Aggleton, Yankah and Crewe (2011) examined the progress made by education in tackling the epidemic from the date since AIDS was first identified over 30 years ago. They examined the consequences and effects of different forms of HIV-related education such as treatment
14 Programme for Appropriate Technology in Health/Family Health International
36 education, prevention education, and education for positive response. They specifically looked at how education could be used to help people develop new ways of seeing, understanding, and coping with the epidemic. They also assessed the impact of education processes and systems in encouraging people to ‘think’ faster than the epidemic. But for the purposes of this study, only findings related to education for prevention were considered. However, in some cases terms such as ‘providing knowledge and understanding’, ‘spreading news of innovation and success’ and ‘facilitating the development of a more supportive environment for HIV prevention and care’ were used to refer to education.
At the time of their study, Aggleton et al. (2011: 497) divulged that “education for HIV
prevention” had been the basis of the international response to HIV and AIDS for well over 20 years. Their findings indicated that the expected increases in HIV infection rates among gay and other homosexually active men, including injection drug users in European contexts for example, were reversed through education. Aggleton and colleagues also identified some studies (for example, UNAIDS, 2009) that reported a 20–30 percent decline of the HIV infection rate in sub-Saharan Africa countries as a result of educational interventions (even though they were not specific as to whether it was in certain or in all countries in the sub- Sahara).
In terms of reducing HIV risk, Aggleton et al. (2011: 497) show that education seemed to have had an important role to play in providing people with information that led to developing knowledge on how to prevent infection, shifting attitudes toward risk reduction and risk behavior change. They give examples extracted from the discoveries made by UNAIDS (2009), which expose that through education, condom use is now widespread in African countries and among gay men throughout the entire world. Injection drug users were persuaded to use clean needles and syringes and educated other users to do so. Through education, sex work was also made safer for both the sex worker and the client.
Also, education appeared to have played a major role in helping, among others, the cultural and political leaders to see the need to deal with obstinate social issues so as to reduce social vulnerability to major factors which are associated with increased risk of HIV. These issues
37 include poverty, gender inequality, war and civil unrest. In Lesotho, the National AIDS
Commission (NAC, 2012: 28-31) indicate these obstinate social issues to contribute to
poverty, unemployment and low rates of male circumcision including such practices as having multiple and concurrent sexual partnerships, low levels of consistent and correct condom use, resistance by people to change patterns of sexual behaviour and high rates of alcohol use.
According to Mahloane-Tau (2010) alcohol tends to interfere with judgement and decision- making and increases likelihood for people to engage in unprotected sexual intercourse due to impaired judgement, which result from the intoxicant.
Pulerwitz and Barker (2008), in Aggleton et al. (2011: 498) indicate that through education laws have been changed to lay foundations for a more “holistic response”. In Lesotho, for instance, the 2006 Lesotho Labour Code was amended, according to the Medical Care
Development International (undated), to include policies, standards of operational procedures and national guidelines for management of HIV and AIDS education programmes in
workplaces. Lesotho also passed the Legal Capacity of Married Person’s Act in 2006. This Act provides equal status to married women, because under traditional customary law women lacked political, financial and social rights, which made it difficult for them to negotiate safer sex practices.
In regard to the mainstream education, Aggleton et al. (2011: 504) elaborate that the majority of educational responses to HIV/AIDS were in a form of “technical remedies, providing checklists against which schools and their performance is [sic] to be measured”. How the epidemic could transform education systems for the better and what kind of HIV education young people value and need seemed not to have been given enough attention. They specify that
… much of the field of education remains unexplored. In particular, little has been done to document the different forms of education around HIV that exist, together with their consequences; the relative contribution of education in general and HIV-related education in particular in bringing about determinate effects … (Aggleton et al. 2001: 504).
38 This is also true in Lesotho; little attention seems to be given to the kind of HIV education that tertiary institutions value and need for their communities. For instance, the initial
investigations for this study in 2012 revealed the National University of Lesotho (NUL) to be the only tertiary institution that had an HIV/AIDS policy and this is still the case to date in 2015.
Aggleton et al. (2011: 504) concluded that education for prevention played a key role, regardless of whether it was given formally or informally, because it seems to have helped communities yield beneficial effects and has displayed significant potential in halting the spread and mitigating the impact of HIV in the past 30 years.
