Knowledge , attitudes and practices related to HIV / AIDS among learners in Vhembe district of Limpopo Province

The purpose of this study is to investigate the knowledge, attitudes and practices related to HIV and AIDS among teenagers in rural schools in Vhembe district. This study focused on teenagers’ sources of knowledge about HIV/AIDS; their knowledge of how to avoid contracting HIV/AIDS; their knowledge of the methods of transmission of the disease; their knowledge of condoms and usage levels; and people with whom they are comfortable to talk about HIV/AIDS. This was a quantitative descriptive research design where a random sample of 128 participants between the ages of 14 and 19 years was selected. The participants were in grades 8 to 12. The study recommended that holistic HIV/AIDS preventive programmes which were culture and gender sensitive be developed. Custodians of culture should be involved in dealing with HIV/AIDS. Parents should also play their role in discussing HIV/AIDS with their children in a non-threatening environment.


Introduction
HIV/AIDS is one o f the fastest-spreading epidemics in the world.There are 42 million people living with HIV worldwide, and m ore than h a lf o f them are adolescents (UNAIDS, 2003).HIV/AIDS is a threat to all age groups, especially those that society relies on for economic prosperity.Research conducted in South A frica (P e ttifo r, R ees, S teffenson, Hlongwa-Madikizela, MacPhail, Vermaak & Kleinschmidt, 2004:10) indicates that the prevalence rate o f HIV was 10.2% among the 15-24 year-olds.This makes HIV and AIDS not only a health issue but a developmental problem as well, since the majority o f the sufferers cannot fully contribute to society, as they tend to suffer from opportunistic infections and are mostly unwell.

