Africa has descended into a sadistic society, where rape - and in particular the horrifically high rape of small children, are grossly under-reported and almost entirely ignored by the 'white' academic world for fear of a 'racism-accusation' witch-hunt. MORE THAN A MILLION BABIES RAPED EACH YEAR Most estimates put the number of such rape crimes at more than a million per year - approximately 3,000 per day. The only academic article worth reading on the 'virgin cleansing myth' is that by ethnologist Suzanne Leclerk-Madlala, in the African Journal of AIDS research in 2002. Title: "On the Virgin Cleansing Myth: gendered bodies, AIDS and Ethnomedicine.' Ethnologist LeClerkMadala: ( at that time her email was leclerkmadlals@nu.ac.za ) SHE WRITES: "The belief that HIV/AIDS can be cured as a result of sex with a virgin has been identified as a possible factor in the rape of babies and children in South Africa. ------------------------ (DIRECT LINK TO HER ARTICLE:) http://scnc.ukzn.ac.za/doc/Health/Aids/LeclercMadlala-S_Virgin_cleansing_myth_HIV-AIDS_ethnomedicine.pdf --------------------------- Leclerk-Madala wrote in 2002: "While the prevalence of this myth has been a matter of concern in local communities for some time, there have been recent attempts to discern the extent to which this belief is exacerbating perceived increases in child rape and the rape of new HIV infections nationwide. This article attempts to reveal the systematic logic upon which is based the idea of 'virgin cleansing' as a therapeutic response to HIV/AIDS amongst people who self-identify as Zulu. Based on ethnographic research in several peri-urban settlements of KwaZuluNatal province, key aspects of ethnomedical knowledge associated with notions of 'dirt' and women's bodies are examined - along with the metaphors that inform local interpretations of HIV/AIDS. The author argues that closer attention paid to the shaping influence of cultural schemas is critical to better understanding belief-behaviour linkages in the context of rape and AIDS. She wrote in 2002: "Despite communities expressing deep concern over men sexually assaulting children in the hope of obtaining an AIDS 'cure', there were no attempts made to publicly address this issue through AIDS education campaigns in KwaZulu-Natal or elsewhere throughout the whole of the 1990s. BODILY DIRT: Sontag's foundational work Illness as Metaphor (1978) points out the historical specificity of the ways in which illness and those affected by illness have been socially conceived. How this social conception accrues meanings has been explored by Fernandez (1986) as a process of 'metaphorizing'. He writes: 'because of their embodied nature, metaphors create meaning not only through representation but through enactment or presentation. The presentation of metaphor takes two forms: 1. Metaphors as cognitive tools that work on our concepts to fashion new meaning; 2. Metaphors as Communicative Acts or Gestures, constrained by social structure yet giving rise to new patterns of social interaction and modes of discourse (cited in Kirmayer 1992, p.332). Central in the process of understanding medical-related knowledge and practice amongst the Zulu, is an analysis of metaphors used to signify ill health. This encompasses more than an examination of a 'system of belief', an analytical approach that is limited in its ability to explain embodied experience and illness management. For one thing, Zulu cosmology is not 'standardized' in theory or practice and therefore varies, not only by researcher interpretation but also by regions of KwaZulu-Natal from which members of individual Zulu clans originated. REGIONAL DIFFERENCES: Thus what might typify medical epistemology and lived experience in Mariannhill may be considerably different in more northern parts of the province for example, where people are 'said to have 'secret knowledge' and 'stronger'medicines. Methodology: "Unravelling the complex web of meanings in which the virgin myth is embedded was part of a broader research endeavouring to understand non-medical representations and cultural constructions of HIV and AIDS amongst peri-urban Zulu-speaking people in KwaZulu-Natal province (see Leclerk-Madalala 1999). "Unravelling the complex web of meanings in which the virgin myth is embedded was part of a broader research endeavouring to understand non-medical representations and