Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal

Abstract

This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance, while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-related health risks.

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African Journal of AIDS Research 2004, 3(2): 1–11
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A J A R
ISSN 1608–5906
Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal
Lise Rosendal Østergaard
1
* and Helle Samuelsen
2
1
AIDSNET —The Danish NGO Network on AIDS and Development, Rosenørns Allé 12-1, DK-1634, Copenhagen, Denmark
2
Department of International Health, University of Copenhagen, Denmark
* Corresponding author, e-mail: lro@aidsnet.org
This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by
policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African
communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with
regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects
in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are
analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance,
while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their
everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-
related health risks.
Keywords: communication, peer behaviour, prevention, sexuality, youth
To talk or not to talk about the risk of sexually-transmitted
HIV infection has become an increasingly visible theme in
the fight against HIV/AIDS over the past years. The role of
communication as a prevention strategy is predominant in
relation to young people in sub-Saharan Africa. The intent of
interventions concerned with behaviour change through
information, communication, peer education and a variety of
organised group activities which facilitate dialogue about
sexual risk reduction, relationships and HIV/AIDS has been
to create an environment where young people are more
open about their sexuality. Such initiatives, however, have
not yielded the expected results. Young people in the cities
of Mbour (Senegal) and Bobo-Dioulasso (Burkina Faso),
where our studies took place, remain reluctant to talk about
HIV/AIDS. We addressed young people because of the
dramatic toll that the HIV/AIDS pandemic has taken on their
communities. Our study looks into the reasons why
behaviour-change interventions may not be working in some
communities.
During the past few years, the theme of sexuality has
been discussed more openly in the international donor
community as well as among many African governments
(Becker & Collignon, 1999; UNFPA, 2002b). Despite sharp
political tension and pointed protests from certain countries
and religious groups, a less timid discourse on sexuality and
women’s rights has gained visibility and has been
incorporated in a so-called ‘improved United Nations-
language’, as for example in the UNGASS declaration on
HIV/AIDS from 2001 and the Plan of Action from the ICPD+5
review in 1999, as well as in many national African HIV/AIDS
plans and policies. Although some researchers have recently
challenged the assumption that HIV transmission in sub-
Saharan Africa is primarily transmitted by sexual activity
(Gisselquist, Potterat, Rothenberg, Drucker, Brody, Brewer &
Minkin, 2003), it is clear that the documented high level of
sexually-transmitted HIV infection has pushed donors and
politicians to discuss sexuality in a way that was uncommon
in the mid-1990s. Harmful sexual practices, pleasure, multi-
partnership and intergenerational sex are no longer referred
to in an anecdotal manner but addressed, to some extent, as
serious risk factors that are having a direct impact on the life
of young people. Also striking is that the intense rhetoric
among policy-makers and opinion leaders has not, according
to our findings, generated the same kind of debate among
the people most concerned: young people in the early stages
of their sexual lives. Even though it is their future that is
threatened, HIV/AIDS remains to a large extent an unspoken
topic. There seems to be a mismatch between the vociferous
rhetoric at the global level and the relative silence at the
individual or relational level where the most important
stakeholders, young women and men, are remaining reticent
about debates concerning HIV/AIDS.
In keeping with recent social theory on young people,
HIV/AIDS, power, silence and resistance, this article
explores why so many young people may remain silent in
regard to their own exposure to HIV/AIDS. While more than
just talk about sex is needed to overcome the immense
obstacles that allow the rapid spread of HIV/AIDS among
young people, as evidenced by the failure of many
information, education and communication interventions, we
argue that the first step is to acknowledge and explore
people’s reluctance to talk with partners and peers about this
Introduction

Rosendal Østergaard and Samuelsen2
risk. The silence of sexually-active adolescents is complex,
as it is both a response to a hierarchical family structure as
well as a form of discrete resistance to the efforts of
authorities — be they adults in general or health care
providers and other experts. In that sense silence can
amplify the risk of sexually-transmitted HIV infection while it
keeps prevention messages from being fully internalised or
actively shared.
HIV/AIDS in sub-Saharan Africa
HIV/AIDS is a global catastrophe but sub-Saharan Africa is
at the epicentre of the epidemic. According to data from
UNAIDS (2004), approximately 23–28 million people are
reported to be living with HIV/AIDS in the region. In 2004,
approximately 2.7–3.8 million new cases were reported and
only 50 000 people were reported to have access to highly
active antiretroviral treatment (HAART).
Although West Africa is not experiencing a generalized
HIV/AIDS epidemic of the same magnitude as in southern
and eastern Africa, the condition is causing increased
human suffering and having progressive social and
economic impact in individual countries. HIV/AIDS in
Burkina Faso and Senegal is predominantly heterosexually-
transmitted. Furthermore, both countries have adopted
important awareness campaigns and behaviour-change
activities, such as those launched under the slogan ‘Rompre
le silence’ (‘Break the silence’).
In Burkina Faso, HIV/AIDS prevalence among those
aged 15–49 is estimated at 6.5% (UNAIDS, 2002b).
Prevalence among young people aged 15–24 is
characterised by important gender disparities. The
prevalence estimate for young men varies from 3.2% to
4.8%, while it is more than double that for young women, at
7.8% to 11.7% (UNAIDS, 2001). In a review of some 50
knowledge, attitudes and practices (KAP) studies from
Burkina Faso, Desclaux (1997) found that although basic
knowledge about AIDS, its modes of transmission and the
most important preventive methods had improved over a 10-
year period (1986–1996), some groups of people, especially
young women in rural areas, remained quite uninformed,
and various erroneous ideas about the contagiousness of
HIV/AIDS still prevailed. In a study among pregnant women,
long-distance truck drivers and prostitutes in Bobo-
Dioulasso (Meda, Sangaré, Lankoandé, Compaoré,
Catraye, Sanou, Van Dyck, Cartoux & Soudre, 1998), more
than 96% of those questioned had heard about AIDS.
