The Maasai are a seminomadic, pastoralist population of approximately 840,000 people living in Northern Tanzania and Southern Kenya. Until the late 1800s and early 1900s, the Maasai functioned largely as an egalitarian society with distinct and separate gendered and age-related roles where both men and women occupied sections of the domestic and public (i.e., economic and political) spheres (Hodgson 1999a, b). Women maintained the Maasai production system by functioning as traders of surplus milk, hides, donkeys, and small livestock with groups of non-Maasai women traveling through their homesteads or with other permanent trading settlements for goods such as grains and other foodstuffs (Hodgson 1999a, b). By trading with other groups, women were “crucial intermediaries in the extensive and active trade networks that enabled the Maasai to sustain their specialized production strategy by linking them to commodities of regional and global commerce” (Hodgson 1999a, b: 48). Hodgson (1999a, b) asserts that while men were more central in the political sphere, women occupied a more central role in the sphere of ritual.

Contemporary Maasai social structure is governed by such age and gender distinctions that were in place prior to German colonialism in the late 1800s. Although German colonialism (1890–1910) had an influence on the Maasai, it was inconsistent and had limited long-term impacts on Maasai social, economic, and political structures. Following World War I, British colonialism in Tanzania significantly altered Maasai society with profound implications for Maasai gender roles. British colonial leadership designated Maasai men as the “authorities” in communications between Maasai communities and the British colonists (Hodgson 1999a, b). British fears of unpredictable young male Maasai “warriors” motivated colonialists to reinforce the power of elder male authorities while disregarding the vital social roles of both young men (moran) and women in guiding and governing Maasai society (Hodgson 1999a, b). At once, the British eroded Maasai women’s economic power as traders and caregivers of livestock, political power as ritualistic leaders, and social currency as a valuable part of the Maasai identity by relegating women to domestic duties (Hodgson 1999a, b). Men became the dominant and most important members of Maasai society, which is now understood by Maasai themselves as “being a pastoralist and a warrior: a dominant masculinity forged in “modernity” and sustained by certain economic and social interventions” introduced and propagated by British colonists (Hodgson 1999a, b: 122).

For Maasai women, the consequences of the colonial-induced shift in Maasai society from an egalitarian system to a patriarchal structure are far-reaching. Most notably, Maasai women have been affected in terms of their rights to livestock, property, ritualistic roles (i.e., facilitating rites of passage for both men and women), and political participation. By and large, Maasai women have been marginalized by being limited to domestic duties with little to no power beyond that sphere, which has further emphasized an already existing stress on female reproduction.

As mentioned previously, Maasai society is governed by “distinct social, developmental and social-sexual phases according to age-gender sets” (Birks et al. 2011: 585). Primary to the age-set system is the division of the male population into hierarchal age groups, which also govern sexual and gender relations in this patriarchal society (Talle 1994). Each male age-set is marked by a rite of passage, starting with circumcision between the ages of 16–18 years, upon which time Maasai men become “warriors” (moran or the preferred term is ilmurran) (Talle 1994). Morans are under the authority of elders, are recognized as protectors of people and livestock, and must refrain from marrying, reproducing, or associating sexually with married women (Talle 1994). During the 7–8 years that Maasai men are part of the moran age-set, they are viewed as “separate” from the rest of society and engage in ritual practises of solidarity such as slaughter, physical togetherness, and commensality, which aim to build their physical and sexual strength (Talle 1994). While building physical strength is important for the protection of people and livestock, the building of sexual strength is an essential part of moranhood and Maasai social structure because moran sexuality is considered to be directly linked to female fertility. In fact, female fertility is a culturally mediated process that does not occur naturally (Talle 1994).

Female fertility is developed over a period of time with the help of morans, who start engaging with young girls in a process of gradual coital penetration, which is ultimately consummated when the girl’s mother and moran agree that she is sufficiently mature (Talle 1994). The early sexual debut of Maasai girls is based on the cultural idea that semen of the morans promotes the development of young females’ breasts and sexual “health,” thus making the “services” of the moran imperative for women’s physical development and attainment of fertility (Talle 1994). Once young women have fully developed physically, have attained fertility through regular sexual interactions with morans, and have been circumcised, they are considered to be ready for childbearing and are married to men 10–15 years their senior (Talle 1994). The implications for women’s sexual and reproductive health are seen in their elevated risk of exposure to sexually transmitted infections, such as syphilis, and more recently HIV. That Maasai gender roles threaten women’s sexual and reproductive health is largely due to the subordination of women and the value ascribed to them as vehicles for propagating as many children as possible.

The primary hospital serving the Ngorongoro Conservation Area population is a faith-based (Roman Catholic) hospital, and is the only hospital in the area that offers HIV/AIDS care and treatment (CTC), voluntary counseling and testing (VCT), provider-initiated counseling and testing (PICT), and prevention of mother-to-child transmission (PMTCT) services, as regulated by Tanzanian government policy. Aside regular outreach clinics for Mother and Child Health (MCH), special outreach camping trips are done. During these special trips, hospital staff sets up camp in remote corners of the catchment area for 2 weeks at a time to offer these services locally (funded by the Elizabeth Glaser Pediatric AIDS Foundation). Around 80% of the catchment population of the hospital is Maasai.

To date, data on HIV prevalence among Tanzanian Maasai remains sparse. Local hospital surveillance estimates HIV incidence at approximately 1.7% as compared with the national prevalence at 6.5% (UNAIDS 2009; Hospital Records 2010). While HIV prevalence among Maasai seems notably low, hospital surveillance reflects only an estimated 12.4% of the total NCA population (i.e., 10,040 people from 2007 to September 2010, out of an estimated population of 81,071) (Census Report Ngorongoro District 2010). Hence, surveillance of HIV may not be reflective of the actual incidence and prevalence of HIV among these Maasai communities. The limited number of people tested for HIV can be explained by several factors including a remote and dispersed population located far from the hospital (the area of the NCA is approximately 8,300 km²), limited access to services, limited medical outreach capacity, stigma associated with both HIV testing and diagnosis, and lack of knowledge and understanding about HIV/AIDS.

Lack of access to healthcare, combined with unique sexual practises, places Maasai at greater risk for health-related problems, including high rates of HIV transmission (Morton 2006). Such risk factors include the cultural practise of polygamy, the widespread perception that HIV is not a Maasai or a rural problem, a reluctance to use condoms due to the belief that fertility and masculinity can be negatively impacted by condoms, as well as difficulties around translating and interpreting the concept of HIV (Coast 2006; Coast 2007; TACAIDS 2008).¹ Additional factors that may amplify the impacts of HIV/AIDS for the Maasai women include the slow decrease in female HIV infections – in Tanzania, 6.6% of women in reproductive age are HIV positive as compared to 4.6% of men (TACAIDS 2008) – Maasai cultural practises (discussed in detail below), exclusion from health education, food insecurity, gendered divisions of labor and decision making, and urban migration (Morton 2006). These factors, linked with the Maasai viewpoint that achieving motherhood is an integral element of successful womanhood, create high risk for HIV infection in Maasai women of childbearing age (approximately ages 14–40 years). Thus, understanding the local cultural setting and applying culturally appropriate prevention and relevant testing and treatment strategies are essential to attenuating the risk of HIV infection in pregnant mothers. The importance of reproduction and children in Maasai culture must be acknowledged as a priority, as the role of mandatory motherhood adds significant complexity to achieving HIV prevention. Therefore, while considering the status of a potential HIV epidemic among these communities, we employed a culturally sensitive research methodology to investigate this emotive topic.