How youth picture gender injustice : building skills for HIV prevention through a participatory , arts-based approach

Based on the existing literature on the positive relationship that exists between high instances of HIV infections and a high degree of gender injustices in southern Africa, there is clearly a need for HIV-prevention interventions, to focus on the need for changing the existing gender norms. Social change begins with change at the individual level, so the question that this article attempts to answer is: How can we engage youth as key actors in educating their peers on HIV prevention, through a gender lens? Proceeding from a critical paradigm, the article describes how a participatory action-research design, using arts-based methods, has enabled youth to develop self-efficacy beliefs in regard to their ability to design and implement peereducation interventions, in order to raise awareness in the school community of the impact of gender injustices on the lives of youth. The data were collected through drawings, focus-group interviews, photographs, and video recordings of peer interventions. Thematic analysis of the data provides convincing evidence that arts-based methods are effective in developing youth agencies to create and disseminate powerful peer interventions around gender injustice that may make a significant contribution to changing gender norms.


Introduction
The link between gender injustices, particularly gender-based violence, and HIV is well substantiated by international literature (Ertürk, 2005;Kaufman, Shefer, Crawford, Simbayi & Kalichman, 2005;Larkin, Andrews & Mitchell, 2006).The Department of Basic Education (DBE) in South Africa recognises the importance of integrating gender into HIV prevention (DBE, 2010); and it includes outcomes to this effect in the Life Orientation Curriculum and Policy Statements (CAPS) (DBE, 2011), as well as recommending the integration of gender into other subjects and co-curricular activities.However, the effectiveness of such integration is questionable, given the difficulty teachers experience in integrating HIV and gender issues into their teaching (Theron, 2009;Wood, 2009a).Even if they do teach effectively on gender and HIV, it is unlikely that the transmission of knowledge alone would be enough to actually impact on behaviour and social norms (Baxen, Wood & Austin, 2011).
There is an emerging body of knowledge (De Lange, Mitchell, Moletsane & Stuart, 2012;Wood, 2009b) that suggests that participatory approaches to gender and HIV prevention are effective in influencing mindsets and behaviour.Participatory methodologies encourage the involvement of participants at all stages of the research process, from problem identification to dissemination of the findings (Piggot-Irvine, 2012;Triantafyllakos, Palaigeorgiou & Tsoukalas, 2008).
This inclusive approach allows the research process itself to become a means of change for the participants.Such research is thus not only for social change, but can be seen as research as social change (Schratz & Walker, 1995).Through authentic collaboration (Piggot-Irvine, 2012), participants are engaged in deconstructing and reconstructing their own knowledge on relevant social issues, so that they can devise and implement appropriate actions to improve their own social circumstances.This article will explore the effectiveness of arts-based methods, within a participatory action-research design, to help youth to develop self-efficacy beliefs in their ability to be effective peer educators on gender issues.The theoretical framework, on which the study is based, will first be explained, before the research design, methods and findings are discussed.
How do the youth learn about gender?Gender refers to a set of beliefs that a particular community constructs around what it means to be male or female in that particular context (Chong, 2005).Children learn from an early age how they should behave, and since much learning takes place by vicariously observing others, and in particular those adults that are significant in our lives (Schunk, 2008), parents, teachers and peers are an important source of information.In the case of gender, the patriarchal ideas that are propagated in many South African communities have resulted in gender imbalances being a significant structural determinant of women's vulnerability to HIV infection, poverty, violence and social isolation (Bruce, 2007).
However, just as the environment affects individuals, so the individual can shape the environment (Bandura, 2002).This assumption is important for influencing change in gender norms.Viewing gender as a social construct (Deutsch, 2007) opens up the possibility for change, as the individual's potential for agency can be encouraged and promoted through specific interventions.Through critical reflection, the youth can be taught to "unlearn" what they have learnt, through in-depth exploration of what is, as opposed to what could be; to constructively challenge existing social norms and behaviours, as enacted by their parents, teachers, peers and the community at large; and to take responsibility for beginning change by reflecting on the reciprocal influence of their own assumptions, values and behaviour (McNiff & Whitehead, 2011).
