Theoretical frameworks for investigating the resilience of HIV positive adolescent girls

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INTRODUCTION

Sub-Saharan Africa is the most heavily affected region in the global HIV epidemic with 23.5 million people living with HIV. This figure represents 69% of the global HIV burden while women account for 58% of the cases (UNAIDS, 2012). Statistical reports from the facts sheets of the National Agency for the control of AIDS (NACA, 2012:10), also reveal that Nigeria, with its booming population of 162 million people, has the second largest population living with HIV. About 3.5 million of these are infected with HIV while the prevalence is on the upward trend of 4.2% (especially in the western part of the country where the Yoruba resides and urban towns experience a prevalence of 10.2% (NACA 2012).

In the words of Achebe (2004:261-262), “Our collective record on AIDS clearly suggests that we have not tamed the ‘animal’, and should compel us to hire many more ‘animal trainers’ to rescue the world’s most vulnerable groups from the clutches of this infectious holocaust.” Achebe (2004) further asserts that the face of HIV/AIDS is primarily linked with the youth, women and girls who bear the burden of the epidemic. These findingsare supported by the statistics in Nigeria as collated by the National Agency for the control of AIDS (NACA, 2011) which reports that people aged between 15-24 years contribute to 60% of the infections while HIV is the leading cause of death and disease among women of a reproductive age (15-49 years).

The prevalence among young women aged 15-24 years is estimated to be three times higher than among men of the same age and females constitute 58% (about 1.72 million) of persons living with HIV. Each year, 55% of AIDS deaths can be attributed to women and girls (NACA, 2011:419). Fashola, Francisco and Madigan (2011) point out that the major issue of HIV/AIDS prevention is that the majority of interventions by the Nigerian government lack theoretical foundations. Fashola et al. (2011) posit that theoretical models should be used to design interventions to change negative attitudes with the perceived threat of HIV/AIDS. Okonofua (2012) also supports the idea that theoretical frameworks and scientific arguments for understanding the complex and often interwoven issues which surround adolescent sexuality and well-being in sub-Saharan Africa is necessary in order to stimulate a deeper understanding of how family structures and evolution can impact the nature of adolescent sexual behaviour. Taking into consideration this initiative, it is illuminating to note that researchers have discovered that even though the epidemic is difficult to track down because of its “heterosexual nature of transmission” (NACA, 2001:4), particularly in Nigeria and in Sub- Saharan Africa, a large number of people living with HIV make concerted efforts to cope with their situation and status thus becoming resilient by “bouncing back” to normal life (Ungar, 2008:218).

It seems that some key issues embracing contextual factors such as culture, family, peers, religion, community coupled with individual psychological differences, “life circumstances” and notions of sexuality exert significant influence on how people infected with HIV/AIDS, navigate their path towards physical and psychological well- being. The Yoruba is one of the largest, urban ethnic groups, dominating the western part of Nigeria and enjoy a sense of unity achieved by a common language, history and culture. The HIV scourge also takes its toll on the Yoruba people especially affecting the youth, just like any other culture within Nigeria and the sub-Sahara region of Africa. The HIV positive Yoruba adolescent girl finds herself therefore in the midst of a myriad of complexities of the epidemic and the cultural values. This study will attempt to qualitatively investigate and explore the contextual factors that enhance her ability to become resilient, adapt and adjust to normal life after experiencing the trauma and stigma of having contracted HIV/AIDS.

THE RATIONALE FOR THE STUDY

The Yoruba culture is dynamic in nature like many other cultures but has resisted the impingement of foreign influences, “absorbing numerous new cultural traits and breathing into them new life from the old traditional culture”, mainly because the culture is firmly rooted in the environment and is used to solve their sociological and economic problems which enhances its preservation (Ojo, 1966:272). The previous statement can best be illuminated by referring to the Yoruba’s sustained belief in myths especially concerning premarital sex, time of sexual debut for girls’ infertility and early marriage that have had negative effects on sexual abstinence, wrong perceptions about HIV/AIDS, which consequently impact its intervention programmes (Oladepo &Fayemi, 2011). These crucial aspects will be discussed in the next chapters. I worked as a principal in some secondary schools both in the rural and urban areas of Ibadan city (capital of Oyo state, Nigeria), for thirteen years, which triggered a growing interest in community development and research among, vulnerable groups especially adolescent girls. From my observation, the rural areas lack resources and social amenities such as, pipe born water, electricity, employment opportunities and good roads.

