office (03) 9820 3006 or 920 3008
fax (03) 9820 3007

Communicable and contagious diseases

Cultural competence in HIV/AIDS prevention in Cambodia

Eisenbruch, M.
John Hirschman Fund, $5,000

Contagion - The anthropology of contagion HIV/AIDS and malaria in Cambodia
Background: This research study, begun in 1997, concerns the traditional beliefs and practices of people in Cambodia about contagion and how it explains risk behaviour and HIV/AIDS, malaria and dengue hameorrhagic fever. Cambodia may have the most serious HIV epidemic in Asia. The campaigns for 100 percent condom usage face cultural barriers. In an effort to pinpoint these barriers and to recommend a culturally appropriate strategy, the aim of this study is to determine the local understanding of Sexually Transmitted Illness (STI) and HIV/AIDS by  Cambodian traditional healers and their patients .
Methods Healers are observed treating patients, and followed up with focused semi-structured interviews. For each indigenous illness category, the terminology, taxonomy, aetiology, pathogenesis, clinical features, diagnosis, treatment, and outcome are explored.
Findings The indigenous categories of sexually transmitted illness form a ‘fuzzy set’, and the central condition termed ‘mango illness’. Three subtypes (‘normal mango’, ‘erupted mango’, and ‘crouching mango’), match the description of primary, secondary, and tertiary syphilis. ‘AIDS’ is seen as a late phase of ‘crouching mango’. Prostitutes create ‘mango illness’ and ‘AIDS’ germs and develop leucorrhoea, while clients acquire ‘mango illness’, which sometimes became ‘AIDS’. Menstrual blood also harboured the germs. ‘Mango’  and ‘AIDS’ also cross by steam of urine, sweat and breast milk –  believed to be blood-based – against which condoms were useless. ‘Gonorrhoea’ could transform into ‘mango illness’. A man contracted ‘normal mango illness’, which became ‘emergent mango’ and ‘crouching mango illness’  – critical because of the misconception that the advanced form is AIDS. Women with leucorrhoea develop tuberculosis or uterine cancer, not ‘AIDS’. ‘Mango illness’ crosses from father to foetus and the child could develop furunculosis, and the descendants leprosy.
Interpretation ‘Mango illness’ may be the local equivalent of the clinico-pathological condition syphilis, and it can evolve into other conditions which resemble the clinical picture of leprosy,  and AIDS. The findings show how the AIDS campaign may be at cross-purposes with local notions of contagion. Efforts to reduce risk should exploit local beliefs. This refocusing may help to reduce the spread of STI and AIDS, and add to the understanding of gynaecological and contagious diseases including tuberculosis and leprosy, in Cambodia and neighbouring countries.
Researcher: Maurice Eisenbruch, (Chou Sam Ath, Naren Cheth, assistants)
See earlier publications, reports Netting the Cambodian mosquito: Cultural competence in social marketing for malaria (based on WHO report)

Comparative study in Thailand, Cambodia, and Laos, of representations of AIDS. Reducing risk behaviour.

Lemoine, J. (CNRS) and Eisenbruch, M.
Agence Nationale de Recherches sur le SIDA, France. $40,000

Promoting behaviour change in malaria prevention and impregnating hammock nets in Kratie province, Cambodia

Eisenbruch, M. (Consultancy with WHO)