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The Glocalization and Acculturation of Hiv/Aids: the Role Of THE GLOCALIZATION AND ACCULTURATION OF HIV/AIDS: THE ROLE OF COMMUNICATION IN THE CONTROL AND PREVENTION OF THE EPIDEMIC IN UGANDA Samuel Muwanguzi, B. A. Thesis Prepared for the Degree of MASTER OF ARTS UNIVERSITY OF NORTH TEXAS December 2005 APPROVED: Pratibha Shukla, Major Professor John S. Gossett, Committee Member and Chair Department of Communication Studies Brian K. Richardson, Committee Member Sandra L. Terrell, Dean of the Robert B. Toulouse School of Graduate Studies Muwanguzi, Samuel, The glocalization and acculturation of HIV/AIDS: The role of communication in the control and prevention of the epidemic in Uganda. Master of Arts (Communication Studies), December 2005, 214 pp., 11 tables, references, 156 titles. Grounded in the social constructivism tradition, this study examined the role of communication in the glocalization and acculturation of HIV/AIDS by a section of sexually active Ugandans then living in Rakai district during the advent of the epidemic in 1982. Sixty-four women and men participated in ten focus group discussions in Rakai and Kampala districts. Five themes emerged from the data highlighting how individuals and communities made sense of the epidemic, the omnipresence of death, how they understood the HIV/AIDS campaign, and how they are currently coping with its backlash. The study concludes that HIV/AIDS is socially constructed and can be understood better from local perspectives rather than from a globalized view. The study emphasizes the integration of cultural idiosyncrasies in any health communication campaigns to realize behavioral change. ACKNOWLEDGEMENT I wish to acknowledge all the people who dedicated themselves in various and important ways to assisting me complete my thesis and education this far. First, I acknowledge Dr. Pratibha Shukla who served as my major professor. Thank you for challenging and helping me grow as a researcher. Your dedication to the process, your patience with me and words of encouragement inspired me to give my best to the process. You deserve every appreciation I can harness. Second, I wish to acknowledge my committee members, Dr. Brian Richardson and Dr. John Gossett for their critical and insightful advice in the development and completion of this thesis. In a special way, I wish to thank Dr. John Gossett and Dr. Jay Allison for facilitating my admission to the Department of Communication Studies and providing me a teaching assistantship. In many ways, the department has helped me develop as a student, teacher, and researcher. Equally deserving my acknowledgment are all the faculty, staff, and students of the Department of Communication Studies for participation in my education. Third, my appreciation goes to the National Federation of the Blind of Texas for awarding me a scholarship and financial aid that enabled me pay some of my tuition. Your support together with that from the members of the NFB Fort Worth chapter, steered me to these heights. The Criss Cole center for the blind in Austin which provided me training in blindness skills also deserves my gratitude. Fourth, I would like to acknowledge all the assistance from the staff of the office of disability accommodation at the University of North Texas who worked tirelessly to enable me to access the relevant literature used in this study. Your accommodation in conjuction with that from the assistants in the adaptive computer laboratory facilitated the completion of this thesis. ii I also wish to thank all my friends especially; Dr. George Musambira, the late Ruth Finis, Nel LaBar, John Williams, Dale Stephens, Joe Green-Bishop and others for their support throughout my stay in the United States. In a very special way, I like to thank Paul, Richard, Charles, and Eileen who coordinated and moderated the focus group discussions in Uganda. Their commitment and dedication to the process made this thesis possible. To Terry Allen, I want to extend all my sincere gratitude for the tremendous job you did in editing and formatting the manuscript. Finally, I wish to acknowledge the love, patience, and understanding from my family for all my physical and parental limitations. My wife Dorothy and two sons, Keneth and Michael deserve every appreciation for enduring countless nights traveling to and from Euless to Denton to pick me from school. I dedicate this thesis to my entire family in Uganda most especially my father Michael and mother Janet whose love I have missed during the last six years I have lived in the United States. Tina and Brian, thanks for your love and encouragement. iii TABLE OF CONTENTS Page ACKNOWLEDGMENTS……………………………………………………………… ii LIST OF TABLES…………………………………………………………………....... vii Chapter 1. INTRODUCTION…………………………………………………………….... 