ABSTRACT

This paper attempts to examine the connection between one’s socio cultural setting and the prevalence of HIV/AIDS. Often, local communities form the contexts within which people negotiate their social and sexual lives and identities. These communities also play a key role in enabling or restraining people from taking control over their health. The paper will try to demonstrate through specific examples that in African societies, sexual behavior is a product of one’s socio-cultural environment and structural contexts and not the cognitive properties of the individual. The article draws from the qualitative study (Focus group sessions, individual interviews) conducted in three high schools in the Boland area of the Western Cape with about 18 learners, 3 Life skills teachers, 3 Performer-Educators on the efficacy of the HIV/AIDS intervention by The Centre for HIV/AIDS Management theatre group based at the University of Stellenbosch. The aim of the study was to ascertain the cultural content of their campaign model as well as their knowledge of the determinants of sex and sexuality of their target areas. Based on the findings of this study, I argue that theatre will achieve greater success in its campaign against HIV/AIDS in South Africa if the designers of the campaign models adopt a more participatory approach, make indigenous culture central to the design of their intervention model and pay closer attention to what Campbell refers to as “community level of analysis” which simply put implies a greater understanding of the target audiences local communities and its determinants of sex and sexuality.

1. Introduction

According to Hoeken and Swanepoel [1] the estimated prevalence rate of HIV and AIDS in South Africa is 10.8% - 11.2% i.e. 4.5 - 5.5 million of the general population, an estimated 2000 new infections daily and 800 HIV/AIDS related deaths per day. Campbell [2] postulates that the average life expectancy in Sub-Saharan Africa, which would have been 62 years without AIDS is now 47 years. In Botswana, it has dropped to 36, a level last seen in 1950. In Lesotho, people who turned 15 in 2000 have a 74% percent chance of becoming infected before their 50^th birthday.

With all these statistics in mind, and with the knowledge that HIV/AIDS has caused indescribable suffering to millions of people, one wonders as Campbell [2] asks, why people knowingly engage in sexual behavior which could lead to a slow, painful, and premature death and why the best intentioned attempts to stem the tide of the HIV pandemic often have so little impact. In a paper reviewing the factors promoting and perpetuating unsafe sexual behavior in South African youth, Eaton, Flisher and Aaro [3] reveal 50% of young people as sexually active by the age of 16. The majority of school students who had experienced sexual intercourse reported, at the most, one partner in the previous year, with a persistent minority of between 1% and 5% of females and 10% - 25% of males having more than four partners per year. Additionally, 50% and 60% of sexually active youth report never using condoms. These scholars also ask the same question, “Why is it that the South African youth in the 1990’s continue to practice unsafe sex (as evidenced by the spiraling rates of HIV infection), despite the concerted efforts of educational and HIV educational campaigns to influence their behavior?”

2. Theoretical Framework

The task of understanding the transmission and prevention of HIV and AIDS is one that has received much scholarly attention in a range of academic disciplines and levels of analysis. Campbell [2] describes two such levels of analysis; the micro-social level dominated by the opinions of health psychologists who have produced numerous academic papers linking sexual behavior to properties of the individual such as cognitive process instincts, attitudes, sense of personal vulnerability or perceived social norms and the macro social level, where economists, anthropologists and sociologists have drawn attention to the way factors such as poverty, gender inequality and global capitalism have shaped the contexts in which the pandemic flourishes. Campbell believes a key component of HIV and AIDS analysis has been overlooked namely how these micro and macro levels interact at local community level. In analysing the reasons for several failed intervention attempts, Perloff [4] remarks that one main reason for this lack of success is the complexity of the behaviour these interventions are trying to change. Studies have shown a poor understanding of sexuality and its contexts by many HIV and AIDS stakeholders may be responsible for the low success levels recorded against HIV and AIDS campaigns.

Campbell [2] believes many HIV prevention efforts in Sub-Saharan Africa have been dominated by the very biomedical and behavioral understandings of sexuality and health that allowed the epidemic to develop in the first place. It is important, she contends, that if prevention efforts are to have optimal impact, they need to be informed by sound insights into the determinants of sex and sexuality, yet these are the most mysterious and multi-faceted aspects of human behavior. According to her, early in the epidemic, it was assumed that sexual behavior was shaped by the conscious decisions of rational individuals. Locating the cause of sexual behavior at the individual level, she continues, led to individual behavioral interventions. Optimistic health promoters assumed that if only vulnerable people could be reached and educated about HIV and how to prevent it, they would quickly take care and safeguard themselves through changing their behavior. It is as simple as A.B.C. abstain, be faithful, and codomise. But studies have shown that many people knowingly engage in sexual behavior which puts their lives at risk. With full knowledge of the dangers of the epidemic, many people continue to have sex, often with multiple partners. Campbell is of the opinion that the forces shaping sexual behavior and sexual health are far more complex than individual rational decisions, based on simple factual knowledge about health risks and availability of medical services.

Recently, there has been a growing understanding that while sexuality cannot be divorced from the physical body, our instincts or emotions, it is socially constructed (Campbell [2]). Eaton, Flisher and Aaro [3] contend that factors which promote risk behaviours or create barriers to safer sex are structured along three domains of analysis: personal factors; the proximal environment (including interpersonal factors and the immediate living environment); the broader social context (including structural and cultural factors).

