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Health and Wellness Sciences Faculty

Department of Nursing Sciences

Potential health risk factors amongst students at a

Higher Education Institution in the Western Cape with

regard to sexuality and HIV/AIDS

By

Nomzamo Peggy Tabata

Student Number: 193056739

Thesis submitted in fulfilment of the requirements for the degree

Master of Technology: Nursing

Faculty of Health and Wellness Science

CAPE PENINSULA UNIVERSITY OF TECHNOLOGY

Supervisor: Dr H. Vember

Co- Supervisor: Prof T. Matsha-Erasmus

Bellville

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DECLARATION

I, Nomzamo Peggy Tabata, hereby declare that the contents of this dissertation represent

my own unaided work and that the dissertation has not previously been submitted for

academic examination towards any qualification. It represents my own opinion and not

necessarily those of the Cape Peninsula University of Technology.

Sign

Date: 03/12/2018

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ABSTRACT

Health risks are continuing to be a challenge worldwide. Globally, young people aged 15-

24 are amongst the most vulnerable groups. It was revealed that between 2007 and 2010,

the rate of HIV infection increased in this age group. In sub-Saharan Africa, three out of

four new HIV infections are amongst girls aged 15 to 19 years of age. Young women aged

15 to 24 are twice more likely to live with HIV than men in 2019. South Africa is the

country with the largest human immunodeficiency virus (HIV) infected population in the

world, with an estimated 7 million people living with HIV and 380 000 new HIV infections

in 2015. University students are a very important group of young people because they are

being prepared for the world of work and to assume leadership roles. However, they are

the group most exposed to a range of health risks, particularly regarding sexuality and

HIV/AIDS. The aim of this study was to explore potential health risk factors amongst

students at a Higher Education Institution (HEI) in the Western Cape with regard to

sexuality and HIV/AIDS. The objectives of the study were to explore the factors that may

increase health risk behaviours amongst students at an HEI and to discover and describe

the knowledge university students have regarding potential health risks related to sexuality

and HIV/AIDS. A qualitative research design was employed. Focus group interviews were

done to collect data and a thematic content analysis was employed to analyse the data.

Results revealed that the university students engaged in high-risk sexual behaviours, such

as transactional sex, casual sex, multiple partner sexual relationships and unprotected sex.

Such behaviours lead to a high-risk of contracting STIs and HIV/AIDS. Among the factors

that were found to be contributing to these risky behaviours, was the new-found freedom

of being away from the supervision of parents. Peer pressure at HEIs, as well as abuse of

alcohol and drugs, also contribute to risky behaviours. Recommendations were that there

should be organised and measured approaches to expose both lecturers and the students to

HIV/AIDS education through an integrated curriculum design. There should be teamwork

amongst lecturers, support staff and students to create powerful discussions and an

exchange of ideas to clarify issues regarding HIV/AIDS, sexuality and other related topics

to reduce high-risk behaviours and promote solid constructive attitudes amongst the

university community.

KEYWORDS: Students, Higher Education Institutions, High-risk behaviour,

HIV/AIDS, Knowledge, Attitude.

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ACKNOWLEDGEMENTS

I am forever grateful to my Lord Jesus Christ, for his unfailing love, his faithfulness and

for providing me with strength, protection, provision of wisdom, knowledge and

understanding throughout this study and in my personal life.

I also wish to thank:

• My supervisor Dr Hilda Vember, for her professional guidance, encouragement,

continuous support, significant corrections and assistance throughout my studies

and in my personal life.

• Professor Thandi Matsha-Erasmus, for her financial assistance.

• My family especially my daughters Phindile Loyiso Tabata and Yondela Phumzile

Tabata for the support, love and understanding.

• CPUT HIV Unit Director and staff, as well as the CPUT peer educators.

• CPUT Counselling Department.

• CPUT Nursing Department.

• All my friends, especially Lungisile Tshitshi and Ntombomzi Mcanjana for their

support and assistance.

• All the participants who sacrificed their time to take part in this study.

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TABLE OF CONTENTS

DECLARATION ................................................................................................................. i

ACKNOWLEDGEMENTS ............................................................................................... iii

TABLE OF CONTENTS ................................................................................................... iv

LIST OF FIGURES ........................................................................................................... xi

LIST OF TABLES ............................................................................................................ xii

LIST OF APPENDICES .................................................................................................. xiii

LIST OF ABBREVIATIONS .......................................................................................... xiv

DEFINITION OF CONCEPTS .........................................................................................xv

Chapter 1………………….……………………………………………………………….1

The Orientation of the study…..…….……………………………………………….……1

1.1 Introduction ................................................................................................................1

1.2 Background ................................................................................................................2

1.3 Problem Statement .....................................................................................................2

1.4 Justification of the study…..…………………………………………………….….3

1.5 Aim .............................................................................................................................3

1.6 Objectives ...................................................................................................................3

1.7 Research Question ......................................................................................................4

1.8 Theoretical framework ...............................................................................................4

1.9 Literature review ........................................................................................................5

1.9.1 Global impact ........................................................................................... 5

1.9.2 National impact ......................................................................................... 6

1.9.3 Provincial impact (Western Cape) ............................................................... 7

1. 10 Research Design and Methodology.........................................................................7

1.10.1 Design ................................................................................................... 7

1.10.2 Method of data collection………………………………………………………8

1.10.3 Advantages of focus group discussion…………………………………………8

1.10.4 Disadvantages of focus group discussion….…….……..……………………..8

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1.11 Research setting........................................................................................................8

1.12 Population.................................................................................................................8

1.13 Sampling...................................................................................................................9

1.13.1 Inclusion criteria .....................................................................................9

1.13.2 Exclusion criteria ....................................................................................9

1.14 Recruitment of research participants ........................................................................9

1.15 Data Analysis .........................................................................................................10

1.15.1 Data presentation ................................................................................... 10

1.16 Rigour .....................................................................................................................10

1.17 Trustworthiness ......................................................................................................10

1.17.1 Credibility ............................................................................................ 10

1.17.2 Transferability....................................................................................... 11

1.17.3 Dependability ....................................................................................... 11

1.17.4 Confirmability....................................................................................... 11

1.18 Ethical consideration ..............................................................................................11

1.18.1 Declaration of Helsinki .......................................................................... 12

1.18.2 Autonomy ............................................................................................ 12

1.18.3 Beneficence .......................................................................................... 12

1.18.4. Justice ................................................................................................. 12

1.18.5 Confidentiality ...................................................................................... 12

1.18.6 Non-maleficence ................................................................................... 12

1.19 Chapter division .....................................................................................................12

1.20 Summary ................................................................................................................13

Chapter 2 ............................................................................................................................14

Literature Review...............................................................................................................14

2.1 Introduction ..............................................................................................................14

2.2 Theoretical framework .............................................................................................14

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2.2.1 Individual perception ............................................................................... 15

2.2.2 Modifying factors .................................................................................... 16

2.2.3 Benefits of preventative measures ............................................................. 16

2.3 Student life ...............................................................................................................16

2.4 Higher Education Institution (HEI) ..........................................................................17

2.5 High-risk behaviours ................................................................................................18

2.6 Students and HIV/AIDS ...........................................................................................21

2.7 Tertiary students’ knowledge about potential health risks .......................................22

2.8 Attitudes of tertiary students towards potential health risks ....................................23

2.9 Knowledge and attitudes towards condom use ........................................................25

2.10 Summary ................................................................................................................25

Chapter 3 ............................................................................................................................26

Research Design and Methodology ...................................................................................26

3.1 Introduction ..............................................................................................................26

3.2 Qualitative research ..................................................................................................26

3.2.1 Constructivism ........................................................................................ 26

3.2.2 Bracketing .............................................................................................. 27

3.3 Research design ........................................................................................................27

3.3.1 Descriptive design ................................................................................... 28

3.3.2 Exploratory design .................................................................................. 28

3.3.3 Contextual design .................................................................................... 29

3.4 Research setting........................................................................................................29

3.4.1 Cape Technikon ...................................................................................... 29

3.4.2 Peninsula Technikon ............................................................................... 29

3.5 Population.................................................................................................................30

3.6 Sampling...................................................................................................................30

3.6.1 Convenience sampling ............................................................................. 31

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3.6.2 Recruitment ............................................................................................ 31

3.6.3 Inclusion and exclusion criteria ................................................................. 32

3.7 Method of data collection .........................................................................................32

3.7.1 Focus group discussions (FGDs) ............................................................... 32

3.7.2 Advantages of FGDs ............................................................................... 33

3.7.3 Disadvantages of FGDs ........................................................................... 33

3.7.4 Interview schedule and probing questions .................................................. 33

3.8 Process of data collection .........................................................................................34

3.8.1 Recording of FGDs ................................................................................. 34

3.8.2 Data saturation ........................................................................................ 35

3.8.3 Moderator’s role ..................................................................................... 35

3.9 Data protection and management .............................................................................35

3.10 Data analysis ..........................................................................................................36

3.10.1 Transcribing data ................................................................................... 37

3.10.2 Ordering and organising data .................................................................. 37

3.10.3 Coding ................................................................................................. 37

3.10.4 Reflexivity ............................................................................................ 38

3.11 Rigour in qualitative research ................................................................................38

3.11.1 Credibility ............................................................................................ 39

3.11.2 Transferability....................................................................................... 39

3.11.3 Dependability ....................................................................................... 40

3.11.4 Confirmability....................................................................................... 40

3.12 Ethical Considerations............................................................................................40

3.12.1 Autonomy ............................................................................................ 40

3.12.2 Beneficence .......................................................................................... 41

3.12.3 Justice .................................................................................................. 41

3.12.4 Non-maleficence ................................................................................... 41

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3.12.5 Right to privacy and confidentiality ......................................................... 42

3.12.6 Informed consent ................................................................................... 42

3.13 Summary ................................................................................................................43

Chapter 4 ............................................................................................................................44

Results ................................................................................................................................44

4.1 Introduction ..............................................................................................................44

4.2 Biographical Data .....................................................................................................44

4.3 Themes .....................................................................................................................44