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Curationis September 2007 AIDS is therefore a major health crisis, a threat to economic developm ent and social solidarity (N attrass, 2004:13).Dewaal (2003:11) argues that the impact o f AIDS on econom ic developm ent amounts to a development process run in reverse.In South Africa about 5.3 million people are living with HTV (HJORT, 2006:1).The burden of HIV and AIDS is not equally shared among the population as it affects the poorest more than other sectors o f the population.
Information about HIV/AIDS is available in the world but such knowledge does not guarantee change in behaviour.De G aston, Jen se n , W eed and Tanas (1994:267) argue that there is a weak association between sexual knowledge, a ttitu d e and b eh a v io u ral change.
U n d erstan d in g sex u al cu ltu re is important in understanding the AIDS pandem ic (Crothers, 2001;Nattrass, 2004:27).
There is a need to revisit the available preventive strategies such as HIV and AIDS education programmes, condom distribution, as well as the introduction o f life-skills programmes in schools to track their impact on curbing the spread o f the pandemic.According to UNICEF (2 0 0 4 :2 ), H IV /A ID S edu catio n programmes did not succeed in changing behaviour as there was over-emphasis on p ro v id in g in fo rm atio n on the pandemic without focusing on attitudes, values and skills related to hum an sexuality, social norms and gender issues.Furthermore, HIV and AIDS-specific services were not comprehensive.There was a lack o f psycho-social skills, and teachers were not adequately trained and supported (UNICEF, 2004:2).
The high teenage-pregnancy rate is attributed to the inaccessibility o f free confidential family planning, and poor communication with parents regarding safe sexual practices (Hopkins, 2000:16).The lack o f youth friendliness services also contributes to the inaccessibility of serv ices to teen ag ers (A dam chak, 2005:17).
Knowledge, attitudes and behavioural practices among school-going teenagers are important areas of research in a bid to understand what can be done to arrest the spread o f the HIV and AIDS epidemic.Statistics show that young people (10-24 years of age) account for more than 50% o f all HIV infections worldwide (UNICEF, 2004:1).
Although teenagers appear to be the group most ignorant about sex, they are reported to be more likely to be exposed to the risk o f HIV infection through their risky sexual behaviour and irresponsible conduct.This state of affairs is articulated by Fraser (2004:2), who argues that our world has been subjected to the tragedy of being in a "permissive society imposed upon us by the global secular trends", which has exposed our children to the dangers o f contracting HIV and AIDS, where social norms and values are rapidly being eroded.
T eenagers are at a high risk o f contracting HIV/AIDS as they are still at an exploratory stage regarding sexuality.Allard-Hendren (2002:158) argues that teenagers are becoming sexually active at an earlier age and without using any c o n tra c e p tio n ; m ay be victim s o f unplanned pregnancies.Involuntary sexual activities among girls who are y o u n g er than 14 years are at 74% (Kalmus, Davidson, Cohall, Laragus &C assel, 2003:87). A dam s andEast (2002:202) indicate that girls find it difficult or impossible to negotiate for safe sex because many o f them are coerced into their first sexual experience, mostly by older men who usually have multiple sexual partners.This situation of unequal power relations further compromises the decision-making processes as these older and more experienced men are also in charge o f making decisions on condom use, while their [women partners] are passive (Kalmus et al., 2003:87).This ex p o se s them to o th er sex u allytransmitted infections as well as HIV and AIDS.
Dickson, Tetteth and Foy (2000:2) are of the op in io n that teenagers usually engage in short-term sexual relationships that may lead them into having four or more successive sexual partners.This is irresponsible sexual behaviour that predisposes them to HIV infection.A study conducted in the Bushbuckridge area o f Limpopo Province on perceptions o f teen a g ers re g ard in g teen ag e p re g n an cy rev ealed th at p o o r sex education, peer influence and lack o f access to health-care services were associated with high teenage-pregnancy rates (Richter & Mlambo, 2005:65-67).
In a study o f knowledge o f and attitudes towards AIDS among female college stu d e n ts in N agasaki in Japan, M asw anya, M oji, A oyagi, Y ahata, Kusano, Nagata, Izumi and Takemoto (2 0 0 0 :2 ), found th at th ere w as a d isc re p a n c y w ith reg ard to AID S prevention among college students as well as the development o f desirable attitudes towards people with HIV and AIDS.Mass media was viewed as the main source o f information; acceptance o f someone with HIV and AIDS was a sso c ia te d w ith know ledge o f the pandem ic.T hey su g g ested that edu catio n program m es in co lleg es should aim at reducing the discrepancy b etw een general k n ow ledge and desirable attitudes regarding HIV and AIDS.Maswanya et al. (2000:2) argue that the media tend to overemphasize the dreadfulness o f HIV infection and this m ay produce irrational attitudes towards those with HIV and AIDS, especially in cultural context, and ignorance may lead to unnecessary fear and uncertainty among teenagers.
Studies by De Gaston, Jensen, Weed and Tanas (1994:267) and UNICEF (2004:2) have shown that there is no correlation between the amount o f knowledge and change in behavioural patterns.This m eans that even w hen people have knowledge regarding HIV and AIDS it does not necessarily mean that there will be behavioural change.Robinson, Dortzbach, Kiiti, Amalemba, Rakama, Hayman and Wamae (1996:335) indicate the im portance o f involving o th e r stak eh o ld e rs such as church leaders in enhancing behavioural change in preventing HIV, and also advocate the importance o f caring for those affected by the pandemic in their communities and ch u rch es.This study p ro p o ses the draw in g up o f p o lic ie s, p lan s and activities that will be used to control the upsurge o f the disease.The churches were seen as critical and natural first lines o f defence.This study also suggested the importance of considering the design, im p le m e n tatio n , m an ag em en t and evaluation o f effec tiv e, cu ltu rallyappropriate and locally sustainable HIV and AIDS program mes.It found that culture is the foundation upon which behaviour is built.Core values are important in behavioural change.

Problem Statement
The increasing num ber o f infections raises a serious concern regarding the current preventive measures in place.About half of the people living with AIDS in Southern Africa live in South Africa w here the death rate has increased dramatically in the age group o f 15-39 (Nattras, 2004:24).
In South Africa more than 30% of 19-yearold girls have given birth at least once (De Wet, Kaufman & Staundler, 2000:1).In the Vhembe district, our area of focus for this study, statistics indicate that the district had 2072 births from teenagers below the age o f eighteen within six months in 2003 (Health Statistics, 2003).The number o f teenagers who requested termination o f pregnancy was 386 during 2003 in the Vhembe District (Department of Health Statistics, 2003).Based on these statistics we can deduce that these teenagers were not practicing safe sex.Despite the preventive strategies, HIV and A ID S sta tis tic s ap p e ar to be increasing and the death toll among ec o n o m ic ally p ro d u ctiv e people is increasing.There is a need to step up the intervention to slow down the spread of HIV and AIDS.It is therefore important that knowledge regarding HIV and AIDS among teenagers be explored, and their attitudes as well as their behavioural practices be identified in order to develop preventive programmes that will enhance behavioural change so as to eradicate the disease.

