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

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

doi:10.2147/ijwh.s143397

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.

Highlights

In sub-Saharan Africa, the epidemiological distribution of HIV is distinctly gendered
The findings in this paper are drawn from “Broad Brush Survey” (BBS) research conducted with community members in 21 urban, high HIV prevalence communities in South Africa and Zambia enrolled into the HIV Prevention Trials Network (HPTN) 071 (PopART) study
Research activities included conducting a set of group discussions with community members, individual interviews with key informants, and structured observations in communities and health facilities over a period of 12 days (Bond V et al, PopART Broad Brush Surveys [BBS] Technical report for 3ie: Broad Brush Surveys of HIV Prevention, Treatment and Care in 21 Zambian and South African Communities to prepare for HPTN 071 [PopART], unpublished report, 2013)

Summary

Introduction

In sub-Saharan Africa, the epidemiological distribution of HIV is distinctly gendered. Women are physiologically at greater risk of contracting HIV per unprotected vaginal sex act than men.[8] Compounding the increased biological odds is social disempowerment, marginalization, and social risk factors (including risk of violence and assault) that many women face. More broadly, social contexts that reflect wider societal gender relations and hierarchical gendered power dynamics[11,12] can limit women’s agency and indirectly put them at increased risk of contracting HIV These contextual factors include the often subordinate or dependent economic status of women which is often affected by men’s asserted control over specific sexual domains.[13] Women often carry disproportionate responsibility for family care, including care of family members affected by HIV, sometimes to the exclusion of their own health priorities.[14]

Objectives

Methods

Results

Discussion

Conclusion