4.4 Theme 1: Contributing factors to risky behaviour ...................................................45

4.4.1 New-found freedom ................................................................................ 46

4.4.2 Reckless behaviour .................................................................................. 46

4.4.3 Alcohol and drugs ................................................................................... 46

4.4.4 Pressure from peers and influence ............................................................. 47

4.4.5 Multiple partners ..................................................................................... 47

4.4.6 One-night stands of sexual contact ............................................................ 48

4.4.7 Early-stage sexual engagement ................................................................. 48

4.4.8 Transactional sex .................................................................................... 49

4.4.9 Unprotected sex ...................................................................................... 49

4.4.10 Lack of communication with parents ....................................................... 50

4.4.11 Knowing the status of a sexual partner ..................................................... 50

4.4.12 Socio-economic background ................................................................... 51

4.5 Theme: 2 Knowledge ...............................................................................................52

4.5.1 Ignorance ............................................................................................... 52

4.5.2 Misconception ........................................................................................ 52

4.5.3 Information needed ................................................................................. 53

4.5.4 Education needed .................................................................................... 54

4.5.5 Uninformed decisions .............................................................................. 54

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4.5.6 Partner testing ......................................................................................... 55

4.5.7 Teen pregnancy ....................................................................................... 56

4.5.8 Condoms………………………………………………………………………56

4.5.9 Abstinence ............................................................................................. 57

4.6 Theme 3: Attitude.....................................................................................................57

4.6.1 Towards HIV/AIDS awareness campaigns on campus ................................ 57

4.6.2 Poor service delivery at on-site student health services ................................ 58

4.6.3 Health risks ............................................................................................ 58

4.6.4 Health services referrals ........................................................................... 59

4.6.5 Stigma and judgement ............................................................................. 59

4.7 Summary ..................................................................................................................60

Chapter 5 ............................................................................................................................61

Discussion of Results .........................................................................................................61

5.1 Introduction ..............................................................................................................61

5.2 Themes .....................................................................................................................61

5.2.1 Theme: 1 Contributing factors to risky behaviour ....................................... 61

5.2.2 Theme: 2 Knowledge ............................................................................... 68

5.2.3 Theme 3: Attitudes .................................................................................. 74

5.3 Summary ..................................................................................................................77

Chapter 6 ............................................................................................................................78

Conclusions, Limitations and Recommendations ..............................................................78

6.1 Introduction ..............................................................................................................78

6.2 Conclusions ..............................................................................................................78

6.2.1 Objective One ......................................................................................... 78

6.2.2 Objective Two ........................................................................................ 79

6.2.3 Objective Three ...................................................................................... 80

6.3 Limitations………………………………………………………..………………..81

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6.4 Benefits of the findings to the HEI and to students..................................................81

6.4.1 Higher Education Institutions ................................................................... 81

6.4.2 Students ................................................................................................. 81

6.5 Recommendations of the study ................................................................................82

6.6 Areas for further research .........................................................................................82

6.7 Conclusions ..............................................................................................................82

References ..........................................................................................................................84

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LIST OF FIGURES

Figure 1: The number of people living with HIV on antiretroviral therapy globally, 2010–

2015...................................................................................................................................... 6

Figure 2 Conceptual Model of HBM ................................................................................. 15

Figure 3: Ecological model to enable and shape the environment of adolescence sexual and

reproductive health............................................................................................................. 24

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LIST OF TABLES

Table 1: Flow diagram illustrating students who were conveniently sampled for the study

............................................................................................................................................ 31

Table 2: Themes and subthemes ........................................................................................ 45

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LIST OF APPENDICES

APPENDIX A : Research Information sheet and Informed consent…………………….93

APPENDIX B : Permission approval letter………………………………….………….96

APPENDIX C : Request letter to conduct study………………………………………..97

APPENDIX D : Briefing sheet for interview and consent to audio record………..........98

APPENDIX E : Letter from student counselling…………………………………….…99

APPENDIX F : Interview Guide: Focus Group Discussion (FGD)……….…………..100

APPENDIX G 1: Example of one transcript group.…………………………….............102

APPENDIX G 2: Coding Thematic Analysis……………………...……………............114

APPENDIX H : Ethics Approval………………………………….……………............132

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LIST OF ABBREVIATIONS

AIDS

Acquired Immune Deficiency Syndrome

CDC

Centre for Disease Control

DoE

Department of Education

FGDs

Focus group discussions

HBM

Health Belief Model

SCT

Social Cognitive Theory

HEAIDS

Higher Education HIV/AIDS Programme

HEI

Higher Education Institution

HIV

Human Immunodeficiency Virus

KZN

KwaZulu Natal

LO

Life Orientation

NSP

National Strategic Plan

SA

South Africa

STI

Sexually Transmitted Infection

SPSS

Statistical Package for the Social Sciences

UNAIDS

United Nations Programme on AIDS

WC

Western Cape

SADEC

Southern African Development Countries

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DEFINITION OF CONCEPTS

Student

“A person who is studying at a tertiary institution” (South African Concise Oxford

Dictionary, 2002:1165).

Human Immunodeficiency Virus (HIV)

According to Mostafa (2015:43) HIV is defined as “Human Immunodeficiency Virus”. It

is an extremely movable virus due to its fast-changing nature. This has caused different

strains of HIV, namely HIV-1 and HIV-2. Both types can cause AIDS. They can be

transmitted through sexual contact, body fluids and mother-to-child.

Acquired Immunodeficiency Syndrome (AIDS)

According to Kortenbout et al. (2009:115), “AIDS is a syndrome of opportunistic diseases

or infections that is caused by HIV”. It occurs in patients who have been infected by HIV

and their immune system is deficient. It can lead to death if there is no intervention, such

as antiretroviral therapy.

Sexually Transmitted Infections (STIs)

According to Espejo (2011:95) “STIs are infections acquired by sexual activities, this may

include mutual masturbation, kissing, vaginal, oral and anal intercourse”. The organism

that causes STI may pass from person to person through bodily fluids, semen and blood.

Sexuality

According to Cieslik and Simpson (2013:96), sexuality is defined as “the way that people

intimately relate emotionally and physically to one another in everyday practices”. It is

further explained that almost everyone is unconvinced about open discussions regarding

sexuality, whereas it helps to be open about it when one wants to explore one’s desires as

they go through puberty and identity.

Attitudes

According to Kambole (2007:4) “An attitude can be defined as a positive or negative

evaluation often based from one’s motion and beliefs of people, objects, events, activities

and ideas or just about anything in your environment that can create an inclination for

action”.

Knowledge

According to Kaplan (1964) as cited by Burns and Grove (2007:13), knowledge is essential

information acquired in a variety of ways, expected to be an accurate reflection of reality

and incorporated and used to direct a person’s actions. Knowledge can be acquired through

traditions, authority, borrowing, trial and error, personal experience, role modelling,

intuition and reasoning. Burns and Grove (2007:13), further explain that “You need to

question the quality and credibility of new information that you hear or read”.

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Behaviour

Refers to the manner in which one acts or conducts her or himself towards others. It can be

a bad or a good behaviour. This definition applies to animals as well (Salati, 2004:8).

Health Risk

“It is a harm that is caused by some specific danger or threat. These factors exist before a

problem arises or continue over time. A community or the general environment can

contribute towards the problem” (Kambole, 2007:5).

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CHAPTER 1

THE ORIENTATION OF THE STUDY

1.1 INTRODUCTION

Health risks are continuing to be a challenge worldwide. This is confirmed by the UNAIDS

(2012:29) which indicated that young people aged 15 to 24 are amongst the most vulnerable

groups globally. The Centre for Disease Control and Prevention (CDC, 2012a) revealed

that between 2007 and 2010, the rate of HIV infection increased in this age group.

According to Global HIV & AIDS Statistics (2017) in sub-Saharan Africa, three out of four

new HIV infections are amongst girls aged 15 to 19 and young women aged 15 to 24 are

twice as likely to live with HIV as men in 2019. South Africa (SA) is the country with the

largest human immunodeficiency virus (HIV) infected population in the world, with an

estimated 7 million people living with HIV and 380 000 new HIV infections occurring in

2015 (Jette, 2017:273-274). Jette (2017) continues to reveal that South Africa is carrying

17% of global HIV-related problems. Swaziland Central Statistical Office and Macro

International Inc. (2008:222) revealed that in Swaziland, HIV prevalence amongst young

people of 15 to 24 years is at 31%. A survey that was conducted in 2012 states that in South

Africa, the rate of new HIV infections had reached 25% of the population. This population

is women aged 15 to 24 years and this rate is four times greater than that of men in the

same age group. This age group accounts for nearly 27% of all new HIV infections globally

(UNAIDS,2012:29). These young people are learners, students, employed and unemployed

young people.

University students are a very important group of young people because they are being

prepared for the world of work and to assume leadership roles. According to Vember

(2013:62-63), students at university are preparing for life in the future. However, they are

most exposed to a range of health risks, particularly regarding sexuality issues. They are

also the group who could turn the tide regarding HIV/AIDS. The question is what can be

done to get these university students to apply what they have been taught in their homes,

churches, communities and high schools regarding sex and HIV/AIDS? Can Higher

Education Institutions (HEIs) help them to become more knowledgeable and to change

their attitude and behaviour in a way that may safeguard them from potential health risks?

Also, despite having this knowledge, why do so many young people still contract

HIV/AIDS? These are some of the challenges that prompted the researcher to engage in this

study. The HIV/AIDS epidemic over the past years has and still affects many families and

communities. It was revealed that in, Mngungundlovu, KwaZulu Natal (KZN)

neighbourhood have reported alcohol abuse and early sexual engagement as barriers to

schooling and these could have negative effects such as rape for the health status of

learners. This was revealed when exploring socio-ecological level for prevention of sexual

risk behaviours of the youth (Khuzwayo & Taylor, 2018).

