Most people in South Africa (and many parts of the world) ‘know’ about HIV and AIDS and ‘know’ how to protect themselves from HIV infection. So why is the HIV infection rate still rising, why is stigma such a problem and what can each one of us do?Listening to those like us

• ‘Knowing’ about HIV and AIDS
• Making information ‘real’

HIV and AIDS are our issues too

• Knowing and Doing

Getting trained: committing yourself

• No Time, But Still Interested

Helping people understand

• What is Abstinence?
• What about Condoms?
• The Technicalities of a Monogamous Relationship in the Era of HIV

HIV As Part of Our Lives

Resources

• Educate Yourself: Internet Resources on HIV and AIDS
• Educate Others: Peer Education Training in South Africa

Listening to those like us

For nearly my entire university career, I was a volunteer student HIV and AIDS peer educator. But being a peer educator does not have to be a formal appointment. To some degree, we are all peer educators: every time we talk with our friends, we are sharing and reaffirming information. This is particularly important in South Africa, where everyone ‘knows’ that HIV and AIDS are problems, but few people ever discuss its relevance to our lives.

The organization I worked with at university gave workshops for university students, high school students and whoever else asked for help. We operated according to the idea that people are more likely to listen to information given by educators they believe are similar to them and who face the same concerns and pressures (peer-to-peer education).

Formal peer-to-peer education programs have proven effective in many different areas. Some examples are: the South African Clothing and Textile Workers Union (SACTWU), which runs a successful worker education program in Cape Town; and programs among mineworkers and their partners at places such as Hlabisa and Carletonville. Reaching the youth is often the first thing that springs to mind when HIV education is mentioned, but everyone can be infected with HIV and affected by AIDS.

‘Knowing’ about HIV and AIDS

Teachers were amazed at the kind of questions that students asked us when we gave workshops at schools. (Teachers were not allowed to attend the workshops, but we would give them general feedback after the workshop on how it went in our opinion.) These ranged from queries that no teenager wants to admit she doesn’t know (”so what is penetrative sex?”), to general questions that a student did not want to ask his teacher as they indicated a possible lack of understanding (”but why do we talk about HIV/AIDS if HIV and AIDS are two different things?”).

Through school programs, students of varying ages in South Africa are expected to have some formal knowledge on HIV and AIDS, often taught by (much older) teachers. The fortunate few who get to university level have received a complete high school education and are usually expected to ‘know’ all about HIV prevention. However, by the time they get to university, youth are bored of hearing about HIV and do not understand why it is important in their lives. Funnily enough, the same questions we were asked at high schools came up again in workshops for university-level students.

Part of the problem is what people are told about HIV and AIDS is often divorced from their everyday lives. You are expected to take (often sterile) information and use it in a diverse range of relationships.

Making information ‘real’

In my experience, youth – and South Africans in general – are told selective ‘facts’, often without either the time or the space in which to discuss them. The social aspects of HIV infection are not (directly or indirectly) addressed. Students do not feel able to ask for clarity or further information, fearing how the teacher or other students will regard them.

For example, most schools talk about ’safer sex’, but they do not include lessons on assertiveness in relationships, particularly with someone you ‘love’ and fear losing. A “Romantic” relationship is a large part of almost any student’s life, promoted by television, films, books, even parents and of course, peers. Peer educators have a better chance of being able to discuss these issues – though this is not usually encouraged by the formal structure of education systems (for instance, giving a workshop in a classroom or within 45 minutes). Talking about social issues also involves a level of assertiveness that most youth have not yet developed.

HIV and AIDS are our issues too

People are scared of being infected or affected by HIV and AIDS. HIV infection is associated with sex and drug use. HIV is still presented as leading to AIDS, and AIDS is said to ‘always’ lead to death. A topic dealing with more taboo social issues is hard to find.

Social stigma and a lack of health infrastructure are the two biggest problems that HIV-positive people face in South Africa. Most people in South Africa do not test for HIV without a specific reason. No matter their level of education, people usually tend to find an excuse not to get tested. You might argue that finding out about an HIV-positive status creates too many problems as HIV is stigmatized and little treatment or support is available.

Every discriminating joke told in a group of friends is another reason for someone to not disclose her or his status. Stigma not only affects a potentially infected individual, but his or her family and friends. It makes HIV infection a “disease” of association and takes many forms – such as rejecting, isolating and blaming. As one person said, ‘we are all involved in stigmatising, even if we don’t realise it”.

