Changing the Course of AIDS

Changing the Course of AIDS: Peer Education in South Africa and Its Lessons for the Global Crisis

David Dickinson
Foreword by Charles Deutsch
Copyright Date: 2009
Edition: 1
Published by: Cornell University Press,
Pages: 272
https://www.jstor.org/stable/10.7591/j.ctt7zj85
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  • Book Info
    Changing the Course of AIDS
    Book Description:

    Changing the Course of AIDS is an in-depth evaluation of a new and exciting way to create the kind of much-needed behavioral change that could affect the course of the global health crisis of HIV/AIDS. This case study from the South African HIV/AIDS epidemic demonstrates that regular workers serving as peer educators can be as-or even more-effective agents of behavioral change than experts who lecture about the facts and so-called appropriate health care behavior.

    After spending six years researching the response of large South African companies to the epidemic that is decimating their workforce as well as South African communities, David Dickinson describes the promise of this grassroots intervention-workers educating one another in the workplace and community-and the limitations of traditional top-down strategies. Dickinson's book takes us right into the South African workplace to show how effective and yet enormously complex peer education really is. We see what it means when workers directly tackle the kinds of sexual, gender, religious, ethnic, and broader social and political taboos that make behavior change so difficult, particularly when that behavior involves sex and sexuality.

    Dickinson's findings show that people who are not officially health care experts or even health care workers can be skilled and effective educators. In this book we see why peer education has so much to offer societies grappling with the HIV/AIDS epidemic and why those interested in changing behaviors to ameliorate other health problems like obesity, alcoholism, and substance abuse have so much to learn from the South African example.

    eISBN: 978-0-8014-5850-7
    Subjects: Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Foreword
    (pp. vii-x)
    Charles Deutsch

    A great deal has been written in the last two decades about HIV/AIDS, especially on the pandemic afflicting Southern Africa. What does this book add, not merely to our library of continuing tragedy, but to the hope that we can someday turn it into an archive helping us learn from the past?

    In Southern Africa we are barely making a dent in rates of new infection. Prevention has always been grossly underfunded, and remains so. But now it is considered a priority to combine biomedical, structural, and social/behavioral prevention strategies. Two decades ago some virologists were confident that adequate investment...

  4. Acknowledgments
    (pp. xi-xvi)
  5. 1 “Empowered with Information I Have Influenced a Lot of People”: The Quest for Behavioral Change
    (pp. 1-43)

    Robert Mokwena is a forty-five-year-old African miner who works for Mineco—a fictitious name for a large South African mining company. Over the past decade he has watched family and friends die. His best friend of many years, Benny Modise, died shortly after telling Mokwena that he was HIV-positive. At the time of his friend’s death, antiretroviral treatment was unavailable. As he became more and more debilitated, Modise was unable to work and was put on medical disability. Admitted to hospital he grew increasingly despondent. Finally, Modise hung himself from a tree in the hospital grounds. Soon after this tragedy,...

  6. 2 “People Are Dying, but They Don’t Listen When We Tell Them”: The Corporate Response to HIV/AIDS in South Africa
    (pp. 44-70)

    Many outside of South Africa may be puzzled that businesses that are not in health care are responding to the AIDS epidemic. Why are South African businesses—slowly at first and now more visibly—responding to the problem of HIV/AIDS, and how is that response unfolding?

    When questioned, many company managers and management consultants initially offer an economic rationale. Since HIV/AIDS primarily affects those of working age, it makes business sense to prevent HIV infection of workers and ensure, through the use of antiretroviral drugs, that those already infected continue working so that companies don’t lose labor, accumulated skills, and...

  7. 3 “For the Love of People”: Peer Education as a Response from Below
    (pp. 71-93)

    In June 2005, at the South African AIDS Conference, a biannual event in the country’s AIDS calendar, I presented some preliminary ideas on workplace peer education at a session on HIV/AIDS workplace programs. The session was one of the best attended of the conference; around four hundred people in a large auditorium of the Durban International Conference Centre listened to half a dozen papers. Two of them, including my own, dealt with workplace peer educators. The other, a “meta-analysis” or study-of-studies, drew on statistical evaluations of the impact of workplace peer education on infection rates. On the basis of the...

  8. 4 Backstage Social Divisions
    (pp. 94-141)

    A half dozen or so peer educators are holding their monthly meeting in Robert Mokwena’s office in the mining hostel where well over a thousand men live far from their homes. Mokwena has had an office for only a couple of years, though he’s been a peer educator for six. He was promoted to a clerk after twenty years working underground. He is short but powerfully built; underground his job was to shovel loose rock that the mechanical grabs were too clumsy to scoop after blasting. A table is stacked high with brightly colored government leaflets on HIV/AIDS and other...

  9. 5 Slipping Out of Order
    (pp. 142-179)

    There is a sharp contrast between the work of peer educators and institutional responses to HIV/AIDS. Although peer educators welcome corporate initiatives around AIDS, they are aware that these responses often fall short of what is needed. Mokwena in Mineco made the point by contrasting the missionary-zeal of peer education to annual displays of corporate concern on World AIDS Day. “I’m not only doing my job [as a peer educator] at the company, [but also] at the family, at the church, wherever I go I’m a peer educator. I will take that knowledge with me and everything I know about...

  10. 6 To Speak with One Voice
    (pp. 180-203)

    While peer educators strive to change the behavior of their peers, some also recognize the limits of strategies restricted to working with individuals. To put it simply, there are too many avenues of escape for those who prefer, for one reason or another, not to listen to the messages of peer educators, irrespective of its vernacular delivery or sociocultural proximity. In response some peer educators encourage all social actors to “speak with one voice” and to close down these psychological escape routes. One of the main targets of their efforts are the South African unions that have, to date, been...

  11. 7 Social Space, Leadership, and Action: Peer Education and Behavioral Change
    (pp. 204-216)

    In South Africa, one in three women between the ages of twenty-five and twenty-nine and one in five men in their thirties are infected with HIV. South Africa is not alone in facing these levels of HIV infection; many other sub-Saharan African countries face similar or even higher prevalence rates. In developed countries AIDS is largely contained as a problem of marginal groups with specific factors rendering them vulnerable. In developing countries, such as India and China, the epidemic threatens to go on the march, as it is doing in the transitional economies of Eastern Europe and Russia. The epidemic...

  12. Appendix 1: Tables
    (pp. 217-228)
  13. Appendix 2: Methodology
    (pp. 229-234)
  14. References
    (pp. 235-244)
  15. Index
    (pp. 245-252)