Academic Editor:Larance Ronsard, NII - National Institute of Immunology New Delhi, India
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Sport Activities as a Vehicle for HIV/ AIDS Prevention in Trinidad and Tobago: Organizer’s Perspectives
Various sporting activities are being used as vehicles for HIV/AIDS education and prevention within the field of sport-for-development (SFD). Kicking AIDS Out! is one SFD program that aims to promote protective attitudes regarding HIV/AIDS amongst youth. This study explored organizers’ perspectives of the use of sporting activities in the Kicking AIDS Out! program in Trinidad and Tobago. Qualitative case study methodology was used to examine the case. Data was generated through semi-structured interviews with seven organizers who were Kicking AIDS Out! staff or volunteer members. Thematic analysis guided data analysis. Generated themes include: Sport to Draw, There’s Something for Everyone, the Emotional Wow, and Beyond Sports. These themes illuminate the idea that sport captivates and attracts youth, and illustrate the use of sport activities to promote engagement in the program as they are tailored to the skills and interests of youth. Sport activities may challenge values and beliefs regarding HIV/AIDS and may promote engagement in new roles, such as those as advocate or caregiver for individuals with HIV/AIDS, and engagement in healthy lifestyle behaviours, such as safe sexual encounters. The findings of this study offer an opportunity for HIV/AIDS prevention programs to consider their use of sporting activities in a manner that achieves these SFD characteristics.
Second to sub-Saharan Africa, the Caribbean is the region most affected by HIV/AIDS1. In the last twenty years, Trinidad and Tobago experienced a 500% increase in HIV/AIDS cases2; of which 45% were youth aged 15 – 24 3. To target this age group, evidence suggests that direct and continuous prevention programs are required1. Knowledge about HIV/AIDS is the first step to preventing transmission4, followed by resources and support1. It is also critical that prevention efforts are culturally appropriate, stage-specific, and grounded in behavioural theories to be effective5.
Engagement in sport improves self-esteem, problem-solving and social skills, physical and mental health, and academic performance6, 7, 8, 9. Sport and physical activity can contribute to changing behaviour through transformation of attitudes10. As such, sport can be used to achieve international development goals such as combating HIV/AIDS11. In 2001, sport was formally recognized by the United Nations (UN) as a mechanism to address international development goals to eradicate HIV/AIDS12.
Sport-for-Development (SFD) refers to the use of physical activity (e.g. football, basketball, or netball games, and physical energizers) as a tool to achieve international development goals13. Traditional SFD programs add sport to non-sport curriculum to enhance the effectiveness of knowledge transmission and self-development13, 14, which has been found to be more successful than curriculum-only based programs8. These programs have been shown to be effective in addressing social and health issues such as rebuilding relationships, social inclusion and integration, and HIV/AIDS prevention15, 16, 17, 18, 19.
Literature on the use of SFD for HIV/AIDS education and prevention has largely focused on the effectiveness of SFD strategies in specific contexts11, 13, 20, 21, 22, 23, 24. For example, an SFD program in Tanzania that uses peer learning to transmit knowledge on HIV/AIDS prevention, cognitions, and perceived behaviours was found to be effective25. Additionally, Baird et al. (2007) found that incorporating physical games into a program’s curriculum was effective in promoting safer sex behaviours in Trinidad and Tobago. To date, studies have not explored how and why sports are the vehicle for education in HIV/AIDS programming. Therefore, the purpose of this study was to explore organizers’ perspectives on sporting activities in one HIV/AIDS prevention program in Trinidad and Tobago.
To understand the perspectives of program organizers in a SFD organization in Trinidad and Tobago a qualitative single case study was conducted. Case studies were chosen as the preferred strategy because they delineate the nature of phenomena using a detailed investigation of individual cases and their contexts26. Ethics was obtained from the University of Toronto, and authorization to proceed with the study was granted from the Trinidad and Tobago Alliance for Sport and Physical Education (TTASPE). Permission for TTASPE to be identified in this research paper was provided by decision makers in this organization.
Purposive sampling was used to select an organization to study. Inclusion criteria required that the organization operated out of Trinidad and Tobago, explicitly used sport activities to achieve HIV/AIDS prevention programming, and offered programs for youth. The TTASPE chapter of Kicking AIDS Out! met these criteria and was chosen as the case to be studied. In 2006, TTASPE joined the Kicking AIDS Out! Network22. Kicking AIDS Out! uses SFD concepts to educate youth on HIV/AIDS transmission, discourage stigmatization, and promote healthy lifestyles27. Kicking AIDS Out! also develops and implements programs to train youth leaders, trainers and coaches to build capacity at individual, organizational, and community levels.
Seven organizers, affiliated with Kicking AIDS Out! in Trinidad and Tobago, were recruited through purposive and snowball sampling. Organizers were recruited who satisfied the following inclusion criteria: (1) current program staff member or volunteer; (2) minimum of 18 years of age; and (3) able to speak English. Fluency in English was not a barrier to recruitment as it is the national language of Trinidad and Tobago. All organizers provided informed written consent to participate in this study (see Table 1 for organizer characteristics). In presenting the data below, pseudonyms are used to maintain organizer anonymity.Table 1. Description of Organizers: There were 2 female and 5 male organizers, ages ranging from 19 to 41. Their roles varied across volunteer positions including Peer Leader, Leader Level 1, Leader Level 2, and Management, and staff positions in Management.
|Number of Organizers||Position||Description||Gender||Age|
|2||Peer Leader||Engages program youth in sessions||1 female; 1 male||19; 22 y/o|
|1||Leader Level 1||Organizes sessions for program youth and peer leaders||1 male||30 y/o|
|1||Leader Level 2||Trains leader level ones and performs administrative duties||1 female||22 y/o|
|3||Management||Performs organization level duties||3 males||28 to 41 y/o|
All data were generated through face-to-face semi-structured interviews, approximately one hour in duration, conducted in Trinidad and Tobago by one of the authors. The organizer and the interviewer mutually selected a location for the interview. An interview guide was used for each interview and included questions pertaining to identifying stakeholders and program youth, the program features that drew individuals to the program, individual experiences of the program, and the role of sport in the program. Examples of questions included: What do you like/dislike about the program? Who organizes the program and scheduling? Who attends the program? Who doesn’t attend to the program? What is the balance between sport and HIV/AIDS prevention instruction? All interviews were audio recorded and transcribed verbatim. To provide more depth to the interviews, the interviewer documented field notes on observations on organizers’ behaviours and non-verbal expressions.
Thematic analysis28 was chosen as the strategy for data analysis as it allowed the researchers to extract patterns and interpret the experiences of organizers. To begin the process, the researchers familiarized themselves with the data via transcribing, reading and re-reading, and noting initial theme ideas. A priori codes were developed based on SFD and HIV/AIDS education theory. Once all the data were coded and grouped, each group was assigned a theme name that captured its essence. Similar codes were grouped together with all data relevant to each potential theme. Themes were reviewed and consistency with coded extracts and the entire data set was checked. On-going analysis refined the specifics of each theme, generating clear definitions and names for the themes. The analysis was then finalized, key quotes and passages were selected, and a review was conducted to ensure the analysis related back to the research question and objectives.
To reflexively analyse the data, the researchers immersed themselves in the data by transcribing interview recordings, reading and checking for accuracy of transcripts, reviewing field notes, and documenting their views and opinions. An audit trail tracked the decisions made by the researchers with regards to defining constructs, directing the focus of the study, and developing a rationale for selected codes and themes. Trustworthiness was enhanced through research team analysis meetings for clarification on techniques of analysis and writing reflexive notes.
Four themes were generated that describe how Kicking AIDS Out! uses sporting activities in Trinidad and Tobago. Sport to Draw illustrates how sport was used as a common activity to bring program youth together. There’s Something for Everyone describes how Kicking AIDS Out! collaborates with the program youth and works within the environment to accommodate for program youths’ interests. The Emotional Wow exemplifies how engagement in sport influences program youths’ values and facilitates learning beyond gaining factual knowledge. Finally, Beyond Playing Sports explains that as a result of engaging in Kicking AIDS Out!, program youth feel they have the opportunity to adopt new roles and apply learned skills in other activities.