Purpose
The overall aim o f the study is to assess the level o f knowledge, attitudes and behavioural practices related to HIV prevention among learners in one o f the rural schools in Vhembe district.

Validity and reliability
The questionnaire was developed in consultation with a statistician, and then a language specialist was consulted to assist w ith the tra n sla tio n o f the questionnaire into Tshivenda (a local language).The questionnaires were pre tested to check for clarity of items, time spent completing each questionnaire and co n sisten cy o f resp o n ses.The questionnaires were given to 10 learners who were not included in the study.They all completed the questionnaire within 20-30 m inutes and they understood the questions.

Data collection
Structured questionnaires consisting of closed-ended questions were used to collect data.The questionnaire was divided into the following sections: The first section included information on age, sex and grade.The second part assessed the level o f know ledge regarding HIV and AIDS which included methods o f transm ission, prevention, how they got the information, and if they were to choose, whom they would prefer to teach them about HIV and AIDS.The qu estio n s g e n e ra lly en tailed b asic knowledge o f HIV and whether they knew what a condom was and whether they had used one before.The questions were developed in English and translated into Tshivenda.
The researcher and an assistant visited the school and d istrib u te d the questionnaires to every third learner's desk.It took learners 20-30 minutes to complete the questionnaire.

Data Analysis
Statistical Package for Social Sciences (SPSS) version 14 was used to analyse data.D e sc rip tiv e sta tis tic s o f percentages and graphs were used to describe sources o f information on HIV and A ID S, p re fe rre d so u rces o f in fo rm atio n , k n ow ledg e re g ard in g prevention o f HIV and AIDS as well as their behavioural practices.

Ethical considerations
Ethical measures were adhered to as permission for the research was sought from traditional leaders and the principal o f the school.Most respondents were underage and therefore permission was sought from their parents/guardians.The principal o f the school arranged for a meeting with the traditional leader who allowed the researchers to visit the village during their usual meetings at the kraal to explain the intended study to the parents.A fter a detailed explanation parents gave permission for their children to be involved in the study.Learners were requested to give permission and they were also inform ed that they could withdraw at any time if they did not feel like com pleting the questionnaires.
Anonymity was ensured as they were not expected to write their names on the

Sources of information
Graph 1 presents data collected from grade 8 to 12 learners on their sources of information about HIV and AIDS.From the data collected three sources were identified, namely peers, friends and parents.
It was noted that knowledge o f HIV and AIDS was gathered mostly from friends, followed by peers and parents.Pupils in g rades 9 and 12 got m ost o f th eir information about HIV and AIDS from friends.Among the grade 8, 9 and 10 pupils, their parents did not feature among the people who talked to them or informed them about the epidemic.It was found that about 3% o f the parents provided information on HIV and AIDS to their children in grades 11 and 12.
E d u catin g ch ildren at this level is considered very late since most o f the children are already sexually active.
Based on the data presented above, it is strongly recom m ended that parental guidance for children should start at an e a rlie r age befo re they sta rt th eir secondary education.At secondary education stage, it is a critical stage when they need to be informed more about the dangers o f HIV and AIDS.

Source of knowledge
Information on source o f knowledge is presented in figure 2.
On the sources o f knowledge about HIV/ AIDS, figure 2 presents high school learners' perspectives based on gender (male and female).The most highly-rated source o f information for both sexes (41,3% male and 40% female) is the radio.The outcome on source o f knowledge is influenced by the availability o f resources.For example, a television set is a luxury in this environment, while the radio is a common source o f information.
It was interesting to note that males' other sources o f information about HIV/AIDS were clinic nurses (15,9%), followed by friends (14,3% ) and the new spaper (14,3%), which rated higher than all other sources o f knowledge.Females on the other hand relied on clinic nurses (23,3%) and newspapers (20%) and very few (5%) indicated that they had heard about it from friends.Parents and church leaders were rated among the least-consulted sources o f inform ation.T his is so because most parents and church leaders do not create an environment that allows for free discussion o f sexual issues, including HIV and AIDS.

