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Coexisting discourses: how rural older women in South Africa make sense of the AIDS epidemic UCT Institute of Ageing in Africa July 2008 Enid Schatz, University.

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Presentation on theme: "Coexisting discourses: how rural older women in South Africa make sense of the AIDS epidemic UCT Institute of Ageing in Africa July 2008 Enid Schatz, University."— Presentation transcript:

1 Coexisting discourses: how rural older women in South Africa make sense of the AIDS epidemic UCT Institute of Ageing in Africa July 2008 Enid Schatz, University of Missouri Courtney McDonald, University of Colorado

2 Talking about AIDS This paper questions our assumptions about how much older persons know about AIDS and the ways in which they talk about it Turn to “local discourses” to: Reveal ways older women define and discuss AIDS Explain the origins and existence of AIDS Place blame on certain social groups Shape individuals’ behaviors

3 Local Discourses Construct framework that explains AIDS epidemic within local context and local notions of disease Influenced by economic, social, and political factors Must recognize that local discourses shift and grow May present barriers to biomedical-based prevention programs because at times local discourses challenge/contradict messages Prevention programs must recognize, incorporate or address local discourses

4 Gogo Project Focus on social implications of AIDS for older women Agincourt Health and Demographic Surveillance System census data as sampling frame Annual census update since 1992 Mpumalanga Province, near Mozambican border ~20% of adult deaths from AIDS Life expectancy at birth ~63 Sample (collected June-Dec 2004) 60 Women aged 60-75 30 Mozambicans 30 South Africans

5 Research Design Each group stratified by Verbal Autopsies (2001-03): Households with an HIV/AIDS death Households with another type of adult death Households with no adult death Random selection of households within strata 3 local interviewers conducted 3 semi-structured interviews with each respondent In local language Recorded interviews Fully translated/transcribed Read each interview before next interview to help fill in gaps and pursue new emergent themes

6 Analysis Coded in Nvivo Identified biomedical and local discourses of AIDS Counted the frequency/overlap of each type of construction Analyzed all 60 respondents together No real differences in responses among Mozambicans/South Africans, or 3 strata of households Pervasiveness of AIDS in area means everyone is talking about AIDS, and most older people are affected in some way Mozambicans and South Africans both living in area since AIDS became relevant; similar discourse about it

7 Results Elderly women use variety of discourses Biomedical-based information: Sexually transmitted ABCs: Abstinence, Be Faithful, use Condoms Local constructions of the disease based on: Traditional notions of origin of illness Sexual immorality Assault to traditional values Racial tensions Two types at times contradict and challenge one another, but without troubling respondents

8 Knowledge of biomedical- based discourse Majority mentioned sexual intercourse as a route of transmission of HIV/AIDS 2 never mentioned 1 mentioned, but doubted was true 3 mentioned, but confused how: more polygyny and less condom use in past, but no AIDS then Even if didn’t fully believe, used discourse to counsel children/grandchildren how to behave 51 of 60 mentioned ABCs of prevention 48 of 60 said there is no cure for AIDS

9 Competing/coexisting discourses? No cure, but… 2 said SA gov’t knows cure but not sharing 6 said whites have cure but refuse to give to blacks 9 said sangoma/inyanga can cure AIDS seen by respondents as purview of inyanga because AIDS is constructed as both new biomedical disease and disease that could be caused by jealousy/witchcraft One respondent told story of own kin cured Discourses contradict authority of biomedical establishment, but are held simultaneously with notion that ABCs best way to avoid HIV/AIDS

10 Justifying contradiction 6 of 9 both said “no cure, if you are infected, you will die” and traditional healers can cure AIDS But also believe SA government prevents traditional healers from doing all they can do: “I think HIV/AIDS can be treated by traditional healers but the problem is that the government doesn’t allow them to go to the forest and look for medicine. If they can give them chance to treat people who are HIV- positive, they will cure them.” (Alicia)

11 Sexual Immortality & Othering Blaming AIDS on sexual immortality and loss of traditional values of certain groups Rules of sexual relationships and gender roles determine who is ‘other’ Female prostitutes, men, people in city, adolescents and foreigners Allows respondents to blame ‘others’ while continuing to believe and promote ABC prevention strategies for own kin

12 ‘Others’ 27 of 60 claim that AIDS comes from prostitutes Broad notion of category of “prostitute” 5 of 60 blamed men Men go to cities, have sex with prostitutes, bring disease home 19 of 60 blamed city life and/or mines Majority blamed prostitutes who live there 8 of 60 blamed foreigners Foreign men infect South African women 26 of 60 uneasy about promiscuity of adolescents Early sexual intercourse=erosion of traditional values

13 Breaking Rules Modernity and gender roles The reason [women have many boyfriends] is that they think that they will get money and with that money they buy trousers that make them prostitutes…They know that if they have trousers and put them on, they will get many boyfriends, meanwhile they will get AIDS. (Emelda) Many worried that own children and grandchildren would become infected because sexually active outside marriage Discourse of rules and traditional values didn’t override belief that AIDS is spread by having sex with someone already infected

14 Return to traditional values Reported worry that young people no longer listen to or respect elders (14 of 60) “Nowadays our children don’t listen to us…Just because they don’t listen to us that makes our children cause a lot of AIDS.” (Abigail) “I don’t believe in AIDS. What is happening now is that children are dying because they don’t follow instruction or rules of our culture. Because when someone dies in a family, they give that family laws or rules to obey. If they fail to obey the instruction, they would become sick and doctors would not know [how] to cure the disease. If the doctors see that they don’t know how to cure the disease, they say it’s AIDS.” (Mumsy) To halt AIDS epidemic need to return to traditional values

15 Racial Tension & Slow Poison Non-biomedical explanations were common along side issues related to sex Believe AIDS exists, but 28 of 60 blamed whites for either causing AIDS or refusing to cure it Most common theory AIDS white conspiracy, put in food, meant to reduce blacks’ political expression Beliefs reflect socio-political context of lives

16 Well articulated theories Political motivation I think it is from the whites who put poison in the mealie- meal…Because the whites are worried. They say we blacks are more than them. And that’s why they do this to us. They want to eliminate us so that next time when we vote we must not vote in large numbers. Then they will win back this land. (Pearl) Whites avoid AIDS by buying more expensive food or having access to medicine to prevent infection These whites are too clever. They don’t buy the same mealie- meal and the same sugar we [are] use[d] to buy[ing]. They buy the very expensive one, [in] which they know that there is no poison. And they know that we are too poor. We can’t afford to buy it. They put poison in cheap mealie-meal. (Ethel)

17 Discussion Co-existence of biomedical and local discourses most interesting Trying to make sense of epidemic using variety of sources of knowledge Not phased by potential contradictions/challenges within held beliefs Use different discourses in response to different questions, or under different circumstances Use both discourses to warn and advise children and grandchildren, but with more emphasis on sexual transmission and ABCs

18 Policy implications/questions Programs must recognize these coexisting beliefs, many of which are based on local social, cultural and political beliefs/experience Older women employ biomedical discourse, but just as readily turn to local discourses -- does this have to be problematic? Prevention is currently based solely on biomedical -- can programs make use of both discourses? Older women are already advising young people on their behavior -- can programs employ older women as means of reaching young people?

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