Young people, HIV prevention and policy making in the rural Eastern Cape, South Africa

There has been limited success in tackling the spread of the HIV epidemic among young people, despite years of interventions. This research contributes to an understanding of why intervention success has been limited by examining HIV prevention among young people in the rural Eastern Cape of South Africa. Shifting the focus from the specifics of individual interventions, it draws on the theoretical work of Foucault to examine how young people and their sexuality are being constructed and understood within policy discourse, and how this relates to young people’s own everyday experiences of the virus. In doing so it highlights both the disjuncture between these understandings, and the ways in which, despite this, young people are engaging with policy narratives in often unexpected ways. Using qualitative approaches the research was carried out in four rural communities. Repeat dependent interviews (n=108) were conducted with young people (n=56) over a 10 month period. These were supplemented by participant observation, key informant interviews (n=15), and analysis of policy documentation. The study finds that the ways in which evidence is used to make knowledge claims about young people and their engagement with the virus is problematic. It argues that the dominance of particular forms of knowledge within policy processes work to exclude those forms of knowledge which are grounded within young people’s everyday lived experiences of their sexuality and the virus. As a result, in claiming to ‘know’ young people, this decontextualized knowledge works to construct a particular subject position of youth in which agency is ascribed to fit within dominant gendered and medicalised narratives of the virus. These constructions are in stark contrast to how young people themselves understand and perform their own sexual identities, which are spatially and temporally located. The research finds that young people come to construct and perform their, often multiple, identities in ways which reflect their subjective interaction with the context of their daily lives. It finds that young people’s narratives of sexuality and HIV are embedded in discourses of pleasure and poverty, and are shaped by a complex web of social and gender relations. Despite this disjuncture, the research finds that young people are not simply ignoring, but rather are engaging, with these policy narratives in complex ways, as they become part of their context of interaction. Drawing upon Long’s interface model the research finds that as policy narratives come to intersect with young people’s lifeworlds, new forms of knowledge and social practice are produced. Within this interface ‘youth’ as an identity emerges as an asset which young people can draw upon and utilise to make sense of their situation, as well as provide access to opportunities. At the same time young people appropriate the policy narratives of individual responsibility and the medicalised discourse of HIV to rationalise, and make sense of, their own risk taking behaviours. The thesis' methodological contribution examines research practices themselves as sites of knowledge production about young people. Turning the analytical lens on my own work, as well as that of others, it examines the challenges in conducting such research and the ways in which it can serve to reproduce the narratives it seeks to uncover. In going beyond identifying the disjuncture between policy narratives of youth sexuality, and those that young people construct for themselves, the research generates new insights on how we think about young people, their identities and behaviours, in relation to the virus. By moving from the specifics of interventions themselves to the assumptions and conceptualisations which underpin them, it draws attention to the importance, and problematic nature, of what we do know, what we can know, and the implications of these knowledge processes in the everyday lives of young people. In doing so it generates a number of key implications for policy and future research.