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1.2 BACKGROUND

Every year, this HEI enrols approximately thirty-four thousand students from different

socio-economic backgrounds (CPUT Annual Report, 2016:12). They are coming from

different high schools nationally and internationally. Several of them also come from rural

areas outside of the Western Cape (WC). A survey conducted by Snider (September 8th US

News and World Report, 2014) indicated that 23 % of these HEI students are also full-time

employees and attend classes on a part-time basis. Some of these different groups are

enrolling for the first time at a university. For some of them, it is also their first time away

from home and in another province. This new-found freedom could pose problems for them

(Vember, 2013). Hence, they are faced with various challenges, including those of

sexuality and HIV/AIDS. However, they all have the same goal of completing their chosen

qualification. Therefore, the researcher finds it vitally important that HEIs should come up

with comprehensive strategies and interventions to assist these young people to cope with

these challenges. The integration of HIV/AIDS education into all curricula is currently high

on the agenda at HEIs in South Africa and it is on-going (HEAIDS, 2010:6). According to

Van Deventer (2009), cited in Hill, Draper, De Villiers, Fourie, Mohamed, Parker, and

Steyn (2015:3), Life Orientation (LO) is “life-in-society”, which helps learners to produce

their desired living, learning and overall well-being. Centre for Sexualities, AIDS and

Gender (2016:14), stated that the children and adults can benefit from the qualities of

integrated curricula, because it can provide different ways of learning and encourage their

involvement in promoting good attitudes and behaviours towards sexuality and prevent the

spread of HIV/AIDS. Furthermore, it will enable students to build meaning, gain insights,

use fresh knowledge and improve their thinking skills in real world. Potential health risks

are dominating in the HEIs, whether they are sexual or non-sexual. It is important that these

issues be dealt with for this group to understand the implications and consequences thereof.

According to Kelly (2001:1-4), “there is enough evidence to suggest that students at HEIs

in Africa are at risk of contracting HIV/AIDS. They experiment with sexual activities”.

Prostitution is also rife at HEI campuses (Vember, 2013:61). Engaging in unprotected sex

with multiple partners remains a concern at these HEIs (Vember, 2013:61). This all

contributes to risky behaviours. A study done by Kabiru, Beguy, Undie, Msiyaphaza Zulu,

and Ezeh (2010) and Moloney, Hunt, Joe-Laidler and MacKenzie (2011), cited by Cieslik

and Simpson (2013:100), stated the effect of poverty as a leading contributory factor to

risky behaviours, such as unsafe or early sex. In these instances, some students make wrong

choices, because they need the money, and this leads to risky behaviours. They seemingly

also lack knowledge about HIV/AIDS (Cieslik & Simpson, 2013:100).

1.3 PROBLEM STATEMENT

In several countries, there is a significant decline in new HIV infections. However, there

are still signs of increased risk in the sexual behaviour of young people (UNAIDS, 2013:2).

It was revealed that in sub-Saharan Africa, HIV is widespread amongst young people

between the ages of 15 to 24. However, there was a decline of 42% between 2001 and

2012. According to the UNAIDS Global Report (2013:17), the HIV/AIDS infection rate

amongst young women in Sub-Saharan Africa is still twice as high as that of young men.

Burke (2010), cited by Goosen (2013:10) revealed that another high-risk behaviour is that

of alcohol use. High alcohol use, especially amongst students, can affect their decisions

negatively and this can lead to life-threatening circumstances. Many researchers have

concluded that alcohol, poverty and drugs lead to unsafe casual sex, which could result in

HIV and STI transmission (Mbatha & Ally, 2013:2-4). According to Ng’ang’a, Ochanda,

3

Imbuga, Lang’at-Thoruwa’, Ngumi, Monda, Mwangi, and Xi (2015:2), universities have

not been spared from the HIV scourge. It is further explained that it is estimated that the

real impact of the scourge will not be felt until 2050. It is known that universities have a

key responsibility for developing human resources and providing society with leadership

direction. In this case, universities should be involved in addressing the HIV/AIDS issues

at a personal and at a professional level in their efforts to combat this epidemic, as students

can be exposed to potential health risk factors in the environment within HEIs.

1.4 JUSTIFICATION OF THE STUDY

Students in HEIs are held in high regard by their different communities, as they are

recognised as privileged and as the more knowledgeable members of their society (De Bois

& Stauber, 2003, cited by Cieslik & Simpson, 2013:134). The purpose and justification of

this study is to empower them with knowledge regarding HIV/AIDS and sexuality. It is

also to educate them about their attitudes and behaviours that may place their health at risk.

According to Vember (2010:9), ‘‘HIV/AIDS and sexuality have become the greatest threat

to the continent's development and many affected countries are losing valuable community

members''. Students in HEIs are regarded as role models in their respective communities.

Yet, new infections are still observed amongst these young people. The higher education

sector has been criticised for its inability to produce skilled human resources that South

Africa (SA) requires. It has been clouded by dropouts, financial constraints and some

students are struggling to complete their studies within a limited timeframe. This has

caused HEIs to pay less attention to their secondary problems of HIV/AIDS (HEAIDS,

2010:7).

According to UNAIDS (2012:15), behaviour change is complex. For this group to change

their behaviours and attitudes, they must be informed regarding the risk factors which

might lead them to being infected with STIs or the HIV. Young people need to be motivated

to take care of their sexuality and to make informed choices. These choices are based on

socio-cultural norms as well. The youth should be empowered sexually by opening

platforms for reflection and they should be helped to clearly express their thoughts and

feelings about sex and sexuality (Shefer, Kruger, Macleod, Baxen and Vincent, 2015:83).

This shows that the “scare tactics” that are used are not effective and sustainable anymore.

Therefore, HEIs should rather aim at developing students and academics to be able to

manage and speak openly about sexuality issues in the lecture halls (Turnbull, van Schaik,

and Wersch, 2016:9).

1.5 AIM

The aim of this study was to investigate potential health risk factors amongst students at an

Higher Education Institution (HEI) in the Western Cape with regard to sexuality and

HIV/AIDS.

1.6 OBJECTIVES

The objectives of the study were to:

• Explore the factors that may increase health risk behaviours amongst students at an

HEI.

4

• Explore and describe knowledge of university students regarding potential health

risks related to sexuality and HIV/AIDS.

• Explore the attitudes students have towards health risk behaviours, regarding

HIV/AIDS and other sexuality-related behaviours.

1.7 RESEARCH QUESTION

What are the factors that may contribute to the increase of health risks amongst students at

HEIs?

1.8 THEORETICAL FRAMEWORK

The theory that will be applied in this research, is the Theory of the Health Belief Model

(HBM). According to Skinner, Tiro, and Champion (2015:75), the HBM has been one of

the most widely used conceptual frameworks in health behaviour research to explain the

change of health-related behaviour and as a guiding framework for intervention. This is

done by focusing on the attitudes, knowledge and beliefs of individuals. However, Coulson,

Goldstein, and Ntuli (1998:64) argued that even the health promoters sometimes get

confused by the behaviour of people when they are not realistic about their own risks in

many circumstances. This theory examines the point of view of an individual and how they

would view the risk and effect (susceptibility and severity) based on their background, for

example, geographical location, age, race and sex. It also involves a clue to action that can

activate the behaviour change. In this case, the participant is able to watch certain

programmes on television (TV) about health promotion, or have a conversation with peers,

family or even academics. This could lead to perceived benefits; meaning if an individual

believes that condom use will help to prevent HIV or taking a test will assist with early

diagnosis, he/or she would benefit (Tarkang & Zotor,2015). Hence, the HBM will assist to

understand the participant’s perceptions, their beliefs, behaviour, knowledge and attitudes

towards HIV/AIDS and related sexuality issues. This might help in personal responsibility

and choices that the participants make to prevent themselves from contracting the HIV and

STI’s (Skinner et al., 2015:75).

However, health still needs a collective action so that people can change their behaviour

and try to overcome their social barriers (Robbins, Lauver, Le, Davis, Langley and

Carlstrom, 2004:267) as cited by (Bowman & Denson, 2014:125). Skinner et al. (2015:75),

have also confirmed that HBM has been used to foresee preventative health behaviours and

it has worked for sexual behaviours respectively. It is important for HEIs to understand that

students do have a social life. When health behaviour is addressed, students need support

and encouragement without judgement. The HBM is relevant for this research because it

deals with individual behavioural change.

The HBM is supported by Social Cognitive Theory (SCT) (Tarkang & Zotor, 2015). The

SCT has three divided, shared natures that have a causal effect relationship, influencing the

procedures that are entailed by this theory; namely the person, the environment and the

behaviour (Zimmerman, 1989). Slavin (2012) states that this theory focuses on the

significance of observational and self-regulated learning of behaviour with the emphasis of

stages that inform behaviour modelling. Bandura (1989) states that people learn through

direct experiences. Furthermore, Bandura reveals that people observe and imitate the

behaviours of others. Both HBM and SCT are relevant for this research.

5

1.9 LITERATURE REVIEW

An extensive literature review of books, journals and articles was done on health risk

behaviours, related to sexuality and HIV/AIDS. The spread of HIV/AIDS amongst

university students is a problem and a concern. Students need to be informed about sexual

behaviour, STIs and HIV/AIDS. It has been researched and stated by many researchers that

if you improve knowledge about HIV/AIDS, it can improve attitudes and behaviour

towards people living with HIV (PLHIV) and of HIV itself (Platten, Pham, and Nguyen,

2014). Refer to Chapter Two for in-depth discussion of the literature review.

1.9.1 Global impact

HIV’s impact has affected many countries of the world. In Asia, Taiwan has been at nearly

a 15% HIV infection rate per year since 1997. This rate was the fastest in Asia and caused

by lack of knowledge and negative attitudes towards the disease (Tung, Ding, and Farmer,

2008:1). Global HIV and AIDS statistics 2018 facts sheet has revealed that globally, an

estimated 36.9 million people were living with HIV in 2017. However, many countries

have made great strides in education regarding the prevention of HIV transmission and

behavioural interventions to reduce risky behaviours, especially amongst young people age

15 to 24 (UNAIDS Global Report, 2013:14).

In some countries, there is evidence that there is still an increase in the number of sexual

partners that young people engage with. These countries include Burkina Faso, Congo,

Cote d’Ivoire, Ethiopia, Gabon, Guyana, Rwanda, South Africa, Uganda, United Republic

of Tanzania and Zimbabwe (UNAIDS Global Report, 2013:14). A study that was

conducted in two private universities in Ghana in 2014 revealed that 71.8% of the

participants did not regard themselves as ‘at risk’ of HIV infection, although 52% of them

admitted that they had sexual intercourse, including unprotected sexual intercourse, prior

to this research (Asante, Boafo, and Nyamekye, 2014:15). In a study conducted in Canada,

many researchers revealed that sexual health knowledge amongst all university students is

minimal. It was further reported that the results of different researchers indicated that,

although students are familiar with the names of many STIs, they do not know how they

are transmitted, the symptoms and how to be diagnosed (Cassidy, Curran, Steenbeek, and

Langille, 2015:20).

According to the Swaziland Central Statistical Office and Macro International Inc.

