Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014

• Type of Material: Article
• Authors: Kate Winskell Enger, Emory University; Robyn Singleton, Emory University; Gaelle Sabben, Emory University; Georges Tiendrebeogo, Fondation Bouisson Bertrand; Chris Obong'o, University of Memphis; Fatim Louise Dia, Emory University; Siphiwe Nkambule-Vilakati, Super Buddies Club; Benjamin Mbakwem, Community and Youth Development Initiatives; Robert Stephenson, Emory University
• Language: English
• Date: 2020-03-06
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Winskell et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0227878
• Title of Journal or Parent Work: PLOS ONE
• Volume: 15
• Issue: 3
• Start Page: e0227878
• End Page: e0227878
• Grant/Funding Information: This research was also supported by the Emory Center for AIDS Research (P30 AI050409) and the Mellon Foundation.; Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD085877 (PI: Winskell).
• Keywords: SOUTH-AFRICA; BEHAVIOR; Science & Technology - Other Topics; Multidisciplinary Sciences; PERCEPTIONS; HEALTH; Science & Technology
• Research Categories: Health Sciences, Public Health

Abstract

HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre- and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma.