Exploring the Utilization of Indigenous Priorities Among HIV/AIDS Programs in Africa: A Scale Developed to Assess Local-Global Intersections

Background: High incidence rates of HIV/AIDS in Sub-Saharan Africa have been accompanied by a proliferation of foreign developed intervention strategies. Despite the effectiveness of these programs in some settings, the adaptation of these international strategies based upon cultural values, norms and priorities is needed to guarantee there diffusion among local recipients. The purpose of this study was to develop a scale that could be used to assess international HIV/AIDS programs use of local South African indigenous values and priorities. This tool has been developed to identify strengths and areas of needed improvement in the transplantation and cultural adaptation of strategies developed internationally, and used in local contexts.

 Methods: Cultural advisers with expertise in the field of HIV/AIDS were consulted in the development of an initial set of items for the scale. Purposive sampling was used to recruit foreign funded HIV/AIDS organizations in South Africa. Forty-five organizations agreed to participate in the research. The initial set of items was administered to staff members working in these foreign funded HIV/AIDS programs, and who provide direct service to clients (N=502). Principle Component Analysis was used to fit items into the fewest number of subscales possible. Analysis also included establishing the internal consistency reliability of the subscales. Mean item total correlations were calculated and used as content validity coefficients. Items that detracted from reliability, and that had low variability were removed from the subscales. Additional measures were included in the survey to establish the construct validity of each of the subscales. Multiple hypotheses were developed, and tested using correlations to establish each of the subscales convergent and divergent validity.

 Results: Following tests of reliability and validity, the final HIV/AIDS Related Indigenous Priorities (HARIP) scale consisted of 18 items. PCA was used to identify four subscales including HIV/AIDS program’s use of (a) community decision making, (b) community focused strategies, (c) women focused strategies, and (d) local spirituality. Each of the subscales were found to have acceptable to good levels of content validity, and internal consistency reliability (α =.74-.84). Significant findings of hypothesized correlations between each of the HARIP subscales and variables such as employee job satisfaction, organizational commitment, program’s use of local languages, and the perceived benefit of programs to the community confirmed the convergent validity of the subscales. Similarly tested hypotheses confirmed the discriminate validity of subscales.

 Conclusions: Many of the factors included in the HARIP scale have recently been affirmed in the international arena. Programs such as the USA’s Global Health Initiative have emphasized a focus on community decision making and the use of women focused HIV/AIDS strategies. As such, the HARIP index represents an important diagnostic tool by which organizations can assess global programs’ attention to these local cultural priorities. However, future research will need to contribute to the continued validation of the scale, the examination of additional South African cultural values that can be incorporated into the scale, and the possible adaptation of the scale to cultural groups in the broader African context.