Socio-cultural factors contributing to the differential HIV statuses between Agnuak and Nuer communities in Fugnido refugee camp, Ethiopia
Alemayehu, Betel Getachew
According to the 2005 Ethiopian Demographic Health Survey, HIV prevalence in Gambella
region where Fugnido refugee camp is located is 6%, which is the highest prevalence data
recorded in the country. Similarly, the United Nations High Commissioner for Refugees
(UNHCR) Health Information System (HIS) demonstrates that Fugnido has the highest HIV
prevalence compared to other refugee camps in Ethiopia and furthermore shows variation in
prevalence among the two main ethnic groups in the camp, namely Agnuak and Nuer (about
8.5% and 2.3% respectively). The study seeks to investigate why a significant difference
exists in the number of people with known HIV positive status among the Agnuak
community compared to the Nuer community in the Fugnido refugee camp in Ethiopia. It
does this by investigating factors that are presumed to explain HIV high risk-behaviour and
vulnerability. This was a cross-sectional study of Agnuak and Nuer tribes living at the
Fugnido refugee camp. The sampled population involved men and women refugees from the
ages of 15 to 49 years. The study used a mixed method approach or methodological
triangulation. Cluster sampling technique was used for the quantitative data collection. The
sample size was 831 refugees (439 Agnuak and 390 Nuer). Seven (7) Focus Group
Discussions (FGDs) and 3 Key Informant (KI) interviews was used for the qualitative data
collection. Findings show that the Agnuak were almost 4 times (OR=3.8, 95% CI [1.9-7.4] p< 0.05) more likely to practice risky behaviour compared to 0.3 times (OR=0.3, 95% CI [0.1-
0.9] p < 0.05) likelihood among the Nuer refugees. Factors associated with differences in
risky behaviour for both Agnuak and Nuer included, inter alia, primary education as the
highest level of education attained, 50% among the Agnuak (OR=0.5, 95% CI [0.3-0.8] p <
0.05), compared to Nuer community’s 30% (OR=0.3, 95% CI [0.2-0.6] p < 0.05). Access to
HIV and voluntary counselling and testing (VCT) services was lower for the Agnuak
(OR=1.8, 95% CI [1.1-2.9] p < 0.05) compared to the Nuer (OR=2.9, 95% CI [1.6-5.1] p <
0.05). Unlike the Nuer refugees, the Agnuak refugees who had experienced forced sex
(OR=7.3, 95% CI [2.9-18.8] p < 0.05) and had a positive attitude (lack of or reduced stigma)
towards HIV (OR=2.1, 95% CI [1.3-3.7] p < 0.05) were more positively associated with risky
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behaviour (than the Nuer). The Nuer had no factor associated with risky behaviour that was
different from that of the Agnuak. The study revealed more Agnuak refugees than Nuer
refugees had been engaged in risky sexual behaviour by having multiple sex partners and
being involved in transactional sex. The Nuer was more closed and reserved to having sexual
relations outside of their group than the Agnuak were which contributed to their relatively
lower HIV prevalence. Furthermore, there was very low condom use among the Nuer
community compared to the Agnuak community, which was based on differential attitudes
between the two communities concerning trust of partner and monogamous relations. The
study findings recommend that humanitarian workers and community partners need to
collaborate to develop congruent HIV interventions that go beyond traditional strategies of
distributing condoms and focus on correct and consistent use of condoms in the camp.
Humanitarian and community workers’ understanding the socioeconomic context of the
communities and the influence of cultural and other factors, including behaviour with
intervention strategies,could also curb the epidemic.
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