Perceptions among a group of at-risk individuals: the discrepancy between unsafe sex practices and knowledge about HIV/AIDS transmission

English: Due to its rapid spreading, AIDS has been declared a global epidemic. Especially sub- Saharan Africa has been the most affected by the epidemic. South Africa is no exception to the devastating impact of the epidemic. Over the past few years, HIV-prevention initiatives have been underway on a full scale in an effort to combat the destructive powers of the epidemic in the country. These initiatives appear to have adopted a health belief approach in their strategies to decrease HIV-infections. This approach to HIV prevention assumes that the desired behaviour change, namely increasing safe sexual practices and decreasing high-risk HIV/AIDS behaviour, can be achieved through rational decision-making based on knowledge of the disease and its consequences. The findings of studies on sexual behaviour and HIV/AIDS such as KAPB (knowledge, attitudes, practice and belief) studies appear to reaffirm the fact that knowledge alone is not sufficient nor effective in bringing about the appropriate behaviour change to combat HIV/AIDS. These studies point towards a high level of knowledge about AIDS in the general population, yet the ever increasing HIV-infection rate remains undeterred. The discrepancy between knowledge about HIV/AIDS and the unchanged high-risk sexual practices of the population which is seemingly knowledgeable about the disease, prompts a need for research to identify the underlying causes of this discrepancy, thus the rationale for this study. In view of the inadequacy of a health-belief approach to HIV-prevention, this study proposes an alternative approach to HIV-prevention that would supplement the health belief approach, and thus explain the hiatus between knowledge and manifest sexual behaviour. This is approached from a socio-behavioural approach, which assumes that HIV/AIDS is a behavioural issue that is firmly rooted in sexual behaviour. In addition, it acknowledges that sexual behaviour is influenced by the interplay of psychological, sociological and cultural factors in sexual decision-making. This decision-making process often has little to do with maintaining good health and more to do with satisfying motivational needs that have a psychological basis or with options that are socially or economically or emotionally determined. Thus, a multidisciplinary approach to analysing factors that influence sexual behaviour was utilised. Based on a multidisciplinary analytical model of sexual behaviour, the study aimed to identify factors that impede the practice of safe sex. The developing of this model was informed by various perspectives (i.e., psychological, sociological and anthropological) of behaviour and two theories that take account of the social context in explaining the behaviour change process (i.e., attitude accessibility model and theory of reasoned action). The multidisciplinary model, in turn, informed the development of the research instruments and interpretation of the findings. The community of Thabong, in Welkom, was selected because of the high HIV prevalence in the District and because of the involvement of the Centre for Health Systems Research & Development in the proposed Youth Multi-function Centre in Thabong. Welkom has the highest HIV-prevalence of all the districts in the Free State (30,63%). Second, the study intends to inform HIV-prevention initiatives about impediments to safe sex. Thus, this study will inform- the proposed Youth Multi-function Centre in Thabong, which aims to decrease HIV-infections among the youth in the community. Towards informing the study aim and objectives, individual in-depth interviews were conducted with 30 confirmed HIV-positive males and females between the ages of 15 - 49 years. The interviews were guided by a semi-structured individual questionnaire. Also, 15 focus group discussions were conducted with males and females from various social strata in the community, and who were assumedly HIV-negative. The focus group discussions were conducted with the aid of a semi-structured group discussion schedule. The two forms of data collection served to complement each other and promoted the validity and quality of the data collected. The study design opted for was explorative in nature, as little is currently known about the community-specific obstacles to safe sex. All respondents were purposively sampled. The main findings of the study point towards the need for HIV/AIDS to be viewed in the light of the socio-cultural and socio-economic contexts of sexual behaviour. Factors that were identified as influencing sexual behaviour, and therefore HIV/AIDS, include the unbalanced power in gender-relations, socio-economic status and perceived self-efficacy, amongst others. Also, there is a need for detailed knowledge about the specifics of HIV prevention and transmission, as well as safe sexual practices. This will serve to address myths and misconceptions about the three modes of safe sex, namely condom use,' sexual abstinence and mutual faithfulness. Overall, the research indicates that HIV/AIDS is a socio-behavioural problem rooted in the sexual practices of individuals. Attempts to successfully change high-risk sexual behaviours should first identify factors that influence the progression of the disease in order to develop community-specific effective and efficient HIV-prevention initiatives. To a large extent, this study has identified those factors that influence and limit the options and opportunities that people in Thabong have when it comes to practicing safe sex. In this community, these are the factors that should be taken into account when HIV/AIDS prevention initiatives are planned and implemented. These factors include, inter alia, low socio-economic status of women, gender-role stereotypes, myths and misconceptions about HIV/AIDS and safe sex, violence, socio-cultural norms and gender imbalances.