Widow cleansing and inheritance among the Luo in Kenya: the need for additional women‐centred HIV prevention options

Abstract

IntroductionThe customs of widow cleansing and widow inheritance are practiced in several communities throughout sub-Saharan Africa. In the Nyanza Province of Kenya, according to tradition, Luo widows are expected to engage in sexual intercourse with a “cleanser,” without the use of a condom, in order to remove the impurity ascribed to her after her husband's death. Luo couples, including widows, are also expected to engage in sex preceding specific agricultural activities, building homes, funerals, weddings, and other significant cultural and social events. Widows who are inherited for the purpose of fulfilling cultural obligation have a higher prevalence of HIV than those who remain un-inherited or are inherited for the purpose of companionship.MethodsAs part of a larger descriptive qualitative study to inform study procedures for FEM-PrEP, an HIV prevention pre-exposure prophylaxis clinical trial, we conducted 15 semi-structured interviews (SSIs) with widows, 15 SSIs with inheritors, and four focus group discussions with widows in the Bondo and Rarieda districts in Nyanza Province to explore the HIV risk context within widow cleansing and inheritance practices. Thematic qualitative analysis was used to analyze the data.ResultsThe majority of widows reported in the demographic questionnaire being inherited, and most widows in the SSIs described participating in the cleansing ritual. We identified two main themes related to HIV prevention within the context of widow cleansing and inheritance: 1) widows must balance limiting their risk for HIV infection with meeting cultural expectations and ensuring that their livelihood needs are met, and 2) sexual abstinence undermines cultural expectations in widowhood while the use of condoms is deemed inappropriate in fulfilling culturally prescribed sexual rituals, and is often beyond the widow's ability to negotiate.ConclusionsWomen-controlled HIV prevention methods such as antiretroviral-based oral pre-exposure prophylaxis, vaginal gels, and vaginal rings are needed for HIV-negative widows who engage in sexual rituals related to widowhood.

Couple interdependence impacts HIV‐related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis

“…Among some communities in sub-Saharan Africa, including the Luo in southwestern Kenya, wife inheritance is a cultural practice whereby widows are inherited by a brother or close relative of their deceased husband [24, 25]. Several female participants mentioned wife inheritance as a challenge to maintaining one's relationship and HIV-negative status, because these women may have had husbands who died of AIDS and thus may also be infected.…”

Identifying Risk Factors for Recent HIV Infection in Kenya Using a Recent Infection Testing Algorithm: Results from a Nationally Representative Population-Based Survey

“…It is possible that sexual rituals related to widowhood may be facilitating new infections in this population. Widow inheritance or widow cleansing, where a male assumes the social or sexual responsibility of female widow after the death of her husband, is a traditional practice is some regions in Kenya, and the use of condoms in these rituals is discouraged [ 34 , 35 ]. Further exploration around sexual practices and cultural expectations of widows is needed to provide more clarity on factors that may be contributing to the spread of HIV infection among widows to provide culturally-sensitive options for risk reduction in this population.…”

Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention

“…This finding and the comparatively high prevalence in our study site suggests that the transmission of HIV infection extends beyond fishing villages and into the surrounding communities, with exception of the negative cluster. Unique cultural practices, including transactional sexual practices [ 13 , 15 ], widow inheritance, cleansing rituals [ 38 , 39 ], and internal female migration [ 14 ], may have contributed to the high prevalence of HIV seen in the fishing communities near Lake Victoria. Furthermore, the recent and rapid proliferation of motorbike taxis in the study area may also have contributed to the spread of HIV to the surrounding areas.…”