Perceptions among a group of at-risk individuals: the discrepancy between unsafe sex practices and knowledge about HIV/AIDS transmission

[摘要] English: Due to its rapid spreading, AIDS has been declared a global epidemic. Especially sub-Saharan Africa has been the most affected by the epidemic. South Africa is no exceptionto the devastating impact of the epidemic. Over the past few years, HIV-preventioninitiatives have been underway on a full scale in an effort to combat the destructivepowers of the epidemic in the country. These initiatives appear to have adopted a health beliefapproach in their strategies to decrease HIV-infections. This approach to HIV preventionassumes that the desired behaviour change, namely increasing safe sexualpractices and decreasing high-risk HIV/AIDS behaviour, can be achieved through rationaldecision-making based on knowledge of the disease and its consequences. The findingsof studies on sexual behaviour and HIV/AIDS such as KAPB (knowledge, attitudes,practice and belief) studies appear to reaffirm the fact that knowledge alone is notsufficient nor effective in bringing about the appropriate behaviour change to combatHIV/AIDS. These studies point towards a high level of knowledge about AIDS in thegeneral population, yet the ever increasing HIV-infection rate remains undeterred. Thediscrepancy between knowledge about HIV/AIDS and the unchanged high-risk sexualpractices of the population which is seemingly knowledgeable about the disease, promptsa need for research to identify the underlying causes of this discrepancy, thus therationale for this study.In view of the inadequacy of a health-belief approach to HIV-prevention, this studyproposes an alternative approach to HIV-prevention that would supplement the health beliefapproach, and thus explain the hiatus between knowledge and manifest sexualbehaviour. This is approached from a socio-behavioural approach, which assumes thatHIV/AIDS is a behavioural issue that is firmly rooted in sexual behaviour. In addition, itacknowledges that sexual behaviour is influenced by the interplay of psychological,sociological and cultural factors in sexual decision-making. This decision-making processoften has little to do with maintaining good health and more to do with satisfyingmotivational needs that have a psychological basis or with options that are socially oreconomically or emotionally determined. Thus, a multidisciplinary approach to analysingfactors that influence sexual behaviour was utilised.Based on a multidisciplinary analytical model of sexual behaviour, the study aimed toidentify factors that impede the practice of safe sex. The developing of this model wasinformed by various perspectives (i.e., psychological, sociological and anthropological) ofbehaviour and two theories that take account of the social context in explaining thebehaviour change process (i.e., attitude accessibility model and theory of reasonedaction). The multidisciplinary model, in turn, informed the development of the researchinstruments and interpretation of the findings.The community of Thabong, in Welkom, was selected because of the high HIV prevalencein the District and because of the involvement of the Centre for HealthSystems Research & Development in the proposed Youth Multi-function Centre inThabong. Welkom has the highest HIV-prevalence of all the districts in the Free State(30,63%). Second, the study intends to inform HIV-prevention initiatives aboutimpediments to safe sex. Thus, this study will inform- the proposed Youth Multi-functionCentre in Thabong, which aims to decrease HIV-infections among the youth in thecommunity. Towards informing the study aim and objectives, individual in-depth interviewswere conducted with 30 confirmed HIV-positive males and females between the ages of15 - 49 years. The interviews were guided by a semi-structured individual questionnaire.Also, 15 focus group discussions were conducted with males and females from varioussocial strata in the community, and who were assumedly HIV-negative. The focus groupdiscussions were conducted with the aid of a semi-structured group discussion schedule.The two forms of data collection served to complement each other and promoted thevalidity and quality of the data collected. The study design opted for was explorative innature, as little is currently known about the community-specific obstacles to safe sex. Allrespondents were purposively sampled.The main findings of the study point towards the need for HIV/AIDS to be viewed in thelight of the socio-cultural and socio-economic contexts of sexual behaviour. Factors thatwere identified as influencing sexual behaviour, and therefore HIV/AIDS, include theunbalanced power in gender-relations, socio-economic status and perceived self-efficacy,amongst others. Also, there is a need for detailed knowledge about the specifics of HIV preventionand transmission, as well as safe sexual practices. This will serve to addressmyths and misconceptions about the three modes of safe sex, namely condom use,'sexual abstinence and mutual faithfulness.Overall, the research indicates that HIV/AIDS is a socio-behavioural problem rooted inthe sexual practices of individuals. Attempts to successfully change high-risk sexualbehaviours should first identify factors that influence the progression of the disease inorder to develop community-specific effective and efficient HIV-prevention initiatives. To alarge extent, this study has identified those factors that influence and limit the options andopportunities that people in Thabong have when it comes to practicing safe sex. In thiscommunity, these are the factors that should be taken into account when HIV/AIDS preventioninitiatives are planned and implemented. These factors include, inter alia, lowsocio-economic status of women, gender-role stereotypes, myths and misconceptionsabout HIV/AIDS and safe sex, violence, socio-cultural norms and gender imbalances.

[发布机构] University of the Free State