Towards an Ubuntu framework for mainstreaming the participation of South African people living with HIV (PLHIV) in social change communication for HIV prevention. This doctoral thesis, Transcending GIPA: Towards an Ubuntu framework for mainstreaming the participation of South African people living with HIV (PLHIV) in social change communication for HIV prevention, was carried out from February at the Center for Communication, Media and Society, University of KwaZulu-Natal. 2012 to November 2014 under the supervision of Dr. Lauren Dyll-Myklebust. This dissertation focuses on PLHIV participation in social change communication for HIV prevention, an aspect that has only recently been recognized in the HIV response.
Keywords: Ubuntu model, social change communication for HIV prevention, GIPA, participation configuration, PLHIV.
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ACKNOWLEDGEMENTS
Without the support of the Presidential Department, the work would not be possible. Christopher Mushohwe (MP), Executive Director of the Presidential Scholarship Program and also Minister of Youth Development, Indigenization and Economic Empowerment, I thank you. I would also like to acknowledge the contribution of Professor Keyan Tomaselli, especially for your critical comments and insight into this thesis.
Finally, I would like to acknowledge a very important and special person in my life, my all-weather friend and lovely fiancé Polite Masvaura for her unique support throughout this PhD journey.
INTRODUCTION
The aim is to give meaning to the philosophy on which the involvement of South African PLHIV in social change communication for HIV prevention is and should be based. It is also useful to provide a better understanding of the views of PLHIV in South Africa on their participation in social change communications for HIV prevention in the context of both the GIPA participation framework (which is global) and the social realities of South African society. epidemic. Be that as it may, the relevance of current views depends on the acceptability and effectiveness of this study's Ubuntu model for mainstreaming PLHIV participation in social change communication for HIV prevention, as articulated in Chapter Nine.
The model is derived from a systematic analysis of not only the study findings, but also the available literature on PLHIV participation in the HIV response.
CHAPTER ONE
UNAIDS, 2007) perpetuate the other side and exclusion of PLHIV from participation in the global response to HIV/AIDS. Nearly twenty years after the 1994 UN Declaration on GIPA, the participation of PLHIV in the HIV response remains a concern for many. PLHIV are an integral population in the HIV/AIDS discourse and a 'factor' whose consideration is relevant to participatory communication for HIV prevention.
This is viewed from the perspective of selected PLHIV already engaged in the HIV response in light of the letter and spirit of the Denver Principles.
CHAPTER TWO
A key argument in this thesis is that to change the course of the HIV epidemic in South Africa, effective ways are required in which PLHIV can meaningfully participate in social change communication for HIV prevention. A brief emphasis on policy guidelines on PLHIV participation here is useful in laying the context and a broader theoretical overview for the framework presented in this chapter. In the respective approaches of the two instruments mentioned above, two different concepts of a human being are implied.
It is precisely in the culture-centered approach that both the ontological and epistemological positions of the study are rooted. In light of the above, social change communication foregrounds the role of communication/dialogue in organizing the process of social change. For meaningful participation of PLHIV in communicating social change for HIV prevention to succeed in a self-sustaining manner; to borrow Tempels' (1959) phrase, "one has to work through this ontological system which is based on Bantu subjectivity".
First, Kant's importance to the broader understanding of the background to the participation of people living with HIV in the HIV response, and thus in achieving the aims of this study, cannot be completely ignored. This leads to a final but equally important practical imperative, which is the principle of goodwill autonomy. Good will should guide human action regardless of whether it belongs to the intellectual and rational world (G 2: 110).
According to Ubuntu philosophy which; without resolving the ethical identity of the individual is relational (Bujo, 2001), the achievement of the state of being human is constituted by interacting positively or harmoniously with others (Metz, 2009, Vervliet, 2009). It also inevitably led to not only the adaptation but also falsification of the principles of Ubuntu. From the preceding discussion, Ubuntu basically refers to the complementarity of the individual and the community (see Vervliet, 2009).
In view of the above caution, which for this study seems plausible, only attractive principles from both philosophies are highlighted which are considered capable of mainstreaming the participation of PLHIV in social change communication for HIV prevention, especially in contemporary sub-Saharan Africa .
CHAPTER THREE
Examining the place of PLHIV in the HIV/AIDS discourse presupposes and requires the nature of an opposing marginalization of PLHIV. Michele Foucault's understanding of how discourse produces, reinforces and exposes power is used in analyzing the politics of HIV/AIDS discourse. A historical analysis of HIV/AIDS, focusing on the presentation of those affected, is therefore imperative.
