HIV/AIDS awareness levels of TVET students
South Africa’s technical and vocational education and training (TVET) sector comprises 50 colleges with a joint enrolment of some 658 000 students and a staff complement of about 16 000. Geoffrey Setswe et al report on a study to determine the level of HIV/AIDS and TB-related knowledge and attitudes of students and staff that could inform the design of HIV/ AIDS and TB interventions in this sector.
The overall purpose of the Higher Education and Training HIV and AIDS (HEAIDS) programme is to reduce the threat of HIV/AIDS in the higher education sector and to mitigate its impact. In 2009, HEAIDS commissioned a pioneering study on HIV prevalence and knowledge, attitudes, behaviours and practices (KAPB) involving almost 24 000 students and staff at 21 of the country’s 23 universities.
The 2014 national survey of knowledge, attitudes and behaviours (KAB) of students and staff at technical and vocational education and training (TVET) colleges (formerly known as FET colleges) was the first to be conducted in this sector to obtain baseline measures on KAB of HIV and AIDS and related risk factors.
Data was collected from a representative sample of 5 651 students and 1 003 staff members, covering about 70% of campuses. The sample was sufficiently large and representative to allow findings to be generalised to staff and first-year students in the TVET sector.
A member of the research team read the questions to the class, with students completing their own questionnaires. Individuals in sampled classes were free to opt out of the survey but the rate of refusals was very low. Staff members who participated in the survey were sampled on an individual basis. They were either privately interviewed by a fieldworker who completed the questionnaire, or completed the questionnaire themselves.
Findings and discussion
Male and female students were almost equally represented in the sample, about 88% of students were under the age of 25 years and more than three-quarters were from urban areas. Among staff members, nearly 54% were female, about 90% were 25 years or older, and the majority were urban dwellers. The racial composition of the two samples differed slightly (Table 1).
The survey cast some light on the financial circumstances of students and staff, indicating that students were in more constrained circumstances than staff (Figure 1).
Almost one in three students indicated they did not have enough money for food and clothing.
Almost one in three students indicated they did not have enough money for food and clothing, and a further 44% said they went short of other basic things, although could afford to buy food and clothes. Almost three quarters of students (74%) relied mainly on parents or family members for income, while about one in 10 indicated a bursary was their main source of finance.
About 8% of male students said they derived most of their income from a part-time job, compared to nearly 3% of female students. About 5% of female students relied on a partner or husband for income and another 5% on child support or a social grant. Male students were less likely to report being supported by a partner, spouse or social grant.
83% reported they were single, yet more than 60% later reported they had sexual partners.
The reported relationship status of students is shown in Figure 2. The striking feature was that 83% reported they were single, yet more than 60% later reported that they had sexual partners.
Information on living arrangements indicated that 51% of staff members lived with their husband or wife and 8% with their sexual partner, while 23% indicated they were in a relationship but did not cohabit. Table 2 shows the sample composition in terms of sexual orientation.
Table 2: Sexual orientation of students and staff members at TVET colleges (figures rounded off)
Awareness and knowledge of HIV/AIDS and TB
Staff members consistently showed higher awareness and knowledge of HIV, AIDS and TB compared to students. There was high awareness about sexual transmission of HIV and the preventative role of consistent condom use. Knowledge of mother-to-child transmission of HIV and antiretroviral (ARV) prevention was slightly lower than knowledge of sexual transmission. A surprising finding was that about that 30% of students and about 19% of staff were not clear on the fact that AIDS could not be cured.
Staff mostly reported that they sourced information on HIV/ AIDS from the mass media.
Staff mostly sourced information on HIV/AIDS from the mass media, including TV (68%), radio (59%) and newspapers (48%), and about half also got information from health facilities. Only one in five students obtained information from the media or health facilities, and even fewer from education institutions. Online and social media were not widely used by TVET students to access HIV/AIDS information.
Attitudes towards condoms and their use
Half of male respondents and a third of females said condoms felt unnatural (Figure 4). In addition, 38% of male students and 40% of male staff felt that condoms changed the sensation of orgasm. Female respondents were only half as likely to report this as their male peers.
A third of male respondents and one in five women said they only used a condom if their partner wanted this. Four in 10 male respondents said condoms should only be used when having sex with non-regular partners. One in four females shared this opinion.
Patterns of condom use
• Reported condom use at last sex with a (main) partner was 55% for students and 35% for staff.
• Condom use at last sex with a non-regular partner was around 75% for all respondents.
• Consistent condom use (‘every time’ or ‘almost every time’) was reported by 80% of students when having sex with their partner and by 74% when with a non-regular partner.
• The corresponding figures for staff members were 72% and 74% (Table 3).
Table 3: Consistency of condom use with partner and non-regular partner
Rates of condom use at last sex for students and staff were consistent with previous studies, including the 2012 HSRC household HIV prevalence survey and the HEAIDS 2010 study. However, reported rates of consistent condom use in this study were considerably higher than those in the 2012 study.
It is clear the students surveyed have acquired a fair amount of knowledge about HIV/AIDS, but some lack an appreciation of their personal risk for, and the relationship skills that would allow them to conduct their sex lives in a way that keeps them safe from, HIV, unwanted pregnancy and STIs. Staff were a step ahead of their students in terms of HIV knowledge, their active search for information, and more accepting views of HIV treatment, people living with HIV, and lesbian, gay, bisexual, transgender and intersex groups (LGBTI). More than half of staff members were married and living with their spouse; this may have contributed to their low perception of personal vulnerability to HIV.
The survey revealed relatively high levels of knowledge on HIV prevention methods, alongside negative attitudes to condom use. The figures on self-reported condom use at last sex and on unplanned pregnancies indicated that a high proportion of students and staff engaged in unprotected sex with their regular sexual partner. But data on consistent or ‘almost’ consistent condom use painted a different picture, yielding the high rates of consistent condom use relative to other studies. The subjectivity of self-reporting on sexual behaviour might have influenced this result.
Authors: Professor Geoffrey Setswe, deputy executive director, HIV/ AIDS, STIs and TB (HAST) programme, HSRC; Dr Musawenkosi Mabaso, senior research specialist, HAST, HSRC; Professor Sibusiso Sifunda, chief research specialist, HAST, HSRC; Ntombizodwa Mbelle, chief research manager, HAST, HSRC; Vincent Maduna, master’s research intern, HAST, HSRC; Dr Jacqueline Mthembu post-doctoral research fellow, HAST, HSRC.