How youth in Uganda experience televised HIV and AIDS education

HOW YOUTH IN UGANDA EXPERIENCE TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES by Frederick Kakembo Submitted in partial fulfillment of the requirements for the degree Philosophiae Doctor (Adult and Community Education and Training) in the Department of Curriculum Studies Faculty of Education University of Pretoria Promoters: Prof. Linda Van Rooyen and Prof . C. Hartell PRETORIA 2010 © University of Pretoria ii I dedicate this study to my family: My wife Mary Nsangi Kakembo and my children, Rhoda, Brian, Arnold, Eric and Jonathan: my parents Samuel and Catherine Ntambi. Your support, sacrifice, patience and encouragement inspired me to complete this study. iii ACKNOWLEDGEMENTS To begin with, my gratitude goes to the Almighty God who provided me with the resources, courage, guidance and strength that made this study possible. I wish to appreciate the contribution made by the following people towards the successful completion of this study: • My promoters, Professor Linda van Rooyen and Professor Dr Cycil Hartell – their endless patience, support, sacrifices and motivation has made this work possible. I particularly appreciate the sleepless nights that they spent to guide me to produce work of high quality • My wife, Mary Nsangi Kakembo, for the endless support, patience and sacrifice during the time that I conducted this study. • My children, Rhoda, Brian, Arnold, Eric and Jonathan, for the love, patience and understanding during the difficult period of my study. • My parents, Samuel and Catherine Ntambi, for keeping in touch and encouraging me to endure up to the end of my academic path. • Professor Patrick Manghene of Uganda Christian University for the moral and material support extended to me during my study. • Dr. V.A.O. Okoth for the language editing of this thesis. • Ms Adrie Van Dyk for the tremendous work done to edit this thesis. • The young men and women who were willing to sacrifice their time and graciously participated in the study. • The officers in various department organisations who provided the information that was needed to make this study successful. The Uganda AIDS Support Organization TASO, Health Communication Partnership HCP, Young Empowered And Health YEAH, Naguru Teenage Information and Health Centre, Kibuli Teachers College, Uganda Television Institute, St Kizito High School Namugongo, and Makerere University. ---oOo--- “The fundamental basis of learning is discovery” (Piaget 1973) and “The real challenge today is not to teach, but to stimulate learning” (Von Feilitzen 1999). iv DECLARATION I, Frederick Kakembo, declare that this thesis which I hereby submit for the degree Philosophiae Doctor in Adult and Community Education and Training is my own work and that it has not been previously submitted by me for a degree at this or any other institution. ______________________ Frederick Kakembo August 13, 2010 ---oOo--- v ABSTRACT How youth in Uganda experience televised HIV and AIDS educational programmes by Frederick Kakembo Promoters : Department : Degree : Prof. L. van Rooyen & Prof. C. Hartell Department of Curriculum Studies Philosophiae Doctor This study investigates