Organizers expressed that program youth had been exposed to HIV/AIDS education prior to participating in Kicking AIDS Out!, through mediums such as billboards, commercials, and formal education. As a result, they had not initially been interested in learning about HIV/AIDS, because they felt they had heard about it many times before. Monique described the attitudes youth have when initially invited to Kicking AIDS Out! :
The majority of them they will come with the impression that ‘oh gosh another HIV/AIDS…’ they wouldn’t even say HIV they will just say ‘*tsk* Another AIDS talk boy…’ and yeah so they come like ‘Oh gosh wasting my time here already cuz I’m hearing about this all the time.’
With a similar experience, Larissa would not have gotten involved with Kicking AIDS Out! had they only used lectures as an education tool.
If the approach was more of … speaking lectures, I wouldn’t have gone. Honestly I wouldn’t really have been really interested. Most people like certain things to be lively so they can remember the information, they can actually participate. When you’re in a plenary session it’s more of … the lecturer’s speaking and you’re just listening. You’re not really generating much information, flow of ideas. But the ideas, the way in which Kicking AIDS Out! was able to present this information to me and to the other participants, is what really captivates your interest.
Due to Daniel’s familiarity with sport, it was a suitable way to captivate him and his peers in a way that didactic learning would not. To him, the element of ‘fun’ was crucial to the learning experience. The idea of the using sport as a tool to draw participants to the program, with the goal of educating youth about HIV/AIDS, is summarized by Joe:
Well the beautiful thing of sports is that it’s a fantastic entering wedge; it’s used really as a tool. Sport is not the end of everything; it’s the tool that is used to really engage people, to capture them, to captivate them. And that’s one of the powerful things of the Kicking AIDS Out! approach. It uses sport and movement activities to engage people.
Once youth participated in the introductory activities offered by Kicking AIDS Out!, organizers aimed to maintain program youths’ interest in the program to facilitate continued participation in future sessions. Kicking AIDS Out! organizers collaborated with program youth, working within their environmental context to incorporate program youths’ interests. For example, Nicholas explained that certain groups may not be drawn to competitive sports, but would be attracted to physical activities such as movement games and circuits:
Sometimes in certain environments we don’t even use sport, we just use physical activities depending on the environment, the people are not just that into sport… so we take what they’re into.
Similarly, Monique explained that understanding the interests of the group prior to engaging with them could also assist peer leaders in planning effective and engaging sessions:
So if you can know before hand, let’s say you are [leading a Kicking AIDS Out! session for] a netball team, you will want to use more activities that uses skills specific to netball. While if you are going to a basketball team or even a football team you use games that are specific to football or type of sport. And even another thing that you will want to know before too is the age groups because the games that are created, they have specific age groups as well.
Ultimately, session organizers and leaders aimed to ensure program youth were engaged in order to continually captivate them. By maintaining program youth’s interest, organizers could continue to encourage self-reflection on experiences in Kicking AIDS Out! in relation to HIV/AIDS education.
Keep it participant-centred … because information is not going to stay with kids unless they themselves are having fun and are open to it. (Lyndell)
Kicking AIDS Out! organizers understood the value of having well-suited activities. Throughout their training, leaders were provided with Kicking AIDS Out! resources and were also encouraged to draw from their personal experiences and expertise to cater Kicking AIDS Out! sessions to any particular group. The ability to integrate the interests of program youth, the environmental context, and goals of HIV/AIDS education was essential to providing successful sessions.
What [Kicking AIDS Out!] is trying to do is provide the leaders with a pool of resources, and they decide based on the context that they’re in which one might be more appropriate for this situation (Joe).
Engaging in sports and physical games influenced program youths’ values and facilitated learning beyond gaining factual knowledge. Leaders facilitated debriefing sessions after each sporting activity to explore program youths’ experiences. During these reflections, program youth were confronted with their pre-conceived assumptions and unconscious attitudes. For example, when playing a catching and throwing game, a program youth may have subconsciously avoided throwing to the player who was labelled HIV positive. By having leaders point out their actions in relation to others during a game, program youth were able to better understand how they act based on their own values and assumptions, and how it affected others.
