What's culture got to do with HIV and AIDS?

We know that the HIV and AIDS crisis is rooted in personal and social issues. If, as research suggests, culture is a factor in transmission and impact, it follows that prevention and care require a cultural approach. This means developing a working process which strives to understand a community's sense of itself and tries to engage with that community, respectfully, at its own level. It means working with the socio-cultural environment -- power structures, history, relationships -- as well as creative and expressive culture. And it means devising communication programmes which go beyond message delivery and instead engage with the cultural meanings that people create for themselves. Using a cultural approach also challenges donors to think how their own institutional cultures can respond to, rather than overwhelm, the distinct needs of the communities in which they are working.

This key list draws on the recent Findings paper, What's culture got to do with HIV and AIDS? available at www.healthlink.org.uk. We welcome your feedback: please send comments or suggested additions to sourceassistant@hi-uk.org.

Selected resources

AIDS communication

September 2005

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This paper sets out DFID's Information and Communcation Directorate's understanding of the role of communication in HIV programming. It is intended primarily as a resource for DFID staff; but presents a holistic and engaging framework for HIV communication which will be useful beyond, as well as within, DFID. The paper encourages a shift away from often inappropriate programme targets of individual behaviour change, and toward community participation, access to education, information and dialogue -- processes which acknowledge and harness local community resources and capacities. It also promotes integrated communication around prevention, treatment and care

Handbook for appropriate communication for behavior change. Culturally appropriate information/education/communication : elaboration and delivery


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This handbook is part of the UNESCO initiative on HIV and culture. It deals with building culturally appropriate information/education/communication (IEC) material and processes. It aims to tailor the content and pace of action to people's beliefs, value systems, capacity to mobilise, and to modify international and national strategies and policies, project design and field work accordingly. It gives a conceptual introduction to the issue and then presents the methodological research to be carried out (evaluation of the current activities, understanding, sensitising and mobilising cultural references and resources accordingly). It then identifies proposed target audiences and their specific characteristics. It concludes by proposing appropriate IEC models combining message elaboration and delivery

Missing the message? 20 years of learning from HIV/AIDS


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This report focuses on the way in which the response to the HIV pandemic has been shaped, with a particular emphasis on the way in which communication has been used.
Often the emphasis is on information dissemination, and the distribution of health messages. While information is vital, past successes in fighting AIDS suggest that approaches need to be far broader than this. A politicised civil society, with communities able to take ownership of the response to HIV/AIDS, can catalyse extraordinary change and mobilisation. Similarly, a media able to support informed, inclusive debate will also be critical to future successes.
This report provides an overview of these issues, and suggests how the problems can begin to be addressed through work with policymakers, civil society and the media

Culture and sustainable development : a framework for action

DUER, Kreszentia

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This report describes the World Bank's evolving programme for culture and sustainable development. It articulates criteria that justify lending for culture, and criteria that limit the Bank's participation. This modestly sized programme is geared toward enhancing the World Bank's effectiveness, and adds an important proactive emphasis on culture and identity to the World Bank's ongoing work

Cultures, spirituality and development


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This booklet puts forward the point of view that development processes are only successful if they take into consideration the cultural and spiritual dimensions of people's lives. Drawing on examples from different parts of the world, it discusses what this means in practice and suggests how it may be done. It includes sections on development paradigms and the relevance of inclusive, participatory approaches; the relevance of culture; ideas toward a 'code of conduct' or way of working with culture in development; and raises methodological issues. The aim is to open up a debate about issues which have often been ignored because of their intangible and sometimes sensitive nature

Human development report 2004 : cultural liberty in today's diverse world

et al

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This Human Development Report focuses how development work can help build inclusive, culturally diverse societies -- both as a means to achieving other, more traditional development priorities, and as an end in itself. It examines and rejects the claim that cultural differences lead to social, economic and political conflict, and that cultural rights supercede political or economic rights (eg the right to education). The report acknowledges the importance of legislative recognition of diverse cultural backgrounds, but stipulates that, to achieve real change, political culture has to change as well: people need to think , feel and act in a way that respects and values the needs of others. Finally, it considers the threats and opportunities presented by globalisation, in terms of the intellectual property of indigenous people; cultural goods markets; and emerging and established multicultural societies

Routemapping culture and development : report on a pilot research project exploring the use of cultural approaches to development within five UK development agencies

GOULD, Helen

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This research highlights the inconsistent approach and limited explicit policy with reference to cultural activities in development, despite finding over 350 examples across five development agencies over two years. The study considers the different uses of culture in development, finding a lack of consistency in implementing projects, little understanding of how cultural processes work, and few examples of appropriate evaluation

Through African eyes : culture [chapter 3] | Our common interest : report of the Commission for Africa

March 2005

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Chapter 3 of the Report of the Commission for Africa explores how a number of aspects of African cultures impact on a range of areas of policy making. Challenges some misunderstandings about African history, and asserts that culture is dynamic and adaptive, rather than static bounded 'tradition' as it is often assumed. Considers Africa's great diversity and creativity, and considers the role of the range of networks, including religious networks, in African development processes

