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HIV/AIDS Prevention and Control

(Cultural Approach to HIV/AIDS Prevention & Care)

Background
It is increasingly being recognized worldwide that the conventional Information, Education and Communication (IEC) campaigns have utterly failed in bringing in-depth and long-term changes in risky behaviour for halting the spread of HIV/AIDS pandemic. The mass media information has also been predominantly general and non-targeted information on HIV/AIDS prevention and care, the form and content of the messages are mostly not tailored to be understood and integrated by diverse population groups. This major shortcoming has been unambiguously acknowledged by the UNESCO and the UNAIDS, which have admitted in their country assessment reports that the national policies to-date have not brought significant changes in behaviour among the population in respect of HIV/AIDS prevention, care and support. The 2006 Report on the Global AIDS Epidemic, brought out by the UNAIDS, estimated that 38.6 million(33.4 million-46.0 million) people globally were living with HIV in 2005; with an estimated 4.1 million (3.4 million-6.2 million), becoming newly infected with HIV; and an estimated 2.8 million (2.4 million-3.3 million), having lost their lives to AIDS.

The failure of the IEC, including mass media campaigns, has been essentially because of the fact that HIV/AIDS prevention strategies and policies; have been considered purely a bio-medical problem or a cognitive issue; rather than as a complex societal and cultural phenomenon. The focus has been dysfunctionally or ineffectually on the individual behaviour and attitude; rather than understanding the same as an integral part of the collective societal and cultural norms, practices and settings.

Besides the insufficient consideration and integration of people’s societal and cultural references and resources (which include, people’s life style, their ways of thinking, and their motivational responses); the HIV/AIDS control and prevention strategies also have other serious deficiencies like standardized communication messages, pre-cooked preventive education, partial and fractured involvement of the community as well as inadequate and passive involvement of the stakeholders and civil society.

The existing HIV/AIDS control strategies followed by the governmental agencies are perceived by people at large as a superimposed external intervention. Community has the most important role in stimulating debate, defining activities, creating motivation and generating interest in HIV/AIDS prevention and control strategies; as the community, as a group of people; is normally bounded by a set of beliefs, practices, life styles and religious convictions; and depending upon its participation and integration will be motivated or dis-motivated to act as a group in relation to HIV/AIDS prevention, care and support. Community participation has been reduced to rapid and superficial process, in which contacts are established only with the most accessible members of the community. This sort of participation is an administrative obligation and it is often viewed by the participants as mere formalities or a mere waste of time.

Any HIV/AIDS prevention and control strategy needs to recognize the continuous and over-sweeping changes from rural, traditional and relatively stabilized social system to modern urban, competitive and destabilized life conditions. The process of globalization has created both opportunities and aggravations, impinging upon the traditional cultural practices and value system. The global changes; with national, regional and local manifestations and ramifications include;

  • rural decline (impoverishment of small farmers and landless labourers; migrations of unemployed and underemployed youth to the cities and towns; as well as loss of traditional family identities and family life as a result of encroaching urbanization and industrialization);
  • urban explosion(pressure on scarce and almost undependable urban space; unplanned and limited housing; impoverishment and prolitraisation of migrants as well as emergence of new urban sub-cultures; including violence, substance abuse, and unsafe/ irresponsible and forced behaviour); and
  • gross gender disparity (larger onus of burden on women in rural area; destabilization of family structure; growing promiscuity; and migration of women to cities and towns for livelihood earning; with the resultant vulnerability).

To further elaborate the rapid and constant socio-economic and cultural changes; having direct bearings on the spread of HIV/AIDS by contributing towards risk-taking behaviour and vulnerable situations; particularly among the adolescents, youth and young people; include;

  • decline and disintegration of traditional family system;
  • chronic unemployment and under-employment, particularly in rural area;
  • social and group isolation, lack of person-to-person and person-group-communication;
  • large scale rural migrants and impoverishment of migrants;
  • emergence of new urban sub-culture including violence, growing promiscuity, substance abuse and unsafe/non-responsible and forced behaviour;
  • vulnerability of girls and women (particularly, the homeless and migrant girls and women);
  • greater adherence to the urban life and consumeristic culture;
  • inroads of the mass media (particularly, the electronic media) into household;
  • inequitable gender relations, with women in majority, having a marginal role in decision-making in family, societal and workplace life; and
  • adoptation of a westernized, liberal and permissive life-style.

