THEORISING SOCIAL CHANGE COMMUNICATION FOR HIV PREVENTION A CULTURE-CENTERED APPROACH
It has been noted in the previous chapter that formalisation of the Greater involvement of people living with HIV/AIDS (GIPA), a framework that recognises agency of people living with HIV (PLHIV) in responding to the HIV epidemic occurred after PLHIV themselves (who had been marginalised by the dominant HIV/AIDS discourse) challenged the status quo that kept them in the margins of society. This study set out to explore the experiences and perceptions of South African people living with HIV (PLHIV) about their participation in the HIV response as they continue seeking spaces to enact their agency in altering the face of the HIV epidemic. The notion of marginalisation and resistance to it has been the focus of cultural studies; a discipline within which this study is located and a field of inquiry which draws from different fields such as postcolonial and subaltern studies among others (see Dutta, 2011).
Conceptually, both the phenomenon examined in this study and the methodological approach adopted for its execution (see Chapter Six) find expression in the culture-centered approach to social change which recognises the agency of the marginalised in negotiating structures and in seeking spaces for change (Dutta, 2011). In health communication the culture-centered approach revolves around concepts of structure, culture, and agency (Airhihenbuwa, 1995). The key proponent of this approach, Collins Airhihenbuwa (1995) and his ‘disciples’ in this aspect such as Mohan Dutta (2008) define structure as the distributary mechanisms for health resources in societies which simultaneously limit and create cultural participants’
opportunities for enacting agency to engage in practices that influence their
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health and well-being. These structures include policies, medical infrastructures, food resources, and transportation systems. They define agency as the capacity of individuals, groups, and communities to participate actively in determining the health agendas at the local level and creating solutions for community health problems. The culture- centered approach posits that culture and health are mutually constitutive it provides the communicative context for health meanings in communities. It is also through the expression, interpretation and reinterpretation of culturally circulated meanings that individuals enact their agency (Dutta, 2011).
Premised on the view that in the (South) African context culture and beliefs exercise a great influence on the thought and actions of people (Ovens, 2003) including those that may predispose people to HIV, this study seeks to gain a deeper understanding of the philosophy upon which the participants’
configuration of involvement of PLHIV in social change communication for HIV prevention is, and its mainstreaming should be based. From a cultural studies perspective as well as the culture-centered approach to social change, listening to PLHIV is critical as it allows cultural members opportunities to participate in processes aimed at identifying their own social development problems so much so that they can develop solutions to these problems (Dutta, 2011). A key argument in this thesis is that in order to change the course of the South African HIV epidemic, effective ways in which PLHIV can meaningfully participate in social change communication for HIV prevention are required.
This is only possible when PLHIV are, and indeed feel recognised and part of the community from which they have been decentered. PLHIV as with everyone are bound to the community in which each has an equal moral worth and agency as human beings.
The view advanced in this thesis is that the notion of agency and humanity are mutually constitutive. The cultural-centered approach to social change is indeed a response to the structural violence that perpetuates subalternity
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through discursive erasures that render the marginalised inhuman. This violence is enacted in the form of inability to the basic capabilities of life (Farmer, 1999), a process which - by limiting agency of human possibility - effectively dehumanises. It means, therefore, that central to the politics of agency is the question: what is being human/what is humanness? Indeed this question and an answer to it arise from the way one person views the other.
Clearly an understanding of what it means to be human can only happen when one views themselves in relation to the other. As such, this fundamentally locates participation of PLHIV in social change communication for HIV prevention in a philosophy that addresses human relations.
Participation, as shall be shown ahead is a key concept underlying mutual human relations. The argument presented in this chapter is that participation of/dialoguing with PLHIV - a cardinal principle for social change communication - is axiological. The axiology here is twofold. Firstly, for HIV prevention to occur, it is normative for PLHIV to participate. Secondly, allowing participation of PLHIV in dialogue on HIV prevention enjoins everyone to respect, not only each other’s right to be heard but also each other’s views. In my estimation, this view about participation provides a useful starting point for theorizing HIV prevention whereby respect for the dignity of the other might serve as a mechanism for developing meaningful HIV prevention interventions involving PLHIV.