However, 41% of the pregnant women, 40% of the truck
drivers and an alarming 61% of the female prostitutes did
not see themselves personally at risk. According to the most
recent Demographic and Health Survey (DHS) from Burkina
Faso (INSD, 1998/1999), 98.7% of urban females and
99.8% of urban males had heard about HIV/AIDS. In
addition, 58.7% and 78.8% of urban females and males,
respectively, knew that using condoms could prevent
HIV/AIDS (INSD, 2000). However, the DHS also showed
that only about 3% of young women aged 15–24 used a
condom during their most recent sexual relationship. The
percentage for men in the same age group was significantly
higher (40%) (INSD, 2000).
Studies in Senegal similarly show a gap between
knowledge and practice (Republique du Sénégal, 1997);
people do not necessarily change passive awareness into
active self-protection just because they gain new knowledge
or information. As statistics show, it is not enough to pass on
the message that people should make behavioural changes
while knowing little about how those messages are
interpreted in a local cultural context and how their meaning
is worked out and negotiated among sexual partners.
Senegal is considered one of the few success stories in
the global fight against AIDS (UNAIDS, 2000; Piot & Coll
Seck, 2001; Barnett & Whiteside, 2002; Family Health
International, 2001; UNAIDS, 2002a; UNFPA, 2002a;
Thompson, 2003). The country has experienced a
concentrated epidemic since 1986, when the first six cases
there were reported to the World Health Organization, but it
now has an estimated prevalence of around 1% of the adult
population (UNAIDS, 2004). However, important variations
within the adult population can be noted. National
epidemiological data from sentinel sites show a prevalence
of 0.5–1.5% among pregnant women, 4% among male
patients at clinics which treat sexually-transmitted infections
(STIs) and a prevalence of 15–33% among female
commercial sex workers (Republique du Sénégal, 2002).
The official Senegalese discourse — referring to
l’exception Sénégalaise (Republique du Sénégal, 2001, p.
13) — points to national political commitment, the religious
leadership among the Muslim brotherhoods and a strong
national AIDS programme that has been untouched for the
past decade by changes in key staff. Other researchers
mention the systematic screening for STIs and HIV among
female commercial sex workers as well as a delay of age in
onset of sexual activity to 17 years for women (Barnett &
Whiteside, 2002; Family Health International, 2001).
The nascent phases of the epidemic in many parts of
Africa were characterised by denial and the blaming of
immigrants from neighbouring countries (Becher, 1993).
AIDS was initially considered an imported problem, but that
attitude has changed, and changing governments have
since adopted a number of AIDS action plans. Today there
is a growing media and political focus on the impact of the
epidemic, and all politicians and intellectuals are familiar
with HIV/AIDS-related terms. Yet, it must be noted that the
language used in both Senegalese as well as Burkinabe
campaigns on ‘Fidelité ou la capote’ (‘Faithfulness or
condoms’) is dominated by Western policy and biomedical
thinking, sponsored by specialised UN agencies and
Western NGOs, and voiced by an increasingly well-
organised AIDS-NGO community. In Senegal and Burkina
Faso there appears to be limited established place for
anthropologists’ examinations of local perceptions of the
complexity of the condition or of the underlying contextual
factors that impede prevention. To paraphrase Heald
(2002a), it is time to reflect on the absence of ethnographic
understanding of local knowledge, especially now when
UNAIDS is advocating increased cultural sensitivity and the
integration of local practices and institutions into prevention
programmes.
The increase in HIV incidence among adolescent girls in
Senegal and Burkina Faso provides a marker for the future

3
direction of the epidemic. This trend inspires the question of
how long Senegal, for example, can maintain its relatively
low prevalence level even if the focus on so-called high-risk
groups is maintained but the broader sexual and
reproductive health concerns of young women are ignored.
Focus on young people
If Africa is the geographic epicentre of the HIV/AIDS
epidemic, young people are certainly the nucleus of this
epicentre. Adolescence is a formative life period in all
cultures, although it will likely manifest itself differently
depending on historical, social and cultural factors. In
Senegal and Burkina Faso, the years from childhood to
adulthood include the management of nascent sexuality,
development of gender roles, decreasing authority of
parents and increasing links to peers and partners. What
happens during this period in any domain is crucial for the
quality of life of the individual. Much of the anthropological
literature on youth emphasises agency and how young
people are actively engaged in the construction and
reconstruction of their own identity as well as in shaping their
role in the community. But our arguments are more in line
with Cole (2004) when she calls for an approach that ‘places
youth in changing historical, political and economic
circumstances’ (p. 574); hence, it is possible to examine
young people’s attitudes towards HIV/AIDS, lover
relationships and gender roles in relation to the economic
situation they live in.
The threat of HIV infection, and having to link the
pleasures of sex to death, is a burden to young people.
Youth is in most cases a healthy period of life. It is critical to
remember that to most people sexuality is about anything
other than health protection, as noted by Gammeltoft (2002).
However, people might not fully acknowledge that they know
they are exposed to risks (Setel, 1999; Collins & Stadler,
2000; Dilger, 2003). We know little about whether or not
young people in reality underestimate their own exposure to
risk as compared to adults, but we do know that they do
expose themselves to risks. Caldwell (2000) has further
suggested that risk-taking — including sexual risks — under
peer pressure is an important characteristic of the period of
adolescence.
The public health reason for focussing on young people in
relation to HIV/AIDS is well founded in sheer numbers alone.