The importance of a person’s family in both breaking down and reinforcing social taboos cannot be under-estimated. What parents choose to tell children, and what is seen as ’suitable’ conversation at the dinner table, form people’s ideas of what is acceptable. This does not mean every family gathering should pick a socially taboo subject to discuss (deliberating masturbation over supper is extreme), but that these subjects can be brought up without automatic censure.

Knowing and Doing

A common perception about HIV and AIDS education (and any issues concerned with sex) is that it advertises socially unacceptable behavior, especially among youth. Talking about sex is often viewed as akin to promoting it.

This has not been proven by studies on the subject, instead, the reverse appears to be true. Open communication with youth about sex delays sexual relationships. However, the separation of HIV preventive education from sexual relationships means this is not necessarily the case in South Africa.

Getting trained: committing yourself

Formal training as a peer educator is usually through an established HIV and AIDS organization. You can be trained on a variety of issues, from HIV prevention to treatment. (HIV and AIDS counseling is usually separate.)

However, training takes resources and organizations usually demand a certain level of commitment from the volunteers they train. (Even if you offer to pay for your training, the organization must still provide facilitators and time.) Think about how much time and energy you can give as a trained educator: a minimum of 4 hours every two weeks is usually required.

If there is no HIV education organization to join in your area, you can also set up your own community-based group. HIV and AIDS cover such diverse subjects that you may even wish to investigate educating on issues such as stigma or how to access local health resources. (Asking your local ATICC or health center about their needs and/or wants is a good place to start.) Again, this involves a high level of commitment. The service you seek to provide is important and people will rely on your consistency.

No Time, But Still Interested

Constant HIV and AIDS education is a necessity for any community, at a variety of levels. You may not have the time to formally train and educate, but informally there is as much (if not more) work to do. As a parent, co-worker, friend or relative, you have the power to affect people’s perceptions of HIV and AIDS.

Helping people understand

Most people in South Africa have enough information that they ‘know’ how to prevent HIV infection through either abstinence, using a condom or being in a faithful, monogamous relationship. But that information is interpreted in a variety of ways. An easy way to act as a ‘peer educator’ in your life is to learn more about HIV and AIDS and ask your friends, family and yourself a few simple questions.

• What is Abstinence?

  Some people think abstinence is limited to no vaginal penetrative sex. Abstinence technically means not engaging in any sexual contact with potentially HIV-infected fluids (blood, semen, vaginal fluid and breast milk). So engaging in oral sex is not abstaining.

• What about Condoms?

  The most common complaint that people have about condoms is that they are not reliable. This is almost always the result of human error. (Check your knowledge on how to use a condom against the list of “must-dos” when using a condom.)

  Another problem is that a person uses condoms the first couple of sexual encounters with a new partner, and then stops. This is partly due to cost, availability and dexterity, but also relates to social ideas on the meanings of using of a condom.

  Using a condom is interpreted in some cases as implying something about either the person (”I don’t trust you and think you might have an STD”) or the relationship (”I don’t regard us as being in a long-term relationship”). The question of using a condom becomes ‘Do I love/need this person enough that I will stop using a condom so this relationship continues?’

• The Technicalities of a Monogamous Relationship in the Era of HIV

  A long-term, mutually faithful relationship (without condom usage) presumes each partner is HIV-negative. This requires that firstly, each partner stays sexually faithful to the other for the entire relationship and secondly, that each partner is tested for HIV before unprotected sexual intercourse begins.

  Trust is always subjective and each relationship is unique. However, it is imperative that couples are open with each other about their interpretations of sexual faithfulness, whether a condom is used if not sexually faithful, and the results of HIV test results. Much of this may seem implicit, but it is easily misinterpreted if not clearly stated.

HIV AS Part of Our Lives

The numbers of South Africans infected and affected by HIV and AIDS grows every year. The impacts of HIV and AIDS are personal, social, economic and political.

HIV’s relatively long incubation period before illnesses usually develop, and the diverse ways that AIDS-related conditions manifest, mean that many people do not recognize its impact on their lives. Your contributions as a formal or informal educator are priceless in ensuring that we all develop ways of dealing with HIV and AIDS in the ways we live both now and in the future.

