AN INVESTIGATION INTO THE 
KNOWLEDGE AND ATTITUDES 
OF SCHOOL GIRLS 
WITH REGARD TO SEXUAL PRACTICES 
AND AIDS 
BY 
MAUREEN MOGOTSI 
SUBMITTED IN FULFILMENT OF THE 
REQUIREMENTS FOR THE DEGREE OF MASTER OF 
SOCIAL SCIENCE (SOCIAL WORK) 
DEPARTMENT OF SOCIAL WORK 
UNIVERSITY OF THE NORTH WEST 
1 DECEMBER 1996 
SUPERVISOR: PROFESSOR W.W. ANDERSON 
(ii) 
DECLARATION BY STUDENT 
11 I declare that the dissertation for the degree of Master of Social Science in 
Social Work at the University of the North West hereby submitted, has not been 
previously submitted by me for a degree at this or any other university , that it is 
my own work and that all material contained herein has been duly 
acknowledged 11 • 
MAUREEN MOGOTSI 
30 NOVEMBER, 1996 
(iii) 
DEDICATION 
This dissertation is dedicated to the memory of my mother, Dorcas Mogotsi. Her 
determination in life instilled the value of education, discipline and ambition 
within me, I am truly indebted. Her love and integrity have become cherished 
memories for me. 
(iv) 
ACKNOWLEDGEMENTS 
At the very onset, my deepest appreciation goes to the Almighty God, for giving 
me the strength to complete this project. 
I acknowledge with gratitude the friendly guidance afforded me by Professor 
W.W. Anderson, my supervisor. His unfailing support helped to make this 
dissertation a reality. 
Many thanks to my colleagues in the School of Health and Social Sciences , at the 
University of the North West, who were kind enough to comment critically on 
the proposal and the development of the questionnaire. 
I am also indebted to Mrs Thandiwe Manong for her willingness and patience to 
type the report. Sincere thanks to Principals of high schools in the North West 
Province, who granted me the permission to undertake this study , in their 
respective schools. The research could also not have been possible without the 
cooperation of respondents. 
Finally my deepest thanks go to my family who expressed confidence in me and 
gave me support. It is difficult for me to express what their love, prayers and 
strength have meant in my life. You made it all worthwhile! 
(v) 
ABSTRACT 
In South Africa, HIV transmission is overwhelming on the basis of unsafe sexual 
practices. The future demography of the country depends on the sexual 
behaviour of the present generation. A healthy generation of young people in the 
1990's will ensure a healthy generation of adults needed in the 21st century. 
However AIDS threatens the existence of this next generation. 
This study was undertaken to determine the level of knowledge and attitudes of 
school girls with regard to sexual practices and AIDS. The major tools used for 
data collection were questionnaires and literature reviews. A sample of 488 
respondents was drawn from 12 high schools in the North West Province. 
The findings revealed that substantial proportions of school girls have 
11 superficial II know ledge about AIDS. This know ledge is characterised by lack 
of sufficient information, misconceptions and misperceptions. Their lack of 
sufficient knowledge is due to the fact that there is no formal education on AIDS 
offered in schools. 
The rev.i ew of literature, on prevention of AIDS, pointed to a need for education 
in schools. Involvement of the school is of utmost importance because of its 
potential to reach many young people. Moreover, virtually all young people are 
in schools before they initiate risk-taking behaviours. 
(vi) 
The study suggests therefore, that school based prevention programmes be 
introduced in schools. In addition, AIDS education should not be offered singly 
but be integrated in other strategies of prevention programmes. These may 
include life skills education and primary health education. 
Finally, the study submits that, to be successful prevention should focus on 
comprehensive team approach. Prevention is not a limited function of social 
workers, teachers or health practitioners, but it can be provided in a concerted 
effort by all these professionals, interested groups as well as parents. By this the 
spread of the disease can be minimized among young people. 
(vii) 
LIST OF TABLES 
PAGE 
TABLE 1 THE FIRST SOURCE OF INFORMATION 
ABOUT SEX 85 
TABLE 2 ATTITUDES WITH REGARD TO PREMARITAL 
SEXUAL INTERCOURSE 87 
TABLE 3 AGE GROUP AND KNOWLEDGE ABOUT AIDS 88 
TABLE4 WAYS OF AIDS TRANSMISSION 89 
TABLE 5 CURE FOR AIDS 93 
TABLE6 KNOWLEDGE AND EDUCATION LEVEL 94 
TABLE 7 SIGNS AND SYMPTOMS OF AIDS 94 
TABLE 8 SIGNS, SYMPTOMS AND GEOGRAPHICAL 
AREAS 95 
TABLE 9 ATTITUDES TOWARDS SEXUAL INTERCOURSE 
BEFORE HEARING ABOUT AIDS 104 
TABLE 10 AWARENESS OF AIDS AND CHANGES 
MADE TO SEXUAL ACTIVITIES 104 
TABLE 11 CHANCE OF INFECTION WITH HIV 105 
TABLE 12 NO RISK TO CONTRACT AIDS 106 
TABLE 13 THE BEST CONTRACEPTIVE METHOD 107 
TABLE 14 RESPONSIBILITY FOR PROTECTION AGAINST 
AIDS 108 
TABLE 15 REASONS FOR UNPREPAREDNESS TO 
UNDERGO BLOOD TEST FOR AIDS 110 
TABLE 16 BEST METHOD TO COMMUNICATE AIDS 
INFORMATION 111 
TABLE 17 WAYS OF PREVENTING AIDS SPREAD IN 
SCHOOLS 113 
(viii) 
LIST OF FIGURES 
PAGE 
FIGURE 1 FIRST SEXUAL ENCOUNTER MAY RESULT 
IN HIV INFECTION 90 
FIGURE 2 HIV IS THE VIRUS THAT CAUSES AIDS 91 
FIGURE 3 THERE IS A DIFFERENCE BETWEEN HIV 
AND AIDS 92 
FIGURE 4 HIV INFECTED PERSONS SHOW SIGNS OF 
THE DISEASE AFTER INFECTION 96 
FIGURE 5 HEALTHY YOUNG PEOPLE DO NOT GET AIDS 97 
FIGURE 6 HIV INFECTION CAN BE RECOGNISED IN A 
PERSON'S PHYSICAL APPEARANCE 98 
FIGURE 7 HIV INFECTED PERSON WHO APPEARS 
HEALTHY CAN INFECT OTHERS 99 
FIGURE 8 AIDS VICTIMS CAN LIVE FOR MANY YEARS 
WITHOUT BEING ILL 100 
FIGURE 9 OPPOSITE PARABLES 102 
FIGURE 10 BLOOD TEST CAN DETERMINE AIDS 
INFECTION 109 
FIGURE 11 WILLINGNESS TO UNDERGO HIV BLOOD 
TESTS 109 
FIGURE 12 BEST PROFESSIONALS TO COMMUNICATE 
AIDS MESSAGES 112 
(ix) 
TABLE OF CONTENTS 
PRELIMINARIES 
(i) TITLE PAGE 
(ii) DECLARATION 
(iii) DEDICATION 
(iv) ACKNOWLEDGEMENTS 
(v) ABSTRACT 
(vii) LIST OF TABLES 
(viii) LIST OF FIGURES 
(ix) TABLE OF CONTENTS 
PAGE 
CHAPTER ONE : INTRODUCTION AND GENERAL 
ORIENTATION 1 
1.1 INTRODUCTION 1 
1.2 THE STUDY AREA 3 
1.3 STATEMENT OF PROBLEM AREA 5 
1.4 OBJECTIVES OF THE STUDY 5 
1.5 MOTIVATION FOR THE STUDY 6 
1.6 ASSUMPTION OF THE STUDY 6 
1.7 LIMIT A TIO NS OF THE STUDY 6 
1.8 DELIMITATIONS 7 
1.9 DEFINITIONS OF CONCEPTS 7 
1.10 METHODOLOGY 9 
1.10.1 RESEARCH DESIGN 9 
1.10.2 METHODS OF DATA COLLECTION 9 
1.11 SAMPLING 11 
1.12 PILOT STUDY 12 
(x) 
PAGE 
1.13 DATA ANALYSIS 13 
1.14 PRESENTATION OF DATA 13 
CHAPTER TWO : AIDS - AN OVERVIEW 14 
2.1 INTRODUCTION 14 
2.2 AIDS-THE BACKGROUND 14 
2.3 THE ORIGIN OF AIDS 18 
2.4 AIDS - A GLOBAL PROBLEM 21 
2.5 AIDS IN AFRICA 22 
2.6 AIDS IN SOUTH AFRICA 24 
2.7 THE CURRENT STATUS OF THE AIDS EPIDEMIC 
IN SOUTH AFRICA 24 
2.8 FUTURE OF THE AIDS EPIDEMIC 26 
2.9 THE IMPACT OF AIDS IN SOUTH AFRICA 29 
2. 10 CONCLUSION 30 
CHAPTER3: UNDERSTANDING THE DISEASE 31 
3.1 INTRODUCTION 31 
3.2 FROM HIV INFECTION TO AIDS 31 
3.3 HIV INFECTION 32 
3.4 THE CASE DEFINITION OF AIDS 35 
3.5 MODES OF TRANSMISSION 35 
3.5.1 BLOOD 37 
A. BLOOD TRANSFUSION 37 
B. NEEDLE AND SYRINGE SHARING 38 
C. INJECTIONS 38 
3.5.2 SEMEN AND VAGINAL SECRETIONS 39 
(xi) 
PAGE 
A. HETEROSEXUAL INTERCOURSE 40 
B. ANAL INTERCOURSE 41 
C. FEMALES 41 
D. ORAL SEX 42 
E. MASTURBATION 42 
F . SEXUALLY TRANSMITTED DISEASES 42 
3.5.3 VERTICAL TRANSMISSION - MOTHER-CHILD 42 
3.6 RISK GROUPS 43 
3.7 CONCLUSION 44 
CHAPfER4: HUMAN SEXUAL BEHAVIOUR AND 
ATTITUDES TOWA RD AIDS WITH 
SPECIAL REFERENCE TO AIDS 45 
4.1 INTRODUCTION 45 
4.2 HIGH RISK SITUATIONS 46 
4.2.1 THE SOCIAL STATUS OF FEMALES 46 
4.2.2 ECONOMIC FACTORS 47 
4. 2.3 MOBILITY 48 
4.3 FEMALE ADOLESCENTS 49 
4.4 THE IMPA CT OF AIDS ON FEMALES IN 
SOUTH AFRICA 52 
4.5 UNDERSTANDING HUMAN SEXUAL BEHAVIOUR 53 
A. SOCIO ECONOMIC FACTORS 55 
B. SOCIALIZATION PROCESS 55 
C . CULTURE 56 
D. ALCOHOL AND DRUG USE 57 
E. PORNOGRAPHY 58 
4.6 KNOWLEDGE WITH REGARD TO AIDS 58 
(xii) 
PAGE 
4.7 ATTITUDES TOWARD SEX 60 
4.8 ATTITUDES TOW ARD AIDS 62 
4.9 CONCLUSION 63 
CHAPTERS: PREVENTION OF AIDS 64 
5.1 INTRODUCTION 64 
5.2 BASIC CONCEPTS AND DEFINITION 64 
5.3 PRIMARY PREVENTION 65 
5.4 STRATEGIES OF PRIMARY PREVENTION 66 
5.5 GLOBAL STRATEGIES 66 
5.6 SCHOOL-BASED PREVENTION PROGRAMS 68 
A. CULTURE 69 
B. SUPPORT OF PARENTS 69 
C. EDUCATION LEVEL 70 
D. METHOD OF TEACHING 70 
E. CONTENT OF EDUCATION 71 
5.7 THE ROLE OF TEACHERS IN AIDS EDUCATION 73 
5.8 COMPREHENSIVE SCHOOL-BASED PROGRAMS 74 
5.9 THE AIDS EDUCATION PROCESS 75 
5.10 MASS MEDIA-BASED PREVENTION 76 
5 .10.1 TELEVISION 76 
5.10.2 RADIO 77 
5 .10. 3 LOCAL NEWSPAPERS , MAGAZINES AND 
DIRECT MAIL 77 
5.11 LIMITATIONS OF THE MASS MEDIA 77 
5.12 THE FAMILY-BASED PREVENTION 78 
5.13 THE SOCIAL WORK BASE FOR PREVENTION 79 
5.14 THE HEALTH BELIEF MODEL 81 
5.15 CONCLUSION 83 
(xiii) 
PAGE 
CHAPTER6: PRESENTION AND ANALYSIS OF DATA 84 
6.1 INTRODUCTION 84 
6.2 DEMOGRAPHIC DATA 84 
6.3 KNOWLEDGE ABOUT SEX 85 
6.4 KNOWLEDGE ABOUT AIDS 87 
6.5 ATTITUDES TOW ARD SEXUAL INTERCOURSE 103 
6.6 PRECAUTIONARY MEASURES 106 
CHAPTER SEVEN : MAIN FINDINGS, CONCLUSION AND 
RECOMMENDATIONS 114 
7.1 INTRODUCTION 114 
7.2 RESTATEMENT OF THE OBJECTIVES 114 
7.3 GENERAL RESUME 114 
7.4 MAIN FINDINGS 115 
7.4 .1 KNOWLEDGE ABOUT AIDS 115 
7.4 .2 SOURCES OF INFORMATION REGARDING 
SEXUAL MATTERS 116 
7.4 .3 ATTITUDES TOW ARDS AIDS AND PREMARITAL 
SEXUAL INTERCOURSE 117 
7.4.4 SEXUAL BEHAVIOUR 118 
7.4.5 PREVENTION 119 
7.5 FINDINGS OF THE CURRENT STUDY IN TERMS OF 
SIGNIFICANCE DIFFERENCES IN EXPLANATION OF 
VARIABLES 119 
7.6 RECOMMENDATIONS 120 
BIBLIOGRAPHY 123 
APPENDIX 
1 
CHAPTER ONE 
INTRODUCTION AND GENERAL ORIENTATION 
1.1 INTRODUCTION 
Since the first identification of Acquired Immune Deficiency Syndrome (AIDS) by the 
Centre for Disease Control (CDC) in 1981, AIDS has continued to wreak havoc as one 
of the most serious epidemics of our time. The World Health Organisation (WHO) 
described AIDS as being one of the most serious health problems, and it is estimated 
that by the year 2000, there will be 40 (forty) million of cases including men, women 
and children (Wilkinson 1994:166-168). AIDS is now, one of the ten leading causes 
of death worldwide and if progress is not made in preventing its spread, we face the 
dreadful prospect of a world- wide death toll in tens of millions a few years from now . 
With the recent manifestation of AIDS, society is being confronted with an infectious 
disease of pandemic proportions to which medical science as yet has no answer. A 
decade has passed since the discovery of human immune deficiency virus (HIV) as the 
cause of AIDS (Seligson and Peterson, 1990:89) however, there is still no cure for 
AIDS. In the absence of a vaccine or any cure, prevention seems to be the only 
method for avoiding the devastating effects of the disease . 
Based on available data , scientists have concluded that AIDS is transmitted through 
various ways i.e. social contact, blood or other body fluids (Flitzpatric and Milligan, 
1987:6 ). However the bulk of the research carried out throughout the world has shown 
that AIDS is in the majority of cases transmitted sexually . To reduce the spread of 
AIDS, people have to fundamentally change their lifestyles including the most intimate 
ones. In this regard education can play a vital role to effect to requisite change . 
The present study is of the notion that a healthy , productive generation of adolescents 
in the 1990' s will ensure that South Africa has a healthy generation of 
2 
adults in the 21st century. The AIDS epidemic threatens the viability, perhaps the very 
existence of this and the next generation. 
Evidence exists that HIV infection has entered the adolescent population. According 
to Sapire (1990:47) more teenage cases of AIDS are acquired by heterosexual 
transmission. The reason advanced for this is that, adolescence is the period in the life 
cycle when risk-related sexual activities begin. Furthermore the most preferred method 
of sexual intercourse among this group is heterosexual intercourse. It should also be 
noted that the majority of adolescents become sexually active at an early stage (Van 
Coeverden De Groot and Greathead, 1987: 1). The combination of the abovementioned 
factors places adolescents at the risk of becoming infected with HIV. 
Although all adolescents are at risk of HIV infection, there is general consensus among 
experts that there is a changing pattern in the groups of people who are infected with 
AIDS (Schoub, 1994:99) . Females seem to be the highest group having AIDS. This 
trend is also evident in the latest figures on the number of AIDS cases reported in 
South Africa as given by the Department of Health (See Appendix 2 and 3) . These 
findings confirm the contention that wherever HIV transmission is predominantly 
heterosexual, women are infected with HIV in greater proportions and at an earlier age 
than men. 
The study was prompted by the concern of the researcher with regard to the alarming 
increase in the number of young women becoming infected by the virus daily 
throughout the whole world. The impact of AIDS is particularly devastating on women 
as its ramifications has a profound effect on women individually and in their multiple 
roles in society. Young women are regarded as a high risk population since they are 
exposed to strong pressure to experiment with sex (Mouli, 1992:6). 
The study was conducted in high schools situated in the North West Province . Schools 
are one of the institutions in society which are regularly attended by most young 
people. Moreover, virtually all youth are in schools before they initiate risk-taking 
3 
behaviours that may expose them to HIV. Thus schools are perceived as the 
public institution with the broadest opportunity for reducing HIV-risk taking 
behaviours. 
1.2 THE STUDY AREA 
The North West Province is one of the nine provinces forming the new South Africa . 
The community of this Province lives within a specific territory consisting of five 
regions, namely, the Central, Eastern, Far east, Southern and the Western regions (see 
the regions as indicated in the map attached). 
I-NWU l LJBRARy_ 
The Province is semi urban-rural, however most parts of the regions are rural. The 
province has approximately 205 schools and nearly 90 % of children in the province 
attend these schools . 
According to the AIDS statistical records , 471 people in the province are already 
infected with HIV (Epidemiological comments 95(v) 22). Although accurate statistics 
of female adolescents infected with AIDS are not available, there is a general consensus 
among experts that HIV is increasing largely among this group of the population. 
I NAl:lALIMt:ll 
PROVINCE 
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5 
1.3 STATEMENT OF PROBLEM AREA 
AIDS is invariably fatal and could become one of the leading causes of death in South 
Africa within the next ten years. According to Centre for Disease Control (CDC : 
1987:581-589) , in many regions , the number of persons infected with the AIDS virus 
is at least one hundred times greater than the reported cases . Although AIDS initially 
affected mainly homosexual men, there has been a dramatic increase in HIV infection 
among adolescents . It is already among the top five causes of death for young people 
between ages 15 to 24 (Diclemente, 1992:3) . If current trends continue it is inevitable 
that by the year 2005 many young people would have died of the disease . According 
to Hevesi (1989) as quoted by Diclemente (1992:4) by the year 2000, there will be 
20% fewer 15 to 24 year old's as a result of HIV infection than in 1980. Because of 
its rapid spread, AIDS has become a threat to human society. The international 
interdependence of nations in the fight against AIDS has often been emphasised. 
Demands for international co-operation have become common place in meetings and 
conferences . A vast amount of research is being done and the objective is clearly 
established to fight AIDS. However despite all the efforts made , the number of people 
infected increases daily. 
In order to influence young people to change their unsafe sexual behaviour, education 
campaigns are facilitated. In this regard recent studies (Diclemente, 1992:6, Mogotsi , 
1994:62, Kaya and Kau, 1993: 10) found that the majority of adolescents were 
knowledgeable of the disease however they have many misconceptions which make 
them highly vulnerable. Despite the knowledge held by students very few changed their 
unsafe sexual practices . These findings suggest that there is a need for research to 
investigate how AIDS knowledge can be translated into effective self protection action 
against HIV infection. The writer assumes that findings from this study will form a 
sound basis for the establishment of effective prevention programs in schools. 
1.4 OBJECTIVES OF THE STUDY 
The objectives of this study are as follows: 
6 
To determine the knowledge and attitudes of school girls regarding AIDS and 
prevention of HIV infection; 
To determine the knowledge and attitudes of school girls towards indiscriminate 
sexual intercourse as the major means of spreading of AIDS ; 
To assess the contribution which social workers can make in the prevention of 
AIDS ; 
To suggest practical recommendations for the prevention of AIDS . 
1.5 MOTIVATION FOR THE STUDY 
Although research about AIDS in the social sciences has increased, it should be pointed 
out that little is being done in the social work profession in terms of preventative 
action . The study is necessary since except for the classical writing and clinical 
approaches, few social scientific efforts have been undertaken with regard to AIDS and 
sexual matters . Sexuality is often implicitly regarded as a private affair. Transmission 
of AIDS through sexual contact forces researchers to look at behaviour and practices 
that might increase the risk for HIV/ AIDS infection. The present study hopes to arrive 
at strategies to prevent the spread of AIDS/HIV in schools. Furthermore it is hoped 
that the study will contribute information to the available body of literature for the 
understanding of AIDS in relation to sexual behaviour. 
1.6 ASSUMPTION FOR THE STUDY 
The following assumption was held throughout the study: 
Indiscriminate sexual intercourse increases the major spread of AIDS . 
1.7 LIMITATIONS OF THE STUDY 
As a result of conducting this study the following limitations can be noted : 
Due to the sensitiveness of the research topic, the researcher was forced to use 
7 
a self administered questionnaire (where respondents fill in the questionnaire 
on their own) instead of a personal interview as it afforded one greater 
flexibility in an attempt to elicit information. 
Young females who are not scholars were excluded from participating in this 
study. This is a major limitation as AIDS does not only affect scholars but all 
people. However, a pilot study was done on university students in 1994 in 
order to gain information from a group other than school girls . With regard to 
young females who do not attend school , the difficulty arises from the fact that 
they do not have any specific location where they can be encountered. 
Because the study will not cover the whole population, inferences cannot be 
made about the general population, but only with regard to female scholars. 
1.8 DELIMITATIONS 
The study was delimited in the following way : 
The subjects of the study were Black female students between the ages of 12 
and 22 years enrolled in the high schools of the North West Province. 
1.9 DEFINITIONS OF CONCEPTS 
The following concepts are defined as they are used in the study: 
Attitude - refers to a learned predisposition to behave in a consistent evaluative manner 
towards a person, a group of people, an object or a group of objects (Morgan, King 
and Robinson, 1981: 450). 
Sexual practices - for the purpose of this study sexual practices refers to sexual 
intercourse. 
8 
Sexual Intercourse 
Sexual intercourse also known as coitus or copulation refers to the union of two people 
of opposite sex in which the penis is introduced into the vagina, typically resulting in 
mutual excitation (Mosby's Medical and Nursing Dictionary, 1980:260) . 
AIDS - AIDS is the acronym for Acquired Immune deficiency syndrome. 
Acquired - means to get especially by one's own efforts or qualities (Universal 
Dictionary, 1986: 24). 
Immune - refers to a defence function of the body that produces antibodies to destroy 
invading antigens (Lerole, 1994:9). 
Deficiency - refers to a quality or condition of being deficient (Universal Dictionary, 
1986:409). 
Deficient - means lacking an essential quality or element, a shortage or insufficiency 
(Universal Dictionary , 1986:409) . 
Syndrome - refers to the combination of different abnormalities making up this 
condition (Lerole, 1994:9). 
Acquired Immune Deficiency Syndromes can be defined as the end-stage disease 
manifestation of an infection with a virus called HIV (Schoub , 1994: 19) . 
HIV - The full name of HIV is Human Immunodeficiency Virus. It is an infectious 
virus, which destroys the natural body defences and can spread from one person to 
another through a variety of routes (Lerole , 1994:9). 
School - refers to an institution for educating children or giving instruction (The 
9 
Concise Oxford Dictionary, 1983:938). 
Girl - means a female child from birth to about eighteen years of age (The World Book 
Dictionary, 1989:901). 
1.10 METHODOLOGY 
The research methods and procedures that were used to accomplish the purpose of the 
study are as follows: 
NW U . 
1.10.1 Research Design luBRAR'fJ 
Research design refers to the overall plan which includes every aspect 
of a proposed research study from the conceptualization of the problem 
right through to the dissemination of the findings (Grinnell , 1988:219). 
The descriptive research design was used in this study. A descriptive 
research design is the one which describes the characteristics of a 
population when the characteristics of interest are known (Reid, 
1984:71). It is used by investigators in order to make accurate 
statements about the characteristics of the individual situation. When 
using the descriptive approach the researcher does not manipulate any 
of the variables but instead, the researcher is interested in describing 
what is or what was (Bush, 1988:68). 
Since the present research is basically descriptive it will seek to 
describe the level of knowledge and attitudes of female students toward 
AIDS and related sexual practices. 
1.10. 2 Methods of Data Collection 
According to Reid (1984:9) data may be collected through 
questionnaires, interviews, observation of direct interaction and using 
available materials such as case records and statistical data. In addition, 
literature review and experience surveys can be used to gather available 
data . The following methods were implemented in gathering data: 
Literature Review 
Review of the literature can be defined as the systematic identification, 
location and analysis of documents containing information related to the 
research problem (Babbie, 1992: 11) . As such, it involves extensive and 
critical examination of publications relevant to the research project. 
Literature review focuses only on the information that have direct 
relevance to the present study . 
By reviewing the literature, the researcher accomplished two main 
goals , that is identifying and becoming familiar with all of the relevant 
published materials and composing this foundation so that it puts the 
present study into the context of the previous research. Background 
data was obtained by reading literature available such as books, 
magazines and articles related to the relevant topic, AIDS and related 
sexual practices. 