A brief highlight of the policy guidelines on participation of PLHIV here are useful in laying the context and a broader theoretical insight to the framework presented in this chapter. The two main principles: the Denver Principles of 1983 and the GIPA Principle of 1994 discussed at length in Chapter Five are the instruments guiding involvement of PLHIV. Both instruments can also be said to be axiological as they enjoin people to respect each other as humans regardless of serostatus. However, the former has an ethical and human
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responsibility emphasis and the latter adopts an individual rights approach to the HIV response.
Implied in the respective approaches of the two instruments mentioned above are two different conceptions of a human being. Consistent with its emphasis mentioned above, the Denver Principles arguably characterise humans as beings who have a responsibility to do what is ethical and to respect others.
The GIPA Principles on the other hand conceive a human being as an agent with individual rights that always need to be respected. It advocates policies to be made that do not hinder PLHIV from exercising their individual rights. This distinction will be much clearer further in this chapter when I discuss Kantian philosophy and Ubuntu as the two philosophies underlying the notion of participation. The significance of the distinction of emphasis between the Denver Principles and GIPA is fundamental in the understanding of the configuration of participation by South African PLHIV. This will provide a foundation on ways to mainstream participation of PLHIV - as human beings - in social change communication for HIV prevention in meaningful ways.
This chapter conceptualises social change communication for HIV prevention.
Dutta (2011) argues that conceptualisation of social change is integral to the ways in which we practice social change initiatives and the ways in which these initiatives are measured. In the section below, the concept of social change communication for HIV prevention is conceptualised from Dutta’s (2011) culture-centered approach to social change. It is in the culture-centered approach that both the ontological and epistemological positions of the study are rooted. The philosophy underlying two central elements underlying the social change process: dialogue and collective action are examined from the perspective of the cultural participants. Two principles guiding involvement of PLHIV, The Denver Principles, and GIPA are also viewed from the same perspective.
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Social change communication for HIV prevention
Communication for social change is generally understood as transition or change in people’s lives that occurs when the affected people take part in decision making of the change processes. Neil Ford et al., (2003) define social change communication as a process of dialogue “through which people define who they are, what they want and how they can get it” (Ford, Odallo and Chorlton, 2003: 607; also see Gray-Felder and Deane, 1999). From a culture- centered approach perspective, social change is premised on the capacity of local communities to come together as a collective and engage, through dialogue, in what Paulo Freire (1970) calls communal reflection or social praxis. According to Dutta (2011), in social change, the affected community is the locus and their collective agency to seek out spaces for transformation draws upon the cultural resources. There may be no better way of conceiving participation of PLHIV in their struggle for recognition; against social death created by HIV/AIDS-related stigma, and their contribution to HIV prevention and self-determination than through communication for social change philosophy.
What is clear in the above understanding of social change is that transformation results from communal reflection. According to Freire (1970) people converge to reflect and act upon their situation in order to transform it.
In other words people converge to discuss the problem in order to act collectively upon it. In Freirian terminology, this is called social praxis. He defines praxis as “reflection and action upon the world in order to transform it (Freire, 1970: 33). For Freire, praxis is a central defining feature of human life and a necessary condition of social change. This, Freire holds, enhances people’s capacity to be self-defining subjects by providing necessary conditions for each person to be conscious of their situation. It is only after one is conscious of their situation that they can act to transform it. The lifeblood for action/transformation here is participation in open dialogue or critical inquiry
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and analysis that seeks to reconstruct the undesired situation and transform it.