(2008:222), young people between the ages of 15 to 25 are the most susceptible group in

Swaziland to get infected with HIV. UNAIDS Global report (2016:7), reveals that the HIV

prevalence in many countries is higher in cities, and this is where these HEIs are situated.

Furthermore, this is where these young people encounter great opportunities, vibrancy and

anonymity of urban life at the same time. However, these opportunities are capable of

increasing risky behaviours that may lead to increase the risk of getting HIV infections, as

these students interact for more prospects. This creates more challenges in HEIs in most of

the countries. Since HEIs are a microcosm of communities in which these students are

found.

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Figure 1: The number of people living with HIV on antiretroviral therapy globally,

2010–2015

Sources: Global Aids Response Progress Reporting (GARPR) 2016; UNADS 2016

estimates

1.9.2 National impact

It was estimated that there are 7,1 million people live with HIV in South Africa (SA)

(National Strategic Plan (NSP), 2017-2022:6). Amongst these people, HIV prevalence for

15 to 49 years of age was estimated at 19,1% and the overall population prevalence was at

12,8%. However, the plan is to eradicate the HIV infections by reaching all key and

vulnerable population with customised and targeted intervention (National Strategic Plan,

2017-2022:6-9). As it was mentioned that the new HIV infections have increase target to

reduce the HIV infections, especially for the young people aged 15 to 24 in South Africa

(National Strategic Plan (NSP), 2012-2016:11).

The Higher Education HIV and AIDS programme (HEAIDS) is an intervention of the

national Department of Education (DoE). It was restructured in 2009 to assist HEIs and the

Department of Basic Education to combat HIV threats. HEAIDS reacted to the assumption

that students and staff members in the HEIs are living with HIV or AIDS. Some students

are facing a high-risk of HIV infections (HEAIDS, 2010:1). The NSP (2012-2016:22),

reveals that the results of a household survey that was done in 2008 in South Africa, showed

that there was 11% of HIV positive people that are injecting drugs recreationally. These

people are likely 10,000 to 50,000 in South Africa.

Health care systems in South Africa are carrying a huge burden because of sexually

transmitted infections (STIs) and HIV/AIDS. The burden can deplete resources from

education if not addressed urgently. This can lead to an increase in absenteeism and in

7.5

9.1

10.9

12.9

15

17

0

2

4

6

8

10

12

14

16

18

2010

2011

2012

2013

2014

2015

2015 target within the 2011

United nations Political

Declaration on HIV and AIDS

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dropouts. There is a great need to expand HIV/AIDS training in schools, as 26% of

infections are in the age 15 to 19 brackets (Vember, 2010:37).

1.9.3 Provincial impact (Western Cape)

South Africa is one of the countries with the largest number of HIV infections (UNAIDS

Gap Report, 2014). Although many countries, including South Africa, have made great

strides in HIV prevention education, young people age 15 to 24 have not really changed

the behaviour regarding multiple partners. This could put them at risk for contracting HIV

(UNAIDS Global report, 2013:14). A study that was done in one of the universities in the

Western Cape (WC) to understand trends in HIV risk behaviour of incoming first-year

students over a six-year period (2007- 2012), disclosed that these students are already

sexually active, by the time they enter universities. They also do not use condoms and they

are engaging in alcohol and drug use that could negatively influence their power of making

decisions. They are having multiple partners and have not been tested for HIV. The study

continues to show that the percentage of students reporting having had vaginal sex

increased from 44% in 2007 to 51% in 2012 and the condom-use percentage decreased

from 60% in 2007 to 51% in 2012. These students were tired of being told about HIV

prevention. Despite these results, it further revealed that 45% of these students are not yet

sexually active (Blignaut, Jacobs, and Verganani, 2015:15). Another study that was done

in nine schools between the Eastern Cape (EC) and the Western Cape (WC) revealed that

powerful discussions in classes of Life Orientation (LO) regarding gender and sexuality,

revealed that, for example, women must take responsibility for sexual practices at a young

age. It further made known that schools in general still believe that scaring students will

direct them away from sex and those scare tactics would make learners control their sexual

activities more (Shefer et al., 2015:82).

In a study conducted amongst schools in the Western Cape, Hill et al. (2015:2) suggested

that promoting healthy lifestyle behaviour is the responsibility of the schools because

children spend many hours at school. If learners are engaged in projects promoting a

healthy lifestyle at school level already, they would be equipped with more knowledge on

sexuality and HIV/AIDS issues when they enter universities. A study that was done in one

of the HEIs in the Western Cape showed that the influence of an HIV/AIDS peer education

programme was welcomed by staff, peer educators and other students. It further revealed

that students felt empowered and they were so sure that they could deal better with people

who are affected and infected by HIV/AIDS. They wanted these programmes to be frequent

on their campuses. Others also felt that there was an increase in people who are going for

testing and they were confident enough to make informed decisions about their social life

(Vember, 2013:169-170).

1. 10 RESEARCH DESIGN AND METHODOLOGY

1.10.1 Design

A descriptive, explorative, contextual qualitative design was used. The focus of a

descriptive design is to discover what is happening in a circumstance or situation. It also

focuses on the fact that the data can be confirmed if necessary, with the individuals

involved (Denzin & Lincoln, 2018:810-811). Refer to Chapter Three for an in-depth

discussion.

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1.10.2 Methods of Data Collection

Focus group interviews were conducted to collect data. Focus group interviews have been

described as a method of collecting research data in qualitative research. It is a group

discussion where a group of six to eight participants who are sharing a certain characteristic

will be discussing a specific topic (Silverman, 2014:206). Focus groups were divided into

groups of five to ten. Focus group discussion (FGD) duration time was 60 to 90 minutes

and was clearly explained to the participants. It was revealed that focus groups that are

less than 60 minutes are not likely to be effective, because the subject was not discussed

in-depth, as required. The FGD’s focus on various views and the researcher could gather

enough data in an hour’s time (Patton, 2015:477). The researcher recorded the dialogues

with a digital hand recorder. The researcher explained the nature and purpose of the

research to all the participants. All participants signed a written consent form, prior to the

focus group interviews (refer Appendix A for an information sheet and consent form). The

researcher asked questions from the interview guide (refer Appendix F). There were no

emotional discomforts to any of the research participants during the research. If any

discomfort would occur, the researcher would refer them to the Student Counselling

Department for counselling (refer Appendix E).

1.10.3 Advantages of focus group discussion

According to Rule and John (2011:66) focus groups, storytelling and interviews are a few

of the many ways that data can be collected in a research project. Focus group interviews

can be used as a method on its own to collect data and it can be used with other methods in

research (Schwandt, 2015:122). According to Patton (2015:478), the advantages of focus

groups are that participants can easily share and argue about ideas and in the process, they

gain insight into the pressing matter at hand and quality data is generated and improved in

the process.

1.10.4 Disadvantages of focus group discussion

The major disadvantage of focus group interviews is when there are dominant members of

a group who want to influence the quiet members in the discussion. This means that the

participants might influence each other, as there is no single response (Polit & Beck,

2017:511).

1.11 RESEARCH SETTING

The setting was an HEI in the Western Cape. The selected institution has two main

campuses where the research took place. The researcher booked a venue on the two

respective campuses to do the focus group interviews, to secure confidentiality and privacy.

1.12 POPULATION

Polit and Beck (2012:273) describe population as the whole collection of a targeted group

of individuals or objects that have some common characteristics in which the researcher is

interested in. The population for this research was female and male students at the

university in the Western Cape. This selected university is widely diverse, therefore all the

different cultures, races, religions and genders were included in this research. These

9

targeted individuals were also needed to meet the research inclusion criteria (refer to

Inclusion and Exclusion Criteria, Sections 1.13.1 and 1.13.2).

1.13 SAMPLING

This selected HEI has six faculties and it is broadly diverse. Sampling is the method of

choosing individuals who are representative of the population being studied (Grove, Burns,

Gray and 2013:708). They continue to describe sample as a subset of the population that is

chosen for a certain research. There are two types of sampling techniques, namely

probability and non-probability sampling (Schwandt, 2015:277). From these two types,

non-probability sampling was selected for this research. Convenience sampling, also called

“accidental sampling”, was then employed. Convenience sampling is a type of sampling

that is used to gather information from participants who are readily available. The

researcher constantly went to the two main campuses of this selected HEI and visited each

faculty in an attempt to recruit five to seven students for discussion. These individuals were

recruited until a minimum number was reached, regardless of their diversity (Maree,

2016:197-198). Examples of convenience sampling could be a classroom of students or

subjects who attend a support group (Burns & Grove, 2011:305). Students who were

available and willing signed a consent form and participated in the research.

1.13.1 Inclusion criteria

• Students that were currently registered with the HEI.

• Students had to be 18 years or older.

• Males and females were included.

• Part-time and full-time students were selected for inclusion.

• Students staying inside or outside of these two campuses.

1.13.2 Exclusion criteria

• Both male and female students that were not registered with this HEI.

• Both male and female students that was younger than 18 years old.

1.14 RECRUITMENT OF RESEARCH PARTICIPANTS

Participants were selected from the two main campuses of the HEI. Students could belong

to any faculty or department at this selected HEI. All students who availed themselves

voluntarily and who were willing to sign a consent form, were able to participate in this

study.

The researcher contacted the HOD’s of the various departments to inform them regarding

the research. Once ethical approval was obtained from the Health and Wellness Sciences

Faculty Research Committee, the researcher contacted the lecturers across faculties to get

appointments to address the students on both campuses to inform them regarding this

research project. The researcher asked for voluntary participation, as the contact details of

both the researcher and the supervisor were left on the information sheet with the students.

All focus groups were conducted at convenient times for the students, so that it did not

impact on their class times.

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1.15 DATA ANALYSIS

Responses from all these focus group interviews were audio recorded. The researcher

listened to the responses and transcribed them into a Microsoft Word document. It was

recommended to immediately listen to recordings after an interview, as data analysis can

be done at the same time with data collection (Jooste, 2018:346). This assisted the

researcher to be able to listen to the audio responses and compare the typed document. The

transcribed data was also given back to respondents to verify if that is the information they

gave. This is called ‘member checking’ and was to ensure the trustworthiness of the

research data (Streubert & Carpenter, 2011:67). Coding was done on all the transcriptions

and a thematic content analysis was applied.

1.15.1 Data presentation

Data was presented in various themes and subthemes and was discussed and referred to by

means of the transcriptions.

1.16 RIGOUR

In qualitative and in quantitative research, the researchers have a responsibility of

providing the proof of their data. This means they need to show how valid, reliable or

trustworthy the information is. Therefore, in qualitative research, the researcher is directed

by trustworthiness with its methods, whereas in quantitative, the researcher is directed by

validity and reliability to prove how valid the data that is generated is. Hence, there is

rigour; it incorporates trustworthiness, validity and reliability. Trustworthiness involves the

methods of credibility, transferability, dependability and confirmability (Jooste, 2018:350-

351).

1.17 TRUSTWORTHINESS

According to Lincoln and Guba (1985), as cited by Schwandt (2015:308-309),

trustworthiness is the quality that makes the study remarkable to the readers; they also

discussed standards that can prove trustworthiness. These standards included credibility,

transferability, dependability and confirmability. It is important for a researcher to be

trustworthy and flexible because they have a responsibility of telling the truth about the

research so that participants can trust and respect the researcher (Jooste, 2018:313).

1.17.1 Credibility

According to Lincoln and Guba (1985), as cited by Schwandt (2015:308-309), credibility

focuses on how the researcher had portrayed the experiences of the participants. To develop

credibility of the study, the researcher spent hours in the HEI engaging with students.

Sometimes, the researcher was invited by the students to come and listen to their health

education talks that they facilitated in their hostels or in their classes, as part of their project

presentations related to HIV/AIDS. The researcher participated in many workshops with

the HIV/AIDS Unit in this HEI, as Polit and Hungler (1997:305); Botes (2003:180); Brink

et al. (2012:172) as cited by Jooste (2018:351), suggest that trust and relationships are built

through spending more time and engaging with the participants.

11

1.17.2 Transferability

According to Botes (2003:181); Burn et al. (2013:202) as cited by Jooste (2018:353),

transferability is mentioned when the participants are applying the findings from this

research to other experiences or incidents of the same problem. This means that this

research would be able to help the HEI students to make an informed decision and educate

their peers as well. Peer educators of this HEI would be able to share or transfer the

knowledge.

1.17.3 Dependability

According to Lincoln and Guba (1985), as cited by Schwandt (2015:308-309),

dependability focuses on the methods to confirm that these procedures were consistent,

traceable and documented. The researcher provided all the various research steps and

justification of the processes that took place when the data was collected and analysed to

ensure dependability and trustworthiness of the study. According to Polit and Hungler

(1997:306), as cited by Jooste (2018:354), dependability states the stability of the findings

over time and conditions. This emphasised the fact that if the same research could be

repeated, the same findings would be reached.

1.17.4 Confirmability

According to Lincoln and Guba (1985), as cited by Schwandt (2015:300-309),

confirmability focuses on the fact that the findings of the research can be confirmed. In this

research, the findings could be confirmed by audio recording, transcripts and the

independent coder. All the data of this research was kept at the Nursing Department in a

locked cupboard for audit purposes. Only the researcher with the permission of the

supervisor and the supervisor who could access the research with a key.

1.18 ETHICAL CONSIDERATION

Every researcher must be aware of ethical issues when planning to conduct research. It was

vitally important that the researcher gain permission to do research. For this study, ethical

clearance was obtained from CPUT and the Faculty of Health and Wellness Sciences

Research and Ethics Committees (refer to Appendix H). Support letters (refer to Appendix

E) were obtained from the Student Health Centre and Student Counselling Services. This

was pre-causative, in case a student might have become sensitive and reacted to some of

the questions that were asked during the focus group interviews. The student could then be

referred to Student Counselling for attention. A permission letter (refer to Appendix B) was

also obtained from the Director of the HIV/AIDS Unit, in support of this study. Each

participant signed a written consent, prior to participating in this study both the

participation in the focus groups and for permission to be recorded. An information sheet

regarding the study was attached to this consent form (refer Appendix A).

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1.18.1 Declaration of Helsinki

Developed by the World Medical Association in 1964, the Declaration of Helsinki was the

first significant effort of the medical community to regulate itself. It is legally binding. It

consists of 35 ethical principles and includes:

• voluntary consent, risk or benefit ratio and the right to withdraw from the study;

• additional principles for medical research combined with medical care; and

• access of participants to the best-proven methods identified by the study.

(www.crede.co.za).

The researcher will also adhere to the following ethical principles discussed below.

1.18.2 Autonomy

Every individual has the right to make decisions for him or herself. It is a guiding principle

and it is binding for health professionals and they should adhere to it unless it is outweighed

by another principle (Pera & van Tonder, 2011: 72).

1.18.3 Beneficence

Beneficence relates to the researcher’s duty to do no harm to all participants. Some

philosophers divide the principle of beneficence into one that ought not to harm, but prevent

or remove harm, as well as do or promote wellness (Pera & van Tonder, 2011:55).

1.18.4. Justice

The principle of justice is the obligation to be fair to all. All participants were treated

equally and with respect (Mulaudzi, Mokoena, and Troskie, 2010:204).

1.18.5 Confidentiality

Emphasises the importance of protecting and safeguarding every individual’s privacy

because everybody has a right to confidentiality (Pera & van Tonder 2011:150).

1.18.6 Non-maleficence

Non-maleficence provides a concrete guidance of how to prevent harm in the care of a

participant (Pera & van Tonder, 2011:55). The research participants, their organisations

and communities must not be harmed at any stage of the research (Rule & John 2011:112).

1.19 CHAPTER DIVISION

Chapter One: The orientation of the study

The orientation of the study. This includes the research problem and the background of the

research, the aim and objectives of the study, the significance of the study, definition of

terms, the research design, methodology and analysis.

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Chapter Two: Literature review

An extensive literature review of books, journals and articles, done to determine how health

risk behaviours affect students globally, nationally and provincially in HEIs.

Chapter Three: Research design and Methodology

The research design and methodology are discussed in detail in this chapter. The rigour and

trustworthiness are also discussed.

Chapter Four: Results

The research results and the implantation of the data are presented in this chapter. The

themes and subthemes that emerged are also presented.

Chapter Five: Discussion of results

In this chapter, the results of the study are discussed into detail.

Chapter Six: Conclusions, Limitation and Recommendations

This chapter will conclude the study by highlighting the conclusions, limitations and the

recommendations made on the basis of its findings.

1.20 SUMMARY

Chapter One described the orientation and background of the study. It also highlighted the

methodology, design and analysis that were applied to this study. The ethical principles

applied in this project were well defined in this chapter. Chapter Two will follow,

discussing the literature review that was done.

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CHAPTER 2

LITERATURE REVIEW

2.1 INTRODUCTION

A literature review is a systematic way of demonstrating the amount and level of

information that exists in study (Holloway & Galvin, 2017: 36-42; Mohan, 2013:135).

This amount of work is produced by researchers who established the original work on the

topic. There are reports, summaries or references that are originating from another person

other than the researcher. These are secondary sources (Holloway & Galvin, 2017: 36-

42; Mohan, 2013:135). Researchers review the literature to discover what is already well-

known about the topic and recognise those who have done all the work. Other reasons are

to recognise the gaps in knowledge and provide the opportunities for researchers to build

on each other’s work. It also clarifies the predicted issues that are related to the research

question(s) (Holloway & Galvin, 2017: 36-42; Mohan, 2013:135).

The review of literature in this chapter places emphasis on publications, articles, books

and internet sources that deal with findings on university students and potential health

risk factors regarding sexuality and HIV/AIDS. The literature has been reviewed under

the following major headings: students’ life, Higher Education Institutions (HEIs), high-

risk behaviour, students and HIV/AIDS, knowledge and attitude. Programmes that have

been recommended for intervention will be considered.

2.2 THEORETICAL FRAMEWORK

According to Majelantle, Keetile, Bainame, and Nkawana (2014:2), many theories have

been established and used to try and comprehend health behaviours and their outcomes.

They added that out of these theories, such as the theory of reasoned action, planned

behaviours and the risk reduction model (and others), have been used to analyse health

behaviours. No single theory can be singled out to discuss health behaviours, hence one

or more cognitive theories may be combined (Michielsen, Chersich, Temmerman, Dooms

and Van Rossem, 2012:18, as cited by Wirtz, Kamba, Jumbe, Trapence, Gubin,

Umar,Stromdahl, Beyrer, and Baral, 2014).

The most common theory that is tailored to all is the Health Belief Model (HBM) and it

is the most generally used theory. Skinner et al. (2015:75) have confirmed that the HBM

has been used to foresee preventative health behaviours and it has worked for sexual

behaviours respectively. However, these theories were unable to interpret the

communities’ thinking about the spread of HIV amongst young people. Therefore, Social

Cognitive Theory (SCT) goes into detail on the relationship between the individuals, their

behaviours and their environment in which they find themselves in. It has been relevant

and used to direct studies that are related to HIV/AIDS knowledge, attitudes and beliefs

of young people. This theory was able to develop the prevention approaches that are

intended for youth. In this research, the theory refers to university students and the HEIs

as the environment (Bandura, 1986; Bandura, 1988:5). The premise of these theories is

that actions are based on a person’s intentions and behaviours. These theories of group

behaviour can be used to study individuals as a group. The HBM, as well as SCT, were

used in the study to investigate the factors associated with potential health risk behaviours

amongst university students (Michielsen et al., 2012:18, as cited by Wirtz et al., 2014).

15

According to Dennill, King, Lock and Swanepoel (1999) and Polit and Beck (2004) as

cited by Tarkang and Zotor (2015), HBM was among the first theories that were

established to describe the process of change in relation to health behaviour. It was

revealed that HBM was one of the first models of health-promoting behaviours. It is still

the greatest, widely acknowledged conceptual framework for health behaviours. The

theory clarifies the behaviours of health from a social psychology viewpoint. This is

accomplished by using theories of value-expectancy and the making of choices

(Kronenfield & Glik, 1991; Mikhail, 2001:159-165). Onega and Lancaster (2000:265-

283) as cited by Tarkang and Zotor (2015) reveals that the HBM is divided into three key

components as illustrated in Figure 2.

Figure 2 Conceptual Model of HBM

(Onega & Lancaster, 2000:265-283 cited by Tarkang & Zotor, 2015)

2.2.1 Individual perception

Perceived risk and effect are individual’s views or beliefs regarding the risk of developing

a health problem and the potential negligence and consequences of the health problem

based on their background; for example, age, sex and geographical location (Janz &

Becker, 1984;11:1-47), as cited by (Wirtz et al., 2014). This research focused on potential

16

health risk factors amongst university students regarding their sexuality and HIV/AIDS.

