Enhancing Relevance and Appropriateness of Hiv/aids Policy Interventions

Chapter Eight

Enhancing relevance and appropriateness of HIV/AIDS policy interventions: Lessons from lived experiences at a fishing village in Uganda

8.1 Introduction

The social groups which have so far proven to be most vulnerable to HIV infection are those which have long faced discrimination and stigma, blame and stereotype labels, or have suffered economic hardships due to austere macro-economic and neo-liberal policies and have limited social services. Evidently, lakeshore people are disproportionately represented among those infected with HIV/AIDS. This may not change fundamentally as long as focus is placed on prevention intervention through generic approaches for education and behavior change as the immediate solution to the AIDS crisis.

The hegemonic paradigm that largely informs most of these approaches is flawed, narrow and linear. While elements of this paradigm are perhaps essential to our understanding of individual human behavior, its commitment to the ideology of individualism and consequent blindness to broader political and economic issues limits its utility when weighed against the lived experiences of lakeshore people. An integrated approach is therefore necessary, to take cognizant of both individual cognitions as envisioned under this paradigm, but also to go beyond and capture the wider community and societal contexts within which the HIV/AIDS epidemic is reproduced.

In this I expound on my main argument and generate suggestions for enhancing relevance and appropriateness of HIV/AIDS policy interventions by drawing lessons from lived experiences at a fishing village in Uganda. In order to anchor my argument and proposed way forward on evidence, first, I present a synopsis of the lived experiences of the fishing village, pulling out some of the key emerging issues from this experience. Later, I make an attempt to critically relate and weigh these experiences to ongoing policy interventions in HIV/AIDS prevention in order to sieve out salient issues and gaps in policy interventions when assessed vis-à-vis life at the fishing village. It is from this synthesis that my line of argument is further developed and my thinking about ways for bridging gaps between lived experiences and policy interventions for HIV/AIDS prevention is derived.

The important thread running through this analysis, and indeed the thesis of my work is that rethinking the present interventions for HIV/AIDS prevention requires, first accepting the limitations of current behavioral models guiding current policy responses to the epidemic, and consequently, reformulating the approach to HIV/AIDS prevention through the recognition of economic and cultural meanings, social identities and community lived experiences. The later calls for a shift towards community-based empowerment efforts aimed at transformation of values, norms and the constitution of collective meanings of sexuality, risk and HIV/AIDS itself. Using empowerment practice as used in Social Work and in other helping professions, and in Social Sciences generally, I endeavor to demonstrate how, and why effective policy should be that that begins with the community, as agency, and then moves to the political arena.

In choosing to use empowerment, I am alive to the common fear that many use the term empowerment without understanding what it really means. Even my attempt to review the literature resulted in no one single precise definition of the concept, especially one that could cross disciplinary lines. It is for this reason that I have offered to get back into the semantics and conceptualizations to finally develop an epistemological standpoint which I prefer to use in articulating empowerment throughout the rest of the chapter. My preference in this chapter is to simply consider empowerment as a multi-dimensional social process that helps people gain control over their own lives. It is a process that fosters power in people for use in their own lives, their communities and in their society, by acting as agents, on issues they define as important. Given the vulnerabilities explored from the fishing village, I consider empowerment as the most logical and plausible way to bring change, both to individuals and to their social environs to deal with HIV/AIDS. Let me start on each of the sub-themes of this concluding chapter, cumulatively as one theme builds into the next, and then make my conclusion.

