CHAPTER 5: PERCEPTION OF RISK OF HIV INFECTION
5.3 Perceived Severity of HIV/AIDS in the Community
“I think people are aware of HIV/AIDS, although I am doubtful. However, we, the youth, sometimes when we are enjoying ourselves, we do not care about condoms, but people are aware of HIV/AIDS”.
(Rural non-married female, IDI # 09)
“I usually go out on Fridays to have a drink with my friends, in the “barracas”
[shebeens], and I always get surprised with what I see there. I see people having sex in the public. It is possible that people do not know that their behaviour may lead to them getting infected with a disease”.
(Urban non-married males, FGD # 18)
The quotes above suggest that although respondents are aware of HIV/AIDS, perception of personal risk of HIV infection may still be elusive for a large number of men and women. This may be a cause of concern in the context of a generalized HIV/AIDS epidemic.
Table 5.3: Percentage of respondents who reported that they knew someone infected with HIV/AIDS or died of AIDS
Men Women n % n % Know someone infected with HIV
Yes 46 22.1 75 34.7 No 162 77.9 135 62.5 Not sure 0 0.0 6 2.8
Knew someone who died or suspect has died of AIDS
Yes 110 52.9 109 50.5 No 98 47.1 87 40.3
Not sure 0 0.0 20 9.3 Total 208 216
Table 5.3 shows that few men and women reported knowing someone who is infected with HIV/AIDS. This is not surprising, since secrecy is still one of the major obstacles to behaviour change. Studies have shown that fear of stigma, discrimination and social marginalization increase HIV risk and vulnerability (UNAIDS 2008). Research suggests that stigmatizing attitudes to HIV and those most at risk of HIV infection derive from two main sources. The first is fear of contagion, which is an important source of disease-related stigma through the ages. The second is negative, valued-based assumptions about people living with HIV, which intensifies prejudice and discrimination (UNAIDS, 2008). In addition about half of both men and women reported that they knew someone who died or they suspect had died of AIDS which is of particular note. In this regard, women were more likely than men to report that they knew somebody who was currently infected with HIV/AIDS. This may be due to the fact that, in general women are caregivers and may be more exposed to those who suffer from health problems including HIV/AIDS. In addition, women may share information about people’s health problems both with families and other community members.
About 35 percent of women reported knowing somebody who was infected with HIV/AIDS compared with about 22 percent of men. Similarly, half of respondents of both sexes reported that
they knew someone who died of HIV/AIDS or they suspected the death was caused by HIV/AIDS. In this regard, about 53 percent of men reported that they knew someone who died or they suspect had died of AIDS compared with 51 percent of women. These findings confirm that the impact of HIV/AIDS within communities has become a sad reality which, in principle, would encourage or compel men and women to adopt protective behaviour. However, it seems that conflicting values and gender norms including the tradition notions of masculinity which encourage men to seek multiple sexual partnerships and the association of condoms with illicit sex and disease may constitute the big challenges hampering men and women from adopting safer sex practices
To assess their perceptions about the severity of HIV/AIDS in the community, respondents were asked during focus groups discussions and in-depth interviews about the seriousness of HIV/AIDS in the study areas. They were also asked whether they felt confident that both men and women were taking all the necessary precautions to curbing the HIV/AIDS pandemic in their communities. In both the study sites, HIV/AIDS was seen as a very serious problem. In some situations the high levels of morbidity and mortality had become an undisguised reality in the community. They argued that this was because many people, particularly women, were falling sick and even dying. This is well illustrated in the following quote:
“In this area, people know of this disease, because of people who come from South Africa are already sick [mine workers]. We have seen great numbers of people coming back from there without life. People start believing that this is real. Even in meetings, the first thing we talk about is about this disease. We have received information from brigades that talk to us about this.
Therefore the people are aware about it. The disease is killing a lot of people”.
(Rural married females, FGD # 04)
The perception that the HIV/AIDS epidemic is very serious is also clear among respondents who witnessed the death of acquaintances and loved relatives. In addition, some men and women were caring for children orphaned by HIV/AIDS.
“We have a problem in Trevo neighbourhood. We have plenty of orphaned children because of AIDS. In fact, we are losing our children to this disease. In my block there are six people who are infected with HIV/AIDS and it seems that only one is taking treatment.”
(Urban married female, FGD # 04)
“I had a brother- in- law who was a truck driver. We used to tell him to be careful when you are on the road”, but unfortunately he died. He was a victim of AIDS.”
(Rural married male, IDI # 11)
This quote may serve as a clear example of the impact of HIV/AIDS on families and community.
On the other hand, however, it may reinforce the association of HIV/AIDS with particular groups of people such as truck drivers, sex workers, mine workers, etc. While these categories of people are vulnerable to HIV infection as the quotes show, the attitude that HIV/AIDS affects others may have some unintended consequences encouraging some people who are neither truck drivers nor mine workers, for example, to think that they are at low or no risk of HIV infection.
Furthermore, the widespread perception that the level of HIV/AIDS in the community is severe is also demonstrated by the comments of one HIV positive respondent who observed that there are many people in the community with similar physical symptoms as him.
“There are many cases here, but if a person does not tell you something, or does not do the test you will never know that he or she has this disease. But yes, there are many cases here.
We suspect HIV/AIDS when a person falls sick and does not get better, or when we see infections that cause death”.
(Rural married male, IDI # 13)