The labyrinth of HIV and AIDS education and teaching
3.2 The HIV and AIDS pandemic
In this section, I outline the historical background of the HIV and AIDS pandemic and delineate its magnitude globally as well as in the South African context. Additionally, I draw attention to the HIV and AIDS epidemic in the province of KwaZulu-Natal where this research study was conducted.
3.2.1 A global perspective of the HIV and AIDS pandemic
The HIV and AIDS pandemic is certainly one of the most challenging and overwhelming of our time (Bullers, 2001; Otaala, 2003; Sidibe΄, 2010; Stuart, 2006). For Lamptey, Wigley, Carr and Collymore (2002, p. 3), HIV and AIDS is the “most devastating epidemic in human history” since “the disease continues to ravage families, communities and countries throughout the world”. The first incidence of the disease, now known as Acquired Immune Deficiency Syndrome (AIDS), was reported in 1981 in homosexual men by the United States Centres for Disease Control. However, the human immunodeficiency virus (HIV) which attacks the immune system and causes AIDS was only discovered two years later, in 1983, the same year in which incidence of AIDS was reported in central Africa. Globally, Bullers (2001) contends, AIDS is dreaded since no cure is forthcoming almost three decades later despite advances in medicine. Global HIV and AIDS statistics in 2008 estimate: 33, 4 million people are living with AIDS; 2,7 million new infections per year of which 430 000 are children and 910 000 are young adults; 2 million AIDS-related deaths per year; 40% know their HIV status; 10 million are waiting for treatment and 5 million are on treatment(UNAIDS, 2009; UNAIDS, 2010).
Global predictions of the HIV and AIDS pandemic have been far exceeded; with a corresponding impact on worldwide populations and social and economic development (Kelly, 2000; Lamptey et al., 2002; Piot et al., 2001; Shaeffer, 1994). Less developed countries, such as Botswana, Swaziland, Ethiopia and Kenya, and women and young adults
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in particular, are most severely affected. While Africa has borne the brunt of the global HIV and AIDS pandemic; the Caribbean, Eastern Europe, former Soviet Republic, Haiti, China, India, Nepal and Cambodia are also facing severe epidemics. In North America, western and eastern Europe and China, HIV transmission ranges from predominantly injecting drug users, to men having sex with men and sexually transmitted diseases. However, epidemic drivers shift to heterosexual sex, unsafe or unprotected sexual practices, sexually transmitted diseases, prostitution, to multiple sexual partners and work migration in sub-Saharan Africa, India, Latin America and the Caribbean (Lamptey et al., 2002; Piot et al., 2001).The global impact of HIV and AIDS, Piot et al. (2001, p. 971) contend, is magnified given that it affects mainly young adults: “HIV infection is highest in young women and men in their most productive years, including those in the best-educated and skilled sectors of populations”. By this they mean that AIDS-related illness or absence, funeral attendance and deaths severely influence productivity in the workforce, which erodes social and economic capital. Kelly (2000, p. 5) puts it this way: “It is carrying off the most productive members of society, those in the 15-49 age range. It is disrupting social systems, exacerbating poverty, reducing productivity, wiping out hard-won human capacity, and reversing developmental gains”.
Young adults are more susceptible and vulnerable to HIV infection given the greater probability of them engaging in risky behaviour, such as unsafe or unprotected sex, having multiple partners, consuming alcohol and using drugs.
As one of the leading causes of deaths worldwide, HIV and AIDS has devastating consequences: increases in child mortality rate and number of children living with AIDS, AIDS orphans and child-headed households; an explosive Tuberculosis epidemic and increased incidence of sexually transmitted diseases; decreased life expectancy; negative impact on social and economic growth and loss of the skilled, experienced, and most productive workers. It has been argued that the global HIV and AIDS pandemic show no signs of abating (Kelly, 2000; Lamptey et al., 2002; Piot et al., 2001; Shaeffer, 1994).
Despite recent statistics indicating a slight decline in numbers of newly infected individuals (UNAIDS, 2009), the HIV and AIDS situation is still alarming. The following section draws attention to the HIV and AIDS epidemic in South Africa.
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3.2.2 HIV and AIDS: A South African perspective
While every nation has in some way been affected by this pandemic, it is in Africa that the grip of HIV and AIDS has been, by far, the deadliest.
(Visser, 2004, p. 11)
Sub-Saharan Africa is the region most severely affected by HIV with the highest incidence of HIV worldwide: In 2008, the region accounted for 72 % of AIDS-related deaths; 67% or 22, 4 million people of the global population living with HIV and 14 million AIDS orphans (UNAIDS, 2009). Globally, South Africa has the largest population of people living with HIV, estimated at 5,7 million people, which translates into 18,1% of adults (15 years and older) being HIV-positive. South African statistics also indicate that in 2008 there were 1500 new infections per day and 1 million on treatment (UNAIDS, 2009). This signals the overwhelming HIV and AIDS epidemic in South Africa:
The epidemic’s scale and intensity is startling. It is estimated that at least 350 000 adultsand around 59 000 children were infected with HIV in 2009.
Nearly 1000 South Africans die every day of AIDS-related diseases.
(UNAIDS, 2010, p. 77)
In South Africa, trends in HIV prevalence are frequently estimated based on tests of women who attend state antenatal HIV clinics. Estimates of a South African Department of Health study in 2010, based on a sample of 32 225 women attending 1 424 antenatal clinics across the nine provinces in South Africa, indicate that 30,2% of pregnant women between the ages of 15 and 49 were HIV-positive. In 2010, the highest HIV prevalence across the nine provinces in South Africa was evident in KwaZulu-Natal (39,5%), followed by Mpumalanga (35,1%), Free State (30,6%) and Gauteng (30,4%). The Northern Cape (18,4%) and Western Cape (18,5%) were the provinces with the lowest HIV prevalence (Actuarial Society of South Africa, 2011). However, estimates of HIV prevalence from women’s antenatal clinic attendance cannot accurately estimate HIV prevalence in men, babies and children due to variations by age and sex in HIV infection rates in different groups. Therefore, the Human Sciences Research Council (HSRC) conducted the South African National HIV ‘household’
survey, based on a representative sample of geographical, social and racial groups. In 2008, estimates of the ‘household’ survey indicated: 10,9% of the South African population over 2
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years old were living with HIV; HIV prevalence in children aged 2-14 years was 2,5% and the highest HIV prevalence was in females aged 25-29 years and males aged 30-34 years.
The HIV prevalence per province corresponded with estimates from the Department of Health antenatal clinics (Actuarial Society of South Africa, 2008).
Of the nine provinces in South Africa, the HIV epidemic is most severe in KwaZulu-Natal. In 2008, HIV statistics for KwaZulu-Natal indicated: 1,6 million people (16%) living with HIV;
134 000 new HIV infections per year; 115 000 AIDS-death per year; 297 000 people in need of antiretroviral treatment and 127 000 people accessing antiretroviral treatment. Added to this, almost one third (28%) of the adult population in KwaZulu-Natal are probably HIV- positive, with 366 new infections per day and 316 new deaths per day (Actuarial Society of South Africa, 2008). Such disturbing statistics puts the HIV and AIDS epidemic in KwaZulu- Natal under scrutiny: the largest number of HIV-positive people, the largest number of people in need of antiretroviral treatment, but not accessing it, and the largest number of AIDS- related deaths. A promising note, nevertheless, is that a mature phase of the epidemic has, indeed, been reached, as new infections even out. As such, this outline of statistics is significant since this is the province in which this study was conducted.
These alarming statistics drive home the gravity and reality of the situation.South Africa is experiencing an extremely dismal HIV and AIDS epidemic, affecting young women more than men, with increasing numbers of AIDS orphans and child-headed households. What are the drivers of the HIV and AIDS epidemic and why is HIV prevalence so high in South Africa?
In Africa, the HIV and AIDS epidemic is driven by lack of knowledge of the disease, inadequate access to prevention, insufficient treatment and care facilities and stigma and discrimination (Lamptey et al., 2002). Across sub-Saharan Africa, the HIV and AIDS epidemic has shifted from high risk populations and urban areas to a generalised epidemic and rural areas; with the main drivers being heterosexual sex, mother-to-child transmission, inequality, poverty, and labour migration (Piot et al., 2001). In the same vein, Gibbs (2009) highlights the drivers of the South African epidemic: labour migration, gender inequality and multiple concurrent sexual partners and HIV-related stigma. Gender inequality and violence place women and young females at greater risk (Gachuhi, 1999; Gibbs, 2009; Visser, 2004);
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whose risk is also intensified from a physiological or biological perspective (Lamptey et al., 2002; Visser, 2004). The HIV and AIDS epidemic, therefore, is exacerbated since it not only affects young adults, women and the poor, but also essentially educated, trained and skilled workers, like teachers, miners, truck drivers and agricultural workers.
The HIV and AIDS epidemic and AIDS deaths severely affect the health, economic and educational sectors as well as families and communities, with far-reaching economic, social, educational and psychological impacts (Kelly, 2000; Lamptey et al., 2002; Visser, 2004).
Consequently, the corpus of research on HIV and AIDS from an epidemiological, biomedical and education perspective has increased phenomenally. In the following section, I briefly outline the landscape and epistemological trends in two areas of research, namely, teaching and teachers and HIV and AIDS education, which is significant in relation to the purpose of this study.