“Entre las ánimas y el cuerpo”fenomenología del VIH en Guinea Ecuatorial : estudio de caso

Abstract

Given the alarming situation of the generalised HIV epidemic levels in Equatorial Guinea, and given the urgent need to implement effective and efficient policies for the prevention and treatment of the epidemic in the country, the relevance of conducting the ESEVIGUE case study arises, within the framework of the development cooperation agreement between Spain and Equatorial Guinea. So, in 2010 the research began with the purpose of providing and generating scientific evidence to support the development of national strategic plans and guiding decision-making about how to implement certain international recommendations, and in particular the expansion of early diagnosis of HIV across the Equatorial Guinean population (WHO, 2002). The starting point of the research has been to investigate what relationship exists between globalisation and the HIV epidemic from a macro-sociological perspective, then to subsequently descend to a micro-social level, through ethnographic fieldwork conducted in Bata, with the objective of understanding how the Equatorial Guinean population perceives and lives with the phenomenon of the epidemic from a «phenomenological perspective» (Schütz, 1962). The research strategies employed in the development of the «case study» (Stake, 2005) have been fundamentally qualitative. However, in the description and understanding of the social context of the object of study, quantitative secondary sources have also been used. Specifically, the data collection techniques applied have been non-participant observation, individual interviews and discussion group. As for the most relevant results obtained in the investigation, firstly it is noted that the HIV epidemic in Equatorial Guinean society responds to the «social determinants of health» (WHO, 2005) conceptual model. It therefore constitutes a clear exponent of «global health inequality» (Ritzer, 2007). In this sense, structural factors such as public policy, political and economic context and culture and values have an impact on prevalence levels in the country. Also, gender, ethnicity and education level as axes of inequality, are also factors that determine greater vulnerability for social groups to the virus. These determinants and inequality axes also help to understand and explain why in the space of everyday life; certain social groups do not adopt some preventive measures to protect themselves from the threat of HIV. Such is the case of male condom use amongst women. And finally, as for the conceptual model of social determinants of health, it is noted that the intermediate determinants, such as the coverage and accessibility of modern Equatorial Guinean health services, also represent a determining factor for health care and protection from HIV. In this sense, the existing accessibility barriers are causes of abandonment and non-adherence to HIV diagnostic services and treatment. In relation to the grounds of abandonment of the services and non-adherence to the treatment, the results show that traditional medicine, unlike other African countries where it has a greater influence (Asgary et al., 2014; Merten et al., 2010), it is not the main barrier to early diagnosis of HIV nor the main cause of abandoning health and diagnostic services. Many other aspects, which from a phenomenological perspective constitute significant structures, i.e. the «intersubjective world" in the terms of Schütz (1962), have a greater influence on the understanding of the meaning and the significance of the behaviours and actions against HIV. So the coexistence of different meanings regarding HIV is evident, where the local cultural context is key in shaping said significant structures. For example, such is the case of the existing unanimous perception of a «hospital disease» , as opposed to traditional diseases. However, a transversal and common element to all the meanings or perceptions that the virus acquires is in the identification that occurs between HIV and the AIDS disease, ultimately being perceived as the "AIDS disease" and therefore the meaning of "deadly disease» ultimately being connotated. Some of these significant structures, such as "a disease of sexual abuse" and "a deadly disease", making it real in the «lebenswelt» (Berger & Luckmann, 1967), ultimately result in the construction of a «social representation» (Moscovici, 1979) of HIV as negative and unfavourable. The major contribution of this result is emphasised given that it has a strong explanatory value in the ways in which people think, act and feel regarding HIV. However, because HIV has acquired an unfavourable social representation, having the virus acquires the social category «secondary deviation» (Lemert, 1951), thus modifying the «social role» (Parsons, 1951); «social identity» (Tajfel & Turner, 1979); and, ultimately, redefining and reorganising the «self-concept» (Mead, 1934) of the person who has it. Therefore the consideration of secondary deviation, triggers certain mechanisms of social control, such as local gossip, rumours, laughter, stigma and prejudice that ultimately crystallise into forms of social rejection and discrimination around HIV-positive people. This consideration of HIV as secondary deviation also affects the social perception of risk, as long as it is mediated, in part, by «exogroup discrimination» (Tajfel & Turner, 1979). Therefore, in view of the results obtained, one of the main conclusions obtained from the research is the influence of social determinants of health on an increased vulnerability before the HIV epidemic. As well as the explanatory value that different social constructs have, created around the virus in the acquisition of preventive practices and in the ways of thinking about, acting on and living with the phenomenon of the epidemic in the country.