For some scholars, communitarianism has been argued to be a metatheoretical assumption underlying social change communication described above (see Dervin and Huesca, 1999). However, for the purposes of this study, communitarianism has to be construed not as Western collectivism but as African socialism or communalism espoused by African communal thinkers such as Leopold Senghor (1964). It may also be viewed in light of Kenneth Kaunda’s humanism, Julius Nyerere’s (1967) Ujamaa and Kwame Nkrumah’s (1964) Consciencism. These ideologies by African thinkers enjoin people not to be merely a collection but to depend on each other in order to safeguard and respect humanity or dignity of the other. Because of dialogue and reciprocity, the group has priority over an individual without crushing him but allowing him to blossom as a person (Senghor, 1966). This can only occur through respectful and empowering dialogue in which each other’s views are valued.
Locating ‘respect for the other’ in social change communication thus conjures elements of communalism which stipulates dialogue, reciprocity, tolerance of diversity/harmonious relationships and interdependence as normative requirements for what Leopold Senghor (1963: 4) calls “a community based society” where people conspire together, united to the very centre of their being”.
Nkrumah’s Consciencism, Senghor’s Communalism and Nyerere’s Ujamaa are all similar in that they seek to rally African colonies in their pursuit for social change; that is independence from Western hegemony. As with Freire’s (1970) dialogue for critical consciousness that takes into account the experiences of colonisation and exploitation, these philosophies were emancipatory movements with a strong orientation to affirming the dignity of the formerly colonised/oppressed by empowering people to achieve a level of critical consciousness so that they are able to recognize their situation as well as their
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own roles to transform (see Vervliet, 2009). This conjures a Marxist view of social change which, as with the structure aspect of the culture-centered approach to social change, engages with revolutionary possibilities of structural transformation in order to address material inequalities in society (Dutta, 2011). In this sense, social change is constituted in challenging the relationships that maintain the status quo. Here dialogue still plays a central role in organising the social change process.
The African thinkers’ philosophies highlighted above have often been regarded as key elements of African moral philosophy whose key principle is respect for the dignity of the other which is often achieved through dialogue and consensus. Detailed analyses of these ideologies are offered by Emmanuel Chukwudi Eze (1998), Chris Vervliet (2009), Parker English and Kibujjo Kalumba (1996) among others. In light of the foregoing, social change communication thus foregrounds the role of communication/dialogue in organising the social change process. Unlike the dominant paradigm of development which used one-way communication channels (Lerner, 1964;
Schramm, 1964) to create changes in knowledge, attitude and behaviour at an individual level (See Chapter Four), here communication is seen as an active process of meaning making through which affected communities come to understand their context and act upon them (Dutta, 2011).
Dialogue as shared space for meaning making
At the core of the culture-centered approach to social change is the idea of listening to communities at the margins, those whose voices have been erased and silenced from dominant platforms. The politics of the dialogic approach top social change lies in articulation of subaltern standpoint, hence listening to their voices offers possibilities of change as it ensures presence of their narratives in the discursive spaces where policies and decisions for the social change process are made (Dutta, 2011). This view had earlier been expressed by Brenda Dervin and Robert Huesca (1999: 170) who contend that if social
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change has to occur, ordinary human subjects, the grassroots, the oppressed
“are the most solid vessels of wisdom and knowledge concerning their situations and must be involved in planning as well as implementation process of social change”. The act of collective problem identification, decision-making, planning as well as implementation is thus a fundamental communication for social change principle (Figueroa, et al., 2002; Bessette 19996). For Freire’s (1970) liberation theology, dialogue is a catalyst for critical consciousness that is a prerequisite for one’s transformation. It brings people together and ensures widespread participation in all aspects in the public sphere in order to resolve conflict.
Dialogue is thus a cardinal principle for social change (Bessette, 1996; 2004;
Melkote and Steeves, 2001 and Servaes, 1991; Dervin and Huesca 1999) and is fundamental to the journey that humans collectively travel towards finding solutions to their problems. As Maria Elena Figueroa, et al., (2002: 17) postulate, a key characteristic of social change is “participation of those who are most affected by the problem”. Through dialogue, concerns, ideas and opinions of all the people are able to occupy space in any public discussion.
