CHAPTER 2: LITERATURE REVIEW
2.4 Rationale and aims for the study
In order to prevent HIV and AIDS and sexually transmitted infections, there is interest in
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studying high-risk sexual behaviours. The 2012 South African National HIV Survey indicated that HIV and AIDS continue to spread in South Africa despite concerted efforts to prevent it (Shisana et al., 2014). The survey indicated a significant increase of almost 1.2 million people living with HIV in South Africa between 2008 and 2012. Thus, changing behaviour in response to HIV and AIDS remains a significant problem in South Africa. It also indicates that attempting to prevent the spread of HIV and AIDS by educating people about the risks and promoting a change in risky sexual behaviours is not enough to reverse the HIV pandemic (Rohleder, Swartz, Kalichman & Simbayi, 2009). HIV and AIDS remain a problem and a most challenging disease, especially in developing countries (Parker, 2004). To develop appropriate interventions that can address HIV prevalence and prevent transmission of HIV infection, an understanding of sexually risky behaviours is crucial.
It is critical to understand why there is a lack of behaviour change in response to the HIV- prevention interventions already put in place, especially as a remedy for HIV in terms of medication or vaccines still seems far away. To address the challenges posed by STIs and the HIV pandemic, researchers have focused on cognitive theories and models to inform prevention programmes (Protogerou, Flisher, Aarø & Mathews, 2012). These theories focus on the assumption that sexual behaviour is an individual decision-making process. However, other authors such as Parker (2004) question their applicability, arguing that cultural and community factors are crucial in understanding HIV transmission. There has been increasing awareness that contextual factors affect individual behaviour (Parker, 2004). However, there has also been recognition that neither cognitive nor context-based theories provide an adequate framework for understanding sexual behaviour change (Van der Riet, 2009).
Consequently, there is a need for a conceptual framework which incorporates the dialectical relationship between the context and individual. In terms of understanding sexual behaviour change, there is a need for a theorisation of activity “in which people continually shape and are shaped by their social contexts” (Roth & Lee, 2007, cited in Van der Riet, 2009, p. 75). Thus, this study focused on activity theory. It is the only theory that provides a conceptual framework for the dialectical link between the individual and society (Engeström, 1999). Activity theory thus provides an alternative lens for analysing sexual activity in the context and community that supports it. There are limited studies (Engeström, 1996; Van der Riet, 2009; 2012) that have applied activity theory specifically to health issues. Activity theory may provide a more
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comprehensive and effective understanding to guide interventions aimed at changing high-risk sexual behaviour.
The findings of this study might be beneficial to South African HIV and AIDS programmes which are aimed at preventing the spread of HIV and AIDS. It could contribute to the important body of knowledge of HIV and AIDS. It could also assist policy makers and non- governmental organisations to apply appropriate interventions by providing empirical data on why people continue to engage in risky sexual practices regardless of their awareness of the negative consequences.
2.4.2 Aims of the study
The main reason for this study was to find out why people continue to engage in risky sexual practices which expose them to the risk of HIV and AIDS, despite knowledge and information about HIV and AIDS. The study sought to understand a lack of sexual behaviour change in response to HIV and AIDS using the framework of activity theory (Engeström, 1987). This study use secondary data from a broader NRF project exploring people’s responses to HIV and AIDS. The participants in this study were from a rural area in the Eastern Cape, called Ematyholweni. This is discussed in more detail in Chapter 3.
This study analysed the way in which people in Ematyholweni talk about sex, sexual relationships, and their response to HIV and AIDS. It focused on the tensions and dilemmas in the positions that men and women in Ematyholweni take in relation to sexual activity and relationships. The main aim was to understand the different dilemmas and tensions within sexual relationships related to condom use and safe sex practices. It also explored whether and how these tensions and dilemmas relate to contradictions in the sexual activity system.
Understanding the relative state of contradictions in the activity system assisted in conceptualising HIV and AIDS interventions in similar contexts.
2.4.3 Research questions
1. What are the dominant dynamics around sexual activity and risk-reducing sexual behaviour in Ematyholweni?
2. What is the response to HIV and AIDS among people in Ematyholweni?
3. What is the response of people in Ematyholweni to condom use?
4. What tensions and dilemmas occur in the activity system of sex of people in
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5. What is the state of contradiction in the activity system of sex among people in Ematyholweni?
This chapter explored literature related to the study. It presented literature on socio-cultural factors that may act as barriers to safe sex practices, activity theory as a theoretical framework of this study and the principle of contradictions in this theory. It finally presented the aim and rationale of this study.
The next chapter will discuss the methodology employed in this study. It outlines the research design, sampling, the data collection and the data analysis procedures. It also discusses the steps for ensuring the validity and reliability of the study. It also explains in detail the ethical consideration of this study.
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