how youth in Uganda experience televised HIV and AIDS educational programmes. Television is the medium that can be used to address the resurgence of HIV and AIDS in Uganda. The factors responsible for the resurgence include prevention fatigue and the saturation of HIV and AIDS messages in the media. The audio-visual component of television makes it possible to convey HIV and AIDS messages innovatively through education-entertainment. Despite its potential, television has not played a leading role in conveying HIV-related knowledge, skills, and attitudes to urban youths. The study required looking at the televised HIV and AIDS educational programmes from the perspective of young people. In line with the interpretivist and social constructivist framework, the primary source of information about the programmes is the experiences of young people who are the target audience. A qualitative research approach was used in the study and an instrumental case design in particular was employed in data collection. Data were collected through focus group discussions, personal interviews, document analyses and participant observations. Findings have revealed that young people can learn about HIV and AIDS from both educational programmes and television soaps. While they undergo sexual socialisation through television soaps, they have the capacity to distinguish between fiction, fantasy and reality. However, they dislike the didactic and authoritarian approaches that are used in the educational programmes. An important finding is that communication gaps characterise televised HIV and AIDS educational programmes. Some of the prevention messages and the values propagated by vi television HIV and AIDS education are detached from the experiences and world views of the youths. This could be attributed to insufficient knowledge on the part of HIV and AIDS educators regarding the way in which youth experience televised HIV and AIDS programmes. KEY WORDS Constructivism Educational programmes Experiences HIV and AIDS Interpretivism Television Television soaps Urban youth ---oOo--- vii EXPLANATION OF KEY TERMS AND CONCEPTS (Adopted from the Uganda AIDS Commission, 2006, 2007) ABC: HIV prevention approach based on Abstinence, Faithfulness, Condom use. AIDS: Acquired Immunodeficiency Syndrome. ARV: antiretroviral drugs Commercial sex worker: The perpetual dependency on sex for money or other items. Constructivism: This is a philosophy of learning founded on the premise that people construct their own understanding of the world by reflecting on their experiences. Education: the processes through which individuals acquire knowledge, values, attitudes and skills. Edutainment: Educational entertainment or entertainment education. It is a form of entertainment designed to educate as well as to amuse http://en.wikipedia.org/wiki/Edutainment. Expectations: Based on their experiences, expectations are the things individual youth believe that ought to happen in a specific way, at a specific time, in a specific order. Experiences: In the context of this study, this will be taken to mean the sum-total of the insights that an individual acquires as he/she grows up within a specific environment. High Risk