For Freire, dialogue for critical consciousness is not some kind of conversation but a social praxis that allows the oppressed to “speak a true word” and overcome their silencing (Freire, 1970). In this dialogue, the everyday language, understanding, and way of life of the concerned people must be respected so that they can more deeply express their own hopes and intentions. Here dialogue is axiological. Tolerance of diversity and respect of each other’s views is normative.
Ngaire Blankenberg (1999: 46) posits that dialogue creates relationships, and valuing of these relationships as well as each other’s opinion ensures freedom of expression which is the foundation of effective participation. While individual freedom may be interpreted in a Western liberal democracy perspective that premiums individual or freedom of the sacred self from intrusion by others, in
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most African communities a person’s freedom as depends on personal relationships with others in the community (Christians, 2004). Freedom of expression therefore means that “a community is able to freely articulate its questions and concerns” (Blankenberg, 1999:47). From an African perspective, humans are relational; they depend completely on one another for their development and one’s desire for freedom is realised to the full the more one is fully involved in community with others (Shutte, 1994). This conjures a moral value approach to communication which stipulates that communication
“begins with dialogue between people who respect each other”, a dialogue without which sustainable development becomes difficult to achieve (Ford, et al., 2003: 611).
Collective participation is, therefore, essential for human development, “for what your neighbour has to offer in terms of experiences, knowledge and ideas is essential to your own growth” (Blankenberg, 1999: 46). Here participatory communication for social change, as Blankenberg (1999) observes, resonates with African traditional open air sessions known as pungwe where all people can air their grievances, propose ideas and solutions in response to the question of 'what shall we do' that is common to African communities.
As shall be shown in this chapter, in the African thought the personal pronoun
‘I’ is always replaced by plural ‘We’ signalling an Ubuntu principle that an individual is inextricably bound to their community and is enjoined to always think of themselves as part of a group (Metz, 2007a). In the pungwe practice leadership function is shared as much as is the facilitative function in Freire’s dialogue for critical consciousness. As with Freire's (1970) dialogical process, this becomes a process of learning for both 'facilitator' and 'participant' (Blankenberg, 1999). The Freirian pedagogy contends that mere transfer of knowledge by experts or authorities to passive recipients cannot transform the latter to become a human being with an independent and critical conscience capable of influencing and changing society (Bessette 1996).
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Social change communication thus moves from a focus of informing and persuading people to change their attitudes, to focus on facilitating self- determination through dialogical and respectful communication between the concerned people to address a common problem or achieve a common goal (Dutta, 2011; Bessette 2004; Figueroa, et al., 2002). In Ubuntu normative theory for African ethics discussed later, respect, shared identity are cardinal principles that are emphasised in order to achieve harmonious relations.
Social development problems such as HIV/AIDS have demonstrated how health is linked to social, political and economic environments where issues of sex and sexuality are difficult to debate in public (Gray-Felder and Deane 1999).
This has triggered the need for a wider social and political change, a change of which to be sustainable has to emerge from all affected people within societies, acting as a collective with shared objectives. Ideally, this is what has been construed above as self-determination. Communication for social change in the context of HIV/AIDS thus entails placing emphasis on self-determination of PLHIV through peer exchanges as well as integrating expert knowledge with experiential knowledge of PLHIV among other things (Medley, et al., 2009; Ford, Odallo and Chorlton 2003). From what has been pointed out in the foregoing, for self-determination to occur, cooperation between the infected and experts demands respect for each other. For Immanuel Kant (1724-1804), a German moral philosopher, self-determinism entails respect for the other person. Kant believed that self-determination is a “basic goal that ought to be preserved out of respect for the person” (Altman, 2011: 2).
It should be noted that the underlying objective of participation is empowerment of marginalised communities who in this study are PLHIV. As discussed in the next chapter (Chapter Three), PLHIV have been dislocated in the margins of society, their voices having been erased from the dominant HIV/AIDS discourse where responses to the epidemic are planned and implemented. This violent dislocation of PLHIV through the dominant