Social sciences and humanities in HIV

29 July 2015
Joyce Wamoyi and Annie Holmes

Does the HIV field pay enough attention to the social sciences and humanities? This remains a valid question 30 years into the epidemic and led to the formation of Association for the Social Sciences and Humanities in HIV (ASSHH). The third in a biannual series of ASSHH conferences gathered social scientiests in Stellenbosch, South Africa, 6–9 July 2015, to address the theme of Questioning rhetoric, questioning reality.

Transactional sex

One of STRIVE’s working groups focuses on developing and measuring this concept. At the conference in Stellenbosch, Dr Joyce Wamoyi of the Tanzanian National Institute for Medical Research (NIMR), one of the co-chairs of the group, presented the findings of a systematic review of transactional sex. She found that transactional sex remains a little-known idea for many in the field.

For people who were not familiar with the dynamics of sexuality in sub-Saharan Africa, it was difficult to conceptualise the idea that exchanging gifts or money for sex – especially among young people – is not sex work.

Dr Joyce Wamoyi, National Institute for Medical Research, Mwanza

After her presentation, Dr Wamoyi was challenged to broaden the focus from sub-Saharan Africa. The audience agreed on the importance of understanding sexual exchange through the lenses of love and consumerism, not only as an indication of vulnerability, the most common framing to date. 

Emerging themes

The conference saw new or renewed emphasis on a number of questions, including the importance of:

  • context and particuliarity in determining vulnerability and health behaviour
  • variable meanings of 'relationship' in different contexts, moving away from essentialist to more realistic understandings of the roles of men and women
  • acknowledging the possibility that men and women may have multiple sexualities within different contexts
  • research on men who have sex with men in sub-Saharan Africa
  • how best to disclose their HIV status to adolescents who were infected perinatally
  • the influence of parenting on adolescent sexualities and sexual decision making
  • revisiting the meaning of 'women's empowerment' in different contexts
  • not always approaching sexual relationships from the perspective of risk and vulnerability but rather from agency, pleasure and love

Why is there little research on 'love' in sexual relationships in sub-Saharan Africa? Does ‘love’ only exist or matter in relationships in Western countries?

Allison Ruark (paraphrased)

Terms often beg questions. Take the expression 'hard to reach populations' for example: hard for whom to reach? Interrogation by anthropologists and other social scientists is valuable in revealing the biases and assumptions underlying methodologies and guidelines. Reflection on a circumcision project in Botswana and an infant feeding program in Uganda demonstrate how important it is to adapt health guidelines for particular contexts. Who draws up the agenda, and for whom?

Learning from social science and from HIV

Many biomedical colleagues have misunderstood the potential role of social science in clinical trials and medical research. For example, says Dr Shelley Lees of the London School of Hygiene & Tropical Medicine, social scientists were asked to investigate women’s experiences of and views about using microbicide gel. This provided useful insights for the trial itself but, given wider scope, social science research can address bigger questions around the ethics and positive impacts of engaging in trials. From the MDP 301 trial, for instance, Dr Lees’ work discovered:

  • rumours about the gel (“dangerous substances”) and the trial (“blood stealing”)
  • the potential social capital to be gained from connections with trials staff, as an element of a potential participant’s calculation about signing up
  • “materiality” – reimbursements and other gains that offset a participant’s reservations about giving blood
  • women’s views about their everyday lives and their sexuality – informative in itself but also indicative of another unacknowledged benefit of participation: the opportunity for reflection and frank discussion

Presenting at the ASSHH conference, Dr Lees outlined lessons from the HIV field to benefit research on other diseases including ebola. Social scientists, she emphasised, need to be at the forefront rather than being summoned belatedly to fill gaps.