Traditional cultures often form the contexts for peoples sexual behaviour, for instance Sithole ([5] discusses cultural factors which contribute to the spread of HIV/AIDS in Southern Africa and singles out key cultural practices which act as contributory factors to AIDS to include male circumcision, female genital mutilation, early and compulsory marriage of girls, sexual abuse and rape of women and girls, cosmetic tattooing or administration of charms, widow inheritance and death cleansing. Other factors include breakdown of family patterns, gender relations, traditions, moral values and behavioural patterns caused by a shift from rural to urban environments. According to Sithole [5] the perception amongst many African communities is that sexual activity is related to social status and for males, an important expression of their masculinity. The view of sex is as an activity for fun and fame; if a man sleeps around, he is more popular. The culture in Swaziland supports the multiplicity of sexual partners for men. A man who engages in multiple sexual encounters is known as ingwanwa which is positive and widely accepted. The female equivalent ingwandla is a derogatory term. The upbringing of boys and young men encourages them to dominate at family, community and societal level, thus sex becomes a means and a symbol of domination and power over the other sex. The metaphor of a bull, symbolic of strength is usually associated with manliness: the perception of a man is always searching for mating partners along life’s journey.

Inness [6] describes the South African culture as being generally male dominated, with women accorded a lower status than men. Men have been socialised to believe women are inferior and should be under their control; women are socialised to over-respect men and act submissively towards them. The unequal power relations between the sexes particularly when negotiating sexual encounters, increases the women’s vulnerability to HIV-infection accelerating the epidemic.

Gender inequality in Africa continues to be a major obstacle for HIV prevention programmes. For example, a woman who is faithful to her husband cannot, in many African societies, refuse sexual advances from her high risk husband, without fear of physical harm, economic retaliation or social ostracism (Van Dyk [7]). Rape or seduction of teenage girls by rich older men continues at alarmingly high rates in African societies (Attawell, [8]). Findings from studies conducted on sexual behavior suggest that poor women may be particularly vulnerable to HIV-infection. This is evident in sustained high-risk sexual practices by women who are aware of HIV/AIDS transmission and prevention. Many women may abandon safe sexual practices in exchange for economic and financial security, despite knowing the risks of doing so. Poverty appears to play a prominent role in influencing sexual decision-making by limiting individuals’ decision-making powers in sexual relationships (Department of Health et al. [9]; Fourie and Furter, [10]; Fourie and Furter, [11]; Attawell, [8].). The resultant consequence is a high risk population. Widow inheritance, ukungena-in Ndebele/ Zulu or kugara Nhaka in Shona is widely practiced in many parts of Southern Africa, especially in a country such as Swaziland. The practice entails the younger brother or relative of the deceased husband “remarrying” the surviving woman and if not observed, the spirit of the dead man will visit the living to make demands. The reasons behind the practice are: to prevent the widow from committing adultery; to keep the wealth of the deceased within the family and in some societies, to appease the spirit of the deceased and prevent it from visiting the living and exacting punishment. The belief is that the spirit of the dead resides among the living overseeing all their daily activities (Van Dyk, [7]). Among some communities within the Southern African region and among minority groups in Zimbabwe, widow inheritance follows a practice that widely exposes both the widow and the deceased’s brother to HIV/AIDS. Death in many African societies is a bad omen and in many cases, families are cleansed following the death of a family member. Different activities are performed to cleanse the family of this bad omen; it could be a simple ritual by traditional healers and other activities of a sexual nature. According to this practice, it is expected that a woman undergoes sexual cleansing. She is compelled to sleep with a stranger, in some cases someone with mental illness, in order to transfer this bad omen to the person that society considers useless (Sithole, [5]). Common belief is that a person who is normal and productive cannot take the weight of a bad omen. The dangerous part of this ritual cleansing is that the person whom the widow sleeps with may be infected and in turn, infecting the widow, who will then pass it on to her inheritor. Central to the whole practice is that the family tends to force the wife to accept inheritance or the brother to inherit the deceased brother’s wife. Another unfortunate aspect of this cultural belief is the non publication of the cause of death even if it is HIV and AIDS.