Personally Administered Questionnaires 
Data sometimes lie buried deep within the minds or within the attitudes, 
feelings or reactions of men and women. An instrument that could be 
used to observe beyond the physical reach is the questionnaire . 
Polansky (1976:62) defines a questionnaire as a common research 
instrument which comprises a series of questions that are filled by all 
participants in a given sample . In this study a questionnaire consisting 
of approximately 26 questions was developed by the researcher (see 
Appendix 1). 
The questionnaire was compiled in a way that it was composed of 
attitude statement questions and multiple choice questions where the 
respondents were allowed to choose one response from several fixed 
11 
alternatives . 
After compilation the questionnaires were distributed to the sample and 
collected by the researcher after the respondents completed them. 
Experience Surveys 
The researcher also conducted semi-structured research interviews with 
two experts who are more knowledgeable about the subject under study . 
Interviews were held with the following people: 
Ms Prudence Mabele, Researcher, employed by the Department of 
Welfare, statistics section The researcher held an interview with Ms 
P Mabele on the 17th October 1995. 
Professor W. W. Anderson, Professor in the Department of Social 
work at the University of the North West. The researcher contacted 
Professor Anderson several times between 1st September 1995 and 8th 
November 1996 . 
. 11 SAMPLING 
Sampling is a process of selecting a portion of the designated population to represent 
the entire population (Lo-Biondoo-wood and Haber, 1980:207). Further sampling 
determines the extent to which the research findings from the study sample can be 
generalised to the larger population from which the sample was drawn. Subjects who 
participated in this study were taken from a population of female students registered 
at high schools in the North West Province . 
SAMPLING PROCEDURE 
A list of all appropriate schools (High schools) was secured from the 
Department of Education. From the total number of schools , twelve schools 
were selected by means of a simple random sampling procedure . Schools that 
12 
were selected were as follows: Ramaboa, Tswelelopele, Baitshoki, L.G. 
Holele, Bafokeng, Barolong, Batloung, Leteane, Modiri, Rantailane, H.F. 
Tlou, and President Mangope high schools. 
As all the high schools, consist of standards 8, 9 & 10 female pupils, one class 
standard was drawn from each of the selected schools in order not to burden 
one school with too many disruptions during the interviewing of selected 
respondents. Care was also taken to select a proportionate number of pupils 
from each standard . 
After the random selection of schools and classes were completed, lists of 
names of the pupils in the specific selected standards were secured from each 
principal. By means of simple random sampling forty female pupils were 
selected from each standard. This procedure was followed in all of the twelve 
selected schools. After completion of this procedure, the sample comprised of 
480 respondents . 
1.12 PILOT STUDY 
The questionnaire was presented to twenty female students enrolled at Batswana high 
school in Mmabatho (capital city of the North West Province) . 
The aim was to ascertain: -
Whether the questions as they were phrased would achieve the desired results 
by obtaining the required information 
Whether the questions were clearly understood by all respondents 
Whether additional questions were needed or whether some questions were 
redundant and should be eliminated, and 
13 
To determine the amount of time it will take to interview each person 
On the basis of the feedback received , minor corrections were made. 
1.13 DATA ANALYSIS 
According to Kerliger (1980) as mentioned by Reid (1984:243) data analysis is the 
categorizing , ordering, manipulating and summarizing of data to obtain answers to 
research questions. Information gathered from questionnaires was categorized by the 
researcher herself. As questionnaires were submitted upon completion, each was 
numbered and coded for tabulation purposes. 
Data describing the frequencies for all responses was arranged as frequency 
distributions in order to obtain information about the respondents and identify the 
number of responses received. The responses according to each item was converted 
into a percentage value and was interpreted. Uni-variate and where applicable bi-
variate distributions were used. 
As this study is basically descriptive in nature, the researcher used descriptive statistics 
and tables in presenting data . According to Behr (1988: 12) descriptive statistics are 
procedures that are concerned with summarizing or describing data . 
1.14 PRESENTATION OF DATA 
The study is arranged as follows : 
The present chapter, is an introductory chapter. It outlines the purpose and research 
methodology of the study. 
Chapters two (2) to five (5) concentrate on selected literature that is relevant to the 
subject under study. Chapter six (6) presents the analysis of empirical data followed 
by the discussion of the major findings, conclusions and recommendations in chapter 
seven (7) . 
14 
CHAPTER TWO 
AIDS - AN OVERVIEW 
2.1 INTRODUCTION 
The first priority for educating others is to learn about the disease so that myths and 
rumours that surround AIDS could be dispelled. The purpose of this chapter is to give 
a brief background of the disease, the origin and the extent of the problem worldwide. 
Particular emphasis will be on the biology of the disease , symptoms and the ways it is 
transmitted. 
2.2 AIDS: THE BACKGROUND 
Although the history of AIDS can be dated back to 1981 at the centres for disease 
control (CDC) in Atlanta Georgia , the first cases were seen in 1978 (Bezel , 1988 in 
Mwale and Burnard, 1992:9). Between October 1980 and 1981 an alert physician, Dr 
Michael Gottleib together with his colleagues in Los Angeles , became intrigued with 
the physical conditions of five male young patients under their care. Their age ranged 
between 29 and 36. All of these men were suffering from a type of pneumonia called 
Pneumonia Cystiscarinii Pneumonia (PCP) (Mpati 1992:3) . In addition all these men 
had evidence of having been infected with a virus called cytomegalovirus (CMV) which 
is common in immunosuppressed patients. All five were also infected with thrush . 
A further feature was that all of the five men were sexually active homosexuals. These 
first cases were initially published in early June 1981 by the CDC (Schaub, 1994:6). 
Following investigations by health officials a month later, twenty stx other 
homosexuals were found suffering from a rare skin cancer called Kaposi sarcoma (KS). 
Green and Miller (1986: 16) stated that this skin cancer usually attacks elderly men 
whose immune system has been depressed. However in these cases, it was different 
since all of the twenty six men were young . At that stage homosexual life 
15 
style was associated with a sexually transmitted disease, as well as the evidence of 
immunodeficiency with no cause. Other cases followed rapidly on the heels of the first 
reports. 
In September 1982, the Centre for Disease Control named the new disease 
ACQUIRED IMMUNE DEFICIENCY SYNDROME (Gee and Moran, 1985:5) . A 
new disease is considered as such, when it has a unique set of characteristics for which 
there are no preexisting categories or labels. A new problem is also recognised when 
a serious or severe outcome, such as death, occurs as a result of the disease. AIDS 
falls under that category because it fatally affected many people. 
The Centre for Disease Control (CDC) produced a provincial case definition of AIDS 
in the autumn of 1982. AIDS was defined on the basis of its occurrence of unusual 
infections or cancers such as PCP and KS in previously healthy individuals due to an 
immune deficiency of unknown cause. 
Since 1982/3 more cases were identified. Data received by the CDC offices from 
investigators showed that the incidence of AIDS was roughly doubling every six 
months (Pratt, 1988:2) . Certain aspects of this disease were especially alarming, its 
cause was unknown at that time as well as its means of spread. Treatment of the 
various infections and concerns seen in this disease was ineffective . Fear of the disease 
became a parallel epidemic in its own right. 
Simultaneously or possibly earlier, medical practitioners in Africa came across unusual 
symptoms. People were dying from an AIDS-related condition called the slim disease 
(Mpati, 1990:3). Victims especially young people dramatically lost weight as a result 
of diarrhoea. The same disease was reported in countries like Zaire, Uganda and 
Rwanda. It seemed likely that the disease found in Africa was the same as the new 
AIDS identified in western countries. 
16 
By March 1983, an average of 4-5 cases per day were reported to the CDC . In 
addition to the known symptoms it was also discovered that many individuals with 
AIDS presented themselves for treatment for a less form of AIDS which was then 
referred to as the AIDS Related Complex (ARC) (CDC update on AIDS , 1982:507-
514). Later that year, in June 1983 an AIDS Committee of the National Institute of 
Health defined AIDS Related Complex as the presence of certain clinical symptoms 
suggestive of immunodifficiency in the absence of any known underlying cause . 
People with ARC frequently experience unexplained persistent and swollen lymph 
glands, fever, night sweats, fatigue and weight loss (Pratt, 1988:4) . Although ARC 
occurs in many patients with AIDS , it is not a determining factor because there is no 
way to predict whether the person with ARC will progress to more severe diseases or 
remain unchanged . 
In 1984, the causative agent of AIDS was discovered. The credit for the discovery is 
shared between French and American researchers (Schoub, 1994:6) . The American 
team named the virus lymphadenopathy associated virus (LAV) and the French team 
named it human T-cell lumphotrophic virus type -3. By international convention a 
neutral name was chosen for the virus, and was named Human Immunodeficiency 
Virus (HIV). Immediately after the causative agent was discovered, diagnostic tests 
for the virus were developed. Despite the overwhelming evidence establishing HIV as 
the cause of AIDS, scientists such as Dr Peter Duesberg , still believes that HIV per se 
is not the cause of AIDS, but merely presents itself as a "passenger virus". 
With the discovery of HIV, the different ways in which the epidemic was spreading 
also became clear. The rapidly increasing number of cases suggested a trend of 
epidemic proportions . The disease seemed confined to particular population groups. 
It became clear as the roll of fatalities unwound, that those people who had fallen 
victims to the disease shared two major links i.e. sex and/or blood. 
Although a specific sexual lifestyle had been one factor in the development of the 
disease other characteristics were equally associated with the risk of the disease . 
17 
Because the very first cases occurred in gay men, it was easy to assume that AIDS was 
a disease of homosexual men. However, epidemiological data made it evident that 
other groups were also affected . It became clear that AIDS cases were appearing also 
in male and female heterosexuals and intravenous drug users . 
The year 1985 marked the introduction of a blood test which could detect antibodies 
to the virus in the blood. One of the early tests that was used was known as the Elisa 
test. By means of this test it became possible to carry out surveys of different groups 
of the public to determine the different levels of the infection. This test also showed 
that not all individuals infected with the HIV went on to develop AIDS. It was further 
found that a period of more than five years could take place between being infected 
with the virus and developing symptoms of AIDS (Hubley , 1992:3) . For each person 
with the symptoms there could be 50 to 100 others who were carrying the virus but did 
not have the disease. 
Up to 18 December 1987, over 46000 cases had been reported to the CDC (CDC-
update , 1987:581-589). The centre for disease control further predicted that more 
people would be infected and would die of AIDS as years went by . There was no 
doubt that AIDS posed the most significant public issue. It was also during 1987 that 
the member nations of the WHO (World Health Organization) mandated by the 
UNITED NATIONS, recognised the seriousness of the emerging AIDS epidemic. 
According to Hubley (1992:3) a special programme on AIDS was established to 
respond to the growing threat of AIDS . In this programme the WHO was mandated 
to provide the global leadership in the fight against AIDS. 
During 1988, the special programme conducted by the WHO on AIDS , became a 
global programme which became the focal point for an intense international plan for 
the prevention and control of AIDS. The cornerstone of the programme has ever since 
been to stimulate and provide support for AIDS prevention activities within each 
country . 
18 
Eight years following the establishment of the global programme, the world has seen 
an escalating development of the disease which outweighs any other disease 
experienced in human history. Because of a broader international interest in AIDS this 
disease can now be studied more easily and effectively than before. However a cure 
has not yet been found and AIDS still remains a life threat. 
At the 10th Annual Conference on HIV/AIDS held in Yakohoma in 1994, 3500 
representatives of different organizations communicated their progress on the war 
against AIDS . After four days of discussion, the goal of controlling HIV seemed as 
distant as ever before. Others have even concurred that the global battle against 
HIV/ AIDS has been lost. There is no cure, no effective treatment or no vaccine for 
AIDS , and there seems very little significant progress in the near future. Even in 1996 
a cure and treatment for AIDS still remains illusory. 
This section merely gave the background information on AIDS. The following section 
will attempt to answer the question of the origin of AIDS. 
2.3 THE ORIGIN OF AIDS 
Where does AIDS originate? The simple answer is that no one knows for sure. The 
origin of the HIV virus and AIDS is still a mystery. There are many theories , but none 
so far has proved the origin of the virus. An early pronouncement stated that the virus 
started in Africa (Hubley , 1992: 18) and spread to other countries . However there has 
been no convincing proof that the virus originated in this particular continent. To 
African people this was seen as a form of racism. This is not surprising because not 
only AIDS but other diseases such as syphilis were blamed on other communities . For 
instance in Britain syphilis was seen as a French disease. 
The origination of AIDS has been argued at great depth in scientific as well as health 
forums. However a consensus has never been reached but instead it aroused 
considerable controversy and hatred . In fact little is known about the origin of any 
human virus let alone HIV (Schoub, 1994: 12) . At present, the answer to the origin 
19 
of the disease remains as unresolved as when the questions was first posed . 
Based on literature, the disease AIDS was first recognised in the USA and only 
somewhat later was the epidemic as such observed in Europe and the African continent. 
Although no one knows where AIDS started, there are five theories which attempt to 
answer the question of the origin of AIDS . 
[~.~~Ryj 
The first theory as stated by Hubley (1992: 15) emphasises that the disease is not a new 
disease, but that the virus has always been present but remained unnoticed and confined 
to an isolated group of people. This may explain why the African continent was 
pointed out on the basis of isolation and uncivilization. Belgian and French scientists 
as quoted by Schoub (1994: 12) hold that infection with HIV has remained undetected 
in many countries. They base their argument on the fact that diseases such as fever in 
Africa were usually ascribed to malaria and pneumonia without any further 
investigation. Thus, they stated that HIV could also have been an endemic virus , 
present for centuries in central Africa. 
The spread might have been facilitated by political developments in Africa together 
with the revolution in regional and international travel between countries . The spread 
could also have been as the result of sexual revolution and the widespread drug 
administration. 
This theory seems to be unacceptable. Given the rapid spread of the disease, it is 
hardly likely that the virus could have circulated in humans far much before the late 
1950's and still remained unrecognised. This is also corroborated by reports of doctors 
with many years of clinical work experience in Africa, who agree that the damage 
caused by AIDS on the physical body of a victim is too great that it would have been 
most unlikely that a whole epidemic could have existed unnoticed. 
A variation of this theory is that the human immune deficiency virus originated from 
animals. This theory states that in animals the virus did not cause the disease but was 
20 
transferred to humans where it caused the disease. The animal that has received most 
attention as a possible source has been the African Green monkey (Hubley , 1992: 18). 
There is evidence that simian immune deficiency virus (SIV) found in Green monkeys 
is infectious . The information that appeared to support this theory is that the virus 
(HIV 2) is genetically similar to SIV. However, there has been no convincing proof 
that the virus is present in monkeys caught in the wild. There is however a strong 
possibility that the monkeys may have been contaminated with the virus from man in 
the laboratory . In this regard Schoub ( 1994: 13) stated that SIV under natural 
conditions only infects monkeys and not humans. 
Furthermore it has been proved that the original AIDS epidemic is based on HIV 1 
which is distinct from HIV 2 which only appeared at a later stage. Thus the Green 
monkey theory leaves the origin of the original HIV 1 unexplained. 
The third postulated scenario holds that oral polio vaccines could be the source of SIV 
infection of humans with its subsequent mutation to HIV (Schoub, 1994:3). These 
scientists believe that viruses are continually changing and mutating into new strains. 
It seems a highly likely hypothesis that a mutation took place in SIV to HIV in humans. 
According to the aforementioned author oral polio vaccine was tested in humans in 
1950. This was done in several hundred thousands of people in some central African 
countries e .g. Rwanda and Zaire (precisely at the time of the early epicentres of the 
AIDS epidemic in Africa). Oral polio vaccines are produced from monkey 's kidneys. 
Apparently these vaccines were not tested from contaminated simian viruses, hence SIV 
entered human beings . 
Other researchers believed that transmission possibly existed in cases where the polio 
vaccines were used to treat cold sores on the lips and genital organs . This could in 
theory have afforded the opportunity for any contaminated SIV to have been inoculated 
through the skin barrier and reaching the receptive cells to infect. Based 
on the vast genetic differences between SIV and HIV it would seem that this theory is 
also unacceptable. 
21 
The fourth theory mentioned by Hubley (1992: 10) and which incidentally does not 
implicate Africa, is that HIV was produced by the so-called American military germ. 
This theory has been criticized by the American Government, as the technology for 
genetic engineering did not exist in the early 1970's. Thus HIV would make a highly 
unsuitable pathogen for germ warfare . Furthermore, this theory was postulated by 
German scientists and therefore it could also be seen as a propaganda set. 
The last view point on the origin of AIDS which holds more truth is that AIDS is a 
new disease. It began in humans in the late 1970's and early 1980's and has ever since 
increased in extent. Supporting this theory are studies which have revealed very little 
prevalence of infections with HIV in USA, Europe and Africa before the late 1970's 
and 1980's (Schoub, 1994:17). 
This section has established that the debates about the origin of AIDS are still doubtful. 
All that has culminated from this is that it created bitterness and diverted attention on 
prevention measures. The focus of the following section will be on describing the 
massive advancement of the AIDS epidemic . 
2.4 AIDS - A GLOBAL PROBLEM 
In the second decade of the pandemic AIDS, the society is now confronted with a 
global problem which is not only a specific challenge but also a threat to human 
existence. Lachman (1995:6) stresses that a global strategy for AIDS prevention 
incorporates the concept that no country will be able to stop AIDS until it is stopped 
in all countries . 
At a meeting to commemorate world AIDS Day in Paris on December 1, 1994, the 
Secretary General of the United Nations, Dr Boutros-Galli stressed the recognition of 
a planetary emergency and asked that global strategies be invoked to halt the spread of 
AIDS. However, in 1996 the AIDS pandemic is still out of control and the 
transmission of the AIDS virus is still continuing. AIDS is now a true pandemic and 
it is evident that the worst is yet to come according to Dr Michael H Marson the 
22 
Director of the WHO (Tanne, 1992, 305). 
The cumulative number of HIV infections to date exceeds 17 million world wide 
(WHO, 1995:1112). If present trends continue the figure will be more than double to 
reach 30 to 80 million by the year 2000 (Evein, 1995:6) . Further estimates indicate 
that for every case of AIDS there may be between 50 to 100 other persons who are 
infected but because of being unaware of the fact may possibly spread the disease to 
others . Unfortunately it is not easy to estimate the extent of AIDS sufferers and those 
infected with the virus as all cases are not reported. Especially those people living in 
remote rural areas who may die from AIDS without even being diagnosed. This 
would suggests that merely judging the extent of the problem by means of the cases 
reported will be misleading. 
The spread of AIDS is outrunning the community's ability to deal with it. Despite 
substantial progress made by the medical profession, a cure for AIDS has not been 
found. Perhaps the most important task is now left with the social scientists to 
strengthen preventative strategies. All health providers have an obligation and 
responsibility to ensure the promotion of a healthy life style. This is an urgent matter, 
especially in Africa, since the number of AIDS cases is rising rapidly. 
The key to success is collective efforts as stressed by Mann (1988:9). People of Africa 
need to be informed and educated so as not to obviate the adoption of preventive 
behaviour. This would be further discussed in the following chapters. 
2.5 AIDS IN AFRICA 
According to an estimated projection produced by WHO on the global programme on 
AIDS , the AIDS problem in Africa is outstripping the rest of the world (Steinberg, 
1993 :49). It is generally accepted that Africa is the continent hardest hit by AIDS . 
In the last decade, AIDS or more accurately the HIV pandemic , had spread 
dramatically throughout much of central and Eastern Africa. Due to the fact that there 
is no geographical limit to its spread, the pandemic has now affected every single 
23 
country on the African continent. 
Although AIDS is evident in all African countries, there are substantial differences 
within Africa. Research shows that the level of AIDS is highest where AIDS was first 
recognised, i.e. Central and Eastern Africa. Evein (1995:6) in this regard stated that 
in South Africa the levels of AIDS are much lower compared to all other areas. The 
incidence of AIDS in Africa is worsened by a number of factors : 
Africa is a third world developing continent. Developing countries do not have 
enough resources and infrastructures of health services. An estimated 60% of 
people in Africa are without access to basic health services, with the most acute 
problems occurring in Sub-Saharan Africa (Lachman, 1993:37) . Safe drinking 
water is unobtainable by some 150 million Africans. Too many scarce 
resources are centred in urban hospitals rather than on rural primary care. 
Therefore people in remote rural Africa are less likely to be informed about 
AIDS . 
The most depressing factor is that some countries are pushed into a battleground 
which has led to increased migration, refugee problems and the weakening of 
traditional stable family patterns . Due to the scarcity of resources there is a 
tremendous movement of people from rural to urban areas. This movement 
ensures a more rapid spread of AIDS in these countries. Davies (1991) writing 
on this as quoted by Whiteside (1992:64-65) noted that the high number of 
workers whose wives live in rural areas tend to increase the number of partners 
and thus the rate of the spread of the virus . 
Factors that reduce the body's immune and general level of health make it 
easier for the AIDS virus to enter the bloodstream and infect a person. Those 
co-factors include malnutrition, lack of sanitation and potable water. The 
current drought in some parts of Africa is likely to cause malnutrition and 
increased poverty. Therefore a great number of Africans live in poverty. The 
24 
combination of all the aforementioned factors exposes people of Africa to AIDS 
which without any doubt is one of the major challenges facing Africa. 
2.6 AIDS IN SOUTH AFRICA 
AIDS epidemic is a substantial and rapidly growing problem for South Africa. On 
world AIDS day, December 1st 1994, President Mandela stated that one out of ten 
persons in South Africa was infected with the AIDS virus . There is now consensus 
among analysts that South Africa is currently entering a period of explosive growth of 
the AIDS disease. This will definitely be the case as long as no vaccine or effective 
curative agent is developed. However South Africa is more fortunate than many of her 
neighbouring states in being at a much earlier stage of the HIV/AIDS epidemic. This 
creates the theoretical opportunity to learn from the experience of other countries to 
prevent the spread of HIV and come up with efforts that will mitigate the worst effect 
of the epidemic at all levels . 
In order to contextualise the present research, the AIDS disease-scenario in South 
Africa requires specific analysis. The first cases of AIDS in the RS.A. were 
recognised on two homosexual men in Pretoria in 1982 (Becker, 1986: 23). The pattern 
of infection in South Africa as revealed by clinical cases and sero-epidemiology 
excluded South Africa as the original source of AIDS. Research conducted by 
S.A.I.M.R. in 1983-1985 however showed that the number of people with AIDS 
increased to 21 (Sher , 1986:23-24). Up until November 1988, 174 cases were 
diagnosed . At the end of 1994, 5641 people were reported as having AIDS in South 
Africa (Epidemiological comments, 1995 :234) . 
2.7 THE CURRENT STATUS OF THE AIDS EPIDEMIC IN SOUTH AFRICA 
An assessment of the present size and future projections of the AIDS epidemic is 
needed in order to estimate the actual impact of AIDS in South Africa. This section 
briefly reviews the available data on AIDS and HIV infection in South Africa. 
The most recently available evidence suggests that by the end of 1995 approximately 
25 
8784 people would have been diagnosed as suffering from AIDS (Epidemiological 
comments, 1995:234). It is further estimated that 2 million people are at present HIV 
infected. According to Evein (1995:17) this figure is expected to rise to 3-5 million 
HIV infected people over the next three years. In this regard experts calculate that 
more than 500 people are infected every day. South Africa therefore is challenged by 
the prospect of a vast and growing burden of illness and death associated with AIDS . 
Research also shows that the mode of transmission in the majority of cases is 
heterosexual transmission (Epidemiological comments, 1995 :234). Out of 8784 cases, 
5408 victims were infected through heterosexual transmission (see appendix 2) whereas 
538 cases stem from homo/bisexual relations. Haemophiliac is 24, blood transfusion 
30, mother to child 909 and 1872 are those where the origin of the infection was 
unknown. 
These figures confirm that the disease is now being transmitted heterosexually and that 
it is no longer, as has been suggested, confined to white homosexuals. Sitiloane 
(1990:4) stated that this spread is in keeping with the pattern observed in the rest of 
Africa, namely an African-type HIV pattern where transmission of HIV is likely to be 
heterosexual . 
Of the nine provinces in South Africa, Kwazulu-Natal has the highest incidence of 
AIDS, followed by Gauteng province (see Appendix 1). The reason for the higher 
incidence of AIDS may be that both these provinces are overpopulated with a high rate 
of unemployment. Commenting on the North West, it is estimated that 288 people are 
suffering from AIDS (Epidemiological comments, 1995:234). However it is necessary 
to point out that this province is mostly rural and that all cases of AIDS are most 
probably not notified. 
Furthermore research shows that the majority of people having AIDS in South Africa 
are blacks (Epidemiological comments, 1995 :234). It is estimated that out of 8784 
people suffering from AIDS, 66,2 % are blacks. These statistics reflect that blacks are 
26 
possibly more vulnerable to AIDS in South Africa. However it should be noted 
that Blacks are the majority population group in the country and will therefore 
proportionally reflect a greater number. 
The statistics also show that out of 3489 people who contracted the disease through 
heterosexual intercourse, the majority are women with 1838 cases while men are only 
1606 (Epidemiological comments , 1995:234) . Although this difference is not great, 
this information is threatening. As already pointed out in the preceding sections, AIDS 
was first identified amongst men. The fact that presently, more women than men are 
infected with AIDS, may be an indication that the disease is spreading more rapidly 
among women than men. 
