Empowering Yoruba Women in Nigeria to Prevent HIV/AIDS: The Relative Significance of Behavioural and Social Determinant Models
This article uncovers the relevance to practice of behavioural and social determinant models of HIV prevention among Yoruba women in Nigeria. Exploring what factors influence health behaviour in heterosexual relationships, the key question raised was whether the women’s experiences support the assumptions and prescriptions for action of these two dominant public health models. Eight focus group discussions and 39 in-depth interviews were conducted, which involved 121 women and men who were chosen purposefully and through self-nomination technique. This study revealed that the women were very much constrained by social environments in negotiating safe sex, despite having at least a basic knowledge of HIV prevention. Limiting factors included the fear of relationship breakup, economic dependence, violence, and the difficulties in justifying why they feel the need to insist on condom use, especially since initiating condom use is antithetical to trust. Furthermore, evidence suggested that improved access to income and education might be vital but it does not automatically constitute a direct means of empowering women to prevent HIV infection. The limitations of both behavioural and social determinants perspectives thus suggests the need for a combination prevention model, which focuses on how social, behavioural and biomedical factors overlap in shaping health outcomes.
Amaro, H. (2000), ‘On the margin: Power and women's HIV risk reduction strategies’, Sex Roles, 42 (7-8), 723-49
Amaro, H., A. Raj and E. Reed (2001), ‘Women’s sexual health: the need for feminist analyses in public health in the decade of behaviour’, Psychology of Women Quarterly, 25 (4), 324–34
Argemi, X., S. Dara, S. You, J. Mattei, C. Courpotin, B. Simon, Y. Hansmann, D. Christmann and N. Lefebvre (2012), ‘Impact of malnutrition and social determinants on survival of HIV-infected adults starting antiretroviral therapy in resource-limited settings’, AIDS, 26 (9), 1161–166, doi: 10.1097/QAD.0b013e328353f363.
Bambra, C., M. Gibson, A. Sowden, K. Wright, M. Whitehead and M. Petticrew (2010), ‘Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews’, Journal of Epidemiology and Community Health, 64, 284-91, doi:10.1136/jech.2008.082743
Blas, E., L. Gilson, M. Kelly, R. Labonté, J. Lapitan, C. Muntaner, P. Ostlin, J. Popay, R. Sadana, G. Sen, T. Schrecker and Z. Vaghri (2008), ‘Addressing social determinants of health inequities: What can the state and civil society do?’, Lancet, 372 (9650), 1684–68, doi: 10.1016/S0140-6736(08)61693-1.
Blumberg, S. (2000), ‘Guarding against threatening HIV prevention messages: An information processing model’, Health Education & Behavior, 27 (6), 780–95.
Bowleg, L., F. Belgrave and C. Reisen (2000), ‘Gender roles, power strategies, and precautionary sexual self-efficacy: Implications for Black and Latina women’s HIV/AIDS protective behaviours’, Sex Role, 42 (7-8), 613–35, doi: 10.1023/A:1007099422902
Commission on Social Determinants of Health (2008), Closing the gap in a generation: Health equity through action on the social determinants of health, http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf, accessed 10 September 2009
Dane, F. (1990), Research Methods, California: Brooks/Cole Publishing.
Doyal, L. and J. Anderson (2005), ‘My fear is to fall in love again...' How HIV-positive African women survive in London’. Social Science and Medicine, 60 (8), 1729-738
Economic and Social Research Council (2012), ESRC Framework for Research Ethics (FRE) 2010 Updated September 2012, http://www.esrc.ac.uk/_images/Framework-for-Research-Ethics_tcm8-4586.pdf , accessed 15 January 2013
Fetterman, D. (1998), Ethnography: Step by Step, Applied Social Research Methods Vol. 17, Thousand Oaks, California: Sage Publications.
Fishbein, M. (2000), ‘The role of theory in HIV prevention’, AIDS Care, 12 (3), 273-78 https://wiki.umn.edu/pub/EWB/UgandaCommunityHealth/The_role_of_theory_in_HIV_prevention.pdf, accessed 14 May 2011
Fishbein, M. (2008), ‘A Reasoned Action Approach to Health Promotion’, Medical Decision Making, 28 (6), 834-44.
