HIV and AIDS and risk behaviours

Get Complete Project Material File(s) Now! »

Introduction

While HIV and AIDS prevention programmes seem to be reasonably effective for some groups of people in some geographic areas, they are ineffective in other areas, especially amongst certain gender and age groups. In some sectors of society in South Africa such programmes have been unsuccessful in reducing the HIV and AIDS infection rate or prevalence. In South Africa young people and especially young women, remain a high risk group.
In their study Shisana et al. (2014) found that 24.1% of all new infections in the country occurred in young females aged 15 to 24 years. Shisana et al. (2009) also recorded that HIV prevalence is increasing in provinces such as Mpumalanga and Kwazulu Natal whereas it is decreasing in other provinces such as Western Cape. The spread of HIV and AIDS is thus complex and subject to various context-specific factors. Based on this complexity, Taylor (2004) criticised the use of generic HIV and AIDS prevention programmes as different geographical areas, cultural and age groups may have different norms, beliefs and constructions of sexuality which contribute to different behaviour patterns. In an effort to contribute to the development of HIV prevention interventions, the researcher interacted with young people in Venda, in Limpopo province, to understand their constructions of sexuality and the influence of these constructions on their sexual risk behaviour. In this chapter (Chapter 1) an overview is given of the extent of the HIV epidemic in South Africa and of risk behaviours prevalent among young people. The overview is followed by a description of the context of the study, which includes brief background information to introduce the researcher’s reasons and motivation for doing this study. The researcher’s commitment and the aims of the study are explained. The chapter concludes with an outline of the study. Overview of HIV in South Africa

HIV prevalence

HIV infection has developed from a virtually unknown disease into a worldwide pandemic during the past four decades. It was estimated that in 2014 36.9 million people were living with HIV globally. Of the global number of people living with HIV, 25.8 million are from sub-Saharan Africa. Women account for 58% of the total number of people living with HIV globally (UNAIDS, 2015) and 80% of women living with HIV are from the sub-Saharan region (UNAIDS, 2014). Fifteen percent of those living with HIV are between 15 and 24 years old. It was estimated that more than 80% of the children living with HIV globally are from sub-Saharan Africa. In the sub-Saharan region in 2013, South Africa accounted for 25% of people living with HIV followed by Nigeria at 13% and then Kenya at 6% (UNAIDS, 2014).
The high number of people living with HIV in South Africa is partly as a result of the increase in the roll-out of ART which prolong the lives of those living with HIV. According to the Human Sciences Research Council (HSRC) 2012 survey, overall HIV prevalence in South Africa has increased from 10.9% in 2008 to 12.6% in 2012 (Shisana, et al., 2014). In line with the global prevalence, Shisana, et al. (2014) found that females in South Africa have a significantly higher HIV prevalence rate than males (14.4% vs. 9.9%). The higher prevalence among women is already evident in the 15 to 19 year age group. UNAIDS (2013) reported that HIV prevalence among adolescent girls aged 15 to 19 years is unacceptably high. This can be ascribed to factors such as gender inequality, culture and biological vulnerability.
HIV prevalence is increasing in provinces such as Mpumalanga and Kwazulu Natal whereas it is decreasing in other provinces such as Western Cape and Limpopo (Shisana et al., 2014). There was a 2.7% increase in HIV prevalence from 2005 to 2008 among young people in Limpopo (Shisana et al., 2009) followed by a decline in 2012 (Shisana et al., 2014). While HIV prevention interventions were increasingly rolled out and made available to most people in South Africa for the past three decades, it is still uncertain why HIV prevalence among young people, especially females, is not decreasing. One reason may be that prevention interventions implemented are mostly generic in nature and not directed at the specific needs of identified groups. There is an obvious need for research in this regard and for the development of HIV prevention interventions that specifically target factors which influence young people’s sexual behaviour.

New HIV infections

It is estimated that 2.0 million people were newly infected with HIV globally in 2014. Sub- Saharan Africa accounted for at least 66% of new infections in 2014. A large proportion of new infections in sub-Saharan Africa occur among young women and adolescent girls (UNAIDS, 2014). As high as the incidence rate is, new HIV infections are said to have declined between 2000 and 2014. South Africa accounted for the largest decline in new infections with 98 000 fewer new infections in 2010 (UNAIDS, 2014).
Despite the decline in HIV new infections, South Africa still has the highest rate of new infections compared to other countries in sub-Saharan Africa. South Africa accounts for 23% of new infections, followed by Nigeria at 15% and Uganda at 10% (UNAIDS, 2014). The Department of Health (2011) indicated that there were at least 4181 new infections in children aged 0 to 14 in Limpopo in 2009. Incidence among young people aged 15 to 24 was 1.5% in 2012. Shisana et al. (2014) reported that there was a 2.5% of HIV incidence among young females aged 15 to 24 years. This was indicated as a special concern (Shisana et al., 2014). As indicated above, HIV prevalence and infections differ across geographic areas, contexts, gender and age groups. Some groups, especially young women, are more vulnerable to HIV infection than others. The differences in context and vulnerability curtail the effectiveness of generic HIV prevention interventions. It is therefore important to consider contextual factors and culture in the development of HIV prevention interventions.

