Disco funerals, a risk situation for HIV infection among youth in Kisumu, Kenya

Abstract

Objective

We investigated the so called ‘disco funeral’ phenomenon in Kisumu, Kenya, whereby community members including adolescents congregate at the home of the deceased for several days, accompanied by music and dancing. We explored whether disco funerals are a risk situation for HIV/STI infection among youth.

Design

Cross-sectional qualitative study.

Methods

We conducted 44 in-depth interviews with male and female adolescents aged 15 to 20 in Kisumu municipality in Nyanza Province, Kenya. We also made observations during 6 disco funerals.

Results

Disco funerals were an important place for young people to hang out; they increased the opportunities to meet and engage in (risky) sexual activities. Many adolescents reported having casual sex on these occasions, sometimes with multiple partners, and mostly without condoms. Some girls were forced into sex, and there were several accounts of gang rape. Sex in exchange for money was reported frequently. Drugs and alcohol seemed to facilitate unprotected, multiple-partner, coerced, and transactional sex.

Conclusions

In Kisumu, a town with a generalized HIV/AIDS epidemic, the high AIDS mortality leads to frequent disco funerals. Because many adolescents are having unprotected, transactional, or coerced sex at these occasions, disco funerals might contribute to the high HIV prevalence among youth, especially among adolescent girls. HIV interventions urgently need to include outreach actions to youth who hang out at disco funerals, and link up with parents and funeral organizers to reduce risk situations.

Introduction

The multicentre study on factors determining the differential spread of HIV in African towns showed that in Kisumu, male HIV prevalence was 19.8% and female 30.1%. The study highlighted the high HIV prevalence (23%) in young women aged 15-19, compared with in young men (3.5%) [1]. Such a contrasting HIV prevalence between boys and girls is a pattern observed in many parts of sub-Saharan Africa [2, 3]. The multicentre study results suggest that the high HIV prevalence among girls is linked to their higher susceptibility to HIV infection. Girls had older sexual partners than boys and higher rates of herpes simplex type 2, which are both risk factors for HIV transmission [4, 5], and reported very few sexual encounters, which may be due to underreporting but also may indicate that there is high transmission after loss of virginity [2].

We conducted a qualitative follow-up study in Kisumu to explore findings from the multicentre study regarding the sexual behaviour of young people. In this paper we describe a phenomenon known as ‘disco matanga’ or disco funerals as the setting of risky sexual encounters among youth. Other findings of the qualitative study will be reported elsewhere. Disco is an abbreviation of discotheque; matanga means funeral in Swahili. ‘Disco matanga’ involves dancing and partying at a funeral, mostly at night, at music played by a DJ or a band. Disco funerals are organised by family members of the deceased, to raise money for burial expenses, e.g. through bidding games. The current phenomenon of disco funerals has not been described in literature. Our study postulates that the high AIDS mortality in Kisumu has lead to a high number of funerals, which contribute to high the HIV prevalence among girls through risky sex at disco funerals.

Methods

In-depth interviews and observations were used to explore the socio-cultural dynamics of sexuality of young people in Kisumu. This town is the capital of Nyanza Province in the west of Kenya, and is mainly inhabited by the Luo people. The Institute of Tropical Medicine in Antwerp, Belgium and the Ethical Review Board in Kisumu approved of this study.

For the in-depth interviews, 75 girls and 75 boys aged 15-20 years were interviewed at their households. Study sites within Kisumu municipality were sampled randomly, using the sampling framework of the multicentre study [1]. Quota sampling was used to ensure diversity in age, socio-economic and educational status. An interview guide was developed in English, translated into Swahili and Luo, then pre-tested in communities neighbouring the study sites. The interviews were conducted in Luo, Swahili or English, and tape-recorded; they lasted about 45-60 minutes. Prior to the interviews, verbal informed consent/assent was obtained from all adolescents, in addition to parental consent for minors. When asked about relationships, 44 out of 150 participants (28 boys and 16 girls) spontaneously mentioned disco funerals. There was no explicit question about disco funerals. For the present paper, only these 44 interviews are used.

Observations were conducted at places where youth ‘hang-out’, such as nightclubs/bars, video halls, shopping malls, and funerals. We sought permission from the persons in charge and ensured confidentiality of all collected information. During the 2-to-3 hour observations, the field workers took short notes and compiled detailed notes afterwards, describing physical settings, activities taking place, socio-demographics of participants (estimated age, gender), and (non-)verbal behaviour. Six out of 48 observations took place at disco funerals.