These factors are responsible for a serious rural-urban migration of youths and even adults are looking for a means of survival especially after leaving school. Apart from drifting from nearby villages to the city, some other ethnic groups from Nigeria like the Ibos, Hausas and other minority ethnic groups find the city comfortable to settle in, because of its (relative) peace, hospitality of the indigenes, free health and education programmes. Its availability of cheaper food and housing in contrast with the more expensive living costs in other towns and cities also add to its popularity as an attractive place to reside in. The HIV epidemic consequently disseminates among the cities and its environs inconspicuously, through risky sexual behaviors, exposure to foreign cultures and non-adherence to the Yoruba traditional norms and values governing marriage and sexual relationships. The HIV epidemic, as a result, startsclaiming lives, gnawing away at the self-esteem and capabilities of the youth and those infected (Achebe, 2004:270). The adolescent girl, who is highly at risk of the HIV infection, finds herself isolated In the midst of these problems. In her pursuit of happiness and a possible partner sharing an intimate relationship, she becomes predisposed to HIV infection and gets infected unwittingly. Being ignorant and vulnerable due to a number of contributory factors such as her gender and customs of the Yoruba culture, this disease progresses to full blown AIDS.

Even though traditions and religion regard sex before marriage as an “immoral” act, this disease is seen to spread and affect the adolescent girl. Once diagnosed with HIV, she becomes vulnerable, fearful of being stigmatized and consequently believes that “life has been permanently altered” (De Santis & Bassoro, 2011:348-350). She experiences physical, mental and spiritual changes which cause life stressors as she is left with little or no psychosocial support available to “ease these stressors” (De Santis & Bassoro, 2011:348-350). The reason for this feeling of inundated pressure can be ascribed to the very epidemic itself, which is aptly identified as a “chronic stressor” that in turn becomes a salient characteristic of adolescent behaviour (Ebersöhn & Eloff, 2002:78). Her world crumbles and falls apart as in most cases she may be sent back to the village to bear the trauma single-handedly, because nobody would want to associate with an HIV/AIDS infected person. People in general are in fear of catching the deadly virus themselves.

CHAPTER 1 KEY FACTORS ENHANCING THE RESILIENCE OF HIV POSITIVE ADOLESCENT GIRLS

• 1.1 INTRODUCTION
• 1.2 THE RATIONALE FOR THE STUDY
• 1.3 THE PROBLEM STATEMENT
• 1.4 RESEARCH QUESTIONS
• 1.5 PURPOSE OF THE STUDY
• 1.6 ASSUMPTIONS
• 1.7 EXPLANATION OF THE KEY CONCEPTS
• 1.8 LITERATURE REVIEW
• 1.8.1 ADOLESCENCE AS A DEVELOPMENTAL STAGE
• 1.8.2 VULNERABILITY OF ADOLESCENT GIRLS
• 1.8.3 RESILIENCE
• 1.9 THEORETICAL FRAMEWORK
• 1.10 RESEARCH METHODOLOGY
  • 1.10.1 RESEARCH PARADIGM
  • 1.10.2 RESEARCH APPROACH AND DESIGN
  • 1.10.3 RESEARCH TYPE: THE INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS (IPA)
  • 1.10.4 SAMPLING
  • 1.10.5 THE ROLE OF THE RESEARCHER
• 1.11 DATA COLLECTION STRATEGIES
  • 1.11.1 PHOTO VOICE
  • 1.11.2 THE INDIVIDUAL SEMI-STRUCTURED INTERVIEW
  • 1.11.3 FIELD JOURNAL
• 1.12 DATA ANALYSIS AND INTERPRETATION
• 1.13 QUALITY CRITERIA
• 1.14 ETHICAL CONSIDERATIONS
• 1.15 PLAN OF THE STUDY
• 1.16 CONCLUSION

