6.3 Perfecting condom use skill
6.3.1 Female condom use and transformative learning
There were examples where group members identified resistance or differential stages of understanding over the same topic. This next section provides an example of resistant learning around the topic of female condom use and also how the subsequent dialogue impacted on new meaning making. Members discriminated against the female condom due to its structure. They complained about its size that it looked too big. Most members said it was embarrassing to wear it in the presence of a sexual partner because it requires positions that are too explicit. Other members swear not to wear a female condom because it has to be supported with hands during penetration to avoid entering by its side. The feeling revealed here was that the female condom was not user friendly hence some members resisted its use. This is what Zille said:
Zille: A female condom is shameful, I personally hate it, I never found a soft spot for its use, therefore, I am the last person to advocate for its use. But I am okay with male condoms anyway.
The following discussion on the use of female condoms indicated that new learning and understanding within the group had continued in different ways, suggesting that even if one was resistant during discussion, new attitudes could materialise over time. Zille was aware that a friend of his (Dockie) in the support group had already taken a bunch of female condoms with him. He knew the friend previously had negative attitudes towards the use of female condoms.
Zille was also aware that his friend now had positive attitudes towards them and used them.
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Zille: Good members, you should be aware that simple but persistent health education changes attitudes. My friend Dockie understands all preventive measures and has adopted female condoms use so much that he always makes sure he has them with him. Right now he can show you a bunch already in his pocket.
Dockie took out female condoms from his pocket; he put them on the table for everyone to see.
His smile indicated that he felt he had made a good decision. He then said:
Dockie: I had this bundle of female condoms because I am using them in my family. You know very well that my first wife died in 2007 and it was only last year (2012) when I decided to marry another wife to help me raise my kids. You once said, ‘in HIV if one does not use ears to listen one will feel the pain on the skin (Haosa utloe ka litsebe, otla utloa ka letlalo)’. You taught me a good lesson. I once accompanied my wife for Ante- Natal Care at Mother and Child Health where I got brief education on the advantages of using a female condom. I used to hate them, but that lesson went straight to this small head. All examples from your life experiences also helped me change. I never thought I would use a condom no matter whether it was a male or a female condom. But my coming here to this support group has made me a changed person.
At this juncture, one saw an evidence of the value of the support group – as a collective, as a resource for sharing and a resource for learning through dialogue. Malpas and Lavoie (2016) highlight the benefits which the support groups gain through working together. The benefits signified positive collective impact achieved through networking and resource sharing which led to positive social change. Therefore, medical discourses could be re-stated and made more intelligible through local cultural language or images. Price (2009) indicates that efforts need to be made for individuals to understand the relationship between medical discourses and culture.
Labhardt et al. (2014), in the context of medical criticism and cultural health, argue that at times cultural efforts fail to save individuals from the slavery of illnesses, hence there is a need to emphasise the significance of seeking medical opinions when such times emerge. Dockie continued to show his appreciation to the group for being patient with him during the time when he had not understood the importance of using condoms. He acknowledged the value of their persistence in talking to him until he changed his attitudes.
Dockie: My attitudes have changed because I use to tell myself that Ministry of Health have introduced all these interventions to make us run to the hospital like babies. But
154 now I know it is to save people like myself who have already lost a wife and a kid due to my resistance to change. Most of the support group members like myself; used to claim to be a die-hard until now. Now I do not want to burn or get hurt again for losing people I love – and just look at me carrying a bunch of condoms home. I am now used to them and like them. To me it is good because I used to hate wearing a condom but with this one I do not feel that barrier which I had because it is worn by her and I never feel that distraction at all. So during sex, mine is just to work like a strong saw in the hands of a knowledgeable tree cutter. That is why I have already taken this many from the dispenser.
He sat down and they laughed, he did not mind them but busily started to collect his female condoms from the table where he had displayed them while talking and started to put them back into his pocket. By using the medical discourse of consistent female condom use, but re-wording it for his layman’s language he introduced new knowledge. Sowa (2015) argues that the use of medical discourse has been complex through-out the years. Re-wording it for layman’s language may result into a slight deviation from the original meaning. Therefore, proper networks and sources need to be used for appropriate re-wording that sustains the actual meaning.
Nevertheless, Sowa (2015) argues that rewording complex discourses for laymen’s understanding had been a brilliant strategy that shapes understanding. Such examples as those portrayed in the above examples show the powerful role that culture and language play in adult learning. Dockie’s speech was evidence of transformed learning and acquisition of a new meaning perspective. Nabb and Tann (2009) confirm that the process of transformed learning and acquisition of a new meaning perspective requires an individual to purposively question their own assumptions, beliefs, feelings and perspectives to allow for educational maturity because personally explored options for new roles, relationships, and planning a course of new actions play a pivotal role in learning. In the support group context, the collective nature of the community of practice also played a pivotal role in facilitating that process of new meaning making.
The nurse realised those improved attitudes and behaviour from the die-hard members of the support group. She felt compelled to congratulate the change of behaviour that she had observed.
She knew that if members received motivation for minor positive changes, the good behaviour would be repeated. Harrison et al. (2015) show in their study on managing unwanted behaviour, that good behaviour (minor or major) is likely to be repeated if it receives positive reinforcement.