Finally, it should be noted that AIDS statistics are provided to the Department of 
Health on a voluntary basis by mainly hospitals . The truth is that the figures provided 
severely underestimate the actual case load as it is widely accepted that a great number 
of AIDS cases remain undiagnosed . 
2.8 FUTURE OF THE AIDS PANDEMIC 
The future of AIDS is best described through the work performed by M.P. Doyle and 
his colleagues for the Life Insurance Company (Lachman, 1995 : 113). The impetus for 
this type of model was to meet the actuarial needs of life insurance. This model, unlike 
the previous models focuses on the complex situation of AIDS reflecting all the 
population groups, and predicted scenarios, as illustrated in the following figure. 
Doyle's model 
HIV Prevalence: Adults Aged 15 ·- 49 
287.,---.-------.------,-------r------,-----;:--:-::-;;,---,r----, 
267. 
247. 
227. 
207. 
H37. c:rr 
167. 
u N 
u -....J 
C 
IV 147. 
0 
> 
IV 127. 
'-
0.. 
107. 
87. 
47. 
27. 
07.'--.-+-+-A-+- --='<-------.,___ ____ _._ ______ .._ _____L ----.i 
1985 1990 1995 2000 2005 2010 
. Year 
+ SCEN60 o SCEN61 
28 
The first phase (A), is the so called FREE EPIDEMIC PHASE, during which very 
few people in the community are infected with HIV. In South Africa the early 1980's 
marked the start of this phase where only a few cases of AIDS were discovered. The 
growth in the epidemic during this phase is generally slow and may remain unnoticed. 
Phase (B), is the so called EPIDEMIC PHASE during which there is a more rapid 
growth in the epidemic . In this regard many researchers believe that South Africa is 
already witnessing the rapid rise of the epidemic and already fall within the phase B 
category . 
The next phase (C) is the so called ENDEMIC PHASE. It is believed that the rate of 
infection will reach a plateau stage where the infection will be more constant. The 
postulaters of this model are of the opinion that this rate will become constant at about 
24 % of the 15-49 year age group of the population as shown by curve C 1. Thus one 
in four people would be infected (Steinberg, 1993:53). It is also exactly the same rate 
currently experienced in many African countries such as Zambia. The aforementioned 
author also stated that it is not an idle speculation, but a highly probable one indicating 
that in the year 2005 South Africa will have reached that rate . 
The endemic rate does not suggests that the epidemic is over. It only suggests that at 
this stage many people would have died and that less children will be produced as a 
result of infected mothers. According to Lachman (1995: 114) the prevalence rate of 
27% is expected in the year 2010 if conditions remain equal and the AIDS pandemic 
takes its expected course and prevention efforts are in vain. 
The second curve (CII) shows the best probable outcome given the success of 
prevention programmes. Doy le et al. (Steinberg, 1993: 53) admit that this is mere 
speculation. However the speculation is based on the possible success of educational 
campaigns. If people are prepared to change their sexual behaviour which puts them 
at risk, it is assumed that there will be a decrease in the transmission of the AIDS 
virus . 
29 
The model also shows that, the transmission of AIDS from male to female is in such 
a way that it doubles that of female to male (Lachman, 1995 : 114). Furthermore the 
model states that the incubation period, that is the period from sero-conversion to AIDS 
sickness, varies according to the age of the person at the time of infection. This 
implies that younger persons take longer to become AIDS sick than older persons. 
Therefore, young people who do not undergo tests may remain infected and capable 
of infecting others for a longer period without knowing. Education is therefore 
imperative for the younger generation. 
2. 9 THE IMPACT OF AIDS IN SOUTH AFRICA 
The rate at which AIDS is spreading in South Africa will have far-reaching 
implications tearing at the fabric of social life in this country . Some of these 
implications are economic consequences of the epidemic. The direct cost on a micro 
level includes those for screening, diagnosis , and providing information as well as the 
loss of productivity and increased mortality. 
AIDS is a real threat to the productivity of all commercial firms. If managers , 
engineers, technicians and all other skilled workers are frequently absent from their 
work because of AIDS related illnesses , economic output is bound to be affected . It 
is also extremely difficult to replace qualified staff when they die . 
The disease will also have a negative impact on the household. As greater numbers of 
youths and adults succumb to the disease , there will be fewer economically active 
people to support and care for children and elderly people. According to Carswell 
(1988) the disease will also put pressure on the household where people have to cope 
with the person suffering from the disease. 
The growing number of orphans is an extremely worrying development. It is estimated 
that 20-40 percent of children of HIV positive mothers will develop AIDS and probably 
die before the age of five (Whiteside, 1992:71). However 60 to 80 percent will not be 
30 
infected but remain orphaned, especially those who were born before the virus was 
introduced to their parents. This is threatening since every child needs financial as well 
as emotional support and the care from their parents as they go through different stages 
of life. 
The spread of AIDS may also affect the demand for certain services and the ability to 
supply them. The prime example here is medical care. The recent news as presented 
on SABC channel I (1996\03\17) stated that most hospitals in Kwa-Zulu Natal are 
experiencing shortages in medical services for AIDS patients. This shows that the 
provision of health for all is inevitably seriously affected. 
AIDS is the disease which when left unmanaged will become catastrophic to all South 
Africans. 
2.10 CONCLUSION 
This chapter has established that the origin of AIDS is unknown and it is rapidly 
increasing. The review of the background of AIDS emphasised that education will 
have to play a more important role in the prevention of AIDS. South Africa has 
entered the epidemic phase where the rapid spread of AIDS will be experienced. 
Therefore targeting specific groups seems to be an urgent issue. 
31 
CHAPTER 3 
UNDERSTANDING THE DISEASE 
3.1 INTRODUCTION 
While the content of AIDS and the HIV virus is understood by many, the process of 
the disease is neglected. This chapter intends to set forth in detail the dynamic process 
incorporating all phases of the disease and various ways in which the disease can be 
transmitted. The chapter also looks at some groups of people and factors that 
perpetuate the spread of the disease. 
l-NWU LIBRARYJ 
3.2 FROM HIV INFECTION TO AIDS 
It is a well established fact that HIV is the causative agent for AIDS. In brief, HIV is 
the most recent member of the newly discovered family of viruses known as 
retroviruses. According to Gee and Moran (1985:326) these organisms are called 
retroviruses because they reverse the usual flow of genetic information. Most viruses 
have genetic material made up of deoxyribonucleic acid (DNA) . Unlike other viruses 
the retroviruses' genetic material is in the form of ribonucleic acid (RNA) . Instead of 
using the DNA, HIV uses an enzyme described by Hubley (1992: 10) as Reverse 
Transcriptose. This enzyme allows the viral RNA to make its own DNA which is 
subsequently incorporated into the host cell. The virus will persist in the host cell and 
cannot be eliminated. These new virus particles seek out infected cells and the cycle 
repeats with HIV continually infecting and destroying host cells . 
This clearly indicates that HIV is unique and deadly. According to Gee and Moran 
(1985:326) it attacks a key group of cells which co-ordinate the body's immune defence 
system. More importantly it leaves the body open to infection that can ultimately result 
in death. 
32 
3.3 HIV INFECTION 
HIV infection is a process incorporating various phases. The phases are discu.-sse 
as outlined by Pratt (1988 :83). The process of HIV to AIDS is illustrated in th 
following figure . 
·- A D E D 
\ I 
\ I 
\I 
C 
F 
5 or more years · Usually 1-2 years 
.. ··• ·~ 
. 
t . ·
.···· ··t 
·. . , . ·, '.· . ' 
Infection with H·tv · .A i Os "diagnosi i 
. .s  Time Death 
Clini~I _dyn. amic. s. of. .HIV. . .:i nfectiori ·. 
33 
PHASE A (THE SILENT PHASE) 
The body has a vast array of defences against diseases which are known 
collectively as the immune system. HIV attacks the system directly and 
undermines its efficiency by attacking most important cells of the body. 
Thereafter the person moves to the first phase of the infection. AIDS is 
associated with a long incubation period. The typical time between 
transmission of the virus and appearance of antibodies directed against the virus 
has been estimated to be 6-8 weeks (Evein, 1995: 14). During this stage tests 
for the detection of viral antigen in the blood are usually negative. 
Nevertheless , a person during this stage remains infectious . Simultaneously 
virus replication is occurring even though it is not apparent on testing of the 
blood (Schoub , 1994:88) . 
Individuals during this phase may develop an acute glandular fever , although 
to others this acute reaction can go unnoticed. The clinical condition is referred 
to as the sero-conversion illness because the problem is non-specific (Evein, 
1995:25). Sooner or later the patient then advances to the next phase. 
PHASE B (THE ANTIBODY PHASE) 
Following infection and the silent phase , the infected person moves to the 
antibody positive phase . This simply means that the person becomes antibody 
positive. According to Pratt (1987 :43) the infected person during this phase 
looks and feels very well but, as time goes on, the viral load increases thus the 
patient progresses to the next phase . 
PHASE C (THE SYMPTOMATIC PHASE) 
After 3-7 years of infection a large number of virus · particles are produced 
which consequently destroy enough of the immune deficiency (Evein, 1995: 6). 
At this stage it becomes difficult for the body to defend itself against many 
infections and cancers . 
34 
In time, most HIV infected persons develop a variety of indicators of ill health. 
These signs and symptoms are usually referred to as opportunistic diseases . 
This is because they take opportunities provided by the lowered immune system 
to infect the body . Today, these indicators are known as AIDS Related 
Complex (ARC). According to Evein (1995:27) individuals with ARC usually 
appear chronically ill. The immune system at this stage continues to deteriorate 
and this ultimately in many patients leads to the next phase namely AIDS . 
It is not yet clear whether all infected persons will progress to AIDS, however 
research conducted in all parts of the world shows that approximately 80 % of 
HIV carriers will most probably develop AIDS within 2 years of infection 
(Evein, 1995:25). 
PHASE D (AIDS PHASE) 
Research shows that 20% of ARC victims develop fatal full blown AIDS during 
the next two years (Mpati , 1990:3) . In this regard insignificant organisms, 
cause life threatening infections associated with severe immuno-deficiency . 
Patients are normally treated for a variety of infections and tumours (Schoub, 
1993 :26-27). These conditions are therefore referred to as "AIDS defining 
illnesses" and are listed in the WHO staging system for HIV Infection and 
Disease (see appendix 4). 
PHASE E (PERIODS OF REMISSION) 
This phase includes treatment of opportunistic diseases encountered in AIDS . 
Treatment might result in a period of remission and relative good health. 
Periods of remission alternate with new opportunistic diseases (that is phase D) 
and eventually patients advance to the last phase. 
PHASE F (THE TERMINAL PHASE OF THE ILLNESS) 
At this stage the body becomes progressively weaker with repeated infections 
and tumours . Commonly the patients experience premature greying of hair and 
35 
wrinkling of the skin. Death usually occurs 6 months to 3 years after 
developing AIDS defining illnesses (Evein, 1995: 31). 
According to the preceding particulars it is clear that AIDS per se is not a single 
disease but a disease with a variety of signs and symptoms. The existing health 
status of an individual determines how long it will take to develop immune-
deficiency diseases. 
3 .4 THE CASE DEFINITION OF AIDS 
Acquired Immune Deficiency Syndrome is an evolving phenomenon. The case 
definition of AIDS has already undergone several minor revisions between 1982 and 
1993 (Lachman, 1995 : 172) which were mainly brought about by various research 
developments. It is reasonable to assume that the data base of the disease will continue 
to change as researchers are still investigating the implications of the disease . 
Between 1982 and 1986 the definition of AIDS included the presence of specific 
malignancies such as Kaposi Sarcoma in previously healthy persons . It was in August 
1987 that the definition was revised (Green and Moran, 1989: 10). According to this 
revision the case definition included cases of mild immunodeficiency and persistent 
generalised lymphadenopathy. The 1987 case definition was amended during April 
1992 and became official on the first of January 1993. The definition was revised to 
include patients with ARC diseases . The case definition is reproduced in (Appendix 
5). The case definition remains to be used world wide as it is considered to be precise, 
consistently interpreted and highly specific in AIDS cases for surveillance purposes. 
3.5 MODES OF TRANSMISSION 
According to Simbayi (1993:22) people in many countries are afraid of AIDS . Much 
of the fear and panic surrounding AIDS is due to lack of understanding of how it is 
transmitted . Based on available data, scientists have concluded that throughout the 
world HIV is transmitted through sexual contact and blood as well as from infected 
mother to child. Despite intense international scientific scrutiny, no evidence has 
36 
emerged to suggest any other modes of HIV transmission. 
Although transmissible , the AIDS virus is more difficult to be transmitted than other 
recognised viruses . Epidemiological studies conclude that HIV may be transmitted by 
infected individuals in any stage of illness as the virus is found in a variety of body 
fluids and substances such as semen, vaginal secretions , tears, saliva and urine. 
However, although HIV is sometimes present in fluids such as tears, saliva and urine, 
they are not considered significant routes of infection because they are considered as 
fluids with low viral concentration. 
BODY FLUIDS KNOWN TO BE INFECTED WITH HIV 
A : Higher concentrations/most patients 
(i) Blood 
(ii) Semen and vaginal secretions 
B : Low concentration/ some patients 
(i) Saliva 
(ii) Tears 
(iii) Urine 
(iv) Breast milk 
(v) Amniotic fluid 
[Gerberding J and Green J . , Occupational Exposure, 1987: 18] 
From the above mentioned categories it is clear that the HIV virus is mostly present in 
blood and semen as well as vaginal secretions, which comprise the most important 
fluids through which the virus can be transmitted. Therefore it is worth looking at each 
in detail and also considering ways in which transmission can be avoided . 
37 
3.5.1 BLOOD 
Infection through blood takes place when HIV infected blood gains entry into 
the body of another person. Transmission through blood is apparently not a 
real risk for most people. For infection to take place HIV infected blood must 
bypass the barrier of the skin and enter directly into the body . Since neither 
blood nor virus can penetrate an intact skin, infection is highly unlikely , 
however, infection can occur if someone's skin has a cut. Fortunately the 
process that protects cuts against infection occurs very rapidly after injury and 
therefore the likelihood of infection is decreased. 
Most guidelines on the control of HIV infection discourage the sharing of 
toothbrushes and wet-shave razors, because many people bleed from their gums 
or may cut themselves when shaving . There is however no evidence that 
confirms that the HIV virus can be passed from one person to the other in either 
of these ways. However, the most important factor to note is that transmission 
of HIV virus blood is possible. 
Following are different ways in which the HIV infected blood can be passed 
from one person to another . 
A. BLOOD TRANSFUSIONS 
Receiving blood contaminated with HIV will most probably lead to infection. 
Many people in countries like Zaire have contracted HIV from blood 
transfusions (Hubley, 1992: 28) and this has elicited fear in the general public. 
Fortunately with the introduction of screening of all blood donations, the 
likelihood of HIV infection by means of blood transfusions has been reduced. 
This has been confirmed by research conducted in many countries which 
showed that since the introduction of testing of blood, the number of AIDS 
cases through blood transfusion have decreased (Mann, 1988: 5). 
38 
Although the testing of blood is very helpful, there are some problems that are 
encountered. In this regard the test presently used does not remove all the 
possible risk factors for transmission. This is because, it takes weeks after 
infection for the body to produce antibodies. If blood of the infected person is 
donated during this period it is likely that the result may appear to be negative . 
However the testing of donated blood, reduces the risk of HIV infection. 
B. NEEDLE AND SYRINGE SHARING 
Abuse of drugs is becoming an increasing problem among young people in 
South Africa (Senyaapelo , 1994:8) . Contaminated blood can be passed from 
person to person through intravenous drug injections and therefore intravenous 
drug users are a group particularly at risk. When drug dependents inject drugs , 
they frequently draw a small amount of blood into the syringe. If the same 
needle is used by another person, the blood together with any HIV infection are 
conveyed to the next person. According to Schoub (1994: 112) "HIV epidemic 
in the intravenous drug abusing population has often been characterised by a 
very rapid spread and high prevalence of infection. " 
It would however seem that programmes aiming at slowing down the spread of 
HIV infection amongst intravenous drug users have had little success if any . 
Possibly the reason for this is confidentiality as the use of illegal drugs is a 
criminal offence . As a result, it is not easy to target this group . 
C. INJECTIONS 
The use of syringes and needles that are not properly sterilized may also be a 
possible route of infection. According to Schoub (1994: 114) to date, twenty 
eight doctors have been documented to have contracted AIDS through this way . 
This is because health workers frequently come in contact with HIV infected 
persons and can accidentally prick themselves with injection needles. To 
prevent accidental injuries , universal blood precautions have been introduced. 
Since the introduction of precautionary measures the possibility of transmission 
39 
has decreased. 
3.5.2 SEMEN AND VAGINAL SECRETIONS 
HIV has been found in semen as well as seminal fluid (Hubley, 1990:26). This 
suggests that artificial insemination can also be a source of infection. 
According to Green and Miller (1986: 10) the majority of Australian women 
who underwent artificial insemination in the eighties were found to be infected 
with mv. Although this was a problem, in the past, it is apparently no longer 
a threat as all semen donors are properly screened to ensure that they are free 
of HIV infection. 
However , men in general who are HIV infected can infect other people by 
ejaculating their infected semen into the vagina or rectum. This seems to be the 
main route for infection during sexual intercourse . Women with HIV in their 
vaginal secretions can also infect other people during sexual intercourse . This 
will be discussed further under heterosexual transmission of HIV. 
It is now conceded world wide that the predominant mode of HIV transmission 
is sexual intercourse . Research shows that 90 % of all HIV cases world wide 
are as a result of sexual intercourse (Evein, 1995: 17) . This is an acceptable 
statement as sexual intercourse is considered a normal part of human existence. 
In fact the need for sexual intimacy is regarded by Maslow (1969) as a basic 
need of the human being. With the emergence of AIDS, sexual intercourse has 
become a major threat to the survival of human beings. 
During sexual intercourse, a number of organisms pass from one partner to the 
other. Having sexual intercourse with a person who is HIV infected may result 
in the other person being infected. It follows that the more sexual 
partners one has, the more likely it would be to associate with an infected 
partner. Sexual promiscuity has been identified as a major factor in the rapid 
spread of AIDS. 
40 
Hubley (1992:26) emphasises that a single sexual encounter can be sufficient 
to transmit HIV. However some researchers believe that the risk from a single 
act of intercourse can be as low as one chance in a hundred. Although the risk 
of a single sexual act is low, the more times a person has sexual intercourse 
especially with more than one partner, the greater the likelihood of 
transmission. 
The likelihood of HIV virus transmission during sexual intercourse depends on 
a number of factors which are as follows : 
A. HETEROSEXUAL INTERCOURSE 
Whereas HIV infection originally , mainly involved homosexuals and bisexual 
males , heterosexual intercourse at present is the most common way in which 
HIV is transmitted. The increase of AIDS among heterosexuals is attributed to 
the following : 
Heterosexual intercourse has been identified as the most preferred 
method of sexual intercourse (Evein, 1995). At the moment the virus 
has a strong base among heterosexuals. If that base continues to rise as 
statistics confirm many people will be infected resulting into a disaster. 
According to Nifbrik (1994: 10) vaginal intercourse is a common route 
for transmission among heterosexuals. Damage or trauma to the vagina 
increases the chances of transmission of HIV. 
The abovementioned facts make heterosexual intercourse a major risk activity 
for HIV infection. 
B. ANAL INTERCOURSE 
The universal dictionary (1988 :310) defines anal intercourse also known as 
rectal intercourse as "sexual intercourse where the penis is inserted into the 
41 
other persons anus" . Although the pattern of transmission has changed from 
mainly homosexual activities to heterosexual activities, anal intercourse remains 
a high risk activity. 
According to Schoub (1994:90) the receptive partner is especially in danger of 
acquiring infection because of high frequency of trauma to the mucosal lining 
of the rectum during rectal intercourse. The wall of the lining of the anus is 
delicate and is easily tom when an object is inserted which increases the 
likelihood of the virus to penetrate the blood stream. Clearly, the rectum is far 
less equipped to withstand the injuries that can occur during sexual intercourse. 
Mouli ( 1992: 11) points out that although anal intercourse is most common 
among male homosexuals, it is also practised amongst heterosexuals. This 
therefore also implies that some women might be infected in this particular 
manner. 
C. FEMALES 
The way in which women become infected has been the subject of much debate. 
The transmission of HIV from man to woman is believed to be more effective 
than woman to man. According to Green and Miller ( 1986: 111) the reason for 
this is that the semen remains in the vagina for a longer period of time. In 
addition, there are many receptors in the vagina which create a greater 
possibility for HIV infection. These receptors enable the virus to successfully 
attach and gain entry into the body cells (Evein, 1995: 11) . This fact make 
females more susceptible to AIDS . 
Furthermore, it is a well known fact that a woman infected with HIV will 
harbour the virus in her menstrual blood. Sexual intercourse during menstrual 
periods will therefore increase the possible spreading of the disease. 
42 
D. ORAL SEX 
There has been no evidence as yet that the virus can be transmitted by means 
of oral sex. However, during oral sex ejaculation may take place into the 
mouth of the other partner which may lead to HIV infection. The possibility 
of infection is even heightened if there are sores in the mouth of the recipient. 
Green and Miller (1986:26) suggest in this regard that oral sex should be 
avoided until this matter has properly been researched . 
~N wu. I 
E. MASTURBATION ILIBRARY_ 
This sexual act involves the stimulation by hand of the sexual organs. 
Masturbation can either be self stimulation or mutual stimulation where 
stimulation takes place between two partners . There is no risk of HIV 
transmission from self masturbation provided that the semen or vaginal fluids 
do not come into contact with the sexual organs of another person. Mutual 
masturbation on the other hand is a vulnerable activity. Added to the 
abovementioned Hubley (1992: 10) highlights that there is a slight risk if the 
hand used to stimulate the other person's sexual organs has cuts or sores. 
F. SEXUALLY TRANSMITTED DISEASES 
According to Hubley (1992: 11) sexually transmitted diseases increase the 
probability of HIV transmission. Sexually transmitted diseases include amongst 
others chancroid, gonorrhoea, syphilis and granuloma. 
3.5.3 VERTICAL TRANSMISSION - MOTHER-CHILD 
The most biologically intimate association between two individuals is that 
between a mother and the foetus developing in her womb or a mother with her 
new born baby. Schoub (1994:118) stated that HIV infection may be 
transmitted while the foetus is still in the uterus or during the delivery process. 
Infection may also take place after birth as the baby ingests milk from the 
mother. 
43 
According to Hubley (1992:42) the overall risk of vertical transmission is 
approximately 30 %.  There is no way of telling in advance which babies will 
be infected. This is why women who are infected are advised not to have any 
further babies. The transition from being infected to the development of AIDS 
and death is much quicker with babies than adults (Hubley, 1992:23) as the 
child who is HIV infected is attacked by many childhood infections. 
Following the discussion on ways of HIV transmission the people that are 
regarded to be at a greater risk of infection will be discussed. 
3.6 RISK GROUPS 
Hubley (1992:27) defines risk groups as populations exhibiting risk factors related to 
the disease occurrence. The researcher has identified two of such vulnerable groups 
which are as follows : 
PROSTITUTES 
According to Ruitenberg et al. (1992:69) prostitutes and their clients are 
traditionally regarded as a most vulnerable group for AIDS infection because 
of their unusual sexual behaviour. In addition, the spread of HIV among 
prostitutes provides a good indicator of the spread of AIDS among the 
heterosexual population. On account of the large number of changing sexual 
contacts within the prostitutes world, HIV can be transmitted to a large number 
of clients . 
SCHOOL CHILDREN 
Manyaapelo (1994:5) stated that "Today's youth become sexually active in their 
early teens" . They consider teenage years as a time of sexual experimentation. 
This unfortunately results in many unwanted pregnancies as well as HIV 
infection. Teens therefore are at risk of acquiring AIDS. 
44 
3. 7 CONCLUSION 
In this chapter it was established that HIV (AIDS) is mainly transmitted by sexual acts 
and blood transfusions. Heterosexual acts being performed as a normal , accepted part 
of life , will therefore be one of the main contributors towards HIV infection. Two 
most vulnerable groups who knowingly or unknowingly spread the disease seem to be 
prostitutes and promiscuous teenagers. 
45 
CHAPTER4 
HUMAN SEXUAL BEHAVIOUR AND ATTITUDES TOWARDS AIDS WITH 
SPECIAL REFERENCE TO FEMALES 
4.1 INTRODUCTION 
AIDS is becoming an increasing global problem especially among females. It is 
reported by the WHO (1990:3561) that during the first decade of the HIV/AIDS 
pandemic there were about 500 000 cases of AIDS in women and children. As the 
AIDS epidemic advances to its third decade of existence more people are infected by 
the AIDS virus. Predictions based on the prevalence of HIV among women are 
unfortunately not favourable . It is estimated that 13 million females are to be infected 
by the AIDS virus before the year 2000 (WHO, 1990:7) . According to Dr Schall , 
from the Medical Research Council , a realistic scenario of the development of AIDS 
in South Africa shows that the disease could halt the population growth of South 
African blacks by the year 2000 when about 80 per cent of women would be infected 
(Pretoria News, 1/3/1990). 