cultural constructions of HIV and AIDS amongst peri-urban Zulu-speaking people in KwaZulu-Natal province (see Leclerk-Madalala 1999). This research was based on ethnographic fieldwork that took place primarily between 1995 and 1998 in the greater Mariannhill area of Durban. An open-ended questionnaire schedule was used as a guide for in-depth interviews with key informants representing a wide cross-section of members from the Mariannhill community. For the most part interviews were conducted in Zulu. During that fieldwork period South Africa was experiencing a rapid and steady rise in HIV infection rates. Towards the close of the 1990s the HIV epidemic showed signs of maturing into an epidemic of AIDS-related morbidity and death. By the mid 1990s the virgin myth had established wide currency in several communities in the area. In interviews and discussions with a range of informants, 'virgin cleansing' was identified as a possible 'cure' for this new disease that people dared not to mention by name. While some informants professed a belief in the myth, more often they claimed that it was 'other people' who believed in virgin cleansing as an HIV/AIDS treatment. TRADITIONAL HEALERS: "Certain traditional healers were blamed for perpetuating the myth, as it was said that healers advised their HIV-infected clients to seek a virgin for 'cleansing'. It was a widely-held view amongst informants that this belief was helping to drive the spread of HIV and contributing to increased incidences in the rape of children (Leclerk-Madlala, 1996). TRADITIONAL HEALERS: "Certain traditional healers were blamed for perpetuating the myth, as it was said that healers advised their HIV-infected clients to seek a virgin for 'cleansing'. It was a widely-held view amongst informants that this belief was helping to drive the spread of HIV and contributing to increased incidences in the rape of children (Leclerk-Madlala, 1996). According to a nationwide study by the University of South Africa, onemillion women and childrenare raped annually, and this probably reflects afraction of the total rape problem, as most rape survivors never report toauthorities (1).As part of what is perceived to be anational rape crisis, the rape of youngchildren has elicited the strongest form ofpublic outrage. In late 2001 an articleby two medical doctors appeared inthe South African Medical Journaldescribingpatterns of injury and appropriate treatment management of child victims of rape(van As et al, 2001). This was followed by commentaryon infant rape in SouthAfrica in the prestigious Lancet, with the authors speculating on the role of the‘virgin myth’ as a motivating factor for this particular crime (Pitcher and Bowley, 2002). Several South African researchers were quick to respond by drawingattention to the more pervasive structuralviolence that existsin contemporarysociety as a result of the country’s brutal past (2). The Director of gender andhealth research at the Medical ResearchCouncil, R. Jewkes, argued that “theroot of the child rape problem substantially lies atmore mundane doors. Itshould be regarded as part of the sp ectrum of sexual violence against womenand girls (cited in Michaels, 2002).” According to studies conducted by Jewkesand others, there was no evidence overall that child rapes were increasing in South Africa. Such suggestions haveleft members of themedical professionand child protection services aghast, many of whom report to never haveimagined dealing with the levels and brut al nature of child rape cases that havebecome a routine part of their work (3). In spite ofthe fact that there is noavailable statistical evidence of an increasein this particular crime, there remains wide public perception of anational child rape crisis.In April 2002 South Africa’sMinister of Education commented thatthe country was quickly earning thereputation of baby rape capital of the wo rld, as it appeared to be tragicallyunique in its current baby rape scourge (4). This paper is neither an attempt to verify perceived increases in the sexualassault or rape of children, nor is it anattempt to explain these crimes in thecontext of present-day South Africa. Ra ther it focuses onthe prevalent myththat sexual intercourse with a virgin isan effective treatment for AIDS. Theauthor suggests that the same iteration of psychosocial denial that informs public discourse on AIDS in South Africa