Finally, Edberg (2015) postulates that when exploring the utility of HBM, it is not always clear how all six HBM constructs influence changes in behaviour. Most health research use HBM certain of the constructs but not all of them at once, casting a light of apprehension on the utility of the entire model in predicting behaviour change. This apprehension is supported by Simons-Morton,McLeroy, and Wendel (2012) who argue that the HBM in its entirety with all its constructs has been poorly, inadequately and inappropriately applied to health research settings. This has only perceived susceptibility and severity being accessed in some instances, leaving out the rest of the constructs of the HBM. This form of methodological inconsistency casts doubt on the applicability of the HBM as a comprehensive model for predicting health behaviour.
In response to the above, this study responds to the above criticism by firstly testing the utility of the various constructs of the model while suggesting new ways of addressing “developmental” cues such as communication discussed above. Furthermore, it addresses the prediction of the health behaviour amongst MSM a key population that is disproportionately affected by HIV with a paucity of recent research that uses the HBM as a lens to reflect on the behaviour of MSM and the decisions on whether to take up PrEP.
visible the multiple positions of an individual that constitute their everyday life, accentuating the power relations that are central to this lived experience. Nash (2008) argues that the Intersectionality Theory emerged as a theoretical tool designed to combat feminist hierarchy, hegemony and exclusivity. A comprehensive and accessible definition for the tenets of intersectionality is presented by Garry (2011: 827) who argues that;
Oppression and privilege by race, ethnicity and gender, sexual orientation, class, nationality and so on do not act independently of each other. In our individual lives or in our social structures; instead, each kind of oppression or privilege is shaped by and work through the others. These compounded, intermeshed systems of oppression and privilege in our social structure helps to produce (a) our social relations, (b) our experiences of our own identity and (c) the limitations of shared interests even among the member of the "same" oppressed or privileged group.
Therefore, it is evident why intersectionality is sometimes simultaneously regarded as “crossroads” or a dynamic process that is context specific and considers time and location when understanding the proliferation of intersectional issues that individuals experience.
Over the past two decades, intersectionality has become a foundational concept for understanding society and sociological constructs. Its increased popularity is based on the fact that it offers new frames for exploring the social injustices that characterise the everyday lives of individuals. As a theory reliant on the use of new frames of understanding issues. Crenshaw (2018) asserts that Intersectionality Theory challenges against conventional ways of thinking. It requires us to unearth and reconfigure the singular lens or frame or form of thinking used to explore the varied issues of race, sexuality and gender. At its core, it necessitates that new ways of thinking are uncovered to reflect on the multiple characteristics that define the lived experiences of individuals. From the above, what is evident is that Kimberlé Crenshaw problematises a single axis of viewing the world, but rather encourages a multi-dimensional axis of exploration (Crenshaw, 2018). In her 1989 seminal article, she contends that single-axis analysis distorts the multi-dimensional nature of the marginalised group or individuals’ experiences (Crenshaw, 1989). With developments in the theory supporting this and arguing that theoretically, Intersectionality disputes the essentialist view, that it is a single characteristic
(race, class, or gender) that defines the inclusion of one in the group but rather propagates that there is diversity within groups (Hancock, 2007). An example could be college students, although there is an urge is to delineate themas only being students. Whereas, the group is extremely diverse, with different genders, races, ages, sexual orientations, social economic status (SES), and able and disabled individuals. Therefore, above remark about diversity by Hancock (2007) emphasises the impracticality of using a single frame of analysis to understand a category and subtly encourages for a multi-dimensional frame that will assist in accounting for the differences and how all these intersect to create the diverse group.
In a recent interview, Kimberlé Crenshaw asserts that “you cannot understand progressive outcomes without understanding how they come about” (Crenshaw, 2018). Considering this study, this statement by Crenshaw propagates how an intersectional prism can lead to a better understanding of how certain factors intersect to illuminate what informs certain health-seeking behaviours and preferences for preventative methods. As demonstrated in the literature review, this study’s exploration of perceptions and attitudes of BMSM toward PrEP cannot be competently executed without acknowledging the marginalisation that BMSM experience. Marginalisation disproportionately places BMSM at higher-risk of HIV infection. Therefore, Intersectionality Theory proposes to interrogate the various constructs of this marginalisation from a multi-dimensional perspective. This involves explorations not based on race, class, or gender but a more fluid exploration that examines how these various constructs intersect.
Underscoring the focus on a multi-dimensional view, Nash (2008) asserts that Intersectionality subverts binaries in the service of theorising identity in a more complex manner. Therefore, a single axis view of the marginalisation of BMSM would presuppose that they are marginalised because of their same-sex desire while the Intersectionality theory uses a more exhaustive and multi-dimensional approach that interrogates, racial, gendered, social, economic and political constructs that intersect to maintain this marginalisation.
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.