Sexual-Health Communication across and within Cultures: The Clown Project, Guatemala

"The planned interplay between the grassroots and the scientific community in HIV/AIDS and sexual-health communication, to use the example around which the experience of the Clown Project in Guatemala has been constructed, has ensured an apt 'translation' of scientific knowledge into community language and created lasting avenues for the scientific community to inform and be informed by the grassroots."

Published in Development in Practice (Volume 19, Issue 4-5), this paper examines the experience of the Clown Project, which uses face-to-face street theatre and dialogue, participatory workshops, and symbolic communication such as print-based materials to reach those most vulnerable to the spread and impact of HIV and AIDS in Guatemala and elsewhere in Latin America. In the context of this initiative, after examining issues in cross-cultural communication and decoding, as well as a brief consideration of debates on cultural appropriateness, the paper shares lessons learned in selected communities in Guatemala and other countries in Central America. The authors put forward an argument in favour of careful and critical analysis of culture in formulating communication strategies with and for specific groups. This analysis takes into account relations of power within and between vulnerable groups, examining the "centre-periphery dynamic" between classes, genders, ethnicities, age groups, and other social identities. Both "appropriately supported insider perspectives and appropriately processed outsider knowledge" are recommended, along with ways of bridging science and the field, theory, and practice.

As detailed here, the Clown Project is implemented by the Asociacio´n Payasos Atz'anem K'oj, a Guatemalan community-based organisation. It has been active since 2001, principally in the Guatemalan highlands, but also in Mayan indigenous communities in Chiapas (Mexico), in Afro-Caribbean communities along the Atlantic coast in Guatemala and Honduras, and in rural and urban marginal areas. The project fields teams of educators who stage theatre-based educational interventions in communities that meet specific vulnerability criteria to both the spread and the impact of HIV and AIDS. The street-theatre strategy includes mass distribution of educational materials for low-literacy groups and the implementation of peer-led participatory workshops on HIV and AIDS for specific groups, such as adolescents, prison inmates, soldiers, sex workers, religious and secular leaders, and migrant workers. Since 2001, the Clowns have worked in over 750 communities in Guatemala and neighbouring countries, reaching an estimated 470,000 beneficiaries, and distributing hundreds of thousands of condoms and print-based materials.

The next section of the paper ("Communities with diverging interests and mutually unintelligible codes") explores from a theoretical perspective communication challenges associated with interplays between the scientific community and the grassroots (equated here with the economically poor). The authors make a distinction here between (i) "organic communication", which parallels traditional ways of learning (through lengthier processes of repetition, example, mentoring) and communication (storytelling, oral tradition, music and dance, ritual) in economically poor communities; and (ii) "symbolic communication", which is "abstract, condensed, aimed at helping people draw broad conclusions from theoretical specifics. The written word, the picture, or photograph...can be...highly practical tool[s] for communicating essential ideas across cultures, provided explicit care is taken with spelling out matters in a way that assumes a very low level of common ground and shared experience between the communicator and her or his audience."

According to the authors: "Both forms of communication have been shown to work well in situations where spelling everything out is not necessary; that is, where there is some cultural homogeneity between the actors....Having seen one of the Clowns' street-theatre shows, a young woman asks herself whether what she is being told about virginity, 'first times', and exposure to unwanted pregnancy and sexually transmitted diseases (STDs) is in fact true. She poses an Anonymous Question during a question-and-answer session with the Clowns after the show. The answer comes clearly, and a short explanation is given, debunking various myths and confidently, caringly, and convincingly delivering accurate information kept deliberately free of moral baggage and judgment. Perhaps it is a small-group situation where the youth peer educator is able to make eye contact and otherwise engage with the young woman and her colleagues. A conversation ensues between the young woman and her friends, whereby the information is processed and at least partly assimilated. The distribution of print-based materials further reinforces scientifically accurate information. As a result, the young woman is able - although perhaps not yet entirely empowered - to more articulately and convincingly negotiate condom use with her partner."

Next, the authors outline several practical barriers to "linking the listening skills of the powerful with the communication skills of the poor". For example, "Communication is often perceived as an imposition from the outside - particularly when it's bad news and that those delivering it are not seen as insiders....Behaviour change and the delivery of messages are perceived as just two more forms of oppression."

A number of lessons learned are shared from the Clown Project experience. These lessons are organised around topics such as: the fact that peers speak to peers; the importance of systematically presenting abstracts and lessons learned at national and international gatherings where experience is described in narrative and collective analysis; the value of beneficiary-group representatives attending learning exchange events with prior training, specific learning objectives, mentoring during the event, and after-the-fact debrief and discussion; South–South exchanges that bring professionals from other contexts into contact with the Clown programme; hosting study periods for young researchers to experience life at the grassroots; and including essential messages derived from new scientific evidence into clowning sketches and street theatre, storytelling, and song. Another message: "If cultures are to change in a negotiated way at the grassroots, they will more likely do so in the interests of those actively empowered and engaging in the dialogue, within couples, families, workplaces, and communities. Building women's capacity - and that of other subordinate groups - therefore ultimately works to strengthen the culture's ability to respond appropriately and humanely to the pandemic."