Social representations of mother-to-child transmission of HIV and its prevention in narratives by young Africans from five countries, 1997–2014: Implications for communication

Abstract

International recommendations related to the prevention of mother-to-child transmission (PMTCT) of HIV have evolved rapidly over time; recommendations have also varied contextually in line with local constraints and national policies. This study examines how young Africans made sense of mother-to-child transmission (MTCT) and PMTCT and related barriers and facilitators between 1997 and 2014 in the context of these complex and changing recommendations. It uses a distinctive data source: 1343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24 from 5 African countries (Senegal, Burkina Faso, Nigeria, Kenya, and Swaziland) between 1997 and 2014. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. MTCT occurs in 8% of the narratives (108), while it is prevented in 5% (65). Narratives differ according to whether they depict MTCT or PMTCT (or, rarely, both), evolve over time, and show cross-national thematic variation. In the aggregate, representations shift in line with increased access to testing and antiretroviral medications, with PMTCT narratives becoming more frequent and MTCT narratives becoming more hopeful as diagnosis becomes the gateway to ART access. However, storylines of intergenerational tragedy in which MTCT is depicted as inevitable persist through 2014. Alongside cross-national differences in theme and tone, narratives from higher prevalence Swaziland and Kenya situate MTCT/PMTCT more centrally within descriptions of life with HIV. Findings illustrate the need to improve communication about PMTCT, reframing negative cultural narratives to reflect the full promise of developments of the past decade and a half.

Health communication in low-income countries: A 60-year bibliometric and thematic analysis

“…A multinational study from LICs in Africa surveyed children, adolescents, and young adults through HIV-themed scriptwriting competitions to check their awareness on mother-to-child transmission of HIV and its prevention. [ 30 ] While prevention awareness and narratives were reported to be more prevalent, intergenerational belief in which mother-to-child transmission of HIV was depicted as inevitable persisted in some groups, emphasizing the need for better communication methods to reflect the full promise of developments and prevention mechanisms available today. [ 30 ] In Guinea, a study examined gender norms and perceptions in children on topics of sex, sexual relationships, and HIV.…”

“…[ 30 ] While prevention awareness and narratives were reported to be more prevalent, intergenerational belief in which mother-to-child transmission of HIV was depicted as inevitable persisted in some groups, emphasizing the need for better communication methods to reflect the full promise of developments and prevention mechanisms available today. [ 30 ] In Guinea, a study examined gender norms and perceptions in children on topics of sex, sexual relationships, and HIV. [ 31 ] Males were reported to use more explicit language in discussions related to sex and talk more publicly about it, which emphasize the need for proper health communication tools to increase sex and HIV education programs among females.…”

Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014

“…Warning against dangerous complacency, a 2018 Lancet Commission report [2] argues that the dominance of HIV treatment and biomedical approaches has resulted in the neglect and underfunding of primary prevention, along with efforts to address HIV-related stigma and other social and structural drivers. The shift of emphasis we observed in the narratives may reflect a declining prioritization of general youth prevention in the context of the increasing biomedicalization of the epidemic, as prevention has become less a matter for the general population and more focused on key populations and more clinic-based [26]. While mass media and community-level communication strategies were critical to the HIV response in the early days of the epidemic, they may be less prominent in light of more targeted approaches (summed up in UNAIDS "Know your epidemic, know your response" priority) [27].…”

Social Representations Theory and young Africans' creative narratives about human immunodeficiency virus/acquired immune deficiency syndrome, 1997–2014

“…More than 150,000 young people from across sub‐Saharan Africa took part in HIV‐themed scriptwriting contests held at 8 discrete time points between 1997 and 2014, creating over 75,000 narratives. Over recent years colleagues and I have engaged in the analysis of a stratified random sample of close to 2000 narratives from five or six (depending on the study) epidemiologically and culturally diverse countries (Beres, Winskell, Neri, Mbakwem, & Obyerodhyambo, 2013; Singleton, 2019; Singleton, Winskell, Nkambule‐Vilakati, & Sabben, 2018b; Winskell, Beres, Hill, Obyerodhyambo, & Mbakwem, 2011; Winskell, Brown, Patterson, & Mbakwem, 2013; Winskell, Hill, & Obyerodhyambo, 2011; Winskell et al., 2015; Winskell, Kus, et al., 2018; Winskell, Obyerodhyambo, & Stephenson, 2011; Winskell et al., 2020; Winskell et al., 2020b).…”

“…The winning ideas in each contest are selected by local juries and, following adaptation, transformed into short fiction films by prominent directors. By 2014, the process had generated 39 short films (http://www.youtube.com/globaldialogues) and an archive of over 75,000 narratives (Winskell, Singleton, & Sabben, 2018) written by young people in almost every country in sub‐Saharan Africa.…”