Many African cultures consider it taboo for men to have sex with their wives during menstruation and late pregnancy. At such times, many men do not abstain or seek alternative means of release, such as non-penetrative sex, but seek sex with other women. It is not uncommon for a man to contract HIV through casual sex while his wife is pregnant. He then transmits it to his wife after childbirth, and she passes it to the baby through breastfeeding being during the initial stages of HIV infection. Men who have been ill for lengthy periods may be advised by traditional healers to sleep with a virgin girl (Sithole, [5]), a dangerous urban myth making the rounds in South Africa’s urban rural settlements known as “townships”. It has led a number of HIV-positive men raping little girls and babies. In Tswana culture, the interpretation of a long is as the result of a spell or a curse rather than anything to do with sexual behaviour. Traditionally, prolonged illness can be attributed to a number of factors such as sleeping with a woman during her menstrual period, having intercourse with a widow or a woman who has had a miscarriage (Akinade, [12]). Pervasive polygamy is a practice most common in certain areas of South Africa, Zimbabwe and Swaziland. In this practice, parents give their young daughters to older men who are already married with several wives, for economic benefits. In most cases there is consultation with the innocent girl and early marriages like this expose the young girls to high risks of contracting HIV and AIDS. There also exists a cultural practice known as “dry sex” in many parts of the African continent where, women, mainly prostitutes, insert substances into their vagina prior to intercourse to prevent wetness of the vagina. The belief is this produces a hot tight and dry environment which men find pleasurable. There are also cultures where virginity is highly regarded as criteria for respectability and subsequent marriage. Many young women in these cultures resort to anal sex, a practice reported in South Africa, Malawi and Zambia (Sithole, [5]), to keep their lovers from looking elsewhere for sex and maintain their respect which society accords to virgins. All these expose women to high risks of contracting HIV and AIDS. Van Dy, (2003) believes that unless salient aspects of the African cultural practices such as the ones mentioned above are taken into account by AIDS educators, the battle against HIV/AIDS will continue to be an uphill battle.

Many theatre interventions have been dominated by top down communication model in which groups, armed with pre-scripted, pre-rehearsed plays, without any idea of the cultural and economic dynamics of their target audience into communities hoping to achieve some measures of success in HIV/AIDS intervention. The audience in this case become passive recipients of “superior knowledge” by these groups. Eyoh [13] refers to it as “turning the audience into guinea pigs for our experiments”.

3. Context for the Study

Research Tours with the Centre for HIV/AIDS Management Stellenbosch University

In April, 2011, I travelled with The Centre for HIV/AIDS Management theatre group on their HIV and AIDS campaign tours of various schools in the Boland area as a non-participant observer. My intention was to observe their dramatic performances to the learners in these schools and find out how much of the cultural as well as socio-economic dynamics of this target audience was encapsulated in the play.

The group performed to mainly learners in high schools. The drama performance piece, entitled Lucky, the Hero! traces the journey of a young man, Lucky, who becomes aware of his risky behavior through information given on a radio programme. Lucky has taken the brave step to get tested after realizing his risks by having sexual contact without using a condom. After revealing his status to his best friend who gossips the information to the whole community, he is ostracized stigmatized by all. From facts given to him as an anonymous caller on the radio station, he gains considerable self assurance and confidence that his life still has great value and a positive and bright future. He disguises himself as “Captain Aids Fighter” to inform the community about HIV and AIDS and change their thinking about the disease as well as on how they treat people with the disease.

To ascertain whether or Centre for HIV/AIDS Management theatre group’s performances have improved the learners’ awareness of issues relating to HIV and AIDS, I undertook a post-performance evaluation. I undertook a focus group session with the pupils (the target audience) with their life skills teachers as moderators. I also held individual interviews with the Life skills teachers in the schools concerned as well as the performer-educators of the group.

The expected objectives of this survey were to:

• Ascertain the level of awareness-raising of the group’s performances in the schools where it was designated to perform and raise awareness on HIV and AIDS.

• Assess how much of the cultural norms and values of the community was contained in the play performed to the target audience and how this impacted on the learners reception of the message of HIV/AIDS encapsulated in the play.

• Set a baseline for future research regarding HIV and AIDS awareness campaigns by theatre groups in South Africa.

4. Methodology

This study utilizes qualitative research methodology to gain insight into the efficacy or otherwise of models and theories used by theatre groups in HIV/AIDS campaigns in South Africa. My study aims to gather an in-depth understanding of human behavior around HIV/AIDS and the reasons that govern such behavior. It interrogates the place of culture in sexual behaviour. The methodology applied in this study aims to analyse detailed descriptions of situations, events interaction and observed behaviour; quotations from people about their experiences, programme receptivity, attitudes, beliefs and thoughts.

4.1. Research Design

This is a Case Study of Centre for HIV/AIDS Management Theatre group with specific emphasis on the Western Cape province of South Africa.

Data Collection

Data collection was done using focus group interviews with learners in primary schools around Western Cape Province, individual interviews with the Life skills teachers of the respective schools. In addition to these I applied the participant observation strategy in which I operated as non-participant observer.

4.2. Population of Study

The research is based on 1) The activities of a prominent theatre group from the Centre for HIV/AIDS Management which is involved in HIV/AIDS campaign around the country.

2) Target Audience: The above named theatre group guided my selection of schools. As is usually the procedure, the group is usually invited by the schools upon application, to perform HIV/AIDS plays to their learners. 3 high schools based in the Boland district of the Western Cape invited the theatre group to perform. Using probability Sampling, I selected a total of 6 learners from each school bring the total number of learners to 18 learners. Three Life skills teachers one from each school were also selected.

The Western Cape

Our tour of the Western Cape took us to three high schools in the Boland area. Some of the schools are traditionally coloured schools while some were mixed in terms of race and ethnicity. The focus group sessions took place with 18 learners, while the individual interviews had 3 life-skills teachers, and 3 performers.

5. Findings of the Study

Table 1 represents the themes and categories selected from the focus group interviews as well as interviews