Community workers and HIV/AIDS: stories from Botswana.

INTRODUCTION

There has been a lot of research work done on women and HIV/AIDS at a global picture level. The United Nations Organization, and in more recent years, the UN has played a key role in conducting and publishing reports on HIV/AIDS. It is estimated that 28.1 million people are living with HIV and AIDS in sub-Saharan Africa (United Nations and WHO 2001, #18). In this region, Southern Africa is currently the worst hit with countries such as Botswana leading the prevalence rates in the world at nearly 40% (United Nations and WHO 2001; United Nations Development Programme 2000; United Nations Special Session on HIV/AIDS 2001; WHO and UNAIDS 2000; United Nations AIDS and WHO 2002). The majority of infected people in the region are women.

While a lot of research has focused on the issues of women in relation to their position in society and factors facilitating for a high infection rate amongst women, (Schapera 1938; Mwale and Burnard 1992; Mufune 1996; Lesetedi 1999; Molutsi and Badade 1999; Stegling 2000; Lister 2000), little attention has been paid to the female community workers in the area of HIV/AIDS. What challenges do they face? How do they cope with these challenges?

The purpose of this paper is to share findings of a case study research project undertaken with a group of fifty participants over a period of 6 months. The stories are part of a wider research aimed at investigating HIV/AIDS policy processes in Botswana. Specifically the study examined the impact political, economic, and sociocultural factors have on the policy process. Part of the research, where community workers were the target population, involved gathering stories from these community workers of their experience in the work-field.

The stories shared in this paper are from two female community workers living and working in Botswana. They have been, and continue to work with HIV/AIDS programmes in Gaborone, the capital city of Botswana. Using a qualitative method, information was gathered through the use of conversations with the participants. The stories shared are not aimed at giving solutions rather they raise issues of practice for women in this area.

INFORMATION GATHERING PROCESS

A qualitative methodology was chosen to allow new knowledge and ways of understanding issues to emerge from the information gathered. Denzin and Lincoln (2000) view qualitative method as a multi-method, involving an interpretive, naturalistic approach to its subject matter. Researchers using this method are engaged with the study of things in their natural settings, attempting to make sense of meanings people bring with them.

In addition, Ely, Anzul, Friedman, Garner, and McCormack Steinmertz (1991) state that qualitative represents the descriptive nature of work, which is different from the emphasis of quantitative methods. Ely et al (1991) note that it involves various ways of gathering data and analysing, rooted in a number of traditions, such as field studies and ethnography, which employ observation as a primary form of data collection; action research, which focuses on the purpose of the research and the role of the researcher; grounded theory; and finally the many types of phenomenological sociological research efforts, which aim to describe the social world.

To meet the demands of qualitative research, a case study methodology was employed due to its allowance for an "exploration of a bounded system or a case (or multiple cases) over time through detailed, in-depth data collection involving multiple sources of information rich in context" (Creswell 1998, 61). Through a case study, a holistic approach was undertaken that provides for rich information. He emphasizes a "complex, holistic picture, a reference to a complex narrative that takes the reader into the multiple dimensions of a problem or issue and displays it in all its complexity" (Creswell 1998, 15). It is with this in mind that it is hoped the stories shared here, will demonstrate this complexity.

In-depth unstructured interviews were employed to understand the complex behaviour of members of society without imposing any a priori categorization that may limit the field of inquiry (Fontana and Frey 1994). Interviews are generally seen as purposeful conversations between two people (and more) in order to get information. Kvale (1996) sees interviews as conversations that have a structure and purpose. The study employed conversations as a way of getting participants to relax and allow for indepth conversations about the issue of HIV/AIDS, resulting in an interaction between the researcher and participants resulting in negotiated, contextually based results (Alasuutari 1998).

PRESENTING THE STORIES

The stories are presented in the form of anecdotes and vignettes. Ely et al. define an anecdote as an "event that can be about something that happened to others, to the researcher or both, but the key is that it means something to the person writing it and that in the anecdote the nugget of meaning somehow gets put into writing" (1997, 65). Vignettes are seen as narrative investigations that carry within them an interpretation of the person, experience, or situation that the writer describes. Unlike an anecdote, "a vignette restructures the complex dimensions of its subject for the purpose of capturing, in a brief portrayal, what has been learned over a period of time" (Ely et al. 1997, 70). In the vignette the writer can add his/her words with those of the participant.

