Engaging the fertile silence: towards a culturally sensitive model for deal with HIV and AIDS silence.

Abstract

Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

This thesis critically examines one of the major hindrances to dealing adequately with the HIV and AIDS problem facing Africa – the issue of silence. The study has examined the hypothesis that there are cultural factors underlying the silence that surrounds the disease, which when investigated and identified, will provide cues for breaking the silence and a
 way forward for dealing with the HIV and AIDS epidemic. The study utilises the concept of ‘cultural context’ proposed by Hall and ‘dimensions of culture’ postulated by Hofstede, to investigate the cultural reasons behind the HIV and AIDS silence among the Zulu people in and around Pietermaritzburg in the Kwazulu Natal province of South Africa. Testing these theories in the field with participants in a community-based HIV and AIDS Project called the Community Care Project (CCP) the study found that cultural contexts
 strongly influence silence around HIV and AIDS. In terms of dimensions of culture, the area was found to exhibit high power distance, low uncertainty avoidance, high collectivism and is feminine in nature in terms of assertiveness, but having high gender inequality (high masculinity in terms of gender egalitarianism). The analysis of the results of the field research revealed that each of the dimensions of culture contributes in various ways to the silence around HIV and AIDS. The study argues that there are two kinds of silence, namely barren silence and fertile silence, existing on a continuum. In a low context culture, barren silence is the silence that exists as absence, because when people do not talk about the issue, then there is no communication at all about the issue. In a high context culture, fertile silence is the silence that exists as presence, because when people do not talk about the issue at hand, they may still be communicating about it – either through non-verbal signs, or through coded language.
 The concepts of barren and fertile silence provide new insights into the issues of stigma and discrimination. Reasons for the silence included stigma, rejection, gossip, witchcraft, shame, blame, discrimination, secrecy, judgement, suspicion and taboo. It was found that each of the themes had something to do with stigma and discrimination, and lead to
 infected persons keeping silent about their HIV and AIDS status.
 In the final chapter, the research shows that when an intervention such as CCP takes the question of fertile silence seriously, then it is much easier to break the silence around HIV and AIDS and to deal with stigma and discrimination. The research therefore concludes that the concept of ‘Fertile Silence’ and ‘Barren Silence’ has provided us with clues as to how to ‘break the silence’ around HIV and AIDS in a high context culture such as that of Africa.