“The Mosquito Brings the Sickness”: Local Knowledge, Stigma, and Barriers to Zika Prevention in Rural Guatemala

Abstract

The emergence of Zika virus and the resulting occurrence of intrauterine infections has been responsible for increased numbers of spontaneous abortions and significant neurological deficits in newborns-termed the congenital Zika syndrome. Globally, South and Central America are experiencing the highest rates of Zika infection and associated neonate microcephaly, creating a critical need for knowledge regarding barriers to effective Zika prevention. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have issued recommendations to block the future spread of the disease through mosquitoes and sexual transmission. Although well intentioned, these recommendations fail to account for some of the significant barriers to preventing the spread of Zika in areas with weaker public health programs, such as rural and impoverished areas of South and Central America. In particular, these are areas where indigenous people and mestizos are concentrated. In this chapter, we address some of the economic and cultural barriers that rural populations face in accessing preventative health care against Zika. We combined data from a two-month ethnographic study with 40 semi-structured interviews in a mestizo farming community in Escuintla, Guatemala. Although 87.5% of participants were able to identify Zika virus transmission risk through mosquitoes and associated preventative measures, only 5% reported sexual transmission as a risk, and none of the participants listed condom use as a way to prevent transmission. Our research illustrates that, although this population was able to articulate the need for preventing mosquito bites, their actual ability to prevent these bites is limited. We discuss the role of taboos and stigmatization surrounding sexual practices and critical preventative measures that can influence individual decision-making and place people at higher risk of contracting Zika infection. Taken together, challenges in complying with public health recommendations may disproportionately affect less affluent mestizo communities, leading to an increased burden of risk.