also affect public discou rses on the virgin myth. It has only been with the increa sing media attention given to especially horrific cases of child rape in the past year and the interest shown by overseas press in the issue of rape in South Afri ca, that the virgin myth has come under closer scrutiny. What foll ows is an analysis of wh at may be considered as significant cognitive and metaphoric constructions from which the virgin cleansing myth is derived. As such, it is an exercise that involves contestations of world-views and the challenge of in terpreting one highly integrated and systemic medical cosmology (African and Zulu), through the use of symbols and idioms borrowed from a ve ry different but equally integrated and systemic western and biomedical cosmology. Sh edding light on the nature of some ethnomedical beliefs that may be informin g and underpinning this myth is the intended purpose of this pa per. What follows is an unpacking of some prevalent notions and shared knowledge of Zu lu-speaking people relating to ethnopathological processes, women’s bo dies and notions of illness and illness management. As the virgin cleansing myth relates to the disease of AIDS, a brief analysis is provid ed of some commonly held ways in which people conceptualise and experience this relati vely ‘new’ illness. Studies of HIV seroprevalence amongst pregnant women at tendees of antenatal clinics around the country, reveal a 22.8% rate of HIV infection (South Afri can Department of Health, 2001). For the provin ce of KwaZulu-Natal, where research for this paper was undertaken, HIV seroprevalence is es timated to be betw een 36 and 38%. It is hoped that by elucidat ing a deeper understanding of why a man might seek sex with a virgin in the current context of a formid able AIDS epidemic, may contribute towards a more sensitive enga gement with the problem of child rape and our ability to addr ess both rape and AIDS more effectively. Methodology Unravelling the complex web of meanings in which the virgin myth is embedded was part of a broader research en deavour to understand non-medical representations and cultural construction s of HIV and AIDS amongst peri-urban Zulu-speaking people in KwaZulu-Natal province (see Leclerc-Madlala, 1999). This research was based on ethnographi c fieldwork that took place primarily between 1995 and 1998 in the greater Mari annhill area of Durban. An open- ended questionnaire schedule was used as a guide for in-depth interviews with key informants representing a wide cross-section of members from the Mariannhill community. For the most part interviews we re conducted in Zulu. During that fieldwork period South Afri ca was experiencing a rapid and steady rise in HIV infection rates. Towards the close of the 1990s the HIV epidemic showed signs of maturing in to an epidemic of AIDS-rel ated morbidity and death. By the mid 1990’s the virgin myth had established wide currency in several communities in the area. In intervie ws and discussions with a range of informants, ‘virgin cleansin g’ was identified as a po ssible ‘cure’ for this new disease that people dared not to ment ion by name. While some informants professed a belief in the myth, more often they claimed that it was ‘other people’ who believed in virgin cleansing as an HI V/AIDS treatment. Cleansing cures As a form of non-ritual pollution the state of being ‘dirty’ isa central concept ofdisease among the Zulu, and it would seem the neighbouring Xhosa as well,through which othercausal factors (be they witchcraft/sorcery, the ancestors, nature etc.) work. Ratherthan being an alternative causal typology, the state ofbeing ‘dirty’ can be understood as an explanatory model for illness. To say thatone has ‘dirty’ kidneys or a ‘dirty’ womb, is to saythat one has an illness inrelation to these organs.As part of a therapeutic process to ‘cure’ the specificillness, one would necessarily take steps to‘cleanse’ that orga n of the ‘dirt’.Various preparations, some obtainablethrough modern pharmacies and othersobtainable through traditional medical practitioners, are used for therapeuticcleansing that involves purging the body of harmful ‘dirt’. Commercial laxativesand enema preparations are used primarilyfor the cleansing of ‘dirt’ believed tobe affecting organs in the abdominal region. Diuretics are used primarily for urinary complaints. Emetics are believed effective