Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa


Autoři: Catherine MacPhail aff001;  Nomhle Khoza aff002;  Sarah Treves-Kagan aff005;  Amanda Selin aff006;  Xavier Gómez-Olivé aff003;  Dean Peacock aff008;  Dumisani Rebombo aff008;  Rhian Twine aff003;  Suzanne Maman aff009;  Kathleen Kahn aff003;  Stephanie M. DeLong aff011;  Lauren M. Hill aff009;  Sheri A. Lippman aff003;  Audrey Pettifor aff003
Působiště autorů: School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia aff001;  Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff002;  MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff003;  STRIVE Research Programme Consortium, London School of Hygiene and Tropical Medicine, London, England, United Kingdom aff004;  Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America aff005;  Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff006;  INDEPTH Network, Accra, Ghana aff007;  Sonke Gender Justice, Cape Town, South Africa aff008;  Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America aff009;  Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden aff010;  Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America aff011
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225694

Souhrn

Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the ‘One Man Can’ intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and community members (n = 52) to explore their experience of being part of the intervention and their experiences of change associated with the intervention. The objective of the study was to examine processes of change in community mobilization for gender equity and HIV prevention. Our analysis showed that over time, participants referred to three key elements of their engagement with the intervention: developing respect for others; inter-personal communication; and empathy. These elements were viewed as assisting them in adopting a ‘better life’ and associated with behaviour change in the intervention’s main focus areas of promoting gender equality and HIV risk reduction behaviours. We discuss how these concepts relate to the essential domains contained within our theoretical framework of community mobilization—specifically critical consciousness, shared concerns and social cohesion -, as demonstrated in this community. We interpret the focus on these key elements as significant indicators of communities engaging with the community mobilization process and initiating movement towards structural changes for HIV prevention.

Klíčová slova:

Behavior – Consciousness – HIV prevention – Human families – Human learning – Sexual and gender issues – Social communication


Zdroje

1. Courtenay WH. Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Social Science and Medicine. 2000;50:1385–401. doi: 10.1016/s0277-9536(99)00390-1 10741575

2. Peralta RL, Tuttle LA, Steele JL. At the intersection of interpersonal violence, masculinity, and alcohol use: the experiences of heterosexual male perpetrators of intimate partner violence. Violence Against Women. 2010;16(4):387–409. doi: 10.1177/1077801210363539 20200407

3. Jewkes R, Morrell R. Hegemonic Masculinity, Violence, and Gender Equality: Using Latent Class Analysis to Investigate the Origins and Correlates of Differences between Men. 2018. p. 547–71.

4. Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society. 2010;13:6. doi: 10.1186/1758-2652-13-6 20181124

5. Greig A, Peacock D, Jewkes R, Msimang S. Gender and AIDS: time to act. AIDS. 2008;22(Suppl 2):s35–s43.

6. Skovdal M, Campbell C, Madanhire C, Mupambireyi Z, Nyamukapa C, Gregson S. Masculinity as a barrier to men's use of HIV services in Zimbabwe. Globalization and Health. 2011;7:13. doi: 10.1186/1744-8603-7-13 21575149

7. Pulerwitz J, Michaelis A, Verma R, Weiss E. Addressing Gender Dynamics and Engaging Men in HIV Programs: Lessons Learned from Horizons Research. Public Health Reports. 2010;125(2):282–92. doi: 10.1177/003335491012500219 20297757

8. Siu GE, Seeley J, Wight D. Dividuality, masculine respectability and reputation: how masculinity affects men's uptake of HIV treatment in rural eastern Uganda. Social Science and Medicine. 2013;89:42–52.

9. Gottert A, Barrington C, Luz McNaughton-Reyes H, Maman S, MacPhail C, Lippman S, et al. Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa. AIDS and behavior. 2017. doi: 10.1007/s10461-017-1706-9 28161801

10. Pitpitan E, Kalichman S, Eaton L, Cain D, Sikkema K, Skinner D, et al. Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa. Journal of Behavioral Medicine. 2013;36(3):295–304. doi: 10.1007/s10865-012-9423-3 22526526.

11. Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol Use and Sexual Risks for HIV/AIDS in Sub-Saharan Africa: Systematic Review of Empirical Findings. Prev Sci. 2007;8(2):141–51. doi: 10.1007/s11121-006-0061-2 17265194

12. Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: directions for future research and interventions. Social Science & Medicine. 2000;50(4):459–78. http://dx.doi.org/10.1016/S0277-9536(99)00270-1.

13. The Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017 [Internet]. Pretoria: Human Sciences Research Council; 2018; July, 2018

14. Morrell R, Jewkes R. Carework and caring: a path to gender equaitable practices among men in South Africa? International Journal of Equity Health [Internet]. 2011; 10:[17 p.].

15. Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E, et al. Towards an improved investment approach for an effective response to HIV/AIDS. The Lancet. 2011;377(9782):2031–41. http://dx.doi.org/10.1016/S0140-6736(11)60702-2.

16. UNAIDS. A New Investment Framework for the Global HIV Response. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011.

17. Coates T, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. The Lancet. 2008;372(9639):669–83.

18. Rao Gupta G, Parkhurst J, Ogden J, Aggleton P, Mahal A. HIV Prevention 4: Structural approaches to HIV prevention. The lancet. 2008;372(9640):764–75.

19. Anderson A, Stern E, Mokganyetji T, Rebombo D, MacPhail C, Khoza N, et al. The "One Man Can'' model: community mobilization as an approach to promote gender equality and reduce HIV vulnerability in South Africa. 2016.

20. Jana S, Basu I, Rotheram-Borus MJ, Newman P. The Sonagachi Project: a sustainable community intervention program. AIDS Education and Prevention. 2004;16(5):405–14. doi: 10.1521/aeap.16.5.405.48734 15491952

21. Kegeles SM, Hays RB, Pollack LM, Coates TJ. Mobilizing young gay and bisexual men for HIV prevention: a two-community study. AIDS. 1999;13:1753–62. doi: 10.1097/00002030-199909100-00020 10509578

22. Lippman S, Chinaglia M, Donini AA, Diaz J, Reingold A, Kerrigan DL. Findings from Encontros: a multilevel STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil. Sexually Transmitted Diseases. 2012;39:209–16. doi: 10.1097/OLQ.0b013e31823b1937 22337108

23. Reza-Paul S, Beattie T, Syed H, Venukumar K, Venugopal M, Fathima M, et al. Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention among female sex workers in Mysore, India. AIDS. 2008;22(Suppl 5):S91–100.

24. Ramesh BM, Beattie TSH, Shajy I, Washington R, Jagannathan L, Reza-Paul S, et al. Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, south India. Sexually Transmitted Infections. 2010;86(Suppl 1):i17–i24. doi: 10.1136/sti.2009.038513 20167725

25. Sweat M, Morin S, Celentano D, Mulawa M, Singh B, Mbwambo J, et al. Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infectious Disease. 2011;11:525–32. doi: 10.1016/S1473-3099(11)70060-3 21546309

26. Lippman SA, Neilands TB, MacPhail C, Peacock D, Maman S, Rebombo D, et al. Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017;74:S44–S51. doi: 10.1097/QAI.0000000000001207 27930611

27. Lippman SA, Maman S, MacPhail C, Twine R, Peacock D, Kahn K, et al. Conceptualizing community mobilization for HIV prevention: implications for HIV prevention programming in the African context. PLoS One. 2013;9(10):e78208.

