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

Abstract

Lario Viljoen,1 Rhoda Ndubani,2 Virginia Bond,2,3 Janet Seeley,3 Lindsey Reynolds,4,5 Graeme Hoddinott1 On behalf of the HPTN 071 (PopART) Study Team 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 2Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Lusaka, Zambia; 3Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; 4Population Studies and Training Center, Brown University, Providence, RI, USA; 5Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa 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, gender, vulnerability, community beliefs

Keywords

• HIV/AIDS
• gender
• vulnerability
• community beliefs