In a similar desktop study in India, Das and Gupta (2011) examined the importance of
awareness and prevention strategies for HIV/AIDS among men and women aged 15–49 years living in the seven states of the northeastern region of India. They looked particularly at findings from the National Family Health Survey (NFHS-3; 2005-06). Their findings support the conclusion of Aggleton and colleagues that education has an important role to play in holding the spread of HIV and, therefore, concluded that all people need to be educated about HIV, regardless of whether infected or not. Their findings revealed that people who are not infected need to be educated so that they are able to guard against the infection, while those who are already infected need to be educated so that they can avoid being re-infected or infecting other people. Above all they learned that education can help those who are already infected to harmoniously live with the virus (Das and Gupta, 2011).
Das and Gupta’s study (2011: 874) was undertaken to investigate the impact of HIV/AIDS education in view of the devastating effects of the epidemic, which seemed to continue to tear down communities despite ‘valiant’ educational efforts that were undertaken by the
government and societal groups to equip people with information about “the nature of the disease” and what they needed to do in order to protect themselves against it. An overview of their literature review revealed that a number of studies showed that a majority of the
population in India was knowledgeable about HIV/AIDS. Yet this knowledge did not seem to have helped them to stop stigmatizing the disease or discriminating against people with HIV.
39 Also, this knowledge did not seem to have helped people to guard against the disease, as the rate of new infections kept on increasing. Consequently, Das and Gupta agree with other researchers (such as Pradhan et al., 2008) that for countries to be able to fight HIV and AIDS, people do not only need to be equipped with information or knowledge about HIV/AIDS, but governments need to consider other factors (such as economic factors and social
vulnerability). It therefore became apparent to Das and Gupta that it is not only ignorance that influences the spread of HIV, but that it can also spread as a consequence of certain
behavioural patterns caused by some of the aforementioned factors. Thus, they recommended that preventive policies and awareness efforts through the media and interpersonal
communication should also target the poor, the rural and the uneducated people in the
northeastern states of India, since awareness and preventive measures seemed to be inadequate in that part of the country. Likewise, they recommended that while HIV preventative efforts were focused on addressing the issue of HIV/AIDS among the economically productive and those leading risky lifestyles such as the commercial sex workers, injecting drug users, males having sex with males and all sexually active members of the community, the focus should also be directed to other groups like students, youth, migrant workers in urban and rural areas as well as women and children.
Although the Government of Lesotho (GoL) started undertaking efforts to protect all these vulnerable groups from HIV from the beginning of the twenty-first century (GoL 2000b), the impact is still felt as adults become too sick to work and children orphaned by AIDS are left to run households. Efforts undertaken in Lesotho include awareness education and promotion of condom use targeted towards sex workers, taxi and truck drivers, migrant labourers (including mine workers) and factory workers. As indicated in the introduction to this chapter, little has been done to target communities in tertiary institutions. It can, therefore, be argued that while the GoL considers issues that influence the spread of HIV among communities, special focus should be directed to tertiary institution learners.
One study that targeted young people was undertaken in Ethiopia by Bekele and Ahmed in 2008. Upon realizing that stigma and discrimination continued to hinder interventions through
40 IEC materials which were being used as a major instrument in the prevention of HIV/AIDS, Bekele and Ahmed undertook an interventional study to assess the perceived sufficiency and usefulness of HIV/AIDS IEC messages and materials. They aimed to identify preferences for IEC sources and methods in four high schools in 2007. These interventions included:
interpersonal communication between intervention implementers (health officers and high school teachers trained on how to organize the intervention sessions and supervise the overall activities), reading of pamphlets and watching educational videos, or a combination of the three. Similar to the situation in Lesotho, findings by Kimaryo, Okpaku, Gitthuku-Shongwe and Feeny (2004) revealed that stigmatizing attitudes among the pupils are fueled by social and economic factors that include religious beliefs, myths and misconceptions that HIV is transmitted through witchcraft, among other things.
In reviewing literature related to their study, Bekele and Ahmed learned that an increase in knowledge and a change of stigmatizing and discriminatory attitudes towards HIV/AIDS issues is maximized by exposure to HIV/AIDS messages when they are provided through electronic IEC materials such as television, radio and film rather than print materials like pamphlets. However, a combined use of all IEC materials was found to be more effective in creating awareness and reducing stigma and misconception, as different people have different learning preferences. Although print IEC materials such as pamphlets were a cheaper method of communication, they seemed to have yielded low results in Bekele and Ahmed’s study and in other studies that they came across during their literature review because, they stated, people are “lazy to read” (Bekele and Ahmed, 2008: 240). They, therefore, concluded that interventions needed to be strengthened by using combined IEC interventions in order to address misconceptions, stigma and discrimination in the transmission and prevention of HIV/AIDS among adolescents. Goldstein, Usdin, Scheepers and Japhet (2007: 481) confirm that “environments need to be saturated with consistent messages that reinforce information”
from pamphlets in different ways so as to reinforce one another and to extend their
communication reach.Consequently, this study sought to find out whether readers in Lesotho were any more willing to respond to print media messages in a climate where HIV is a dominant factor in people’s lives.