People will throw to a specific person in a group and they may not realize it, and then when you debrief the activity and when you let them know what you noticed from the outside then they’ll be like ‘wow’ and you will be able to explore okay, what could be causing this? Why subconsciously you were only passing to this one specific person and not this person? (Monique)
As a result of the debriefing sessions, program youth experienced sporting activities as an opportunity to break down barriers of perceived negative social attitudes and behaviours, enabling them to feel connected to individuals different from themselves. Simon describes the program youth connecting to these experiences when he said:
When people move, that experience connects everything. So it’s not just cognitive activity, it’s the cognitive, physical, and emotional connecting. So when you move in a game and you play, the movements bring a different level of awareness.
Developing a higher level of awareness of the cognitive, physical, and emotional aspects of play allowed program youth to learn about others in an emotional way. Influenced by these experiences, they felt a shift in their beliefs and felt enabled to apply it to future behaviours.
Where [Kicking AIDS Out!] gains its strength, as opposed to other HIV/AIDS initiatives, is that it looks to not just share information with people, but really look at the attitudinal side of things … there’s too much research out there about behaviour change and modification and it doesn’t happen just through information. I know we all know about the dangers of smoking for example in cancer development... and I know countless doctors who smoke. So it’s not just about information, it’s really about how do you affect people in such a way that the message is strong enough to make them want to change their behaviours… (Joe)
As a result of engaging in Kicking AIDS Out! sporting activities, organizers felt that program youth integrated what they learned about social attitudes and behaviours into other areas of their lives. Daniel explained the breadth of this generalization of attitudes:
Honestly after this program I saw a change in my life, you know, how I look at stuff, how I act, how I treat people, how I go about my daily activities and stuff like that.
Changes in attitudes about issues discussed in Kicking AIDS Out! were reported to have affected the way in which program youth engaged in their roles as siblings, children, students, peers, and role models. Monique saw program youth being empowered from sessions and adopting the role of advocate to promote knowledge transfer outside the program between program youth and their social circles. For example,
...At the end of the workshop and even the sessions… they are empowered to go and speak to even their parents and their peers, and let them know ‘well this is what’s happening and I learnt this,’ that’s how the progress goes on at the end of the day…each one reach one…
Through Kicking AIDS Out! program youth learned to disregard myths or preconceived notions about HIV/AIDS. The organizers talked about youth taking on new roles, such as a caregiver for family members with HIV/ AIDS, once they had a better understanding of the disease. For example, Joe described one youth who was able to take on a caregiving role as a result of participating in Kicking AIDS Out!,
A young lady’s grandfather contracted AIDS and she would not touch him because she was afraid she would contract it. And one day when her mother went out, her grandfather was calling for some attention. She would not go because she was so scared she would get ill if she was there. And subsequently she was exposed to the Kicking AIDS Out! program... And that helped her to understand the issues and she said that up to the time her grandfather died she was able to be there for him and help him, so it totally helped change her whole attitude and that’s a very personal experience.
The purpose of this study was to explore organizers’ perspectives of the use of sport activities in a HIV/AIDS prevention program in Trinidad and Tobago. The findings describe a progression in the role sport activities play to promote HIV/AIDS education and prevention. Findings add to current literature within the field of HIV/AIDS education by demonstrating how and why sport activities chosen by Kicking AIDS Out! attract youth, engage youth by matching their skill level, and enable transformations in attitudes and behaviour.
A recent scoping study found that sporting activities are the most widely cited in literature as being explicitly chosen to deliver development programming to youth29. Kicking AIDS Out! program organizers perceived sport as an interactive tool to attract youth to the program as they see sport as fun, enjoyable, and an activity that provides social support for all youth. One participant described sport as ‘the entering wedge’ (Joe) that is used to capture the attention of youth and draw them to the program. Sporting games and activities capture the attention of youth. They are embedded within Trinidad & Tobago’s cultural context and follow a universal language of physical movement.