According to UNAIDS (2002b) and UNFPA (2002a), 67% of
all newly-infected young individuals are females between 15
and 24 years. That puts young women as well as the young
men that they may later marry under great pressure. It has
been argued by Mensch, Bruce & Green (1998) that while
adolescence is a time of critical capacity-building for both
sexes, it is in particular a period of heightened vulnerability for
girls: ‘During adolescence, the world expands for boys and
contracts for girls. Boys enjoy new privileges reserved for
men; girls endure new restrictions reserved for women’ (p. 2).
It is a basic assumption of this article that gender issues are
critical to any analysis of HIV/AIDS, especially effective
prevention efforts.
We began by introducing the discrepancies between
global discourse and the realm of local life. Although policy
interest in youth and sexual risks and practices has grown
considerably over the past two decades, there is still a
shortage of data on how and to what extent young people
themselves talk about sexuality, gender issues and bodily
functions in low-income countries. Furthermore, much of the
problem-oriented research has taken place in the context of
adult activities and concerns (Bucholtz, 2002), with the
many KAP studies serving as an example. As discussed by
Desclaux (1997) and Parker (2001), KAP studies provide
useful quantitative and comparable data regarding how an
individual might answer a question when directly asked. But
that type of study provides us with little insight into what
people themselves would bring up as an issue had they not
been probed. Sexuality and other controversial issues seem
particularly unfit for such a study design.
We know very little about how young people draw on the
catalogue of passive knowledge that they may possess and
how they might translate this into active prevention. We still
lack detailed and well-founded analyses of the dynamics
between local cultural practices, the global cultural
discourses articulated in the mass media and the numerous
health awareness campaigns (Tufte, 2003). Regardless of
the many audience analyses undertaken by health
communication specialists, we have limited insight into how
young people in reality make sense of the maelstrom of
prevention messages and how they perceive their own
vulnerability.
More striking is how little we know about why young
people prefer to be silent about AIDS in a situation where
they are increasingly confronted with HIV/AIDS information
campaigns. For obvious reasons, KAP studies do not report
silence and pauses, but — as we shall see below — in order
to understand young people we should pay more attention to
the issues that they do not bring up. We argue that the
unwillingness to speak should not be understood only as the
outcome of individual decisions but also as a socially-
produced phenomenon which needs to be understood in a
broader social context.
Public discourses and silence
To understand the tension between articulated discourses
and silence, we should explore the relationship between
sexuality and the phenomenon of ‘not speaking’. The French
philosopher Michel Foucault described the ‘discursive
explosion’ around and about sex as characteristic of the last
three centuries (Foucault, 1998, p. 17). With the HIV/AIDS
epidemic, we have experienced a discursive explosion on
sexuality particularly during the last few decades, although
the purpose and ways of communicating this discourse is
very different from the one analysed by Foucault. In The
History of Sexuality, Foucault (1998) describes the changing
discourses on sexuality in Western Europe from the
Victorian period to present-day bourgeois society, with a
focus on the relationships between sexuality, knowledge and
power. He describes one of the characteristics of this period
as:
an institutional incitement to speak about it [sexuality], and
to do so more and more; a determination on the part of the
agencies of power to hear it spoken about, and to cause it
African Journal of AIDS Research 2004, 3(2): 1–11

4
to speak through explicit articulation and endlessly
accumulated detail (Foucault, 1998, p. 8).
While the overall idea of liberation and individual
freedom is not enveloping today’s discourse on sexuality as
it did a few hundred years ago, we see the same
accelerating tendency of engaging in public and explicit
articulations about sexuality at a global level today, where
international as well as national institutions and
governments are becoming involved in the AIDS pandemic.
The current discursive environment is clearly very different
from that of the 17
th
and 18
th
centuries, but technologies of
power and the relationship between sexuality, language and
power are important aspects of both discourses. Today,
components of HIV prevention and communication activities
about AIDS are beginning to be mainstreamed into a great
many development projects in all sectors, often without prior
consultations with project participants and rarely with solid
knowledge of local perceptions about HIV/AIDS (Holden,
2003).
In the eighteenth century, when referring to sex
…one had to speak of it as of a thing to be not simply
condemned or tolerated but managed, inserted into
systems of utility, regulated for the greater good of all,
made to function according to an optimum. Sex was not
something one simply judged; it was a thing one
administered (Foucault, 1998, p. 24).
This characteristic also finds its parallel in today’s public
discourses on HIV/AIDS and sexuality. Moral issues related
to sex and sexuality are not included in the public discourses
on HIV/AIDS and sexuality. The terminology is neutral;
rather than using words like promiscuity, for example, we
talk about multi-partnerships. This approach helps reduce
further stigmatisation and discrimination. However, in many
communities, at least in West Africa, sex and sexuality is still
a highly moral issue. Foucault argues that the need to
pronounce a discourse on sex was originally based on an
attempt to regulate sex as a technique of power. With
capitalism, the administration and regulation of the
‘population’ became important. The future of a society was
tied not only to the number of its citizens, their marriage
rules and family organisations, but also to the manner in
which each individual chose to be sexual (Foucault, 1998, p.
26). The need to regulate the population is perhaps even
stronger today where the AIDS epidemic kills many adults
during their most productive years, and thus orphans many
children and young people whose chances of becoming
productive citizens are compromised. Today, the regulating
of sexuality is not so much about creating prosperous states
but more about avoiding the total collapse of entire societies.
Foucault (1998) described an increasing control of
where and when one could speak about sexuality, adding in
that there were areas or relationships where it seemed
totally inappropriate to talk about sexuality: ‘Areas were thus
established, if not of utter silence, at least of tact and
discretion: between parents and children, for instance, or
teachers and pupils, or masters and domestic servants’ (p.
8). In other words, it is important not only to focus on what is
actually spoken about in public discourses, but also to pay
attention to silence. What is the distribution of those who can
and those who cannot speak about sex and sexuality?
