Community narratives about women and HIV risk in 21 high-burden communities in Zambia and South Africa

Lario Viljoen, Rhoda Ndubani, Virginia Bond, Janet Seeley, Lindsey Reynolds, Graeme Hoddinott, Lario Viljoen, Rhoda Ndubani, Virginia Bond, Janet Seeley, Lindsey Reynolds, Graeme Hoddinott

Abstract

Public health researchers repeatedly represent women as a group vulnerable to ill health. This has been particularly true in the field of HIV research, where women are disproportionately affected by HIV in terms of disease burden and the social effects of the epidemic. Although women have been the focus of many prevention and treatment programs, structural barriers to implementation of these targeted programs persist. In this article we explore how high HIV-burden communities in South Africa and Zambia engage with the concepts of "woman" and "HIV risk". The data are drawn from participatory storytelling activities completed with 604 participants across 78 group discussions between December 2012 and May 2013. During discussions we found that participants made use of the core archetypal caricatures of "goodness," "badness," and "vulnerability" when describing women's HIV risk. Community members shifted between these categories in their characterizations of women, as they acknowledged the multiple roles women play, internalized different stories about women, and sometimes shifted register in the same stories. Findings suggest that health implementers, in consultation with community members, should consider the multiple positions women occupy and how this impacts the wider community's understandings of women and "risk". This approach of taking on board community understandings of the complexity of HIV risk can inform the design and implementation of HIV prevention and care programs by rendering programs more focused and in-line with community needs.

Keywords: HIV/AIDS; community beliefs; gender; vulnerability.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Character cards depicting women used for wealth, poverty, and risk ranking activity. Notes: Figures reproduced from Kidd R, Clay S, Chiiya C, editors. Understanding and challenging HIV stigma: Toolkit for action. Academy for Educational Development, International Center for Research on Women, and International HIV/AIDS Alliance; 2007. © Illustrations: Petra Röhr-Rouendaal, 2006.