Engagement in activity is commonly believed to affect health and influence quality of life30. Apparent in the literature is engagement of youth to achieve outcomes such as: raising awareness through education; empowerment; impact on physical and psychological health; and general welfare23. Organizers explained that program youth met program outcomes through behaviour change and transformation in attitudes towards HIV/AIDS awareness and prevention as a result of participating in Kicking AIDS Out!, thereby affecting their health and quality of life.
Keeping environmental resources and youth interests in mind, sport activities need to achieve Kicking AIDS Out! goals. Facilitating learning through challenging values and attitudes and transferring learned skills to other roles is consistent with four key features described by Townsend (1997). The active process of how activity provides potential for personal and social transformation is described through (1) learning, (2) organizing time and place, (3) discovering meaning, and (4) exercising choice and control31. Learning refers to experiential learning and learning through reflection, in which program youth engage during sport activities and during debriefing sessions thereafter. Organization of time and place refers to material, temporal and spatial resources. Though this feature does not relate directly to our findings, organizers described how peer leaders learn to manipulate environmental resources as part of their training. Inherent in the goal for HIV/AIDS prevention, sport activities hold meaning for program youth, and so has the potential to guide social transformation. As Kicking AIDS Out! programs were tailored to program youth’s interests and skill level, program youth felt connected to the physical experience. As they participated in these activities, organizers described that program youth developed self-awareness of their values and behaviours, and how cognitive, physical, and emotional experiences influenced future actions and behaviours. Exercising choice and control gave program youth the opportunity for decision making with regards to choosing to engage in program activities to direct their learning. Organizers described how program youth integrated their learning to influence how they applied their new perspectives to outside the program, such as engaging in healthy lifestyle choices, such as safer sexual encounters, or adopting advocate or caregiving roles for themselves, families or friends affected by HIV/AIDS.
Findings of this study illustrate the potential of sporting activities to captivate youth, engage them in activity that matches their skills and interests, and elicit behaviour change and learning from their experience, that influences the choices they make in HIV/AIDS prevention. These findings offer an opportunity for HIV/AIDS prevention programs to consider their use of sporting activities in a manner that achieves SFD characteristics. To elicit behaviour change by increasing knowledge and transforming attitudes, prevention programs must ensure their methods consider the ages, interests and cultures of the participants, and tailor their programming to participant skill-level. Optimal engagement in SFD programs geared towards HIV/AIDS prevention will ensure the target youth population are receiving the appropriate resources and supports for HIV/AIDS eradication.
The sampling method used in this study aimed to provide an in-depth understanding of the value of sport in Kicking AIDS Out! from differing perspectives across the organization. However, management level organizers assisted in recruiting other research participants, and as such, organizers’ perspectives may have only included those who experience great value in sport activities. The researchers attempted to minimize these effects by posing questions about program youth who may not be benefiting from Kicking AIDS Out!, or if organizers are experiencing any gaps in programming.
Future research could explore the perspectives of program youth including those who do not continue in Kicking AIDS Out! to gain insight into elements that may be lacking from the programs. Understanding program youths’ experiences would inform program organizers of limitations in their programming to develop it further to access more youth.
Existing literature in the SFD field aims to primarily evaluate program impact on HIV/AIDS prevention. However, examining how and why engagement in sport activities achieves these outcomes is yet to be fully understood. The purpose of this study was to explore organizers’ perspectives of the use of sport as an activity in a HIV/AIDS prevention program in Trinidad and Tobago. Findings support the existing use of sport to captive youth, and illustrate the role sport activities play in meeting program objectives. Findings suggest that youth are optimally engaged if their skills and interests are considered when choosing sporting activities. This may lead to experiences that challenge their values and attitudes towards HIV/AIDS. Learning from these experiences may be applied to life outside of the program to encourage healthy lifestyles and meet HIV/AIDS prevention program outcomes. Future research should further explore the perspectives of program youth, including those who do not continue in Kicking AIDS Out!, to gain insight into elements that hinder engagement and transformational learning.