Furthermore, it is noted by Nifbrik (1994: 10) that women are fast becoming the 
leading edge of the AIDS pandemic. The statement is confirmed by Lachman 
(1995 : 12) who has stated that AIDS has become the leading cause of death among 
females of the child bearing age in major cities in America, Western Europe and Sub-
Saharan Africa . 
The above contentions are substantiated by a study conducted in the United States 
which shows that about 90 % of adult female AIDS cases occur in the age group 14 to 
39 (Mwale and Burnard, 1992:23) . In view of this , it is clear that the general 
consensus among experts is that females are the greatest group at risk to contract AIDS . 
46 
The vulnerability of females to contract AIDS is determined and perpetuated by a 
number of factors. This chapter will therefore focus on identifying these risk situations 
that expose females to HIV infection. The knowledge of sexual behaviour and attitudes 
of females towards AIDS will also be discussed. 
4.2 HIGH RISK SITUATIONS 
Evidence has been presented in the introductory part of this chapter that the burden of 
the AIDS disease is becoming heavy on females . The changing of the AIDS scenario 
suggests an urgent need to assess all factors which place females at a higher risk to 
acquire HIV. Researchers need to understand complexities of all these factors if they 
are to be able to develop appropriate and successful strategies . A range of social, 
psychological, economical and biological high risk situations are discussed below: 
4.2.1 THE SOCIAL STATUS OF FEMALES 
The status of females within the family and society makes them particularly 
susceptible to HIV infection. This is a social vulnerability related to their 
generally low status. From literature, it is clear that gender , power and 
sexuality are intimately connected with one another. According to Miles 
(1992:4) sexuality is one of the main areas in which gender inequality is 
manifested in the society. Traditionally , women's roles in sexual relationships 
have been that of passive participants. Women are often expected to be the 
recipients with little choice of their own. Hubley (1994:7) is of the opinion that 
women in many communities are less able to control their own sexuality. The 
inequality between males and females affects women, especially with regard to 
negotiation of safer sex. 
Adolescent females find themselves in a more difficult situation to negotiate 
safe sex. Society generally considers girls to have a traditionally feminine 
personality such as compliance, nurturance and unassertiveness (Maboya, 
1996:4) Girls that do not behave accordingly are considered unfeminine and 
may be a target of ridicule by peers . According to the aforementioned author, 
47 
this inevitably make it difficult for adolescents to negotiate their way out in 
instances such as unsafe sex. 
It is also clear that no matter how motivated girls are to adopt safe sex 
strategies, they experience difficulties in implementing their convictions. Data 
from the surveys collected in Massachusetts indicates that although female 
adolescents are aware of the principal modes of transmission, many are 
continuing to engage in unprotected sex (Diclemente, 1992:8-10) . Furthermore 
the study revealed that adolescents fear that condom use will raise questions 
from partners about fidelity and about whether they expect and plan to have sex 
and do not have strict moral values . 
Some female writers such as Makuku (1991) and Aminata Sow Fall (1990), as 
mentioned by Kang'ethe (1996:5), suggested that to change the status of 
females, there need to be a change in the way sexuality is constructed and 
perceived by society. Feminine sexuality should be directed by the needs and 
wants of females rather than the traditional ideology of passivity and 
submissiveness. 
4.2.2 ECONOMIC FACTORS 
Females are often in a greater financial disadvantaged position than males. This 
is because girls from childhood are socialized to be financially dependent on 
others . The concept of socialization is viewed by Barker (1987:53) as the 
process by which the roles, values, skills and norms of culture are transmitted 
to its members. The family and the school as agents of socialization make 
important contributions to the life of any child. Social expectations regarding 
'gender appropriate' behaviour are conveyed to girls explicitly and implicitly 
throughout their entire lives. 
In many black cultures girls are taught at an early stage that the women's place 
is in the house whereas boys are trained to take economic positions. Boys are 
48 
considered to have characteristics such as self-confidence, as well as being 
adventurous and energetic . Therefore girls are encouraged to acquire skills 
associated with their traditionally feminine personal characteristics whereas 
boys are encouraged to have leadership qualities. This therefore alienates 
females from positions of power and they assume inferior positions which earn 
them little income. 
The school also plays a role especially with regard to poor job opportunities for 
women. When pupils begin to choose between subjects, boys are encouraged 
to opt for physics and chemistry whilst the reverse is true for biology, home-
economics and religious studies for girls (Maboya, 1996:6-7). According to the 
aforementioned author, subjects such as home-economics are defined as more 
suitable for girls as they focus on the traditional role of females. 
The above mentioned factors result in females developing dependency-related 
behaviours, such as conformity. According to Frieze et al. (1986:54-56) 
females have dependency-related behaviours when they begin to modify their 
own judgement of an event in order to agree with responses of others. This 
may suggest that a woman may continue to engage in unprotected sex to secure 
her relationship with the sexual partner. Lack of financial independence creates 
a barrier for women to exercise personal control over their own sexual 
situations. 
4.2. 3 MOBILITY 
Teenage years are ages when many young people leave their homes for the first 
time to go to boarding schools or even tertiary institutions. A female student 
who finds it difficult to control her independency since being away from home, 
may also find it difficult to control her sexual impulses and therefore increases 
the possibility of being infected by HIV. 
One area of serious concern is that of loneliness. In the absence of one partner, 
49 
the other partner might find him/herself another sexual partner. Information 
on relationships generally shows that many marriages break because of extra-
marital affairs. Extra marital affairs are likely to happen without the knowledge 
of the other party and in this way HIV can be passed on silently . 
The afore-mentioned factors contribute to a great extent to females engaging in risky 
behaviour. Data from the Department of Education (North West Province) indicate 
that the majority of pupils in high schools are adolescents. Specifically their ages falls 
between fourteen and twenty-one (Statistical data 1993 - Department of Education). 
The following section will focus on female adolescents. 
4.3 FEMALE ADOLESCENTS 
Each stage of life is seen as bringing new central issues, role patterns, feelings and 
insights into focus. The adolescent years (ages 15-21) are times characterised by 
exploration and development of one's capacity for intimacy . Young people reach out 
to others in a desire to share their new-found sense of self. According to Frieze et al. 
(1986 :68) this quest for intimacy is the dominant theme of the adolescents . These 
intimacy goals, most fully expressed in love relationships, make them a most 
vulnerable group to possibly contract the HIV virus. 
Furthermore Sapire (1990:47) stated that there has been a universal increase of sexual 
activity at an early age. The reasons given are earlier age of puberty, relaxation of 
controls, absence of structured leisure time and liberation of values regarding intimacy. 
With economic dependence delayed and postponement of marriage many young people 
find convincing reasons for engaging in sexual relationships prior to marriage. This 
is confirmed by a research conducted by Diclemente (1992:5) in which he found that 
the majority of adolescent females are sexually active. 
Furthermore it would seem that girls fall easy prey to rape. Sapire (1990:47) is of the 
opinion that sexual ignorance often leads to sexual abuse and exploitation. This is a 
serious matter as especially young women are not aware of the danger or possibility of 
50 
being raped. Statistics on sexual violence toward females indicate that rape is a well 
founded fear (Kau, 1993:10) . With the emergence of AIDS , rape is not only a 
traumatic experience per se but added to this is also the possibility of acquiring AIDS. 
During forced intercourse, an HIV infected rapist can infect the victim with HIV. The 
more violent the attack is , the more likely that the female person will suffer internal 
bruising and bleeding. This may make it easier for the virus to enter the bloodstream. 
Music is one component of an immersion into an adolescent subculture (Lachman, 
1995 :22) . The explicit sexual and violent lyrics of some form of music often clash 
with the themes of abstinence and rational sexual behaviour. With its associated lyrics , 
its effects on teenagers are subtle and cumulative. Some of these lyrics are frankly 
pornographic. The above mentioned author stresses that HIV infection can be fuelled 
by the apparent rebellion of youth as expressed by their musical preferences and sexual 
practices. Music is particularly omnipresent for the adolescent today. The availability 
of music that pervades their thought may subscribe to their unleashing primitive 
passions and desires. 
Adolescent sexual life style may also be affected by the lives of popular stars especially 
those who are regarded as role models . Unfortunately some of the popular stars are 
characterised by low morals . Their intimate lives and sexual habits may be revealed 
as more unacceptable, for example, recently Brenda Fassie, one of the successful South 
African music stars was exposed as a drug addict. Furthermore her sexual preference 
which is less acceptable in the black community was brought to the surface. Although 
the abovementioned musician is a successful person, her sexual behaviour and life-style 
in general might have a negative effect on the behaviour of many adolescents. 
Although the mass media can be a potentially important channel for disseminating 
knowledge about AIDS , its role with regard to AIDS spread must also not be under-
estimated. Commonly the mass media use sexual connotations in some of their 
programmes which might encourage young people to engage in sexual activities at an 
early stage. The findings of a study by Kau (1993 :11) revealed that the majority of 
51 
respondents (girls between the ages 13-19) have had their first sexual encounter 
unprepared and the media played a significant role in that. 
Peer pressure also has a tremendous influence on young people. Many admit that the 
early onset of sexual intercourse is associated with peer pressure (Sapire, 1990:47). 
A minority of young females also become involved in commercial sex activities, often 
in response to economic pressure . This is more likely to occur in lower socio-
economic settings (Richardson, 1987:27). In addition, young girls are particularly 
vulnerable to pressure from 'sugar daddies' to provide sexual favours in exchange for 
gifts or cash. This exposes them to the risk of being infected with HIV. 
South Africa is experiencing a rapid growth of alcohol and drug abuse among the 
youth. Alcohol abuse especially with regard to young females causes a great concern. 
The influence of alcohol and other drugs is a problem since it provides less safety in 
sexual practices. A telephone survey among adolescents in Massachusets revealed that 
alcohol and other drugs lower inhibitions and discourage teenagers from using condoms 
(Lachman, 1995 : 134) . This finding shows that young people who abuse drugs are at 
risk of contracting the AIDS virus . 
The young people who are addicted to intravenous drugs run the risk of being infected 
with the HIV virus . Infection is transmitted by sharing blood-contaminated needles and 
syringes. Although the number of HIV infected youth is unknown in South Africa, it 
is clear from literature that AIDS is rising rapidly among young people. 
Beliefs about how young females are expected to behave sexually are also of great 
importance . A girl who prepares herself for sexual intercourse (e .g by carrying 
condoms) is often perceived to be a loose woman who is constantly looking for sexual 
relationships. Richardson (1987 :86) maintains that girls who suggest the usage of 
condoms or other forms of non-penetrative sexual activities are at risk of destroying 
their reputation as well as possibly losing their boyfriends. They may be blamed for 
52 
talcing sexual initiatives. Because of this stigma young females shy away from taking 
these initiatives and thus expose themselves to the possibility of contracting AIDS. 
Finally, teenagers are at the stage where they want to know more about sex and are 
inquisitive about their environment. Because of their urge to explore, they end up 
being victims of circumstances . Sapire (1990:47) states that many young people are 
caught unaware and unprepared to cope with strong sexual pressures . Matthews, Kuhn 
and Jouberton (1990: 10) argue that sex education is necessary at an earlier stage. 
Young people must be helped to understand that sex, like fire and water, is a powerful 
force. It can give pain or pleasure depending on how it is handled. 
4.4 THE IMPACT OF AIDS ON FEMALES IN SOUTH AFRICA 
The impact of AIDS for the women of South Africa is one of the major challenges 
facing this country . The effect on females means that life itself is threatened. The 
dynamics of the South African culture and beliefs make the situation more difficult to 
handle . 
Traditionally , women play a focal role in South African society. The predominant 
roles for women are now, as in the past, those of homemaker, wife, mother, worker 
and student. The African family is held together by women who are also the 
embodiment of care and nourishment for life (Kerin, 1990 as quoted by Mwale and 
Burnard, 1992: 12). Mothers are primarily responsible for supplying both physical and 
emotional care for their infants and young children. They are as well regarded as 
income generators and health providers in the family. However with the increasing 
number of young females with AIDS, many will be unable to perform these tasks . 
Women are also a powerful labour force in South Africa. Reports from various 
demographic studies show that women account for 50 % of the human population 
(Frederick Kang'ethe 1996:2). It is therefore self evident that they play an important 
role in the economic development of the nation. The emergence of AIDS, however 
53 
becomes a barrier in the performance of their tasks efficiently at the work place. From 
the above , it is evident that economic burdens imposed by AIDS on women can be 
heavy. 
Apart from economical burdens the physical burdens imposed by AIDS on women can 
have a tremendous effect. One of the roles of a woman in a traditional black family 
is taking care of a sick family member. However taking care of a patient with full 
blown AIDS can be traumatic . Frieze et al. (1986:56) assert that the majority of 
women become frustrated when experiencing major crises. Emotional breakdown often 
leads to stress which can have negative effects on their physical body. 
According to Nkowane (1990) as mentioned by Mwale and Burnard (1992:9) the 
majority of children with AIDS , inherited it from their mothers . Because HIV does 
not reduce fertility, HIV infected females may have many children while they are 
infected . The growing number of orphans is an extremely worrying development in 
South Africa. 
The above discussions have shown the threat posed by AIDS on women. For many 
women, the threat of AIDS begins with lack of control over their sexual lives and even 
of their sexual partners. In the following chapter human sexual behaviour is discussed. 
4.5 UNDERSTANDING HUMAN SEXUAL BEHAVIOUR 
One of the most frequently given explanations in relation to the increase of AIDS 
among female adolescents and women in general is that of behaviour - specifically 
uncontrolled sexual behaviour. Thorough understanding of any behaviour requires 
some knowledge of its genesis. This section therefore begins with the genesis of sexual 
behaviour within the framework of human behaviour. 
Behaviour is defined by Katchadourian and Lunde (1980:27) as the way one acts and 
also what can be witnessed by others in contrast to inner feelings and thoughts. The 
definition implies that behaviour is an integrated whole of inner feelings and thoughts 
54 
which is put into action. Closer scrutiny of human behaviour reveals that all aspects 
and activities in life may have a certain amount of sexual significance. For the purpose 
of this study, focus is on sexual behaviour that culminate in sexual intercourse. 
Psychoanalytic theory emphasises that sexual energy is the basic motivator of human 
behaviour and is apparent in all human beings (Katchadourian and Lunde, 1980:217) . 
However, this sexual energy emerges during adolescence years . Adolescent sexuality 
is thus viewed as having several psychological dimensions. Included is first and 
foremost the need for intimacy which is defined by Mitchel (1971 :24) as the need to 
relatedness with others as well as oneself. The second dimension is the need for 
belonging. Both the mentioned dimensions compels adolescents toward one another 
which may lead to sexual behaviour. Furthermore for females there is the possibility 
to accede to the sexual demands of their partners because their sense of belonging may 
be threatened if they refuse. This will be further discussed under cultural factors. 
Sexuality in adolescence also means experimentation and searching. The expression 
of sexuality is a fundamental human need and particularly is driven by biological forces 
that are difficult but possible to regulate. Because of this sexual pressure and the need 
for relatedness, adolescents often engage in sexual relationships to satisfy their needs. 
This contention is confirmed by Van Coeverden, De Groot and Greathead (1987:1) 
who in their study of female adolescents found that 81 % were sexually active . 
Behaviour relating to sexuality has changed dramatically over the years . Sexual 
behaviour is by and large viewed by adolescents as exciting, stimulating and has 
become an acceptable norm. This change is therefore marked by the acceptance of pre-
marital sexual intercourse. According to Diclemente ( 1992:6 ) the liberal attitudes 
toward premarital sexual activities are a serious concern especially with the emergence 
of AIDS. 
Apart from biological forces there are other factors which have an influence on 
people's sexual behaviour. Often these factors force people in situations in which they 
55 
have little control over their lives. These factors are discussed below. 
A SOCIO-ECONOMIC FACTORS 
In low socio-economic areas , some young women might be forced to sell their 
own bodies for money. The concern here is that a male figure might argue that 
if he has paid for sex he's entitled to have the kind of sex he wants. 
Many men, for instance, don't like using condoms and may refuse to wear one 
(Diclemente, 1992:35-38) . Some may even offer extra money to have sex 
without a condom. Unsafe sexual practices exposes human beings to HIV 
infection. 
Nwu I 
B SOCIALIZATION PROCESS lL IBRARV_ 
Human sexual behaviour is highly dependent on learning. This process where 
human beings internalise the norms, values and beliefs of society , is known as 
socialization (Barker, 1987: 4 71). Most commonly, the socialization process 
takes place in the family. school or peer group situations. 
The family is generally viewed as a unit into which children are born and 
prepared for their roles in society. The family exerts a most profound influence 
on human beings and is the primary determinant of individuals' behaviour. For 
example, if premarital sexual intercourse is condoned and accepted within the 
family structure, young people are more likely to practice it. 
The school also serves as an important agent of socialization. In the process of 
schooling, adolescents make friends who become a major part of their lives . 
According to Sapire (1990:47) young people may indulge in promiscuous 
sexual encounters to maintain popularity and acceptance by their 
peers. It can thus be concluded that the influence of peers on sexual behaviour 
can facilitate HIV infection. 
56 
C CULTURE 
Taylor (1971) as quoted by Schusky (1978:54) defines culture as "that complex 
whole which includes knowledge, beliefs, art, morals , law, custom and many 
capabilities and habits acquired by man as a member of society". The elements 
of culture are extremely relevant to determine the social characteristics of a 
particular community . 
Culture is a diverse and controversial issue especially in the black communities . 
It can both facilitate and hamper HIV-related educational campaigns. In a 
recent study by Rooyen ( 1994) it was found that there is a strong relationship 
between AIDS and culture (Social Work Practice 1995:5). More than half of 
the sample (57 %)  suggested that culture had a problematic impact on 
HIV/ AIDS education and training . 
Amongst the most difficult culturally based issues which can be identified is 
sexuality. In the black culture sex has been considered to be a man's right - in 
fact a man's need - and a woman's duty. The man play the dominant role in 
initiating and determining the pattern of sexual interactions . The man is 
presumed to be the "sex expert" who knows what to do in coitus . On the 
contrary females are presumed to have less interest in sex, a lower sex drive 
and a sense of discretion that would prevent them from initiating sexual 
activities. 
Furthermore, in most cultures, sex is not openly discussed and is considered a 
taboo subject. Women in the black culture are prohibited to talk about the issue 
even in the bedroom situation. This position marginalise women's ability to 
negotiate safer sex. However the cultural myth that men are sex experts has not 
been substantiated by either laboratory research or field studies. Women and 
men need to communicate and learn more about sexual matters together to 
prevent AIDS spread. At this point it is noteworthy to mention that the cultural 
influence cannot disappear in a short period of time but it is a process . 
57 
Cultural beliefs also make it difficult for people to understand the finality of the 
disease. These belief systems often allow people to see AIDS as not a disease 
but rather the result of being bewitched, and externally imposed entities which 
can be removed through traditionally , culturally related processes . 
In the study of Rooyen as mentioned earlier, participants reported that it is not 
easy to convince clients that they are HIV positive or have AIDS because of 
their beliefs. This finding confirms the contention that culture makes 
prevention difficult to persuade people in the black community to purposefully 
change the behaviours that put them at risk of HIV infection .. 
Polygamy which is a culturally acceptable practice is also a major concern 
pertinent to people who are fighting the spread of the disease. Polygamy is 
known to hamper prevention strategies. However, if partners practising 
polygamy are loyal and faithful to each other, the risk of HIV contraction is 
minimized. The problem lies with young people who are more likely to imitate 
their parents. Frieze et al. (1986: 151) state that children imitate same sex 
practices from their parents. Unfortunately, adolescents tend to have more 
partners outside marriage . This therefore puts them at risk of contracting the 
disease . 
D ALCOHOL AND DRUG USE 
According to Godse and Maxwell (1990:5) a drug is a chemical substance other 
than those required for the maintenance of normal health which on 
administration alters biological functions. Drugs and especially the so-called 
'legal drugs' have become an increasingly common part of everyday life-style. 
The tendency in the community is that the compulsive use of drugs is not 
acceptable. However, even the simple use of drugs can be problematic 
especially with the emergence of AIDS as the usage of drugs has an immense 
influence on sexual behaviour of persons. Under certain circumstances 
drinking may affect a person's judgement. Since a person is not in a good state 
58 
of mind, it might be more difficult to practice safe sex. Evein (1995 :236) 
stresses that people under the influence of alcohol and drugs are more 'loose 
and care free' . 
E PORNOGRAPHY 
Today's world is characterised by democratic efforts . Pornography is at present 
in the light of democracy a debated issue in South Africa. Nevertheless, 
children are continually exposed to nude pictures in magazines , movies and 
television. Considerable work done on this issue shows that viewing or reading 
erotic materials is sexually arousing for a significant percentage of the 
population particularly males (Katchadaurian and Lunde , 1980:47). This 
suggests that mental stimulation leads to sexual action. If a person is unable to 
control his/her sexual behaviour, the possibility is that he/she will engage in 
sexual activities despite the consequences. 
Another area of concern is the violence against women being depicted in some 
pornography . Some researchers argue that there is a relationship between 
pornography and sex crimes (Katchadeurian and Lunde, 1980:422). However, 
the cause and effect relation has not been established . In the realm of AIDS, 
the risk cannot be ignored. 
The general picture that has been presented in the above discussion is that uncontrolled 
sexual behaviour plays a role with regard to the spread of AIDS . 
The last section of this chapter focuses on knowledge of, and attitudes of female 
adolescents with regard to AIDS and sexual intercourse. 
4.6 KNOWLEDGE WITH REGARD TO AIDS 
No doubt AIDS is the most talked about disease in South Africa today. Perhaps the 
most talked about disease of the century . Despite the fact that AIDS receives much 
59 
focus and attention the spread of the disease is still increasing. Simbayi (1993: 1) states 
that many published studies on students have generally reported high levels of 
knowledge about AIDS. However some studies such as those by Kau and Kaya 
(1993: 10) and Mogotsi (1994:4) revealed that although students are knowledgeable 
many misconceptions about the contents of the disease still exist. 
The fact that a person can be infected with HIV and not have AIDS is one of the many 
misconceptions people are not clear about. Thus it raises the issue of whether 
education campaigns have done enough in informing people about AIDS. Due to the 
complexity of the topic and lack of knowledge on the part of most people, it is 
questionable whether or not people will be able to change their unsafe sexual 
behaviours . 
Another important issue which has raised many questions is that of the HIV antibody 
test. A study conducted by Schrunik and Schrunik (1990:21) found that many people 
prefer not to know whether they have AIDS or not. However, what people need to 
know is that these tests do not determine whether one has AIDS or not but they only 
show whether one is HIV infected or not. According to the aforementioned author, 
"knowing that you are antibody positive gives one a chance to cut his life-style in ways 
that may possibly reduce the risk of developing AIDS" as research in many countries 
has indicated that not all people with HIV develop full-blown-AIDS . 
The negative aspect of the knowledge that one is HIV positive may lead other people 
to spread the disease often as a result of anger or fear of dying alone . As uncontrolled 
sexual intercourse has been cited in literature as one way of increasing the spread of 
AIDS it emphasises the importance of pre-test-counselling. 
Another reason why people are reluctant to know about their health status is that there 
is no cure for AIDS. According to Evein (1993 :73) many people are of the opinion 
that there is little to be gained in undergoing the test because there's no effective 
treatment for those who discover that they are antibody positive . 
60 
Mwale and Burnard (1992:76) in their study on rural women and AIDS found that 
women have knowledge that promiscuous behaviour is the quickest mode of HIV 
transmission. Furthermore they indicated that sticking to one partner and using 
condoms are the most effective ways to prevent AIDS spread. It is clear from the 
above observations that many women know how and what should be done to prevent 
AIDS . However , experts are of the opinion that no matter how accurate the 
information people may have about AIDS , it has not led to long term behaviour 
changes (The Star, 11 July 1991) . 
Although it is evident that there is a growing favour of fundamental changes in sexual 
behaviour, the norms of sexual behaviour such as having multiple sex partners can only 
change if attitudes are changed. For safe sex to be a socially acceptable behaviour, 
attitudes toward safe sex play a major role . Following are the attitudes of people 
towards safe sex and AIDS . 
4 .7 ATTITUDES TOWARD SEX 
The concept of attitude has been of interest to many social scientists over the years . 
Words such as feelings, tendencies to react, fears, threats, prejudices , ideas and biases 
have been used interchangeably with or to refer to attitude . Although there are many 
definitions of attitude Ashmore ( 197 5: 1) maintains that all of these have three common 
elements namely : that attitude is not directly observable; that it is an evaluative 
response ; and lastly that attitudes in conjunction with individual and situational 
variables influence behaviour. 
Lefton (1969:2) defines attitude as "an enduring pattern of feelings , beliefs and 
behaviour tendencies toward other people, ideas or objects" . Furthermore attitudes are 
established through learning often early in life . They are learned in response to a need 
for reaction to particular circumstances and tend to become internalized. 
There are a number of factors that determine attitudes of people . These factors are 
discussed below with reference to sex and AIDS . 
61 
CULTURE 
According to Frieze et al. (1986:290) attitudes are reinforced by cultural 
beliefs . However cultures are not static but change over time . Modem 
industrial societies have changed considerably in the past over several centuries 
and will undoubtedly continue to change in the future . Attitudes about 
sexuality are among the cultural patterns that are changing rapidly . The 
opinions and views of people toward sex in the 1990' s are considerably 
different from the pattern of the 1950's and 1960's. For example , the black 
society in South Africa used to be quite restrictive in its attitudes about 
sexuality. On the contrary many sectors presently have become progressively 
more accepting of sexuality. This contention is supported by Sapire (1990:47) 
who states that there has been an increase of sexual activity among the youth. 