In this study, individual perceptions concerning the student’s belief about their

vulnerability to HIV/AIDS and their perceived harshness of HIV/AIDS will be explored

and described.

2.2.2 Modifying factors

According to McCormarck (1999) and Onega (2000) as cited by Tarkang and Zotor

(2015), modifying factors involve demographic, socio-psychological and structural

factors. Furthermore, they mentioned that these variables can influence the individual’s

perception which leads to one’s health-related behaviour.

The socio-demographic factors, for example, would influence the student’s perception of

vulnerability to HIV and the seriousness of contracting HIV. The students could also be

influenced by socio-economic and structural factors to make certain decisions regarding

perceived benefits or barriers. These students are coming from different provinces with

different backgrounds, therefore, some of these young peoples’ socio-economic factors

may influence their decisions toward risky behaviours (Tarkang & Zotor, 2015).

2.2.3 Benefits of preventative measures

In this research, the benefits of preventative measures would be the fact that the students

would use safety measures (using condoms) or abstinence to prevent HIV infections or

seek help by accessing information. Therefore, the benefits of preventative measures

would depend on their perception of weighing benefits against barriers. One needs to

believe that by taking a certain action would assist in preventing a certain danger from

occurring (Janz & Becker, 1984; 11:1-47), as cited by (Wirtz et al., 2014). HBM cues to

action require motivation from the individual to conform to the prescribed remedy, be it

to be involved in health education activities or peer support groups etc. (Polit &

Hungler,1999).

2.3 STUDENT LIFE

According to Mbatha and Ally (2013:1) students are part of an educational community.

Student life refers to the period of a student leaving the parents behind for the first time

and heading to a HEI. This phase can also be referred to a Grade 12 high school learner

who’s going to be starting a new journey at an HEI (HEAIDS, 2017:4). This is a crucial

stage for most of the students and families as HEIs offer a transitional phase of being a

young adult. In this phase, even the students do not regard themselves as children

anymore, although they are not completely adults (Myers, Kelly, and Motuba, 2012:9).

Being young and being a student leaving home for HEIs means taking responsibility for

your own actions and setting goals for yourself to achieve your qualification (HEAIDS,

2017:4). Students also enter this stage of their lives, where, as students, they do not have

any major obligations, except for concentrating on their studies. During this phase of their

lives, they are exposed to a life that is full of fun, joy, freedom and risks. It can also be

lonely at times (HEAIDS, 2017:4).

According to Freitas (2017:294-314), colleges do not only provide students with

academic processes but also with accommodation in its residences. Some of the

17

residences are in public spaces, while others are private. The students are staying on their

own and some are sharing with other students. New friendships are formed in these

residences. Allison and Risman (2014:103) reveal that students tend to lose focus when

they are at HEIs. Instead of creating the norm of committing to their main purpose of

being at HEIs, they have a habit of “hooking-up” with friends with no intention of

studying. Allison and Risman (2014:103) define “hooking-up” as a casual sexual

behaviour that involves kissing and other behaviours that could lead to oral or penetrative

sex and other risk behaviours. The students tend to do this as groups, which is where the

influence of peers takes place. According to Bogle (2008); Freitas (2008); Kimmel

(2008); Wade and Heldman (2012) as cited by Allison and Risman (2014:103), ‘hooking-

up’ has taken over on many college campuses. It has created sexual grounds in residences

situated on HEIs campuses and even in private residences.

Student life relates to freedom, sexual experiments, inconsistent condom use, alcohol and

drug abuse, having sex with multiple partners and dating older people (blessers). All of

these features expose young people to a high-risk of contracting sexually transmitted

infections (STIs) including HIV and other health risks (Abels & Blignaut 2011; Mutinda,

Govender, Gow & George, 2013, as cited by (Ngidi, Moyo, Zulu, Adam, and Naidu

Krisha ,2016). White (2015:268) added by saying that American colleges and universities

are also facing these same health risks, including sexual assault. However, White

(2015:269-270) reveals that despite all these challenges, students are supported with

counselling, mentoring, coaching and academia. All these support systems are to assist

students to make informed decisions about their future.

2.4 HIGHER EDUCATION INSTITUTION (HEI)

According to Brook, Fergie, Maeorg and Michell (2014:3), HEIs are viewed as a place of

multiple, complex and diverse social relations, identities, communities, knowledge and

practices. They further say that people (students) would enter these broad varieties of

social relations by enrolling at the HEIs for the first time. They enrol with the expectation

of furthering their studies and acquiring skills and knowledge through universities.

White (2015:267) suggests that as soon as these students are admitted, HEIs need to attend

to the challenges immediately so that they will be able to ensure that more students will

graduate. Much of the research has suggested that multiple interventions that have been

employed to assist students to complete their studies successfully, have proved to be futile

(White, 2015:267). According to HEAIDS (2017:4-5), HEIs welcome all students from

all walks of life, providing support academically and mentally. There is additional support

to all those who are not coping well in the initial stages of entering HEIs. The HEIs have

provided different departments to support these students even outside of their academic

life. These departments consist of Student Affairs, Student Counselling, Student Health

Clinic, Health and Wellness clusters and more. These departments are designed to assist

students academically, physically, socially, emotionally and spiritually. Each year,

students are orientated to all these departments (HEAIDS, 2017:4-5; Status Update,

2018:2-3).

Additionally, the minister of Higher Education and Training, Doctor (Dr) Blade

Nzimande, revealed in his 2014 speech that poverty and financial suffering of the HE

students, were among the priorities of government. The minister called upon different

stakeholders, including the National Student Financial Aid Scheme (NSFAS), to assist

18

students in their education and in improving their lives financially. The minister also

encouraged the partnership between employers in industries and institutions, as this will

assist in the required experience needed for employment in the future (Nzimande, 2014).

Despite all the aforementioned support, students are still exposed to high-risk health

factors.

According to HEAIDS (2010) as cited by Ngidi et al. (2016), South African universities

are continuing to have great concerns with the high incidents of health risk factors about

HIV/AIDS and other social health-related risks. Furthermore, these institutions also

introduced peer educators to assist and influence student’s behaviour changes and

communication. Peer educators are young people (students) who advise and develop other

students, since they are also students, but they are trained to be able to do all these

activities (HEAIDS, 2015:17). In addition, there were suggestions that with regards to

student’s background and cultural belief systems, educators should be empowered and be

updated so that they can understand the student’s behaviour and their transition pathway

better (Brook, Fergie, Maeorg and Michell, 2014:8) and (Vember, 2013:38).

Braxton (2000), as cited by Johnson, Wasserman, Yildirim and Yonai (2014:76) agree by

saying that now is the time for educators to look at different models that can assist to

recognise the factors that contribute to student’s stubborn and uninformed decision-

making. This will improve the challenges around communication academically and

socially. Aud, hussar, Johnson, Kena, Roth and manning et al. (2012) as cited by Johnson

et al. (2014:76) reveal that focussing on one model limits the educators in terms of

understanding the students’ paradigm. They further say that a single paradigm affects the

improvement of graduation rates and the period that students take to complete their

qualification. Some of the students complete a four-year course in six years, which has

serious ramifications for HEIs (Aud et al., 2012, as cited by Johnson et al., 2014:76).

Many types of research have surveyed the connection between social, academic

integration and student’s determination. Robbins, Lauver, Le, Davis, Langley and

Carlstrom (2004:267) as cited by Bowman and Denson (2014:125), have identified the

indicators of collective involvement that are critical and identical with social integration.

These include the level in which students feel associated to the HEIs environment, the

quality of student’s relationships with peers, faculty and others in HEIs and the

involvement of students in campus accomplishments.

2.5 HIGH-RISK BEHAVIOURS

Health risks are continuing to be a burden amongst young people across the world. All

over the globe, the sexual health of young adults has been a concern and is identified as

a serious matter by leading health organisations (Kuete et al, 2016). Sub-Saharan Africa

has been challenging numerous global health and growth issues, as it is the fastest-

growing region in the world (Vember, 2013:33). Many researchers have done a lot of

work researching factors that may increase health risk behaviours amongst young people.

According to Burke (2010:26), as cited by Mbatha and Ally (2013:2), South Africa has

been mentioned as one of the countries with the highest alcohol consumption and drug

use in the world. These can lead to high-risk behaviours. These can be unprotected sex,

unwanted or unplanned pregnancies, contracting STI’s and HIV. Burke (2010) further

mentions that consequences of alcohol to students who abuse it, lead to academic failures

and absenteeism. Alcohol and drugs are problematic, especially if they are taken regularly

and are depended upon. This dependency can lead to psychological, physical or financial

19

problems and it becomes impossible to stay away (HEAIDS, 2017:50). According to the

South African Department of Social Development as cited by HEAIDS (2017:50), people

who use substances are suffering from serious health and socio-economic difficulties.

They added that in South Africa, young people aged 15 and older consumed more alcohol

than any other African countries. This leaves the students in vulnerable spaces.

Furthermore, experimentation, boredom, peer pressure, lack of recreational facilities and

poverty are mentioned as contributing factors. Spending time with people who are

substance abusers can lead students to the same behaviours. Whitehill, Rivara, Moreno

(2014) add by citing marijuana and cannabis as having more negative influences on

underage college students. They further stated that these substances are common, and

they can lead to fatal accidents amongst these young people.

UNAIDS Global Report (2012:29) revealed that new STI’s and HIV infections are

occurring in young people and they account for nearly 27%. Mengistie, Wolie, Abawa,

Ebre, Aderan (2015) disclose that unprotected sex is a threat to the health and existence

of millions of youths. They further elaborate that every day, over 700 young people aged

10 to 24 are infected by HIV/AIDS. Vember (2013:115) added by stating the contributing

influences that lead to risks of getting HIV/AIDS and STIs include violence-related

behaviours, alcohol and substance abuse, suicides attempt, bullying, sexual activities,

multiple sexual companions and unplanned pregnancies.

In a study that was done between 2013 and 2014 regarding sexual knowledge,

contraception and accessing contraceptive methods amongst university students, it was

revealed that the rate of unintended pregnancies and STIs has gone up. It was a great

concern to the health department (Turnbull et al., 2016:9). The study also revealed that

there was an assumption that sex and relationship education that was provided in schools

was sufficient. These outcomes clearly exposed that the HEIs need to address these issues

adequately. It also exposed that although the universities provide this information, they

need to identify that even adult students do not have enough knowledge on these matters

(Turnbull et al., 2016:9).