155 Harrison et al. further indicate that a positive approach to promotion of good behaviour benefits all. The assumption for this group indicated that members would attempt to adapt and change in several other activities.
Nurse: Thank you Dockie for sharing how it feels to use female condoms. Dockie is a good example that education can influence change of attitudes from negative to positive.
Is there anybody else to share?
‘Yes!’ That was from Zaga seated next to me. The chairperson realised that Zaga was eager to share his views about condom use and gave him the platform.
Chairperson: Zaga I have observed your hand and your eagerness to share with the respective support group how you previously felt about condoms. Please continue.
Zaga was a hefty man in his early forties. He was usually very silent in the support group but always eager to go for hunting and said he enjoyed hunting tasks because it gave him exposure to how people inside and outside the group felt in relation to different health topics. Zaga stated that he had previously hated condoms and was totally against women using them, because he associated them with medical supplies given to women and children who attended monthly health services. Therefore, he previously thought encouraging condom use was belittling for him:
Zaga: I would first like to apologise to members of the support group who used to show me the benefits of using condoms. I know that I was rude when encouraged to use condoms because I never liked them and thought that being encouraged in the correct and consistence condom use was indirectly belittling me. Dockie, you have gained by your persistence in encouraging me to try condoms. These days I am confidently giving my testimony and swear by my living God that I will use male and female condoms forever. I am asking if the same support group can be formed for HIV negative individuals so that they change their negative attitudes towards condom use before any damage occurs.
In a study by Preece and Ntseane (2004), Batswana men illustrated similar feelings about condom use and it was argued that their reluctance contributed to a delay in HIV protection, thus encouraging the spread of HIV. Mazama (2008) indicates that referring to the male as ‘head of family’ was a valued slogan in most African countries which implied the family brain of a man could decide whether or not to use a condom with the spouse or a concubine. Mazama further
156 states that the phrase was commonly used in African communities in order to demonstrate the value of responsibilities and obligations that males had in families. As a result of this understanding Fletcher (2007) indicates that African women negotiating safe sex is considered a big turn off for males, in that such women are thought to be too westernised in attempting to direct males on what to do and what not to.
The nurse in that support group was highly appreciative. She encouraged participation by always motivating members for their good participation. The Nurse congratulated Dockie for being patient with Zaga until he recognised him for adopting condom use practices.
Nurse: Thank you Zaga for sharing your previous experience of female condoms. I am grateful that Dockie has done that wonderful job to educate you and encouraged you to take them for trial again. I bet you will love them like he does and next time you will share a different story. Is there anyone else to share or can I proceed?
It was evident that the sharing and dialogue amongst the group members had the effect of influencing the thinking of others in the group. Bates (2014a) indicates that working together to acquire knowledge, information and education, impacts positively on learners and leaves them empowered and confident in their own field too. In Bate’s study collaborative learners understood that knowledge was co-created and all members of the support group took part.
The nurse still felt the need to give words of encouragement to the group. After each revelation by group members she always gave a positive reinforcement to them for doing well in encouraging their support group members even outside their scheduled monthly meetings. She acknowledged the importance of their informal meetings as friends and neighbors. There was a silence, so she continued.
Nurse: I want to start by convincing you that really the female condom has improved and no longer has the distractions it had before. Nowadays it can be worn just when the couple gets into bed due to its user friendliness. Lesotho has improved condom distribution, so it is even available in all health providing institutions. I want to encourage all of you to take even just two to go and try them. Like I said, you will all like them.
Next time when you discuss this topic I want to be there to hear how it went. Give yourself a big hand for discussing condom use because if we can work hard on it, we will have reduced the spread of HIV since this is the core of prevention intervention.
157 That piece of the medical discourse she repeated several times in that support group. She consistently made the link between condom use and reduction of HIV and that almost became a
‘strap-line’ so that a message that became associated with condoms then turned into a ‘common- sense’ discourse about condoms. Fairclough (2005) argues that discourse includes language and behaviour representing attitudes, beliefs and assumptions that crystalise into rationales that people use for justifying their point of view, behaviour and attitudes. There are medical discourses, gender based discourses, political discourses, economically based discourses and culturally embedded discourses (as manifested in proverbs etc.). Fairclough argues that social change comes about through a discursive process that links personal needs and social practices to accommodate social expectations. On this aspect, the support group realised that for members to practice condom use as a foreign idea, it had to be linked with the reduction of HIV because the members had deceased friends and family members due to HIV and they realised the need to take action. When the new, legitimised common sense is adopted its existence can be sustained, such as the discourse about condom use to reduce HIV infection. The practice in Lesotho to advocate for, network about and legitimise condom use has become a new social practice, articulated as a discourse for HIV prevention.
Nurse: Therefore, we will be proud to be part of people who reduce occurrences of new HIV infections in the country.
Fairclough (2005) further talks about re-contextualising a practice. By this he means that it is possible to position new or different discourses to enable meaning making. Similarly, Laclau and Mouffe (2001) indicate that through networking, a foreign discursive substance or object can become part of new, legitimized ‘common sense’.