HIV / AIDS risk factors among residence students at the University of the Free State

The aim of this study is to investigate the sexual campus culture of students at the University of the Free State (UFS), by specifically focussing on gender and culture as patterns of high-risk sexual behaviour. The sample consisted of 396 participants, 211 female and 185 male students, with a mean age of 19.9 years. Sixty one percent (61%) of the students associated themselves with a Western cultural background and 39% with an African cultural background. In this article an exposition is provided on information collected in a survey conducted at the UFS to help provide a better understanding of risk factors for HIV infection among UFS students in comparison with the behaviour patterns of students at other universities. Stereotypes identified as known risk factors making students at other universities more vulnerable to HIV and high-risk sexual behaviour, were also found among UFS students. Results indicated the existence of the following statistical significant correlations: African cultural students, gender and their viewpoint that there is a stronger relationship between homosexuality and HIV/AIDS; their opinion that HIV/AIDS is more strongly associated with African students. Data obtained from this survey questionnaire show that even if students have a great deal of knowledge to their disposal, and even if they recognised that they were personally at risk, some students' sexual practices and risk-taking behaviour remained unchanged. Despite the fact that the majority of students (85%) concluded that it is unacceptable for a woman or a man to have more than one sexual partner and that it is better to wait until marriage before engaging in a sexual relationship, 17% of male students (Western culture) and 4% of female students indicated that they have had more than five sexual partners in their lives. Statistical significant correlations also existed between African students, gender and their sexual activity the last six months. Contradictory to research results reported in literature, data obtained from this survey indicate that the majority of students view condom use in a positive light--75% of participating African students disagreed with the statement 'not using a condom during sexual intercourse shows trust in your partner'. Finally, in an interesting revelation, a general sexual culture was identified among UFS students, rather than culturally-based sexual practices.


Introduction
South Africa has the fastest growing HIV/AIDS epidemic in the world: about 10% of those infected worldwide live in South Africa.While millions o f South Africans are infected by the virus, all South A fricans are affected by the pandemic (Coombe, 2002:236).Former president, Nelson Mandela, has called for a new 'w ar' against HIV and AIDS, arguing that it is claiming more lives in Africa, than the sum total o f wars, floods and other deadly diseases, such as malaria.He said: "Its no less than a w a ra world war that affects all of us ultimately.We are, in this modem globalised world, each the keeper o f our brother and sister.We have too often failed in that moral calling" (Carlisle, 2003:122).
Young people are especially vulnerable to HIV.Researchers estimate that in many developing countries, fifty percent or more o f all HIV infections occur among people younger than 25 years.Effective HIV prevention among youth, therefore, is the key to the future course o f the HIV epidem ic and understanding sexual attitudes and behaviours o f youth in terms of HIV risk is critical in this respect (Ma, Ono-Kihara, Cong, Xu, Zamani, Ravari & Kihara, 2006:232).The way that we understand and conceptualised HIV/ AIDS in South A frica has changed radically in the past three decades.R esea rch e rs have re alise d that knowledge alone does not equate to a change in HIV risk sexual behaviour (Ross & Deverell, 2004:200).A greater understanding o f the determinants o f risk -re la te d b eh a v io u r in targ e t populations is an important precursor to the developm ent o f successful HIV/ AIDS prevention programmes.
The rapid spread o f HIV, especially am ongst our youth, is a source o f concern across disciplines focussing on HIV risk reduction programmes.Research findings indicate that while adolescents and young adults have knowledge about sexually transmitted infections (HIV/ A ID S), th is k n ow ledge does not necessarily translate into safe sexual b eh a v io u r (S ath ip arsa d & Taylor, 2006:117).As a result, the incidence and prevalence o f HIV continued to increase.A report issued by the Reproductive Health Research Unit (RHRU) concluded that gender inequalities are a major driving force behind the spread of HIV (RHRU, 2004).Consequently, HIV/AIDS was reconceptualised within the framework of 'culture and gender' (Ross & Deverell, 2004:200).Bayley (2003:8) takes this matter further by making a distinction between the levels o f education o f people being infected.He states that the loss o f a small group o f highly-educated persons will have a greater strategic impact on the economy o f South Africa than the loss o f a bigger group o f lower-qualified employees.
South African students should, for this reason, be regarded as a very important targ e t g roup fo r HIV and A ID S prevention programmes.This may, in the long run, in flu en c e the c o u n try ' C ulture is a system constituting an integrated unit that plays a central part in individuals' lives, and which is also based on and influenced by religion.In the p resen t study the p a rtic ip a n ts ' religious affiliation was mainly Christian (93.5%).Participating students' sexual view s m ay th e re fo re have been influenced by their Christian religious views, and this possible influential power should be giv en the n ecessary recognition.

Data collection
The q u estio n n aire was developed through a review of South African and international literature and was designed to m easure s tu d e n ts ' know ledge, attitudes and self-reported behaviour related to sexual activity and possible HIV risk infection.were advised o f the study's purpose and w hen/w here the survey was to be conducted.At the same time it was explained that non-participation would cause no harm to them and that the participants' privacy and confidentiality would be strictly protected as no personal id en tifiers w ere included in the q u estio n n aire and data w ould be presented only in an aggregated manner.

