Engaging the Fertile Silence: Towards a Culturally sensitive Model for dealing with the HIV and AIDS Silence. By Benson Okyere-Manu Supervisor: Prof. Steve De Gruchy Thesis Submitted in Fulfilment of the Requirements for the Degree of Doctor of Philosophy, in the School of Religion and Theology, University of KwaZulu-Natal VOLUME 1 Main Thesis November 2009 Pietermaritzburg DECLARATION I declare that this thesis, unless specifically indicated in the text, is my own original work which has not been submitted in any other University. ________________________ ________________ Benson Okyere-Manu Date University of KwaZulu-Natal 2009 i ABSTRACT This thesis critically examines one of the major hindrances to dealing adequately with the HIV and AIDS problem facing Africa – the issue of silence. The study has examined the hypothesis that there are cultural factors underlying the silence that surrounds the disease, which when investigated and identified, will provide cues for breaking the silence and a way forward for dealing with the HIV and AIDS epidemic. The study utilises the concept of ‘cultural context’ proposed by Hall and ‘dimensions of culture’ postulated by Hofstede, to investigate the cultural reasons behind the HIV and AIDS silence among the Zulu people in and around Pietermaritzburg in the Kwazulu Natal province of South Africa. Testing these theories in the field with participants in a community-based HIV and AIDS Project called the Community Care Project (CCP) the study found that cultural contexts strongly influence silence around HIV and AIDS. In terms of dimensions of culture, the area was found to exhibit high power distance, low uncertainty avoidance, high collectivism and is feminine in nature in terms of assertiveness, but having high gender inequality (high masculinity in terms of gender egalitarianism). The analysis of the results of the field research revealed that each of the dimensions of culture contributes in various ways to the silence around HIV and AIDS The study argues that there are two kinds of silence, namely barren silence and fertile silence, existing on a continuum. In a low context culture, barren silence is the silence that exists as absence, because when people do not talk about the issue, then there is no communication at all about the issue. In a high context culture, fertile silence is the silence that exists as presence, because when people do not talk about the issue at hand, they may still be communicating about it – either through non-verbal signs, or through coded language. The concepts of barren and fertile silence provide new insights into the issues of stigma and discrimination. Reasons for the silence included stigma, rejection, gossip, witchcraft, ii shame, blame, discrimination, secrecy, judgement, suspicion and taboo. It was found that each of the themes had something to do with stigma and discrimination, and lead to infected persons keeping silent about their HIV and AIDS status. In the final chapter, the research shows that when an intervention such as CCP takes the question of fertile silence seriously, then it is much easier to break the silence around HIV and AIDS and to deal with stigma and discrimination. The research therefore concludes that the concept of ‘Fertile Silence’ and ‘Barren Silence’ has provided us with clues as to how to ‘break the silence’ around HIV and AIDS in a high context culture such as that of Africa. iii DEDICATION This thesis is dedicated to my father, Benjamin Yaw Okyere, my late mother Abena Nyantakyiwah and my late grandmother, Elizabeth Akua Tonoah, who through hard work and dedication showed me the road to higher heights in education, AND to my family: Beatrice, Ebenezer, Gifty, and Emmanuel, for their love, encouragement, care, support and prayer, AND to the staff of the Newfrontier AID Trust (NAT) and the Community Care Project (CCP), all the members of the HIV Support Group for their dedication to this research, May the Almighty God richly bless you all. iv ACKNOWLEDGEMENT My thanks go to the Almighty God, who makes all things beautiful in his time. It is by his grace that this thesis has been produced. My indebtedness goes to Professor Steve De Gruchy, my academic supervisor and mentor, whose personal interest in this study, guidance, encouragement and advice made the completion of this work possible. I particularly wish to thank him for his devotion, patience, long hours and energy spent going through the many drafts and pages several times and offering honest and valuable suggestions, corrections, modifications and alterations at each stage of the study. I specifically want to mention my family for their immense contribution to my life and my studies. I