Which types of discourses are authorised and which forms
of discretion are required in specific situations?
Foucault states that the silence ‘functions alongside
things said’; speech and silence together form discourse;
speech or silence alone do not (Foucault cited in White,
2000).
For the purpose of this article, we draw on the
operational definition of silence that Morrell (2003) has
developed on the basis of Foucault’s insights. This definition
distinguishes between social and personal silence:
…[silence] is a social phenomenon experienced
collectively. The language of discourse offers a useful way
to explain silence. Silence is a result of prohibition and
policing (Foucault, 1978). Understood in this way, silence
is a suppressed discourse. It is thus an effect of power.
Dominant discourses permit and legitimate certain
vocabularies and values while marginalizing or silencing
others. The second meaning which I give silence is
personal. A person who either feels unable to talk about
certain subjects or emotions or is unaware of certain
aspects of his or her history suffers from silence (p. 31).
These two definitions of silence should be understood in
relation to each other, as they mutually fuel one another.
Parallel to the voiced public discourses on AIDS and
sexuality, we also find an unwillingness to speak. Silence
might be interpreted as a form of repression, as part of a
technology of power; individuals or groups of people are
muted, and they do not possess the power to speak. Silence
can also be an expression of resistance; individuals or
groups of people do not want to speak. Or silence might be
interpreted in other ways. For example, the silence of
suffering as described by Morris (1997, p. 27) is a sign of
something which is ultimately unknowable and, as such,
silence might also be a sign of feelings of uncertainty or
insecurity.
Methodology
Our findings are based on two methodologically similar field
studies conducted in 2002 and 2003. The research design
was ethnographic, based on qualitative methods. We
conducted a social situational analysis in order to gain an
understanding of young people’s own perceptions of their
exposure to HIV/AIDS and their related risk-reduction
strategies and negotiations. Although the time span of our
studies was relatively short (2–3 months), we base our
conclusions on the accumulated insights that we gained
from work and research in Burkina Faso and Senegal since
the late 1990s (see Samuelsen, 1999; 2001; 2004a; 2004b;
Østergaard, 1998; 2003). Both field studies were conducted
in urban settings and included focus group discussions
(FGDs), ethnographic individual interviews and key
informant interviews as well as participant observation.
In the Senegalese study, the entry point was a youth-
friendly reproductive health care centre in Mbour, a town of
140 000 inhabitants south of the capital Dakar. The town is
characterised by massive migration and an extended tourist
industry. According to epidemiological surveys (e.g.
République du Sénegal, 2002), the sexual and reproductive
health problems are similar to those in Dakar. The Mbour
Rosendal Østergaard and Samuelsen

African Journal of AIDS Research 2004, 3(2): 1–11 5
study is based on the time that one of us spent living in the
centre of town, close to the health centre. Our interviews and
discussions were conducted with the youth, their families,
the health care staff and their families over long hours. The
sites used for sampling were therefore homes, clubs and
schools as well as some of the many ‘open spaces’ where
young people spend time. The different inquiry activities took
place wherever it was convenient for the group (e.g. at a
school, youth centre or home), whereas most of the in-depth
personal interviews took place in the house of the
researcher. The timing of the activities was adapted to the
schedule of the informants; that is, when they were not
attending classes and not doing their daily chores. All
interviews were tape recorded with oral consent of the
informant and transcribed. Informal observations were
documented in fieldwork diaries. A total of 105 young people
contributed to the research in Senegal: 41 by writing essays,
61 through FGDs and three by in-depth interviews. Both
separate FGDs with either males or females and mixed
FGDs were held. The average age of the informants was
18.8. The participants in the FGDs were recruited with the
help of a local female research assistant who had been
trained as a peer educator and who also served as an
interpreter. The FGDs included an equal number of young
people who were either in secondary school, out of school
and unemployed, or who had completed a vocational
training programme.
In addition, data was collected through narratives written
by students in two different secondary schools. A total of 40
young people, equally divided in terms of young men and
women, were assembled. The writers were asked to
describe the most important event in their personal life over
the past two years, whether they had had any reproductive
health problems, and how they had solved their last conflict
with a partner. This methodology allowed for some very
open individual accounts of the informants’ life projects.
The study in Burkina Faso was part of a comprehensive
joint research project on AIDS communication in South
Africa, Vietnam and Burkina Faso. The study took place in
two different parts of Bobo-Dioulasso: Ouezin and Accart-
Ville. As in the Senegalese case, Bobo-Dioulasso is a large,
modern city with high social mobility due to intense trade
and migration. A total of 57 young people aged 15–25 (30
males and 27 females) participated in this study. The
informants represented a number of ethnic groups but with
the majority being Bobo. About half the young people
(located in the Accart-Ville) had limited schooling, while the
other group consisted of young people who were either still
attending school or had reached an advanced level of
schooling. These young people were followed over a three-
month period using anthropological fieldwork methods
including FGDs, in-depth interviews and participant
observation. Four local research assistants participated in
the data collection. Both separate FGDs with males and
females, and mixed FGDs were held. The main research
themes were covered over a series of three FGDs with the
same group of people as well as in individual interviews.
Additionally, key informant interviews with radio journalists
and personnel at an anonymous testing facility and at other
facilities counselling and informing young people about
health and sexuality were carried out. The two study sites
were conveniently selected as the research assistants
already had contacts in these two quarters of the city. The
themes were sequenced so that the most sensitive topics
were dealt with last.
Most of the interviews were conducted in French with a
few conducted in local languages. All the interviews were
taped and transcribed, with the ones in local languages
translated into French.
The most important limitations for both studies were
encountered during FGDs in terms of time constraints on
sensitive issues. We recognise that to reach a genuine
understanding of people’s local worlds it is necessary to
devote more than a few months’ to fieldwork. However, the
FGDs were carried out until we had reached a point of
saturation — when the informants started to repeat and
confirm what had been previously said by other participants.