1 Background of the Study The Constructivism Perspective The Glocalization Concept The Acculturation Concept Overview of the HIV/AIDS Status Statement of the Problem Rationale Theoretical Framework Symbolic Interaction (SI) Theory Diffusion of Innovations (DOI) Theory Research Questions 2. REVIEW OF LITERATURE…………………………………………………… 23 History and Origin of HIV Scientific Description Background Information on Uganda Timeline of the HIV/AIDS epidemic in Uganda Genesis of the Epidemic Upsurge in the Infection Rate and Interventions Decline in the Infection Rates Mainstreaming AIDS in Community Life The Nature of Epidemics HIV/AIDS Research on the Ugandan Campaign Research on Symbolic Interactionism iv The Glocalization Connection The Acculturation Link Application of the Diffusion of Innovations Theory 3. METHOD……………………………………………………………………..... 54 Procedures Research Participants The Focus Group Discussions Analysis Decision Rule 4. FINDINGS AND DISCUSSION………………………………………………. 81 Genesis and Sense-making process Advent of HIV/AIDS Sense-making process Desperation, Stigmatization, and Sensitization Desperation and Fatalism Stigmatization and Denial Sensitization and Dissemination Enlightenment and Change Enlightenment and Change Adaptation and Compliance Transformation and Integration Transformation and Distigmatization Pragmatism and integration Institutionalization and Backlash Institutionalization and visibility The AIDS paradox and campaign backlash v 5. SUMMARY AND CONCLUSIONS…………………………………………... 162 Summary Conclusions Limitations Implications APPENDICES………………………………………………………………….………. 175 REFERENCES……………………………………………………………………….… 199 vi LIST OF TABLES Table Page 1 Timeline of HIV/AIDS Evolution in Uganda………………………………… 27 2 Participant Demographic Characteristics for Focus Group No. 1- Kampala…. 64 3 Participant Demographic Characteristics for Focus Group No. 2- Kampala…. 65 4 Participant Demographic Characteristics for Focus Group No. 3- Kampala…. 66 5 Participant Demographic Characteristics Focus Group No. 4- Kampala……... 67 6 Participant Demographic Characteristics Focus Group No. 1- Rakai……….... 69 7 Participant Demographic Characteristics Focus Group No. 2- Rakai………… 70 8 Participant Demographic Characteristics Focus Group No. 3- Rakai………... 71 9 Participant Demographic Characteristics Focus Group No. 4- Rakai………... 72 10 Participant Demographic Characteristics Focus Group No. 5- Rakai………... 73 11 Participant Demographic Characteristics Focus Group No. 6- Rakai………... 74 vii CHAPTER 1 INTRODUCTION Background of the Study This exploratory study examined the role of communication in the understanding of the global human immune virus (HIV) and acquired immune deficiency syndrome (AIDS) by a section of the sexually active Ugandan population then living in Rakai district where the epidemic was first identified in 1982. The study demonstrates how the knowledge acquired during that sense-making process was used by the section of the population now aged between 40 to 50 years to adapt new life skills to cope with the epidemic in their continuously changing social environments. Grounded in the social constructivism perspective, the introductory chapter of this study begins with an explanation of the basic assumptions of the constructivism perspective and describes the glocalization process through which the new global HIV/AIDS pandemic was localized and understood by a section of high risk Ugandans then living in Rakai district, the epicenter of the epidemic in the country. The chapter also describes the acculturation process to demonstrate how a section of the Ugandan population then aged between 17 to 27 years adjusted to the HIV/AIDS epidemic and adapted strategies that are gradually leading to the integration of the disease in their culture. Next, the chapter presents an overview of the status of the HIV/AIDS pandemic with statistics that highlight the human crisis orchestrated by the devastating pandemic in Uganda and elsewhere in the world. This is followed by a statement of the problem and the rationale for the study. Finally, the chapter includes an explanation of the theories replicated in the research and concludes with a statement of the research questions. 1 The Constructivism Perspective The constructivism or the social constructivism perspective (e.g., Berger & Luckmann, 1966) has led to a growing body of literature from social science researchers in the health field who contend that reality is a product of human action which constantly creates and recreates within a given social context. Proponents of this sociological tradition (cf. Engelhardt & Spicker, 1974; Eisenberg, 1977) argue that the world does not exist only in our heads but also is collectively constructed through constant human interpretative activity. According to Engelhardt and Spicker (1974)
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