The reasons given are amongst others the earlier age of puberty , relaxation of 
controls, absence of structured leisure time and liberation of values regarding 
intimacy. 
Many studies show that the attitudes of the youth have changed before those of 
the rest of the population (Katchadaurian and Lunde, 1980:419) . The 
frequency of premarital virginity appears to have decreased among female 
adolescents . This statement is supported by the study conducted by Van 
Coeverden, De Groot and Greathead (1987:1) in which they found that the 
majority of respondents (female adolescents) were sexually active . 
SOCIAL ENVIRONMENT 
Attitudes of people are also influenced by the social environment. It is in the 
context of individuals ' immediate social environments that their logical 
dispositions and attitudes are developed. Other people constitute an individual's 
social environment. As one matures , one's social environment is increasingly 
populated by peers . According to Frieze et al. (1986:293) peers serve as 
models of sex behaviour. As already stated in this report, the majority of 
adolescents are in favour of premarital sexual encounters. It has been found 
62 
that people who value a group such as a group of peers and want to be accepted 
by it tend to conform to existing group norms. Therefore , they will accept the 
attitudes and values of the group with which they identify . 
A further area of growing concern is that of contraceptives . The present 
generation, grows up with access to the pill and other contraceptives in its 
environment and has new values and beliefs about them that are different from 
those who lived in pre-pill society . Contraceptives are presently more 
accessible and people can talk about it openly . The reality of the above 
contentions is confirmed by Anderson's (1994:36) findings which indicated that 
more than half of his sample group (51.9%) agreed that teenagers should be 
encouraged to use contraceptives such as condoms. This suggests that the 
attitudes of the youth toward sex have become more liberal than in the past. 
4.8 ATTITUDES TOWARD AIDS 
As the potential magnitude of the AIDS epidemic becomes more widely understood, 
there has been an outpouring of public fear and concern expressed in a range of 
responses (Blendon, 1992:267). Merely mentioning the acronym for Acquired Immune 
Deficiency Syndrome arouses fear into people . AIDS is an emotive issue because of 
its associated high mortality rate which is colloquially referred to as "AIDS is a death 
sentence". 
Attitudes toward life and death determine the value placed on health by individuals . 
In view of conditions such as poverty, a person's attitudes towards life may generally 
be negative. For example, an impoverished matriculant student whose hope for the 
future is not promising because of lack of financial assistance may be affected to an 
extent that she/he cares less about her/his own health. 
Attitudes of people toward AIDS, may also be influenced by the way they perceive the 
disease. Gilman (1988) as mentioned by Lesley (1992:42) states that people with AIDS 
are socially construed as "others" in the society. That is , many people believe that 
63 
AIDS happens to someone else or another group rather than themselves or their group . 
People especially the youth have a tendency to project AIDS away from themselves 
into other groups . 
Denial also has an effect regarding change of attitudes . According to Silgerson and 
Peterson (1990: 123) most human beings are still faced with a 'denial syndrome' of 
saying "I have no chance of becoming infected". This therefore makes prevention 
strategies very difficult to implement. 
4.9 CONCLUSION 
Adolescents sexual behaviour exposes them to HIV infection. Factors such as alcohol 
intake, peer pressure, and low socio-economic status are known to influence unsafe 
sexual activities. Although the above mentioned factors play a significant role it would 
seem that the attitudes held by the youth toward sex permit them to enjoy more 
freedom but simultaneously place them at risk to contract the AIDS virus. 
64 
CHAPTERS 
PREVENTION OF AIDS 
5.1 INTRODUCTION 
In the preceding chapters, the reality of heterosexual transmission of AIDS was 
presented. Many young people, especially females run a considerable risk of being 
infected through this mode of transmission. AIDS is presently a true pandemic and the 
worst is yet to come if the spread of the AIDS virus is not considerably decreased. 
In the absence of any cure or vaccine, prevention is the only hope for overcoming the 
fatal disease . Prevention of infection with the AIDS virus requires people to exercise 
control over their own sexual behaviours. Social efforts designed to control the spread 
of AIDS have centred mainly on informing the public about how the AIDS virus is 
transmitted and how to safeguard one against such infection. Unfortunately 
information alone does not necessarily exert much influence on health-impairing habits. 
It has not slimmed the obese, eradicated cigarette smoking, and it certainly will not 
make the sexually active people celibate. 
To achieve self-directed change, people need to be given not only reasons to alter risky 
habits but also the means, resources and social support to do so . This chapter will 
focus on prevention considering the above mentioned factors. 
In order to understand the basis for prevention, it is necessary to define the term as 
used in this study. 
NWU . , 
IL IBRARY 
5.2 BASIC CONCEPTS AND DEFINITION 
In everyday usage 'prevention' is a catchall, sufficiently global term embracing three 
qualitative different strategies, namely : primary, secondary and tertiary prevention 
strategies (Zax and Cowen, 1976:88). Tertiary strategies are programmes designed to 
reduce the effects of AIDS on the HIV infected person. This includes supportive 
65 
services for AIDS victims and mutual aid groups. The tertiary programmes enable 
victims of AIDS to cope with the stress of daily living. Although necessary , these 
programmes have little effect on prevention of HIV infection because they are 
implemented after infection has taken place. Furthermore, focus is only on the victims 
rather than people who are at risk to contract the virus. 
Secondary prevention on the other hand focuses on medical strategies that seek to 
reduce the spread of the disease (Cowen, 1983 : 11). This involves screening of blood 
(HIV test) to determine the health status of a person. A common element in all 
secondary prevention efforts is the sense that systematic early findings will enable 
people to practice safe sex hence not to spread the disease . However, Hubley 
(1990:57-58) is of the opinion that knowing that one is HIV positive may propel a 
person to spread the disease possibly because of anger or fear of dying alone . This 
may increase rather than decrease the rate of infection. 
The alternative approach to prevalence reduction is an attempt to reduce the rate at 
which new cases of AIDS develop. This approach is formally known as primary 
prevention. This approach focuses on reducing the rate of infection through promoting 
healthy sexual behaviours in the community (Maforah, 1991 :64) . 
In this study, 'prevention' refers to primary prevention. The following section presents 
strategies and approaches of primary prevention. 
5.3 PRIMARY PREVENTION 
Bower (1979:78) defines primary prevention as "getting children through the health, 
family and school institutions smelling like a rose" . This author has outlined a detailed 
framework for pursuing primary prevention. Of importance in this framework is the 
conviction that prevention can be accomplished through medical , social , and 
psychological actions which occur during early periods of life in the areas of the 
normal social milieu such as the school. The primary purpose of the school is 
education. Schools are therefore perceived as public institutions with the broadest 
66 
opportunity for reducing HIV-risk-taking behaviours. This is based on the fact that 
effective education often leads to behaviour change (Diclemente, 1992:9). 
Primary prevention does not seek to prevent a specific person from being infected, 
instead it seeks to reduce the risk for the entire population. This contention is 
emphasised by Rae-Grant (1979:3) who stated that primary prevention aims at reducing 
the incidence of new cases of disease and improving the quality of life in target 
populations (female adolescents). The school is the one institution attended in the 
society by most young people. It is believed that primary prevention at this level can 
reduce unprotected intercourse among young people which may ultimately lead to HIV 
infection. 
5 .4 STRATEGIES OF PRIMARY PREVENTION 
Primary prevention activities can be classified into two main categories namely : global 
and specific. Global strategies on the one hand encompass all methods that are aimed 
at reducing the number of new cases, while specific strategies , on the other hand refer 
to different ways through which the global strategies can be implemented (Maforah, 
1991:65) . 
5.5 GLOBAL STRATEGIES 
The most important way to prevent the spread of AIDS is for people to ensure that their 
sexual life-styles do not put them at risk to contract the AIDS virus . 
There are three major changes of sexual behaviour that are needed namely : the 
reduction in number of sexual partners, the use of protective measures during coitus 
and abstinence. 
REDUCTION OF SEXUAL PARTNERS 
Safer sexual practice means having as few sexual partners as possible. In fact 
there seems to be a general consensus among experts that sticking to one partner 
is one of the major ways of reducing the AIDS spread on condition that it is 
67 
important for both partners to maintain a faithful sexual partnership . Although 
essential, faithfulness is not enough especially if one partner is already infected 
with HIV. Therefore it is a must for a person to know his sexual partner, his 
state of health, his life-style, and his sexual habits (past and present) before 
engaging in any sexual relationships . This implies that people should avoid 
having sexual intercourse with people they know little about. 
Although reducing the number of sexual partners or delaying sex until marriage 
is contemplated, the act does not completely remove the risk of infection. It is 
not impossible to tell from appearance that one is infected or not. In this regard 
the afore-mentioned author stated that the most effective way of ensuring that 
a partner is free of AIDS is through testing. Undertaking HIV blood tests 
enables people to know their health status. 
PREVENTING THE EXCHANGE OF BODY FLUIDS DURING COITUS 
The AIDS virus is transmitted in the semen and vaginal fluids. If these fluids 
' 
are prevented from entering the body of the other sexual partner the possible 
spread of AIDS is minimized. Condoms to a large extent are the only way to 
prevent this exchange of body fluids if used correctly during coitus . 
While condoms prohibit the transmission of HIV, their effectiveness as a risk 
reduction strategy is dependent on proper and consistent use. A number of 
studies show that condoms rupture and slip off even when used properly 
(Evein, 1995 : 6) . Furthermore the risk of bursting of condoms increases 
dramatically to more than 30% of users especially when it is stored in very hot 
conditions. Other factors such as lubricants (e g. vaseline) can destroy the 
condoms ability to protect. 
Although condoms do not provide absolute protection, most researchers believe 
that when used properly they offer some protection. Unfortunately , increasing 
the consistent use of condoms among adolescents has been a formidable 
68 
challenge. In their studies Seenhat . (1992:32), Kau (1992: 110) and Simbayi 
(1993:3) found that the use of condoms is extremely unpopular among both 
male and female adolescents. It was also revealed that people fail to use 
condoms because of fear of losing the opportunity for pleasurable sex and 
romance. The reasons for failure emphasise the importance of education. 
ABSTINENCE 
Abstaining completely from sexual intercourse is the safest way of avoiding 
infection (Hubley, 1992:38). Although sexual abstinence is the most effective 
method to prevent the transmission of HIV, few adolescents adopt this HIV-
preventive behaviour. This contention is supported by Sapire (1990:47) who 
stated that the delay in engaging in sexual intercourse is rare in many societies. 
If a cure for AIDS is not found this method will be the last option people are 
left with. 
Effective self regulation of behaviour requires certain skills, and moreover, being able 
to use them consistently and effectively. The following section focuses on specific 
strategies that can play an important role in helping individuals to achieve self-directed 
change . 
5.6 SCHOOL-BASED PREVENTION PROGRAMMES 
The education system is a potentially important channel for disseminating AIDS 
knowledge and influencing the behaviour of young people . Nearly 95 % of all children 
and youth are attending schools (Kirby, 1992: 159). Moreover, virtually all youth are 
in schools before they initiate risk-taking behaviours that may expose them to HIV. 
Although it is an established fact that education is necessary in preventing AIDS , sex 
education including AIDS is not yet part of the syllabus in South African schools (Sher , 
1991 as mentioned by Sitiloane, 1992:6). As the youth are one of the most vulnerable 
groups to contract AIDS it has become imperative that sex and AIDS 
education should be introduced in schools as an integral part of the educational 
69 
curriculum. 
AIDS education is primarily health education. According to Maforah (1991 :66) the 
goal of health education is to promote a healthy living by motivating and persuading 
people to make vital modifications in their mode of life . With regard to AIDS 
education people are helped to acquire knowledge, attitudes and sexual behaviour 
patterns that will reduce their risk to contract AIDS. 
The success of school-based prevention programmes depends on a number of factors 
which are as follows: 
A CULTURE 
South Africa is a society with several cultures and therefore the cultural 
plurality needs to be reflected in all educational strategies . In this regard more 
attention should be given to the cultural perceptions of sexuality and AIDS . If 
intervention is to be successful it needs to consider the style, language, customs 
and practices of a particular community. In this regard Sitiloane (1992:6) is of 
the opinion that a special brand of information on AIDS and the prevention of 
AIDS need to be developed for Black communities. 
B SUPPORT OF PARENTS 
Closely related to culture is the support of the older generation. According to 
Diclemente (1992: 163) the single most common problem preventing sex 
education is opposition from parents. For this reason many experts suggest that 
educators need to get support from the older generation which involves 
explaining to them the importance of educating the youth about sexual practices 
and the possibility of acquiring AIDS . Getting their approval will help 
especially with reinforcing what has been taught at school and in the family 
setting . 
70 
C EDUCATION LEVEL 
One of the important decisions regarding sexual and AIDS education, is the 
time at which this education should be started. Sapire (1990:47) states that 
although it is tempting to leave AIDS education until children are in secondary 
and high schools, it may prove to be too late . The above statement is based on 
the presumption that many children begin experimenting with sex at an early 
age in their lives which may even be years before they attend high school. In 
addition, there are some students who do not advance to high schools because 
of a variety of reasons. 
Considering the aforementioned facts, it is suggested that sex education needs 
to be initiated at the elementary or primary level where the majority of young 
people are not yet exposed to sexual activities. 
D METHOD OF TEACHING 
According to Diclemente (1992: 101) AIDS education should not be treated in 
isolation but should be incorporated into health education, sex education and 
into life skills education. Subjects such as biology, drama, music and religious 
studies can also serve as means of providing this education. This can 
effectively be accomplished in primary schools where basic concepts such as 
health, diseases and human relationships are taught gradually, as children grow 
older, progress can be made to more detailed information. 
Creative involvement of children is essential if programmes are aimed at 
changing behaviours. Pupils need to feel that they are given credit for their 
own insight and their own ability to innovate solutions . In this regard Maforah 
(1991 :221) is of the opinion that education should not be prescriptive but allow 
for broader participation. 
The ability to learn by social modelling provides a highly effective method for 
increasing human knowledge and skills. A special power of modelling is that 
71 
it can simultaneously transmit knowledge as well as valuable skills to large 
numbers of people (Bandura, 1986 as quoted by Diclemente, 1992: 103). 
Applications of modelling principles to AIDS prevention should focus on how 
to manage interpersonal situations and one's behaviour in ways that afford 
protection against the abuse of one's body. Both self-regulative and risk-
reduction strategies for dealing with a variety of risk situations should be 
modelled to convey general guides. 
E CONTENT OF EDUCATION 
AIDS education needs to first identify the specific learning needs of teenagers . 
Surveys of adolescents ' knowledge about HIV and AIDS found that substantial 
proportions of adolescents , although knowledgeable about AIDS , had 
misperceptions about how HIV is transmitted, protective measures and the 
process of HIV transmission to AIDS (Diclemente, 1992: 9, Mogotsi , 1994: 63 , 
Kaya and Kau, 1993: 10). These findings all point to a need for education about 
AIDS transmission. 
It is also clear that despite learning the principal modes of AIDS transmission, 
many adolescents are continuing to engage in unprotected sex. In all surveys 
conducted to date, it would seem that the majority of sexually active adolescents 
are not in favour of using condoms (Kau, 1992:123, Sapire, 1992:47) . Clearly 
a need exists to move beyond simply educating adolescents about modes of HIV 
transmission. In this regard Diclemente (1992:22) is of the view that educators 
should discuss the adolescents ' beliefs about AIDS and should emphasize the 
growing susceptibility of adolescent females to infection. They should 
reinforce the fact that while some drugs can prolong the lives of HIV positive 
persons no cure exists. Therefore the most effective form of avoiding infection 
is sexual abstinence. 
Added to this educators should emphasize that condom use is critical for those 
who are not prepared to refrain from sexual activity. Mouli (1992:26) supports 
72 
the above statement by stating that educators should demonstrate how to use 
condoms correctly and should indicate where condoms can be obtained. 
Perhaps even more important, adolescents need to receive instruction on how 
to negotiate safety with a potential sexual partner. Hingson and Strunin (1992) 
in Diclemente (1992:29) suggested role playing exercises which can be 
particularly helpful in teaching these communities about HIV infection and 
AIDS . 
Education should not only include discussion about AIDS but it should also 
cover beliefs and attitudes about other sexually transmitted diseases. According 
to Diclemente (1992:22) many adolescents are unaware that some sexually 
transmitted diseases can be asymptomatic. Further, many may not be aware 
that STD infection can also increase the likelihood of HIV transmission. 
One of the sexuality facets that need focus in education is peer pressure . A 
need to identify with others can drive some people to experiment with sex at an 
early age. The findings of a study of 3337 U.S teenagers on the relationship 
between pre-marital sexual intercourse and peer pressure showed that 90 % 
experienced peer pressure (Caitor, 1993: 1). Furthermore 80% admitted giving 
in to peer pressure at least once a week even if that meant doing something 
wrong. Peer pressure can lead to tragic consequences especially with the 
emergence of AIDS. Education must therefore stress the importance of a 
person's individuality and of standing up to this kind of pressure. Female 
adolescents need to be empowered to resist pressure based on the notion that 
peer pressure can be overcome. Furthermore assertiveness training should be 
incorporated in AIDS education. Richardson (1990:87) stated that young 
people especially females need to know when and how to say NO. Added to 
this they should also know why it is imperative to say no. 
Finally, adolescents should be warned about the use of alcohol and drugs which 
may contribute to unprotected sexual intercourse . According to Hingson and 
73 
Strunin (1992:8) in Diclemente (1992:26) adolescents who were more likely to 
have sex after drinking and drug use tended to have had more sexual partners 
and reported that they were less likely to use condoms. As a result they are 
obviously at greater risk of HIV infection. 
5. 7 THE ROLE OF TEACHERS IN AIDS EDUCATION 
Children spend most of their time in schools and therefore teachers are in regular 
contact with school children over several years. Because teachers are in the school all 
the time offering education and guidance to students, they are in a better position 
to offer AIDS education. Teachers however, need further training to disseminate 
accurate information (Mouli, 1992:26). 
Before teaching others , teachers themselves must be comfortable with sufficient 
knowledge and terminology to be used. Teachers must be aware that various cultures 
use different terminology for certain terms . For example, in some parts of Africa, 
condoms are referred to as gumboots and raincoats. According to Zazayokwe (1992:7-
8) the use of academic terms may embarrass the students or make education distant and 
remote. Furthermore, words such as condom do not exist in any Black language. To 
prevent possible mis- communication the use of polite local expressions has proved to 
be more useful. 
Teachers should also serve as good role models for their pupils. Bandura (1986) in 
Diclemente (1992: 103) is of the view that people judge their own capabilities in part 
from how well those whom they respect exercise control over various situations . 
Teachers are encouraged to regulate control over their sexual behaviours. Students 
might be skeptical of messages such as" delay sexual intercourse" ," have only one 
sexual partner" etc,. if teachers' actions differ with such messages. They may see 
teachers as trying to deny them the pleasure that adults enjoy . 
Because of the potential magnitude of the AIDS disease, additional resources are 
needed to intensify the school-based prevention programmes. These include skills and 
74 
knowledge of other professionals as well as parents and interest groups . 
.8 COMPREHENSIVE SCHOOL-BASED PROGRAMMES 
AIDS education is not a function limited to teachers, nor is it exclusively the 
responsibility of the school. In this regard Motang (1992: 16-19) stated that efforts by 
one discipline without the involvement of others will certainly fail. Extensive 
collaboration should take place between the teacher, the physician, the public health 
practitioner, ministers of religion and other special interest groups. 
When using the inter-disciplinary team approach, all participants use their skills , 
knowledge, techniques and approaches to reinforce behaviour changes. Education 
involves much more than the mere giving of information and therefore the team needs 
to discuss all aspects of AIDS and be fully supportive of one another. The success of 
the team approach depends on the attitudes of the members, their willingness to 
participate and respecting each other (Sineloff, 1982). 
Apart from professionals, comprehensive school programmes should include other role 
models found in the society . It is an established fact that people listen to people whom 
they admire and respect. Role models such as musicians , football players and 
actresses need to be involved. According to Mouli (1992:26) these people are regarded 
highly by young people and could play an important role in influencing behavioural 
changes . 
Finally, young field workers can also play an important role in the team. Adolescents 
are strongly influenced by their peers. In this regard peer pressure can be used 
positively to change unsafe sexual habits. This approach has been successfully used 
in addressing other problems such as alcohol and drug abuse. For example, in South 
Africa TADA (teenagers against drug abuse) groups have proved to be effective in 
warning teenagers against the use of drugs. In order to avoid duplication, the same 
groups may be encouraged to adopt AIDS education as one of their objectives . By 
using these groups of young people it is hoped that other teenagers will be able to give 
75 
them an ear, especially because the message comes from people of the same age . 
5.9 THE AIDS EDUCATION PROCESS 
Informing people about AIDS is not a simple task but a process comprised of five 
stages. The stages described below are based on those offered by Lombard (1990: 11) 
in his discussion of facilitating AIDS education. 
STAGE ONE (CHOOSING THE TARGET GROUP) 
This involves identifying groups that needs to be reached in the community. 
Every target group has different information it needs and will require separate 
and distinct approaches. For example, adolescence is the period in the life 
cycle when the risk-related sexual and drug activities begin. Therefore , 
education about safer sexual and drug use can be offered to this group. 
STAGE TWO (AWARENESS) 
After a target group has been identified, the process of creating awareness can 
begin. This stage is based on the assumption that once people are made aware 
of the dangers of the disease, they could start thinking about how to protect 
themselves. Gee and Moran (1985:391) support the above contention by stating 
that awareness is characterised by an increased interest in making the situation 
better. 
STAGE THREE (DISSEMINATION OF KNOWLEDGE) 
Once people are made aware of the disease, a need for knowledge is created. 
Before giving information Lombard (1990: 11) emphasises that the educator 
should first determine the present knowledge of the audience and whether they 
have any misconceptions or special needs concerning the topic . This can result 
in alteration of knowledge where they are misinformed. 
STAGE FOUR (MOTIVATION) 
Creating awareness and giving information is not enough to change human 
76 
sexual behaviour. Ways to motivate people to act on the information are also 
of great importance. Individuals should therefore be motivated to modify their 
sexual lives in order to fully control the possible spreading of the disease . 
Lombard (1990: 11) states that recognising the value of life and the reality of 
death can motivate people to change their unsafe sexual habits . 
STAGE FIVE (SUSTAINABILITY) 
Finally, education needs to be innovative and sustained. Messages about AIDS 
should be ongoing and repetitive. This could be achieved by combining 
different strategies such as giving talks, seminars, workshops as well as using 
the mass media. 
Given the fact that AIDS education should not be treated in isolation, there is 
a need that education should be incorporated into other various structures other 
than the school. 
5 .10 MASS MEDIA-BASED-PREVENTION 
Although there are other channels for dissemination of health messages, the mass media 
remain particularly important since it can in its various forms reach many people. 
Mass communication includes broadcasting (television and radio programmes) , print 
(magazines, newspapers, direct mail etc) and displays (bill boards and posters). 
5 .10 .1 TELEVISION 
Television is often regarded as a powerful medium resource for 
delivering messages to especially the youth. The AIDS message can be 
delivered in many ways on television depending on the length and 
format of the particular programme. For example, the effects of HIV 
infection may be dramatized in a single episode of a regularly scheduled 
programme. Alternatively, one may reach the same audience with a 
thirty -second message that can be shown on regular intervals. 
77 
5.10.2 RADIO 
This is also a major resource for AIDS educators and one which is 
rather underrated and underused. The radio is probably the only other 
channel that can reach large numbers of young people . People who 
cannot afford television sets are likely to possess a radio (Maforah, 
1991:232). 
5.10.3 LOCAL NEWSPAPERS, MAGAZINES AND DIRECT MAIL 
Printed communication channels have played a key role for many years 
as a means for dissemination of information. The advantage of this 
means of communication is its potential to reach people who do not own 
television sets and radios . However, the press is not interested in dry 
facts or unattractive information. To tell the truth about the AIDS 
threat requires writing about fairly technical matters with many 
qualifications and much circumspection. This therefore makes the 
dissemination of accurate information about AIDS not newsworthy in 
comparison with more urgent crises news items. Despite the above 
mentioned constraints the press can be used to advertise special events 
such as seminars and workshops on AIDS to interested young people . 
Although the mass media play an important role to promote the social 
changes that can help control the AIDS disease, they have some 
limitations which are as follows: 
5.11 LIMITATIONS OF THE MASS MEDIA 
Mass media are undoubtedly the most effective method in disseminating 
information and will hopefully lead to understanding issues relating to AIDS. 
However, the majority of impoverished communities, which constitute a larger 
proportion of the South African population, do not have access to luxurious 
property such as television sets. 
78 
Furthermore, the mass media can sometimes sow doubt, confusion and even 
mislead some people (Maforah, 1991 :97). This can be attributed to the lack 
of clear, accurate, and up-to-date information. Since AIDS is a changing 
phenomenon, such information is not always easy to obtain. 
The family can also serve as an important source of information. 
5.12 THE FAMILY BASED PREVENTION 
The family is widely accepted as the primary socialization agent. Therefore 
Lombard (1990: 11) views the family as the foundation for high morals. Good 
values should be stabilised at home by parents within the family environment. 