Under the umbrella of social cognitive theory, Bandura (1997) theorised that the establishment of self-efficacy beliefs is important for determining the amount of agency an individual experiences.Self-efficacy can be defined as a belief in the power to influence events (Stratton & Hayes, 1993); and this is linked to an internal locus of control, which increases persistence towards goals, even when circumstances appear difficult.
In the context of this study, where gender norms are deeply entrenched in the community, I have premised that youth would have to be helped to believe that change is possible, and that they can be important actors in this change.Self-efficacy beliefs increase hope, effort, motivational levels, positive affect and self-esteem, all of which encourage positive behavioural change (Bandura, 1997).Self-efficacy is developed by performing a task successfully (mastery experience), by witnessing other people perform tasks with success (social modelling), by positive feedback and verbal encouragement (social persuasion), and by encouraging a positive emotional climate while such tasks are being carried out (Bandura, 1997).
My assumption was that engaging the youth in participatory research would provide opportunities for all four of these sources of self-efficacy to be developed, thereby facilitating youth to develop positive beliefs in regard to their ability to be effective peer educators.

Methodology
Participatory action research requires participants to critically reflect on what they know about their situations, and to imagine alternative, and better ways of being (Baum, MacDougall & Smith, 2006), thereby empowering them in the process to improve their own social circumstances (Minkler & Wallenstein, 2003).Such critical reflection on the structural and historical reasons for injustice and repression, within a specific local context and culture, has proven to be more successful in leading to social change than the mere transmission of knowledge in the classroom (McTaggart, 2012;Stringer & Beadle, 2012).
For the purposes of this article, I focus on the data generated by one high school that was part of a larger action research project (see Wood, 2012).The school in question is situated in an under-resourced urban township setting.Four teachers involved in the project invited volunteers from Grades 9 to 11; and 32 learners (18 female and 14 male) participated.The project ran over a year, with the project leader and one or more project researchers meeting with teachers on a monthly basis for training and support.
The teachers worked with the peer educators in schools on a continual basis, meeting at least once every two weeks; while the research team facilitated the workshops discussed in this article, together with the teachers.Some of the participants struggled to express themselves in English, therefore the teachers also acted as interpreters, and helped with the clarification of concepts.
Multiple sources of data generation included visual and arts-based methods (drawings, photo-voice (Wang, 1999), drama, poetry) followed by focus group interviews with learners to critically reflect on the visual data they had generated.Arts-based methods were chosen, since they position the participants as "knowledge producers" (Mitchell, Stuart, De Lange, Moletsane, Buthelezi, Larkin & Flicker, 2010: 214).Moreover, they are "fun" (Mitchell et al., 2010:216), and would therefore appeal to the youth.The active involvement of participants in deciding what data to gather, how to interpret such data and how to use them to design interventions is a fundamental requirement of participatory action research (Wang, 1999).Arts-based methods also allow for the exploration of emotionally distressing experiences, by creating emotional distance (Mitchell et al., 2010:216).
During an initial workshop, learners were first prompted to "Draw how you picture gender injustice", and then to explain their drawings, using the acronym "SHOW(e)D" (Wang, 1999) -What do you See here?What is really Happening here?How does this relate to Our lives?Why does this situation exist?What can we Do to improve the situation?Participants then explained their drawings to the whole group, and discussion was facilitated to stimulate critical thinking (Lichtman, 2012).Using the drawings to provoke discussion, two focus groups (8 volunteers in each) were held a few weeks later, to further explore learner feelings, beliefs and actions around gender.A subsequent photo-voice workshop was then held, where the participants were divided into groups and instructed to take photographs representing: "Ways that you could stop gender injustices." The groups were given about 30 minutes to do this in the surrounding environment.Each group then chose three photographs to work with further, writing narratives to explain the images.Throughout the process of data generation, learners met regularly with teachers as facilitators, to devise ways that they could use the knowledge and data generated, in order to design peer interventions (drama, role-plays, photographic displays, drawing displays, poetry).