8.2 Lived experiences of lakeshore communities: A synopsis

In a largely multi-ethnic, multi-cultural, and socio-economically diverse cluster of three lakeshore villages, this fishing community is characterized by daily flows of people into and out, to trade in fresh fish and, at some sites, as a transit point to the islands; seasonal flows by fish traders, boatmen, and scores of women following shoals; and semi-permanent migration into other fishing communities, their narratives imbued with metaphors such as “life is hard”, “there is no more to fish in the lake” and “it does not matter whether I have slim (AIDS) anyway”.  The unplanned, spontaneous influx of people, and a plethora of needs such influx brings, involves people – scores or youth, sex workers, fortune seekers, speculators and delinquents in their struggle for more anonymity and opportunity – attracted from the hinterland where their livelihoods may have failed, and those who are speculatively drawn by the prospects of relatively easy money in the fishing sector. Engendered by neo-liberal economic policies in the fish economy, poor fishing habits (envuba embi), and inaccessible public health services, the hitherto somber, humdrum small population of indigenous fishers and farmers in this village a decade ago has turned into a drunken, vicious, unpredictable collection of hundreds of individuals scrambling for economic survival.

For the people of at this lakeshore, over the last decade, good health, or, for that matter, their sense of wellness is a thing of the past. Most of them are nostalgic about the fish boomera when, according to them, “everything used to be affordable” and life was good. Now they can only reminisce in order to re-construct and reaffirm their shared experiences and cultural memories -to make sense of and negotiate the present- a present that has seen the implementation of neo-liberal policies which have resulted in the proliferation of the large scale processing, packing and export of fish fillets to which everyday people seemingly have no control. In fact, one can hardly buy good fish at the fishing village, only perhaps the “rejects” left behind by the factorymen and their ice boxboard trucks. Naturally, there are exceptions to discourses about the “good old days” and the “life is hard” now; these are produced mostly by fisheries officials and community leaders. Even those with counterdiscouses agree that something has changed; the murky and elusive relations between fishers or “bosses” and boatmen, fishers and their new “bosses” the transporters, processors, exporters amid an export market environment filled with lacuna and exploitative tendencies.

As a result, the first category of “bosses”-fishers- have had to cut down on the number of people (boatmen, ice boys, loaders, et cetera) they employ, releasing fewer boats into the lake on a typical night and, therefore, fewer boatmen to try their luck. And with only limited options for people not directly involved in fishing, “life is hard” and is increasingly getting harder at this lakeshore. Even those who venture find that “there is no more to fish in the lake”.

Added to the narratives, often infused with both nostalgic remembrance of the past and a melancholic view of the ongoing societal and economic changes, the existing social support networks are evidently weak. In the absence of organized social safety nets, for many, life is hard.

These experiences add to the concerns about debilitating health and a plethora of lake-related “neglected diseases” to create an uncertain situation where HIV/AIDS is perceived simply as “another disease”, and consequently “it does not matter whether I have slim (AIDS) anyway”.

Within this sense of ambivalence and uncertainty, sexual relationships flourish both among those that can be termed “vulnerable” or sexually exploited, those in various forms of consensual conjugal links or “marriages”, but also those who wear the stature of “experienced professionals” in sex trade, exercising agency, partly a consequence of available opportunities at the lakeshore, not with the hundreds of fishers, dealers, business people, and transient groups littered everywhere. Not surprising, some people within and outside the landing site, including local leaders and public sector workers summarily describe this fishing village as a drunken, vicious, unpredictable collection of “abavubi” (literal term for boatmen) and “bamalaya” (derogatory term for sex workers), taking insurmountable risk in the course of scrambling for economic survival. The discourse about HIV/AIDS in this fishing village is nearly narrowed to these two categories; it is deeply entrenched and widespread. Being called “omuvubi” (singular for abavubi) is not necessarily about being a boatman, rather a metaphor used to connote risk takers, wasteful men, never plan or save, assured of more freebies of nature due to the lake; not mindful of one’s health or wellbeing; shabby but with lots of cash to spend on “bamalaya”, living on fate or luck; may die any time. While there are inhabitants in this community who exhibit some of the behaviors described above, all the men at this lakeshore are erroneously caricatured under this portrayal. On the side of the boatmen (the actual abavubi in the literal sense), this misleading blanket label has had the effect of producing a category that evidently feels stigmatized, is ambivalent on matters related to poor health, and to HIV, and has distaste for health providers and for local authorities and prefers to reside a distance away from everyone else.