Contents :

• Declaration
• Ethics Statement
• Abstract
• Key Terms
• Dedication
• Acknowledgement
• List of Figures
• List of Tables
• List of Acronyms and Abbreviations
• Glossary
• Chapter 1 Background
  • 1.1 Introduction
  • 1.2 Overview of HIV in South Africa
    • 1.2.1 HIV prevalence
    • 1.2.2 New HIV infections
    • 1.2.3 Motivation of focusing on constructions of sexuality and Venda
  • 1.3 Context of the study
    • 1.3.1 Venda
    • 1.3.2 Motivation of the study
    • 1.3.3 Suitability of social construction theory for this research
  • 1.4 Aims of the study
  • 1.5 Outline of the study
    • 1.5.1 Research Methodology
  • 1.5.2 Overview of the Chapters
• Chapter 2 Literature review
  • 2.1 Introduction
  • 2.2 HIV and AIDS and risk behaviours
    • 2.2.1 Multiple Concurrent Partnerships (MCP)
    • 2.2.2 Intergenerational relationships
    • 2.2.3 Early Sexual Debut
  • 2.3 Behaviour change theories
    • 2.3.1 Health Belief Model
    • 2.3.2 Theory of planned behaviour (TPB)
    • 2.3.3 Social ecological model
    • 2.3.4 The PEN-3 Model
    • 2.3.5 Conclusion
  • 2.4 HIV and AIDS Prevention Interventions
    • 2.4.1 HIV and AIDS Biomedical Prevention Interventions
    • 2.4.2 Current Behavioural Prevention Interventions
    • 2.4.3 Behavioural prevention interventions for young people
    • 2.4.4 HIV and AIDS Structural Prevention Intervention
    • 2.4.5 Conclusion

• Chapter 3 Culture and sexuality
  • 3.1 Introduction
  • 3.2 Culture
    • 3.2.1 Musevhetho
    • 3.2.2 Vhusha/Vhukomba
    • 3.2.3 Murundu/Mula
    • 3.2.4 Tshikanda
    • 3.2.5 Domba
  • 3.3 Gender, risk behaviour and HIV prevention
    • 3.3.1 Gender
    • 3.3.2 Hegemonic Masculinity
    • 3.3.3 Femininity
  • 3.4 Summary and conclusion
• Chapter 4 Research Methodology
  • 4.1 Introduction
  • 4.2 Theoretical framework
    • 4.2.1 Postmodernism
    • 4.2.2 Social Constructionism
  • 4.3 Research Methodology
    • 4.3.1 Qualitative research methodology
    • 4.3.2 Participants and sampling
    • 4.3.3 Data collection
  • 4.3.4 Method of Analysis
  • 4.3.5 The process of discourse analysis
  • 4.3.6 Conclusion
• Chapter 5 Analysis and Discussion
  • 5.1 Introduction
  • 5.2 Constructions of sexuality
    • 5.2.1 The male sexual drive discourse
    • 5.2.2 Discourse of sex as a Commodity
    • 5.2.3 Discourse of traditional hegemonic masculinity
  • 5.3 Community Leaders’ Discourses
  • 5.3.1 Constructions of young people’s sexuality
  • 5.4 Young people’s discourses about HIV and AIDS
    • 5.4.1 Normalisation of HIV: AIDS is like flu
    • 5.4.2 Discourse of invulnerability
    • 5.4.3 Discourse of male circumcision protecting one from STIs
  • 5.5 Community leaders’ discourse about HIV and AIDS
    • 5.5.1 Traditional ethno-medical discourses
    • 5.5.2 Disease caused by cultural erosion
  • 5.6 HIV and AIDS messages aimed at young people
    • 5.6.1 Advertisements too complicated and not interesting
    • 5.6.2 Not available in vernacular
    • 5.6.3 No formal school HIV intervention
  • 5.7 Cultural strategies that were used in the past to reduce STI’s and pregnancy
    • 5.7.1 Virginity Testing
    • 5.7.2 Mixing of blood
    • 5.7.3 Tying to prevent pregnancy (U vhofha)
    • 5.7.4 Summary
• Chapter 6 Conclusion and Recommendations
  • 6.1 Introduction
  • 6.2 Evaluation of the study
    • 6.2.1 Reflexivity
    • 6.2.2 Credibility of the study
    • 6.2.3 Limitations of the study
    • 6.2.4 Implications of the study
  • 6.3 Recommendations
    • 6.3.1 The male sexual drive discourse
    • 6.3.2 Abstinence
    • 6.3.3 Safer sex Programme
    • 6.3.4 HIV prevention targeting pregnancy
    • 6.3.5 Constructions of sexuality
    • 6.3.6 Governmental Financial support
    • 6.3.7 Participative HIV prevention interventions
    • 6.3.8 Traditional Male Circumcision
    • 6.3.9 Combination Interventions
    • 6.3.10 HIV prevention messages
    • 6.3.11 Change in parents’ authority
    • 6.3.12 Parental skill programme
    • 6.3.13 Alternative to parental sex education
    • 6.3.14 Parent-child Programme
    • 6.3.15 Process for development of prevention interventions for young people of Venda
    • 6.4 Conclusion
  • References
  • Appendix 1 Definition of key terms
  • Appendix 2 Permission
  • Appendix 3 Informed consent form for adult participants
  • Appendix 4 Informed consent form for parents of juvenile participants
  • Appendix 5 Assent form for learners

GET THE COMPLETE PROJECT