A prominent feature of an African society is that life is organised around the 
family . Thus the family is entrusted with the responsibility of promoting health 
and improving the quality of life of all its members. 
Although the family has an important function in educating the youth, a !)umber 
of current trends such as rural-urban migration, rapid urbanisation, marriage 
breakdown and the need for both parents to work, make it difficult for parents 
to spend enough time with their children. In families where both parents are 
working there is a greater possibility that parents have limited time . Many 
leave for work before their children wake up in the morning and find them 
sleeping when they return either because of their long work hours or public 
transport delays . These children are often left on their own and without proper 
attention, guidance or supervision . According to Mouli (1992:33) most 
children therefore learn many things outside their homes. This is supported by 
Kau's (1993:73) study that peers are a major source of information with regard 
to sexual intercourse messages amongst the youth. 
Sitiloane (1992:6) suggests therefore that parents need to be advised that good 
values and morals of society are determined by the time they spend with their 
children. Parents should be encouraged to teach their children the facts of life 
79 
and the prudence of not indulging in casual sex. However this is only possible 
if parents have developed a good parent-child relationship. 
The following section focuses on the role of social workers with regard to prevention 
of AIDS. 
5 .13 THE SOCIAL WORK BASE FOR PREVENTION 
Social work from its earliest beginnings has embraced individual, family and 
community change. The purpose of social work is to address problems occurring 
within the community in which their clients live (Motang, 1992:6). The core of the 
social endeavour is the social worker and the client interacting in relation to problems 
in their social functioning . It is a widely accepted fact that AIDS is a social problem. 
It has emerged as a threat to both health and social development as well as the survival 
of millions of individuals, families and communities. This therefore, gives sufficient 
reason for social workers to be actively concerned about this disease and its 
implications . 
Furthermore, the social worker's knowledge about human development, human 
diversity and social environment, places them at a good advantage of helping in the 
prevention of the spread of AIDS . Preventive social work is defined by Bracht 
(1978 :20) as "an organized and systematic effort to apply knowledge about social 
health and pathology in such a manner as to enhance and preserve the social and mental 
health of the community. " 
I-NWU · 1 .LIBRARY 
With the emergence of AIDS, the primary goal of preventive social work is to translate 
health knowledge into effective self protection against HIV infection. This goal is 
based on the premise that AIDS is completely preventable with adequate information 
and the adoption of appropriate and acceptable behaviours. Unfortunately, most studies 
have indicated that there is still a great amount of ignorance surrounding AIDS. With 
this lack of knowledge it becomes imperative that social workers be involved in AIDS 
education. 
80 
Because of their knowledge of the community, the social workers can link adolescents 
with sources of information. In community work, it is usually emphasised that the 
worker must use the resources within the community, and if they are not available, 
they must be created (Henderson, 1985 : 11) . A valuable approach is to involve all 
people in educational programmes. By involving the communities social workers are 
consistent with the professional principles of individualisation, self-determination and 
self-help. Involving others increases the effectiveness of their intervention. 
As pointed out earlier, human sexuality is a topic that Black people do not feel at ease 
with when it is discussed. One way in which social workers can be more sensitive and 
responsive to the needs of clients is through person to person communication. Because 
of their knowledge of case work, social workers may encourage a relationship where 
individuals can feel comfortable to express deep-seated emotions and fears about AIDS. 
The aim of counselling, is to help them to take necessary actions to ensure that they do 
not become infected with HIV. 
Groupwork can also be used by social workers to discuss issues of human sexuality 
with a greater degree of confidence. It provides a non-threatening environment for 
growth, learning and prevention. This method emphasises mutual sharing of feelings , 
mutual support and integration of solutions (Heap, 1985: 16). In group situations 
female adolescents can encourage one another to practice safe sex, to be assertive and 
also to gain skills of how to negotiate safe sex with their partners. 
One of the techniques that is used extensively is role play . According to Reid 
(1991 :228) role play is used for the purpose of learning in the sense of acquiring new 
behaviour patterns. Role playing demonstrates or illustrates particular behaviour and 
in so doing provides objective data. Diclemente (1992:29) stated that educators should 
demonstrate how to use condoms correctly. In this regard role-playing can be 
particularly helpful. 
81 
Assertiveness training is also an important skill frequently taught in skill-oriented 
groups . It involves direct expression of both positive and negative feelings, at the risk 
of disapproval from other people (Reid, 1991 :229). Because peer group pressure is a 
powerful force in determining behaviour especially female adolescents need/require this 
skill in decision making . 
Finally, there is a need for social workers to be involved in research. This method will 
help social workers to analyse the life-styles and beliefs in respect of this disease , and 
determine how these factors may influence people's behaviour in responding to 
the disease . Understanding people's beliefs and perceptions may help social workers 
to develop helping strategies and skills to accommodate such beliefs . 
The above discussions have established that social workers have a meaningful role to 
play in education and prevention responsibilities. However for social workers to be 
effective they need to have thorough understanding of human behaviour, beliefs and 
practices that put people at risk. The Health Belief Model has become the main 
implicit or explicit reference of most studies in predicting health behaviour. 
5.14 THE HEALTH BELIEF MODEL (HBM) 
The Health Belief Model proposes that there are several factors which determine the 
individual's readiness to take action and engage in health related behaviours (Maforah, 
1991 :67). Emphasis of this model is the way in which healthy people seek to avoid 
illness. There are several reasons why the HBM is relevant to the prevention of AIDS 
especially among adolescents . 
Firstly , it is designed to explain preventive health behaviour which can be 
singled out to be the primary reason for sexual behavioural change. Focus of 
the model is to encourage preventive health behaviour (Williams and Wechster, 
1973 :421). This involves all activities undertaken by a person to protect 
himself/herself from getting the disease . With regard to AIDS, the emphasis 
will be on adopting safe sex strategies to protect oneself from being infected 
82 
with HIV. 
According to Maforah (1991 :66) exercising preventive health behaviour is not 
always easy as it entails discomfort or inconvenience. Despite the 
inconveniences, people may practice the behaviour in order to avoid a more 
major negative consequence at a later stage . Because health is highly valued 
by all individuals, people may be persuaded to change. 
Secondly, the Health Belief Model is designed to incorporate a wide range of 
social and psychological facts that can influence the decision to modify life-sty le 
behaviours . This model proposes that individuals and groups can be assessed 
according to the following two factors namely: personal readiness factors and 
social control and situational factors (Maforah, 1991: 103) . 
On the one hand personal readiness factors refer to matters such as recognition 
of seriousness of the problem, acceptance of personal vulnerability, 
predisposition to take action, motivation to act, ability to act and knowledge of 
desired action. 
Berkanoric (1976: 10) in his review of HBM studies concluded that the stimulus 
that triggers preventive health behaviour depends on individuals ' beliefs about 
the seriousness of the health condition to which the action is addressed . If 
AIDS, for example, is perceived as a serious health threat by the target 
population the probability that people can change their life-style is increased. 
The abovementioned author also stresses the increase of knowledge regarding 
all aspects of the disease which may result in changing inappropriate behaviour. 
Sound information is necessary on how AIDS is transmitted, the process of 
HIV infection and the emergence of AIDS in order to guide people regulate 
their behaviour and preserve their health. 
However knowledge alone cannot result in desired change. The model stresses 
83 
that for knowledge to be translated into action, people need to feel a personal 
vulnerability to the disease. Rather than shifting the blame and denying the 
situation, people are to be encouraged to take personal responsibility for their 
own lives . 
Finally the model stresses that the combination of high susceptibility to the 
illness and perceived benefits of action usually appear as a good 'predictor' of 
adoption of behavioural change. 
On the other hand social control and situational factors refer to the influence of 
the environment and include factors such as social pressure to act, attractiveness 
of the action, and positive previous experience with the desired action. The 
model stresses that the environment needs to be conducive to allow individuals 
to make constructive changes . 
In their intervention social workers have a task of understanding people's needs 
and beliefs and the above discussions have established that the HBM can be 
utilized effectively by them to initiate the required behavioural changes . 
5.15 CONCLUSION 
This chapter has established that for preventive programmes in AIDS disease to be 
successful, the people's participation is vital. There is no doubt that communities can 
adopt preventive behaviour. What is required of educators is to increase their 
awareness and emphasise behavioural changes . The significant contribution of social 
workers lies in making communities aware of prevention possibilities thus increasing 
their orientation towards preventive behaviour or adoption of healthier life-styles. 
84 
CHAPTER 6 
PRESENTATION AND ANALYSIS OF DATA 
6.1 INTRODUCTION 
This chapter focuses on presentation and analysis of data. It outlines the background 
information of the respondents, their knowledge and attitudes with regard to sexuality 
and AIDS. Finally focus will be on prevention of the spread of AIDS among female 
students. 
6.2 DEMOGRAPHIC DATA 
SCHOOL REGISTERED WITH 
The sample was drawn from schools situated in the North West Province . Therefore 
the entire sample consisted of school girls attending schools in this province. 
AGE OF RESPONDENTS 
The majority of the respondents are of the group 16-19 (71. 7 %) . They are followed 
by those who are above 20 (15.2%). The above figures imply that most of the 
respondents are in their teen years. Each stage of life is seen as bringing new 
challenges. Teen years are characterised by exploration and need for intimacy. 
According to Sapire (1990:47) there has been a universal increase of sexual activity at 
this stage. This therefore makes teenagers a most vulnerable group to possibly contract 
HIV. 
LEVEL OF EDUCATION 
All respondents in this study are at high school level of study. This is because the 
sample was deliberately drawn from the Std 8, 9 and 10 classes . According to Kirby 
(1992: 158) high schools are one of the institutions in the society attended by most 
young people. Furthermore the school is regarded as a major socialization agent and 
it thus therefore plays a significant rolein increasing the knowledge of the youth about 
AIDS . 
85 
GEOGRAPHICAL LOCATIONS 
The majority of respondents (51. 7 %)  spent the greatest part of their lives in rural 
areas , whereas 27 .3 % resided both in urban and rural areas. Only 21 % stated that 
they are from urban areas. This division is acceptable as the majority of people in 
the North West Province come from rural areas. This finding has significant 
implications for the prevention of AIDS , because rural areas are considered 
disadvantaged in terms of scarcity of resources. 
CHURCH ATTENDANCE 
Most of the respondents attend church activities at least twice a week (60%). Those 
who attend sometimes constituted 37.3% of respondents. A small percentage have 
never attended any church activity . According to Haralambos (1984:255) religious 
beliefs influence a person 's behaviour. In this instance, responses of students 
especially with regard to sexual activities are likely to be influenced by the values 
advocated by their religious affiliation. 
6.3 KNOWLEDGE ABOUT SEX 
The following table presents respondents ' primary sources of information about sex. 
TABLE 1 THE FIRST SOURCE OF INFORMATION ABOUT SEX 
SOURCE NO % 
Peers 198 41.3 
Parents 17 3.5 
Media 93 19.4 
Teachers 117 24.4 
Others (Doctors) 10 2.1 
Uncertain 18 3.8 
None 27 5.6 
Total 480 100.1 
86 
The above table reflects that peers (41.3%) , teachers (24.4%) and the media (19 .4 %) 
are major sources of information with regard to sexual matters. The most threatening 
finding is the minimum role played by parents (3.5 %). However this was not 
unexpected because in Black South African Institutions , parents are traditionally not 
expected to convey sexual information to their offspring. Any discussion of sexuality 
among the Blacks had been and is still remains taboo. 
According to Vilakazi (1962:36) the traditional black people had adequate social 
institutions such as initiation schools , which were entrusted with the sexual education 
and sexual needs of the youth. Society in the past used to be strict with regard to 
initiation school attendance, however presently in South Africa this is no longer the 
case. The peers, media, and teachers (in formal schools) are therefore major sources 
of information regarding sexuality . 
Given that peers are of the same age group , doubt can be entertained with regard 
to the quality of information they impart to each other. According to Chere 's 
(1996: 18) findings , teenagers have their own beliefs , and concerns where sexuality 
is concerned. They believe that a romantic relationship is meaningless without sexual 
activities. Furthermore, it was found that peers believe in what is done by peers or 
friends than any body else. These findings refer to possible ignorance since peers are 
also misinformed with regard to sexuality. This therefore makes one doubtful of their 
quality of information than the other groups. 
The contribution of the media in informing school girls about AIDS is helpful , 
however Maforah (1991 :231) is of the opinion that the media can sometimes sow 
doubts , confusion and mislead some people, especially on sensitive issues such as 
sexual matters. Given the fact that some films and programmes on television give 
an impression that premarital sexual intercourse is accept.able and good , undermine 
the AIDS message and ongoing maintenance of prevention. 
Finally , these findings revealed that teachers play a significant role with regard to 
sexuality. This is a good sign and positive factor with regard to education because 
8 7 
school-going-people spend most of their time in schools and teachers are in regular 
contact with them. By being in the school , teachers are in a better position to offer 
life skills education. However Mouli (1992:32) states that educators need special 
training to teach this sensitive area - sexuality. 
The following table presents the respondent/ attitudes towards premarital sexual 
intercourse. 
TABLE 2 ATTITUDES WITH REGARD TO PREMARITAL 
SEXUAL INTERCOURSE 
OPINION NO. % 
completely acceptable 289 60.2 
completely unacceptable 80 16.7 
Uncertain 111 23.1 
Total 480 100.0 
Table 2 indicates that the majority of respondents ' (60.2 %) are in favour of 
premarital sexual intercourse. This supports Sapire's (1992:47) findings that the 
majority of teenagers become sexually active at an early stage. Chere (1996: 18) links 
this more directly to peer pressure. The majority of young people accept premarital 
sexual intercourse, not because they want to but that they want to be accepted and 
appreciated by their social groups. Furthermore the above mentioned author is of the 
op inion that a sense of belonging among teenagers is strong and important. This 
finding increases the teenagers vulnerability towards contracting AIDS. 
6.4 KNOWLEDGE ABOUT AIDS 
Respondents were asked to define AIDS m their own words and the results are 
discussed hereunder: 
88 
DEFINITION OF AIDS 
The majority of respondents (69 %)  defined AIDS as an incurable disease which can 
be transmitted either sexually or through blood , 14.6% defined it as a mere sexually 
transmitted disease. This is a positive factor in that many respondents have an idea 
of what AIDS is. However 16.3 % of the respondents indicated that they do not have 
any knowledge , which makes them more vulnerable to the disease . 
Although the overall findings reveal that respondents' knowledge with regard to AIDS 
is high , their knowledge is doubtful as a result of their sources - peers are not 
experts . 
In the following table, the relationship between the ages of respondents and their 
knowledge of AIDS is discussed: 
TABLE 3 AGE GROUP AND KNOWLEDGE ABOUT AIDS 
12-15 16-19 20+ TOTAL 
DEFINITION OF AIDS YEARS YEARS YEARS 
NO % NO % NO % NO % 
A sexually transmitted disease 8 12.7 109 31.7 17 23.3 134 27.9 
An incurable sexually transmitted 
disease 25 39.7 184 53.5 50 68.5 259 54.0 
Do not know 
30 47 .6 51 14,8 6 8.2 87 18.1 
Total 63 100 344 100 73 100 480 100 
As reflected in the above table it appears that knowledge increases with age. The 
majority of students who are of the ages (12-15) were not able to define what AIDS 
is (4  7. 6 %)  . On the contrary students who are above nineteen stated that AIDS is a 
89 
sexually transmitted disease (68 .5 %). These findings support the concept that health 
and sex education should be introduced at an early stage of a child 's life. Sap ire 
(1994 :47) stated that although it is tempting to start this education late in a child 's 
life , students start experimenting with sex at an early stage. Van Coeverden De 
Groot and Greathand (1987:434-6) in their study found that 81 % of female 
adolescents were sexually active and the average age reported at first coitus was 14. 7 
years . 
These findings show that the majority of female adolescents are vulnerable to HIV 
infection . 
Table 4 gives an indication of what respondents think are the major ways of AIDS 
transmission. 
TABLE 4 WAYS OF AIDS TRANSMISSION 
WAYS OF AIDS TRANSMISSION NO. % 
Blood 196 40.8 
Sexual secretion 250 52.1 
Tears 3 0.6 
Saliva 1 0.2 
Perspiration 1 0.2 
Uncertain 29 6.0 
Total 480 99.9 
The above information reveals that the majority of respondents are aware that the 
AIDS virus can be transmitted through sexual secretion (52.1 %) and blood (40.8 %). 
This finding is not unexpected as a larger percentage of respondents (69 %)  defined 
AIDS as a disease that can be transmitted sexually or through blood and 14.6 % 
defined it as a sexually transmitted disease. 
90 
It is quite clear from the above findings that respondents are knowledgeable of the 
major ways in which AIDS can be transmitted. The finding contra,dicts Strebel ' s 
. -'· I 
(1991: 13) notion that there is a great deal of confusion about the modes of AIDS 
transmis.sion among young people. 
On the question whether a person can get infected during the first sexual encounter 
with an AIDS carrier the reaction of the respondents are set out in Fig 1. 
Fiqure 1 
First Sexual Encounter May Result in HIV Infection 
90 
80 
70 
60 
50 
40 
30 
20 
10 
0 
As figure 1 reflects, the most widely held opinion is that HIV infection can take place 
during the first sexual contact (80.2 %). This confirms the findings of other studies , 
such as Schrunik (1990:20) and Mogotsi (1994:48) that the majority of respondents 
are knowledgeable with regard to issues surrounding transmission of the AIDS virus. 
91 
This finding is positive in that knowledge is associated with lower levels of risky 
sexual practices. 
In the following figure , respondents were asked to indicate whether it is true or not 
that HIV is the virus that causes AIDS. 
Figure 2 
HIV is the Virus that Causes AIDS 
TRUE 
As reflected in the above figure almost all respondents (98.3%) agreed that HIV 
causes AIDS . This finding indicates that the present young generation believes in 
scientific facts instead of the traditional beliefs of witchcraft and ancestral wraths . 
92 
The following figure reflects the responses on the statement that there is a difference 
between HIV and AIDS. 
Figure 3 
There is a Difference Between HIV and AIDS 
10 20 30 40 50 60 _ 
93 
The above figure shows that 4 7. 9 % of the respondents are aware that there 1s a 
difference between HIV and AIDS whereas 21 % expressed no difference. The 
remaining percentage (31 %)  were uncertain. This finding corresponds with the 
remarks made by Simbayi (1992:2) , Kau and Kaya (1993: 10) and Mogotsi (1994:47) 
that there are still many misconceptions amongst young people regarding aspects of 
the disease. Their overall knowledge of AIDS therefore leaves much to be desired. 
The table to follow presents the responses to the question namely: Are you aware of 
any cure for AIDS? 
TABLE 5 CURE FOR AIDS 
CURE FOR AIDS NO. % 
No cure 261 54.4 
Prolonging the onset of symptoms 79 16.5 
Definite cure 68 14.2 
~ 
Uncertain 72 15.0 
Total 480 100.1 
Table 5 shows that a large number of respondents (54.4%) are knowledgeable that 
AIDS is fatal whereas 16.5 % are aware that there are measures that can possibly be 
taken to prolong the onset of AIDS. The fact that the majority of the respondents 
realise the fatality of the disease may cause them to be more careful concerning 
sexuality. Unfortunately a significant percentage (29.2 %) believe that there is a cure 
or they are uncertain. This is an indication that there is still a great deal of ignorance 
amongst teenagers regarding this deadly disease. 
In the following table the relationship between educational levels and knowledge of 
respondents with regard to any cure of AIDS is discussed. 
94 
TABLE 6 KNOWLEDGE AND EDUCATION LEVELS 
STD 8 STD 9 STD 10 TOTAL 
CURE OF AIDS 
NO % NO % NO % NO % 
Definite cure 30 18.8 19 11.9 19 11.9 68 14.2 
Prolonging the onset of AIDS 
symptoms 35 21.9 29 18.1 15 9.4 79 16.5 
No cure 64 40.0 79 49.4 118 73.8 261 54.4 
Uncertain 31 19.4 33 20.6 8 5.0 72 15.0 
Total 160 100.1 160 100 160 100.1 480 100.1 
A relationship seems to exist between education and knowledge with regard to AIDS. 
As table 6 shows (49.4 %) and (73.8 %) respectively in education categories (Std 9 and 
Std 10) were able to state that there is no cure of AIDS . These data suggest that 
knowledge increases with the educational level. The higher the standard passed , the 
greater the likelihood that the person is more knowledgeable about AIDS. 
Respondents were asked to identify signs and symptoms of AIDS. The results are 
discussed in the following table. 
TABLE 7 SIGNS AND SYMPTOMS OF AIDS 
SIGNS AND SYMPTOMS NO % 
Drenching night sweat 34 7.1 
Chronic fatigue 80 16.7 
Persistent fevers 46 9.6 0 4-b •l % 
Mental disturbances 27 5.6 
Persistent diarrhoea 37 7.7 
All of them 176 36.7 
Uncertain 80 16.7 
Total 480 100.1 
95 
As reflected in this table the majority of respondents (46. 7 %)  mentioned one main 
symptom of AIDS whereas 36.7% of respondents knew all the signs and symptoms 
of the disease. This finding is important in that school girls need to be in possession 
of accurate knowledge about AIDS. Moreover , being better educated than the 
general public makes them an important source of information for other members of 
society , especially in the rural areas where the majority of them originate. 
The following table indicates a relationship between the areas where respondents 
reside and the knowledge with regard to signs and symptoms of AIDS . 
TABLE 8 SIGNS, SYMPTOMS AND GEOGRAPHICAL AREAS 
SIGNS AND SYMPTOMS URBAN RURAL BOTH TOTAL 
URBAN AND 
RURAL 
NO % NO % NO % NO % 
Drenching night sweat 3 3.0 28 11.3 3 2.3 34 7.1 
Chronic fatigue 2 2.0 59 23.8 19 14.5 80 16.7 
Persistent fevers 1 1.0 31 12.5 14 10.7 46 9.6 
Mental disturbances 3 3.0 23 9.3 1 0.8 27 5.6 
Persistent diarrhoea 7 6.9 18 7.3 12 9.2 37 7.7 
All of them 75 74.2 20 u 81 61.8 176 36.7 
Uncertain 10 10.0 69 27.8 1 0.8 80 16.7 
Total 100 100.1 248 100.1 131 100.1 480 100.1 
From the above table, it is clear that the majority of respondents from urban areas 
(74.2 %) indicated that all of the mentioned signs and symptoms appear to people with 
AIDS. Furthermore a sizeable number of respondents (61. 8 %)  who spend their lives 
in both areas were able to correctly answer the question. Only (8.1 %) of those who 
are from rural areas were able to identify all signs and symptoms. 
These findings were not unexpected since rural areas are characterised by scarcity of 
96 
resources. Lachman (1995:774) points out that people in rural areas are deprived of 
valuable information because resources are centred in urban areas. The data support 
Maforah (1991:140-142) who found that the majority of people in rurai areas are less 
informed about health matters . 
From these findings it appears that there is a need for further education on AIDS 
especially in rural areas. 
The following figure reflects the responses on the statement that HIV infected persons 
show signs and symptoms of the disease after infection. In other words whether they 
can be identified as AIDS sufferers. 
;,.,~1¼n 1 
Figure 4 
HIV Infected Persons Show Signs of the Disease After 
Infection 
97 
The above figure show that a larger percentage of respondents (62 .5 %) believe that 
an HIV infected person develops signs and symptoms of AIDS after infection. Their 
.-:' i 
failure to answer the question correctly leads one to be doubtful of their knowledge 
of the disease which was reflected previously. It seems that the knowledge of the 
respondents is reasonably superficial , as ignorance and a great number of 
misconceptions prevail. 
The findings further revealed the respondents ' vulnerability to HIV infection. 
Because a person with HIV does not show signs , there is a great likelihood that 
sexual intercourse can take place without either party being conscious of infection. 
The following figure presents responses with regard to the following statement: 
Healthy young people do not get AIDS. 
Figure 5 
Healthy Young People Do Not Get Aids 
98 
Figure 5 reflects that the majority of respondents (58. 8 %)  disagreed with the 
statement II Healthy young people do not get AIDS 11 • As the greater percentage of 
youngsters are still in good health , they want to believe that they are not vulnerable 
to AIDS . This is an indication of ignorance concerning the spread of the disease. 
In the following figure the respondents ' opinions are considered with regard to the 
following statement: HIV infected persons can be recognised by their physical 
appearance. Although this question corresponds to a great extent with figure 4 - this 
statement was added as a control question. 
Figure 6 
HIV Infection can be Recognised in a Person's 
Physical Appearance 
0 20 40 60 80 100 
99 
In figure 6 a large percentage of respondents (75 %)  mentioned that an HIV infected 
person can be recognised by his/her physical appearance. Only (14 %)  of respondents 
answered the question correctly. Compared with the findings in Figure 4 the majority 
of respondents in their ignorance are convinced that an AIDS sufferer can be 
identified. Therefore a healthy looking person according to their opinion is free of 
the disease. Carriers of the disease in most cases especially during the first phase of 
infection which may last for years show no signs whatsoever. On face value girls 
may indulge in sexual acts being ignorant of the fact that the person with whom they 
are associating may be HIV infected. 
The following figure presents respondents ' opinions with regard to the following 
statement: An HIV infected person who appears healthy can infect others . 
