Young Africans' social representations of sexual abuse of power in their HIV-related creative narratives, 2005-2014: cultural scripts and applied possibilities

Insufficient responses to rape in Ouagadougou: Reflections on the experiences of young female survivors

The rape of girls and women raises questions about both prevention and the response in Burkina Faso. This article looks at the inadequacy of the response to rape in Ouagadougou. It is based on an analysis of cases of rape experienced by young women in the city and documented between 2005 and 2009. The study highlights the gap between the attitude of the victims, whether or not they are inclined to report the act and seek support, and the existing response in this area, whether in their entourage, at the community level, or at the institutional level. The study concludes that there is a need for more in-depth research into the representations and experiences of rape survivors in Ouagadougou and, more broadly, in Burkina Faso. Such research will enable us to identify gaps and appropriate strategies so that survivors are offered a holistic response that is more conducive to respect for their sexual and reproductive rights. Appropriate responses should involve improving the response system, so as to minimize obstacles and make institutional support more accessible to survivors.

Perceptions of Sexual Abuse in Sport: A Qualitative Study in the Portuguese Sports Community

Child sexual abuse is a complex issue that can take place in different contexts. Sports settings have specific features which pose increased risk for sexual abuse to occur. Recently, a country-specific roadmap for effective child safeguarding in sport was launched. Considering the need to achieve a comprehensive picture of violence against children in sports settings in Portugal, we analyzed the perceptions of the sports community in Portugal regarding child sexual abuse, its victims and perpetrators, and the specific risk factors in sports settings, as studies about this specific topic are scarce at the national level. A descriptive exploratory study was conducted using an online questionnaire with open-ended questions. Three hundred participants, i.e., sports managers, coaches, and athletes over 18 years of age (M = 33.13; SD = 13.062), of which 55.7% were female, answered. A thematic analysis of these data was conducted using NVivo software. Inter-rater agreement was strong for almost all variables. Results indicated that sexual abuse is perceived as being associated with physical and emotional abusive behaviors for which there is no consent from the victim, in a relationship that is guided by a relationship with power imbalances. Victims were mainly perceived as being female children, and perpetrators as adult males in a powerful position over the victim. As to possible signs of sexual abuse victimization, results showed that the participants identify behaviors, such as isolation, and physical evidence, such as marks and injuries. Risk factors specific to sports setting included the physical contact involved in many modalities, as well as the close and trustful relationship established between coach and athlete. Results are in line with previous studies showing that coaches, athletes, and sports managers share a common understanding of sexual abuse, although not always accurate. These results shed light on important practical and policy implications relevant to country-specific sport policies for effectively safeguarding children.

Women's sexual scripting in the context of universal access to antiretroviral treatment-findings from the HPTN 071 (PopART) trial in South Africa

BACKGROUND

HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women's sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment.

METHODS

We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18-35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV.

RESULTS

We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women's thinking about sex. In their scripts, women idealised romantic sex, positioned sex as 'about relationships', and described risky sex as 'other'. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts.

CONCLUSION

These findings suggest that HIV-negative women did not include their partners' use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively-through community-wide viral suppression-rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.

Social Representations Theory and Young Africans' Creative Narratives about HIV/AIDS, 1997-2014

Research on social representations (SRs) has often focused more on categorical than narrative-based representations. However, narratives are considered to play a key role in the organization of social representations. This paper describes an empirical study of some 2,000 creative narratives about HIV written by young Africans from five countries between 1997 and 2014 and examines the theoretical, methodological and applied relevance of SRT for this study and the implications of the study for the intersection between narrative and SRT. The study is unusual within the SR paradigm: it is temporal and cross-national; addresses a subject whose science has evolved over time; and uses creative narratives as its data source. A narrative perspective foregrounds holistic understandings of SRs as systems of thought. Creative narratives fit well within an SR framework. Our triangulating methodologies foreground categorical or narrative dimensions depending on the objectives of specific sub-studies. Central Core Theory provides a framework to articulate stability and change within narrative representations. In creative narrative, objectification also happens at the level of plot and characters, such that dominant cultural narratives can be viewed as a form of hegemonic SR. We link with health communication and embrace more critical streams within SR research.