for cleansing ‘dirt’ associatedwith ailments in the chest or throat.Traditional preparations made fromcombinations of herbs to effect the same purging response are also popular.Managing illness by taking steps to eliminate the ‘dirt’associated withthe ‘dirty’organ, can be viewed as afirst-line defence against illness and a routine part of most all traditional approaches to therapy (Leclerc-Madlala, 1994). The Zuluterm ‘ukwelapha’ is a term that refers broadly to treatment of disease. It may beused to describe a range of therapeuti c procedures thatcould encompass anyand all efforts to prevent, treat or curean illness. Claims by traditional medicalpractitioners that they can ‘cure’ an illness, whether AIDS, brain tumours, or chronic fatigue, are ethnomedical interpretations that can be understood as claims of their abilities totreat disease. The meaningof ‘treatment’ refers to acomprehensive approach to illness that may includeprevention, cure and/orsimple palliative care and treatment of symptoms.An understanding of the concepts of bodily ‘dirt’ and its significance as anethnopathological explanatory model for disease and the wide meaning of theterm ‘ukwelapha’ as treatment, are central components in both the metaphoricconstruction of and therapeutic responseto illness, including illnesses related toAIDS. According to local folk models of the human body, any ‘dirt’ responsiblefor causing illness symptoms in a particularbody part, whether ‘dirt’ associated with ‘dirty stomach’ (experienced symptomatically asany abdominal complaintwhether stomach-ache, diarrhoea, constipation, etc.) or ‘dirt’ associated with a‘dirty chest’, (experienced as persistent cough or any other bronchial pain ordiscomfort), or ‘dirt’ causing ‘dirty kidneys’ (experienced as painful urination,lower backache, etc.), has the ability to ‘mix with the blood’ if not cleansed early- on when the symptoms first appear. When this bodily ‘dirt’ mixes with blood theresult is said to be more generalized illness symptoms than those associated with specific organs or regions of the body. Rela ted to this idea is the notion that all organs in the body are in ter-connected. Thus ‘dirt’ producing illness symptoms in one part of the body may be convey ed to other parts of the body, via the blood, to cause illness symptoms elsewh ere. By purging through the use of enemas and emetics, tradit ional therapeutics aim to cleanse the entire system rather than a singular affected organ. Dirty’ women Conceptions of women’s bodies as high ly suitable places for hiding and harbouring ‘dirt’, echo thro ugh informants’ descriptions of female reproductive anatomy. Research conduc ted in Botswana (Ingstad t, 1990), Kenya (Udvardy, 1995) and Tanzania (Haram, 19 97), reveal similarities in the depiction of adult women’s bodies. Ingstadt (1990) reco rds how women’s bodies were often compared to suitcases that conceal an d transport disease to others. Such imagery resonates in the descriptions of female anatomy in Mariannhill. One young man described how ‘dirt’ especially ‘likes all those fold s and curves inside a woman because it can ‘hide and grow’. Both men and women hold similar views that reflect a symbioti c relationship between women and bodily ‘dirt’. As a place where ‘dirt’ is especially likely to be ‘hiding’, the vagina is described as an open-ended passage that leads up into the womb. This belief may help to explain the widespread fear that a condom migh t ‘go up’ and ‘get lost’. Women express an anxiety that should a condom break or slip off the penis, it may ‘float around inside’ and eventual ly find its way up into the body cavity and cause grave illness. One informan t asked: “What if it (the condom) goes up to the heart or even the throat? It can choke you and then you can die.” Another suggested that a lost cond om could become ‘twisted ’ and thus obstructs the blood flow and cause high bl ood pressure. Studies by Abdool-Karim et al (1995) revealed similar beliefs among commercial sex-worker s who plied their trade between Durban an d Johannesburg. Along with the notion that the vagina opens into the rest of the body, and that it provides a suitable hiding place for dise ase-causing ‘dirt’, there are ideas about vaginal ‘wetness’ that are significant to th e conceptualisation of women as ‘dirty’. The vagina and womb were the two places most often identified as places where ‘dirt’ can ‘hide’, ‘stick’ an d ‘grow’. The HI virus was discursively represented as an especially strong ‘dirt’ that ‘easily enters the blood’ via the vagina and womb. The theme of a ‘wet’ vagina associated with an ability to cause ‘dirt’ to ‘stick’ to its walls featured prominently in informan ts’ discourses on sexually transmitted diseases including HIV. One young nursi ng student described HIV infection in this way: “Women are wet down there. When they have an infection the germs just stick inside and smell. This is how they know they have infections like STDs, HIV or whatever. With men you can’t sme ll it because there’s nothing inside.” One young man expressed sexual anxietie s with reference to similar notions about vaginas. “Inside ther e it is dark, wet, not nice. AIDS can live there, waiting, and you wouldn’t know. Ma ybe the woman herself doesn’t know because it just sticks. She really needs a blood test to know for sure”. Another young man offered the view that nowada ys men are more afraid to touch a woman “down there”, because HIV or AIDS can “stick to your fingers and then pass into your blood if you ha ve a scratch or open sore.” The menstrual paradox Previous writers on the Zulu such as Krige (1974), Bryant (1970) and Berglund (1976) have noted that disease is usually defined by its somatic symptoms. This is still largely the case. With no symp toms, there is often believed to be no disease. With the recent disease of AIDS, popular media and professional medical discourse on the su bject emphasize the long a-symptomatic period of HIV infection. While such a relatively new and differe nt way of knowing illness may contribute to uncerta inty over approaches to treatment, there are physiological processes associated with women, namely mens truation, that is viewed as a means through which ‘uns een’ or a-symptomatic ‘dirt’ may be flushed out of the body. Menstruation is conceived as a kind of built-in cleansing system. Menstrual blood is considered ‘dirty’ because it is believed to be blood that consists of many different kinds of ‘dirt’ that may have accumulated in any region or organ in the body. This ‘dirt’ then ‘mixes with the blood’ before ‘pooling’ in the womb and then exiting through the vagina during menstruation. From an ethnomedical perspective, menstruation is representa tive of a process by which the female body automatically and regularly cleanses itself. Here we s ee the metaphor of ‘dirt’ accruing meaning as both a cognitive tool and a communicative presentation, a process that resonates with Fernandez’s (1986) description of metaphor’s production as a dual meanin g-making process. Menstrual blood and women’s menstruation are ‘polluting’ not on ly in a ritual and symbolic sense, but as they are associated with the coagulation and convey ance of ‘dirt’ from other parts of the body, menstruation in a real ‘lived’ sense is inhe rently unclean. As menstrual blood passes through the vagina , it is believed that some of the infused bodily ‘dirt’ will ‘s tick’ to the walls of the va gina, and form part of the ‘wetness’ conceived as ‘dirty’ and associat ed with adult vaginas and disease. As with any ‘dirt’ that can be expelled or ‘cleansed’ from the body during menstruation, local discourse on the HI virus indicates that it too is believed capable of expulsion during menstruation. However menstruation is not believed to be capable of cleansing all the ‘dirt’ associated with AIDS that may be hiding in the woman. One young woman put it this way: “When a woman bleeds, the dirt all comes out down there. But with AIDS, most of it stays in your blood because it is very strong. But of course the rest th at comes out, well I think most of that just sticks inside. You really only know with a blood test”. As previously noted, many informants think that ‘dirt’ in the blood can be expelled through menstruation, but menstr uation alone is not believed to be completely effective as a wa y to rid the body of ‘dirt’ -inducing illness. This especially holds true for the ‘dirt’ associated with HIV in fection, a type of ‘dirt’ construed as exceptionally potent and stubborn. While most all popular and academic writ ing on menstruation tends to highlight the negative sociocultural meanings attached to the process, there are nonetheless positive associatio ns, not the least of which is with fertility. In the case of the Zulu, the Xhos a (see Jewkes and Wood 1999), and probably amongst other ethnic groups in Southern Africa, menstruation has a positive dimension as a kind of innate health-promoting process or, ethnomedically speaking, a natural mechanism to regularly ‘cleanse’ th e body of ‘dirt’ associated with illness. A popular way to describe a woman who is menstruating is to say that ‘she is cleansing this week ’. The cultural prescription that a man should avoid intercourse during menstruation because it will ‘weaken’ him, has meaning well beyond the realm of spiritual misfortune a ssociated with ritual pollution. In a very real ‘lived’ sense, it makes good ethnomedical sense for a man to avoid intercourse with a woman who is ‘cleansing ’ in order to avoid being ‘infected’ by any manner of bodily ‘dirt’ that may ha ve mixed with her blood and is being expelled through menstruation. The cy clical nature and regularity of menstruation also has meaning as physical proof that the accu mulation of bodily ‘dirt’ is a natural pr operty and process of women. With the continual functioning of what might be described as an au tomatic cleansing system, the physical manifestation is there of a woman’s prop ensity for accumulating and harbouring ‘dirt’. Accordingly, one would have to assume that nature has provided women with the natural ability to expel ‘dirt’ through menstruation because they need such an ability. Thus an adult menstruating woman is conceptualised as ‘dirty’, not only in a ritual or me taphorical sense, but her ‘d irtiness’ has meaning in a very real physical sense. As Kirmayer (1992) argued, it is because of their embodied nature that metaphors cr eate meaning, not only through representation but through actual enac tment and presentation. Menstruation provides the presentation of the ‘dirt’ meta phor associated with women. It also creates a set of meanings attached to the notion of wo manhood and I would suggest it provides a very basic justification for gender inequality . Yet it is this same processual ‘dirtiness’ that is simult aneously proof of her very real power; her fertility, the ability to reproduce new members of society. This would support Douglas’ (1966) theo ry that both positive an d negative valences are reflected in the particular su bstances that a culture selects and codifies as ‘dirt’. Vaginal Anomalies Beyond associations with menstruation,‘dirty woman’ imagery is echoed in descriptions of physiological differences between male and female sexual organs.A woman’s vagina is ‘inside’ and ‘open at top’ while a man’s penis is ‘outside’with only a smallish opening often described as a ‘tube’ leading into the body.While men are said to be capable of expelling bodily ‘dirt’ through their semen, their particular reproductiveanatomy is generally not associated with ‘dirt’ that‘hides away’, ‘sticking’, ‘waiting’ or ‘sitting quietly likea baby inside’ as one maleinformant described ‘dirt’ in the womb that causes STD symptoms. Descriptionsof female reproductive anatomy are descriptions of a wet disease-lined vaginathat opens into a dark nest-like womb, a womb discursively represented asattached to or part ofthe stomach and interconnected in a complex way withother internal organs that convey blood and ‘dirt’ between them. A man whohas sexual intercourse with a woman who is‘cleansing’ (the same term used todescribe menstruation) issaid to run the risk of having his own bloodcontaminated with his partner’s ‘dirt’. As discussed, while some of a woman’sbodily ‘dirt’ will be expelled along with the menstrualflow, some of it can beexpected to ‘stick’ to the walls of the vagina. If one ofthe impurities or kinds of‘dirt’ found in a woman’s blood or sticking to vaginal walls happens to be thekind responsible forthe ‘new’ disease of AIDS, thenthat is what informants saywill be conveyed to her sexual partner. Some young women believe thattoothpaste used to clean the vagina internally after menstruation can help to ‘kill’some of the lingering ‘dirt’. But as HIV infection isbelieved to be especiallystrong, it is said to beresistant to home remedies such as toothpaste,Flagylorantibiotics used to treat STDs. One 16-year-old girlsaid that most infections‘down there’ could be cured by douchingwith salt water, bleach or Dettol (atopical antiseptic) or by applying toothpaste regularly on the sores (if nothingelse is available) for two to three days. Like many young women, this