28. Sonke Gender Justice. Sonke Gender Justice no date [cited 2019 20 June]. https://genderjustice.org.za/.

29. Peacock D. South Africa's Sonke Gender Justice Network: Educating men for gender equality. Agenda: Empowering women for gender equality. 2013. doi: 10.1080/10130950.2013.808793

30. Pettifor A, Lippman S, Selin A, Peacock D, Gottert A, Maman S, et al. A cluster randomized-controlled trial of a community mobilization intervention to change gender norms and reduce HIV risk in rural South Africa: study design and intervention. BMC Public Health. 2015;15:752. doi: 10.1186/s12889-015-2048-z 26245910

31. Pettifor A, Lippman S, Gottert A, Suchindran C, Selin A, Peacock D, et al. Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa. Journal of the International AIDS Society. 2018;21(7):e25134. doi: 10.1002/jia2.25134 29972287

32. Pettifor A, Lippman S, Selin A, Peacock D, Gottert A, Maman S, et al. A cluster randomized-controlled trial of a community mobilization intervention to change gender norms and reduce HIV risk in rural South Africa: study design and intervention. BMC Public Health. 2015;15:752. doi: 10.1186/s12889-015-2048-z 26245910

33. Gómez-Olivé F, Angotti N, Houle B, Klipstein-Grisbusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122–8. doi: 10.1080/09540121.2012.750710 23311396

34. Ritchie J, Lewis J, McNaughton-Nicholls C, Ormston R. Qualitative Research Practice: A guide for social science students and researchers. London: Sage; 2014.

35. Thomson R, Holland J. Hindsight, foresight and insight: the challenges of longitudinal qualitative research. International Journal of Social Research Methodology. 2003;6(3):233–44.

36. Pope S, Ziebland S, Mays N. Qualitative research in health care: analysis of qualitative data. British Medical Journal. 2000;320:114–6. doi: 10.1136/bmj.320.7227.114 10625273

37. MacPhail C, Khoza N, Abler L, Ranganathan M. Process guidelines for establishing Intercoder Reliability in qualitative studies. Qualitative Research [Internet]. 2015:[1–5 pp.].

38. Grossoehme D, Lipstein E. Analyzing longitudinal qualitative data: the application of trajectory and recurrent cross-sectional approaches. BMC Research Notes. 2016;9(1):136. doi: 10.1186/s13104-016-1954-1 26936266

39. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–57. doi: 10.1093/intqhc/mzm042 17872937

40. Lippman S, Neilands TB, Leslie HH, Maman S, MacPhail C, Twine R, et al. Development, validation, and performance of a scale to measure community mobilization. Social Science & Medicine. 2016;157:127–37. doi: 10.1016/j.socscimed.2016.04.002 27085071

41. Gibbs A, Jewkes R, Sikweyiya Y, Willan S. Reconstructing masculinity? A qualitative evaluation of the Stepping Stones and Creating Futures interventions in urban informal settlements in South Africa. Culture, Health & Sexuality. 2015;17(2):208–22. doi: 10.1080/13691058.2014.966150

42. Starmann E, Collumbien M, Kyegombe N, Devries K, Michau L, Musuya T, et al. Exploring Couples’ Processes of Change in the Context of SASA!, a Violence Against Women and HIV Prevention Intervention in Uganda. Prev Sci. 2017;18(2):233–44. doi: 10.1007/s11121-016-0716-6 27682273

43. Ruthig JC, Kehn A, Gamblin BW, Vanderzanden K, Jones K. When Women’s Gains Equal Men’s Losses: Predicting a Zero-Sum Perspective of Gender Status. Sex Roles. 2017;76(1):17–26. doi: 10.1007/s11199-016-0651-9

44. Viitanen AP, Colvin CJ. Lessons learned: program messaging in gender-transformative work with men and boys in South Africa. Global Health Action [Internet]. 2015; 8.

45. Dworkin SL, Colvin CJ, Hatcher AM, Peacock D. Men's perceptions of women's rights and changing gender relations in South Africa: lessons from working with me nand boys in HIV and antiviolence programs. Gender and Society. 2012;26(1):97–120.

