What's Culture Got to Do with HIV and AIDS?

This 8-page HealthLink Findings paper reports the initial findings from a project entitled HIV/AIDS: The Creative Challenge, whose premise is that culturally mediated approaches to communicating messages on HIV/AIDS are more effective than mass media messages from the biomedical community to the local community. The project has been developed by Creative Exchange in partnership with Exchange and United Nations Educational, Scientific and Cultural Organization (UNESCO).

The author, Helen Gould, provides an introductory analysis of the concept of culture, looks at examples and success stories of effective application of cultural approaches to HIV/AIDS communication, and sets out the terms of the debate around culture in the context of the current international HIV/AIDS strategy.

Gould makes these key points:

• "Cultural approaches to HIV and AIDS have built trust and engagement at community level,increasing the likelihood of prevention.
• Cultural approaches to HIV and AIDS are gaining currency because they interact with the values, beliefs, traditions and social structures - the 'webs of significance’ - in which people live.
• Culture is most visible in communication programmes but some programmes are culturally inappropriate and may contribute to infection and stigma because of their focus on behaviour change.
• Where a cultural approach is used in HIV and AIDS communication there is evidence of wider impact on awareness and attitudes, of stigma reduction, and of more inclusion of people living with HIV and AIDS.
• New forms of monitoring and evaluation are required to capture the impact of cultural approaches to HIV and AIDS beyond behaviour change.
• Culture can offer a real benefit to global strategy for HIV and AIDS if it is re-cast as an opportunity for action and engagement with communities, rather than as a barrier to prevention and to bio-medical approaches."

The cultural framework of Creative Exchange evolved from research about development policy makers' and practitioners' definitions of culture, which include: context factors specific to local life - faiths, history, genders, social hierarchies, and time concepts; content languages, practices, objects, traditions, clothing, and heritage; method - drama, dance, proverbs, song, music, video, radio, or television; and expression of the intangible - beliefs, values, feelings, attitudes and world view.

Gould states, "The most powerful examples of a cultural approach to HIV and AIDS can be seen in development communication programmes." She contrasts the results of studies demonstrating the increased prevalence of disease where mass media campaigns have not used culturally sensitive strategies with the following examples of culturally sensitive communication modes: "drawing on the knowledge of traditional healers and local communication methods – rites, dances, dramas and chants..., and working with participatory cultural methods in group and community settings to explore lifestyle change options...[as well as using] minority languages, ... local customs, traditions and technologies."

In her conclusions, she cites a need for more evidence establishing a causal link between credible, locally owned, culturally appropriate HIV/AIDS programmes and increased success in treatment and prevention. Coupled with more evidence she calls for a shift in monitoring and evaluation processes to methods that will measure qualitative and process-based outcomes as evidence. Gould points out the need for donor confidence in using a cultural approach rather than a mass media campaign strategy. This requires a shift away from focus on scale, visibility, and short-term success. Finally, she names local participation as a starting point, exemplified by a UNESCO effort to establish a two-way information exchange between field workers and communities that focuses key cultural groups within communities on their priorities and processes of change while participating in formulating culturally appropriate implementation of treatment and prevention programmes.