During 1993, the first author (* - blinded copy) visited the local primary AIDS service organization (Family Health Trust) in Lusaka, Zambia and met with the Executive Director (Ms. Elizabeth Mataka). She discussed the difficulty of convincing the local community of the seriousness of the AIDS epidemic, when so many simply thought it was the same disease as kaliondeonde. “How can I provide proper HIV education when so many believe that AIDS is nothing more than kaliondeonde?,” she lamented. We learned that some people in central and eastern Zambia believe that kaliondeonde is simply another local word for AIDS. However, others believe that the AIDS-like illness is distinct from AIDS and not at all related.
“Muti” is a white powder with magical properties that is used for medicinal purposes. According to our informants, the traditional folk (emic)A view in central and eastern Zambia of kaliondeonde is that it is caused by failing to put on muti after having an abortion or a miscarriage (Feldman et al. 19932). Men can also become infected with the disease by having sex with a woman who fails to use muti following an abortion or miscarriage. Like HIV/AIDS, it results in a variety of immunosuppressive symptoms. But unlike AIDS, it has a short incubation period, usually five months from infection to death. It is treatable with traditional medicines provided by an indigenous healer, especially if within three months after infection (Feldman et al. 1993, Feldman et al. 19973, Feldman and Miller 19984).
Unlike AIDS, which was first reported in Zambia in 1984 (World Health Organization 20055), kaliondeonde likely existed for decades before then. It is believed to be indigenous to Zambia and Malawi. Indeed, we interviewed an elderly informant during 1993, in a remote village outside Chipata in eastern Zambia near the Malawi border. The informant said that the disease was common when he was a small boy during the 1920’s (Feldman et al.1993). And yet, many Zambians confuse AIDS with kaliondeonde.
We carried out two focus groups of male and female secondary school students in Lusaka during 1993. The two groups, each with about ten students, were very similar in age (mostly 17 and 18 years old), and sex. Both groups were familiar with AIDS and kaliondeonde. We asked both groups whether the two diseases are the same or different. Group 1 reached a unanimous conclusion that AIDS and kaliondeonde were exactly the same. On the other hand, Group 2 reached a unanimous conclusion that the two diseases were entirely different. Clearly, at the time of that study, there was considerable confusion about the two diseases (Feldman et al. 1993).
In a survey conducted during 1997 among 204 high school students in Lusaka, we asked if kaliondeonde and AIDS are the same thing. Exactly half of the students n = 102 (50.0 percent) were not sure, or had a mixed opinion. The other half were nearly evenly split between those who disagreed, or strongly disagreed (n = 49, 24.0 percent), and those who agreed or strongly agreed (n = 53, 26.0 percent) (Feldman et al. 20086)
HIV Risk in Africa
The ten countries with the highest rates of HIV in the world are all on the African continent (CIA 20157). For example, the top three countries, all in southern Africa, are Swaziland (with 27 percent of the adult population, 15–49, HIV positive), Lesotho (23 percent), and Botswana (22 percent). Some of the key factors shown to exacerbate HIV rates in these countries include the lack of male circumcision (Bailey et al. 20078; O’Farell et al. 20069), concurrent relationships with a non-married partner (Halperin and Epstein 200410), untreated sexually transmitted infections, inadequate male and female condom social marketing, stigma, growing homophobia, virgin curing, ritual sexual cleansing, the low status of women, possibly the nature of the HIV-1 subtype itself (Soto-Ramierez, et al. 199611), and likely the practice of dry sex.
Virgin curing is the belief that if an HIV positive person has intercourse with a virgin, often a child, the HIV positive individual will serorevert to being HIV negative (Andersson et al. 200412; Ashforth 200213; Jewkes 200414; Leclerc-Madlala 200315). Sexual cleansing occurs when a widow is expected to marry her late husband’s brother. Often a person who is a commercial sexual cleanser will be paid to have sex with the widow prior to this remarriage, in order to release the spirit of her late husband (Audet et al. 201016; Ayikukwei et al. 200817; Dworkin and Erhardt 200718; Kawango et al. 201019; Nwoye 200420; Perry et al. 201421). Dry sex is the practice by women of using various herbal or other substances to reduce vaginal fluids prior to intercourse, in order to increase sexual sensation for the male (Beksinska et al. 199922; Brown et al. 199323; Civic and Wilson 199624; Sandala et al. 199525; Schwandt et al. 200626).
Relatively little academic research has been done directly on kaliondeondeB. While the Times of Zambia and other local Zambian newspapers and magazines have discussed kaliondeonde at various times for many years, the first mentions of kaliondeonde in the academic literature are Feldman et al.1993, Feldman et al.1997, and Feldman and Miller 1998. We found only nine additional studies based on fieldwork in Africa, dated between 1999 and 2019, which discussed kaliondeonde (see below). Other publications that mention kaliondeonde referred back to these previous studies.
