A critical examination of theorising in the study of the behavioural and social aspects of HIV and AIDS in South Africa

Abstract

Despite its widespread influence on the social and health sciences, Psychology is marked by debates surrounding its relevance, usefulness and status as a scientific discipline. While various corrective measures have been proposed, most notably the application of more rigorous methodological and empirical practices, the value of paying closer attention to theorising and the meta-theoretical structure of psychological science are often overlooked.

When theory, research and practice exist in a synergistic relationship, theory can serve various generative functions. However, theorising that occurs in isolation from research and practice, and theory use which is unreflective and uncritical, produces adverse consequences which may ultimately lead to the stagnation of a scientific discipline. The lack of explicit and consistent theory use has been found to be a common problem in the social sciences, including in Social and Health Psychology.

Since the outbreak of HIV in 1981, psychological theories have played an important role in the social and behavioural study of the disease. While great strides have been made in developing a robust and practically useful social and behavioural study of HIV and AIDS, the disease still poses unique and challenging questions to social scientists. Moreover, there is frustration with the limited success of HIV prevention programmes.

Given the insufficient attention to theorising, this study explores the conceptual development of the socio-behavioural study of HIV and the paradigms that have played a role in how social scientists understand HIV and AIDS in South Africa. It was guided by three aims: a.) To describe the historical development of research focus areas in the socio-behavioural study of HIV and AIDS; b.) To identify and describe the use and visibility of theory in the academic literature; c.) To conduct a meta-theoretical analysis of the most prominent paradigms in the literature. Critical Realism was used as the study’s theoretical point of departure.

The study comprised four phases. The first phase entailed the systematic search for peer-reviewed articles that pertained to the social and behavioural study of HIV in South Africa from 1982 to 2020. Phase two involved the thematic analysis of research themes. Phase three entailed the analysis of theory visibility, the extent to which theory testing and building occurred, and the identification of theories and paradigms in the literature. Phase four involved the meta-theoretical analysis of the three most prominent paradigms in the literature: Socio-Behaviourism, Critical Theory and the Socio-Ecological and Systems paradigm.

A total of 3848 relevant papers were identified and thematically analysed to gain a contextual and historical understanding of the trends in research themes over time. Research on HIV prevention was the most common; however, research on living with HIV and testing and treatment started to increase in visibility from the late 2000s.

A total of 1899 papers (49.9%) demonstrated the explicit or implicit use of theory. Theory visibility remained relatively stable over time. Articles about HIV testing and treatment demonstrated particularly low theory visibility. Theory building, and in particular theory testing, were found to be low. Articles which demonstrated the explicit use and direct naming of theories tended to make greater theoretical contributions. The misapplication of theory was evident, including the vague naming, oversimplified use of theories, and the meta-theoretically unreflective use of theoretical concepts.

The study demonstrates the competition of opposing ideas and perspectives in the socio-behavioural study of HIV. The field developed from being primarily a psychological (specifically, Socio-Behavioural) research programme to increasingly becoming more socio-ecological and critical. Critical Theory and the Socio-Ecological and Systems paradigm became more prominent in the literature from the early 2000s, eventually overtaking Socio-Behaviourism by the late 2010s. The meta-theoretical analysis of Socio-Behaviourism, Critical Theory and the Socio-Ecological and Systems paradigm yielded important insights for the study of HIV and social and health psychology in general. Most notably, the analysis revealed important shortcomings in each paradigm and the degenerative consequences of meta-theoretically unreflective theory use.

Several recommendations for research and practice are made, most notably that theories should be referred to explicitly and should be used in a way that corresponds with what they truly propose and in line with the proposed research topic, question and methodology. Researchers and practitioners are encouraged to engage with theories sceptically and expand their knowledge of the theories that might be appropriate to their disciplines.