The "Fleet of Hope": offering options to achieve healthy behaviour.

PIP: The nongovernmental Tanzania AIDS Project (TAP) has produced a behavior change resource package in conjunction with religious workers. The package contains a resource book, a teacher's book, and a flipchart. The package encourages collaboration between different types of nongovernmental organizations by distinguishing between the roles of the government and other groups in fighting HIV/AIDS. Users of the packet are encouraged to prevent HIV/AIDS by following one of three options: abstinence, fidelity, or condom use. Switching among options is presented as a necessary response to changes in personal circumstances. This package uses a flood to symbolize HIV/AIDS and three boats, "The Fleet of Hope," to symbolize the prevention options. Pretesting of the KiSwahili version revealed that the number of respondents with a low perception of personal risk increased after reading the book, 25% continued to believe that it is possible to identify an infected individual by their appearance, the number reporting engaging in risky behavior decreased, and 97% found the book enjoyable. Modifications were suggested to make the book more straightforward and effective. The pretest of the English version revealed that the materials made respondents feel that AIDS is dangerous, that they should not stay at risk, and that it is possible to avoid AIDS. TAP has used the package since mid-1994 in client counseling to promote condom use and in health educator training activities. Other institutions, including churches, promote the three options equally. Roman Catholic Bishops will not distribute the package but have adopted a policy of "tolerant silence" towards its use.^ieng

Witchcraft and psychotherapy.

Belief in witchcraft, which serves a variety of social functions and personal defences, is bound to emerge in psychotherapy with individuals from a culture that holds such beliefs; endeavouring to understand it can open up new therapeutic possibilities. The nature of witchcraft, the profiles with which it intrudes into therapy, and the socio-psychological functions it fulfills are considered. Referring such patients to witchdoctors is morally unjustifiable, but the witch-doctor's folk-image provides a floating transference, around which the therapeutic relationship can be built. In dealing with witchcraft-ideation, understanding is based as much on cultural as on personal empathy, and to enhance its relevance, therapy may appropriate some of the functional dynamics of the witchcraft system into its own therapeutic manoeuvres.

The cultural perspective of therapeutic relationship--a viewpoint from Africa.

Therapeutic relationship has been considered an important ingredient of all psychotherapies. In communities in which no familiar conventions of such a relationship are available, the therapeutic encounter poses very different problems from those in the West, where such conventions freely prevail. This study has been carried out by five therapists representing three widely disparate cultures, but all working together in Tanzania. It brings together their perceptions of these problems and the strategies they employed to resolve them while working with African patients. In their view, in spite of great disparity between the world view behind Western psychotherapy and that of African communities, it is not impossible to forge a therapeutic relationship if empathic understanding and cultural sensitivity are added to the attitude of acceptance. After all, the therapist must attract and keep the patient before he can expect anything from him. The authors describe how this can be done with African patients.