46. Sideris T. “You have to change and you don't know how!”: Contesting what it means to be a man in a rural area of South Africa. African Studies. 2004;63(1):29–49. doi: 10.1080/0002018042000226148

47. Ratele K. Gender equality in the abstract and practice. Men and Masculinities. 2014;17(5):510–4.

48. O'Sullivan LF, Harrison A, Morrell R, Monroe-Wise A, Kubeka M. Gender Dynamics in the Primary Sexual Relationships of Young Rural South African Women and Men. 2006:99.

49. Albertyn C. Contesting Democracy: HIV/AIDS and the Achievement of Gender Equality in South Africa. Feminist Studies. 2003;29(3):595–615.

50. Campbell C, Cornish F. Towards a "fourth generation" of approaches to HIV/AIDS management: creating contexts for effective community mobilisation. AIDS Care. 2010;22(s2):1569–79.

51. Peltzer K, Parker W, Mabaso M, Makonko E, Zuma K, Ramlagan S. Impact of National HIV and AIDS Communication Campaigns in South Africa to Reduce HIV Risk Behaviour. The Scientific World Journal. 2012;2012:6. doi: 10.1100/2012/384608 23213285

52. Pettifor A, Rees H, Kleinschmidt I, Steffenson A, MacPhail C, Hlongwa-Madikizela L, et al. Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19:1525–34. doi: 10.1097/01.aids.0000183129.16830.06 16135907

53. van der Straten A, King R, Grinstead O, Serufilira A, Allen S. Couple communication, sexual coercion, and HIV risk reduction in Kigali, Rwanda. AIDS. 1995;9(8):935–44. doi: 10.1097/00002030-199508000-00016 7576330

54. Noar SM, Carlyle K, Cole C. Why Communication Is Crucial: Meta-Analysis of the Relationship Between Safer Sexual Communication and Condom Use. Journal of Health Communication. 2006;11(4):365–90. doi: 10.1080/10810730600671862 16720536

55. Vamos S, Cook R, Chitalu N, Mumbi M, Weiss SM, Jones D. Quality of relationship and sexual risk behaviors among HIV couples in Lusaka, Zambia. AIDS Care. 2013;25(9):1102–8. doi: 10.1080/09540121.2012.749339 23336258

56. Pettifor A, MacPhail C, Nguyen N, Rosenberg M, Parker L, Sibeko J. Feasibility and acceptability of Project Connect: A couples-based HIV-risk reduction intervention among young couples in Johannesburg, South Africa. AIDS Care. 2014;26(4):476–82. doi: 10.1080/09540121.2013.841827 24116954

57. Fonner VA, Kerrigan DL, Mnisi Z, Ketende S, Kennedy CE, Baral S. Social Cohesion, Social Participation, and HIV Related Risk among Female Sex Workers in Swaziland. PLOS ONE. 2014;9(1):e87527. doi: 10.1371/journal.pone.0087527 24498125

58. Kerrigan D, Kennedy CE, Morgan-Thomas R, Reza-Paul S, Mwangi P, Win K, et al. Series: A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. The Lancet. 2015;385:172–85. doi: 10.1016/S0140-6736(14)60973-9

59. Sampson RJ. The neighborhood context of well-being. Perspect Biol Med. 2003;46(3 Suppl):S53–64. 14563074.

60. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277(5328):918–24. doi: 10.1126/science.277.5328.918 9252316.

61. Hawkins AJ, Christiansen SL, Sargent K, Hill EJ. Rethinking Fathers' Involvement in Child Care: A Developmental Perspective. Journal of Family Issues. 1993;14(4):531–49. doi: 10.1177/019251393014004004

62. Lohan M. Extending feminist methodologies: Researching masculinities and technologies. In: Bryne A, Lentin R, editors. (Re)searching Women. Dublin: IPA; 2000. p. 167–87.


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2019 Číslo 12