Sexual activity will never be safe as long as young people are told that sexual expression is bad, dangerous and wrong, or where it remains hidden and stigmatised. (Harrison 2012: 85)
In South Africa Abigail Harrison, an HIV social scientist, argues that we need to move away from frameworks that tell young people that âsexual expression is bad, dangerous and wrongâ (2012: 85). She acknowledges that while there are existing sexual health school-based programmes, such as âthe national Life Skills programme, intended to provide sexuality education to school-going youth (Morrell 2003)â (Harrison 2012: 85), these continue to face numerous challenges including student retention, limited avenues for teacher training, and âresistance in schools because of the perceived sensitive nature of the subject matterâ (AVERT 2019a). There are significant gaps in comprehensive sex education, including sexuality and HIV education. A recent United Nations Population Fund East and South African Regional Office (UNFPA ESARO) report found that 59% of South African youth had knowledge of HIV prevention methods, compared with 85% of youth in neighbouring eSwatini (UNFPA ESARO 2016: 2). As Harrison concludes, â[u]ltimately, however, success will lie not in changing one intervention but in altering existing discourse about gender and sexuality, and expanding HIV prevention options for young peopleâ (2012: 85).
This chapter begins by contextualising sexual health communication specifically within the context of HIV in Southern Africa. I have come to realise that many past interventions, while invariably conducted with best intentions, have increased stigma and shame around understandings of sexuality and sexual health worldwide. Rather, to be effective, what is required are local, culturally sensitive, and specific responses that are both meaningful and appropriate. Within the South African context, as I have argued elsewhere, â[i]n order to start conversations around sex and relationships, we need to provide avenues for intimate moments of recognition with the audience, the participants and facilitators. We need to provide a space when exploring sexual health concerns through theatre, where the individual can appreciate the subject within their body and mind, in a way that speaks to their experiencesâ (Low 2017: 154).
Within my research, I consider theatre-making as an alternative yet complementary approach to traditional health education programmes. Part of the impetus for me for theatre-making within the field of sexual health communication was to respond to the South African public health crisis of the AIDS epidemic at that time and to do something that was effective and meaningful. My contention is that engagement in a performative experience can deepen and personalise the conversation around HIV prevention and broader sexual health concerns of, in this instance, young people living in South Africa. The performative nature of the engagement can provide a space where individuals can challenge and complicate understandings of what sexual health means for them. Thus, interventions can become more meaningful and effective because they are devised collaboratively and specifically for the group engaged with the practices.
In this chapter, I acknowledge the understandable desire within the fields of sexual health education and socially engaged theatre-making to evidence impact, which has proven to be challenging historically. Here I consider how theatre has been used to address social concerns through different approaches, including Theatre for Development (TfD) and Theatre in Health Education (THE). The chapter also describes how the Our Place, Our Stage (OPOS) practice research project was established and then addresses a key question in applied theatre around impact and value, the analysis of which informs the thinking throughout this book.
Sexual Health
We cannot act as though we were inhabitants of a medieval city state and exclude those who are sick and/or poor. There is no longer any quarantine, we cannot avoid contagion. This is a vital task for the first decade of the twenty-first century. (Barnett and Whiteside 2006: 389â90)
This section contextualises the field of sexual health, explaining the breadth of the field and introducing some of the main challenges facing any public health response to HIV and/or sexual health communication, namely, acknowledging both the importance of the social aspects of sexual health and the impact on women and their health. Sexual health communication is a vast and complicated field and includes a wide range of areas, from medical understandings of the epidemiology of HIV to social considerations of sexuality. The magnitude of the field is proportional to the breadth of literature available on the topic, from yearly reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation (WHO), donors and government health departmentsâ policy documents, to international and local NGOsâ annual accounts of practice. There are countless studies and research teams considering the epidemiology of different sexually transmitted infections (STIs), Knowledge, Attitude, Belief and Practice (KABP) studies,1 and research into the impact of social conditions on individualsâ health. However, for the purposes of this book, I am interested in the social aspects of sexual health, and my research and practice consider some of the social responses to HIV and sexual health communication, specifically approaches to sexual health education . This acknowledges Tony Barnettâs and Alan Whitesideâs argument that crises such as HIV or gender -based violence cannot be quarantined (2006). Their idea, echoed by other researchers, underpins how vital it is to understand that HIV is a syndrome which is intrinsically linked with race, politics, poverty and gender equity (Stillwaggon 2000; Fourie 2006; Barnett and Whiteside 2006; Baylies and Bujra 2000).
Barnett and Whiteside further argue that â[t]he effects of disease are rarely considered beyond the clinical impact on individualsâ (2006: 5). They acknowledge that the impact on the individual is hard to measure, especially aspects like âquality of life, quality of relationships, pain of lossâ (2006: 6). They conclude that, while it may be difficult to observe the social impacts, in so doing, they acknowledge that â[i]f it is hard to see these things, it is all the easier to deny themâ (2006: 6). This perceived difficulty in calculating the impact of effects explains Andrew Irvingâs view that for âa literature concerning a blood-borne disease, much of it is surprisingly bloodless; the personâs thinking, emotions, and dilemmas, their very flesh and being, are reduced to statistics, the biological body or social structures. Surprisingly few people inhabit these textsâ (2007: 204, emphasis in the original). Irving is not alone in drawing attention to the lack of focus on the individualâs feelings or responses to the AIDS epidemic and the failure of some interventions to recognise that a person is an individual located in a particular community. In the mid-1990s, there was little research conducted on âthe âsafe and satisfyingâ dimensions of sexualityâ because, as Jane Cottingham argues, âresearch into sexuality (and sexual health) was only useful insofar as it contributed to an increase in contraceptive use and a decrease in unintended pregnancies and sexually transmitted infectionsâ (2012: 147). Paul Bolton and Christopher M. Wilk (2003) and Felicity Thomas (2007) also argue that such an approach does not provide a rounded response to the epidemic, especially in emergent nations. An understanding of the complexity of individualsâ lives and the resulting impact on their sexual health needs and desires should be a fundamental part of any public health response to HIV/AIDS, but too often this has not been the case. Such a comprehension of the complexity of an individualâs life is key to the South African context, especially considering the South African womanâs experience of sexual health.
To be a woman in South Africa is to experience an omnipresent threat of potential danger a...