AMCAS Research essay

Five days before Christmas 2007, I woke up wishing for a stellar final day of my semester abroad in Dublin, Ireland, but I was not expecting the highlight to be waiting in my inbox. When I logged into my email account, I found that I had been selected for an internship with Global Service Corps sponsored by the Helen Kellogg Institute for International Studies at the University of Notre Dame. I sprang out of bed and danced across the hall to my neighbor's room, blissfully singing "I am going to Tanzania!"

From May 29 to August 1 of 2008, I lived in Arusha, Tanzania, interning with the international nonprofit volunteer organization Global Service Corps (GSC). For nine weeks, I worked in GSC's HIV/AIDS education and prevention programs as a teacher for secondary school students and community groups of older Tanzanians. I was especially attracted to this internship due to its relevance to both of my undergraduate majors, biology and anthropology. After participating in immunology research and taking anthropology courses concerning African cultures and varied medical understandings, I was eager to meaningfully combine my dual fields of study by volunteering in HIV/AIDS programming in Tanzania.

Upon notification of my internship, I immediately realized that my time in Arusha was a prime opportunity to undertake research in medical anthropology. As an undergraduate student, I had been attempting to orchestrate research that would synthesize my interests in anthropology and medicine into a single senior thesis project. By volunteering in an HIV/AIDS education program abroad, I would be in the midst of a critical field within medical anthropology, allowing me to not only witness but participate in the response to the HIV epidemic in Tanzania.

While none of the current anthropology faculty members at Notre Dame has HIV/AIDS as his or her particular focus, I took my idea to Professor Daniel Lende, an assistant professor in the Department of Anthropology. Professor Lende's research in medical anthropology focuses on behavioral health, particularly compulsive and addictive behaviors. While his research does not address my specific area of interest, I knew from a previous conversation that his experience and knowledge in medical anthropology are extensive and he is exceptionally familiar with current anthropological discussions of HIV/AIDS in sub-Saharan Africa. I also presented my research proposal to the Glynn Family Honors Program at Notre Dame. While the Kellogg Institute funded my trip to Tanzania and internship with GSC, the Glynn Family Honors Program provided an undergraduate research grant to finance my independent project.

Under Professor Lende's guidance, I began my examination of sub-Saharan HIV/AIDS literature in the spring of 2008. While it is well-known that the global HIV/AIDS epidemic has struck sub-Saharan Africa the hardest (over two-thirds of all HIV-positive people reside in this area and it was the site of more than three-quarters of all AIDS-related deaths in 2007), it is less understood that a significant majority of those living with HIV in this region are women. Throughout sub-Saharan Africa, 61% of infected individuals are women. In Tanzania, an apparent disparity also exists between young men and young women's understanding of HIV/AIDS and engagement in prevention behaviors. A recent study showed that significantly more young males than females could correctly identify and had engaged in HIV prevention methods.

In the past, many studies have examined the personal risk behaviors associated with HIV infection, but the cultural and socioeconomic contexts of the virus have been increasingly cited as crucial factors in addressing prevention. Many investigators have correlated high HIV prevalence in females of sub-Saharan Africa to gender-based inequality and violence. A joint study by UNAIDS and UNFPA cites three key factors as contributing to the escalating HIV epidemic in sub-Saharan African women: a culture of silence surrounding sexuality, the prevalence of exploitative transactional relationships and intergenerational sex, and violence against women within relationships. Young women are especially vulnerable to the impacts of gender socialization on HIV prevention, as gendered power imbalances tend to limit their autonomous control over sexual health.

While youth HIV/AIDS education has been a focal point of many prevention programs throughout sub-Saharan Africa, a range of factors (such as low levels of perceived threat of infection, social norms concerning sexuality and condom use, gender inequalities, and economic constraints) challenge the effectiveness of such programming. Another key problem at every level of HIV prevention is a tendency among all people to conceptualize HIV/AIDS as someone else's problem. Although community education is typically held as a pillar of HIV prevention, researchers have pointed to the need to examine the disconnect between rhetoric and the realities of attempting to change behaviors within particular social contexts. Also, the impacts of sociocultural gender inequalities on HIV prevalence in young women and men require much further characterization. Therefore, I decided to direct my research in Arusha, Tanzania toward answering the following inquiry: how do young women's understandings of gender roles and sexuality influence their engagement in HIV/AIDS education and prevention?

Based on my review of recent literature and considering Tanzania's typical socioeconomic structures and cultural norms, I hypothesized that gender inequalities may hinder young women's active participation in community HIV/AIDS education programs and young women may lack the perception or reality of sexual autonomy needed to effectively implement HIV prevention methods. Additionally, I hypothesized that young women in Tanzania may not have a sense of ownership of the HIV/AIDS epidemic, making them further unlikely to engage in HIV prevention.

In order to examine the influence of female conceptions of sexuality on HIV/AIDS education and prevention in Tanzania, I utilized qualitative methods in a dynamic observational multimethod assessment process, including participant observation, interviews, and archive collection. Qualitative methods were particularly useful in my study as this was my first trip to Tanzania, and the active nature of this paradigm allowed me to tweak the project as my research progressed.

During my first three weeks in Tanzania, I taught at a day camp for secondary school students in Arusha. In this time, I focused on participant observation, in particular examining power dynamics and participation differentials between males and females, as well as students' feelings surrounding gender roles and sexuality. I recorded my observations in structured observational checklists and unstructured field notes. I also began my archive collection, seeking out and gathering materials concerning HIV education and prevention in the Arusha area.

Once day camp was completed, I began facilitating GSC's HIV trainings for community groups throughout Arusha. I continued participant observation and also began conducting key informant and semi-structured interviews. Key informants included GSC staff and other youth educators in Arusha, selected for their principle roles in HIV/AIDS education and prevention in the community. Fellow GSC volunteers and, most importantly, young Tanzanian females and males (between 18 and 30 years old) participated in semi-structured interviews.

As my field research advanced, new themes emerged as crucial to the treatment of HIV in Arusha. Specifically, current changes in gender roles and potential shifts in ideas about female sexuality were repeatedly mentioned by Tanzanians in both day camp and community trainings. Interviews highlighted an apparent problem that had not emerged regularly in current literature: a lack of familial ownership of the HIV epidemic. With the family as a key social unit in Tanzania, and youth education crucial to decreasing infection rates, the majority of Tanzanian parents' unwillingness or inability to discuss relationships, sexuality, and HIV with their children leads to a large gap in HIV prevention. I added my observations to interview scripts and observational checklists, making sure to follow the data and include topics that Tanzanians themselves emphasized as important.

Now, upon my recent homecoming to the United States, I am beginning to code field notes, transcribe and code interviews, and organize and code my archive collection. Additionally, I am returning to the literature to further explore shifts in gender roles and conceptions of female sexuality, as well as family dynamics in Tanzania and impacts for HIV/AIDS education. This process will continue into the fall semester of 2008, when I will finish my senior thesis on this research. After its completion, I will present my research at several meetings and will submit my paper for publication to an appropriate anthropological journal. My research should have practical implications for improving HIV/AIDS education in Tanzania, potentially playing a part in alleviating the current crisis. In the future, as a physician and social scientist, I will be able to conduct research in medical anthropology while practicing medicine, enhancing both the immediate and long-term health of communities. My interest in the integration of biomedicine into other traditional conceptions of health plays an important role in the study of sub-Saharan Africa's HIV epidemic, as real change will not be affected until education and prevention programs adequately consider unique cultural contexts.