title: Culture, play and health: A folk media approach to HIV and AIDS research in rural Malawi
Creators: name: Abdulla, Sharifa
Publisher: name: University of Glasgow
Year: 2021

description: Background: HIV and AIDS remains a significant health, social and economic problem in Malawi. Despite improved availability of free HIV related services, multiple behavioural change interventions and high levels of awareness, HIV and AIDS remains the leading cause of death in Malawi. Like other health issues, the response to HIV and AIDS has been significantly affected by colonialism and imperialism where impositions of western naming, understandings, ways of thinking, conceptualizations of disease and treatment practices were made on indigenous populations. Strong arguments have been made to say that HIV and AIDS interventions in Malawi and SSA have often failed because they have largely been conceptualized in western countries and have ignored the realities of the local populations. Attempts to alleviate impositions of interventions and efforts to try to understand communities have been made through calls for dialogical approaches. However, the methods used to dialogue are often imposed on communities which makes it difficult to engage in a truly dialogical, meaningful and transformative manner. Aims: In this study I explore how to work with communities within the paradigms of their own cultures. I investigate how two rural communities in Malawi understand and make sense of HIV and AIDS and the ways in which folk media as a cultural resource and paradigm can facilitate this research. Methods: The approach I took is grounded in decolonial thought and indigenous research methods but also in a critical appraisal of these which led me to conceptualise my work in the terms of folk media. Through folk media workshops in two communities, I worked with community members to elicit and explore understandings of HIV and AIDS using forms of expression of their own choosing. These workshops were video recorded, and participants and I also kept audio diaries/fieldnotes of reflections on the process. These data were analysed collectively with participants and, then, post-fieldwork, using a thematic analysis method. Findings: The research elicited accounts of how HIV and AIDS was initially received by the two communities at the outset of the pandemic. These accounts reveal how these communities first sought to interpret the ‘new’ condition using their existing paradigms, notably conditions which produced the same symptoms. Over time and with the accumulation of experience, the communities came to accept that HIV and AIDS was indeed something novel and not a condition that they had encountered before. However, participants also revealed a range of ways in which biomedical narratives of HIV and AIDS are contested and in tension with their everyday lives. Participants also explored how they approached treatment for HIV and AIDS at length, enabling the construction of a model of treatment-seeking practices, which elaborates the multiple and syncretic approaches that the two communities take. Finally, the thesis reflects on the power of the folk media methodology used in this research to elicit narratives which often remain hidden from community outsiders. In doing so, a methodological model for folk media research is proposed and its limitations considered. Conclusions: The folk media approach that I have developed and deployed in two Malawian communities enabled the generation of rich, contemporary, accounts of how participants make sense of HIV and AIDS. The accounts shared as part of the research included cultural knowledges that are often hidden from ‘outsiders’, demonstrating the potential of the method to enable better understandings of these communities and their needs. However, the method alone has limitations and needs to be followed by dialogical action to address contestations and tensions which have health-damaging consequences. This dialogical action might be grounded in the methods developed in this project, to avoid further imposition-based public health intervention in the two communities.