Hope: A new approach to understanding structural factors in HIV acquisition

Abstract

This paper presents the first empirical results of a long-term project exploring the use of hope as a concept summarising people's experience of the social, economic and cultural world they inhabit. The work has its roots in attempts to understand socio-economic aspects of HIV/AIDS epidemiology through recourse to the term ‘structural drivers’. In this paper, we recognise the distinguished contribution made by that body of work but adopt a different theoretical approach, one based on the idea of emergent social properties. This is an idea derived from the Durkheim's notion of a ‘social current’. One such emergent property is hope and its potential use and applicability as an epidemiological variable is described. The variable is measured using the Snyder scale developed by the late Rick Snyder for quite other purposes in the USA. We use data from the long-standing UK MRC/UVRI General Cohort Study in Uganda together with a smaller study of some fishing communities. The results show that the Snyder scale (1) does measure a real variable, (2) does mean something to Ugandan rural populations and (3) can be used to explore some known risk factors for HIV acquisition.

Keywords:

• HIV/AIDS
• hope
• Uganda
• structural drivers
• social science

Acknowledgements

The authors are grateful to Fatuma Ssembajja, Elizabeth Kabunga and Grace Tumwekwase for data collection and Ailie Tam for assisting with data management and analysis. The authors acknowledge the contribution of all participants for giving their time and information to this study. In addition, they would like to thank Dr Catherine McGowan for support and advice, Dr Shirley Huchcroft for her considerable advice concerning data analysis and Dr Justin Parkhurst for reading and commenting on a very early version of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The intention of this study was to examine prevalence, incidence, risk factors and trends of infection with the human immunodeficiency virus (HIV) in a rural African population (Nunn et al., 1997). More recently, research activity has broadened to include the epidemiology and genetics of other communicable and of non-communicable diseases, including cancer, cardio-vascular disease and diabetes (Asiki et al., 2013).

2. Data are collected through an annual census and since 2012 a biennial questionnaire and serological survey. Details of sexual behaviour, medical, socio-demographic and geographic factors are recorded. Blood specimens are obtained at each annual survey. Serum is tested for HIV-1 and the remaining fraction is stored at −80° in freezers in Entebbe. HIV prevalence has remained relatively stable in this population, with about 8% of participants infected.

3. This word is used ironically to note the often-implicit moral judgement contained within such perspectives when they inform social policy.

4. Personal communication: it was apparently tested on a Korean population in New York.

5. Out of curiosity, we compared the Ugandan scores with those obtained in South Africa. We do not believe that the Snyder scale was ever intended to make cross-cultural comparisons nor should it be used in that way. In general, the Ugandan hope scores were higher than were those in the South African study.

6. By other land, we mean land other than the plot on which the homestead was situated and which was used by members of that household for cultivation.

7. We use this term in inverted commas because our theoretical position assumes that much if not all risk behaviour has a socio-economic and cultural element (Barnett & Blaikie, 1992).

8. We are very grateful to Dr Shirley Huchcroft for her considerable assistance and skill in making this observation.

Additional information

Funding

We are grateful for funding to the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement.