Enhancing relevance and appropriateness of hiv/aids policy interventions

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Chapter Eight

Enhancing relevance and appropriateness of HIV/AIDS policy interventions: Lessons from lived experiences at a fishing village in Uganda

8.1 Introduction

The social groups which have so far proven to be most vulnerable to HIV infection are those which have long faced discrimination and stigma, blame and stereotype labels, or have suffered economic hardships due to austere macro-economic and neo-liberal policies and have limited social services. Evidently, lakeshore people are disproportionately represented among those infected with HIV/AIDS. This may not change fundamentally as long as focus is placed on prevention intervention through generic approaches for education and behavior change as the immediate solution to the AIDS crisis. The hegemonic paradigm that largely informs most of these approaches is flawed, narrow and linear. While elements of this paradigm are perhaps essential to our understanding of individual human behavior, its commitment to the ideology of individualism and consequent blindness to broader political and economic issues limits its utility when weighed against the lived experiences of lakeshore people. An integrated approach is therefore necessary, to take cognizant of both individual cognitions as envisioned under this paradigm, but also to go beyond and capture the wider community and societal contexts within which the HIV/AIDS epidemic is reproduced.

In this I expound on my main argument and generate suggestions for enhancing relevance and appropriateness of HIV/AIDS policy interventions by drawing lessons from lived experiences at a fishing village in Uganda. In order to anchor my argument and proposed way forward on evidence, first, I present a synopsis of the lived experiences of the fishing village, pulling out some of the key emerging issues from this experience. Later, I make an attempt to critically relate and weigh these experiences to ongoing policy interventions in HIV/AIDS prevention in order to sieve out salient issues and gaps in policy interventions when assessed vis-à-vis life at the fishing village. It is from this synthesis that my line of argument is further developed and my thinking about ways for bridging gaps between lived experiences and policy interventions for HIV/AIDS prevention is derived.

The important thread running through this analysis, and indeed the thesis of my work is that rethinking the present interventions for HIV/AIDS prevention requires, first accepting the limitations of current behavioral models guiding current policy responses to the epidemic, and consequently, reformulating the approach to HIV/AIDS prevention through the recognition of economic and cultural meanings, social identities and community lived experiences. The later calls for a shift towards community-based empowerment efforts aimed at transformation of values, norms and the constitution of collective meanings of sexuality, risk and HIV/AIDS itself. Using empowerment practice as used in Social Work and in other helping professions, and in Social Sciences generally, I endeavor to demonstrate how, and why effective policy should be that that begins with the community, as agency, and then moves to the political arena.

In choosing to use empowerment, I am alive to the common fear that many use the term empowerment without understanding what it really means.

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