Figure 7 
HIV Infected Person Who Appearb flealthy Can Infect 
Others 
100 
Figure 7 shows that the majority of respondents (52 .1 %) are not aware that HIV 
infected person who appears healthy can pass the virus to others, while 24.2 % are 
uncertain. These data suggest as does the data in figure 4, 5 and 6 that there is a 
definite lack of proper information about AIDS . 
The respondents were asked to indicate whether it is true or false that an AIDS victim 
can live for many years without being ill . 
Figure 8 
Aids Victims Can Live for Many Years Without Being Ill 
10 20 30 40 50 66 
101 
The respondents' ignorance with regard to HIV and AIDS is once more apparent in 
the above figure . It is clear from literature that full blown AIDS is associated with 
severe immuno-deficiency , thus all people at this stage are not expected to live for 
many years (Pratt 1986:. Considering that the majority of respondents (50. 8 %)  are 
unaware of this , there is a need for further education. 
Respondents were asked to indicate the vulnerable groups or concepts they more 
strongly associate with AIDS. The pairs of opposite parables which were put to the 
respondents are: homosexuality and heterosexuality; promiscuity and chastity ; blacks 
and whites , men and women as well as students and non students. 
102 
Figure 9 
Respondents were asked to indicate the vulnerable groups or concepts they more strongly associate with AIDS. 
The pairs of opposite parables which were put to the respondents were: Homosexuality and Heterosexuality, 
Promiscuity and Chastity, Blacks and Whites, Men and Women, as well as Students and Non students 
. OPPOSITE PARABLES 
• WOMa N 
t 0 STUOIBNTa - UNCl!!Jlll:TAIN • . f,,c)H .Tt.lffl!Nff.____._ _ ___, 
103 
Possibly one should admit at the onset that all the mentioned concepts may not have 
been that well known by all the respondents. 
In the above figure , an overwhelming majority of the sample (81 %) stated that 
promiscuous behaviour is a risk factor to acquiring AIDS. This is a common finding 
in studies about knowledge concerning HIV and AIDS . However , it is noteworthy 
to mention that people can in fact express their opinion , but behave in a way that 
reflects an opposite position. This contention is confirmed by Chere 's (1996: 17) 
findings that the coital behaviour of adolescents is often promiscuous . Young people 
according to Sapire (1994 :47) are mostly driven by a desire to experiment with sex. 
These findings also reveal that the majority of respondents (females) associate/blame 
men for AIDS. Current prejudices surrounding AIDS advance a victim-blaming 
philosophy. According to Ryan (1971) victim blaming is person-centred. It is clear 
from literature that AIDS does not discriminate against sex. However Mouli (1992:6) 
stated that wherever HIV is predominantly heterosexual , females are more often 
infected with the AIDS virus. Therefore females should be made aware of their 
greater vulnerability to AIDS. 
Finally the percentage of uncertainty appears to be high on the remaining opposite 
parables; homosexuality and heterosexuality (72 .1 %) , blacks and whites (78.3 %), as 
well as students and non students (62. 7 %) . This is possibly due to the knowledge 
that all these groups of people are vulnerable to AIDS because the disease does not 
discriminate AIDS cuts across colour , age and sex. 
6.5 ATTITUDES TOWARD SEXUAL INTERCOURSE AND AIDS 
The following table indicates respondents' attitudes towards sexual intercourse before 
having any knowledge of AIDS . 
104 
TABLE 9 ATTITUDES TOWARD SEXUAL INTERCOURSE BEFORE HEARING 
ABOUT AIDS 
RESPONSES NO % 
No sex at all 40 8.3 
Practised safe sex 89 18.5 
Did not practice safe sex 276 57.5 
Uncertain 75 15.6 
Total 480 99.9 
The table below presents answers to the question , namely : Has your awareness of 
AIDS urged you to make changes in your own sexual activities. 
TABLE 10 AWARENESS OF AIDS AND CHANGES MADE TO SEXUAL 
ACTIVITIES I NWU I LIBRARY 
RESPONSES NO % 
Immediately abstained from sex 119 24.8 
Greater concentration on prevention measures 128 26.7 
Limiting sexual partners 182 37.9 
No change 51 10.6 
Total 480 100 
According to the above data, knowledge about AIDS had a significant impact on 
respondents ' sexual behaviour. According to table 9, the majority of respondents 
(57.5 %) practised unsafe sex before hearing of the disease . However after knowing 
about AIDS 24.8% changed to abstainance being afraid of contracting the disease , 
26.7% intensified their prevention measures while 37.9 % limited their sexual partners 
(see table 10). 
105 
Although mere knowledge had an impact on the respondents' sexual lives, further 
education is essential to dispel misperceptions that were reflected earlier in this 
chapter. Through education pupils will be able to make timeous decisions and 
informed choices. 
In the following table the respondents had to indicate whether they thought that there 
may be a chance to contract AIDS . This question proved to be necessary in the light 
of the school girls' apparent sexual permissiveness as indicated in the fore-going 
findings. 
TABLE 11 CHANCE OF INFECTION WITH HIV 
RESPONSES NO % 
Not at all 258 53.8 
A possibility 152 31.7 
Uncertain 70 14.6 
Total 480 100.1 
As reflected in table 11 the majority of respondents (53.8%) stated that they do not 
see themselves at risk to contract AIDS. This data can be explained in terms of the 
Health Belief Model. Janz and Becker (1989: 151-152) in their review of HBM show 
that when the target population has a little personal experience of the disease , it 
becomes difficult to accept the risk. In order for information to be hurried in action , 
people need to feel a personal vulnerability to the disease. 
Summarising , however , it would seem that 53.8 % who believe that they are not at 
risk and 14.6 % who are uncertain (totalling 68.4%) are sufficient proof of their total 
ignorance and nai'vety and ultimate vulnerability. 
The following table reviews reasons given by respondents why they do not consider 
themselves as prone to contract AIDS. 
106 
TABLE 12 NO RISK TO CONTRACT AIDS 
REASONS NO % 
Abstainance 35 13.6 
Concentrate on safe sex 181 70.2 
Uncertain 12 4.7 
Don' t know 30 11.6 
Total 258 100.1 
The total number of responses in this table is less than 480 as only those respondents 
who answered "not at all" in table 11 being 258 were allowed to answer this question. 
The majority of respondents (70.2 %) in table 12 stated they see themselves not at risk 
to contract AIDS because they practice safe sex. The reasons advanced suggest that 
respondents have begun to adopt AIDS prevention strategies. Further , there seems 
to be a relationship between the above findings and findings in table 9 where the 
majority of respondents indicated that immediately after hearing about AIDS they 
changed their unsafe sexual behaviour. The question which remains is whether these 
youngsters have sufficient knowledge of "safe sex". If not, it makes them so much 
more vulnerable as their belief may give them unfounded carteblanche to sexual acts. 
6.6 PRECAUTIONARY MEASURES 
In the following table respondents were asked to mention the most effective 
precautionary contraceptive method against possible AIDS conception. 
107 
TABLE 13 THE BEST CONTRACEPTIVE METHOD 
REASONS NO % 
None at all 44 9.2 
Condoms 399 83.1 
Pills 5 1 
Other 4 0.8 
Uncertain 28 5.8 
Total 480 99.9 
Table 13 shows that the best preferred method of contraception is according to the 
respondents condoms (83.1 %). These findings confirm those made by Kisker 
(1983:44) in his study of adolescent females aged 17 to 19, where he reported that 
condoms were considered by these teenagers as useful in preventing HIV infection. 
However it is noteworthy to mention that if condoms are not used correctly the 
chances of infection will remain. 
The condom-campaigns launched by health officials and the media are apparently 
responsible for this belief that condoms are a safe way of preventing AIDS. On the 
one hand these campaigns are conducive especially to those who are not prepared to 
abandon their sexual life-style. Unfortunately , on the other hand , it may also create 
a false impression or even encourage especially youngsters to indulge in sexual acts 
because this is a so-called safe way of having sex. 
In the following table the respondents were asked who of the two partners in a sexual 
relationship should take the responsibility to ensure that the necessary precautionary 
measures against AIDS are taken. 
108 
TABLE 14 RESPONSIBILITY FOR PROTECTION AGAINST AIDS 
PERSON NO % 
Male 69 14.4 
Female 21 4.4 
Both male and female 364 75.8 
No one 19 4.0 
Uncertain 7 1.5 
Total 480 100.1 
Most of the respondents (75 . 8 %)  as reflected in the above table stated that both males 
and females should be responsible for protection against AIDS. This clearly indicates 
that respondents have realistic understanding of the risk involved in unsafe sex. 
According to Mann (1992:11) it requires the active participation of two sexual 
partners to break the chain of HIV transmission. These findings have a significant 
implication for prevention strategies. AIDS prevention assumes that at all levels 
prevention is everybody ' s business. 
In the following figure respondents ' views of blood tests are considered. 
109 
Figure 10 
Blood Test can Determine AIDS Infection 
Respondents' willingness to undergo HIV blood tests are discussed in the fo llowing 
figure. Figure 11 
Willingness To Undergo HIV Blood Tests 
110 
As reflected in figure 10 an overwhelming number of respondents (96.2 %)  expressed 
belief in blood tests. This shows an exceptional confidence in the ability of blood 
tests to detect if someone has AIDS. The belief in the tests constitutes a sound 
foundation in the development of AIDS prevention efforts . 
Figure 11 shows that there is no consistency between respondents'beliefs and their 
actions. Although 96.2 % of respondents expressed belief in the tests , only 75 % 
stated their willingness to undergo the blood tests. This finding however seems to 
suggest a favourable attitude with regard to acceptance of HIV testing programs . 
In the following table reasons are advanced by respondents for not being prepared to 
undergo blood tests for AIDS. 
TABLE 15 REASONS FOR UNPREPAREDNESS TO UNDERGO BLOOD TEST FOR 
AIDS 
REASONS NO % 
Scared about the outcome of the results 6 7.3 
Do not know the procedures 4 4.9 
Doubt the confidentiality 60 73.2 
Better not to know 5 6.1 
Couldn't care 2 2.4 
Uncertain 5 6.1 
Total 82 100.1 
The number of responses as mentioned in the above table is 82 because only the 
respondents who indicated their unwillingness to undergo blood tests were questioned 
(see Fig 11). 
The above table reflects that the majority of respondents (73. 2 %)  stated that they 
doubted the confidentiality of the testing procedures. According to Larson (1995:20) 
111 
the tradition of doctor-patient relationship is not always clearly defined legally. The 
lack of clarity regarding when confidentiality may be broken creates difficulties for 
persons wishing to know their HIV status. Given this , it is not surprising that some 
of the respondents are reluctant to be tested. 
In the following table , the best method to communicate AIDS as mentioned by the 
respondents is given. 
TABLE 16 BEST METHOD TO COMMU NICATE AIDS INFORMATION 
METHODS NO % 
Interpersonal contact 292 60.8 
Information on printed material 100 20.8 
Media coverage 61 12 .7 
Other 7 1.5 
Uncertain 20 4.2 
Total 480 100.0 
The above findings reveal that interpersonal contact is the preferred method to 
communicate AIDS messages. This could be attributed to the geographical location 
of respondents. Majority of respondents are from rural areas. As already stated 
earlier in this report, rural areas are characterised by scarcity of resources. Existing 
means of communication such as radio and television are not easily accessible. A 
very small number of people in rural areas own these sophisticated channels of 
communication. Thus it would be logical to resort to the traditional modes of 
communication which includes children having discussions with their parents as well 
as teachers in schools. According to Diclemente (1992 :28) if adolescents do not 
receive counseling about AIDS from interpersonal sources of communication, it may 
undermine the perceived importance of communications they receive from other 
sources. It is therefore important that any local prevention strategy should consider 
these modes of communication. 
112 
The finding suggests that there is an urgent need to train people for the delivery of 
preventive services related to HIV and AIDS in schools. 
Respondents were asked to identify the best professionals to communicate AIDS 
messages. The results are discussed in the fo llowing table. 
Figure 12 
Best Professionals To Communicate Aids Messages 
80 
70 
I,._ 1'11/tttr'"• 
60 l81l141l\'] 
50 
40 
30 
20 
10 
0 
113 
The majority of respondents (73.1 %) in the above figure , indicated nurses and doctors 
as the best preferred source to communicate AIDS information. The reason might 
be that in many instances diseases and illnesses are associated with the medical 
profession. However , according to Maforah (1991 :278) health education is not a 
function limited to the medical profession. For any prevention strategy to be 
successful , emphasis needs to be focused on multidisciplinary educational activities. 
In the following table ways to prevent the spread of AIDS in schools are discussed. 
TABLE 17 WAYS OF PREVENTING AIDS SPREAD IN SCHOOLS 
WAYS NO % 
Sex and AIDS education to be incorporated in the school 
education 312 65.0 
Condoms to be distributed in schools 50 10.4 
Sex and AIDS education as well as condoms distribution 84 17.5 
Do not know 34 7.1 
Total 480 100 
As reflected in the above table a sizeable number of respondents (65.0 %) are of the 
opinion that sex and AIDS education need to be integrated into the education system. 
According to Slayen (1980: 889) investigation in South African schools has indicated 
a definite lack of basic education concerning aspects of health. In view of the threat 
posed by AIDS on human existence there is a need of preventative strategies in 
schools. Firstly because school going girls are a vulnerable group and secondly 
because they are the citizens and parents of tomorrow. Beliefs formed during the 
formative years could influence subsequent behaviour of the youth and the messages 
they pass on to others (Mc Ewen, 1983:76). 
114 
CHAPTER 7 
MAIN FINDINGS CONCLUSIONS AND RECOMMENDATIONS 
7 .1 INTRODUCTION 
The main purpose of this chapter is to review the findings emanating from literature 
and empirical research, to discuss conclusions drawn from them and to provide 
recommendations. 
7.2 RESTATEMENT OF THE OBJECTIVES 
Before discussing the main findings and conclusions, the objectives will be restated as 
follows : 
To determine the knowledge and attitudes of school girls regarding AIDS and 
prevention of HIV infection; 
To determine the knowledge and attitudes of school girls towards indiscriminate 
sexual intercourse as the major means of spreading AIDS; 
To suggest practical recommendations for the prevention of AIDS ; and 
To assess the contribution which social workers can make in the prevention of 
AIDS 
7. 3 GENERAL RESUME 
This study was conducted in high schools in the North West Province. Subjects were 
school girls and were selected from the standard eight, nine and ten classes. The 
sample consisted of 480 respondents whose ages ranged between 12 and 22 . The 
majority of respondents were adolescents. Adolescence period is viewed in literature 
as a period in the life cycle when the risk-related sexual activities begin. As a result, 
adolescents are obviously at greater risk for HIV infection. 
115 
The questionnaire comprised of 26 questions on demographic characteristics, 
knowledge about AIDS, attitudes towards sexual matters and lastly prevention of 
AIDS. 
7.4 MAIN FINDINGS 
The findings of the present research can be summarised as follows: 
7.4.1 KNOWLEDGE ABOUT AIDS 
The results from this section indicated a high level of awareness and understanding of 
the disease amongst school children. However there were a number of misconceptions 
and uncertainties about some aspects of the disease , e.g cure existence, symptom 
presentations and modes of transmission. On the whole, compared to other studies 
concerned with the level of knowledge about AIDS, among adolescents, (Sher, 1986: 3, 
and Mogotsi , 1994: 10) the present results concerning knowledge are substantially 
higher. The reasons for this disparity between the results are unclear except for the 
fact that the present study was carried out more than a year compared to the above 
mentioned studies. 
Of particular importance for discussion was question 12(c) where an overwhelming 
number of respondents were able to differentiate between HIV and AIDS. This finding 
is important because it contradicts Sher (1986:23) whose findings indicated failure to 
differentiate between the two. This is a clear indication that respondents knowledge 
about the disease is most probably increasing . However their knowledge is doubtful 
as a result of their sources - peers are not experts. 
The questions about transmission were answered with the highest degree of accuracy. 
Although there still appears to be uncertainty about other body fluids e.g tears, saliva 
and perspiration, subjects generally displayed a good knowledge of major modes of 
HIV transmission. 
116 
Questions related to cure existence were answered with an average degree of accuracy . 
The fact that there are some school girls who still believe that there is a cure for AIDS 
is a matter for great concern. Based on studies of sexual behaviour, people with lack 
of knowledge are likely to perceive the disease as not serious and continue with unsafe 
sexual practices. It can thus be concluded that further education is needed in this 
regard . 
A high degree of uncertainty prevails with regard to groups that are more likely to be 
associated with AIDS. The above observation is understandable as the disease does not 
discriminate. It cuts across race, colour, culture and age barriers . However, an 
interesting feature that surfaced here, is that school girls do not perceive themselves as 
at risk of the disease but associate the disease with men. This is a common finding in 
many studies about prejudices surrounding AIDS (Sher, 1986:24) where the incidence 
of AIDS is attributed to groups outside one's own personal group. This finding 
suggests that school girls need to be warned about their vulnerability to HIV infection. 
This insight (warning) is an absolute necessity as people will not act unless they are 
convinced of their personal vulnerability to the problem. 
Finally, although subjects appear to be knowledgeable about AIDS , their knowledge 
seem to be superficial in that it is characterised by a mixture of appropriate and 
inappropriate information. Lack of in-depth facts about the disease seems to abound. 
The results of this section indicate that further education on AIDS is still needed . 
7.4 .2 SOURCES OF INFORMATION REGARDING SEXUAL MATTERS 
From this study it is clear that parents do not discuss human sexuality with their 
children. This however has significant implications. The socialization process 
generally starts from the family. The way children view issues in the future is among 
others determined by what they learn from home. If children do not receive 
information about sexuality from their interpersonal source of communications, it may 
undermine the perceived importance of communication they receive from other 
sources. This information is likely to be perceived as not serious and can even be 
117 
distorted. The finding therefore indicates a need to involve parents in the education 
process. 
Respondents in the study reported that peers were the main sources in conveying sexual 
knowledge and this inevitably includes ideas about HIV and AIDS. When considering 
the knowledge about AIDS shown by the students, it can be concluded that the above 
mentioned sources have been reasonably useful in creating an awareness of the disease. 
If this is the case, then informed group learning and peer influence should be 
capitalized on and selected students in every school be trained to teach their colleagues 
about human sexuality including AIDS informally and as soon as possible. This 
should , however, be done with the consent of the parents. 
Teachers were also indicated as playing an important role in the educational process. 
Because students spend most of their time in schools, teachers are in a better position 
to convey sexual knowledge. It is hoped that through the findings of this study , the 
Department of Education in South Africa, will consider the promotion of national 
policy supporting the introduction of life skills education (including AIDS education) 
in schools and that this move will place students in a better position to understand 
themselves and be better informed to make decisions regarding their sexual behaviour. 
Although knowledge is necessary to achieve appropriate behaviour change, knowledge 
alone is insufficient for it. It is therefore necessary to examine attitudes toward 
sexuality and AIDS as measured by the present study . 
7.4.3 ATTITUDES TOWARD AIDS AND PREMARITAL SEXUAL INTERCOURSE 
Societal attitudes are regarded as one of the major factors influencing sexual behaviour. 
Although students may not provide a direct prediction of behaviour it is important that 
we assess their prevalence within the present study. 
Firstly, the majority of respondents did not perceive themselves to be at risk of 
contracting the virus. This finding is important, in that it has far reaching implications 
118 
for any strategy to combat the spread of AIDS. The general attitude, that "AIDS can't 
happen to me" needs to be dispelled if education campaigns are to be effective. 
Secondly , the findings reveal that the majority of school girls are in favour of 
premarital sexual activities. In addition it is clear from literature that the majority of 
female adolescents are sexually active. Age 13 to 14 seems to be a critical period 
during which adolescents initiate sexual intercourse with increased frequency reported 
at ages 15 and 16 years (Kau, 1992:70). These findings therefore support the 
contention that life skills education should be introduced at primary school level so that 
children can at an earlier stage adopt a life-style which will enable them to avoid and 
to protect themselves from the exposure to the virus . 
7.4 .4 SEXUAL BEHAVIOUR 
Turning to sexual practices , the findings clearly show that the AIDS scare is having a 
profound influence on the school girls population. The majority indicated that they 
have changed their sexual behaviour after hearing of AIDS . From this finding an 
important hypothesis can be formulated , namely, that fear may play an important role 
in people's decision to adopt preventative actions against AIDS . This finding supports 
the most important assumption of the H.B.M, namely , that the perceived threat of a 
disease plays an important role in a person's decision to prevent a particular disease . 
Finally, one of the important aspects of the results which deserves comment concerns 
two main changes of sexual behaviour indicated by respondents (i .e abstinence and 
adoption of safe sex) . The fact that some of the respondents indicated that they have 
adopted sexual abstinence is interesting because many studies carried out abroad as well 
as a few locally have shown that sexual abstinence although safe seems to be an 
unachievable strategy. This is however an indication of how determined some female 
students are in protecting themselves . 
Overall , the findings on attitudes and sexual behaviour changes are most encouraging . 
It can be concluded that knowledge about AIDS plays a significant role in attitude as 
119 
well as sexual behaviour changes . 
7.4 .5 PREVENTION 
The primary HIV-prevention strategy for adolescents who are sexually active is to use 
condoms consistently during sexual intercourse. The results of this study are positive 
since the majority of respondents indicated condom use as the best precautionary 
measure. However it should be noted that many studies (Kau , 1993 :69 and 
Diclemente, 1992:35) indicated that while most female adolescents believe in the use 
of condoms, few actually use them. The reasons advanced for this are fear of losing 
the sexual partner as well as fear of being perceived as having no strict moral values . 
These perhaps explain why other young females continue with unsafe sex although 
having sufficient knowledge of HIV modes of transmission. Thus it can be concluded 
that it is not enough to merely provide information on AIDS . School girls also need 
education that focuses on self value and the ability to be assertive so that when there 
is a need to say "No" they should do so and also know why this is absolutely 
necessary . I NWU· 
LIBRARY 
Lastly the findings suggest that there is a great need for AIDS education in schools. 
Furthermore, the research findings suggest that no single approach is likely to produce 
a dramatic impact. In combination with other sources of information (medical 
practitioners , social workers , interested groups etc) teachers may have a tremendous 
effect on students' behaviour change . 
4.7.5 FINDINGS OF THE CURRENT STUDY IN TERMS OF SIGNIFICANT 
DIFFERENCES IN EXPLANATION OF VARIABLES 
AGE GROUP DIFFERENCES 
Older age groups tended to be better informed about AIDS than younger 
groups. Furthermore older groups tended to have a more realistic 
understanding of HIV infection and prevention. This finding further supports 
the argument that AIDS education should start at primary school level. 
120 
EDUCATION LEVEL DIFFERENCES 
Higher level of education was associated with better knowledge and 
understanding of AIDS. Respondents with lower education levels tended more 
to spontaneously report inappropriate modes of transmission and cure existence. 
AREA DIFFERENCES 
Respondents who spend most of their time in rural areas were less informed 
about AIDS than those who came from urban areas . Contrary to those who 
came from urban areas, girls from rural areas tended to prefer interpersonal 
communication with regard to education about sexuality and AIDS . The above 
mentioned differences must be seen in terms of availability of communication 
channels. Students from urban areas have frequent access to communication 
channels such as the media. Regular access to sources of information seem to 
be associated with greater knowledge. 
7. 6 RECOMMEND A TIO NS 
An evaluation of the main findings clearly indicates a further need for education with 
regard to sexuality and AIDS in schools. Unfortunately this is not as yet part of the 
syllabus in many South African schools. From the researchers' point of view the 
exclusion of education for life which includes prevention of social and health problems 
among other factors, contributes largely to the spread of the AIDS disease among 
adolescents. 
It is true that many health and social problems such as AIDS, drug abuse, sexual abuse 
of children, violence and even Tuberculosis are constantly on the increase . Evaluating 
the existing problem areas it has become clear that they are all the direct consequences 
of specific life-styles and can therefore only be prevented (combated) if life-style 
practices of people are holistically and positively addressed. Most of the measures 
implemented to combat these problems have until now proved to be unsuccessful. 
Reasons for this failure are amongst others the following: 
121 
Too much reliance on short-term programmes; 
The tendency to concentrate on separate problem areas. In other words , 
problem areas are compartmentalised; and 
The tendency to emphasise curative instead of primary preventive measures 
After a thorough investigation of various programmes the Life Education and school 
based prevention programmes proved to be the most acceptable approaches to educate 
and equip people, especially young people, with skills necessary to prevent the increase 
of various health and social problems. 
THE SCHOOL BASED PREVENTION PROGRAMMES 
The school based prevention programmes emphasise a comprehensive team approach. 
They are based on the fact that no single approach is likely to bring about the required 
change. Providing education is not a function limited to teachers , but it can be 
provided by many other sources such as physicians , social workers, as well as special 
interest groups within the school setting. 
The preventive programmes also emphasise that the pupils' participation is vital. The 
students should be involved right from the planning stage of programmes, be helped 
to identify their own needs and priorities as well as be given help on how they 
themselves can prevent the occurrence of AIDS. 
The aim of the programmes is not only to provide education, but also to instill beliefs 
that students are capable to alter their unsafe sexual habits. The programme should 
emphasise the importance of self-value and encourage students to be able to be 
assertive. 
School based preventive programmes have proved to be effective and successful in 
changing students ' unsafe sexual practices in countries such as Uganda and Zaire. 
122 
LIFE EDUCATION PROGRAMME 
Life Education concept which emphasizes the completeness of human beings and their 
enormous potential, is a positive preventive approach to all forms of social and health 
problems. 
