Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014

Abstract

HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre-and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma.

Social Representations Theory and young Africans' creative narratives about human immunodeficiency virus/acquired immune deficiency syndrome, 1997–2014

“…However, a subsequent slight downturn—accompanied by an increase in the proportion of narratives that included infection—suggested that the hope‐promoting and stigma‐reducing dividend of ART may have partially run its course by 2011/2013. In more qualitative temporal studies, we found that while ART access may have alleviated the association of HIV with death, a thematic core of despair, blame, misogyny, and social stigma persisted, often finding expression in deeply moralistic cautionary tales (Winskell et al., 2020b), aptly illustrating the stickiness of the narrative core described by Jovchelovitch.…”

“…While there are commonalities across country samples, one of the most salient findings from our study is the cross‐national differences in the narratives, particularly as they relate to sexual morality and blame (Winskell, Hill, & Obyerodhyambo, 2011), with representations in the Nigeria sample being persistently most stigmatizing, with the highest prevalence of death, sexual transmission, intentional transmission, and blame, and the lowest prevalence of hope (Winskell et al., 2020; Winskell et al., 2020b). Narratives from Swaziland, the country with the highest HIV prevalence, are—in contrast—those most likely to be hopeful.…”

“…While this reflects HIV prevalence and resulting social proximity, it also suggests that the epidemic was framed in different ways at the national level and that this anchoring and objectification, based both on the local cultural and religious context and, by extension, on communication in the media, including via HIV‐related campaigns, was tenacious. These distinctive cross‐national differences in the narratives point to opportunities to reframe cultural narratives around HIV in less stigmatizing ways, particularly in countries like Nigeria (Winskell et al., 2020; Winskell et al., 2020b). I address applied dimensions of the research in the final section.…”

“…More than 150,000 young people from across sub‐Saharan Africa took part in HIV‐themed scriptwriting contests held at 8 discrete time points between 1997 and 2014, creating over 75,000 narratives. Over recent years colleagues and I have engaged in the analysis of a stratified random sample of close to 2000 narratives from five or six (depending on the study) epidemiologically and culturally diverse countries (Beres, Winskell, Neri, Mbakwem, & Obyerodhyambo, 2013; Singleton, 2019; Singleton, Winskell, Nkambule‐Vilakati, & Sabben, 2018b; Winskell, Beres, Hill, Obyerodhyambo, & Mbakwem, 2011; Winskell, Brown, Patterson, & Mbakwem, 2013; Winskell, Hill, & Obyerodhyambo, 2011; Winskell et al., 2015; Winskell, Kus, et al., 2018; Winskell, Obyerodhyambo, & Stephenson, 2011; Winskell et al., 2020; Winskell et al., 2020b).…”

How a Smart Technology Imposed by an Organization Can Arouse Ambivalent Psychological Empowerment: An Approach Leveraging the Theory of Social Representations

“…In addition, in the last decade, the TSR has captured the attention of researchers in the field of public health management (HIV transmission prevention policies, vaccination programs, breastfeeding campaigns, etc.) (Ares et al, 2020;Winskell et al, 2020), seeking social legitimation of their policies to facilitate their implementation and citizen acceptance. In the case of our research object, while the public electricity distributor Enedis was putting its efforts into deploying smart meters to implement a smart grid for energy transition, at the same time, they were forced to bear the costs of polemics and their media treatment.…”