A major rethinking has been taking place globally to reorient, rejuvenate and reframe the HIV/AIDS prevention and control strategies so as to optimise their impact. This process has been sphereheaded by the launching of the joint project on “A Cultural Approach to HIV/AIDS Prevention and Care”, by the UNESCO and the UNAIDS, with the initiative of the former in May 1998. The cultural approach to HIV/AIDS prevention and care, seeks to integrate the cultural resources/ features and references of a given population; which include their ways of life, traditions, ethos, beliefs, values, family system, ethical factors, religious practices, spiritual observances, indigenous knowledge, traditional know-how, social structure/ stratification, taboos and creativity; in building, implementing and evaluating HIV/AIDS prevention and care strategies and policies. Culture has been succinctly defined by the World Commission on Culture and Development (Our Creative Diversity, 1995) and the Intergovernmental Conference on Cultural Policies for Development (Stockholm, 1998); as the “whole complex of distinctive spiritual, material, intellectual and emotional features that characterize a society or a social group, and that it includes not only the arts and letters; but also modes of lives, ways of living together, the fundamental rights of the human being, value systems, traditions, and beliefs, and that there is accordingly a close link between cultural diversity, peace and development”.

Culture is never homogeneous. It is always marked by diversity. Culture is also never a fossilized or frozen system or a monolithic structure. Culture, on the contrast, is an ever-changing evolutionary phenomenon. It has its internal and intrinsic dynamics. Simultaneously, each culture borrows from the other culture. They borrow ideas, beliefs and practices- tangible or traditional or contemporary. They also interact with and get influenced from all kinds of external socio-economic transformation processes, which any society or a given population undergoes continuously. Culture; therefore; provides the revival, retention, reinterpretation, re-modification and recreation of traditions and ethos. These evolutionary variations, plural dimensions and contemporary adaptations of culture have to be integrated in designing, implementing and evaluating the HIV/AIDS prevention and care strategies.

The culture approach to HIV/AIDS prevention and care facilitates the reinforcement of the positive elements in the local culture of a given population to foster positive behaviour and attitude as well as seeks acceptable and relevant changes in the not-so-positive elements in the same cultural process to motivate the given group or persons to avoid risk-taking behaviour and vulnerable situations. Cultural references and resources of any given population; which are considered as obstacles for HIV/AIDS prevention and control strategies include; sexual violence against women and girls; polygamy; religious dogmas, taboos, exclusivity, and superstitions; lack/inadequacy of primary health facilities in remote rural areas, leading to people’s dependence on unskilled and unsafe heath services; and people’s blind faith in superstitional physco-therapic treatment by the traditional healers. A process of simultaneous co-existence and conflict of positive and negative values, influencing and shaping behaviour pattern and attitude, prevail in any given society or culture or group. The need is to optimize, harmonize and popularize the positive factors in the culture of a given population as well as minimize and eliminate the negative elements or obstructive aspects therein to ensure safe and responsible behaviour to reverse the process of expansion of HIV/AIDS epidemic. No attempt should be made to change the culture of a community or a given population group as the same will be counterproductive and will be deprivation of human rights as culture is the greatest assert and sense of autonomy of a given population. The cultural approach is indispensable if behaviour patterns are to be changed on a long-term basis, a vital condition for slowing down or for stopping the expansion of the epidemic.

The HIV/AIDS prevention and care strategies and policies are therefore have to be comprehensive, multifarious, inter-disciplinary, trans-institutional, and inter-sectoral. To sum up, the factors to be considered in the cultural approaches may include;

  • the links between the epidemic and its social environment need not only to be recognized, but also should be translated into convergent action;
  • social and cultural factors should be considered not only as obstacle, but as positive factors in the developmental process; and
  • the overall characteristic of culture, including the whole fabric of a society should be considered.

Strategies
SANKALP’S strategies and policies on HIV/AIDS prevention is the real-need replication, appropriate application, and effective extension of the cultural approach to HIV/AIDS prevention and care in the national, regional and local cultural contexts to meet the varied needs of the diverse population groups.

Activities
HIV/AIDS epidemic is a multi-faceted issue, which requires multi-dimensional responses; and accordingly the broad goals of SANKALP’S action plans include;

  • ensuring mass mobilization of the communities, groups, families, individuals and governmental and non-governmental organisations;
  • raising public awareness towards behaviour change;
  • building community-based prevention and care programmes;
  • supplementing and supporting new creativity linked to HIV/AIDS prevention and control; and
  • giving special attention to the endangered groups.

The target groups covered by the Organisation’s HIV/AIDS control and prevention programmes include;
Risk groups

  • migrants;
  • commercial sex workers;
  • people in mobile professions;
  • segregated groups; and
  • homosexuals.

Culturally disadvantaged groups

  • disintegrated families;
  • unemployed; and
  • refugees/displaced.

Vulnerable groups

  • poor;
  • women;
  • youth;
  • bridge persons; and
  • general society.