The CDC in Taiwan (CDC Taiwan, 2013) has revealed that 40% of the HIV-infected

population in Taiwan are young individuals between 20 and 29 years. According to

Hedayati-Moghaddam, Eftekharzadeh-Mashhadi, Fathimoghadam and Pourafzali

(2015), STIs and HIV/AIDS occurrences are more advanced in youth, globally. They

further revealed that in Iran, an incidence of unprotected sexual contact amongst

university students has not been researched frequently.

In a study that was done in Spain about the sexual behaviour and risk of STIs in young

female healthcare students, it was discovered that one in every three women was at risk

of contracting STIs by not practising safe sex or using male or female condoms in their

casual vaginal sexual relationship with men. This study also exposed that the reason for

unprotected sex was found to be that these women want to reach an orgasm and feel the

pleasure of interaction with their sexual partners in a more natural way. These behaviours

expose them to a high-risk of contracting STIs (Navarro-Cremades, Palazón-Bru,

Marhuenda-Amorós, Tomás-Rodríguez, Antón-Ruiz, Belda-Ibañez, Montejo and Gil-

Guillén, 2016:8).

The changes in society have brought new obstacles such as communication patterns for

youth throughout the world. Parents are still finding it difficult to talk about sex to their

children and vice versa. Even partners that are in sexually active relationships find it

20

difficult to talk about intimacy and sexual issues; they rather bypass it (Seloilwe, 2015;

Viljoen, Thorne, Thomas, Bond and Hoddinott, 2016). It was revealed by learners that

even in their Life Orientation classes, the teachers themselves make them feel

uncomfortable with their comments (Bawa, 2018:6). One learner quoted a teacher saying

that “why would he buy the cow when he’s getting the milk free of charge”. These are

the values of Life Orientation that most young people encounter in South Africa. The

harmful sexual education in our schools and in HEIs that is promoted by so-called role

models, leads to confusion amongst youth. It encourages the control of men over women,

referred to as “toxic masculity” (Bawa, 2018:6).

Although there are some communication barriers amongst parents and their children,

there are parents who initiate sexual talks. Most of the time, these parents are trying to

open a platform for communication with young people. Usually, these are parents who

are educated. However, there are also those traditional parents who are still finding it

difficult to discuss sexual matters, or educating their children about these issues (Kim,

2007; 2009, as cited by Seloilwe, 2015).

According to UNICEF (2011) as cited by Denno, Hoopes, and Chandra-Mouli, (2014), 1

300 000 and 800 000 young girls and boys respectively, were still living with HIV

worldwide. In 2012, The Ministry of the People revealed that China’s CDC showed an

increase of new HIV infections from 0.96% to 1.73% between 2006 and 2011 amongst

young students (Min-Chen, Liao, Liu, Fang, Hong,Ye, Li, Tang, Pan, W. and Liao,

2016:2). Even today, people worldwide still recognise HIV/AIDS as a bigger health

problem. The awareness of health care providers needs to be evaluated regularly to

improve lives and combat new infections (Kuete, Huang, Rashid, Ma, Yuan, Escalera

Antezana, and Zhang, 2016).

A study that was conducted between 2013 and 2014 in Britain about sexual knowledge,

contraception and accessing contraceptive methods among university students,

highlighted that the greatest number of students found that the sex education they had

received, was poor. They also said that they needed more information about sex and

sexual health. It was also recognised that sex and relationship education (SRE) was not

enough and therefore HEIs need to include sexual health and HIV into their curricula

(Turnbull et al., 2016:13-19).

Another study about knowledge, attitudes and practices towards premarital sex and

HIV/AIDS amongst Mizan-Tepi university students in South West Ethiopia, declared that

the students had a good knowledge and attitude about premarital sex and HIV/AIDS, the

causes and the way it is transmitted, however they were not applying and putting this

knowledge into practice (Mengistie et al., 2015). Regardless of the great strides in

fighting the HIV epidemic over the decade, it is still a root cause of illnesses; the number

of people living with HIV and the amount of deaths from HIV/AIDS continues to grow

globally (Mengistie et al., 2015).

A study that was done by the Human Sciences Research Council (HSRC) at technical

vocational education and training (TVET) colleges in South Africa about HIV

knowledge, attitudes and behaviours, revealed that 59.5% of students and 57.5% of staff

confirmed that they consumed alcohol. Furthermore, it was revealed that other substances

are used. Eleven per cent of these students were using marijuana, whilst 5% of the staff

also confirmed the use of it. Crack cocaine was used by 2% of students and 1% of staff.

21

Mandrax, tik, nyaope and wunga were also used by students and staff members, 1% and

0.6% respectively (Setswe, Mbelle, Mthembu, Mabaso, Sifunda, and Maduna, 2017).

The above results linked with another study that was done in South Africa that was

evaluating the influence of an HIV/AIDS peer education programme at the HEI in the

Western Cape. One of the findings was that the assumption of peer education is that

students are more receptive to the influence of their peers. Though peer educators were

trained and equipped, they themselves had experienced drug use, multiple partners and

other violent behaviours. They were struggling to apply the knowledge they had learnt or

ought to have learnt, in their normal circumstances. Peer educators are students

themselves, therefore they share related values and benefits with their fellow students

(Vember, 2013:157-158).

According to Tildesley, Hops, Andrews (1993:28(9):853-80) as cited by Abbasi-

Ghahramanloo, Fotouhi, Zeraati, and Rahim-Movaghar (2015:5), youth are easily

influenced by their peers. People that are involved in certain behaviours, are more likely

to be attracted to others involved in that same behaviour. The behaviours could take on

any form relating to substance use or abuse. They concluded by saying that the effect that

peers and friends have on each other, constitutes some of the most important factors that

can spread the impact of high-risk behaviours amongst young people (Tildesley et al.,

1993:28[9]:853-80, as cited by Abbasi-Ghahramanloo et al., 2015:5).

2.6 STUDENTS AND HIV/AIDS

According to UNAIDS (2013b), incidents of HIV/AIDS have been a big challenge all

over the world. These patterns vary between countries and regions. The focus of this study

is on potential health risks amongst students at HEIs about HIV/AIDS and sexuality.

Therefore, the focus would be on students, HIV/AIDS infections and their sexuality.

Globally, young people are faced with greater numbers of STIs and HIV/AIDS. Small

countries, like Iran, are more challenged because their total population consists of 35%

young people aged between 10 and 24 years old (Statistical Centre of Iran, 2012, as cited

by Hedayati-Moghaddam et al., 2015). A study that was done to evaluate the prevalence

of sexual and reproductive behaviours amongst undergraduate university students in

Mashhad, a city in Northeast of Iran, revealed a 15% prevalence of premarital sex during

student life. The numbers of males indulging in premarital sex while at HEIs, were higher

than in females. Male students experience sexual relationships four times more than

female students (Hedayati-Moghaddam et al., 2015).

In Spain, a study conducted by Navarro-Cremades et al. (2016:8) on sexual behaviour

and the risk of STIs in young female healthcare students, revealed that one in every three

women was at risk of contracting an STI by not using condoms in their casual vaginal

sexual relations with men (Navarro- Cremades et al., 2016:8). A study that was done in

China regarding a hidden challenge for HIV/AIDS control on a comparison of sexual

knowledge, attitude and behaviour between female Chinese college students from urban

areas and rural areas, suggested that the students from rural areas engaged in the same

level of sexual activity, as those from urban areas. These results correlated with the recent

study that was done in South Africa (Min Chen et al., 2016). Furthermore, Vember

(2013:34) reveals that the youth all over the world share many similarities, therefore the

22

experiences of being a young person are as diverse as the cultures, depending on the area

the person is coming from.

As HEAIDS serves an overwhelmingly young population, they have noted that young

people, especially in their late teens to early 20s, are challenged by HIV. HEAIDS is

striving to steer these students safely through programmes that are focussing on HIV

prevention (HEAIDS, 2015:9). UNAIDS Global Update (2016:8) has revealed that in

2015, young girls and women aged 15-24 years were accounting for 20% of new HIV

infections. This is an alarming situation as these young people are vulnerable. However,

by 2030, the United Nations commits on ending the HIV/AIDS pandemic (UNAIDS

Global Update, 2016:8).

2.7 TERTIARY STUDENTS’ KNOWLEDGE ABOUT POTENTIAL HEALTH

RISKS

According to Grove et al. (2013:8-9), knowledge is vital information that is learned

through traditions, authority, borrowing, trials and errors, personal experiences, role

modelling and mentorship, intuition, reasoning and research. According to Steinberg

(2008:5) the youth are shown to be more risk-seeking than children. This is because of

neurocognitive changes around the puberty stage of their lives. Steinberg (2008)

continues to reveal that there are parts of the brain that release a chemical called

dopamine. This chemical develops at this age and helps people to see rewards and take

action towards them. For example, when students are attending HEIs bashes, there are

many rewards to bargain for like alcohol, drugs and sex. All these rewards entice that part

of the brain and the struggle of self-control, becomes more challenging because that

specific part of the brain, is not fully developed at this stage. Young people generally

enjoy a good life, more than any other age groups. They are not thinking about potential

health risks. These behaviours can affect not only their academic future but the rest of

their lives negatively (Chandra-Mouli, 2015; Steinberg, 2008:5).

Bawa (2018:6) revealed that most of the youth in South Africa do not understand how

their bodies work. This is the result of conservative sex education that is linked to religion.

Bawa (2018:7) continues to reveal that even teachers avoid the issues that are related to

body changes. This leaves the scholars uninformed. They cannot differentiate when the

bodily changes happen and whether it is a healthy or a harmful reaction (Bawa, 2018:6).

Health Minister Dr Motsoaledi reacted to the statistics that were revealed by researchers

in 2017, that new HIV infections have increased amongst youth aged 15 to 24. This was

the study that was done by HSRC of the 5th HIV Prevalence, Incidence, Behaviour and

Communication for 2017. Dr.Motsoaledi made a request to mothers, fathers and

guardians to allow the Health Department to come to schools to promote attentiveness

about HIV/AIDS and probe the issues of multiple partners and blessers. The minister

revealed that parents were against his request. Their reason was that they do not want the

department to complicate the lives of their children and to encourage sex (Motsoaledi,

2018:4). Although the parents were refusing the minister’s request, a study was done

between parents and youth communication patterns on HIV/AIDS, STIs and sexual

matters. It was found that parents are still uncomfortable talking about these issues with

their children. Instead, they threaten them with contracting STIs or falling pregnant if they

are involved in sex. This study also revealed that another reason could be that parents

23

might be lacking information (Seloilwe, Magow, Dithole, and Lawrence, 2015).