CHAPTER 2 CONTEXTUAL AND THEORETICAL FRAMEWORKS FOR INVESTIGATING THE RESILIENCE OF HIV POSITIVE ADOLESCENT GIRLS

• • 2.1 INTRODUCTION
  • 2.2 CONTEXTUAL FRAMEWORK
    • 2.2.1 THE YORUBA CULTURE
    • 2.2.2 YORUBA FEMALE ADOLESCENTS’ SEXUALITY AND THE INCIDENCE OF HIV
    • 2.2.3 RIGHTS OF THE CHILD IN NIGERIA
  • 2.3 THEORETICAL FRAMEWORK
    • 2.3.1 BOURDIEU’S FIELD THEORY AND KEY CONCEPTS
      • 2.3.1.1 The field and the agents
      • 2.3.1.2 Habitus
      • 2.3.1.3 Forms of capital
    • 2.3.2 ERIC ERIKSON’S THEORY OF IDENTITY DEVELOPMENT IN ADOLESCENCE
    • 2.3.3 PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
  • 2.4 CONCLUDING REMARKS

CHAPTER 3 HIGHLIGHTING ISSUES OF RESILIENCE

• • 3.1 INTRODUCTION
  • 3.2 PERSPECTIVES ON RISK
    • 3.2.1 CONCEPTS OF RISK
    • 3.2.1.1 Risk as feelings
    • 3.2.1.2 Risk as exposure
    • 3.2.1.3 Risk and context
    • 3.2.1.4 The cognitive dimension of risk
    • 3.2.2 ADOLESCENCE AS A RISKY DEVELOPMENTAL STAGE
    • 3.2.3 ADOLESCENT GIRLS’ SEXUALITY AS A RISK FACTOR
  • 3.3 RESILIENCE DEFINED
    • 3.3.1 TRENDS IN RESILIENCE RESEARCH
    • 3.3.2 RESILIENCE AND RISK
    • 3.3.3 RESILIENCE AS PERSON-FOCUSED
    • 3.3.3.1 A model for measuring resilience in youths
    • 3.3.4 RESILIENCE AND CONTEXT
    • 3.3.5 RESILIENCE AND PSYCHOLOGICAL WELL BEING
  • 3.4 RESILIENCE VIS-À-VIS THE THEORIES OF BOURDIEU, PIAGET AND ERIKSON
    • 3.4.1 LINKING BOURDIEU’S SOCIAL CAPITAL WITH RESILIENCE
    • 3.4.2 ERIKSON’S THEORY VIS-À-VIS RESILIENCE IN ADOLESCENTS
    • 3.4.3 PIAGET’S THEORY VIS-À -VIS TO RESILIENCE IN ADOLESCENTS
  • 3.5 CONCLUDING REMARKS

CHAPTER 4 RESEARCH METHODOLOGY

• • 4.1 INTRODUCTION
  • 4.2 RESEARCH DESIGN
    • 4.2.1 RESEARCH PARADIGM
    • 4.2.2 RESEARCH APPROACH
    • 4.2.3 RESEARCH TYPE: THE INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS (IPA)
  • 4.3 RESEARCH METHODS
    • 4.3.1 RESEARCH SITE AND PARTICIPANTS
    • 4.3.2 DATA COLLECTION
      • 4.3.2.1 Semi-structured Interviews
      • 4.3.2.2 Photo voice
      • 4.3.2.3 Field Journal
    • 4.3.3 DATA ANALYSIS
  • 4.3.4 TRUSTWORTHINESS
    • 4.3.4.1 Credibility
    • 4.3.4.2 Transferability
    • 4.3.4.3 Dependability
    • 4.3.4.4 Confirmability
  • 4.3.5 THE ROLE OF THE RESEARCHER
  • 4.4 ETHICAL CONSIDERATIONS
    • 4.4.1 INFORMED CONSENT AS A DIALOGUE
    • 4.4.2 CONFIDENTIALITY AND ANONYMITY
    • 4.4.3 PRIVACY AND EMPOWERMENT
  • 4.4.4 CARING AND FAIRNESS
  • 4.5 CONCLUDING REMARKS

