The production of context : using activity theory to understand behaviour change in response to HIV and AIDS.
Van der Riet, Mary Boudine.
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This thesis explores the problem of sexual behaviour change in a country which has the largest number of people living with HIV in the world. Despite awareness of HIV, and knowledge of protective behaviours, many young South Africans still engage in risky sexual practices, exposing themselves to risk of HIV infection. This lack of behaviour change by people who know the risks involved is the focus of this thesis. I begin by developing a critique of the dominant behaviour change theories which underpin HIV and AIDS interventions, and the way in which they conceptualise the relationship between the individual and society. These theories assume a universal, rational individual who engages in decision-making before action, or is prevented by problematic factors of ‘context’ (e.g. poverty, culture, gender dynamics) from engaging in appropriate protective health decisions. This conceptualisation of behaviour is inadequate in understanding the problem of behaviour change. Cultural-historical activity theory (CHAT), with its roots in the theories of Marx, Engels, Vygotsky and Leontiev, enables a different gaze on the problem of behaviour change, shifting the primary focus from cognition to activity. This provides an alternative dialectical conceptualisation of the relationship between the individual and society. In this thesis I articulate and extend the methodology inherent in CHAT. In a study conducted in a rural area in South Africa I recruited qualitative research processes to explore the cultural-historical context of early sexual experiences leading to intercourse; and the participants’ experiences of sexual activity in relation to HIV and AIDS. The conceptual and methodological tools inherent in CHAT enabled the production of the context of sexual activity. The focus on sexual activity as the central object unit and the analysis of the activity system illuminated the activity of sex as a social practice, produced and enacted within particular interpersonal, social and historical dynamics. Through an historical and current contextualisation of sexual activity CHAT-based analysis of the data enabled an articulation of contradictions and turbulence within the activity system. The problem of a lack of behaviour change is understood through this production of context. Activity system analysis revealed how the introduction of the injectable contraceptive gendered the division of labour in sexual activity. An analysis of the relationship between the subject and the object of the activity system revealed a phalocentric identity investment as an outcome of sexual activity. This analysis also illustrated the relative invisibility of HIV compared to pregnancy as a negative outcome of sexual activity. These dynamics of the activity system structure power and resistance to change in the interaction. By accounting for the status of the activity system this analysis facilitated an understanding of a lack of behaviour change in response to HIV and AIDS. This research process forms the basis for a tentative proposal for intervention using the CHAT-based Change Laboratory approach.