THEORETICAL FRAMEWORK
CHAPTER 3 LITERATURE REVIEW
3.8. Tertiary institution students
3.8.1. South African universities
Except for a study undertaken at the University of Durban – Westville, (now a campus of the University of KwaZulu-Natal) (Stremlau & Nkosi, 2001), which revealed an infection rate of 26%
for female students and 12% for male students between the age bracket of 20-24, only limited studies on HIV/AIDS have been undertaken on tertiary education students in South Africa to ascertain the infection rate. In a SAUVCA-commissioned study, Chetty (2000) estimated HIV infection levels in tertiary institutions at 25% for undergraduates, 11% for postgraduates, and 24.5% for technikon students. His projection to 2005 was 33%, 21% and 36% respectively.
However, a recent survey, carried out during the course of this study, on South African universities (Dell, 2010) is probably the first comprehensive of such studies on Universities in South Africa. Dell reported a much cheering prevalence of 3.4% among university students, much lower than national prevalence rate among 15-24 years old put at 11% in 2008 but dropped to 8.6% in the survey under reference.
Chetty and Michael (2005) suggested that HIV/AIDS affects all categories of people that make up the university community: students, academic staff, clerical staff, administrative staff and support staff. The consequences of this are grave for the system and include illness, death, trauma, reduced work capacity (for staff) and studies (for students). Universities lose students and staff through death. Increase in absenteeism affects productivity. Critical skills that sustain
the institution are depleted and the cost of replacement and retraining fresh recruits stifle progress and distort the finances of the institution. Dell’s report revealed that the highest prevalence among service staff in South African Universities was recorded for KwaZulu-Natal Province placed at 20.3%. UNIZULU is located in this Province.
At national level the pandemic reduces population projections and life expectancy, increases child mortality, places burden on health care, generates large number of orphans and increases the need for poverty assistance. In this scenario the highest prevalence is among people in the 15-49 year cohort with major differences for males and females. The prevalence among South African women, 25-39 years of age, was estimated to be 17.7 % in 2002. The corresponding estimate for men was 12.8 % (Phaswana & Peltzer, 2005). Evidently AIDS deaths occur predominantly among workers (and youths, including students in tertiary education institutions) in their prime and in their most productive years.
Certain risk factors and patterns were revealed in finding answers to the question (Eaton, et al., 2003): “Why is it that South African youth in the 1990s continue to practice unsafe sex despite the concerted efforts of educational and HIV prevention campaigns to influence their behaviour? In their review they addressed three types of sexual risk behaviours that have received attention in South Africa: being sexually active (as opposed to abstinence or delay of onset of sexual activity), having many partners (either serially or concurrently) and practising unprotected sex (which includes inconsistent or incorrect use of condoms). The summary of their findings are: At least 50% of young South Africans are sexually active by age 16, and
probably 80% are by 20; boys report earlier sexual debut than do girls; black youth are more likely to start sexual activity in their teens than are other ethnic groups; the majority of school- going adolescents reported having one or two partners in their lifetime, and over 60% of university students reported no partner or one partner in the last year; while it appears that most youths are not promiscuous a persistent minority had more than four partners per year (1-5% of women and 10-25% of men); between 10-30% of sexually active youths have more than one sexual partner at a given time, with more men than women engaging in concurrent relationships and majority of sexually active youths use condom inconsistently, if at all (overall estimate of 50-60% of youths in the studies (range 23-85%) report not using condoms at all).
The age reviewed in the above studies was 14-35 years old. At least 80% of university students in South Africa (and Nigeria) will fall into this cohort. The observation of promiscuous behaviour among school-going youths as against the abstinence/monogamous behaviour among university students sounds contradictory, except if most school-going learners end up not continuing their education to university level or if intervention in the university has positive impact in adoption of positive and safer sexual relationship. The latter is most unlikely, considering the unique university culture.
Campbell, Foulis, Maimane and Sibiya (2005) unpacked the ‘social context’ that shapes the efficacy (or lack of) of HIV-prevention programmes using studies conducted at the peri-urban community of Ekuthuleni in KwaZulu-Natal Province as a case study. In the study they highlighted three dimensions of social context which undermine the effectiveness of youth HIV-
prevention efforts in the marginalised South African communities in which the pandemic flourish. These contexts are: material-political, symbolic and institutional-network. Material- political context included access to money, jobs and political influence; symbolic context refers to the web of social representations into which youths insert HIV prevention messages, and institutional-network context included the extent to which public sector, private sector and civil society networks are supportive of the well-being of youths in general, and HIV prevention efforts in particular. Some of the outcomes of this study reveal:
Young people in the study had accurate knowledge about HIV transmission and prevention.
However, they were driven by negative curiosity to experiment with sex “which we were told is very nice” by their parents who themselves had sex when they were young.
Youths are driven by fatalism and bravado, yielding to the urge to prove that “they were not afraid to die”.
Youths complained of information overload, “If you are going to tell us about HIV/AIDS, we know that already; tell us something new. We are tired of all this AIDS talk all the time”
Poverty has driven girls to depend on sexual partners for money or clothing and this have limited their power to negotiate for condom use.
Social determinants of HIV-transmission like poverty, peer pressure and gender norms are mismatched by emphasis on awareness raising and abstinence that are sold to the youths, without addressing the social roots of the pandemic.
Youth’s sexuality is stigmatised by adults in judgmental language as ‘bad behaviour’,
‘immorality’, ‘wrong doing’ or ‘evil’, even though the adults indulge in the same sexual vices now and when they were much younger.
Peer influence as an important determinant of sexual behaviour.
Most youths in Ethukuleni had little education and few skills, and job prospects were poor and support from family was poor. Some parents lacked confidence to advise their children with more education than they had and others feared children involved in crime and drugs.
‘Dual leadership’ system involving elected political leaders and hereditary traditional chiefs within the same community led to conflicting signals to HIV prevention: the former promoting condoms while the latter promote abstinence backed up by virginity testing.
Eaton, Flisher & AarØ (2003) and Campbell, Foulis, Maimane & Sibiya (2005) appear to
provide framework to understand the risk factors within a university community in South Africa, more so in a rural-based university like Zululand that draw a substantial number of her students from rural communities like Ekuthuleni. In therefore understanding the impact of university unique environment on the sexual profile of university students, one needs to adopt the framework proposed by Eaton, et al. (2003) and examine the distal, proximal and personal factors of risk that fan the spread of HIV infections in the university.