The fact that this study is comparative adds strength to the
findings that we feel they would not have as stand-alone
studies.
The use of qualitative interviews as entry points for
discussion on people’s practices in sexual matters raises the
issue of validity and methodological choices. The issue can
be reformulated as a question concerning how far we can
trust what people choose to say in interviews on sexuality
(see Gammeltoft, 2002). It must be acknowledged that
people do not tell the ‘truth’ in any objective sense,
particularly not when it comes to sensitive issues such as
sexuality. Two analytical strategies were used to overcome
the limitations related to FGDs on sensitive issues. Firstly,
the FGDs were complemented with ethnographic interviews
and participant observations in order to achieve more insight
into young people’s dilemmas. Inasmuch as it was difficult
during both studies to address sexuality and HIV by the
focus group participants, the informal interactions that took
place in homes over long meals, listening to music in private
rooms, going to local discos, etc. provided opportunity for
more in-depth exchanges of concerns and experiences. Our
observations were recorded in field notes as soon as
possible. Secondly, we felt it was important to identify the
unspoken in the communication in order to determine any
significant communicative disjunctions in the transcripts of
the interviews.
The openness and relaxed atmosphere of the
discussions, the fact that the informants volunteered and
actively sought to interact with the researchers and that they
also raised questions on their own indicates to us that the
validity of the studies is relatively sound.
Silence in the life worlds of young people
Silence and family relations
In both Senegal and Burkina Faso, the lives of young people
are often insecure and unpredictable. A general impression
gathered from our numerous FGDs and narratives is that
young people’s lives, to a great extent, are characterised by
instability and restrained choices. This is founded not only in
well-defined social constraints and gender-specific
expectations that put a particularly heavy burden on young
girls, but also in impoverished material and economic

Rosendal Østergaard and Samuelsen6
conditions. Although our informants did not belong to the
poorest fractions of the local population, they live in
household conditions characterised by scarce incomes and
limited access to financial resources. This adds a certain
intangible feeling of seriousness to their worlds. They seem
part of a global media-channelled youth culture, yet the
accessories required to live up to a globalised youth-identity
are hard for them to afford. Consequently, they spend much
time and energy on attaining that goal (e.g. to get the ‘right’
shoes or clothes). The striving to attain the ‘right look’ is not
only self-imposed — or an effect of the wish to seem
attractive in the eyes of other young people — but also very
much related to the social roles they are expected to play by
society. When they leave the house and enter public spaces,
these young people represent not only themselves but also
their families. Furthermore, their experimentation with a
youth identity is intensified by the fact that in these parts of
West Africa, the period of youthful experimentation is
relatively short because many of them, especially the girls,
are expected to get married before they reach 20. This
means that for the young urban girls and boys we
interviewed, their experimentation is characterised by a
feeling of urgency.
Many of the informants expressed a feeling of being lonely
or missing a close connection with their parents. We were
surprised to find that a large proportion of the informants had
experienced a sense of misfortune due to: (i) the death of a
parent; (ii) divorce of their parents; (iii) parents leaving the
home temporarily, to work or visit their home village; (iv) being
sent away as children to live with foster families; and (v) the
personal experience of having a severe disease.
Aïsatou, an 18-year-old girl from Mbour, Senegal,
described in an essay the many dimensions related to the
loss of her father:
The event that had the greatest impact on my personal life
was the death of my father last year when I was 17.
Thinking about him, I have had a lot of problems with my
health as I have lost weight; his death took me by
surprise… Now I suffer from concentration problems in
school and I have trouble studying. But I also have
financial problems because he used to give me money
and that is not the case any more. Since then I think a lot
about him.
Others described how they had to deal with their
bereavement alone, or with little support from any adults.
Some were not able to talk about their emotions or voice
their concerns over the fact that they had lost a parent.
Salif, an 18-year-old young man from Bobo-Dioulasso,
Burkina Faso, living with his paternal relatives, talked about
the constraints he felt after both parents left him:
In CM1 [primary school] during the second trimester, my
mother left me. I couldn’t say that I was alone, but I
understood how life is. During the same class, my father
left for the Ivory Coast. I stayed with my grandparents, my
uncles, my paternal brothers [same father but different
mother]. In CM1 my father had paid my school fees before
leaving for the Ivory Coast. My father was not there; my
mother was not there. I was then with an uncle who paid
for my school (he has now passed away). In 1998–99, I got
my CEP [primary education certificate]. I wanted to go to
secondary school, but my uncle said that he didn’t have
money for it because I had passed the age to go to a public
institution. It was necessary to pay to go to a secondary
school. It was not easy watching my friends go to school.
But that is how it was. At that time, I had a grandfather (he
is dead now) who found an apprenticeship as a car
mechanic for me. That was not the kind of work I wanted.
Others — especially girls who for various reasons were
not living with their parents — often said that their guardian,
typically an uncle or older brother, was too strict with them.
While the extended household may provide for the basic
needs of young people, many of our informants felt that they
lacked emotional support and guidance. In relation to sexual
and reproductive health matters, it seemed parents rarely
talked with their children about sexuality or bodily functions
and most of our female informants had not received any
information at all about the menstrual cycle from parents or
from other adults in their household. As Bintou, an 18-year-
old girl from Mbour, Senegal, said:
I think that in the families, the young people don’t have
any communication with their parents in order to prepare
themselves well for their sexual life, because in the
families such themes are considered taboo and even if at
all covered in the school it is very brief. Thus, the sexuality,
I believe that young people don’t know much about it.
The moral regime of the parents and other adults of the
older generation is characterised by the prohibition of
premarital sexual relationships and silence about sexuality
and elementary bodily functions such as menstruation — a
morality that is found in many parts of Africa (Ahlberg, 1994).