Although this story about the African origins of HIV/AIDS became a contentious topic in the HIV/AIDS debate. It is clear from the foregoing historical overview that the HIV/AIDS discourse produced in the Western world thrived on prejudice. Contrary to Western theories that say HIV/AIDS in Africa is exacerbated by sexual behavior, Mbeki blames poverty for the epidemic on the continent.
In the context of South Africa, an alternative view of HIV/AIDS is attributed to the remnants of the social and political structures of apartheid. Perhaps this can also be seen as a form of resistance to the dominant discourse on HIV/AIDS. The link between HIV/AIDS and poverty underscores President Mbeki's alternative view of HIV/AIDS.
Representations of African sexuality in Western discourse; portraying HIV/AIDS as a disease of the West caused by the immoral behavior of the West;. HIV/AIDS-related stigma and discrimination remain central to the global HIV/AIDS challenge. Addressing the challenge of stigma and discrimination associated with HIV/AIDS is therefore central to the global response to the epidemic (UNAIDS, 2010).
What is perhaps relevant for interrogation is the implication of the preceding presentation of PLHIV in the Western, the African as well as Mbeki's alternative view of HIV/AIDS to the HIV response.
CHAPTER FOUR
Kenneth H Mayer et al. (2010) describe a biomedical perspective on factors associated with increased transmission rates. In the hope that a cure or vaccine would be discovered, the initial response to HIV/AIDS was entirely the responsibility of biomedical researchers (Mulwo et al., 2012: 4). These guidelines also advocate a strategy that institutionalizes circumcision of newborns and young adults (Kelly et al., 2012).
In the former, ART acts as pre-exposure prophylaxis while in the latter it is used as post-exposure prophylaxis (PEP) (Mayer, et al., 2010). Protection may be possible if antiretroviral drugs are taken before a high-risk exposure (Mayer, et al., 2010). PEP consists of one dose of antiretroviral therapy administered within 72 hours of a potential exposure to HIV (Collings, et al., 2008).
These can be individuals, couples, families, peer groups or networks, institutions and entire communities (Coates, et al., 2008). These may include educational, motivational approaches, peer group approaches, skill building approaches and community normative approaches (Coates, et al., 2008). HIV prevention generally refers to protecting individuals from becoming infected with HIV (Gilliam and Straub, 2009; Coates, et al., 2008).
The role of communication or education in behavioral and social change interventions thus becomes apparent (see Coates et al., 2008). Considering health in an ecological context is exemplified in the Social Ecology Model of Communication and Health Behavior (SEMCHB) (Kincaid et al., 2007). These may be physical, cultural, social, community, economic, legal, or other political features of the environment that affect the risk of HIV infection (Kelly et al., 2012).
Thus, progress in incorporating structural approaches into HIV prevention has been limited (Gupta, et al., 2008).
CHAPTER FIVE
The important contribution of people living with HIV to the response to the epidemic must be recognized and strengthened. The aspect of responsibility shown in the above study refers to the Denver Principles, which declare the ethical responsibility of people living with HIV to respect others. The Denver Principles, discussed later in this chapter, remain the foundational principle that informs PLHIV participation in the HIV response.
While the involvement of PLHIV in the HIV response is largely informed by the Paris Declaration, commonly known as GIPA, there are many declarations and political commitments on the involvement of PLHIV, (see the African Union Commission (AUC) and UNAIDS declarations and commitments on HIV/AIDS 1987-2007). It is one of the tasks of this study to investigate how and where PLMIV is involved in the HIV response in South Africa. The study investigated the extent to which PLMIV was involved in the design and planning of the national HIV/AIDS strategic framework (Stephens, 2004).
Problems that characterize GIPA are therefore not only in the lack of involvement of PLHIV, but also in the involvement process itself. Many factors have been offered to explain low levels of engagement prevailing in the global response to HIV/AIDS. What is not addressed (although very important in the political economy of HIV transmission) is the participation of PLHIV in enacting agency, as envisioned in the Denver Principles, in HIV prevention.
CDC's successful implementation of the SAFE approach in the United States (Wingwood, 2000) and encouraging results from positive preventive behavioral interventions in developing countries testify to this (Kennedy, et al., 2010). Successive interventions tailored to the particular needs and circumstances of PLHIV to prevent HIV transmission in the United States include Seth Kalichman (2001) and Mary Jane Rotheram - Borus (2001).
