Author: Helen Nikolas
Nikolas, Helen, 2018 Women and HIV: transformative stories in magazines and the internet as a potential mechanism to address stigma, isolation and prevention of HIV transmission in Australian women, Flinders University, College of Medicine and Public Health
Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact copyright@flinders.edu.au with the details.
Introduction The incidence of HIV in women in Australia is increasing and there is a dearth of prevention campaigns appropriate for women. The proactive and successful HIV prevention strategies to date are aimed at people known to be at high risk, including gay men, drug-users and sex workers. This list does not include women, even though all sexually active people are at risk. Women with HIV face being stigmatised as deviant, which leads to a reluctance to disclose being infected, and this is often associated with social isolation and depression. In addition, because women are not regarded as high risk they face delayed diagnosis and treatment. Public health messages regarding prevention strategies and testing do not reach women and strategies promoting condom use ignore that this may be out their control. There is a need to reach a wide audience of women to raise awareness about their risk for HIV and to encourage personal agency regarding negotiating safe sex and testing. There is agreement that narratives, using specific message features, are persuasive and promote belief in a story’s conclusion. Narratives are useful for health communication, and stories using women’s voices and experiences are empowering for women. This study was designed to investigate whether transformative stories of women with HIV, shared via magazines online, is a potential effective vehicle to reach women about HIV.
A study using hermeneutic phenomenology and narrative enquiry, using both qualitative and quantitative methods for data collection, was set up in three stages. First, to understand how women with HIV are portrayed, a directed descriptive content analysis, of personal stories in magazines on the internet about women with HIV, was conducted. A relational data base organised the large amounts of narrative data to allow for thematic analysis and constant comparison of data. Second, to determine audience reception of the stories, interviews were conducted with eight women without a diagnosis of HIV, using two of the stories. The interview guide was developed from the results of the content analysis, as well as the relevant literature. Third, for all the stories, the message features of transformative stories, which contribute to the persuasive nature of a narrative or story, were assessed, One key feature, transportation, was measured using the same two stories for each of the interviewed participants. Transportation or absorption in the story leads to persuasion and the reader may align with the beliefs in the story.
The women were portrayed positively, as living well with HIV and without the stigmatisation previously described in the literature. The content analysis demonstrated a potential impact of a reduction in social isolation for women and the audience felt that such stories would reduce stigma and raise awareness. The stories supported findings from the literature, including that women get HIV from their partner, which raised concerns about trust in relationships, and are late to test for HIV. There was agreement in responses across all data sets that targeted education is required to reduce ignorance about HIV in the general public. The value of stories was agreed, as long as they were not overly positive, to reduce the likelihood of encouraging complacency. The stories scored only moderately for persuasive message features and could have been written in a way that would have had a more persuasive outcome.
Reducing stigma and isolation in women with HIV has the potential to have an impact on the burden of disease in women with HIV, including depression. In the face of an increase in the incidence of HIV in Australian women and the lack of appropriate prevention messages, sharing personal stories about women with HIV via online magazines, has potential to reach women about HIV, addressing stigma isolation and prevention. Using women’s voices and narrative message features that are known to be effective in changing beliefs, presents a mechanism that could reach a wide audience. Research to date has not included men in prevention efforts for women, and heterosexual men need to be aware of strategies to protect themselves and their partner. Further research to investigate this approach in men’s magazines could address topics of prevention, protection and the negotiation of safe sex within relationships.
Keywords: Women, HIV, Stories, Transformative, Prevention, Narrative, Stigma, Feminist
Subject: Public Health thesis
Thesis type: Professional Doctorate
Completed: 2018
School: College of Medicine and Public Health
Supervisor: Dr George Tsourtos