girlbelieved that HIV was ‘too strong’ to respond to the use of toothpaste or ‘anywhite creams’ alone. Mostinformants concurred thatHIV required additionaltreatment with traditional medicines thatwere black in colour, ‘stings’ whenapplied to sores, or bitter to the taste. Ngubane (1977) provides a detailedanalysis of the significance of colour and indigenous medicinal preparations.Medicines of a blackish colour are believed tobe especially potent for ‘taking outevil’ and counteracting illness associated with witchcraft activityt is a commonly held view that HIV along with a host of other diseases can betransmitted through sex with a menstruating woman. As discussed ‘dirt’ fromany disease with which a woman may be infected, is likely to be lingering in thevagina when not menstruating. One womansaid that if a manreally wanted toavoid HIV or any other infection, one of the surest ways to do this was to wear acondom at all times when sexually involved with a woman. “Germs are alwaysthere. It’s where theycome out. A woman knowsshe must clean down thereoften.” Green (1994) found similar ethnomedical beliefs regarding the sexualtransmittability of a wide variety of illness conditions in other Southern Africaethnic groups in both Swaziland and Mozambique. Some of those same diseasesidentified by informants in KwaZulu-Natal included tuberculosis, conjunctivitis,urinary complaints, biliousness, and skin rashes. “Ifshe is sick with thesediseases then a man can get them if he sleeps with her.” Such was the claim ofone young man who pointed out that because ‘dirt’ can ‘stick’ to wet vaginalwalls, a man may get an infection even when a woman is not menstruating. Likemany others, this young man referred toHIV as an example of a particularly‘stubborn’ infection and for this reason itwas believed to ‘hide away’, ‘waitingquietly’ inside the vaginabetween menstrual periods.He stated: “The HIV isalways there. It doesn’t leave the body easily.”Dry and tight, wet and looseThe presence of vaginal moisture or fluids, along with the width and muscle toneof the vaginal canal, is usedas indices of moral character and sexual experience.Associations of ‘wet’ and ‘loose’ vaginas are mirrored in local discourses onmorally ‘loose’ women. It is women’s promiscuity that is widelyheld to be at theroot of the current AIDS epidemic (Leclerc-Madlala, 1999).The ‘loose’ woman,metaphorically representedin the image of the ‘loose’vagina, is the one heldresponsible for the scourge of AIDS. The growing popularity of virginity testing 15in KwaZulu-Natal can be understood as an attempt toreassert control overwomen’s sexuality at a time when it isperceived to be ‘out of control’ andwreaking havoc in the form of increasing disease and death (Leclerc-Madlala,2001). Based on a set of physical attributes including vaginal characteristics,virginity testers make judgements sexual experience. Virginity isbelieved to beattested to by having a ‘tight’ and ‘dry’ vagina. A non-virgin is said to berecognisable on the basis of having a ‘wide’ and ‘wet’ vagina.Young women acknowledge the importance of being ‘dry and tight’ in order to pass virginity tests and be declared virgins. Being ‘dry and tight’ is alsoimportant when sleeping witha man, especially when doing so for the first time.This was considered necessary in orderfor a man to believe that a woman was‘like a girl’ not ‘someone with many boyfriends’, and therefor ‘clean’. The abilityto give the illusion of virginity by having a ‘tight and dry’ vagina was considered part of a woman’s secret knowledge and sexual repertoire. Women are familiar with a variety of methods and substances that are said to ‘dry’ and ‘clean’ the vagina and hence make sex more attractive and acceptable to men. In a study of commercial sex-workers, Abdool-Karim et al (1995) noted the use of a douche made with Jik (bleach), Dettol or Savlon (topical antiseptics) as forms of contraceptives. Women in Mariannhill sa y that these substances not only ‘kill sperm’ and ‘germs’ but are useful for causing the vagina to ‘tighten up’. Women say they ‘feel fresh’, clean and sexually attractive after such a douche. Other substances identified as useful for drying and tightening the vagina include snuff, bicarbonate of soda, talcum powder, ice-cubes, or plain salt. A most popular substance seems to be coarse salt (the brand name ‘LION’ is often referred to) which is put into