References

    1. Shisana O, Rehle T, Simbayi L, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012: The Health of Our Children. Cape Town: HSRC Press; 2014.
    1. UNAIDS. Country; South Africa Overview. 2016. [Accessed July 31, 2017]. Available from:
    1. Central Statistical Office (CSO, Zambia), Ministry of Health, and ICF International . Zambia Demographic and Health Survey 2013–2014. Rockville, MD, USA: Central Statistical Office, Ministry of Health, and ICF International; 2014.
    1. Higgins JA, Hoffman S, Dworkin SL. Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. Am J Public Health. 2010;100(3):435–445.
    1. Bose CE. Eastern Sociological Society presidential address: globalizing gender issues: many voices, different choices. Sociol Forum. 2011;26(4):739–753.
    1. Heimer CA. Old inequalities, new disease: HIV/AIDS in sub-Saharan Africa. Annu Rev Sociol. 2007;33:551–577.
    1. Reis Machado J, da Silva MV, Cavellani CL, et al. Mucosal immunity in the female genital tract, HIV/AIDS. Biomed Res Int. 2014;2014:350195.
    1. Chersich MF, Rees HV. Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS. 2008;22:S27–S40.
    1. Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa. AIDS. 2008;22:S73–S86.
    1. UNAIDS Gap Report. 2014. [Accessed January 4, 2016]. Available from: .
    1. Connell RW. Masculinities. California: University of California Press; 2005.
    1. Connell RW. Gender and Power: Society, the Person and Sexual Politics. New Jersey: John Wiley & Sons; 2014.
    1. Hunter M. Love in the Time of AIDS: Inequality, Gender, and Rights in South Africa. Bloomington, IN: Indiana University Press; 2010.
    1. Harrison A. HIV prevention and research considerations for women in sub-Saharan Africa: moving toward biobehavioral prevention strategies. Afr J Reprod Health. 2014;18(3):17–24.
    1. Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high HIV incidence in young women in southern Africa: social, behavioral, and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. 2015;12(2):207–215.
    1. Vandepitte J, Lyerla R, Dallabetta G, Crabbé F, Alary M, Buvé A. Estimates of the number of female sex workers in different regions of the world. Sex Transm Infect. 2006;82(Suppl 3):iii18–iii25.
    1. Dunkle KL, Decker MR. Gender-based violence and HIV: reviewing the evidence for links and causal pathways in the general population and high-risk groups. Am J Reprod Immunol. 2013;69(1):20–26.
    1. Shannon K, Leiter K, Phaladze N, et al. Gender inequity norms are associated with increased male-perpetrated rape and sexual risks for HIV infection in Botswana and Swaziland. PLoS One. 2012;7(1):e28739.
    1. Wurth MH, Schleifer R, McLemore M, Todrys KW, Amon JJ. Condoms as evidence of prostitution in the United States and the criminalization of sex work. J Int AIDS Soc. 2013 May 24; Epub.
    1. Zembe YZ, Townsend L, Thorson A, Ekström AM. “Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry. Global Health. 2013;9(1):28.
    1. Campbell C, Nair Y, Maimane S, Sibiya Z. Supporting people with AIDS and their carers in rural South Africa: possibilities and challenges. Health Place. 2008;14(3):507–518.
    1. Woolf-King SE, Maisto SA. Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review. Arch Sex Behav. 2011;40(1):17–42.
    1. Ketchen B, Armistead L, Cook S. HIV infection, stressful life events, and intimate relationship power: the moderating role of community resources for black South African women. Women Health. 2009;49(2–3):197–214.
    1. Wirtz AL, Schwartz S, Ketende S, et al. Sexual violence, condom negotiation, and condom use in the context of sex work: results from two West African countries. J Acquir Immune Defic Syndr. 2015;68:S171–S179.
    1. Poulin M, Dovel K, Watkins SC. Men with money and the “vulnerable women” client category in an AIDS epidemic. World Dev. 2016;85:16–30.
    1. Centres for Disease Control and Prevention Intersection of intimate partner violence and HIV in women. 2014. [Accessed April 10, 2017]. Available from: .
    1. Jewkes R, Morrell R. Sexuality and the limits of agency among South African teenage women: theorising femininities and their connections to HIV risk practises. Soc Sci Med. 2012;74(11):1729–1737.
    1. Schippers M. Recovering the feminine other: masculinity, femininity, and gender hegemony. Theory Soc. 2007;36(1):85–102.
    1. Pettifor A, MacPhail C, Anderson AD, Maman S. ‘If I buy the Kellogg’s then he should [buy] the milk’: young women’s perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa. Cult Health Sex. 2012;14(5):477–490.
    1. UNICEF Preventing HIV infection among adolescents and young people. 2012. [Accessed April 4, 2016]. Available from: .
    1. WHO . The global health sector strategy on HIV/AIDS 2011–2015: an interim review of progress: abridged report. Geneva: WHO; 2014.
    1. Chersich MF, Luchters S, Ntaganira I, et al. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. J Int AIDS Soc. 2013;16(1):17980.
    1. Tilley BC, Alarcon GS, et al. Minocycline in rheumatoid arthritis: a 48-week, double-blind, placebo-controlled trial. Ann Intern Med. 1995;122(2):81–89.
    1. Jewkes R, Nduna M, Levin J, et al. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506.
    1. Coutsoudis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is option B+ the best choice? South Afr J HIV Med. 2013;14(1):8–10.
    1. US President’s Emergency Plan for AIDS Relief Combination prevention: preventing mother-to-child transmission. 2011. [Accessed September 27, 2016]. Available from: .
    1. Klein C, Easton D, Parker R. Beyond Condoms. Berlin: Springer; 2002. Structural barriers and facilitators in HIV prevention: a review of international research; pp. 17–46.
    1. Watts C, Seeley J. Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV response in sub-Saharan Africa. J Int AIDS Soc. 2014;17(1):19849.
    1. Hermans HJ. How to perform research on the basis of dialogical self theory? Introduction to the special issue. J Constr Psychol. 2008;21(3):185–199.
    1. van Dijk TA, editor. The Handbook of Discourse Analysis. London: Academic Press Inc. Harcourt Brace Jovanovich, Publishers; 2001. Critical discourse analysis; pp. 349–371.
    1. Moghaddam FM, Harré R. Words, conflicts and political processes. In: Moghaddam FM, Harré R, editors. Words of Conflict, Words of War: How the Language We Use in Political Processes Sparks Fighting. Santa Barbara: Praeger; 2010. pp. 1–28.
    1. Hayes R, Ayles H, Beyers N, et al. HPTN 071 (PopART) Study Team. HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment – a study protocol for a cluster randomised trial. Trials. 2014;15(1):57.
    1. Murray EJ, Bond VA, Marais BJ, Godfrey-Faussett P, Ayles HM, Beyers N. High levels of vulnerability and anticipated stigma reduce the impetus for tuberculosis diagnosis in Cape Town, South Africa. Health Policy Plan. 2012;28(4):410–418.
    1. Bond V, Hoddinott G, Viljoen L, Simuyaba M, Musheke M, Seeley J. Good health and moral responsibility: key concepts underlying the interpretation of treatment as prevention in South Africa and Zambia before rolling out universal HIV testing and treatment. AIDS Patient Care STDS. 2016;30(9):425–434.
    1. Wallman S, Bond VA, Montouri MA, Vidali M, Conte RL. The Capability of Places: Methods for Modelling Community Response to Intrusion and Change. London: Pluto Press; 2011.
    1. Gibbs GR. Thematic Coding and Categorizing: Analyzing Qualitative Data. London: Sage; 2007. pp. 38–56.
    1. Helle-Valle J. Re-thinking Sexualities in Africa. Uppsala: NAI; 2004. Understanding sexuality in Africa: diversity and contextualised dividuality; pp. 195–210.
    1. Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43(6):1241–1299.
    1. WHO Definitions of key terms. 2016. [Accessed October 24, 2016]. Available from:
    1. Kidd R, Clay S, Chiiya C, editors. Understanding and challenging HIV stigma: Toolkit for action. Academy for Educational Development, International Center for Research on Women, and International HIV/AIDS Alliance; © Illustrations: Petra Röhr-Rouendaal; 2007. 2006.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다