sex: includes sex with multiple partners especially non marital, non consensual; inconsistent or no condom use; commercial, transactional and intergeneration sex including sex for survival; alcohol consumption and drug abuse before sex; unprotected sex with someone whose status one does not know; sex without testing and disclosure. HIV and AIDS education: for the purposes of this study, the concept of HIV/AIDS education will be used to refer to the process by which individuals acquire knowledge, skills and attitudes needed to deal with the issues of HIV/AIDS. HIV: Human immunodeficiency virus, the virus that causes AIDS. Incidence: New infections per population at risk in a specified period of time. Life Skills Education: Training in such skills as interpersonal relationships, self awareness and self esteem, problems solving, effective communication, decision making, negotiating sex resisting peer pressure, critical thinking, negotiation, formation of friendships and empathy. Prevalence: The total number of cases of HIV at point in time per base population. viii Television Soaps: Narratives composed of interlocking story lines, focusing on the relationships within a specific community of characters (Mumford 1995). Transactional Sex: Sex in exchange for money or other items and favours. Trans-generation Sex: (also called Cross-generational Sex): Sex with a partner considered much older than one’s sexual partner. UAC: Uganda AIDS Commission. Urban: Places/areas located within or around cities or towns; with features similar to those in cities, towns or major trading centers. Urban youths: People between ages 15-24 who live in cities, towns or places that have features similar to those in cities and towns. Youths: for the purpose of this study, the youths are those people between the ages 15-24 years (MoH, 2003). ---oOo--- ix TABLE OF CONTENTS Page DEDICATION iii ACKNOWLEDGEMENT iv DECLARATION v ABSTRACT vi KEY WORDS vii EXPLANATION OF KEY TERMS AND CONCEPTS TABLE OF CONTENTS viii x LIST OF TABLES xxii LIST OF FIGURE xxii x CHAPTER 1 INTRODUCTION TO THE RESEARCH STUDY 1.1 THE AIM OF THIS CHAPTER 1 1.2 INTRODUCTION 1 1.3 RATIONALE 2 1.4 STATEMENT OF THE RESEARCH PROBLEM 4 1.5 THE PURPOSE OF THE STUDY 5 1.6 DELIMITATIONS 6 1.7 EPISTEMOLOGICAL COMMITMENT AND PARADIGMATIC PERSPECTIVE 7 1.7.1 THE KNOWLEDGE CLAIM 7 1.7.2 THEORETICAL FRAMEWORK 9 1.8 METHODOLOGICAL APPROACH 12 1.8.1 QUALITATIVE RESEARCH APPROACH 12 1.9 RESEARCH METHODOLOGY AND DESIGN 13 1.9.1 INSTRUMENTAL CASE DESIGN 13 1.9.2 SELECTION OF PARTICIPANTS 14 1.9.3 DATA COLLECTION 15 1.9.3.1 Documentary analysis 15 1.9.3.2 Focus group discussions 15 1.9.3.3 Personal interviews 16 1.9.3.4 Participant observations 16 1.9.3.5 Reflective journal 17 DATA ANALYSIS 17 1.9.4 xi Page QUALITY CRITERIA 18 1.9.5.1 Credibility 18 1.9.5.2 Transferability 19 1.9.5.3 Dependability 19 1.9.5.4 Conformability 20 1.9.5.5 Authenticity 20 ETHICAL CONSIDERATIONS 20 1.9.6.1 Informed consent 21 1.9.6.2 Disclosing details of the study 21 1.9.6.3 Opportunity to withdraw 21 1.9.6.4 Risks and benefits 21 1.9.6.5 Ensuring confidentiality 22 1.10 SIGNIFICANCE OF THE STUDY 23 1.11 ANTICIPATED CHALLENGES 23 1.12 OUTLINE AND ORGANISTION OF THE INQUIRY 