the vagina up to two hours before intercourse. Women claimed that a dry vagina was more pleasurable for men, causing them to ejaculate more quickly,and assisting those with a small penis or one whichwas ‘too soft to do the work’. Beyond the meanings associated with pleasure . here are meanings that accrue psychological value to dry and ‘clean’ vaginas.The metaphor of dry-clean-virgin ha s significance as both a cognitive construction and an enacted experience. A dry vagina negates the fearsconjured up by associationsof female wetness with ‘dirt’ related to illnesses of all kinds that may have descended from other parts of the body. One woman who defended the use of LION salt and talcum powder as drying agents stated simply that the vagina contains dirt that has to be removed from the body. She added that men prefer a woman who is ‘tight’, and ‘dry’ because they (the men) ‘think she is clean’. The use of similar substances to dry and tighten the vagina have been widely reported from other African countries (see Arnfred, 1989; Runganga et al, 1992; Brown et al , 1993; and Green, 1994), but remain inadequately studied in terms of their contribution to the epidemiology of HIVand other sexually transmitted diseases. The therapeutic power of virgins In her ethnographic study of medical notions among the Zulu, Ngubane (1977)made the point that compared to other bodily emissions, female sexual fluidswere a class apart. That author attribut ed the unique status of these fluids to the fact that they represented a woman’s power in the form of reproduction. Itis within this context of patriarchally structured and dominate d Zulu society thatthe dank-and-disease modelof female sexual anatomy must be considered.Douglas (1966) argued thatpolluting substances (readvaginal fluids) symbolisethreatening forces that pose a danger to the very symbolic order that producethem. The vagina is the primary site of male pleasureas well as being the siteor passage of birth. It is a potent symbol of a woman’s sexual and reproductive power, both acknowledged as necessary ingredients for life. Patriarchal fears offemale power all coalesce in the symbolism of the vagina; the dark, wet,mysterious passage fraught with hazards in the form of ‘dirt’ and filled withdelights in the form of sexual pleasures and the issuing forth of new members ofsociety. I would suggest that strong negative associations of the vagina and its fluids can be understood as essentially anexpression of culturally-defined fearsand insecurities vis-à-visa woman’s inherent power,a power at variance withher social inequality and genera l lack of power in society.The process of managing anillness that is etiologically related to sex with a‘dirty’ woman could be expected tofollow the logic ofethnopathologicalprocesses for cleansing bodily ‘dirt’. In addition it could beexpected to drawupon the symbolic meanings attached toadult women and their disease-related vaginal ‘wetness’. The belief that sexual intercourse with a virgin can ‘cure’ a man of HIV/AIDS is embedded in metaphoric associations of sexually activewomen with ‘wet/dirty’ vaginas. According tothe virgin cleansing myth, a mancan ‘cleanse’ his blood of HIV/AIDS throug h intercourse with avirgin, but the girlherself would not be infectedin the process. The broad category of prevention-treatment-cure is encompassed in virgin cleansing therapy, whereby sexualintercourse with a virgin isalso thought to provide atype of vaccination againstthe threat of future HIV infection. Thus virgin cleansin g is believed to have botha therapeutic and a prophylactic effect. In interviews with several traditionalhealers, virgin cleansing or sexual intercourse with a virgin, was said to be a way in which a man thought he could obtaina measure of ‘strength’ against HIVinfection. It was unclear whether thismeant that additional ‘cleansing’ wasneeded periodically in order to maintain the streng th of the inoculation.Although these particularhealers said they were opposed to this practice andrejected claims of its efficacy, they allprofessed to have first-hand knowledge ofother healers who did actually recommend virgin cleansing asa way of treatingAIDS.Amongst this group of healers there was no consensus as to what qualitiesassociated with virginitywere believed to give the girl a special ‘immunity’ against acquiring HIV infection from the infected male sexual partner.