Gillespie, S., S. Kadiyala and R. Greener (2007), ‘Is poverty or wealth driving HIV transmission?’, AIDS, 21 (issue supplement 7), S5–S16
Glanz, K., B. Rimer and F. Lewis (2002), Health Behaviour and Health Education: Theory, Research, and Practice. California: Jossey-Bass Publishers (originally published by the same publisher in 1990)
Gupta, G. (2002), ‘How men's power over women fuels the HIV epidemic’, British Medical Journal, 324 (7331), 183–84
Gupta, G., J. Parkhurst, J. Ogden, P. Aggleton and A. Mahal (2008), ‘Structural approaches to HIV prevention’, Lancet, 372 (9640), 764-75, doi:10.1016/S0140-6736(08)60887-9
Higgins, J., S. Hoffman and S. Dworkin (2010), ‘Rethinking Gender, Heterosexual Men, and Women’s Vulnerability to HIV/AIDS’, American Journal of Public Health, 100 (3), 435-45, doi: 10.2105/AJPH.2009.159723
Jewkes, R., K. Dunkle, M. Nduna and N. Shai (2010), ‘Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study’, Lancet, 376 (9734), 41–48
Jewkes, R. and R. Morrell (2012), ‘Sexuality and the limits of agency among South African teenage women: Theorising femininities and their connections to HIV risk practices’, Social Science and Medicine, 74 (11), 1729-737, doi: 10.1016/j.socscimed.2011.05.020
Joint United Nations Programme on HIV/AIDS (2010), Combination HIV Prevention: Tailoring and Coordinating Biomedical, Behavioural and Structural Strategies to Reduce New HIV Infections: A UNAIDS Discussion Paper. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20111110_JC2007_Combination_Prevention_paper_en.pdf, accessed 20 March 2011
Kim, J., P. Pronyk, T. Barnett and C. Watts (2008), ‘Exploring the role of economic empowerment in HIV prevention’, AIDS, 22 (issue supplement 4), S57–S71
Lee, R. (1999), Doing research on sensitive topics, London: Sage publications
Maman, S., J. Mbwambo, M. Hogan, G. Kilonzo, J. Campbell and M. Sweat (2002), ‘HIV-1 Positive Women Report More Lifetime Experience with Violence: Findings from a Voluntary HIV-1 Counseling and Testing Clinic in Dares Salaam, Tanzania’, American Journal of Public Health, 92 (8), 1331-337
Marmot, M., S. Friel, R. Bell, T. Houweling and S. Taylor (2008), ‘Closing the gap in a generation: Health equity through action on the social determinants of health’, Lancet, 372 (9650), 1661–669, doi:10.1016/S0140-6736(08)61690-6
Mongkuo, M., R. Mushi and R. Thomas (2010), ‘Perception of HIV/AIDS and socio-cognitive determinants of safe sex practices among college students attending a historically black college and university in the United States of America’, Journal of AIDS and HIV Research, 2 (3), 32-47
Moulin, A. (2008), The World Health Organization and the Social Determinants of Health: Assessing Theory, Policy and Practice, http://www.ucl.ac.uk/histmed/downloads/social_determinants/comments/wellcomewhocairo.pdf, accessed 12 October 2010
Murphy, E., M. Greene, A. Mihailovic and P. Olupot-Olupot (2006), ‘Was the “ABC” Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda's Decline in HIV?’, PLOS Medicine, 3 (9), e379, doi:10.1371/journal.pmed.0030379, http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030379, accessed 24 June 2010
Navarro, V. (2009), ‘What we mean by social determinants of health’, Global Health Promotion, 16 (1), 05-16, doi: 10.1177/1757975908100746
National Population Commission and ICF Macro, (2009), Nigeria Demographic and Health Survey 2008: Key Findings. Calverton, Maryland: National Population Commission and ICF Macro, http://www.measuredhs.com/pubs/pdf/SR173/SR173.pdf, accessed 15 July 2012
O'Connor, F. and B. Drury (1998), The Female Face in Patriarchy: Oppression as Culture, Michigan: State University Press
Power, R. (1998), ‘The Role of Qualitative Research in HIV/AIDS’, AIDS, 12 (7), 687-95
Prochaska, J., S. Butterworth, C. Redding, V. Burden, N. Perrin, M. Leo, M. Flaherty-Robb and J. Prochaska (2008), ‘Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion’, Preventive Medicine, 46 (3), 226-31.