thank my wife, Beatrice, for expressing faith in the completion of this study. Once again I thank my three children, Ebenezer, Gifty and Emmanuel, for constantly reminding and encouraging me to finish the work. I thank my father Benjamin and my grandmother Elizabeth, for their financial contribution to my education. Rob and Deborah Ng-Yu-Tin and family, thank you for being friends in difficult times. My sincerest thanks go to Cynthia Harvey-Williams, for sparing her precious time to edit this work without a charge, may the Lord greatly reward you. I thank the eldership of the Grace Generation Church (GraceGen), Pietermaritzburg, for their prayerful support. I wish to thank Pastor Craig Botha for appropriating his prophetic gift in calling me “Doctor B” long before I registered for the programme. I would like to thank the Ghanaian Prayer Group for their unceasing prayer for this study during times when I wanted to give up. Finally, the initial financial contribution for this study provided by the Overseas Council through the Evangelical Seminary of Southern Africa (ESSA) is hereby acknowledged and appreciated. v TABLE OF CONTENTS DECLARATION i ABSTRACT ii DEDICATION iv ACKNOWLEDGEMENTS v TABLE OF CONTENTS vi ABBREVIATIONS xi APPENDICES TO THESIS xiii LIST OF TABLES xiv LIST OF FIGURES xvi LIST OF PHOTOGRAPHS xvii CHAPTER ONE: GENERAL INTRODUCTION TO THE STUDY 1 1.0 Introduction 1 1.1 Background to the study 2 1.1.1 The South African Situation 2 1.1.2 The Kwazulu Natal and Pietermaritzburg Situation 6 1.1.3 The Church in the midst of the HIV and AIDS Crisis 10 1.2 The Aim of the Study 14 1.2.1 Outline of the Topic 15 1.3 Problem Statement and Key Research Questions 15 1.4 Research Design and Methodology 16 1.4.1 Research Design 17 1.4.2 The choice of Research Methodology. 17 1.4.3 The Researcher and Respondents. 18 1.4.3.1 The Researcher as a Participant Observer. 18 1.4.3.2 The Researcher’s Team. 19 1.4.4 The Parents of CCP: Pietermaritzburg Christian Fellowship (PCF) and Project Gateway (PG) 20 1.4.4.1 The Community Care Project (CCP) 23 1.4.5 Selection of Respondents (Sampling) 27 1.4.6 Ethical Considerations 28 1.4.7 Data Gathering Techniques and Methods 29 1.4.8 Data Analysis 30 1.4.9 Validity/Credibility 31 1.5 The Field Data Collection Process and Results. 31 1.6 Limitations of the study 42 1.7 Outline of the Study 43 1.8 Research Finding 45 1.9 Summary 46 CHAPTER TWO: THE SILENCE PHENOMENON 47 2.0 Introduction 47 2.1 Silence as Absence? 48 2.2 Silence as Complex Phenomenon 50 2.2.1 Anthropological Concepts of Silence 51 vi 2.2.1.1 The Philological and Etymological Development and Meaning of ‘Silence’ 51 2.2.1.2 The Symbolic and Mythological Aspects of Silence 52 2.3 Silence as Presence 54 2.3.1 Connotative and Denotative Silence 56 2.3.2 Silence in Low-Context and High-Context Communication 60 2.4 Barren Silence and Fertile Silence 63 2.5 The Cultural Context types in South Africa 66 2.6 Framework: Characteristics of a High-Context Culture Contributing to Silence 71 2.7 Summary 72 CHAPTER THREE: THE DIMENSIONS OF CULTURE AND SILENCE 75 3.0 Introduction 75 3.1 The Dimensions of Culture as a Framework for Analysing Silence 75 3.1.1 Critique of Dimensions of Culture – Essentialism. 79 3.2 Ways in which the Dimensions of Culture Contribute to Silence in a High-Context Culture 81 3.2.1 Time Orientation and Silence 81 3.2.1.1 Time Orientation in Africa 83 3.2.1.2 Time Orientation in South Africa 84 3.2.1.3 Effects of Time Orientation on Silence 85 3.2.2 Power Distance and Silence 88 3.2.2.1 Power Distance in Africa 92 3.2.2.2 Power Distance in South Africa 94 3.2.2.3 Effect of Power Distance on Silence 99 3.2.3 Uncertainty Avoidance and Silence. 101 3.2.3.1 Uncertainty Avoidance in Africa and South Africa 105 A) Characteristics of African Culture Influencing Uncertainty Avoidance 106 I) Time 106 II) Relationships 107 III) Risk-Taking 109 IV) Taboos 109 B) Current Transformational Activities in South Africa Influencing Uncertainty Avoidance 113 3.2.3.2 Effect of Uncertainty Avoidance on Silence 114 3.2.4 Individualism/Collectivism and Silence 116 3.2.4.1 Collectivism in Africa 120 A) Collectivism/Ubuntu 121 3.2.4.2 Collectivism/Ubuntu in South Africa 123 3.2.4.3 Effect of Collectivity/Ubuntu on Silence 125 3.2.5 Masculinity/Femininity and Silence 127 3.2.5.1 Masculinity/Femininity (Gender) in Africa 135 3.2.5.2 Masculinity/Femininity in South Africa 143 3.2.5.3 Masculinity/Femininity and Silence 147 3.2.6 Summary 149 vii CHAPTER FOUR: CULTURAL DIMENSIONS AND HIV AND AIDS SILENCE 152 4.0 Introduction 152 4.1 Locating the HIV and AIDS Silence 153 4.2 What is the HIV and AIDS silence? 157 4.2.1 UNAIDS and the “Break the Silence” Conference.