41 Although some studies did not concentrate on HIV/AIDS only, they were of interest because they investigated the use of print materials on health related issues, including HIV/AIDS, and used the same theories that were used to frame this study. One particular study by Arbuckle (2011, 2014) used semiotics and communication theory and provided some theoretical insights for examining responses to print materials.
Between 2011 and 2014, Arbuckle conducted a study to investigate the extent to which Zulu- speaking adults with low literacy levels understood pictures that portrayed health information in urban and rural areas of KwaZulu-Natal, South Africa. In order to be able to assess the participants’ interpretation of the pictures, Arbuckle asked participants (23 adults who attended Adult Basic Education and Training [ABET] Level 1 Zulu literacy classes in two rural and two urban literacy centers in KwaZulu-Natal) to look at pictures (without text) and to describe their meanings. She used 27 illustrations from health education print IEC materials aimed at adults. These illustrations were used as both data sources for semiotic analysis and as part of the research instruments used in the interviews. The significance of her study is that it could help to “contribute towards the theoretical foundations for understanding how low- literate adults derive meaning from pictures” (Arbuckle, 2014: 7).
To analyze how visual meaning is structured in print materials, Arbuckle first conducted a semiotic analysis of the illustrations to describe how the signs used related to the intended meaning of the illustrations (that is, she constructed meaning out of the illustration). Then she assessed how participants understood the meaning and the practicality of what the pictures represented to the participants who were given the illustrations (Arbuckle, 2011, 2014). The illustrations themselves were placed into two different groups to assess the style and
technique of depiction plus the way in which content, for example, in iconic, ‘realistic’
pictures, compared with those operating more at the symbolic or indexical levels were portrayed.
Results revealed that the level of education does influence a person’s ability to correctly interpret pictures. But the most striking thing to Arbuckle was that participants who appeared to already have knowledge about HIV, probably through experience, interpreted the
42 illustrations correctly, seemingly regardless of their formal education levels.Geographical setting did not have much influence, as the difference between participants from the rural and the urban settings was not as significant as expected, since both rural and urban participants appeared to misinterpret the illustrations in the same manner. Differences in the range of responses towards the pictures supported Arbuckle’s suspicions that, while illustrations somehow enhanced education amongst low-literate audiences, they cannot be relied upon to convey messages on their own, but need health educators to interpret them, especially when used for educational purposes. As a result, Arbuckle (2014: 300) concluded that such illustrations should not be left in isolation without a way to fix or “anchor” the intended meaning and that “captions or other forms of explanation are always necessary” where it is important that the information should not be misunderstood. She added that no matter how convenient (financially) the production of print IEC materials may appear to be to the educators, these materials need to be complemented with face-to-face discussion in order to clarify or correct any misapprehensions. Accordingly, this study sought to determine if these same issues would apply to educated tertiary institution learners in Lesotho.
The overview of all studies: Aggleton et al. (2011), Das and Gupta (2011), Bekele and Ahmed (2008) and Arbuckle (2014), indicated an impact of education on HIV and AIDS in one way or another. Hence, this study sought to find out how much youth and young adults in Lesotho valued and needed print IEC materials on HIV, in order for HIV education to have a better chance of halting the spread and of mitigating the impact of HIV among young people in the country, especially considering that Aggleton et al. (2011) have highlighted that education has significant potential to do this. In addition, it was hoped that this study would influence
policymakers in Lesotho to introduce laws and policies (Das and Gupta, 2011) that target the tertiary institution population as a special entity that needs focused HIV educational efforts. In addition, Bekele and Ahmed (2008), and Arbuckle (2014), enhanced the appreciation of the use of combined methods of educational communication (for example, print IEC materials plus discussion) in order to increase their effectiveness. In addition, it was necessary to find out whether these factors do have an influence on educated audiences like tertiary institution learners in Lesotho.
43 There were also a number of other studies (such as Durojaiye, 2011; NUL, 2011), which were relevant because they looked into knowledge about HIV and AIDS among youth and young adults. These studies were of interest to establish how this target group perceived the
significance and appropriateness of educational materials that may have been used to equip them with knowledge.