Global discourses and experiential speculation: Secondary and tertiary graduate Malawians dissect the HIV/AIDS epidemic

Journal of the International AIDS Society Global discourses and experiential speculation: Secondary and tertiary graduate Malawians dissect the HIV/AIDS epidemic Tyler W Myroniuk 0 0 Department of Sociology, University of Maryland , College Park, MD , USA Background: Since the beginning of the HIV/AIDS epidemic, the perspectives of secondary and tertiary school graduates in sub-Saharan Africa regarding the effectiveness of government and international HIV/AIDS policies and programmes have not been thoroughly examined. When extensive monetary aid is directed toward development in a country like Malawi, it is the educated elites - secondary and tertiary graduates who are heavily involved and influential in the domestic re-distribution and implementation of millions of dollars worth of aid - on whom international expectations fall to decrease the transmission of HIV. Many Malawian jobs related to public health and HIV/AIDS are created as a direct result of this funding and are occupied by the few secondary and tertiary graduates. Thus, it is a practical venture to understand their perspectives on highly contentious and heavily funded HIV/AIDS issues that affect their nation. Methods: Qualitative data was collected in this study in efforts to discover in-depth perspectives on the HIV/AIDS epidemic. Thirty-eight secondary and tertiary graduate Malawians took part in semi-structured interviews. Data was analysed using an early grounded theory approach and subsequent themes of global discourses and experiential knowledge of HIV/AIDS emerged. Results: This group of Malawians frequently responded to questions regarding healthcare and access to medicine, sexual behaviours and methods of reducing the spread of HIV/AIDS by citing and explaining the widespread, international and proper responses. The secondary and tertiary graduate Malawians also discussed these same topics in terms of what they perceive or have experienced. Experiential responses, such as the counter-productivity of circumcision and condoms, the overestimation of HIV/AIDS prevalence, and calls for more authoritarian policing of commercial sex work, were remarkably divergent from the HIV/AIDS discourse. Conclusions: The opinions of this group of secondary and tertiary graduate Malawians do not always coincide with the current literature and policies. They give deeper insight into what is perceived and what may be taking place, and hint at what the future holds for their people. The widespread and divergent perspectives must be seriously considered because these experiences describe the potential positive and negative consequences that occur on the ground throughout Malawi as a result of HIV/AIDS policies. - Background Malawi, the self-proclaimed warm heart of Africa, is a hot-bed for international aid and research. Malawis adult HIV/AIDS prevalence is approximately 12% [1] and Malawi ranks 153rd out of 169 countries on the Human Development Index [2]. Malawis high HIV/ AIDS prevalence and poverty, low socio-economic development levels, political, civil, and military stability, and public battle to minimize corruption make it an attractive sub-Saharan African nation for prospective donors and researchers. HIV/AIDS is a frequently discussed and highly contentious issue in this extremely poor nation. In 2008, Malawi received nearly US$1 billion in official development aid from Britain, Japan, USA, the International Monetary Fund, the World Bank and a host of other nations [3]. Apart from official aid, Malawi is appealing to non-governmental organizations (NGOs) and other donors due to a welcoming government. Around 80% of Malawians live in rural areas, many of whom live in extreme poverty [4]. Much of the research conducted by international organizations, universities, independent researchers and domestic agencies in Malawi has focused on uneducated individuals, rural families, sexual networks, attitudes towards contraception, risky sexual behaviours, and how HIV/AIDS affects rural communities [5-10]. When extensive monetary aid for development comes to Malawi though, it is the educated elites - secondary and tertiary graduates who are heavily involved and influential in the domestic redistribution and implementation of millions of dollars worth of aid - on whom international expectations fall. Many Malawian jobs related to public health and HIV/AIDS are created as a direct result of this funding and virtually all of the respondents in this study had participated in various forms of HIV/AIDS work. Additionally, these educated elites are precariously situated on the edges of Malawian civil society. Nearly all of the secondary and tertiary graduates in this study have lived for extended periods in rural and urban areas. They have a much fuller understanding of their society as a result. However, the explicit perspectives of secondary and tertiary school graduates towards HIV/AIDS issues have been largely overlooked; this includes how they understand the epidemiology of HIV, what they think of the effectiveness of Malawis policies and programmes to stem the epidemic, and their views of the consequences of high mortality due to AIDS for the future of their nation. Thus, it was a practical venture to understand secondary and tertiary graduate Malawians perspectives on highly contentious issues that affect their society. Bourdieu theorized that the ability to obtain cultural capital is closely linked to educational capital, which is measured by qualifications [11]. Bourdieu ultimately suggests that higher-class and more highly educated individuals are enabled to maintain their class positions, and legitimate the dominant positions that they typically go on to hold [12]. For secondary and tertiary graduate Malawians, it is a rational choice to learn the international discourses surrounding these issues in order to potentially obtain upward social mobility. Educated elites know that they must present proper performances of HIV/AIDS knowledge to improve their social statuses in efforts to keep from moving downward [13]. To fully understand the international HIV/AIDS discourse, one must be literate, understand English, and have the resources to stay up to date with recent developments. Secondary and tertiary education in Malawi provides the skills necessary to do so. Considering that only 15.5% of women and 26.3% of men reach secondary school [14], graduating from secondary school, entering a tertiary programme, and even completing tertiary education would seem quite uncommon. Thus, secondary and tertiary graduates are among a small, elite, relatively privileged and influential group within Malawi. Swidler and Watkins [15] research on aspiring or interstitial elites and national elites in Malawi makes it clear that the ability to speak English and discuss the jargon of the international aid community are two skills that instantly set these elites apart from other Malawians. These educated individuals act as the eyes, (...truncated)