Reflections on HIV and AIDS Education - forum theatre

On a global scale at the end of 1999 almost 50 million people have either died of AIDS or have been infected by the deadly HIV-virus (UNAIDS & WHO, 1999). This number of deaths and infections places the AIDS-epidemic along the estimated mortality from the Black Death in fourteenth-century Europe. The epidemic is especially concentrated in the sub-Saharan Africa. At the end of 1997 almost 10 million sub-Saharan Africans had died of AIDS and another 20 million were infected and waiting to die (UNAIDS & WHO, 1998). This concentration of HIV-infections and AIDS-related deaths in sub-Saharan Africa is mainly due to a relatively limited behavioural change here compared to other areas of the world (Caldwell, 2000). The main question in both understanding and fighting the epidemic in this virus-concentrated area is thus to ask why sub-Saharan Africa is so different to other parts of the world in the way people behave towards and during the spread of the virus.

To put up a few answers to this question one could mention the traditional religions of the area, which place emphasis on high fertility and an existence of the highest number of polygamy in the world ­ both factors which lead to a behaviour that encourages people to have several sexual partners thereby increasing the risk of catching HIV. But one of the most important factors is the women¹s relatively limited control over their sexual activity and the men¹s perceived biological need for sexual relations with more than one woman. On top of this lack of concern about changing of and simultaneously sexual partners, there is also a very high degree of prostitution that results in a high level of sexual transmitted diseases. Off course one could argue that a good deal of factors lye behind the above mentioned factors for the high prevalence of HIV in sub-Saharan Africa. E.g. poverty and a lack of a well functioning health system both seem to be reasons for prostitution and the high prevalence of STDs. However, the purpose of this article is not to draw up the complex picture that lies behind the relations between poverty and HIV-transmission.

Changing the above mentioned deeply rooted social and cultural behaviour takes both will and education of the sub-Saharan population for understanding the interrelation between this behaviour and the spread of HIV-virus. Therefore one must take a step back and look at the realistic possibilities for reducing the virus. And here the use of male condoms seems to be the only realistic possibility that meets the sub-Saharan behaviour.

On a global scale there seem to be a lot of focusing on women in the fight against HIV/AIDS ­ partly because women are recognized as vulnerable and partly from an assumption that women, when they are convinced of the need of condoms for protection, will persuade their male partners to use condoms. But, bearing the lack of behavioural change in sub-Saharan Africa in mind, which especially seems to take its point of departure in the man as the sexual aggressor and controller, what seems to be rather strange is the lack of focus on men and a change of their behaviour. Women do not, and especially not in sub-Saharan Africa, seem to be able to control their own sexual life and certainly neither that of their male partners.

To put some epidemiological comparative numbers on the relationship between women and men as target groups and to highlight my point I will make a short quotation: ³Persuading 10 men with several sexual partners to use condoms, sterilise needles or have fewer partners has a far greater impact on the epidemic than enabling 1,000 women to protect themselves from their only partner. The 10 men are the beginning of a chain of infection; the 1,000 women are its last link. (Foreman, 1999: xii). It is therefore highly relevant to see men in a larger extend as focus and target group for HIV/AIDS education (Foreman, 1999; Scalway, 2001).

However, researchers have stated that the epidemic cannot be defeated by more education (e.g. Caldwell, 2000). This, I find, is only half the truth. It is true that most people, even in sub-Saharan Africa, have obtained a basic knowledge about the HIV/AIDS and ways of transmission through information ­ but still they do not change their sexual behaviour. However, there is a great difference between information and therapy. Most education about HIV/AIDS is still obtained through traditional sources of information. What is needed is a combination of the facts about HIV/AIDS and risk behaviour and a more therapeutic space for reflecting about and discussing the already obtained information.

A way to achieve this double goal is by taking use of forum theatre that was developed by the Brazilian instructor Augusto Boal. Boal¹s achievement has been to make a useful theatre that is entertaining, fun, and instructive and takes shape as a context for social therapy. The social therapy is established by focusing on the minds of the audience and by giving them tools for handling their situations and possibilities for changing their behaviour. Basically the idea of the forum theatre is to make the audience participate actively in the performance and make them change the situations that seems wrong. An important element in the forum theatre is that the parts the audience can take over from the actors always represent an oppressed character and that the audience ideally can identify themselves with this character. Thereby the audience gets an experience of how their changed behaviour can lead to a change of situations for the better. After the performance and the participation of the audience the play as a whole is discussed in forum therefore the name forum theatre. (Boal, 1992).

The summarized idea of the forum can thus be said to be to facilitate a reflective process among the audience (and actors) in order to lead to a new experiences of the constructed situations and behaviours that ideally will lead to a change of behaviour.

The primarily purpose of this article is to present and assess the forum theatre as an alternative means of presenting a combined informational and therapeutic education, on men as an underrepresented target group, which can increase the use of male condoms. Furthermore, a second objective of the article and the research done is to present a methodology and guidelines that can be used in either other provinces of Mozambique or other cities on a global scale to build up an empirically based educational theatre....

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Click here for a power point presentation on Theatre in Education by the author.