Rimer, B. and K. Glanz (2005), Theory at a Glance: A Guide for Health Promotion Practice, National Institute of Health (first edition published in 1995) http://www.cancer.gov/cancertopics/cancerlibrary/theory.pdf, accessed 04 July 2010
Rosenstock, I., V. Strecher and M. Becker (1994), ‘The Health Belief Model and HIV risk behavior change’, in DiClemente, R. and Peterson, J. (eds.), Preventing AIDS: Theories and methods of behavioural interventions, New York: Plenum Press, pp. 5-24
Rubin, H. and I. Rubin (2012), ‘Qualitative Interviewing: The Art of Hearing Data, Los Angeles: Sage Publications (originally published by the same publisher in 1995)
Sen, A. (2001), Development as Freedom, Oxford: Oxford University Press
Shelton, J., M. Cassell and J. Adetunji (2005), ‘Is poverty or wealth at the root of HIV?’, Lancet, 366 (9491), 1057-058, doi:10.1016/S0140-6736(05)67401-6
Shneider, D. (2004), The Psychology of Stereotyping, New York: The Guilford Press
Sobo, E. (1995), Choosing Unsafe Sex: AIDS Risk Denial among Disadvantaged Women, Philadelphia, PA: University of Pennsylvania Press
Stevens, P. (2009), ‘Bias in WHO report on the social determinants of health’, Lancet, 373 (9660), 298, doi: 10.1016/S0140-6736(09)60091-X
Stewart, D., P. Shamdasani and D. Rook (2007), Focus Groups: Theory and practice, applied social research methods series vol. 20, Thousand Oaks, California: Sage Publications Inc.
United Nations (2007), Africa and the Millennium Development Goals 2007 update, New York: United Nations, http://www.un.org/millenniumgoals/docs/MDGafrica07.pdf, accessed 16 May 2011
United Nations General Assembly Special Session (2010), Country Progress Report: Nigeria. http://data.unaids.org/pub/Report/2010/nigeria_2010_country_progress_report_en.pdf access 23 July 2011
United Nations Secretariat (2002), HIV/AIDS and Fertility in Sub-Saharan Africa: A Review of the Research Literature. Esa/P/Wp.174. http://www.un.org/esa/population/publications/fertilitysection/HIVAIDSPaperFertSect.pdf, accessed 02 February 2011
Watters, J. and P. Biernacki (1989), ‘Targeted sampling: Options for the study of hidden populations, Social Problems, 36 (4), 416-30
Welsh, E. (2002), ‘Dealing with Data: Using NVivo in the Qualitative Data Analysis Process. Forum: Qualitative Social Research’, 3 (2),
http://nbn-resolving.de/urn:nbn:de:0114-fqs0202260, accessed 10 January 2012
Wiles, R., G. Crow, S. Heath and V. Charles (2006), ‘Anonymity and Confidentiality’, Paper presented at the ESRC Research Methods Festival, University of Oxford, July 2006. http://www.ccsr.ac.uk/methods/festival/programme/aac/documents/anonandconfpaperRMF06.pdf, accessed 11 June 2011
Wilkinson, D. (2002), Condom effectiveness in reducing heterosexual HIV transmission: RHL commentary, The WHO Reproductive Health Library, Geneva: World Health Organization, http://apps.who.int/rhl/hiv_aids/dwcom/en/, accessed 12 February 2011
Wilkinson, R. and M. Marmot (eds.) (2003), Social determinants of health: The solid facts, World Health Organization, http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf, accessed 21 May 2011
World Health Organization (2009), Gender inequalities and HIV, http://www.who.int/gender/hiv_aids/en/ accessed 21 July 2011
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