RESEARCH FINDINGS

   I Am a Woman ... Cheryl's Story

   They are cohabiting and they are looking after the
   husbands ... and they are looking after their common law
   husbands ... what if the common law husband dies ... she is
   not the common daughter in law ... the property rights ...
   there is the children ... It is one of the major problems.
   Because if the woman has been living with this man forever ...
   for 25 years ... her property is his property basically
   you know ... it is in his name ... because they were not
   living in marriage ... now perhaps at some point they were
   married in a traditional way ... but when they are in court
   the laws will argue saying we were not paying lobola ... we
   were paying damages for the children so now you have a long
   story to prove ... and you have no rights. Unless you find a
   Chief or whoever who is going to talk against that particular
   family rather than supporting their government, so what we are
   having are a lot of destitute women ...

   (Cheryl 2001, 19)

In the anecdote above Cheryl (2001) gives a synopsis of the stories she is constantly encountering as a community worker in Gaborone. Women in Botswana society are still regarded as second class citizens resulting in the inability to acquire meaningful employment and earn a decent living, a view shared by Bianco when she says "through out the world, women suffer from the stigma and deprivation of secondclass citizenship based on their sex, as a result women rely on their male partners to survive" (1998, 22). In the advent of HIV/AIDS women, who live in cohabitation relationships and have children within these relationships face a difficult task in securing property left by their deceased partner. Even if the woman was contributing to the acquisition of the property, she stands very little chance to keep it, as the partner's family and the courts are likely to rule against her.

This has resulted in the number of women receiving destitute allowances increasing over the past few years. Although there is no latest figures to show the level of poverty amongst women, previous research conducted in the early to mid 1990s, indicates that women in Botswana are much poorer than men. One can only assume that their situation is worse off than before.

Community workers were asked to share their thoughts about how cultural factors were affecting their work. Unlike in most research where cultural factors have centred on the negative practices, it was interesting to hear stories from workers about the positives of Botswana culture and how they are trying to promote these practices in their work. Nelly (2001) shares her views about this subject.

   Not Everything is Bad Botswana Culture ...

   ... you find that even nowadays this thing of cleansing, you
   know nowadays they just do a ceremonial cleansing because
   people are aware of the disease because the people know that
   my husband has died of the disease then "how do I go and sleep
   with my brother inlaw to cleanse me?" ... I will be passing
   on the disease. May be there are also those other cultural
   practices which when you look at them you think they may also
   be protecting the person from infection not only HIV/AIDS but
   from other infection. For instance here in Botswana ... if
   you look at some of the things they do like when you have
   just had a baby, you are confined for 3 to 4 months
   ... I think that helps you as a mother to grow and for the
   baby to grow ... and it protects you also from all these other
   infections ... and you know what they usually do, is that when
   you are in confinement you don't share your utensils with
   anybody else ... they are specifically for you ... so if you
   apply that may be to someone who is bed-ridden ... they keep
   them in ... you know they separate ... wash them separately ...
   I think that will also help not spread some of the ... things
   like TB and so on ... so there are those cultural practices
   which can be encouraged ... (Nelly 2001, 5-6)

The anecdote shared by Nelly (2001) arises from literature that has painted African culture as encouraging bad cultural practices such as the cleansing ceremonies, in which a woman whose husband had died, was given to her brother-in-law as a wife. Although these practices have received wide condemnation in Africa, especially after the introduction of Christianity, there are still those who practice them. What is emerging from Nelly's narration is that there appears to be a re-adjustment in how these cultural practices are being performed in the era of HIV/AIDS. Her narration suggests that people are now cautious about the cleansing process and taking care to ensure that the passing on of the disease is minimised.

The second point Nelly raises is that of the maintenance of currently practiced cultural ceremonies, which might be useful in enhancing hygiene amongst populations in Botswana. These practices could help in the reduction of diseases that could act as opportunistic diseases to those living with HIV/AIDS. So, instead of seeing Botswana culture as simply a facilitator for high infection HIV rates, some cultural practices need to be incorporated in the current Botswana society.

A major theme arising from the study amongst community workers was that of empowerment. To many community workers this was crucial to the success of the implementation of HIV/AIDS programmes. While most of the community workers spoke of the necessity of empowering communities especially women and young people, some workers saw the complexity of empowerment. I found Nelly's story very interesting and representative of the workers who shared her views.

