A recent study of secondary school leavers in the Pietermaritzburg township areas, conducted by the HAPS Project, revealed that many learners lack the knowledge they need to protect themselves from HIV. Previous South African studies have shown that most learners, especially at the secondary level, are aware of the causes of HIV and the seriousness of HIV/AIDS. The discovery of high knowledge levels has prompted the government to move ‘beyond awareness’ in its campaign to focus on the building of essential HIV/AIDS prevention skills among adolescents, such as risk assessment, planning, and communication. While these skills are critical, the present study shows that key deficiencies in learners’ HIV/AIDS knowledge persist. The HAPS Project survey was administered to 1 200 Grade 8 and 9 learners at five Pietermaritzburg-area township secondary schools in May 2002. Schools were selected on the basis of similar characteristics, i.e., more than 99% of the learners spoke Zulu as their first language, the schools charged similar school fees, and had no boarding learners. The survey was pilot-tested by asking township learners, who were not involved in the study, to complete selected questions and probing their understanding of the questions, as well as translating and back-translating certain questions (English-Zulu-English) to increase comprehensibility for a person whose first language is Zulu.
The survey revealed low knowledge levels in two key areas: efficacy of condoms for prevention and the characteristics of HIV infection. Previous studies have generally found that adolescents have high knowledge of the efficacy of condoms for HIV prevention, but 53% of the learners surveyed by the HAPS Project either did not know or did not believe that condoms will protect a person from getting H IV.’ The HAPS survey also showed that 49% of learners believe that most people with AIDS look sick. If learners fail to appreciate the fact that an infected person may be asymptomatic, they will obviously fail to recognise the danger of unprotected sex with someone who looks healthy. This finding corresponds with evidence from a previous study showing that although many learners recognise HIV/AIDS as a generalised public health problem, few perceive themselves to be personally at risk of being infected (LoveLife, 2001). Still other studies have shown that interpretation of risk tends to be informed by subjective beliefs about who is a high risk partner: ‘outsiders’ are often cited as the most likely to be infected. The perception among many adolescents that a person with HIV/AIDS will ‘look sick’ and that the disease is more likely to affect outsiders than people in one’s own social circle clearly places a barrier to learners personalisation of risk.
The question of at what point the policy makers should be satisfied that adolescents have enough knowledge of HIV/AIDS to move ‘beyond awareness’ depends on what is meant by ‘knowledge.’ Researchers and policy makers are increasingly aware that knowledge in the context of HIV prevention can be thought of as not simply an understanding of key concepts, but a means of knowing what to do or how to assess a particular situation. Hence, prevention efforts are rightfully emphasising the building of adolescents’ skills such as risk assessment and communication.
However, the research and policy communities do not seem as ready to stretch the concept of knowledge to include moral, as well as medical or clinical, knowledge as a basis for skills development. The power of knowledge cannot be realised without a belief structure supporting its application. An adolescent girl may know that a condom will protect her from HIV, but her knowledge is not useful in the context of a belief structure in which females are not viewed as having the right to withhold consent for sex or to have any say in the time, place, or manner in which it occurs.
The HAPS Project survey revealed that 52% of girls said that the first time they had sex, they had wanted it ‘not at all’ or ‘very little’. This finding is one indicator of the broader problem of gender-based violence in South Africa. Researcher Rachel Jewkes (2002) has asserted, ‘The experience of non-consensual or coerced sexual intercourse at some stage in a South African woman’s life is certainly the norm and may be little short of universal’ (p.1240). The fact that a woman s right to withhold consent for sex is routinely ignored in the South African context has direct implications for the spread of HIV. Adolescents’ perception that sex is a choice to be made by both partners rather than simply the right of a male is clearly the sine qua non of HIV prevention.
The prevalence of rape and sexual coercion in South African society and its implications for HIV suggest that it is just as essential for children to have knowledge of HIV/AIDS-related facts as it is for them to have knowledge of basic human rights, such as the right to life, or the right of a person to his or her bodily integrity. Prevention programmes should offer a moral framework that draws on constitutional and universal human rights principles. Such a framework would help learners understand the implications of human rights principles for their sexual behaviour. Public servants and scientists may be inclined to view a prevention programme with a moral grounding as inherently ‘unscientific’ or non-clinical. But it no longer serves adolescents to offer messages that seek to impart only clinical knowledge, while assuming that underlying structures of belief automatically support the application of that knowledge.