Reframing ABC prevention: the value of ethnographic research in creating culturally relevant HIV programs in Belize
DOI:
https://doi.org/10.15173/nexus.v25i0.1585Keywords:
Belize, Africa, HIV, Prevention, ABC, Culture, CulturalAbstract
Since its emergence in 1983, public health professionals have been working to effectively prevent the transmission of HIV. The ABC method or prevention, referring to promotion of abstinence, condoms and being faithful, has been employed extensively throughout sub-Saharan Africa. Contrastingly, the Belizean epidemic has received very little attention from ABC researchers. Although some research exists looking into the determinants of sexual HIV transmission in Belize, very little is understood about the cultural norms that perpetuate these factors. In order to make recommendations for the efficient implementation of ABC programs in Belize, case studies from Botswana, Zaire and Uganda will be used to review past experiences of ABC in Africa, and identify the cultural challenges faced in their implementation. Case studies found that programs that relied heavily on abstinence and condom promotion did not work well in these contexts due to opposing views of sexuality, while balanced programs that emphasized being faithful were more successful within these cultures. Ethnographic research is needed to fill knowledge gaps regarding Belizean sexuality. Namely, future research should seek to understand the male view of sexuality in particular, as well as differences in generational views of sex. Public health workers should also aim to create programs that engage the community in order to build trust, as well as understand the role of community leaders and celebrities in influencing local views of sex. These insights provide future researchers a starting point for building effective ABC programs that work within the given culture rather than against it.
References
Buszin, J., Nieto-Andrade, B., Rivas, J., & Longfield, K. (2012). Multiple partnerships and risk for HIV among the Garífuna minority population in Belize. Health, 4(8), pp.474-482.
Carrier, J., & Bolton, R. (1991). Anthropological Perspectives on Sexuality and HIV Prevention. Annual Review of Sex Research, 2(1), pp.49-75.
Crawford, D. (2007). Deadly Companions (p. 187). New York: Oxford University Press.
Farmer, P. (1992). New disorder, old dilemmas: AIDS and anthropology in Haiti. In G. Herdt & S. Lindenbaum (Eds.), The time of AIDS: social analysis, theory, and method (287-318). Newbury Park, California: Sage Publications.
Green, E., Halperin, D., Nantulya, V. & Hogle, J. (2006). Uganda’s HIV Prevention Success: The Role of Sexual Behavior Change and the National Response. AIDS and Behaviour, 10(4), pp.335-346.
Huedo-Medina, T., Boynton, M., Warren, M., LaCroix, J., Carey, M. & Johnson, B. (2010). Efficacy of HIV Prevention Interventions in Latin American and Caribbean Nations, 1995–2008: A Meta-Analysis. AIDS and Behaviour, 14, pp.1237–1251.
Kane, S. (1990). Reconceptualizing "risk groups" in AIDS intervention: An analysis of prostitution and the military in Belize. Paper presented at the annual meeting of the American Anthropological Association, New Orleans.
Leclerc-Madlala, S. (2009). Cultural scripts for multiple and concurrent partnerships in southern Africa: why HIV prevention needs anthropology. Sexual Health, 6, 103- 110.
Murphey, E., Greene, M., Mihailovic, A. & Olupot-Olupot, P. (2006). Was the “ABC” Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda’s Decline in HIV?. PLoS Medicine, 3(9), p.e379.
Parker, R. (2001). Sexuality, Culture, and Power in HIV/AIDS Research. Annual Review of Anthropology, 30, pp.163-179.
Potts, M., Halperin, D., Kirby, D., Swidler, A., Marseille, E., Klausner, J., Heasrt, N., Wamai, R., Kahn, J. & Walsh, J. (2008). Rethinking HIV Prevention: Public Health. Science, 320(5877), pp.749-750.
Shelton, J., Halperin, D., Nantulya, V., Potts, M., Gayle, H. & Holmes, K. (2004). Partner reduction is crucial for balanced “ABC” approach to HIV prevention. BMJ, 328, pp.891-893.
Schoepf, B. (1988). Women, AIDS, and economic crisis in central Africa. Canadian Journal of African Studies, 22, 625-644.
Su, Y. (2010). The failure of the American ABC HIV prevention model in Botswana. SURG, [online] 4(1). Available at: https://journal.lib.uoguelph.ca/index.php/surg/article/view/1278/1812 [Accessed 4 Oct. 2017].
Vu, L. (2014). Effectiveness of Behavior Change Communications for Reducing Transmission Risks Among People Living with HIV in 6 Countries in Central America. AIDS and Behaviour, published online.
Wilson, D. & Halperin, D. (2008). “Know your epidemic, know your response”: a useful approach, if we get it right. The Lancet, 372, pp.423-426.
UNAIDS. (2017). Belize. Unaids.org. Retrieved 25 October 2017, from http://www.unaids.org/en/regionscountries/countries/belize
UNAIDS. (2017). Fact sheet - Latest statistics on the status of the AIDS epidemic. Unaids.org. Retrieved 25 October 2017, from http://www.unaids.org/en/resources/fact-sheet
UNAIDS. (2015). Annual HIV statistical report. Retrieved from http://www.unaids.org/en/regionscountries/countries/belize