24 1.9.5 1.9.7 ---oOo--- xii Page CHAPTER 2 REVIEW OF RELATED LITERATURE 2.1 INTRODUCTION 26 2.2 THE PREVALENCE AND INCIDENCE OF HIV AND AIDS IN UGANDA 27 2.2.1 NEW TRENDS IN THE FIGHT AGAINST HIV AND AIDS 27 2.2.2 EXTRA-MARITAL SEX 28 2.2.3 MOTHER TO CHILD TRANSMISSION OF HIV (MTCT) 28 2.2.4 HIV DISCORDANCE AND NON-DISCLOSURE 29 2.2.5 TRANS-GENERATIONAL SEX 29 2.2.6 VULNERABLE GROUPS 29 2.2.7 NATIONAL RESPONSES TO HIV AND AIDS IN UGANDA 30 2.2.8 TRENDS IN SCOPE AND INTENSITY OF INFORMATION, EDUCATION AND COMMUNICATION (IEC) FOR BEHAVIOUR CHANGE 30 UNDERSTANDING THE YOUTH IN THE CONTEXT OF HIV AND AIDS AND URBANISATION 32 2.3.1 THE PSYCHO-SOCIAL AND DEVELOPMENT ISSUES OF YOUNG PEOPLE 33 2.3.2 CONCURRENT MULTIPLE PARTNERS AND TRANSACTIONAL SEX 33 2.3.3 URBAN YOUTH AND ACCESSIBILITY TO HIV AND AIDS EDUCATION 34 2.3.4 THE HARD-TO-REACH URBAN YOUTH 35 2.4 URBAN YOUTH AND THE MEDIA 36 2.4.1 EROSION OF CULTURAL VALUES BY THE MEDIA 36 2.4.2 CONTRADICTING MESSAGES AND CONFLICTING ROLE MODELS 37 2.4.3 YOUNG PEOPLE, TELEVISION AND SEXUALITY 38 2.4.4 YOUTH, PARENTS AND TELEVISION VIEWING 39 2.4.5 PEER INFLUENCE ON TELEVISION VIEWING 39 2.5 URBAN YOUTH, SEXUAL SOCIALISATION AND HIV AND AIDS EDUCATION 40 2.5.1 THE PURPOSE OF HIV AND AIDS EDUCATION FOR URBAN YOUTH 41 2.5.2 THE STRUCTURE OF HIV AND AIDS EDUCATION 41 2.5.3 BEHAVIOURAL CHANGE THROUGH EDUTAINMENT 43 2.3 xiii Page 2.6 TELEVISION EDUTAINMENT FOR HIV AND AIDS PREVENTION 44 2.6.1 ASPECTS OF HIV AND AIDS TO BE ADDRESSED BY TELEVISION EDUTAINMENT 45 2.6.1.1 Myths and misconceptions about HIV and AIDS 45 2.6.1.2 Perception of risk 46 2.6.1.3 HIV and AIDS stigma 47 2.6.2 THE CULTURAL FACTORS IN TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 48 2.6.3 PERSONALITY TRAITS AND TELEVISION VIEWING 50 2.6.4 CATEGORIES OF TELEVISION EDUTAINMENT PROGRAMMES 51 2.6.4.1 Advertisement spots or public service announcements (PSAs) 51 2.6.4.2 Television magazines and variety shows 51 2.6.4.3 Reality television 51 2.6.4.4 Educational drama 52 2.6.4.5 Television soaps 52 ROLE MODELING IN EDUTAINMENT 53 2.6.5 2.6.6 2.7 STUDIES RELATED TO TELEVISED HIV AND AIDS EDUCATION………….……………..55 CONCLUSION 56 ---oOo--- xiv Page CHAPTER 3 DESIGNING AND CONDUCTING THE EMPIRICAL RESEARCH 3.1 THE AIM OF THE CHAPTER 59 3.2 INTRODUCTION 59 3.3 PARADIGMATIC APPROACH 59 3.3.1 THE CONSTRUCTIVIST AND INTERPRETIVIST EPISTEMOLOGY 60 3.3.2 THE CONCEPTUAL AND THEORETICAL FRAMEWORK OF THE STUDY 62 3.3.3 THE QUALITATIVE APPROACH TO THE STUDY 64 3.4 RESEARCH DESIGN AND METHODOLOGY 66 3.4.1 INSTRUMENTAL CASE STUDY DESIGN 66 3.4.2 SELECTION OF PARTICIPANTS 67 3.4.2.1 Community youths 68 3.4.2.2 Participants from a high school 69 3.4.2.3 Participants from the teachers’ college 69 3.4.2.4 University students 69 3.4.2.5 Key informants 70 DATA COLLECTION 71 3.4.3.1 Document analyses 71 3.4.3.2 Focus Group Discussions 71 3.4.3.3 Personal interviews 74 3.4.3.4 Participant observations 75 3.4.3.5 Direct observation 76 3.4.3.6 Reflective journal 77 3.5 DATA ANALYSIS AND INTERPRETATION 78 3.6 QUALITY CRITERIA 80 3.6.1 CREDIBILITY 80 3.6.2 TRANSFERABILITY 82 3.6.3 DEPENDABILITY 82 3.6.4 CONFIRMABILITY 82 3.6.5 AUTHENTICITY 83 3.4.3 xv Page 3.7 ETHICAL CONSIDERATIONS 83 3.7.1 