The patriarchal structure of the family also adds to the
difficulties for young women in raising any ‘inappropriate’
problems with their fathers. The mothers are their first
choice if they have to talk with somebody. In the extended
families, young people in general and young girls in
particular are not allowed to speak about sexuality. Yet,
sexual tensions are present (e.g. by way of the value placed
on the virginity of an unmarried girl). In that way, the silence
of the young girls is clearly an effect of unequal power
relationships between them and their parents.
These examples of loss of a significant adult illustrate
how fragile the world of young people is. A study on the
impact of HIV/AIDS on children in Senegal shows how they
can feel affected and threatened by the instability of the
family unit (Niang & Van Ufford, 2002). Our findings show
that young people who sense adults’ social and emotional
instability are also clearly subject to a pronounced feeling of
discomfort. They rightly perceive themselves as exposed to
the risk of loss of social and economic support at a critical
stage of their lives. In particular, this is a great risk for young
women, who are more likely than young men to experience
the impoverished living conditions and weakened social
networks which follow the disruption of the family unit (Niang
& Van Ufford, 2002). In an environment of degrading life
conditions, the risk of HIV transmission becomes one of
many threats to deal with.
In the communities we worked in, according to tradition,
intimate talk about sexuality is restricted to maternal aunts
and to mothers. Many informants referred to their mother as
the person they preferred to communicate with about

African Journal of AIDS Research 2004, 3(2): 1–11 7
reproductive and sexual matters. But quite a few of these
young people were actually not living with their mothers.
Thus, many choose not to share their financial, emotional or
sexual problems with the adults in their extended families,
although they were constantly aware of the tremendous
power the same adults held over their life and future. To a
large extent their silence must be interpreted as an absent
discourse as a result of a social situation where they find
themselves powerless and with limited agency. Their silence
in relation to their parents or other adults seems to be the
result of a social phenomenon that mediates the
relationships of power between generations.
Silence and peer relationships
In the previous section, we saw that parents are often not
available for their children. Nor, very often, are friends
available. Yet, those interviewed called attention to the
importance of friends and peer relationships. Throughout
adolescence, these social bonds grow in influence, possibly
diminishing the role of the parents in socialisation.
Whereas young men often have a rather big group
[grain] of male friends with whom they drink tea and spend
time, the girls do not seem to have the same kind of network.
The young women are more bound to their homes, where
they do specific chores or support their families through
income-generating activities. Young women who are still at
school often have just a few close friends. Some girls said
that they chose not to trust other young females out of fear
of the rumours they would start if they told them anything
confidential. The relationships between girls seemed to be
interwoven with the fear of being let down and the need to
have someone to trust. These young women clearly had the
impression that their female peers would be judgemental if
they disclosed a problem to them, or that they might risk
losing their boyfriends. While both young males and females
are quite conscious that they represent their families and
their family’s honour when they leave their compounds, the
close bond between young women and their households
may make them more vulnerable as a consequence of their
public behaviour as compared to young men.
The lack of trust among female peers contributes to their
vulnerability. When young women do not share experiences
out of fear of being stigmatised, they lose opportunities to
learn from one another and, specifically, may end up
neglecting their own exposure to HIV infection and other STIs.
This introduces the problem of unreliable information.
Locally, young people are exposed to information from many
sources, including official and accurate health information as
well as rumours and misunderstanding (such as the mistaken
notions that condoms are unreliable or only for white
Europeans, etc.). In that atmosphere, public health messages
are not routinely perceived as fact based on biomedical
evidence, but offset by local knowledge and beliefs put
together from friends and other sources. In combination with
poor or non-existent sex education in schools and limited
access to information in youth-friendly health centres, young
people’s unwillingness to share experiences becomes grave
because young girls especially are left without correct, or only
fragmented, information on methods to prevent STIs, HIV
transmission or unwanted pregnancies.
The gendered silence in lover relationships
Silence is not only a widespread phenomenon among same-
sex peers but also among young men and women in lover
relationships. In the absence of a trusted female friend, a
lover relationship or having a boyfriend becomes not only a
constitutive part of teenage female identity but also a way of
extending one’s social network. Adolescent girls find
themselves dually confronted with an indirect pressure for
sex from their male partners and the social obligation to
avoid premarital sex. A young woman informant in Burkina
Faso told us: ‘If you want your boyfriend to be faithful to you,
you have to satisfy him sexually’. Such dilemmas are very
often not voiced because of a lack of trust.
Love, attraction and romance are among the first
motives for having a boyfriend that were mentioned by the
female informants, but exchange of gifts or money and
group pressure were also closely associated with a lover
relationship. During our work in Senegal it became clear that
the notion of lover relationships should be put in plural: many
girls were seeing more than one boyfriend at the same time.
Nomadic fidelity — or infidelity — is not exclusively a male
domain but also a female practice. Multi-partnership, called
mbarane in the local language Wolof, and the related crisis
of wavering trust and distrust, were also recurrent themes in
essays collected among college students. To the girls
mbarane meant ‘to have many boyfriends at the same time,
good ones and bad ones; the bad ones are those who don’t
give you anything, that’s the bad ones’ (female informant,
FGD, Senegal). Gifts included anything from money for
clothes, given before religious feasts, to simple presents
such as bracelets. Seen from a male perspective, this
practice was often described in terms of competition
between generations, since the adult men can afford more
expensive gifts than the young men. The competition is
further sharpened by the fact that in Mbour, Senegal,
European male tourists are known to go out with — and in
some cases marry — Senegalese women, and offer them a
more secure financial future. One male informant underlined
the financial content of mbarane by saying: ‘If you have a
boyfriend who is a driver and another one who is a tailor and
another one who is a football player, well, then you’re safe’
(male informant, FGD, Senegal).
