2.3 Factors that Influence Young People’s Vulnerability to HIV Infection
2.3.4 Rurality and Young People’s Vulnerability to HIV Infections
Some scholars (such as Ralebitso, 1994) suggest that people are products of their environment. This means that people tend to be who they are because of where they come from and who they interact with (physical and social environment). For example, Richter (2013) argues that the development of any child, regardless of any implications related to HIV and AIDS, is highly dependent on her or his environment. From this perspective, this section reviews scholarship on the influence of rurality on the vulnerability of young people to HIV infection.
This contributes to increased vulnerability of young people to HIV infection. In the Southern African contexts, “...rural areas are places that are ‘located far outside of town – where there are no bridges –
… places far from tar and gravelled roads’…. It is (also) where one finds Emaphandleni … simply
‘dust and deprivation’ (Nelson Mandela Foundation, 2005: 31). In this context, rurality is a delineation of geographical position. Hence, rurality implies remoteness, mountainous terrains, sparse populations, open land and other aspects not associated with urban areas (Moletsane, 2012; OSISA, 2012; Redding &Walberg, 2012). In the same manner, Lesotho (a country known as the roof of Africa because of its mountains) is a geographically rural country. It is divided into four geographical regions: mountainous, lowlands, foothills and the Senqu valley. The mountainous area forms three
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quarters of the country. The majority of rural families living in relatively mountainous and remote areas of Lesotho depend on subsistence farming and livestock rearing for their livelihood (Motalingoane, 2010). Scholars in the region have argued that living in rural areas has several implications. For example, the provision of infrastructure, access to essential services such as education and healthcare facilities, are often insufficient, corresponding with the low income and lower educational attainment of its population (see Centre for Rural and Northern Health Research, 2008; Meintjies & Hall, 2013; Moletsane & Ntombela, 2010; Zaid & Popoola, 2010). This contributes to increased vulnerability of young people to HIV infection. Within this context, available literature suggests that the large number of ‘vulnerable’ young people in rural and marginalised communities, where infrastructure and services are inadequate, makes the task of addressing HIV and AIDS, and the required care and support for those infected with HIV or affected by HIV and AIDS, difficult (Mitchell & Murray, 2012; McGrath, 2011). Thus, young people of school-going age in rural communities tend to be more ‘vulnerable’ to HIV infection and are less likely to develop to their full potential. For example, Khanare’s (2015) study in South Africa found that living in a rural area has many challenges including the fact that the majority of young people made ‘vulnerable’ by HIV and AIDS in South Africa are of school-going age. This is because rurality tends to pose challenges for school attendance itself, and for accessing quality learning in particular, including learning about HIV and AIDS. Similarly, scholars such as Argall & Allemano (2009) and Taukeni (2012) argue that apart from a place of teaching and learning, a school is also a space for socialisation and belonging. They argue that when young people are deprived of education, they are likely to be exposed to HIV infection. Mitchell & Murray (2012) as well as Wood (2012) found that school is vital for cultivating social relationships, creating networks for HIV prevention and awareness and for developing skills that are needed beyond school. Therefore, lack of access to schooling puts young people at risk of HIV infection.
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Overall, young people living in rural households experience more challenges, including being affected by HIV and AIDS (DBE and MIET Africa, 2010). For example, studies undertaken by Hall (2013a, 2013b) found that this group lives in extremely poor conditions, resulting in the higher risk of being affected by HIV and AIDS. This is related to the fact that rural areas experience high levels of poverty (Hall, 2013a; Moletsane, 2012; Shackleton, Buiten, & Bird, 2007). The 2013 World Bank
& IMF Global Monitoring Report states that the impact of HIV and AIDS is going to have a long- lasting effect on the lives of young people living in rural areas, reshaping their futures, expectations and their participation in ways that are currently difficult to predict.
While healthy life and quality education are critical for shaping young people’s physical, psychological and holistic development, Hall’s (2013c) study found that children living in poor rural communities are not likely to have access to free health services. This is the case because most health care facilities operate on a schedule of weekdays from 08:00 to 16:00, thus making it inaccessible to many young school people in rural areas, including those who would have to walk long distances from school to clinics to home even when they are ill. According to Delva, Vercoutere, Loua, Lamah, Vansteelandt, De Koker, & Claeys (2009), in spite of compulsory basic education in South Africa and other ways of ensuring access to education (such as no-fee and free-meal policies in the majority of public schools (DBE, 2013) young people in rural communities’ experience difficulty in accessing quality education as well as health-care. One reason for this difficulty includes the inability of governments to attract and to retain competent human resource personnel such as teachers and health workers in many rural communities. This observation is similar to Monk's (2007) argument that “rural schools have below-average share of highly trained teachers…using seasonal and immigrant workers
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to minimise labour costs” (p.155). Untrained teachers and high staff-turnover in rural schools complicates efforts to respond adequately to the diverse needs of ‘vulnerable’ young people, including those at risk of HIV infections. Rural schools, including those in Lesotho, continue to have many teachers who do not live in these areas (Motalingoane- Khau, 2010; Pillay & Saloojee, 2012).
With the multiple socio-economic difficulties facing rural communities, the majority of teachers in most rural schools opt to commute to and from the school. The result is that such teachers spend less time at school and are less likely to interact with ‘vulnerable’ young people in settings outside the school. They often do not facilitate what Namulundah (1998) refers to as “engaged pedagogy” within and beyond the school (n.p.). Khanare (2015) argues that those teachers who happen to stay in the community are not necessarily native residents but might have migrated there because of employment opportunities. These teachers rent houses in the school community but they travel back to their place of origin, in most cases an urban area, for the weekend. Dissemination of information on HIV and AIDS as well as on care and support for these young school children in rural areas is dependent on active and engaged teachers who work during school hours and contribute to after-school activities, including after-school care and support. In the absence of qualified teachers, no access to learning materials and information technologies such as the internet, children in rural schools have to seek information wherever they can. This exposes them to wrong sources of information which can lead them to making wrong decisions, misunderstanding and misinterpretation of the HIV and AIDS messages.
Available research suggests that poverty in rural areas also exposes young people to the risk of HIV infection (Dlamini et al., 2012; Schenk, 2009; Schenk, Michaelis, Sapiano, Brown & Weiss, 2010).
Young people are often targets of harassment and abuse because of their poverty (Irvin, Meece, Byun, Farmer, & Hutchins, 2011). In an effort to alleviate their poverty young people of school going-age
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may take up employment. A study by Erulkar and Ab Mekbib (2007) in Addis Ababa on ‘vulnerable’
and marginalised adolescents found that children as young as ten years of age in this urban area are required to add to the economic assets of their family. The same situation occurs in rural areas. For example, a study by Mitchell et al. (2010) in rural KwaZulu-Natal in South Africa found that children aged 11 to 13 stayed away from school every Friday because they had to go to the local market to buy the basic food needed for the family. Scholars have argued that while the South Africa government continues to allocate a healthy proportion of its budget to education, there is still a high teacher-learner ratio in rural schools which has serious implications for addressing the needs of children, especially those infected or affected by HIV and AIDS (Dlamini et al., 2012; Hlalele, 2012).
The study reported in the present thesis was located in a rural school in Lesotho. As such, the thesis analyses the ways in which rurality and factors associated with it put young people at risk of being infected with HIV.