|Communications Framework for HIV/AIDS: A new direction - A UNAIDS/PennState project (Best Practice - Key materials) (UNAIDS, 1999, 101 p.)|
|The Contextual Domains: A New Direction|
Culture is the collective consciousness of a people. It is shaped by a sense of shared history, language, and psychology. There is no right or wrong culture, despite differences in communication codes and meanings. Certain elements of culture tend to remain over time while others change. Unfortunately, culture is too often seen as a static set of never-changing values and norms. Armed with a list of negative individual health beliefs and practices, the unenlightened practitioner inevitably blames those beliefs and identifies them as cultural barriers. Beliefs are often a product of culture, but not the reverse. Beliefs are often used as a proxy for culture, so that beliefs and knowledge about illness become the focus of culturally appropriate messages and interventions. In fact, the term belief is often contrasted with knowledge. From the perspective of biomedicine, belief sometimes connotes erroneous ideas that constitute obstacles to appropriate behavior. Consequently, it is reasoned that individual negative practices or behaviors could be labeled cultural beliefs, and they are often labeled as barriers.
The dominant value system of Western cultures, to varying degrees, tends to view the self as a product of the individual. On the other hand, many other cultures view the self as a product of the family, community, and other environmental influences over which we neither have, nor want, control.
Culture is often viewed as an exotic collection of beliefs and practices and is mistakenly believed to exist only in Africa, Asia, Latin America, and the Caribbean. An example of this occurs when health educators and campaign planners ignore local health knowledge and seek information about local idioms of expression to better communicate health messages. In other words, there is little attempt to convey understanding through viable channels of local belief and practice. Instead, these channels are used to disguise imported knowledge by presenting it in the local idiom. Beliefs or knowledge of illness and traditional health practice should become the substance of local (or culturally appropriate) messages and interventions.
Unfortunately, culture has become widely equated with negative individual health beliefs and practices. Hence, culture is seen as a barrier to real knowledge, and cultural barriers are commonly cited as a reason for the failure of ill-conceived health communications programs.
This kind of misapprehension has led some health communicators implementing programs in non-Western regions to undervalue the importance of oral communication as a genre. However, traditional oral communication continues to maintain its potency and currency, and it frequently plays a key role in health promotion.
Culture is the central feature of any society. All people belong to a culture, and some might even share more than one culture. It is crucial for health communicators working on HIV/AIDS prevention, care, and support to examine thoroughly not only negative behaviors, but also contextual and individual values. These include positive elements (to be promoted) and existential elements (unique to the culture but not posing a threat to health and well-being). (For more on health and culture, see Airhihenbuwa, 1995.)
The following key points should be considered in factoring cultural variables into HIV/AIDS communication in the new framework:
· The style and use of language in many cultures should be understood for possible application in communications strategies, particularly at the interpersonal level. For example, some languages more than others commonly employ parables, stories, and idiomatic expressions to convey messages.
· Relationships within the family and community should be explored, particularly as they relate to making decisions about adopting preventive health behaviors and caring for the sick.
· The centrality of family and community, rather than the individual, in decision making needs to be taken into account.
· The fact that individual beliefs, although they form a part of the culture, do not explain the whole cultural context, needs to be recognized. Belief, therefore, should not be allowed to become a proxy for culture, though it should be acknowledged as one of the many aspects of culture.
· Differences in cultural characteristics should be recognized, and messages should be relevant to the context.
· Media and interpersonal communications professionals must be involved from the initial planning all the way through to evaluation.
· Recognition of who the caregivers are in any community, and an understanding of their roles, is critical.
· The use of home-based care in many cultures requires systematic and regular information updates to improve patient management and support.
· Whenever possible, traditional healers should be involved in program planning and implementation.