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using them. For example, negative attitudes towards condom use, not taking into account personalrisk, using alcohol or drugs, low self-confidence and reliance on other contraceptive methods, have been the most common reasons put forward for not using condoms (Kalichman, 2000). Despite wanting sex research has indicated that many men are shy about putting condoms on in front of a sexual partner. It is likely that this is because of communication barriers in society about issues relating to sex and HIV infection. Another reason given for non condom use is that as it has been much publicized that condoms do not provide absolute protection high-risk groups for HIV infection explain their non-compliance in condom use by stating I will get sick anyway (Nel, 2003).
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Condoms are used less often with cohabiting or regular partner. In these relationships, on the African continent, females are generally unable to negotiate condom use. Other common reasons given for non-condom use are reduced sensitivity, an association with unfaithfulness, unavailability of condoms, a general dislike of condom use, objections by male partners and stigma attached to condom usage. The findings of various research studies have highlighted and given researchers and policy makers insight into factors that affect the initial and consistent use of condoms, and what some of the perceived and experienced barriers to condom use are.
In the South African context tertiary students are likely to be at risk of contracting sexually transmitted diseases because of their patterns of sexual behaviour. These include sex with multiple partners and inconsistent use of condoms. An increased awareness of condom use among peers is associated with higher levels of condom use (Mashego, 2004). A review of studies at the University of Zululand campus undertaken by Nel, Tebele and Mpungose (2008) noted the following, which because of homogeneity of respondents age and education, can likely be extrapolated to tertiary students generally in South Africa. The study had certain hypotheses which the results supported. It was asserted that women students would be more conservative in sexual behaviour than male students and that female would be more accepting and empathetic towards People living with HIV/AIDS (PLWHA). The study also predicted that there would be a segment of the student population who would reveal a dissonance between attitudes, knowledge and behaviours and also that a proportion of students of both sexes would reveal significant gaps in their knowledge about how HIV/AIDS is
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transmitted. It was also postulated that condom use would be inconsistent this hypothesis was supported nearly seventy percent of the respondents reported multiple sexual partners and inconsistent condom use.
2. 22 HIV/Aids Interventions
Since the early 1980s, most countries have attempted to prevent the spread of HIV, but some have been much more successful than others. Apart from sexual abstinence or a stable mutually faithful relationship with an uninfected partner, condom use is considered the best way to protect individuals from sexually transmitted diseases, including HIV/Aids (Mashego, 2004 & Baumeister, Catanese & Vohn, 2001). Early in the course of the Aids epidemic, condoms were recognized, and are still regarded as the most effective means of preventing or reducing HIV infection, if they remain intact, and are consistently and properly used (Kahn, 2004). It must be also stated that the degree to which condom use can assist in reducing the probability of transmission also depends on the quality of the condom as well as correct usage. However, increasing condom use seems to be difficult in thee South African context as the following discussion illustrates.
As the focus of the pandemic has swung from people dying from Aids to people living with HIV infection, a primary focus of therapeutic interventions has been to enhance quality of life. Probably the most immediate challenge of working with individuals who have HIV or Aids is the preservation and enhancement of their physical health through a
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multidisciplinary team approach. Counselling interventions include helping clients prior to diagnosis to assess their risk status and behaviours through a lifestyle review. This helps individuals in clarifying what HIV testing is about, its advantages and limitations, and to assist individuals in dealing with an HIV positive diagnosis. This counselling also helps individuals to comprehend the challenges of the life-threatening disease giving them the opportunity to ventilate feelings of fear, denial, guilt and despair (Ross &
Deverell, 2004; Lindell & Perry, 2004).
Counsellors may also have to intervene with family, partners and significant others in order to mediate conflict and provide information and emotional support with regard to such aspects as anticipatory mourning and other emotional issues. It may also be necessary to implement culturally sensitive community education programmes.
Kalichman and Simbayi (2003) state that the issue of HIV/Aids prevention in South Africa has attracted less controversy and debate than other aspects of the country’s response to Aids. There have been some notable national efforts, such as, The Soul City Project, which was started in 1994 and educated people about Aids through radio, print, and television, using dramas and soap operas to promote the message. Another campaign, Beyond Awareness, which ran between 1998 and 2000 concentrated on informing young people about Aids through the media. A later programme known as the Khomanani (caring together) run by the Aids Communication Team (ACT), a group set up by the government in 2001, has also had much success. The Love Life campaign is the most prominent HIV prevention campaign to be carried out in South Africa, which
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specifically targets young people and attempts to integrate HIV prevention messages into their culture. It was launched in 1999, with the aim of reducing rates of teenage pregnancy, HIV and sexually transmitted infections amongst young South Africans.
Efforts to prevent the spread of HIV in Zimbabwe have been spearheaded by the Non Governmental Organizations (NGO`s) and religious and academic organizations.
Although HIV prevalence has fallen in some areas, indicating a change in sexual behaviour, it is difficult to say how significant the role of prevention programmes has been in achieving this trend. Prevention schemes have been significantly expanded since the turn of the millennium, but remain critically under-funded. There has also been conflict between the messages promoted by different programmes; for instance, some religious or traditional campaigns discourage the use of condoms and place emphasis on abstinence, contrasting with the strategies of some other organizations. This has led to confusion about how it is best to prevent HIV infection, particularly amongst young people (UNAIDS, 2006).
Children in Zimbabwe are currently taught about HIV and Aids in schools from the age of eight. To ensure knowledge transfer the Government has recently suggested that students take an exam on the subject as part of the school curricula. Outside of school, efforts to educate and inform people about HIV and Aids (which are often organized by NGO`s) have used a number of different means to convey prevention messages,
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including television and radio, drama, and community groups. A greater understanding and awareness of HIV and Aids is thought to lead to changes in sexual behaviour, which has been shown to reduce the number of new HIV infections. A study carried out in 2006 suggested that the adoption of safer sexual behaviours was one of the reasons why HIV prevalence in Zimbabwe has declined.Although these campaigns have probably saved many lives, the actual difference they have made in reducing the number of new HIV infections is very difficult to measure. The prevailing high rates of HIV found across South Africa suggest that either the message isn’t getting through to many people, or that people are receiving information but not acting upon it (UNAIDS, 2006).
There are a number of different types of HIV prevention programme currently taking place in Botswana. These include, public education and awareness which is based on imparting factual knowledge about Aids and has the following slogan: Abstain, Be faithful and, if you have sex, Condomize. Botswana has safe-sex billboards and posters everywhere, but it is unclear whether anyone pays attention. Education for young people is crucial so that HIV education and prevention messages help stem the increasing prevalence rates. School-based learning plays one of the most important parts in educating young people about HIV and Aids. Botswana has produced specific HIV and Aids materials which have been developed for all ages of learners in conjunction with the Botswana Ministry of Education (WHO, 2007).