The boys appeared to feel almost ashamed if they did
not have a girlfriend. Dating is part of the urban youth
culture. The issue of money is extremely important for both
boys and young men. Speaking with two young unemployed
men in their early 20s gave us a sense of the almost
desperate strategies some might use. One of them,
Seraphin, a 24-year-old male from Burkina Faso, was the
father of a child; he did not live with his child’s mother but
had nevertheless accepted his fatherhood (something he
was proud of but also frustrated by because he could not
support either the child or the mother). His strategy seemed
to be to go to the ‘show’, which is the term young people in
Burkina Faso use for going to a bar or disco as often as
possible in order to amuse and distract themselves.
Seraphin said:
I don’t have a girlfriend, I have five. Oh, yes [laughing]
because, why not — it is not my fault that I have five
girlfriends, it is the girls’. It is the girls who make me

Rosendal Østergaard and Samuelsen8
unfaithful; they betray me because I don’t have anything.
To me they are all the same; that is why I also want to be
bad to them. I have seduced many. But my base, as I told
you, is the first one. If she said ‘yes’ to me today, I would
drop the others.
Being in a lover relationship is therefore of great
importance to both young men and women. Yet the
acknowledgment does not readily translate into greater trust
among men and women, not even in the light of a deadly
condition such as AIDS. Very few of our informants said that
it would be possible for them to talk about or negotiate with
their partner(s) any of the following strategies that are likely
to protect them from HIV infection: condom use,
monogamous relationships/fidelity or knowledge gained by
taking an STI/HIV test. It is exactly the sexual nature of
HIV/AIDS that prevents these young people from talking
about it. Although most of our informants acknowledged
AIDS as a problem and knew the signs and symptoms, they
considered its existence at a distance instead of openly
addressing it. Our informants generally did not recognise
themselves as represented in preventive messages, and
even those who were sexually active would typically say that
protective measures, such as consistent condom use, would
only be ‘for girls with many boyfriends, not someone like me’.
We argue that young people in this scenario often ‘suffer
from silence’, as suggested by Morrell (2003). They are
obviously vulnerable to HIV infection but fail to see the
common entry points for protection. In lover relationships
their silence can be seen as an individualised problem with
severe implications for their own self-protection. When
sexually-active young people fail to raise issues such as
condom use, fidelity, trust and other private topics that have
direct implications for their own relationship(s) and healthy
sexuality, they expose themselves to many otherwise
avoidable risks.
Manoeuvring
The young urban people included in our study clearly
perceive their life situations as vulnerable. Their silence
regarding their sexuality is a social phenomenon that is not
only restricted to situations of communicating with adults but
is also dominant among themselves; to a large extent, this,
as argued, can be interpreted as an effect of power. These
young people feel powerless both within the domestic sphere
where family roles and gender roles limit the possibilities of
voicing their problems and concerns, and in public life where
they do not see themselves as independent individuals but
rather as representatives of their families and kin. Social
structures do not empower them to speak about sexuality
and respond to the public discourse on HIV/AIDS. However,
the meaning of this silence might be more complex. To a
certain extent, some of these young people choose to be
silent. One young male informant in a FGD in Burkina Faso
denied the existence of AIDS; however, in a subsequent
individual interview he said that of course he knew that AIDS
exists but that he did not want to talk about it:
Often I don’t have the time to sit down and talk about
AIDS. Among friends we discuss a lot but if they start
talking about AIDS, I get up and leave. I don’t like the word
AIDS at all. If my friends want to get rid of me in a
conversation, they can just start to talk about AIDS. They
know that I don’t like it.
This young man felt especially uncomfortable when
AIDS was raised as a topic in informal conversations.
Although — or perhaps because — he is well informed
about the fatal outcomes of the condition and his own
vulnerability, he resists talking about AIDS or even listening
to others. He appears in denial in terms of his own risk, and
in that sense walking out on the topic becomes a sort of
powerless resistance.
Silence, whether interpreted as originating from
suffering, powerlessness or resistance, does not mean that
young people lack agency or become fatalistic. They find
ways of manoeuvring in everyday life, at moments when
they actively try to manage or overcome their vulnerability.
Some of their strategies may seem inappropriate from a
health perspective but should be understood within the local
context and the world of the informants. Two young men,
Mohammed and Seraphin (quoted above), agreed during a
FGD in Burkina Faso that they could not establish a stable
relationship with a girl due to their financial problems; rather,
they sought to boost their self-confidence and fight their
vulnerability by having one-off affairs:
When you have notes [money] you can quickly find one [a
girl]. So when you have money you can take a girl, you
give her something to eat and you entertain yourself with
her afterwards and then disappear.
In order to cope, on the one hand, with their own
vulnerability and pressure from parents and society, and
maintain, on the other hand, the benefits of a lover
relationship, young women in Senegal repeatedly stated that
one must be malin (French for ‘clever, smart and cunning’).
In addition to the semantic meaning of being clever, the
female informants used the word to designate a woman who
could ‘play the game’ and get more from men than what she
was offering. Two female informants during a FGD in
Senegal explained:
A girl who is malin, that’s a girl who can have many
boyfriends without sleeping with them; it’s also a girl who
knows what she wants, who is experienced.
More explicitly, the next informant followed with: ‘It’s like me,
I’m malin, a girl who goes out with many men without
becoming pregnant’. These informants perceived the notion of
malin as closely associated with knowing how to communicate
— particularly, how to defend yourself in relation to men.
To be malin is also to know when not to talk; the
economy of information that is so obviously practised among
the female informants must be seen as a part of that
strategy. It also means to know when not to tell the whole
truth, when it becomes necessary to defend yourself.
The young people in Burkina Faso had apparently
established a strong discourse on fidelity among partners.
