Time-old traditions addressing a modern health problem
For centuries oral story telling has helped shape society and influence behaviour. It is this tradition that a team of researchers from the University of Newcastle is using to address the widespread impact of HIV/AIDS in China.
Close to one million cases of HIV/AIDS have been reported in China. It is a serious problem in Sichuan province in particular, and the traditional areas where the Ethnic Yi and Tibetans live have the highest infection rates.
Education and behavioural change are the aims of Conjoint Associate Professor Shuguang Wang, Dr Melissa Gao, and psychology Conjoint Professor Daphne Keats’ cross-cultural research project.
Wang and Gao came to Australia to undertake their PhD research at the University of Newcastle. Both are now taking the knowledge and skills they developed during their studies back to their home country to address the growing health issue of HIV/AIDS.
Keats says western approaches to educating people about HIV/AIDS simply do not work in many parts of the world.
"The assumption that you can just hand out a pamphlet and someone will read it and act on it is ludicrous in many cultural contexts," she says. "In some instances, written language is a relatively new phenomenon.
"In China, we have developed an educational program that uses social networks, and deals with people from their own point of view and in their own language."
The project uses health role-model stories that draw on ethnic and cultural contexts to teach people about HIV/AIDS. The aim is to increase knowledge and change behaviour, particularly in increasing the use of condoms to help stem the rate of HIV/AIDS infection. According to Wang, word-of-mouth is a powerful tool that helps to achieve behavioural change.
"One of the key problems we encountered is that people in our target communities think HIV/AIDS does not affect them because it is a ‘foreign disease, it’s overseas somewhere’. Clearly this is not the case. Add to that a lack of knowledge about how the disease is contracted and spread, and we face a significant challenge."
To address the growing infection rate, important health information is translated into the language and style specific to the local community. Information is passed on in the form of stories to a small group of people and they are encouraged to pass it on to another larger group, who pass it on again.
"We might have started with a group of around 50, but as the stories get repeated you can have 2,000 people or more exposed to the message," Wang says.
Gao used her background in communication studies to educate one target group – gay men in Chengdu – about safe sex practices using participation and entertainment. Gao’s research had shown that condom use in this community was as low as 10 per cent, and none of the men surveyed had ever been tested for HIV/AIDS. They also had very little knowledge about how to use condoms.
Studies were conducted using a range of communication tools, in addition to oral story telling, to help educate them about the risk of HIV/AIDS infection.
Gao says, "An example of our education approach was to use a comedy drama to convey the messages about the risk of unprotected sex. Our research showed that after participating in the program, awareness about safe and unsafe sex had increased by 75 per cent."
Wang says the methodology they are using provides a new approach to help local health agencies deal with cultural differences, and will assist in the development of new policy approaches.
The HIV/AIDS cross-cultural research study is being conducted under the auspices of the new Chinese-Australian Centre for Cross Cultural Studies at Sichuan University in China.
Professor Deng Shengqing from Sichuan University has been appointed Director of the Centre, and Associate Professor Wang has been appointed Deputy Director. The Centre's focus is on the folk heritage of ethnic minorities and the challenges they face in coping with the impact of modernisation.
The Cross Cultural Centre and the HIV/AIDS project were provided start-up funding from the John and Daphne Keats Endowment Research Fund and the University of Newcastle, which was matched by Sichuan University.
Wang says the aim is to expand the cross-cultural approach to incorporate new minority ethnic groups in the future.
"Semi-literate communities in Asia-Pacific nations now have the highest HIV/AIDS infection rates after sub-Saharan Africa.
"We aim to expand our project in places like Thailand and Papua New Guinea, where oral traditions are more effective for communicating health messages than written materials."