These in themselves were rich sources of data.A final focus group of eight volunteers was conducted after this, in order to ascertain the self-efficacy beliefs of the participants on their ability to be peer educators.
Data analysis was an ongoing process throughout the project, in line with the cycles of data gathering, reflection and action prescribed by the action-research design (Carr & Kemmis, 2002).At each stage of the project, the participants' written and transcribed oral reflections on their visual 'products' were thematically analysed (Creswell, 2005) by the research team, in order to inform subsequent decisions and actions.
For the purposes of this article, I analysed data through the lens of social cognitive theory -to gauge the effectiveness of the participatory methodology and methods in increasing participant beliefs in their ability to act as peer educators on this issue.
The trustworthiness of the data was enhanced by triangulation of data sources; the use of an independent re-coder in data analysis; checking the findings against the relevant literature and the preservation of an audit-trail of the research process (Janse van Rensburg, 2001).
Since the participants were very keen to have their images and products displayed and accredited to them, precluding anonymity, the ethical principles suggested by Swartz (2011:50) helped to determine our ethical considerations.We attempted to "go deep", by allowing multiple voices to emerge, and by providing multiple opportunities for participants to express and disseminate what they wanted to say through the different interventions they chose and our mediums of data collection.We attempted to "give back" through providing opportunities for participants to facilitate workshops at an international conference, by providing project T-shirts to help them establish an identity as peer educators, flattening power relations by allowing them to choose what/how/where to disseminate their knowledge, ensuring drawings and photos could be preserved and displayed, and by providing each school with several copies of a composite video of the project for educational purposes.
Before the first workshop, we informed the participants both orally and in writing of the purpose of the research, the voluntary nature of participation, and the right to withdraw at any time.We obtained prior written consent from the schools, teachers and participants -to use any material produced by them for research purposes.Since the exploration of gender injustice could give rise to emotional disturbance in learners, access to counselling services was assured -should the need arise (Fargas-Malet, McSherry, Larkin & Robinson, 2010).

Discussion of the findings
The findings will now be discussed in the sequence of the action-research process, which has been split into three sequential cycles for this purpose.However, there was much overlap between the cycles, as is common in an action-research approach, where the process is "messy" (Phillips & Carr, 2010) rather than linear.
Cycle 1: How did participants picture gender injustice?In this first cycle of inquiry, the participants were asked to draw how they pictured gender injustice, and to explain how it affected them -with the aim of beginning to deconstruct and reconstruct ideas around gender.Two focus groups were then held with some of the children, in order to further explore the ideas behind what they had drawn and written.The main themes that emerged from the data analysis are discussed below, with verbatim examples taken from the raw data and compared with the relevant literature.

Figure 1 Men are portrayed as violent and abusive
Men don't take no for an answer!(Female,16) The majority of drawings and explanations confirmed the stereotype of men as being violent, uncaring, powerful and privileged in comparison with women (Leach & Mitchell, 2006;Morrell, Epstein, Unterhalter, Bhana & Moletsane, 2009).The short explanations made it obvious that the participants had first-hand experience of such violence in their homes and in their broader communities.Most of the drawings depicted women with tears on their faces, as men, usually under the influence of alcohol, abused them (see Figure 1).The concrete portrayal of gender-based violence via the drawings was graphic and striking, allowing ensuing discussions to get right to the heart of the matter, yet creating emotional distance, so that the issue could be discussed without eliciting distress.
It was clear the participants did not think that they could exert much agency to change gender norms at this stage: It makes me feel embarrassed because I live in these communities where there are gender inequalities -and like, men beating women, and I am there and I just do nothing.And when I say something to someone who is older, they just say I know nothing because I am just a child.So it makes me feel unappreciated, and my views are not listened to, and it makes me feel like I cannot do anything (Male, 16).The participants related feelings of helplessness and hopelessness, sadness, and experiences of being silenced and ignored.Young girls said they felt they had no value, that men did not take their feelings into consideration: Yes, worthless and like there is nothing we can do about it.And most times it is the way it is supposed to be.Most women who get abused have grown up in that situation, and they feel like there is no way out, and that is the way it is supposed to be (Female,16).