The audio-taped interviews were transcribed verbatim and translated into English, where necessary [6]. Data analysis followed the principles of the grounded theory [7]. This inductive approach consists of carefully reading and rereading interview transcripts and observation notes, exploring and coding responses, and allowing analytical themes to emerge during the process, The first and third author coded the transcripts, using ATLAS.ti 5.2. This paper focuses on the analysis of those responses or notes mentioning disco funerals.

Results

During the study period, there were at least 3 disco funerals per week in various estates of Kisumu town, lasting several days to over a week. During these events community members, including adolescents and children congregated at the home of the deceased. Young people saw the disco funerals as a cheap form of entertainment and an opportunity to meet the other sex. “You know death is rampant here. You will find that someone has died here, another one there and another one also there. It is in these funerals that boys and girls meet, in fact that is where they meet mostly... the funerals” (19-year-old male). Disco funerals were not only seen as a great occasion to meet the other sex, but also to engage in sexual intercourse. Incidents of casual sex were cited: “...during funerals there are those girls who have been left in no hands [no one responsible], you find that someone takes them [for sex] everyday, at times someone takes her at around 10 pm then returns her at midnight [...] somebody else also takes her at that very time...at times this person knows that so and so is going with her [having sex] but he also goes with her” (18-year-old male). Casual sex was often facilitated by the intense atmosphere at the funerals, reinforced by the music. Most songs had strong sexual messages, explicit lyrics, and were accompanied by suggestive dancing. Late at night, when most older people had left, there was little parental control.

At these disco funerals, youth reported that many boys did not take precaution during sex: “A few, yes, do use protection, though there are many who are normally in a hurry and have no time to put on condoms, once the girl has accepted, then he follows her quickly ...” (18-year-old male). Others report that many youth do not have any condoms or they may be uncomfortable using them. Others believed that very young boys and girls would not have STIs, so no form of protection is needed. One boy reported contracting an STD during a disco funeral when he had unprotected sex with a girl he barely knew: “...it was last year that l went to a certain funeral towards Awasi [a village in rural Nyanza]...I had not known her, we went and we had sex... after two days when l was bathing l noticed that it was bruised [...] and when l saw it turn into a wound l went to the hospital.” (16-year-old male).

Although some girls agree to sex, others are forced into sex at disco funerals. A 16-year-old female respondent said: “You’ll find a lot of rape cases here especially during funerals... you may be walking and then you are raped [...] Yes, it happens a lot.” Some boys reported that girls may be forced into sexual relations if they keep on rejecting a boy’s advances: “... say you’ve been dancing with her and you’ve told her about that thing [sex] and she has refused, you just hold her and pull her by force till you go with her ... to the bush or darkness where people don’t go to ... people see but they don’t do a thing”(17-year-old male). During one funeral, fieldworkers witnessed one rape attempt (which was thwarted by bystanders).

Gang rape was also reported to occur during and after disco funerals: 16 of 44 respondents had heard of or knew someone who had undergone gang rape, and one boy admitted to having participated in gang rape. This kind of violence happened when boys wanted to punish an arrogant girl: “There is this new girl who has moved into the community, the boys kept on trying to win her but she was adamant... She was going to dance with her friends [at disco matanga] and the boys waylaid her on her way home. The boys seized her up and forced her to do sex with them... that happened here,” (19-year-old female). Incidents of gang rape were also reported when girls accompanied partners whom they met at the funeral to their dwellings: “... he may trick her to come to the house, after [he has had sex with the girl], he will wake other guys and tell them that you can also have sex with her [...]. Then they will ”combine“ [i.e., all boys will have sex with her]. After the girl has been ‘sexed’, she will be chased away” (18-year-old male).

Disco funerals also featured transactional sex. Many young men believed that buying a young woman drinks or chips would result in sex later: “Buying the girl a drink or giving her a little money during such an occasion is often considered down payment for sex later.” (18-year-old boy). Some girls shared this view: “Girls go there and are bought. Later he goes and sleeps with her ... a girl dances with a boy, he removes the money [from his pocket]... then later this boy tells her they go and he sleeps with her” (18-year-old female). Observers also witnessed drinks being exchanged for a dance or time alone with a girl. Some DJ’s brought girls to participate in the fund-raising games. The highest bidder not only got to dance with the girl but could also have some time alone with her. A 17-year-old boy described such a scenario: “...at the disco matanga, there is often the collection of money, so there is some amount a young man pays to buy a certain girl. Once he has bought the girl then he dances with her, so during the dance with her is when they talk and come to an understanding or they agree on where they are going to meet and they just finish their business [have sex] there and there.”