According to Anderson (1994:52) the aim of the programme is to instill in children 5-
12 years of age , while in their most formative years a deep respect for life , so that they 
will consider it unthinkable to abuse their human bodies. 
The programme further emphasises the value of one's individuality, refusal skills, self 
esteem as well as how to deal with peer pressure. In this way, young people are 
empowered to make right decisions about their lives (see appendix 6) for a detailed 
outline of the life education programme. 
The combination of both Life Education and school based programmes hopefully will 
help in curbing the disease from spreading. Life Education may serve as introductory 
programmes in primary schools while school based programmes serve as follow-up 
activities in middle and high schools . In this way education becomes an ongoing 
process until the students complete their schooling. 
In conclusion it is strongly recommended that the two programmes mentioned above 
be integrated into the educational system in this country . By this, South Africa will 
manage to create healthy children who will again create a healthy generation of the 
future . 
123 
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1. Anderson W, 1994: An Investigation into the Lifestyle of People . Unpublished 
manuscript Uniwest. 
2. Ashmore D , 1975 : Societal and Individual Orientations. Toward Prevention. New 
York; McGraw Hill. 
3. Astone N and Kitagawa M 1985. Social and Environmental Factors Influencing 
Contraceptive use among Black Adolescents. Family Planning Perspectives; 17(4), 
165-174. 
4. Babbie A, 1992: The Practice of Social Research. California; Wadsworth Pub . Co. 
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APPENDIX 1 
A QUESTIONNAIRE 
FOR 
FEMALE STUDENTS REGISTERED AT HIGH SCHOOLS 
IN THE NORTH WEST PROVINCE 
TITLE : AN INVESTIGATION INTO KNOWLEDGE AND 
ATTITUDES OF SCHOOL GIRLS WITH REGARD TO 
SEXUAL PRACTICES AND AIDS 
RESEARCHER: MAUREEN MOGOTSI 
DEPARTMENT OF SOCIAL WORK 
UNIVERSITY OF THE NORTH WEST 
The researcher would like to request your assistance in 
a research study designed to investigate the knowledge 
and attitudes of female students regarding AIDS and 
sexual practices. Approximately 10-15 minutes is 
needed to complete this questionnaire and your timely 
response would be greatly appreciated. 
GENERAL INSTRUCTIONS 
Please answer all questions completely and honestly. 
Remember, you remain anonymous! Mark the appropriate 
answer with a cross (x) or write your response on the 
dotted line. 
2 
A. DEMOGRAPHIC INFORMATION 
1 . School registered with . .. ...... . ..... . ... . .... . .. . . . 
2. Age group 
12 - 15 years 
16 - 19 years 
20+ years 
3. Highest educational standard passed 
Standard seven 
Standard eight 
Standard nine 
4. Where have you spent the greatest part of your life? 
Urban areas 
Rural areas 
Both urban and rural areas 
5 . How often do you attend church activities? 
Once or more per week 
Sometimes 
Never 
B . KNOWLEDGE ABOUT AIDS 
6. In your own words what is AIDS . 
3 
7. Are you aware of any cure for AIDS? 
Definite cure 
Prolonging the onset of AIDS symptoms 
No cure 
Uncertain 
8. Can the AIDS-virus be transferred in the following body 
fluids? 
a. Blood 
b. Sexual secretion 
C . Tears 
d . Saliva 
e. Perspiration 
f. Uncertain 
9. Which of the following do you think are signs and symptoms 
of AIDS? 
Drenching night sweat 
Chronic fat igue 
Persistent fevers 
Mental disturbances 
Persistent diarrhoea 
All of them 
Uncertain 
4 
10. Delineated below are a number of opposite terms. Please 
indicate which of the two concepts you associate with AIDS 
more strongly. Tick the appropriate. 
a. Homosexuality Unsure Heterosexuality 
b. Promiscu i t y Unsure Chastity 
C. Whites Unsure Blacks 
d. Women Unsure Men 
e. Students Unsure Non-students 
11. From what source did you for the first time learn about sex? 
Peers 
Parents 
Media 
Teachers 
Uncertain 
Others 
None 
12 . Indicate whether the fo llowing sta t ements are true false 
a. Healthy young people don't True False Unsure 
get AIDS 1 2 3 
b. A person with HIV can be 
recognised by his / her phy sical 
appearance 1 2 3 
C. There is a difference between 
~IV and AIDS 1 2 3 
5 
ATTI TUDES WI TH REGARD TO AIDS 
13. Delineated below is a number of statements please indicate 
whether you agree, disagree or are unsure with each 
(13a - 13f) 
A = Agree 
DA = Dont agree 
U = Unsure 
A DA u 
a. HIV is the virus which 
causes AIDS 
b. A person can have AIDS for 
many years without being ill 
c. All HIV infected persons 
show signs of the disease after 
being infected 
d. A person who has AIDS v irus but 
feels and appears healthy can 
infect another person. 
e. A person can get AIDS during the 
first sexual encounter with an 
AIDS carrier . 
f. Women are more likely to get AIDS 
than men . 
14. How do you feel about premarital sex? 
Completely acceptable 
Completely unacceptable I Nwu. ·, 
Uncertain '-IBRARY_ 
6 
15. In a sexual relationship who do you consider should be 
responsible for protection against getting AIDS? 
Male 
Female 
Both 
No one 
Uncertain 
16. Before hearing about AIDS how was your attitude regarding 
sex? 
No sex at all 
Practised safe sex 
Did not practice safe sex 
Uncertain 
17. Has your awareness of AIDS urged you to make changes in your 
own sexual activities? 
Immediately abstained from sex 
Greater concentration on preventive measures 
Limiting sexual partners 
No change 
18. Do you think there is a chance that you might get AIDS? 
Not at all 
A possibility 
Uncertain 
7 
19. If not at all (in 18) reason given 
Abstainance 
Concentrate on safe sex 
Uncertain 
Don't know 
PRECAUTIONARY MEASURES 
20. Do you believe that blood tests can show whether someone has 
AIDS? 
Yes 
No 
Uncertain 
21. Would you be prepared to undergo HIV blood test on a regular 
basis? 
Yes 
No 
Uncertain 
22. If you are not prepared to undergo blood tests what is your 
main reason for this decision? 
Scared about the outcome of the results 
Do not know the procedures 
Doubt the confidentiality 
Better not to know 
Couldn't care 
Uncertain 
8 
23. To your own knowledge which precautionary 
contraceptive method is the most effective 
to prevent the spreading of AIDS? 
None at all 
Condoms 
Pills 
Other 
Uncertain 
24. As a student what do you consider to be the best method of 
informing (students) about AIDS? 
Interpersonal contact 
Information on printed material 
Media coverage 
Other 
Uncertain 
25. Delineated below is a list of professionals . Which of the 
following according to your own opinion can play a major 
role in the prev ention of AIDS? Please rank items in 
descending order of importance (use numbers). 
Social workers 
Nurses and Doctors 
Teachers 
Ministers of religion 
All of the above 
9 
26. In your own words, what do you think can be done in schools 
to prevent AIDS from spreading? 
THANK YOU FOR YOUR COOPERATION! 
\  
A P P E N D I X  2  
2 3 4  
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8 7  
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3  1 0  1 0  
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N o r t h e r n  C a p e  ( N C )  7 3  
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4  1 9  3 7  1 4 0  
5  1 7 1  
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F r e e  S t a t e  ( F S )  9  
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APPENDIX 3 
287 Epidemiological Comment s Vol 21(12) December 199~ 
AIDS in South Africa 
Reported AIDS cases as on 30 December 1994 
Number of AIDS cases reported by region ·::...., 
Province 82 -86 87 88 89 90 91 92 93 94 Total 
Eastern Cape (EC) 4 10 32 68 143 128 386 
Western Cape (WC) 12 2 20 32 39 44 63 86 54 352 
Northern Cape (NC) 1 3 10 9 64 73 161 
KwaZulu/Natal (NK) 4 5 19 37 130 162 324 750 990 242 1 
OFS (OF) 1 2 4 9 8 38 45 37 331 475 
PWV (WV) 29 31 44 92 118 153 251 174 79 971 
Eastern Tvl (ET) 2 9 64 40 115 135 366 
North West (NW) 3 4 5 68 146 227 
Northern Tvl (NT) 5 2 7 112 154 282 
Total SA 46 40 92 178 325 509 812 1549 2090 564 1 
Other countries 12 9 6 3 8 20 16 94 53 221 
Unknown 2 2 
Total • 58 49 98 181 333 529 828 1645 2143 5864 
AIDS cases by mode of transmission reported per region 
2500 
D Unknown 
2000 
liZl Paediatric 
II) ■ Blood products 
qi 
II) 
CII m Heterosexual 
(.) 1500 
~ Homo/Bisexual 
0 
.8 
E 1000 
z:l  
500 
i 
0 
EC) wc; cftJc) tSN OF-- wv ' ET · mv.· _. t,lr. 
Provinces 
AIDS cases by mode of transmission 
Asian Black Coloured White Unknown Total 
Male Female Male Female Uni< Male Female Uni< Male Female Uni< 
Homo/bisexual ◄ 77 29 399 3 612 
Heterosexual 6 2 1601 1726 30 69 98 31 13 1 ◄ 3◄ 89 
Haemophiliac ◄ 18 2◄ 
Transfusion 7 12 6 29 
IVDU 1 2 
Mother-to-ohlld 339 293 10 8 6 666 
Unknown ◄66 ◄06 7 11 19 7 12 930 
i 
l 
APPENDIX 4 
Adopted from Evian (1995:92) 
V,A  World Health Organisation Staging System for HIV Infection and Disease 
CLINICAL STAGE 1 
1. Acute retroviral infection 
2. Asymptomatic 
3. Persistent generalised lyrnphadenopathy (enlargement of the lymph nodes) 
Performance scale 1: asymptomatic, normal activity 
CLINICAL STAGE 2 
4. Weight loss, <10% of body weight 
5. Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo (chronic itchy s• 
infections, recurrent oral ulcerations, angular cheilitis (inflammation of the corners of 1 
6. Herpes zoster (shingles), within the last 5 years 
7. Recurren t upper respiratory tract infections (i .e. bacterial sinusitis) 
And/or performance scale 2: symptomat ic, normal act ivity 
CLINICAL STAGE 3 
8. Weight loss, > 10 % of body weight 
9. Unexplai ned chronic diarrhoea,> 1 month 
10. Unexplained prolonged fever (intermittent or constant), > 1 month 
11 . Oral candidiasis (thrush) 
12. Vulvo-vaginal candidiasis, chron ic(> 1 month) or poorly responsive to therapy 
13. Oral hairy leukoplakia (thickening of the dorsal surface of the tongue) 
14. Pulmonary tuberculosis, within the past year 
15. Severe bacterial infections (e.g. pneumonia) 
And/ or performance scale 3: bedridden <50% of the day during the last month 
CLINICAL STAGE 4 (AIDS-defining conditions) 
16. HIV wasting syndrome, as defined 
17. Pneumocystis carinii pneumonia 
18. Toxoplasmosis of the brain 
19. Cryptosporidiosis with diarrhoea, >1 month 
20. Cryptosporidiosis, extrapulmonary 
21 . Cytomegalovirus (disease of an organ other than liver, spleen or lymph nodes) 
22 . Herpes simplex virus infection, mucocutaneous > 1 month, or visceral (any duration) 
23 . Progressive multifocal leuko-encephalopathy (selective destruction of the centra l ner 
24. "Any disseminated endemic mycosis (i .e. histoplasmosis, coccidioidomycosis) 
25. Candidiasis of the oesophagus, trachea, bronchi or lungs 
26. Atypical mycobacteriosis, disseminated 
27. Non-typhoid salmonella septicaemia 
28 . Extrapulmonary tuberculosis 
29. Lymphoma 
30. Kaposi's sacroma 
31. HIV encephalopathy, as defined 
And/ or performance scale 4: bedridden >50% of the day during the last month 
APPENDIX 5 
Adopted from Evian (1995:93-94j 
The Center for Disease Control (USA) 
case definition of AIDS 
Acquired immuno-deficiency sydrome (AIDS) is an aggregate of signs and symptoms and illnesses 
resulting from a compromised immune system . A diagnosis of AIDS requires the defin itive or presumptive 
diagnosis of one or more ' indicator diseases' and, depending on certa in criteria, may or may not require 
laboratory evidence of HIV infection . The following outline is used by physicians in the United States to 
arrive at an AIDS diagnos is. 
A diagnosis of AIDS can be made if laboratory evidence of HIV infection has been established and 
Ia  definitive diagnosis of any of the following indicator diseases has been made - regardless of the presence of other causes of immuno-deficiency. 
0 Ado lescents and adults with CD4 and lymphocyte counts less than 200 ce ll s/mm' 
0 Candidiasis of the oesophagus, trachea, bronchi or lungs 
O Coccidioidomycosis, disseminated 
O Cryptococcosis (extrapulmonary) 
0 Cryptosporid iosis with diarrhoea pers isting more than 1 month 
O Cytomegalovirus disease of an organ other than the liver, spleen or lymph nodes in a patient 
older than 1 month 
O Herpes simplex virus infection causing a mucocutaneous ulcer (e.g. in eyes, nose, mouth, 
and genito-anal areas) that persists for more than 1 month; or bronchitis, pneumonitis or 
oesophagitis caused by herpes simplex virus in a patient older than 1 month 
0 Histoplasmosis, disseminated 
O HIV encephalopathy; also called subacute encephalopathy due to HIV; also referred to as 
HIV dementia or AIDS dementia complex (ADC), which is c linically defi ned as a disabling 
cognit ive or motor dysfunction interfering with the patient's occupation or activities of daily 
living, or loss of behavioural developmental milestones in the absence of a concurrent 
illness or condition 
0 HIV wasting syndrome, defined as involuntary weight loss of greater than 10% of body 
weight plus chron ic d iarrhoea or chronic weakness and fever in the absence of a concurrent 
illness or condition; also referred to as 'Slims disease' 
0 lsosporiasis with diarrhoea persisting for longer than 1 month 
0 Kaposi's sarcoma 
0 Lymphoma (primary) of the brain 
0 Lymphoid interstitia l pneumonitis (LIP) and/ or pulmonary lymphoid hyperplasia affecting a 
chi ld under 13 years of age 
0 Mycobacterial disease including pu lmonary infection, disseminated and extrapulmonary 
Mycobacterium tuberculosis disease 
0 Non-Hodgkin's lymphoma 
0 Pneumocystis carinii peneumonia 
0 Progressive multifocal leukoencepha lopathy 
0 Sa lmonella septicaemia, recurrent 
O Toxoplasmosis of the brain in a patient older than 1 month ,. 
0 Any combination of at least two of the followi ng bacterial infections wrthi n a 2 year period 
affecting a patient less than 13 years of age: septicaemia, pneumonia:ineningitis, bone or 
joint infection, or abscess of an internal organ or body cavity caused by haemophilus, 
streptococcus or other fever-inducing bacteria 
0 Recurrent pneumonia 
0 Invasive cervical cancer 
Adopted from Evian (1995:92) 
A diagnosis of AIDS can be made if laboratory evidence of HIV is positive and any of the following 
11 indicator diseases is,diagnosed presumptively. (A presumptive diagnosis is generally made in situations in whic~.-the patient's condit ion does not permit the performance of definitive testing.) 
D Candidiasis of th·e oesophagus 
D Cytomegalovirus retinitis with loss of vision 
D Kaposi's sarcoma 
D Lymphoid interstitial pneumonitis and/or pulmonary lymphoid hyperplasia affecting a 
patient less than 13 years of age 
D Mycobacterial disease, disseminated 
□ Pneumocystis carinii pneumonia 
D Toxoplasmosis of the brain in a patient older than 1 month 
A diagnosis of AIDS can be made if laboratory evidence of HIV infection is lacking or 
I I Ii nconclusive but a definitive diagnosis of any of the following indicator diseases is made, provided other known causes of immuno-defic iency are ruled ou t. 
D Candidiasis of the oesophagus, trachea, bronchi, or lungs 
D Cryptococcosis, extrapulmonary 
D Cryptosporid iosis with diarrhoea persisting longer than 1 month 
D Cytomegalovirus disease of an organ other than the liver, spleen, or lymph nodes in a 
patient older than 1 month 
D Herpes simplex virus infection causing a mucocutaneous ulcer that persists longer than 1 
month ; or bronchitis, pneumonitis or oesophagitis affecting a patient older than 1 month 
D Kaposi's sarcoma affecting a patient below 60 yea rs of age 
D Lymphoma of the brain (primary) affecting a patient less than 60 years of age 
D Lymphoid interstitial pneumonitis and/or pulmonary lymphoid hyperplasia affecting a 
patient less than 13 years of age 
□ Mycobacterium avium complex or M ycobacterium kansasii disease, disseminated 
□ Pneumocystis carinii pneumonia 
D Progressive multifocal leukoencephalopathy 
D Toxoplasmosis of the brain in a patient older than 1 month 
A diagnosis of AIDS can also be made when laboratory evidence of HIV infection is negative. If.: 
IV all other causes of immuno-deficiency are excluded and the patient has had either a definitive. diagnosis of Pneumocystis carinii pneumonia or a definitive diagnosis of any of the indicator 
diseases of AIDS and a CD4 (T4) cell count less than 400 cells/mm'. 
APPENDIX 6 
DErAIIED LIFE EIJX'M'ICN m:x?RlM1E 
SUHHEME FRE-
'lHEMES TTI'I.ES 0AJMS/CBJECI'IVES FRIM SIB A SlB B SID. 1 + 2 SID 3 '+ 4 SID 5 SID6+7 SID 8 SID 9 
SE[F-ESI'EE1 Self-kn::wlerlJe am. it'Ib t.e:x::ne aware that X X X X X X X X X X X X 
~ curselves. re.en p:t:s:n is a unique 
c::rea.ture v..h::m Q:rl l oves. 
ve n2Erl to love Him, 
arrselv es am. ot:lErS. 
*Self aCl:l::pt:an::e. 
l HE1illIH{ * Nutritim ""The inp:rt.an::e of g:xrl X X X X X X X X X X 
.JFESIYI.E * Rest am. Ie:::re:i.tim nrtritic:n; prc:p?r rest am. X X X X X X X X X X 
* D:ru;JS p::sitiw  ra:::reatic:n. X X X X X X X X X X X X 
* Alc:x:h)l X X X X X X X X X X X X 
* &tddrq *vhat sul:::starx:E ah.Jse d::e3 to X X X X X X X X X X X X 
* I l.1.re:s arrl DLCA39?" the l:xxly. FllI.1rer ~ X X .. i\. X X X X X X X "A  X 
+ (AICE) far the irrliv idlal in s:ciety. 
* Safe Liv inJ X X X X X X X X X X X X 
* Ould Ah.Jse am. *~ to a-void il.1.re:s . X X X X X X X X X X X X 
ra::rlect X X X X X 
* stres.s ~ it'Ib leam the fa±s am. results X X X X X 
* ~ iritisn/satanisn of sexuu h:h:i.virur am. ab.Ee. X X X X 
am. link with sub-
stan::e ab.lSe am. *~ to ~ /protect yo.rrself 
life style /get the TY?O:SSal:Y h:tlp. 
*~ to l10Ilcge stress. 
*Awaren::s.s ofjkn::Mlai:.}= of •~ 
d:u:k side of Life" am. the 
a:tn:ctim with life style. 
~ - - - - ) f ~ :  . ~ - ·  " ·  - " t i ;  _  ~ ~ ~ s f f l ~ ! ' , ; ' / ' . ~ ~  . " > e ! : > J m . 1 ; ; .  •  , . , ~ t ' . : ~ ; - i , ~ . _ : , _ : " - : - _ ~ - • : " . ; > - 7 : ~ ' : " : ? ' "  . .  _ ' . : : ' ,  ~ . , , _ ; . ' ( . . : ,  
A P P E N D I X  ~6  
E M E S  
E f f i - . J i l I D - 1 E  
A I M 3 / 0 0 J E C T ' I V E S  
I R E -
' 1 T r I . . E S  
S I D ,  
f f i I M  
~ A  
~ B  
S I D 1 + 2  
S I D 3 + 4  
S I D  5  S I D 6 + 7  
S I D  8  
' i t ' I b  s t r e s s  t h e  i n p J r t a r l : E  
o f  h a v : i J B  a  v i s i m / g : a l .  
' i t ' I b  e n : x : u r a : J e  p t " C d u ± i w  
a r r l  C X E E . t i W  U 9 e  o f  t i n e .  
' i t ' I b  e n : : x : : u r a : J e  c r e a t i w  
t b i n k i n J  a s  a  w a y  o f  
e n h a n : : i n J  c r e '  s  q u a l i t y  o f  
l i f e .  
/ \ C E  E i l . U \ T I C N  
*  ' v h : 3 . t  i s  p : E . C E ?  
" " I l E  r a : : : e s s i t y  f a r  a i : p r o -
X  
X  X  
X  X  
X  
X  
X  
X  X  X  
X  
*  s t . c n : i e s  a h : : u t  p r - i a t e  a t t i t u : : l e s  a r r l  a c t i c : n ;  
X  
X  
X  
X  
X  
X  
X  
X  X  X  
X  X  
p : E . C E  r r a k e r s .  
t o  c x : : u n t e r a c t  t h e  e f f e c t s  o f  
X  
X  
X  
X  
X  
X  
X  X  
X  X  
X  X  
v i o l E : ! " ' X : B  i n  r u r  s x : : i e t y .  
*  W : l r l < s h : : p ; .  
X  
X  
X  
X  X  
X  
X  
X  
X  X  
X  X  
*  G a r r E s  
*  I m : : l q : o r a t i n : J  P = E - C E  
* L e a m i n : J  t h e  i n p : : : : i r t a r X E  o f  
X  
X  X  
X  
X  
X  X  
X  
X  X  X  
X  
a v . e r e n : s s  i n  a l l  r u r  
C E T C C r a t i c  c n - q : e r a t i m  a r r l  
i d ? a s  r u r l  a c t . i c n s .  
t o l e r a n : : : E .  
*  D i . s o  l S S i c : n ;  
X  X  
X  X  
I V J : R : N . 1 E N I N ,  
*  M I D  a r r l  h i s  e n v i r c : n -
~  h a w  a  : r e s p : : r s i b l l i t y  t o  
X  
X  X  
X  X  
X  
X  
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X  X  
X  X  
J A R E N E : S N - 1 )  
I ! B 1 t .  
~  r u r  n a t u r a l  : r e s a m : : e : ;  
X  
X  
X  
X  
X  X  
X  
X  
X  X  
X  
X  
R E  
*  f o l l u t i m .  w i r e l y .  
X  
X  X  
X  
X  
X  
X  
X  X  
X  X  
X  
*  w a s t e  P r c x : i r t . s .  * H : l N  t o  u s e  v . e s t e  p r w . . c t . s  
X  
X  
X  
X  
X  X  
X  X  
X  
X  X  
X  
*  R e s t a r i n J  n a t u r e .  
p : : s i t i w l y  ( e g .  r e c y c l i r g ) .  
~ t  t h e  i n : l i v i d . l a l  c a n  o o  
t o  c a r e  f a r  t h e  e : u : t h  a r r l  a l l  
l i v i n : J  t h i n ; J s .  
APPENDIX ·6 
I.SIC * ICE.l1tify rEEds ~. ll:'It> re aware of rur rans arrl h::M X X X X X X X X X X X X 
MAN Rlysical arrl to nEet tlan in a p:::sitive way 
!KS sa:::urity rEEds. within the frarra..ark of an 
'lb give arrl re::E.:i.v e acn:ptable ~ systan. 
affECticn; 
* Nea:1 far acn:ptan::e; X X X X X X X X X X X X :x 
Nea:1 far sel£-develcp-
Il'0'lt arrl re,/ ~e-
:n:::ES. 
llfi'ICN * Fel.at.i.aEhip: ll:'lb acquire the sccial arrl a::rnru- X X X X X X X X X X X X ) 
ITP * O:mrunica.ticn ni.caticn skills ~ to farm X X X X X X X X X X X X } 
* Asserti'\eES.S frierrl:,hjp3 with neci.et:s of the X X X X X X X X X X X X } * Rights arrl feelllq; @lt'e arrl q:p::site sex X X X X X X X X X X X X } 
of otlErS 
* M:3kin:J arrl keep.irg ll:'It> ta:::x::rre aware of oth:!rs' X X X X X X X X X X X X } frienj; frelirgs. I.earnin:J to re a:nsi- X X X X X X X X 
* X X X X 
} 
Yrur p::siticn in the derate 
family. ll:'lb <X{E as the eldest, mid::lle, X X X X 
,,. ;,, .:- X X X X X X X X ) * Eri1an:::irg a:1mur ii- yo.irgest & ' a1ly chl1d in tm 
ca.ticn. family. X X X X X ) * WB1 cx:nflict arises 
- cx:nflict h:m:llirg. 
* ~ arrl their ll:'It> acquire asserti' \eES.S arrl X X X X X X X X X X X X ) 
e.>qltBSSicn. cx:nflict ~ skills. 
* love - its varirus 
nmninJs ll:'lb IlEke reqx:nsihle c:hoiCES in X X X X X X X X X X X X '4  
relaticn to the ~icn of 
frelirgs. 
~ inp:n:tan:E of natur.irg 
eroticrally.