"Women are also to blame!" (Female,15) Although mostly portrayed as helpless victims, there was also recognition of the role that women played in perpetuating the problem.Several drawings portrayed girls as using sex for material gain, because of the lack of other opportunities to make money.Poverty, drug abuse and the lack of employment all mean that young girls have limited choices to improve their material situation (Moletsane, Mitchell, Smith & Chisholm, 2008).The notion of transactional sex and the sugar-daddy phenomenon have been recognised as being contributory factors to the increasing vulnerability of women to HIV infection and gender violence (Gilbert & Walker, 2002).However, other studies suggest that women of all socio-economic statuses are also capable of asserting agency in this regard, using sexual relationships to boost their status through material gain (Fox, 2010;Luke, 2005;Pisani, 2008).
Being able to refer to the drawings and discuss the particular aspects of each case enabled a more nuanced view of "the sugar-daddy syndrome" (Female,17) to emerge.This prompted discussion on the positive and negative types of agency available to young people and the life consequences of each.
The fact that many women used their "assets" (Male, 18) for material gain appeared to be untenable to the majority of male participants, indicating recognition that this behaviour was injurious to the self-worth of the girls, and that they, as males, should initiate change by first changing their own behaviour: We do want to change cos it is bad that the girls have no self-esteem.They are supposed to feel appreciated and they must be independent (Male, 16) Figure 2 Women use sex for material gain This suggests that the discussion of the drawings facilitated a first step in breaking contemporary male hegemonic conceptualisations of gender (Skovdal, Campbell, Nyamukapa & Gregson, 2011), since the boys realised that they would have to change, rather than just expecting girls to change.

Stereotyping begins at a young age
At home I have a brother and my dad will say "Go clean his room; do his laundry" -and then I will know that I have to do it.And then if I get a husband; and he says "We must sleep, and not use a condom", I will do that because I grew up saying '"Yes" to Dad and doing everything my brother says.So if my husband says I must do it, I must (Female, 14).The quotation above summarises the content of many drawings that depicted assigned gender roles that set the stage for unequal power relations later in life.This leaves girls feeling they are not valued or appreciated: He is the one that must lead, and I don't have a say in the matters.And when one's self-esteem drops, they don't see anything wrong and end up staying in that situation, and they don't go forward because they cannot stand for themselves.Because of what happened when she was young… (Female, 15).Most of the boys, and many of the girls, were of the opinion that the image of the stereotypical male abuser was not one with which they wished to be associated, and they felt "sad", "ashamed" and "angry" that men acted in such a way.
It makes me feel sad, cos when I think of it, it is going to affect our generation, and then it will pass through the generations… .It makes me feel sad to think of these souls (Female,17).It makes me afraid; if this keeps happening, our future generations will be doomed (Male,15).This indicates that they realised that gender violence and inequality are structural problems that are perpetuated through the generations (Alderman, Hoddinott & Kinsey, 2006;Belden & Squires, 2008).
In their discussions, it became apparent that they perceived such gender norms as having a detrimental effect on their life chances: It is going to mean that all my dreams are shoved in the beams, so I must just do my work and stop being…and I must respect my husband, so I cannot move on with my life, because in the world there are many things in life waiting for me (Female,15).It spoils your life and inhibits you from going on with your life (Female, 14).One boy said: "They say boys are more powerful than girls" (Male, 16) and when I enquired as to whom "they" were, I received answers similar to the following: Everybody, you just know it (Male, 15) As a young black woman you know…and the man he kind of feels like he owns you.With lobola he feels like your parents sold you (Female,16).Yet, in the focus groups many of the participants voiced the opinion that things had to change "So everyone can have a better chance" (Male,19) My sister got married and they are equal.They are happy and share everything.And I also have a sister who is independent and does not want to marry; she has her own money and cars and house, and it's like the path I want -and they are both successful (Female, 16).The drawings were thus able to be used as a powerful tool for exploration of the participants' ideas about gender injustice, and how they had formed them, as well as offering them an