Alcohol and drug use facilitated and reinforced sexual risk behaviors at funerals. A 17-year-old reported: “...after taking alcohol at funerals, it starts to control oneself. So when boys meet a girl, sometimes they do not know her at all nor where she is from, but they will seize the girl by force; they will all have sex with her. This has happened several times here and occurs amongst boys who take bhang.” Fieldworkers repeatedly observed that young girls and boys were taking locally-brewed alcohol and drugs such as khat, cannabis, and ‘kuber’ [tobacco/betel quid]. Several interviewed adolescents mentioned that girls were sometimes taken advantage of while under the influence of alcohol.

Discussion

Disco funerals in Kisumu provide opportunities for adolescents to engage in (risky) sex: they have casual sex on these occasions, sometimes with multiple partners, and mostly without condoms. Some girls are forced into sex, others have sex in exchange for money. Drugs and alcohol often facilitate unprotected, multiple-partner, coerced, and transactional sex.

Our study has a few limitations. We aimed to examine the context of youth’ sexuality and sexual networking patterns; disco funerals were only mentioned spontaneously by a subgroup of interviewees (44 of 150). This may have biased our results. Moreover, we interviewed a fairly small number of youth, all residing in urban Kisumu. Although disco funerals are common across Nyanza Province, caution is suggested when generalising these findings. Despite these limitations, the study was able to generate new knowledge on a little-known phenomenon.

Our study gives clearly indicates that disco funerals create a context for potential HIV/STI transmission among youth in Kisumu [1-3]. Girls are especially at high-risk. They tend to have sex with boys/men older than themselves, who have a higher HIV prevalence than age mates [6]. Sexual coercion increases HIV risk for girls, due to damaged vaginal tissue. Early sex may also be extremely risky for young girls because of cervical ectopy and other biological features of the immature female genital tract [2, 8-10]. Furthermore, adolescent girls tend to lack sexual negotiations skills, often leading to unsafe sex.

Our findings need to be seen against the background of Luo culture. Traditionally, sex plays a role in many parts of Luo life such as during harvesting, planting, and widow cleansing [11-13]. Luo are polygamous; multiple-relationships are generally condoned. Adolescents are sometimes allowed or even encouraged to have pre-marital sex. Parents may be aware that disco funerals provide opportunities for sex, and may see it as a culturally appropriate way for young people to begin their sexual careers. It may therefore be culturally inappropriate for parents to monitor their children at these occasions. This calls for improved communication between parents and children, to make sure that their children - in case they are having sex at these occasions - at least are having safe sex. Studies have shown that parental monitoring, parent-adolescent communication, and parenting styles are associated with adolescent sexual behaviours [14-17].

Most forced sex happened as a result of alcohol and drug abuse [18-19]. Peer pressure also played a role, with boys colluding in plotting the timing and circumstances of coercive sex. Deeply rooted gender norms in Luo society contribute to a perception that controlling women is a sign of masculinity. Several studies in sub-Saharan Africa illustrate how such norms influence sexual identities of young people and contribute to extremely high rates of rape [10, 20-24].

Our findings also highlight the occurrence of transactional sex. AIDS reinforces poverty through medical/funeral costs, lack of income, school drop-out, and orphanhood. In such settings, female school drop-outs and orphans are more likely to engage in transactional sex to continue schooling or simply to survive [2, 24-26]. Our interviews showed that young girls - especially out-of-school girls - tended to have sex with slightly older men who are working and therefore have cash, such as minibus touts and bicycle-taxi operators. Other studies in sub-Saharan Africa noted that once gifts are accepted, girls believe they have no right to refuse sex or demand condom use; hence transactional sex significantly reduces young women’s bargaining power for safer sex [26-28].

Young people all over the world meet potential sexual partners at parties and disco’s, where sometimes alcohol and drugs are used. However, disco funerals differ regarding the duration and circumstances. They can last from several days to a fortnight, and may bring together up to a hundred people, with some visitors needing local accommodation. Funerals are traditionally associated with sex in several ways, such as wife inheritance, or widow-cleansing whereby evil spirits are expelled through sexual intercourse. This association with sex may be the reason why some parents see disco funerals as a culturally appropriate way for young people to experiment sexually.

The phenomenon of disco funerals may be part of the multiple factors underlying and explaining the high HIV prevalence among youth, and especially girls, in Kisumu. Interventions are needed at disco funerals that reach youth, as well as parents and organizers of these events, to challenge the risks encountered by youth. One approach can be to integrate the promotion of safe sexual practices in these events, using the DJs as popular peer educators, and making condoms freely available. Interventions should also target parents, to stimulate positive parenting influence on adolescent health, e.g., by improving communication about sexual risk behaviour. Further research is needed to study the generalizability of our findings, and the ways in which disco funerals can be used to promote safe sex practices.