Fidelity was an issue often discussed among friends.
Justine, a 19-year-old woman who did not have a boyfriend,
said that when she visits her neighbour they often talk about
the problems the neighbour has with her boyfriend:
We talk about her ga [boyfriend]. One time when she went
to see her boyfriend she met another girl there; she got
very angry and the boyfriend tried to give an explanation.

African Journal of AIDS Research 2004, 3(2): 1–11 9
This is what we talk about because my neighbour is very
jealous.
To be in a lover relationship appears to have a strong
impact on young people’s self-perception, emotional stability
and the construction of their own identity. That might be true
for adolescents worldwide, but the course is more risk-prone
in the context of HIV/AIDS. Many of the young women that
we encountered seemed involved in a lover relationship that
arguably created more problems than benefits, at least
regarding the protection of sexual and reproductive health.
Their choice, therefore, may be interpreted as one way of
coping with uncertain life conditions.
Conclusion
We have outlined the global context of an increasingly
pronounced public discourse on HIV/AIDS and sexuality and
shown the dilemmas that the confrontation with this
discourse creates in young urban people in Burkina Faso
and Senegal who do not possess a language to negotiate
safer sex. Our intention has been to describe the
discrepancies between the public discourse on sexuality and
the ‘silent discourse’ of the young people and to explore
possible reasons for young people’s silence. We ended by
discussing some strategies that young people do apply in
their attempt to cope with these dilemmas.
Our observations show that the paradoxical situation of
having a strong public discourse on sexually-transmitted
HIV, on one hand, and young people’s inability to articulate
themselves with regard to sexuality and HIV, on the other
hand, constitutes a serious challenge to any HIV prevention
effort. This discrepancy calls for a refined analysis of the
silence of young people in countries that are greatly affected
by HIV/AIDS, and in particular the way that AIDS prevention
messages are communicated. Our interpretation is that
silence must be interpreted to some extent as an expression
of powerless resistance. Knowing that they cannot protect
themselves without compromising certain much-needed
social and financial opportunities, young people are
confronted with a complex dilemma: the pressure and power
of their parents who expect them to balance traditional
norms and values against their own wishes to live up to the
requirements of an urban, sexualised youth culture. While
public discourse on sexuality and AIDS may be consciously
neutral and strongly public health-oriented with regard to
morality, the local discourse on sexuality is loaded with
morality and taboos. In that situation these urban African
youths often feel powerless and unable to act to protect their
own health.
Many young people, both male and female, experience
difficulties in fulfilling expected gender roles. Although both
young boys and girls are subject to moral and religious
restrictions, the heaviest burden is on young girls. Both
sexes share the risk of STI and HIV transmission, but girls
are at risk of early pregnancies and unsafe abortions.
Furthermore, where the dilemma for a young man might be
between him and his religious conscience, a young girl’s
dilemma in relation to premarital sex is between her and
society, represented by her family and in-laws. Sexual
matters are, by nature, a relational affair and a change in
practice requires negotiation among partners. Young people,
particularly young girls who are disempowered and without
strong communication skills, find themselves incapable of
negotiating condom use. In terms of HIV prevention
programmes, broad life-skills activities in so-called safe
spaces, aimed at creating more life opportunities for young
unmarried girls, seem to have the potential to empower
young people.
As a result of our research, we clearly see a strong need
for new approaches to HIV prevention programmes as well
as for related research. More critical research is needed that
can explore how young people understand the prevention
messages they are exposed to and how they employ that
information to move from awareness to active self-
protection. We do not, however, propose a talk-about-sex
model as the greatest solution to the problem of young
people’s silence. We do suggest including the reality of
young people and their perceptions of sexual health risk,
morality and sexuality much more systematically into
HIV/AIDS prevention programmes.
Acknowledgements — The authors are grateful to the young people
in Mbour and Bobo-Dioulasso who participated in this study with
openness, generosity and commitment. Our work in Burkina Faso
was part of a larger research project called ‘HIV/AIDS
communication and prevention: a health communication project’
(2001–2004), headed by Professor Thomas Tufte, Roskilde
University, and funded by the Danish Council for Development
Research. Helle Samuelsen gratefully acknowledges support from
the Carlsberg Foundation for a Senior Research Fellowship at
Churchill College, Cambridge, UK and from the Department of
International Health, University of Copenhagen. Lise Rosendal
Østergaard would like to thank the Enhanced Research Capacity
Programme (ENRECA) and Professor Ib Bygbjerg at Copenhagen
University. Both authors thank external lecturer Jeffrey V Lazarus
for valuable comments and proofreading of the text.
The authors — Lise Rosendal Østergaard, MA, MIH, is co-ordinator
of AIDSNET, a Danish non-governmental organisation network on
AIDS and development. She has a Bachelor of Arts in French
(University of Roskilde, 1994), Master of Arts in Development
Studies (University of Roskilde, 1998) and Master in International
Health (University of Copenhagen, 2003). From 1999 to 2001 she
worked for the United Nations Population Fund (UNFPA) in the
country office in Benin and in the regional technical advisory office
in Senegal, where she provided technical assistance on youth
involvement, health communication with adolescents and gender
issues. Her research efforts have focussed on Senegal, in the areas
of adolescent reproductive health and discourses on HIV/AIDS,
including negotiating strategies among men and women, and
HIV/AIDS among African immigrant groups in Denmark.
Helle Samuelsen, PhD, is an Associate Professor in medical
anthropology at the University of Copenhagen and director of the
Masters Programme in International Health. Her main research
interests are local perceptions of disease and illness and health-
seeking behaviour. She has conducted extensive research in
Burkina Faso and has recently begun to investigate adolescents
and reproductive health, including HIV/AIDS, in other parts of Africa,
Denmark and south-east Asia.
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