Data analysis
For the purpose of this research, the Chisquare test (x2 ) o f statistical significances was used to estimate the relationships between variables in the population.Neuman (2000:332) explains that, as a measurement o f association, the Chisquare may be used for nominal or ordinal data.

Discussion
Data that met the following criteria will now be discussed a) the x2 had a significance/ probability o f smaller than or equal to 0.05; b) no more than 20% of the cells were smaller than 5, and c) there were no empty cells (Neuman, 2000:338-339), will be highlighted.
The independent variables are gender (male or female) and culture (African cultural background or Western cultural background).The dependent variables are id en tified as the p ractices and b eh av io u r o f stu d en ts, as w ell as knowledge and attitudes.

Culture, stereotyping and stigmatisation as risk factors for students
In South Africa, HIV is mainly spread through unsafe heterosexual practices; however, there seems to be a general inclination among students to stereotype certain groups as the carriers o f the disease (Uys & Alexander, 2002:296).
Research by Levine and Ross, 2002:104, recognized that students stigmatised the following groups as carriers of HIV: a) homosexuals, b) promiscuous people (heterosexuals or hom osexuals), c) prostitutes, d) drug addicts and e) poor black people living in rural areas.Existing stereotypes w ere also investig ated among students at the University o f the Free State.When students were asked whether they perceive homosexuality or heterosexuality to be more strongly asso ciated w ith HIV and A ID S, a statistical significant correlation was demonstrated between students from an African cultural background, gender and their viewpoint that there is a stronger relationship between homosexuality and HIV/AIDS ( f = 26.796;df = 4; p = 0.000).
Seventeen (17%) of males and 11% of fem ales from an A frican cu ltu ral background viewed homosexuality as having the strongest relationship with HIV and AIDS.However, a total of 23% o f female students in this empirical study felt neutral in this regard.
Gender also plays a role in a person's views regarding which groups they believe are m ore in clin ed to be responsible for the spread of HIV.The lite ratu re on g en d er provides overwhelming evidence o f the influence of submissiveness.The fact that a larger percentage of male students admitted to being sexually active, may be linked to male students striving to be seen as masculine by their peers.However, it is important to mention that our data may not be a totally true reflection.According to De Wet (2006) research findings indicated that, when sexual matters are discussed, men tend to over report and woman tend to underreport.
M asculinity m ay be placed on a continuum between what is seen as masculine and "macho", and what is seen as refined or being a "sissy".In order to earn the label o f 'masculine and macho', m ale students have to m eet certain expectations.As at other universities the risk for m ale students lies in these expectations, and includes having several sexual partners (Selikow, Zulu & Cedras, 2002:24).
When participating male and female students from W estern cu ltu ral backgrounds were asked how many sexual partners they have had in their lives thus far, the following results proved to be statistically significant (%2= 18.677; d f= 4 ;p = 0.001).
The majority of Western male students (17%), admitted to having had five of more partners, while only 4% of the female students indicated that they had had more than five sexual partners.With regard to Western female UFS students, 23% of sexually active females (reflecting the majority of the female sample) stated that they had had only one sexual partner since becoming sexually active.

Financial status, gender and sexual activity -African cultural perspectives
The South African literature makes it abundantly clear that financial status is a major risk factor, often influenced by gender.A lower economic status adds to the problem of female students having unwanted sexual relationships (Evian, 2003:204) Ntuli, 2001:67-69).Female students from A frican cultural backgrounds often believe that not using a condom will enhance their social status with their male partners.In both African and Western cultures, gender may influence the use of the male condom as a barrier against HIV and AIDS (Harrison, et al., 2001:67-69).Since the male student controls the use of the male condom, every sexual encounter requires negotiation between partners (Marcus, 2002:3).The results of the follow ing statem ents related to condom use will now be displayed and discussed in  (Seloilwe et al., 2001:204).
Several researchers have found that the use o f condoms as a way of protecting oneself against HIV infection, is viewed in a negative light (Marcus, 2002:8-9;Skidmore & Heyter, 2000:31;Serlo & Aavarinne, 1999:469).It is of serious concern that the majority o f students from an African cultural background (male and female) were uncertain when asked whether a condom diminishes pleasure during sex.A total number of 128 (56%) o f African students from the sample of 228 who answered this question, showed uncertainty.From Table 1 it is further evident that a statistical significant correlation was found with regard to this statement.In addition, the majority of stu d en ts from a W estern cultural background (20 % of the male students and 42% female students) do not agree w ith the statem ent "condom use d im in ish es p leasu re during sex" , demonstrating a statistical significant correlation.Moreover, these research fin d in g s dem o n strate that a clear distinction may be drawn between UFS students from an African or Western cultural background.Whereas students from an African cultural background showed uncertainty in this regard, the majority o f students from a Western cultural background stated that they do not believe that condom s dim inish pleasure during sex.
The fact that some students may choose to use condoms only during casual sexual encounters makes them vulnerable to HIV infection from their long-term sexual partners.Students who frequently make a negative association between physical pleasure and condom use, raise the risk o f HIV infection.With regard to the following statement "not using a condom indicates permanency in a relationship", a statistically significant relation was dem onstrated for students from an African cultural background.A total number o f 66% of the participating male and female students from an African cultural background disagreed with the statement.When looking at the findings more closely, some interesting data is revealed.A greater percentage of African female students (43%) than male students (23%) disagreed with this statement.The fact that the remaining percentage of respondents either indicated uncertainty (26%) or agreed (8%) with this statement, can possibly be attributed to the fact that (according to research), the associations made by students between love, passion and trust combine in such a way that asking about p revious sexual relationships and requesting condom use during sex are deemed inappropriate (Levine & Ross, 2002:94).
Furtherm ore the data in the present study, indicated that that the majority of African UFS students (54%) indicated that they were mainly concerned about unwanted pregnancy during unprotected sex.A statistically significant correlation existed between students from an African cultural background, gender and their opinions regarding the posed question (X2 = 16.869;df= 2; p = 0.000).Research findings also show that male students (32%) seem to be more concerned about unwanted pregnancy during unprotected sex than female students (22%).These findings concur with the findings o f researchers at other universities (Marcus, 2002:8-9;Skidmore & Heyter, 2000:31;Serlo & Aavarinne, 1999:469).