Am I Empowered? ... Nelly's Story

   It is very difficult to empower women at a personal level.
   It is easy to bring women together and say 'look this is how
   you vote ... tomorrow you are going to vote for Mrs so and
   so ... this is how you write' ... but it is difficult to
   empower them so that when they go home ... that they can go
   home and negotiate with their partners and say 'today I
   have brought back a condom'. I think there it will take more
   than just women's organisations ... It has to start right
   from the home and it has to include men ... We have to tell
   men that it is o.k. for the women to bring a condom back home.
   You just don't tell them that when you get home. You know
   there is a female condom ... you give to me and say
   you should learn to negotiate ... I can go home and tell
   my husband, "look this is the female condom". It is good ...
   but my husband has not been empowered. He will say, "look I
   also have my demands and needs". So on a very personal level
   ... at the household ... at the family level ... I don't
   think they have succeeded.

   Community level, yes. You should see women speak out for
   themselves and as a group...have a good time ... we can
   do almost everything. [Name of organisation withheld] is
   doing a good job ... but go back to the home ... the same
   women in [name withheld], I don't think they can negotiate.
   I don't think any of them carry a condom around. They are
   scared ... what will the partner think? So it's ... may be
   that is the starting point. I don't know ... but at the
   household ... uhhh ... no. It will take a long time if it
   will ever change ... and then with this HIV/AIDS, I even say
   that they have ... I term it feminisation of HIV/AIDS ...
   its like it is a woman's disease. It is a woman's disease ...
   it's the women who are mostly affected ... it's the
   women who care for those who are ill.

   And yet at the same time, we turn around and say that women
   don't have ... they are not empowered? Have you ever seen a
   woman look after a big person ... how strong they are? You
   know you tell yourself it is amazing. This woman, the son is
   just ... you know at one time we found a mother nursing a
   daughter and a son ... both of them have HIV ... you look at
   this woman and you tell yourself that if it's a man
   he would have run away ... he would have just abandoned them.
   But this is the same woman we say ... "no ... they have no
   negotiating skills". But they are managing somehow ... so may
   be we should look at it from that perspective, that may be
   even though they are not empowered out there ... may be there
   is something in women that makes them go on even when there is
   no hope at all ... yeah ... with this ... all the carers are
   women ... we never came across one man looking after a sick
   person ... no ...it was always women ... they will
   look after their partners ... when their partners die ... it's
   another woman who will come and look after them
   (Nelly 2001, 8).

The vignette gives a complex portrayal of Nelly's dilemmas about the notions of empowerment. While empowerment is a buzzword for community workers, there was evidence from the study that workers are beginning to ask questions about the meaning of the term in practice. The vignette shared by Nelly challenges our normally held assumptions about empowerment. In the empowering of women, community workers see empowerment as a process of educating women about their rights, and the power they possess to make decisions in their own situations. This has worked to a certain extent, but as Nelly points out, at an individual level, a lot more needs to be done for women to reach a level of full empowerment, assuming that such a state exists.

The second issue she raises is that of empowerment amongst workers. Nelly gives an example of her position as a female community worker, married and a mother. During the day she spends her time working on HIV/AIDS programmes, mostly with women clients. In her work, she spends most of her time empowering women. However, when she goes home after work she becomes one of the disempowered women as she finds herself unable to negotiate for issues such as sexual issues with her husband.

Finally, Nelly challenges us to see empowerment as much more than about negotiating rights and position in society, that women who are in caring positions within their societies are also empowered. That the fact that they are able to look after and care for a sick person is empowerment, and should not be made to feel that they are not.

CONCLUSION

The stories shared by Cheryl and Nelly were reflective of other community workers' views in the study. The issues raised in these anecdotes and vignettes provide an insight into the practices of community workers in Botswana, specifically women.

The stories also demonstrate that community workers are constantly becoming reflective of their practice and how to enhance it. Community workers see their role as beyond that of working with HIV/AIDS affected populations, rather as ways of developing skills that are suitable within the society. Some writers (Osei-Hwedie 1996a; Osei-Hwedie 1996b; Mupedziswa 1992; Mupedziswa 1997) in Africa have been calling for an indigenous approach to community work, one that encourages the engagement of positive African cultural practices. Whether this will materialise, can only be speculated on. The important thing from this study and a challenge for community work is that female community workers will have an important role to play in the way practice will be shaped for the future.

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Bridget Ng'andu *

* Author:

Bridget Ng'andu: Zambian woman, currently completing a PhD in the School of Social Work and Social Policy at Curtin University, Perth. Bridget completed her Bachelor of Social Work at the University of Botswana, a country she resided in for 12 years, and enrolled for a Masters in Social Work degree at Curtin University in 1999. Bridget wishes to thank her Supervisor Professor Jim Ife for his constant support.