There is evidence that Intersectionality offers a strong viewpoint through which to better understand social structures and how they influence lived experiences. As a framework of analysis, the Intersectionality Theory can be integrated into various types of research as a method for knowledge production (Dhamoon, 2011).
Fundamentally, Kimberlé Crenshaw (1989) asserts the necessity of an intersectional lens by arguing that any analysis that does not take Intersectionality into account cannot sufficiently address the way marginalised groups are subordinated. For its utility as a theoretical foundation in this study and the role that it plays in acknowledging how the intersection of identity, sexuality, race and privilege have the potential to define the way BMSM in Msunduzi Local Municipality perceive their sexual risks and define their response to HIV prevention methods such as PrEP. Intersectionality focuses its attention on the determinants of health, whilst also accounting for both between and within-group differences.
These kinds of approaches help explore the extent to which interlocking systems of oppression and privilege become embodied in health disparities (Green et al., 2017). Hence in this study, enables an analysis of how racial, gender and sexual orientation stereotypes play themselves out in health care and how this influences the decision making of BMSM regarding preventative methods.
critique of the inefficacy of anti-discriminatory laws and how they addressed the inequality experienced by American black women in the employment sector (Crenshaw, 1989). Therefore, it can be argued that a focus towards transformative ideals is inherent in the purpose of Intersectional Theory.
Thought leader in transformative research work Donna Mertens argues that the fundamental principle of transformative paradigmatic assumptions is the enhancement of social justice, the furtherance of human rights and the respect of culture (Mertens, 2010). These underlying assumptions are considered when arguing towards the transformative nature of a construct or theory. It is assumed that Intersectionality Theory is based on a transformative outlook since historically it was developed out of the need for generating better tools of analysis to interrogate the social marginalisation that black women were experiencing in the employment market. The lack of equal employment opportunities is a social issue and efforts to address this and to better understand the impediments present in these is intrinsically in tune with addressing the social justice issues of black women.
Based on the above associations, this study argues that Intersectionality can be understood as a transformative tool. This suggestion is supported by Gopaldas ( 2013), who asserts that Intersectionality research is positioned as critical and transformative because it is critical of power relations that influence social (dis)advantage or advantage of certain groups based on the conceptions of social identity constructs.
This statement mergers characteristics of Intersectionality, namely that it is part of critical race theories and that it also possesses a transformative capacity.
Furthermore, Intersectionality Theory is considered a theory that can be used to better understand and explain certain social justice issues hence fundamentally making its premise transformative. Mertens (2007) contends that transformative outlooks are imbued in the recognition that realities are constructed and shaped by social, political, cultural, economic, and racial or ethnic values which indicate that power and privilege are important determinants of social reality. Crenshaw (1991) theorises that Intersectional subordination is not intentionally produced but in fact, is frequently the consequence of the imposition of one burden that interacts with pre-existing vulnerabilities to create yet another dimension of disempowerment. Therefore, collectively, an outline can be drawn between how a transformative perspective views social reality and the establishment
of a socially unjust reality as well as how Intersectionality unpacks this reality with the intention to explain how the elements inherent in the environment intersect to define ways of being and living.
The transformative nature of Intersectionality can be applied to this study, on the basis that at its core, the study is set in the backdrop of an unequal social system and grapples with the social issue of health care for marginalised groups. This is illustrated by the inaccessibility of life-saving preventative medication for the majority of BMSM who are disproportionately affected by the HIV epidemic. This study, therefore, attempts to mitigate this by establishing the acceptability of PrEP and advise on the efficacy of an implementation programme in Msunduzi Local Municipality. Therefore, an Intersectional prism allows for the interrogation of the social constructs that influence the lived experiences of these BMSM, which would ultimately affect their decision-making process. It allows for a close analysis of BMSM who experience multi-dimensional marginalisation as part of the various identity categories which they fall into. With the intention to provide knowledge on this group and in a minor manner address the social issue at hand. Therefore, the transformative role Intersectionality can play in this study is evident.
Another transformative consideration of Intersectionality is linked to the widely held argument for the use of a Socio-Ecological Model (SEM) in collaboration with a Health Belief Model for predicting health behaviour.
There are many ways in which health behaviour can be explained either internally, such as belief, attitudes and externally which is based on the social environment. The preceding prominence of ecological models is based on the view that ecological models predict health behaviour by using both the internal and external factors and not one or the other. Explicating the socio-ecology Simons-Morton et al. (2012:42) state that it is the “study of the effect of the interrelationships of social levels behaviour and health”. They argue that personal health is influenced by an array of factors, including their cognitions, relationships with others, affiliations with organisations, politics and the economy, as well as their position within the community.” From the above definition, it is evident that the SEM seeks to understand the multiple and interrelated factors that influence individuals to do what they do, not to critique, or transform the current social systems, but merely to explicate and position the various elements according to categories. This makes the outlook of SEM quite linear and not critical.
Conversely, the Intersectionality Theory portrays, interrogates and critiques the current social identification structures that influence the marginalisation or privileges experienced by a particular group. This critique position innately adds projects of seeking to transform these structures with the idea of addressing the social injustices they perpetuate. Therefore, this study employs an Intersectional lens rather than a Socio-Ecological perspective, because it is innately based on seeking to produce knowledge that grapples with the social injustices that BMSM experience and the saliency of these issues in relation to preventative health.
Furthermore, Simons-Morton et al. (2012) argue that a socio-ecological perspective is a sound basis for predicting and changing behaviour. This study aims not to influence behavioural change but to rather access the attitudes and perceptions of BMSM towards PrEP. Therefore, an Intersectional frame allows for a comprehensive analysis, of the social identity structures rather than argue for habitual change. Finally, although the elements highlighted in the Socio-Ecology Model are closely linked to the social constructs of Intersectionality, the socio-ecological perspective aims to identify these environment-related elements and how they may influence decision making. On the other hand, the Intersectionality Theory addresses the resultant effects that these social constructs have on identification, illuminating on a multi-dimensional view of these constructs and how they intersect with each individual.