A ‘must-do’ checklist for male condom use:

• Make sure the condom’s expiry date is at least two years in the future (condoms are made out of rubber and deteriorate over time) and that it has an SABS stamp of approval. Only Department of Health condoms do not have the SABS stamp on every single condom as it is on the box.
• Only use condoms stored in cool and dry places and not exposed to a lot of friction. (A condom in a wallet has a life of about a week before it needs to be replaced). Again, remember that condoms are made out of rubber and deteriorate in the same way that any rubber does when exposed to heat and friction
• Don’t tear the condom! Push it away from the edge as you open the packet and be careful of fingernails and teeth. Remember to gently squeeze the tip of the condom as you roll it down the penis (otherwise the trapped air will cause it to pop).
• Use water-based products, like saliva or KY jelly, not oil-based products for lubrication. Oil-based products cause condoms to break.
• …And remove the condom while the penis is still erect, after ejaculation. If it is left on until the penis is limp, then the semen will come out of the condom.

Resources

Educate Yourself: Internet Resources on HIV and AIDS

The varied amount of available information on HIV and AIDS can be confusing. The politics of HIV and AIDS all over the world are such that any information must be interpreted in light of that organization’s presumed goals. In general, site addresses ending in ‘edu’, ‘gov’ or ‘org’ are relatively reliable. The internet sites listed here provide an introduction to authoritative sites on HIV and AIDS issues.

New Mexico AIDS InfoNet
This site provides comprehensive summaries on HIV infection and treatment. Each topic prints out onto a single page in either Word or PDF format. Some particularly useful pages are:

- What is AIDS?
- Stopping the spread of HIV
- Safer sex guidelines
- How risky is it?
- Internet bookmarks for AIDS
(A comprehensive list, by category, of the different kinds of internet-based sites you can find on HIV and AIDS.)

Lovelife
Information for parents on the importance of talking to children and practical tips on how to do so.

Talking with Kids
This website offers practical tips and techniques for talking with young children ages 8 to 12 about issues such as sex, HIV and AIDS, drugs and alcohol.

Advocates for Youth
Highlights the importance of peer education and provides academic references for further reading

AIDS Treatment Data Project
Provides a glossary of HIV drugs & treatments
Project Inform
A comprehensive site covering most HIV and AIDS issues.
Wise Words publication

The Body
This information on this site is specifically aimed at people infected and directly affected with HIV. Useful pages include:
- HIV and AIDS Basics and Prevention
- Project Inform Drug Interactions Fact Sheet at The Body
- Body Positive Magazine

Center for AIDS Prevention Studies (CAPS) at University of California, San Francisco
Has easily understood HIV prevention Fact Sheets and links to HIV inSite at UCSF: http://hivinsite.ucsf.edu/InSite

CDC Division of HIV/AIDS Prevention
Provides a variety of information on the science of HIV and AIDS

CDC (Centers for Disease Control) NPIN Daily Summaries
Condomania’s World of Safer Sex
A fun and interactive site on using condoms effectively

United Nations Programme on HIV and AIDS
UNAIDS has information on various aspects of HIV and AIDS world-wide.

The UNIFEM Gender and HIV/AIDS Portal
Henry J. Kaiser Family Foundation: http://www.kff.org/hivaids/
This site offers an email Daily Reports on HIV and AIDS service, which summarises each day’s USA and international news on HIV and AIDS.

AEGIS
This online library offers a database of publications on HIV and AIDS.

TAC (Treatment Action Campaign)
This organization is well known for campaigning for access to HIV antiretroviral medication. However, it also has links to small community-based organizations and itself periodically requires help.

AIDS Consortium
Provides a referral database with the details over 1,000 HIV and AIDS organizations in South Africa. Allows searches by organization, province and keyword.

AIDS Directory
Provides the ability to search for an organization by type, province, keyword, name or contact person.

Educate Others: Peer Education Training in South Africa

Training is at a community-based level. Contact these organizations for information on groups offering formal training in your area.

ATICC
There are AIDS Training, Information and Counselling Centers (ATICCs) in most South African cities and large towns. ATICCs provide training as HIV and AIDS educators and counselors, as well as a free testing service. Contact your local ATICC for a comprehensive list of HIV and AIDS organizations in your area that provide training. If there is no ATICC in your area, contact the local health center.

PPASA (Planned Parenthood Association of South Africa)
A national organization offering a variety of training workshops and community intervention projects.