Gender and multiple partnering
As seen in Western and African cultures in South Africa, male dom inance in society plays a m ajor role in the behaviour of female students.The female is expected to be submissive to her male partner, and to raise their children (Ferrante, 2003:342).The man is expected to be a leader in the community, and in family life (Taylor, Peplau & Sears, 2000:247).M ale students are often expected to prove their masculinity by having several sexual partners, having control over w om en, and ow ning expensive items (Selikow, et al., 2002:24).Statistical significant data that focus on gender and m ultiple partnering will subsequently be reflected in Tables 2 and  3 and will be discussed in the next section.
The following statements were posed to the students: • It is acceptable for a woman to have more than one sexual partner-A frican cultural background.

•
It is acceptable for a man to have more than one sexual partner-A frican cultural background.was unacceptable for a woman to have more than one sexual partner (X: = 11.845;d f= 2 ;p = 0.003).

It is clear from
From Table 3 it is further evident that the m ajority o f A frican students (85%) indicated that it is unacceptable for a man to have more than one sexual partner.A statistically significant relation was demonstrated for UFS students from an African cultural background regarding this statement (x2= 22.889; d f = 3; p = 0.000).However, this finding seems to be contradicted in literature.Literature findings suggest that having more than one sexual partner is considered more acceptable for male students than for female students (Coetsee, 2007:13).
From the findings and discussions above the researchers can conclude that it Being away from home makes is easier to experiment with sex -

African cultural perspectives
When students leave their homes, they are also leaving behind the rules and regulations of a controlled environment; in addition, they are at an age where they enjoy autonomy (Strydom & Strydom, 2002:263-264).Thus, this newfound freedom may make it easier for them to experiment with sex.It is clear from Table 5 that the majority of the participating sample (84%) stated that they thought it was better to wait until marriage before having sex.A statistical significant correlation was obtained (x2 = 15.852;d f = 2; p = 0.000).This results however, seem to contradict previous data obtained from this questionnaire which focus specifically on the high risk sexual behaviour o f students (sexual activity the past six months and the number o f sexual partners they have had).An assumption is that this point of view may be ascribed to experience gained from sexual activity, or could be a cultural belief that is not being applied.

Conclusion
An in-depth analysis was done by using con tin g en cy tab les to evaluate information collected during a survey in August 2006 among residence students at the UFS.Main outcome measures included e stab lish in g po ssib le relationships that existed between culture (A frican and W estern), gender and students' viewpoints regarding HIV/ AIDS-related knowledge, stereotypes and high risk sexual behaviour.
Data in this empirical study revealed the following important statistical significant relationships between UFS students' cultural background, gender and certain viewpoints regarding high risk sexual behaviour.The view that homosexuality is associated more strongly with HIV/ AIDS than heterosexuality supports the findings o f previous studies at other universities, namely that stereotyping and stigmatisation make students more vulnerable to H IV /A ID S infection.Twenty eight (28%) o f students from African cultural backgrounds viewed homosexuality as having the strongest association to HIV/AIDS, while data regarding p o ssib le cu ltu ral stigmatisation indicated that African students m ore stro n g ly asso ciated African students with the HIV/AIDS disease.Although the majority o f African students indicated that it is unacceptable to give your sexual partner gifts in exchange for sex, data obtained from the survey revealed that these practices may indeed be taking place at the University of the Free State.
A significant statistical relationship was found in both students from African and Western cultural backgrounds when asked whether they believed that condom use diminishes pleasure during sex.The majority o f students from a Western background disagreed, w hereas the majority o f male students from an African background agreed and most females were uncertain.
The general conclusion that can be drawn is that the views of students from a Western cultural background on sexual matters are more closely associated than those of students from an African cultural background, w here there is a big difference between the views of male and female students within this group, on sexual matters.
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