This approach considers cultural structures and practices. It brings into the fore the need to recognize people‘s knowledge systems and epistemology in the development of HIV and AIDS intervention programmes and campaign materials such as posters advocating for condom use. This approach is bottom – up in the sense that it puts to the fore a people‘s agenda rather than an alien agenda. It makes use of participatory methodologies as local communities are involved in every aspect of the developmental project. It embraces issues of ideology (the taken-for- granted assumptions about reality that influence taken-for-granted perceptions of situations and events) and hegemony (the process of manufacturing consent among those that are subordinated such that the dominant group can maintain its power) (Dutta and Souza, 2008: 330). It thus questions mololithic assumptions embedded in the dominant paradigm of health campaigns by providing ―… a window into the fractured nature of knowledge, the multiple realizations of truths as seen through multiple lenses‖ (Ibid: 331).
This bottom-up approach does justice to issues of structure and culture which become pivotal in planning, implementation and evaluation of health communication campaigns. In this approach cultural beliefs are seen as a resource rather than as barrier to health communication campaigns. For example, Diop (2000, in Ibid: 332) noted that socio- cultural and religious factors were the reasons behind the low HIV and AIDS prevalence rate in Senegal. In addition to ―universality of marriage and rapid remarriage of widowed and divorced persons‖ (Ibid: 333), it was noted that in Senegal there was strong moral lessons that discouraged people to engage in any form of cohabitation. These curbed the spread of the pandemic.
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In addition to health behavior by an individual, there are a wide range of socio-political factors that impact on an individual and the community which are critical in the fight against HIV and AIDS. For example, it was found out that ―…income inequality, politics and lack of democratic norms can impact health behaviours‖ (Dutta and Souza, 2008: 334). Current health campaigns target the micro- (individual behavior change) and not the macrocosm (the entire society or population). However, the critical-cultural approach celebrates and privileges local knowledge and wisdom and thus gives the community chance to present its problems and to design and implement campaigns in keeping to its needs (Airhihembuwa and Obregon, 2000 in Ibid). Through privileging indigenous communities people are not only given voices and empowered to participate in social change (Ibid). As argued by Dutta and Souza, 2008: 337) the critical – cultural approach is reflexive and thus enables the researcher to raise the following questions regarding efficacy of HIV and AIDS campaign materials:
a) How is culture conceptualized in such culturally sensitive campaigns? b) Whom do these campaigns serve?
c) For what purposes does culture get used in the campaigns?
These questions are critical in the analysis of the discourse of HIV and AIDS campaign messages as given in newspaper reports and the people of Zimbabwe.
Efficacy of the culture – centered approach in crafting health campaigns was discovered in the city of Kolkata, in West Bengal, India (Basu and Dutta, 2009). In this research Basu and Dutta (Ibid: 86) exposed the short-comings of the traditional linear message transmission model of health campaigns and the effectiveness of culture-centered model which puts attention to dialogue and locates the agency of the cultural participants in the culture being studied. In this approach dialogue and community members‘ participation are critical. It is a bottom-up approach.
In their study, Basu and Dutta (Ibid: 88) worked with two large communities of commercial sex workers (CsWers). The studies reveal that ―…Commercial sex workers at Sonagachi and Kalighat in Kolkata, West Bengal demonstrated awareness about, and resistance to, mainstream communication patterns that portray them merely as passive subjects of persuasive messages (Basu and Dutta, 2008, 2009). It was also
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noted that condom – promotion efforts in Indonesia have not yielded positive results (Basuki, et al., 2002 in Basu and Dutta, 2009).
Basu and Dutta‘s project (Ibid) with CSWers combined HIV and AIDS awareness, prevention, and control with community development activities. The benefits of the project to CSWers were as follows:
daily meals to more than 125 children of commercial sex workers; five free health clinics every week;
residential hostel for adolescent girl children of CSWers (Ibid: 91).
Given the above benefits, the CSWers were found to be more powerful and assertive in that they began to bargain for safe sex and condom use with their clients. It was also revealed that positive change is realized through the employment of a well calculated participatory approach in which dialogue plays a central role to focus on culture and structure and agency of those involved. In the research, the CSWers were actively involved in planning, designing, implementation and evaluation of HIV/AIDS programmes. They used participatory communication – ―…a communicative effort that enables community members to weave together individual and collective discourses on health and living (Frey, Adelman, Flint, and Query, 2000; Frey, Query, Flint, and Adelman, 1998 in Ibid: 89). It is critical to reflect on discursive strategies used by newspaper reports to reflect on cultural aspects related to the implementation of the HIV and AIDS policy. Accordingly, views from the people of Zimbabwe are considered with regard to the role played by culture in the implementation of the policy.