A Variational Approach to Scripts

This paper proposes a formal reconstruction of the script construct by leveraging the active inference framework, a behavioral modeling framework that casts action, perception, emotions, and attention as processes of (Bayesian or variational) inference. We propose a first principles account of the script construct that integrates its different uses in the behavioral and social sciences. We begin by reviewing the recent literature that uses the script construct. We then examine the main mathematical and computational features of active inference. Finally, we leverage the resources of active inference to offer a formal model of scripts. Our integrative model accounts for the dual nature of scripts (as internal, psychological schema used by agents to make sense of event types and as constitutive behavioral categories that make up the social order) and also for the stronger and weaker conceptions of the construct (which do and do not relate to explicit action sequences, respectively).

A smartphone game to prevent HIV among young Kenyans: local perceptions of mechanisms of effect

Electronic games delivered via smartphones have the potential to become valuable tools in HIV prevention in high-prevalence and low-resource international settings. To ground theoretical elaboration around novel mHealth interventions in contextual realities, it is important to understand the mechanisms of their effects as perceived by local populations. Such perspectives are particularly important when working cross-culturally. 'Tumaini' is an interactive narrative-based smartphone game that uses a 'choose-your-own-adventure' format. It is designed to prevent HIV among young African adolescents (aged 11-14) by increasing age and condom use at first sex. It was developed with a US-based commercial game developer and is grounded in social behavioral theory, evidence-based practice and contextually relevant scenarios. In a 2017 randomized pilot study (n = 60) in Western Kenya, 'Tumaini' showed promising effects on behavioral mediators of sexual debut. In subsequent focus group discussions, adolescent participants and their parents shared their perceptions of the game's mechanisms of effect, which included motivation to play, future orientation, decision-making, relationship to a diverse range of characters and a bridging of the virtual and real worlds. These findings align with our theoretical framework, confirm its successful translation into the intervention and will inform mediation analyses in an upcoming efficacy trial.

A Smartphone Game to Prevent HIV among Young Kenyans: Household Dynamics of Gameplay in a Feasibility Study

OBJECTIVE

mHealth interventions often favour individual-level effects. This is particularly problematic in contexts where social support and shifts in social norms are critical to sustained behaviour change. Mobile digital games represent a promising health education strategy for youth, including in low-resource settings. We sought to better understand the interpersonal and social interactions that can be elicited by digital games for health.

DESIGN

We piloted Tumaini, a smartphone game rooted in interactive narrative designed to prevent HIV among young Africans (aged 11-14), in a randomised controlled feasibility study and analysed reports of the household dynamics surrounding gameplay. Following a 16-day intervention period, phone gameplay log files were downloaded and intervention arm participants (n=30) completed a gameplay experience survey; eight focus group discussions were held, four with intervention arm participants (n=27), four with their parents (n=22).

SETTING

This study took place in Kisumu, Kenya, in Spring 2017.

METHOD

Descriptive statistics were computed from survey responses and log files. Focus group transcripts were labelled, analysed thematically, and compared demographically using MaxQDA software.

RESULTS

Data from log files, survey and focus groups indicate that the game generated considerable interaction and dialogue with parents, siblings, and friends, and served as a catalyst for children to act as advocates for healthful decisions about sex, both within the family and beyond. The game showed a high level of acceptability with parents.

CONCLUSION

Serious digital games using a smartphone platform can generate considerable household interaction. Games can model and facilitate these exchanges, maximising multi-level effects. An additional app for parents could reinforce these effects.

Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans

The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework-integrating intervention design, mediators, and behavioral outcomes-and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini (hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the "My Story" component links the game world to the player's own life and goals, and a reward system motivates continued play. With its "choose-your-own-adventure" format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration.