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  • 00:01

    [MUSIC PLAYING][Researching HIV/AIDS in BotswanaUsing Transformative Methods]

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    DONNA MERTENS: Hello, I'm Donna Mertens. [Donna MertensProfessor, Retired, Gallaudet University]I was a professor at Gallaudet University for over 30 years.While I was at that university, I developed an approachto research that was specificallyfocused on issues of social justice and human rights.The name of this approach to research

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    DONNA MERTENS [continued]: is Transformative Research.And it is anchored in the conceptof a transformative paradigm or a setof philosophical assumptions thatlead us to design our research in ways to takeinto consideration cultural issuesand to lead to the transformative change that's

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    DONNA MERTENS [continued]: necessary in communities that are marginalizedor that experience discrimination and oppression.I want to share with you an example of a study that usedthe transformative approach.This is a study that was conducted in Botswanaand it was conducted in response to the HIV/AIDS crisis

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    DONNA MERTENS [continued]: in that part of the world.Just to give you some background, almost 25%of the Botswana population is infected with HIV/AIDS.The government of Botswana was seriously concerned about thisand said, we cannot have a generation of our population

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    DONNA MERTENS [continued]: disappear.What we need are studies that will have an effect on reducingthis rate of infection.So the University of Botswana wasable to go to the National Institutes of Health, the NIH,in the United States and get fundsin order to address this serious problem.The study's principal investigator

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    DONNA MERTENS [continued]: was Dr. Bagele Chilisa, who is a professorat the University of Botswana.The goal of the study was the preventionof HIV/AIDS and other sexually transmitted diseases for youthaged 14 to 17.My role with the study was as an advisor.And so I didn't actually go into the field and collect data,

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    DONNA MERTENS [continued]: but I was able to interact with the researchersand listen as the study progressedand offer some advice.[Transformative Paradigm]I want to put this study into the context of paradigms,as I mentioned in my opening remarks--that a paradigm is really your world view, what assumptions

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    DONNA MERTENS [continued]: you make about research.And typically, in research, we lookat four sets of assumptions.And those assumptions include the axiological assumptionor your assumptions about the nature of ethics,the ontological assumption, or your assumptionsabout the nature of reality, the epistemological assumptions

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    DONNA MERTENS [continued]: about the nature of knowledge and how the researcher relatesto the people in the study, and the methodological assumption,related to the nature of systematic inquiry.In this particular case study, I'mgoing to focus primarily on the axiological and ontological

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    DONNA MERTENS [continued]: assumptions.But to give you just a brief understandingof the meaning of the transformative paradigm,it functions as a metaphysical umbrella.And what it allows us to do, as researchers,is to bring together those many dimensions of diversity thatare used as a basis of discrimination and oppression

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    DONNA MERTENS [continued]: that need to be recognized if we areto address issues of human rights and social justice.It's applicable to people across the globe whoexperience discrimination and oppression on whatever basis.And that can be on the basis of gender,on race, on ethnicity, language, particularly in Africa,

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    DONNA MERTENS [continued]: looking at issues of poverty, tribal affiliation,immigrant status, refugee status, and sexual identity.And it's this approach to researchthat allows us to bring these variables consciouslyin to even the beginning conversations that we have

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    DONNA MERTENS [continued]: as we begin to develop a research study.And so the transformative paradigm,with these four assumptions that I've mentioned, focus on,from axiology, looking at cultural issues, howwe designed the study to promote social justiceand human rights, how we consciously address inequities,

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    DONNA MERTENS [continued]: how we give back to the communities that we work with,so a sense of reciprocity and also recognizingthe strengths in the community.This is what I'm going to illustrate with a case studyfrom Botswana, this particular study.I'm also going to talk about ontologyand that is the versions of reality,

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    DONNA MERTENS [continued]: multiple versions of reality, where they come from.What is the reason that there's such a high rate of infectionand who holds different opinions about those reasons?And how do we challenge reasons thatmight serve to continue an oppressive status quo rather

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    DONNA MERTENS [continued]: than result in an intervention that will actuallycreate the kind of change that we're looking for?And so this is going to be the focus of this particular casestudy that I describe for you.[Transformative Methods]In Botswana, in terms of the transformativemethods that they used, to begin with,

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    DONNA MERTENS [continued]: in axiology, what we're talking aboutis who has to be involved?Who are the members of the communitythat need to be involved?The researchers knew that it was veryimportant to involve parents.Family orientation is a huge part of the culture thereand that that would be critical for them

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    DONNA MERTENS [continued]: to have good relationships with the parents of the students.And so they did begin with making contacts with parentsand bringing them into the discussion about the researchvery early in the process.They also knew, culturally, that talking about sexdirectly was not going to be something

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    DONNA MERTENS [continued]: that would be considered culturally appropriate.And yet, we know HIV/AIDS is a sexually transmitted diseasefor the most part.And so it was important for them to have the understandingof how can we talk about this sensitive topic in a culturallyappropriate way through the use of metaphors,

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    DONNA MERTENS [continued]: through the use of stories, through the use of myths thatare present in the culture.These became important data collection points for thembecause it allowed them to discuss this sensitive topicsafely.They also knew that youth would be

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    DONNA MERTENS [continued]: reluctant to talk to adults about this particular topic.And so in the part of their processof planning the research from an ethical point of view,to collect valid data they built the capacity of youthto be co-researchers, to actually collect data

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    DONNA MERTENS [continued]: through interviewing the youth in their schools.They knew that it was important to have a communityadvisory board so that they could have churches on board--again, faith-based activities, very important in this culture.They knew that they would be using some self-report surveys.

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    DONNA MERTENS [continued]: So what you can see is the emergenceof a mixed methods design that's rootedin the culture of Botswana.One of the things that they also didwas to analyze songs because in songs, a lot of the youthculture is reflected about topics related to HIV/AIDS

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    DONNA MERTENS [continued]: and related to sexual behaviors.Another very clever and creative wayto address this sensitive topic was through the useof radio call-in shows.And they also collected quantitative dataon the prevalence of the disease and theydisaggregated that data by age, by tribal status,

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    DONNA MERTENS [continued]: and by language.[Transformative Ethics]These transformative methods are reflectiveof the ethical concerns rooted in an understandingof the culture and the power dimensions.So this was the beginning point of how they designed

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    DONNA MERTENS [continued]: their study to be responsive.They knew they had to include the major stakeholdergroups, including people from the university,including the youth, the families, and the churches.They knew they had to be concernedabout the cultural beliefs and normsand these were related to sex, to risky behaviors,

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    DONNA MERTENS [continued]: to the concept of abstinence, and to the concept of HIV/AIDS.That in talking about these behaviors,they came to understand that the youth don't use the wordsHIV/AIDS.They use the word "this sickness."And it's a very important to understand

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    DONNA MERTENS [continued]: that "this sickness" carries many cultural connotations thatwere relevant to understanding howto design an intervention that would actuallyhave the potential of reducing the rate of infection.They also knew that it was important to bringin the history, politics, and policies

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    DONNA MERTENS [continued]: with it at the national level.Botswana was a colonized country and they'revery conscious of having outsiders come in and tell themwhat is wrong with them and what the appropriate solutions are.This is a continuation of the colonial mentalitythat is greatly resisted by the Botswanan people.

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    DONNA MERTENS [continued]: And so this had to be an Afrocentric studyfrom the very beginning.It had to utilize the knowledge that came from this culture.They were aware that it was important to bring in,consciously, issues related to discrimination, oppression,and associated power structures.

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    DONNA MERTENS [continued]: This brought forth the issue of poverty and its rolein terms of the prevalence of the disease.Also important-- and this is, again,rooted in the axiology of the transformative paradigm--is the recognition of the expertise,knowledge, and strengths within the community.So this brings up a cultural concept of Ubuntu.

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    DONNA MERTENS [continued]: Ubuntu is a spiritual concept thatcomes from the people of Africa that talks about positioningyourself as someone who has a responsibilitynot only to the people around you at this present time,but have a responsibility to those who came before you

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    DONNA MERTENS [continued]: and to those who come after you.And not only to people, but to all livingand non-living things.And so to me, this raises a question for all researchers.How would we design our research differentlyif we worked from a consciousnessof those who came before us, those who come after us,

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    DONNA MERTENS [continued]: and the effect of our research on all livingand non-living things?This was a critical part of cultural knowledge relatedto ethics that was brought into the study in a veryconscious way.Also, establishing a platform for an authentic engagement,having stake-holder engagement from the very beginning,

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    DONNA MERTENS [continued]: training youth researchers so that theycould go out to where the youth areand capture authentic data about their experienceswith this sickness.[Transformative Ontology]Now I'm going to turn to the assumption of ontology

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    DONNA MERTENS [continued]: and look again at its methodological implicationsand then look at how it was implementedin this particular study.The ontological assumption looks at reality as multifaceted,that versions of reality exist, that these versions of reality

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    DONNA MERTENS [continued]: come from different social positionalitiesand that there are consequences for which version of realitywe use as a basis of moving forward with our research.That these different versions of realityare present in every context and, as researchers,we have a responsibility to bring to visibility

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    DONNA MERTENS [continued]: what those versions of reality are.We also need to be able to bring to visibility thosewho have the power to define which versions of realityare going to be accepted, what the costs are of acceptingthose different versions of reality,and the potential for the development of interventions

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    DONNA MERTENS [continued]: that will be successful in that context.[Botswana Ontologies]And so let's look at how that was appliedwithin the Botswanan study.In terms of the multifaceted consequences of privilege,the methods were used to reveal what those versions of reality

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    DONNA MERTENS [continued]: are.Now let me take you back again into that concept of knowledgebeing socially and historically located.That there were different versions of reality,that a US partner university saidthat the version of reality that should prevail

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    DONNA MERTENS [continued]: and that would explain why there wassuch a high rate of infection wasthat the youth did not know how the disease was transmitted.And so their proposed interventionwas to bring this youth to the university for a weekend

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    DONNA MERTENS [continued]: and teach them about condoms and abstinence.The University of Botswana research team,using the transformative approach,said, let us test that assumption.Let us have our youth interviewers go outinto the field and talk to the youth

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    DONNA MERTENS [continued]: and find out how they talk about this sickness, whattheir experience with this sickness is.Also, they wanted to understand who is most affected?What are the characteristics?And so there was quantitative data collectedand qualitative data collected.

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    DONNA MERTENS [continued]: In the qualitative data, through the observation of the youth,the interviews with the youth, the analysis of the metaphorsand songs that I mentioned previously,led them to come to the understandingthat the youth experienced the sickness with a profound senseof sadness, that that was overwhelming

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    DONNA MERTENS [continued]: and that their sadness came from the factthat they had lost so many people.So many people in their families and their communitieswere lost to this disease.Many of the youth were now head of household.So they'd taken on tremendous responsibility.

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    DONNA MERTENS [continued]: In addition, their understandingswere that they didn't have a sense of a future.They're looking around and they're seeing people dieand they say, I may not have a future.So if you put together this version of reality,taking those elements, it's sadness, It's loss.

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    DONNA MERTENS [continued]: I may not have a future.And as youth were able to convey in many different ways,that sex feels good.And so they felt like, why not just have sexsince I'm going to die anyway and I don't reallyhave a future?Think about how these research methods led

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    DONNA MERTENS [continued]: them to come to this very different, verynuanced understanding of the version of realitythat was operating in that contextand what the implications of thatwould be for the development of an intervention.If you're developing an intervention

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    DONNA MERTENS [continued]: based on an assumption that the version of realityis a knowledge gap-- you just don't know-- thenyou teach knowledge.But if you're developing an interventionbased on where people are in terms of their emotions,in terms of the economics of the situation,

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    DONNA MERTENS [continued]: in terms of an understanding of the myths thathave operated in that country, surroundingthe concept of AIDS.One of the myths-- and I mentionedthe radio call-in show as data collection-- was that if youhave sex with a virgin, that you will be cured of the disease.

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    DONNA MERTENS [continued]: Now, was this myth actually acted upon?Yes, it was.And the people from the University of Botswanawere able to very creatively collect data thatsupported that this was a myth thatwas leading to the increase in the rate of infection.So what they did was advertise that they

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    DONNA MERTENS [continued]: were going to have a call-in show on the topic.And men called in and said, it's not a myth.It's a fact.And in order to have sex with a virgin, this is what we do.We go into the townships where the very poor people live

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    DONNA MERTENS [continued]: with a cell phone, with groceries,and we say we will give you these in exchange for sex.And if you consider the context of the abject povertythat many of these people live in in the townships--

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    DONNA MERTENS [continued]: without sanitation, without running water--the tradeoff is that they have something they wouldn't haveotherwise.And maybe something that they need to survive.And so putting this indigenous knowledgethrough creative mixed methods data collection

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    DONNA MERTENS [continued]: allowed the researchers to have a fuller understandingof the reality of this disease in this specific context.And they were then able to design an intervention thatwas responsive to this reality.And that is a demonstration of how, as researchers, we

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    DONNA MERTENS [continued]: can use the assumptions of the transformative paradigm,the axiological, and the ontological assumptions,in particular, to gain knowledge about the realities thatcould be hidden and not shared but arecritical to understanding how to move forward

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    DONNA MERTENS [continued]: with effective interventions thatcan address these critical issues of human rights.And so I ask you to give considerationto your understanding of the meaning of ethicsin the conduct of research, to the meaning of understandingthe experiences of the people that you do the research with.

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    DONNA MERTENS [continued]: Are you framing your research in a waythat protects those people, that keeps them safe,that has the potential to lead to an intervention, thatcan address these violations and leadto the kind of transformative change that you desire?


Using a case study on HIV/AIDS prevention in Botswana, Professor Donna Mertens explains the transformative approach to research. This approach is rooted in understanding the philosophical and cultural issues that underpin a research project, for the purpose of evoking positive social change.

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Researching HIV/AIDS in Botswana using Transformative Methods

Using a case study on HIV/AIDS prevention in Botswana, Professor Donna Mertens explains the transformative approach to research. This approach is rooted in understanding the philosophical and cultural issues that underpin a research project, for the purpose of evoking positive social change.

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