INFORMED CONSENT 84 3.7.2 DISCLOSING DETAILS OF THE STUDY 84 3.7.3 OPPORTUNITY TO WITHDRAW 84 3.7.4 RISKS AND BENEFITS 84 3.7.5 ENSURING CONFIDENTIALITY 85 3.8 CLOSING REMARKS 85 ---oOo--- xvi Page CHAPTER 4 FINDINGS FROM THE STUDY 4.1 AIM OF THE CHAPTER 87 4.2 INTRODUCTION 87 4.3 TELEVISED HIV AND AIDS EDUCATION DRAMA AND SUBMINIMAL CUTS 87 LIFE CHOICES AND OTHER TELEVISED EDUCATION DRAMA 90 4.3.1.1 Motivation for selecting Life Choices 91 4.3.1.2 The story set-up and the structure of Life Choices 92 4.3.1 4.3.2 4.3.3 4.3.1.3 Participants’ perceptions of HIV and AIDS messages in Life Choices 100 4.3.1.3 Analysing participants’ perceptions of HIV and AIDS messages in Life Choices and other televised drama 108 SUBMINIMAL CUTS 112 4.3.2.1 Missing the goal 112 4.3.2.2 The caring father and husband 113 CONCLUSION ON TELEVISED HIV AND AIDS EDUCATIONAL DRAMA AND SUBMINIMAL CUTS 114 4.4 HIV AND AIDS MESSAGES IN COMMERCIAL TELEVISION SOAPS 115 4.4.1 MOTIVATION FOR SELECTING SECRETO D’MOUR 116 4.4.2 THE STORY SET-UP AND STRUCTURE OF SECRETO D’MOUR 116 4.4.2.1 The main characters 116 4.4.2.2 The saga of HIV and AIDS in Secreto D’mour 117 PARTICIPANTS PERCEPTIONS OF HIV AND AIDS MESSAGES IN SECRETO D’MOUR 119 4.4.3.1 Irresponsible sex behaviour 120 4.4.3.2 Peer influence and role modelling 120 4.4.3.3 Testing and counselling 121 4.4.3.4 Social and moral support to people living with HIV and AIDS 121 4.4.3.5 Behavioural transformations 121 4.4.3.6 Openness about ones’ HIV status 122 4.4.3.7 HIV discordance among couples 123 4.4.3.8 HIV and AIDS and death 123 4.4.3 xvii Page 4.4.4 4.4.5 4.5 4.5.1 4.5.2 4.5.3 ANALYSING PARTICIPANTS’ PERCEPTIONS OF HIV AND AIDS MESSAGES IN SECRETO D’MOUR AND OTHER TELEVISION SOAPS 124 4.4.4.1 Representation of real-life situations in television soaps 124 4.4.4.2 Purposive viewing of television soaps 126 4.4.4.3 Sexual socialisation in television soaps 126 4.4.4.4 Attachment to television soap characters 127 4.4.5.5 Role model in television soaps 128 4.4.4.6 Influence of television soaps to non-television viewers 128 4.4.4.7 Fantasy and fiction in television soaps 129 4.4.4.8 Engendered sex-role stereotypes in television soaps viewing 131 CONCLUSION ON YOUTH’S PERCEPTIONS OF HIV AND AIDS MESSAGES IN TELEVISION SOAPS 132 KEY INFORMERS’ ASSESSMENT OF TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 132 USING MEDIA TO ADDRESS THE YOUTH’S EXPERIENCES ON HIV AND AIDS 135 4.5.1.1 Saturation of HIV and AIDS talks in the media landscape 135 4.5.1.2 Complacency to HIV and AIDS transmission 135 4.5.1.3 Contradicting messages on HIV and AIDS 136 4.5.1.4 Multiplicity of television channels and the cost of airtime 136 4.5.1.5 Existence of competing programmes on television 136 ASSESSMENT OF TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 137 4.5.2.1 Fear-arousing presentations 137 4.5.2.2 Defiance and resistance to HIV and AIDS messages 138 4.5.2.3 Balancing stories 139 4.5.2.4 Bias towards adults materials 139 4.5.2.5 Preachy and didactic plots in educational dramas 139 4.5.2.6 Preference for television soaps 140 4.5.2.7 Youth’s involvement in development of dramas 140 CONCLUSION ON KEY INFORMERS’ ASSESSMENT OF TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 