CHAPTER 5 DATA COLLECTION ANDANALYSIS

• • 5.1 INTRODUCTION
  • 5.2 ANECDOTAL NARRATIVE FOR GAINING ACCESS
    • 5.2.1 MEETING WITH THE SOCIAL WORKERS
    • 5.2.2 MEETING WITH THE FIVE HIV POSITIVE ADOLESCENTS
  • 5.3 TRUSTWORTHINESS
  • 5.4 DATA ANALYSIS
    • 5.4.1 PARTICIPANTS’ BIOGRAPHICAL DATA
    • 5.4.2 KEY FINDINGS: PHOTO VOICE TECHNIQUE
      • 5.4.2.1 Mary
      • 5.4.2.2 Modupe
      • 5.4.2.3 Ajoke
      • 5.4.2.4 Adijat
      • 5.4.2.5 Cecilia
• 5.4 2.6 Closing remarks
  • 5.4.3 KEY FINDINGS: INTERVIEWS
    • 5.4.3.1 Mary
    • 5.4.3.2 Modupe
    • 5.4.3.3 Ajoke
    • 5.4.3.4 Adijat
    • 5.4.3.5 Cecilia
    • 5.4.3.6 Closing remarks
  • 5.4.4 KEY FINDINGS: FIELD JOURNAL
    • 5.4.4.1 Mary
    • 5.4.4.2 Modupe
    • 5.4.4.3 Ajoke
    • 5.4.4.4 Adijat
    • 5.4.4.5 Cecilia
    • 5.4 4.6 Closing remarks
  • 5.4 5 KEY FINDINGS FROM SOCIAL WORKERS INTERVIEWS
    • 5.4.5.1 Social worker A
    • 5.4.5.2 Social worker B
    • 5.4.5.3 Closing remarks
  • 5.4.6 THEMES AND CATEGORIES
• 5.5 CONCLUDING REMARKS

CHAPTER 6 DATA INTERPRETATION

• • 6.1 INTRODUCTION
  • 6.2 INTERPRETATION OF THE THEMES AND CATEGORIES PER DOMAIN
  • 6.2.1 DOMAIN 1: INTERNAL FACTORS
  • 6.2.1.1 Theme 1: HIV positive Yoruba adolescent girls’ perceptions
  • 6.2.1.2 Theme 2: HIV positive adolescent girls’ coping mechanisms
  • 6.2.2 DOMAIN 2: THEME 3: CHALLENGES AND STRESSORS
  • 6.2.3 DOMAIN 3: EXTERNAL FACTORS
  • 6.2.3.1 Theme 4: HIV positive adolescent girls’ socialization
  • 6.2.3.2 Theme 5: HIV positive adolescent girls’ ambitions
  • 6.3 CONCLUDING REMARKS

CHAPTER 7 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

• • 7.1 INTRODUCTION
  • 7.2 OVERVIEW OF CHAPTERS
  • 7.2.1 CHAPTER
  • 7.2.2 CHAPTER
  • 7.2.3 CHAPTER
  • 7.2.4 CHAPTER
  • 7.2.5 CHAPTER
  • 7.2.6 CHAPTER
  • 7.3 SUMMARY OF KEY FINDINGS
  • 7.3.1 SUMMARY OF LITERATURE FINDINGS
  • 7.3.2 SUMMARY OF EMPIRICAL FINDINGS
  • 7.4 RESEARCH CONCLUSIONS
  • 7.4.1 RESEARCH SUB-QUESTION
  • 7.4.2 RESEARCH SUB-QUESTION
  • 7.4.3 RESEARCH SUB-QUESTION
  • 7.4.4 MAIN RESEARCH QUESTION
  • 7.4.4.1 Life context
  • 7.4.4.2 “Powers” in the “habitus”
  • 7.4.4.3 Individual developmental trajectories
  • 7.5 RECOMMENDATIONS
  • 7.6 RECOMMENDATIONS FOR FUTURE STUDIES
  • 7.7 LIMITATIONS OF THE STUDY
  • 7.8 CONCLUDING REMARKS
  • LIST OF REFERENCES
  • APPENDICES

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