Turning the ordinary into the extraordinary : the green pendelu and maternal health in Mali


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This paper introduces the philosophy and elements of the DIORO approach in which indigenous cultural resources in Mali, including songs, singer/storytellers (griots) and traditional clothing, were used in a successful campaign to increase communication between husbands and wives regarding pregnancy and to improve health-seeking behavior during pregnancy. Assisted births in the project area increased from under 20% at the start of the project to 77% in the year after the IEC campaign was implemented

What do we do with culture? Engaging culture in development

March 2005

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This short briefing paper gives a critical overview of recent attempts to engage culture in development work, and in HIV and AIDS work in particular. It also outlines a range of insights from anthropological work that relate to understanding and addressing culture in development. Areas covered include moving beyond a focus on the individual in analysis of change, looking beyond the local setting only, considering the role of the organisational culture of development institutions, valuing indigenous knowledge, and looking at the way mobilising culture and cultural resources is intimately linked to power relations

Working from within : culturally sensitive approaches in UNFPA programming


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The nine case studies presented in this brochure are drawn from a longer UNFPA report entitled, "Culture Matters: Working with Communities and Faith-based Organizations". It highlights the necessity of mainstreaming cultural analysis and sensitivity in development efforts addressing issues such as gender equality and equity, HIV/AIDS, female genital cutting, gender-based violence and reproductive health. Presents an outline of key principles for working within cultures in a culturally sensitive way, and briefly looks at examples of programming in a number of countries highlighting what works in each case

A cultural approach to HIV/AIDS prevention and care : UNESCO/UNAIDS research project. Summary of country assessments : an international overview


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This overview of the UNESCO project on cultural approaches to HIV and AIDS begins with a description of the programme, its methods and scope. Part two describes the country assessments and identifies common trends and culturally vulnerable groups. It presents a summary of the major findings and lessons, considerations and recommendations for future work

HIV/AIDS stigma and discrimination : an anthropological approach. Proceedings of the round table

UNESCO. Division of Cultural Policies and Intercultural Dialogue

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As part of UNESCO's work on culture and HIV/AIDS, this round table on stigma and discrimination in 2002 highlights the way stigma is rooted in and reflects existing social inequalities, and points to a need for close examination of the 'local dynamics of discrimination and solidarity' in any setting. Notes how key 'cultural resources' to fight against discrimination have often been devised principally by people infected or affected by the disease. Many institutions, on the other hand, may gain political advantage through encouraging discrimination. At the same time, constraints of poverty can encourage reactions of denial and avoidance for those facing the prospect of death of loved ones

Rights passages from 'near death' to 'new life' : AIDS activism and treatment testimonies in South Africa

ROBINS, Steven
October 2005

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This paper investigates how the moral politics of AIDS activism in South Africa are contributing towards new forms of biological/health citizenship that are concerned with both rights-based struggles and creating collectively shared meanings of the extreme experiences of illness and stigmatisation of individuals living with AIDS. The paper argues that it is precisely the extremity of 'near death' experiences of full blown AIDS, and the profound stigma and 'social death' associated with the later stages of the disease that produce the conditions for AIDS survivors commitment to 'new life' and social activism. It is the activist mediation and re-telling of these traumatic experiences that facilitates AIDS activist commitment and grassroots mobilisation. It is the profound negativity of stigma and social death that animates the activist's construction of a new positive HIV-positive identity and understanding of what it means to be a citizen-activist and member of a social movement

Sexual-health communication across and within cultures : the clown project, Guatemala

SAVDIE, Anthony
June 2009

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This paper puts forward an argument in favour of careful and critical analysis of culture in formulating communication strategies with and for specific groups, based on experience drawn from the Clown Project in Guatemala and other countries in Central America. The Clown Project uses labour-intensive face-to-face street theatre and dialogue, participatory workshops, and symbolic communication such as print-based material to reach those most vulnerable to the spread and impact of HIV and AIDS . The analysis takes into account relations of power within and between vulnerable groups, examining the centre-periphery dynamic between classes, genders, ethnicities, age groups, and other social identities. Both appropriately supported insider perspectives and appropriately processed outsider knowledge are recommended, along with ways of bridging science and the field, theory and practice

The cultural approach to HIV/AIDS prevention

SOMMA, Daryl B

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This paper explores how culture can be used in various forms (theatre, music, dance, traditional medicine, and more) as a means to communicate and encourage behavior change for HIV/AIDS prevention. It highlights theater for development and collaboration with traditional healers as viable alternatives to more conventional communication and behavior change models. It presents several case studies, good practices from the field, and lessons learned. The authors' understanding of a cultural approach to HIV/AIDS prevention means understanding and using a community's cultural references as a framework for the design and implementation of prevention policies and programmes. Programmes that have employed this approach are characterized by their participatory approach that fosters community ownership and in turn, can result in both greater efficacy and sustainability within the community