141 xviii Page 4.6 APPLYING INSIGHTS GENERATED BY THE STUDY OF TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 142 4.6.1 ADDRESSING THE CHANGING FACE OF HIV AND AIDS 142 4.6.2 COMPLEMENTARY FUNCTIONS OF EDUCATIONAL DRAMAS AND TELEVISION SOAPS 143 4.6.3 ENHANCING SEXUALITY EDUCATION AND SEXUAL SOCIALISATION 143 4.6.4 IMPROVING ADULTS’ PERCEPTIONS TOWARDS YOUTH’S CULTURES 144 4.6.5 THE EVOLVING ROLES OF TELEVISION 145 4.6.6 TURNING LIABILITIES INTO ASSETS: USING TELEVISION SOAPS FOR HIV AND AIDS EDUCATION 145 4.6.7 ENHANCING CULTURAL ASPECTS IN TELEVISION VIEWING 146 4.6.8 SEX-ROLE STEREOTYPES 147 4.7 CONCLUSIONS 148 ---OOO--- xix Page CHAPTER 5 SYNTHESIS, FINDINGS AND RECOMMENDATIONS 5.1 THE AIM OF THE CHAPTER 149 5.2 SYNTHESIS 149 5.3 PRESENTATIONS OF FINDINGS ACCORDING TO RESEARCH QUESTIONS 151 RESEARCH QUESTION 1 152 5.3.1.1 Message construction and presentation in televised educational drama 152 5.3.1.2 Generation gaps, clash of interests and defiance 153 5.3.1.3 Characteristics of the youth as an audience 153 5.3.1.4 Television soaps and sexual socialisation 154 RESEARCH QUESTION 1.2 155 5.3.2.1 Saturation of HIV and AIDS talks in the media landscape 155 5.3.2.2 Didactic and fear-arousing programmes 155 5.3.2.3 Quality of the HIV and AIDS programmes 155 5.3.2.4 Balancing stories 156 5.3.2.5 Bias towards adult materials 156 5.3.2.6 Youth’s involvement in the development of drama 156 RESEARCH QUESTION 1.3 157 5.3.3.1 Addressing the changing face of HIV and AIDS 157 5.3.3.2 Complementary functions of educational drama and television soaps 157 5.3.3.3 Improving adults’ perceptions towards youth’s cultures 157 5.3.3.4 The evolving roles of television 157 5.3.3.5 Using television soaps for sexual socialisation 158 5.3.3.6 Cultural dimensions in televised education HIV and AIDS Programmes 158 5.3.3.7 Sex-role stereotypes 159 5.3.4 Conclusion 159 5.4 DISCUSSION OF FINDINGS 159 5.4.1 ADDRESSING THE CHANGING TRENDS OF HIV AND AIDS IN UGANDA 159 5.4.2 INTEGRATING YOUTH SUB-CULTURES INTO TELEVISED HIV AND AIDS EDUCATION 161 5.3.1 5.3.2 5.3.3 xx Page 5.4.3 ISSUES AND CHALLENGES IN DEVELOPING TELEVISED HIV AND AIDS EDUCATIONAL PROGRAMMES 162 5.4.4 THE KNOWLEDGE CLAIM 163 5.4.5 CONCLUSION…………………………………………………………..……………171 5.5 RECOMMENDATIONS 5.51 FOCUSING ON PURPOSE OF TARGET AUDIENCE…………………………..174 5.5.2 MEDIA LITERACY…………………………………………………………….….174 174 5.5.4…UTILIZATION OF EXISTING RESOURCES………………………………….…174 5.5.4 AREAS FOR FURTHER STUDY 174 5.6 POSSIBLE CONTRIBUTIONS OF THE STUDY 175 5.7 POSSIBLE LIMITATIONS OF THE STUDY 176 5.8 FINAL REMARKS 176 ---oOo--- REFERENCES 177 APPENDICES 202 ---ooOoo--- xxi LIST OF TABLES Page Table 1.1: Outline of the study 25 Table 4.1: Composition of the participants in the seven focus groups 89 Table 4.2: Comparison between the consequences of good and bad choices in The drama 100 Table 4.3: Composition of the key informants for personal interviews 134 Table 5.2 Epistemological perspectives on televised HIV and AIDS Educational programmes 173 LIST OF FIGURES Page Figure 2.1: Diagrammatic summary of the literature review Figure 3:1 57 A schematic presentation of the research approach and design……..………….86 ---oOo--- xxii