SANKALP’S strategic priority in HIV/AIDS prevention and control include;

  • Culturally appropriate communication for behavioural change by developing new strategy and new IEC practices; which will attempt to;
    • understand people’s cultural references and resources;
    • identify the societal and cultural conditions for people’s sensitization and mobilization;
    • pinpoint the specific demands and needs of the targeted audiences in respect to their relations to high-risk behaviour, their socio-economic situation, their self-behaviour and their relation to society at large; and
    • assess the impact of relevant messages.
  • Innovative, appropriate and culturally relevant preventive education with avoidance of pre-cooked instruction materials and emphasis on emphatic dialogue as well as consideration of the targeted group’s behavioural norms and understanding capacities;
  • building community-based partnership/ responses; which may include;
    • personal visits to community and key opinion leaders
    • establishing bonds of real friendship and minimizing professional distances;
    • enlarging and diversifying contacts with representatives of population sub-groups from different classes, castes, age-groups and sexes;
    • becoming familiar with the religion as well as the local customs, norms, values, practices and issues;
    • learning the local dialect/language and semantic habits; and
    • participating in major events in the life of the community (celebrations, ceremonies, social gatherings, and cultural and sporting events), and using these occasions as opportunities to interact with large group of people; and
  • enhancing joint mobilization of and co-ordination among the stakeholders, public institutions, private agencies, non-governmental Organisations, elected representatives, traditional leaders and civil society.

SANKALP’S strategies seeks to provide realistic responses to the individual and collective vulnerability to HIV/AIDS and, therefore, attempt to avoid the pitfalls in the communication process to bring the desired behavioural change; which include; i) over-information; ii) under-information; iii) rushed-information; and iv) precooked-information.

The Organisation’s strategies have been attempting to consider and integrate the specific relevant characteristics of a given population, which include;

  • differences between conventional needs and real needs;
  • resources and capacities within community (knowledge, know-how, methods of solving problems and conflicts, open-mindedness to locally relevant innovations and will to change);
  • points of differences (conflictual situation and the corresponding possibilities for establishing consensus); and
  • available points of leverage.

One of the thrust areas of SANKALP’S HIV/AIDS prevention and control activities is School HIV/AIDS Prevention Education. The Organisation recognizes that there are serious obstacles for imparting HIV/AIDS education in schools. These impediments include;

  • the subject is considered too controversial;
  • the curriculum is overloaded;
  • prevention education may be limited to certain age-groups;
  • only facts about AIDS, not behaviour skills, are taught; and
  • there may be only partial coverage of schools/ students in a big country like India.

SANKALP’S School HIV/AIDS Prevention Education distinguishes the diversity, complexity and changing characteristics of children, youth and adolescents; their living environment; their life styles; and the cultural references and resources they represent. These distinctive characteristics are essential to build up appropriate responses for the in-school children.

The thrust of such prevention education is on new creations and appropriate innovations in HIV/AIDS prevention strategies to ensure behavioural and attitudinal changes by providing knowledge, fostering attitudes and conferring skills through culturally sensitive and effective communication. These include; orientation workshops, intensive workshops, refresher courses, trainings, peer education, group discussions, interactions and creative activities; with participatory involvement of the students, teachers, parents, officials, community representatives and local self-government representatives in the design, implementation and monitoring of the programmes.

One of the creations of SANKALP in School HIV/AIDS Prevention Education is “Creativity for AIDS Reduction Education (CARE)”, which seeks to use arts (performing and visual) as a powerful medium to promote behavioural and attitudinal change among the students for HIV/AIDS prevention and control. CARE represents a new contribution; tailoring the action plans for HIV/AIDS prevention and control to students’ perceptions, beliefs and value systems. CARE involves choreographing/ conceptualizing/ visualizing/ articulating and staging/exhibiting/ presenting original production/work on performing and visual arts; interactive workshops; as well as thematic competitions. Such programmes are being conducted at different levels; intra-school /inter-school/ intra-college (university)/ inter-college (university)/State /zonal /national.

One of the prime plank of CARE is “Theater Education for AIDS Control and Health (TEACH)”. It is widely recognised that theater is the most powerful and effective medium to propagate the themes and messages of HIVAIDS prevention and control methods and strategies among the young people in a culturally acceptably, fully understood and highly valued (culturally integrated) manner.

The prevention education has not only contributed towards the removal/ dispelling of the popular misconceptions, errors and myths relating to HIV/AIDS; but also has succeeded in imparting certain life-long skills which include;

  • decision making;
  • interpersonal relations;
  • self-awareness;
  • stress and anxiety management ;
  • coping with pressures;
  • negotiations of contentious situations;
  • assertiveness;
  • self-esteem and self-confidence; and
  • promotion of healthy lifestyle.

These distinctive characteristics are essential to build up appropriate responses for the in-school children. The Organisation has been adopting relevant indicators to assess the cultural changes among the targeted students. These indicators include;

  • broadening acceptability and recievebility of the preventive education by the students;
  • decrease in unsafe practices;
  • increased readiness for discussing HIV/AIDS related risks within the school, family and the community; and
  • growing participatory mobilization of the targeted schools, teachers, parents, officials, communities and local elected representatives.

The core of the whole process is empowerment- to provide knowledge, foster attitudes and confer skills through culturally appropriate, relevant and sensitive communication and education for a healthy life style.