CHAPTER 4: RESULTS
4.4. Risk reducing behaviours adopted by population under study
4.4.2 HIV testing
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62 I: Ja.
63 P: Because mos I met her when she was at that age and she was also just continuing 64 with her own life.
65 I: Ja.
66 P: So when I used to talk about that ,it became as if I don’t trust her, like I suspect her 67 that she has something.
… 76 I: Ja ok, I hear you. So you were the one that raised the topic that we must use a 77 condom?
78 P: Yes, to such an extent that it became the main reason for our arguments.
79 I: mm mm
80 P: It became like I was suspicious of her or maybe she is doing inappropriate things.
Another strategy that couples used to minimise the risk of HIV was going for HIV testing and disclosure of prior HIV status. For some participants, HIV testing was an alternative to the use of condoms in managing sexual risk.
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Another extract of this view is from an interview of an unmarried man aged between 26-34 years. The participant agrees that they talk about the sex risk in their relationship and says he mentioned HIV testing to his partner as an alternative to the use of condoms. However, he emphasises that if sex happens outside the relationship, then they must use “gloves” (line 200), meaning condoms.
Extract 81
198 I: Mm ok...ok so when you [and your girlfriend] talk about [sex-related] risks, who 199 is the person that usually initiates the discussion, when you talk about risks?
200 P: ... <You mean like when people do not use “gloves” [condoms]>?
201 I: Yes.
202 P: Hmm well yes uh >I have sometimes mentioned it myself< in fact I asked her “Ok 203 we can use these ‘plastics’ [condoms] but perhaps if we were to get tested together, we could 204 then stop using them. You can then stop using them, but only if you know that you will not be 205 doing anything elsewhere or if you do as long as you use ‘gloves’. I might not be here and 206 you may want to do something with someone else, just make sure you use ‘gloves’” She went 207 there but she did not tell me that she was going; she only showed me the results after she had 208 been there. She was not actually the first one to show me that, I had also seen it with the first 209 one that I had been with at the time that she was pregnant. I guess she had been tested there 210[at the clinic] and –
Many of the participants seemed to have started to substitute condom use with HIV testing.
They go for testing to avoid the use of condoms. An example of this is presented in the extract below from an interview of an unmarried man aged between 26-34 years; he indicated that he and his partner went to be tested because they were tired of using condoms. This extract also shows that people prefer injectable contraceptives to prevent pregnancy (lines 190-191).
Extract 82
189 P:…After four months (.) I suggested that we
190 go get tested together because I was tired of using a condom. She will continue to go 191 for her injection [unclear].
192 I: Oh okay, okay. So you did not want to use a condom anymore?
193 P: Yes, I did not want to use a condom.
The following extract, from a focus group of young women aged between 18-24 years also indicated that people go for testing to avoid condom use. They claim that condom use is “not nice” (line 1261); therefore, it is better to get tested and not use condoms.
Extract 83
1254 I: Ok what makes you, let’s [say] here you are, you are having sex now and you say that it is 1255 chafing you. What do you think you could do that is better than telling him to stop using the 1256 condom?
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1257 P1: You must go and test you see. That thing is right when you are like, you are going to stop 1258 using the condom but you are going to go and test first because isn’t they say you must test how 1259 many times again?
1260 P2: Three.
1261 P1: mm Because a condom is really not nice so rather you go and test then. So that you 1262 cannot condomise then.
Not knowing one’s partner’s status meant that you cannot be sure if your partner is negative. In the following extract from an interview of a young man aged between 18-25 years, he reveals that he has tested but he uses condoms “all the time” (line 77) because they have not been to
“get tested together”(lines 77-78). He reported that he was aware of his own status but does not know his partner’s status. This suggests that the participant would continue to use condoms until they both tested.
Extract 84
74 I: Ok, ok, ok so (.3) ok do you use condoms when you, when you have sex?
75 P: Yes we use them.
76 I: O:k, ok how often perhaps, all the time when you sleep together or some of the time?
77 P: (.2) Ya let me say hayi all the time we use it, just because we have not yet gone to get 78 tested together
79 I: You have not yet gone to get tested?
80 P: No (.2) I go alone, you see.
81 I: And does she go?
82 P: On that part, I do not know, which is why I say I cannot be sure and so that’s why I use a 83 condom.
Disclosure of prior HIV test results decreased condom use. Participants who knew their own and their partner’s HIV status were reluctant to use condoms. They used this knowledge as a justification for not using condoms. In the following extract from an interview of an unmarried man aged between 35-45 years, the participant showed his girlfriend the HIV test results which indicated that he was negative and then asked the girlfriend about her HIV results which she indicated were negative. He then decided not to use condoms (lines 36-37).
Extract 85
30 I: Ok=o=ok eh [pauses] so now as people who have decided to get into this relationship,
31 did you perhaps discuss the options that are available in a relationship regarding sexual intercourse?
32 P: mm uh... The first time that she came to my house, I tried to come to an understanding 33 with her about that and I requested that we use a condom before we ‘see’ each other, you know 34 that I had recently had some blood drawn [tested], uh at the end of January and I found that 35 everything was fine, so we continued, you understand, and she did not have problem with that so I 36 then asked whether she had been to get her blood drawn and I showed her my results which 37 indicated that I was fine, you understand. She then said that her results were at her home and I did 38 not ask her to produce them. So I then decided that I did not need a condom and we had sexual 39 intercourse without a condom.
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Another illustration of this was found in the extract below from an interview of an unmarried man aged between 26-34 years. The participant says his girlfriend got tested for HIV when pregnant and showed him the results (lines 200-201). He was then motivated to go and test for HIV himself and found that he was HIV negative so decided to stop using condoms with her (line 202) but use them outside the relationship (line 203).
Extract 86
200 P: Yes when she was pregnant, when she came back from the clinic, she showed me the
201 results and so this one [his current girlfriend] showed me her results as well, so I also decided to go. I 202 found that I was negative but I was told to return after a certain time. I figured that I could stop 203 using protection and that we could just do it but when I am with someone else. I use protection. It 204 happens occasionally when I go out or I meet someone else, somewhere else but I use protection. Like 205 I said to her, if something like that were to happen with her, she ought to use protection. I will 206 not really know what happens but the choice is hers. Just like I know that with other women, I will use 207 protection, she must also know that with other men, she must use protection.
However, many women reported having gone for HIV testing due to pregnancy, rather than because they were initiating finding out about their HIV status. This is found in the following extract from an interview of an unmarried woman aged between 18-25 years.
Extract 87
396 P: Me... I got tested now when there was the possibility that I was pregnant... °I was 397 pregnant you see.°
Another example is found in the extract below, from an interview of an unmarried woman aged between 35-45 years.
Extract 88
427 I: What made you to get tested?
428 P: The reason why I got tested is because I got pregnant with my child in 2006.
Some women explained that their male partners depended on them finding out their status and then inferred their own HIV status from them. An example comes from the following extract taken from an unmarried woman in the age range 26-34 years. Knowing their partner’s status was an excuse not to go for testing.
Extract 89
314 I say he must go and get tested and he says if he did have it then I would also have it 315 seeing as I got tested when I was pregnant. He then says that means he does not have it.
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As already stated, the above thematic analysis was a preliminary step to provide a picture of the issues surrounding sexual activity in the research area. The next section presents the analysis of the data using Engeström’s (1987) model of human activity. The main aim of this study was to analyse the data using Engeström’s (1987) model of human activity to understand and explain the lack of sexual behaviour change in response to HIV and AIDS. This model allows for a deeper understanding of the complexity of sexual activity.