Research methods used included interviews, focus groups, and participant observation with informants in Malawi and Zambia. Two of these nine additional studies do not explicitly refer to this illness as “AIDS.” Banda (200832) identified kaliondeonde as an illness which a man contracts through intercourse with a woman who has had an abortion. The illness then causes him to become “thinner and thinner” until he dies (2008:112). Banda also refers to this as an “AIDS-like disease (emphasis ours; 2008:xiii).
Three additional studies (Green 199933; International Planned Parenthood Federation34 2014, Hunleth 201935) stipulate that kaliondeonde was probably one of several local names for AIDS, rather than being a separate medical condition. Green states that “kaliondeonde in Zambia…has...wasting symptoms…[It] is believed to result from death pollutionC, is considered fatal, and was translated by Zambian informants as AIDS” (1999:147). Green agrees with this assessment by his informants, because “[kaliondeonde] was described in a way that accurately reflects the profile of AIDS as it manifests in Africa” (1999:160). He also adds that it is not thought to be treatable with biomedicine. In another example, the IPPF reports that a peer educator in Malawi told them, “We thought HIV/AIDS was just one of the [Chewa] STIs [sexually transmitted infections] popularly identified as kaliondeonde [italics added]. We treated it like other STIs such as syphilis and gonorrhea” (2014). In her study on Zambian children’s caring labor within the home, Jean Hunleth used “Kaliwondewonde” as a local word for “HIV” (2019:182).
The remaining four studies (Houston and Hovorka 2007; Muula 2005, 2008; Uys et al. 2005) assume that kaliondeonde is definitely the same exact thing as AIDS. Uys and colleagues found that a common euphemism for AIDS in Malawi is kaliondeone or oonda, which both refer to “slim people” (2005:15). Muula states that “in Malawi, [AIDS] has been called kaliwondewonde (wasting or slim disease). This [is] due to the marked weight loss that many AIDS patients experience…” (2005:854). He again refers to kaliwondewonde as “slim disease” in a later publication (2008:187).
Based on focus groups in Malawi, Houston and Hovorka found that “[traditional] healers…spoke of HIV infection or AIDS as a disease [i.e.: kaliwondewonde] with a long history in [their country]” (2007:210). These traditional healers believed that kaliwondewonde had recently become lethal for two reasons: “Modern” contraceptives were identified as weakening women, by interfering with their natural menstrual cycles. Second, new and “improved varieties of vegetables and many hybrids” were viewed as less nutritious than their traditional forms, and were thought to cause malnutrition, which decreased one’s ability to resist infections (2007:210).
To summarize then, a review of the academic literature demonstrates that comparatively few studies have directly investigated kaliondeonde. Of the nine studies conducted through fieldwork, one identified the condition as a result of “death pollution” from an abortion; while also associating it with AIDS (Banda 2008). A second study states “some [traditional] healers identify AIDS with the symptoms of ‘kalyondeonde,’ which is thought to be curable” (1996:320). Here, it is treated as a purely emic condition. Six other studies make the assumption that kaliondeonde is probably or definitely the same thing as AIDS. Except for the preliminary study conducted by Feldman (1993), none of these previously cited authors seem to have considered the possibility that kaliondeonde might be a biomedical condition, which is different from AIDS. Except for one other study which identifies kaliondeonde as a synonym for “wasting,” they all assume it either definitely is AIDS, or that it probably is AIDS. No testing was done among the additional nine studies to learn whether or not patients identified as having kaliondeonde were HIV positive. As Ramin notes, “it is exceedingly rare for medical doctors and anthropologists to sit down and exchange ideas, even about an issue as important as the global HIV/AIDS epidemic” (2007:136). We argue that there is a clear need for medical doctors and cultural anthropologists to design a new research study together, to determine whether kaliondeonde is the same as HIV/AIDS, an altogether different biomedical condition, or an emic sicknessD. If kaliondeonde is indeed a separate biomedical condition, it is necessary to find the etiology and an appropriate biomedical treatment.
There are, however, a few published descriptions of sicknesses from the folk or emic perspective which share some of the same traits as kaliondeonde. For example, kahungo is believed by the Tonga of southern Zambia to be caused by pollution associated with miscarriage. A woman who miscarries, but does not apply traditional medicine, is thought to develop a cough and sores. She can transmit these to men through sex. A person who steps over the grave of a miscarried fetus can also contract kahungo. However, it is believed to be self-limiting; a woman can transfer it to a man, but it cannot be spread further by him. This is in direct contrast to HIV, which is transmitted to further partners by intercourse without a condom (Mogensen 199537). Additionally, Kornfield and Namate (199738) describe two similar AIDS-like illnesses (called tsempho and kanyera) in Malawi (Feldman 2008).