Comfortable to talk to about HIV/ AIDS
The collected data was analysed in such a m anner that perspectives also took issues o f gender into account.According to the data (figure 3), female teenagers felt comfortable talking about HIV and AIDS with their parents (38.6%) and friends (24,6%), followed by teachers (14%) and nurses (10.5%).We could ascribe the female level o f comfort in talking to their parents to the fact that most o f their families were composed of single parents who were likely to be mothers, while their male counterparts would prefer friends (35.5%), followed by parents (21%), then nurses (19,4%) and teachers (17,7%).It is interesting to note that both female and male pupils seemed to be less comfortable talking about this epidem ic w ith p eer ed u c ato rs and traditional healers, as these categories scored lower (both at 3,2% -3,5%) than other categories.The ideas presented by the participants in this study about whom they trusted when it came to talking about this topic, suggested that boys still preferred an egalitarian environm ent when it came to comfort in talking about HIV/AIDS.Girls, on the other hand, still wanted to be connected to people whom they assum ed to po ssess su p e rio r know ledge about the ep id em ic.Interestingly, both m ales (21% ) and females (36%) felt comfortable talking about HIV/AIDS with their parents.This data presents a challenge to the present health system as it suggests that teen a g ers are less in fo rm ed about pregnancy, childbirth and breast-feeding as com m on m eans o f contracting or transm itting HIV and AIDS, even to unborn babies and infants.

Knowledge about HIV transmission methods
There might be a need to acknowledge that if societies are not open about the divergent modes o f transmission so as to offer holistic educational programmes to the teenagers, the scourge o f HIV and AID S w ill tak e a long tim e to be combated.where you can get a condom?condoms?
Males Females

Knowledge about the ABC of preventing HIV transmission
With regard to knowledge on prevention o f the transmission of HIV and AIDS, the use o f condoms rated high in all grades among the high school learners, whilst abstinence from sex rated second, and staying with one partner rated third.
A voidance o f sex w ith non-regular partners rated the least in all grades.This data tends to suggest that as early as grade 8, which is the cohort group o f 14 -15-year-olds, cited condom as the preferred way o f preventing transmission o f the virus.This goes against the common wish that children at these ages should regard abstinence as the most preferred mechanism against the spread of HIV and AIDS.Using a condom in this list should be portrayed as the last resort, if one fails to abstain or be faithful.(See figure 5) The use of condoms Knowledge about condoms and where to get them was well demonstrated by both m ales and fem ales, as they all affirmed yes.They presented themselves as having a clear idea o f what a condom is.They were also aware o f where to get them.A difference in responses between genders was also observed (males 90.9% and females 86%).The responses to these questions might be ascribed to the fact that girls could not request their sexual partners to use condoms, or if they requested them to do so, their partners refused to use condoms.This revealed th at fem ales w ere not em p o w ered regarding their sexual practices.Findings revealed that both sexes felt comfortable talking about HIV/AIDS with their parents, so it is important for parents to create an atmosphere that will enhance discussion o f HIV/AIDS and not wait until so m eth in g goes w rong.

Figure 1
Figure 1 Sources of information about HIV/AIDS

Figure
Figure 2 Source of knowledge about HIV/AIDS

Figure 3
Figure 3 Who would you feel comfortable to talk to about HIV/AIDS

FigureFigure 5
Figure 4 Knowledge of methods of transmission HIV and AIDS preventive programmes should be holistic and culture sensitive.Program m es should also targ et the a v a ila b le re so u rces w ith in the community.It is important to develop innovative strategies in the prevention of HIV/AIDS.Intervention programmes should be d ev e lo p e d to en h an ce behavioural change that incorporates cultural practice.Parents/guardians should take their roles as parents and should start to discuss sexuality issues with their children as they are m ost trusted by th eir own children.They should start sexuality education at an early stage in life before the child start secondary education.
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