According to Svanemyr et al. (2015:S8), students can be involved in high-risk situations

and they do have the ability to control the high-risk behaviours when they are equipped

with necessary resources, skills and knowledge. They further state that when students

recognise resources and opportunities, their behaviour will be redirected to opportunities,

instead of risky behaviours.

2.8 ATTITUDES OF TERTIARY STUDENTS TOWARDS POTENTIAL

HEALTH RISKS

According to Kambole (2007:4), an attitude can be defined as a learned tendency to

evaluate things in a certain way. This tendency can be positive or negative, depending on

one’s motion and beliefs of people, objects, events, activities and ideas or just about

anything in your environment that can create an inclination for action. A study that was

done in Botswana about knowledge, opinions and attitudes towards HIV/AIDS amongst

youth, revealed that there are still misconceptions about HIV transmission amongst

learners. These misconceptions differ depending on which age the learner started to be

sexually active and their level of education (Mejalantle et al., 2014).

Another study that was done in South Africa about predicting primary and secondary

abstinence amongst adolescent boys and girls in the Western Cape, revealed that the

attitude or perceived negative consequences of abstinence and social norms were

reasonably and consistently linked with intentions to abstain from sex but not with the

sexual activity itself. Additionally, this showed that if social norms, attitudes and risk

perceptions are addressed before sexual debut, they can promote sexual abstinence

amongst youth (Eggers, Mathews, Aaro, McClinton-Appolis, Bos and de Vries,

2016:1425).

According to Ukhtomsky’s (1966) and Uznadze (1961) as cited by Tretyakova, Fedorov,

Dorozhkin, Komarova, and Sukhanova, (2016:8287-8288), studies “on a dominant” and

theories of attitudes, revealed that the foundation of personal health is probably done by

health saving attitudes. They further say that this attitude is possible by introducing

certain activities. In the case of students, their attitude towards health whether passive,

active and creative attitudes, can assist to preserve and promote health. These attitudes

are possible by implementing high responsibilities about health education, development,

promotion, motivations and behavioural change in faculties. These attitudes should be

addressed not only with students but with everyone that is involved.

Ham, Hariri, Kamb, Mark, Ilunga, Forhan, Likibi and Lewis (2015:27) discovered that in

healthcare centres, the healthcare providers show negative attitudes towards young men

who complain about STIs. They prefer to listen to what these patients are reporting, rather

than examining them. They added by stating that if these attitudes are not addressed, they

can delay the partner treatment process or HIV prevention can be missed. Hence Dinkins

(2011:2) as cited by Selenga and Jooste (2015:9), encourages health care workers to have

empathy towards human beings, especially to patients as they are guided by ethics.

Additionally, empathy eliminates challenges and it promotes effective cooperation on

everyday communication. Navarro-Cremades et al. (2016:9) agree by saying that even

the university curriculum should not solely rely on education for the sexual behaviour and

risk of STIs in students. They should include precise programmes about preventative

techniques. This was revealed after there was an assessment of sexual risk behaviours

24

amongst female healthcare students from Spain. This could assist these students to be able

to promote more initiatives, positive attitudes and public awareness campaigns in their

communities and when they are qualified, this can continue to the workplace (Navarro-

Cremades et al., 2016:9).

There is so much evidence that norms and attitudes towards gender and sexuality are

formed during childhood and at teenage years. These are the drivers of sexual behaviours

amongst youth (Svanemyr, Amin, Robles, and Greene, 2015: S13). However, Svanemyr

et al. (2015) discuss and outline an ecological model and promising approaches that could

create an enabling environment for adolescent sexual and reproductive health. They

revealed that these approaches need group interaction because the factors that are

affecting young people are interlinked. The figure below outlines the framework and the

application collectively.

Figure 3: Ecological model to enable and shape the environment of adolescence

sexual and reproductive health

(Adopted from Krug et al. (2000) as cited by Svanemyr et al. (2015:S8).

Svanemyr et al., (2015:S8) revealed that the approach should start at the individual level,

where the focus would be empowering the youth, both socially and economically. This

could be done by helping them create efforts that enable them to access resources that are

needed. At the relationship level, a focus would be to build healthy relationships by

supporting and strengthening a positive attitude in their relationships, instead of judging

them. This could include partners, parents, peers and other sexual partners because these

are the people that influence their sexual experiences. The community would assist to

create positive social norms and promote safe sexual behaviours. Access to sexual

reproductive health education, involving institutions, schools, neighbourhood and

workplaces, are of utmost importance. The societal level would support them by

promoting the laws and policies. Educating youth about their rights, would assist them to

be able to negotiate in their sexual relationships, understanding their economic, social,

health and education positions around society (Svanemyr et al., 2015:S8).

According to Bawa (2018:6), young people can only be knowledgeable through inclusive

sex education. This will assist them in informed decision-making. They will be skilled in

knowing whether their human rights are violated or not. Additionally, Bawa (2018),

revealed that empowering classrooms with issues that are related to sex education, makes

the teaching space relevant. It also becomes appropriate to change the public’s attitude.

Additionally, one of the stakeholders in Dr Motsoaledi’s report revealed that out of nine

provinces in South Africa, five provinces showed low consistent condom usage. These

were sexually active children under the age of fifteen (15) years, especially boys. These

25

provinces were Western Cape, Eastern Cape, Mpumalanga, Free State and KZN

(Motsoaledi, 2018:4).

2.9 KNOWLEDGE AND ATTITUDES TOWARDS CONDOM USE

According to Hojat, Shapurian, Nayerahmadi, Farzaneh, Foroughi, Parsi, and Azizi

(1999) as cited by Hedayati-Moghaddam et al. (2015), youth are using condoms in their

sexual experimentation. Hedayati-Moghaddam et al. (2015) continue to state that many

researchers have revealed that in different countries, the occurrence of unprotected sex is

high amongst university students. They added by stating that condoms are used as the

best vital contraceptive technique these days. People are aware that condoms are efficient

and can prevent STIs, unintended pregnancies and HIV. Their quality was tested for

strength, leakage, lubrication and proper packaging (Brown, Duby, Bekker, 2012:48

&98) and (Holmes, Levine & Weaver, 2004, as cited by Navarro-Cremades et al.,

2016:1).

According to Granich, Gilks, Dye, DeCock, and Willians (2009) cited by Myers et al.

(2012:10), although there is enough knowledge about condoms in HEIs, negative

attitudes are still observed. Furthermore, they reported that the condom knowledge is not

applied by students. A study done in Spain on female students by Navarro-Cremades et

al. (2016:8), revealed that women want to reach an orgasm, thus are not using the

condoms as they want to experience sexual intercourse naturally. They claim that

condoms prevent orgasms from happening spontaneously. However, these behaviours

make them vulnerable to STIs.

HEAIDS has introduced pre-exposure prophylaxis (PREP) at universities. This is a

treatment that can be taken by people who are at a high-risk of contracting HIV. It is

known as “Truvada’’ and is an anti-retroviral medicine that can be taken daily. HEAIDS

has presented PREP to Nelson Mandela University, University of Venda, Rhodes

University, University of Limpopo, University of Free State, Vaal University of

Technology and the University of Zululand. It was revealed that the PREP was previously

introduced to sex workers and to men having sex with men by the Department of Health,

as this population was pronounced as a high-risk (Status Update, 2018:15).

2.10 SUMMARY

In this chapter, the literature was reviewed according to the objectives of the study. This

chapter explored the major topics about the student’s life, Higher Education Institution

(HEI), high-risk behaviours, Student and HIV/AIDS, knowledge and attitude. In the

following chapter, the research design and methodology will be discussed.

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CHAPTER 3

RESEARCH DESIGN AND METHODOLOGY

3.1 INTRODUCTION

Methodology serves as a guide. This is the process where researchers collect the data, to

analyse, describe and to explain the phenomena (Maree, 2016). Sandelowski (2000) stated

that in methodology, there has to be some knowledge of the world, which includes theory,

method or paradigm. It is the design and methodology that will explain how the researcher

is going to gather the data, analyse and describe the results. Methodologies analyse and

develop the kinds of problems that are worth being researched (Schwandt, 2015:201).

According to Bazeley (2013:8), methodology is an idea of how the investigation should

proceed.

In this case, the complete research strategy will be revealed by the choice of the method

the study has employed. The method that the researcher chooses is going to add to the

generation and development of knowledge. However, the method and the tool has to be

clear and well-defined. This will help to understand the issue that has been investigated

(Silverman, 2013:122-123). Methods are specific research techniques that are used by a

researcher to design a particular research and to assemble and examine data.

The aim of the research and the nature of the data that is going to be collected, needs to be

considered when these methods are employed (Schwandt, 2015:199; Denzin & Lincoln,

2018:809). The methodology employed in this research is discussed below under the

following headings: qualitative research, research design, population and sampling,

method of data collection, rigour and trustworthiness.

3.2 QUALITATIVE RESEARCH

Qualitative and quantitative are both adjectives that describe the type of research that is

employed in a study. Qualitative research describes data in the form of words (non-

numeric) and quantitative research defines it as numeric (quantifying) respectively

(Schwandt, 2015:256-260). According to Clow and James (2014:39), quantitative research

is organised data and can be analysed through statistical techniques. Quantitative research

makes use of reasonable judgement. A researcher is able to start with a hypothesis and then

perform data collection to confirm the hypothesis. By doing this, it makes the quantitative

analysis quick, inexpensive and easy to execute (Mohan, 2013:139).

According to Holloway and Galvin (2017:12-13), qualitative research focuses on peoples’

reality within their social and cultural context. This approach helps the researcher to

understand the participant’s experiences, thoughts and ideas. According to Clow and James

(2014: 39), qualitative research is unstructured, and it can give findings that are

subjectively interpreted. Mohan (2013:139) explains that it is expensive and requires

labour. The research paradigm that was utilised in this study is constructivism.

3.2.1 Constructivism

According to Schwandt (2015: 35-37), constructivism is a vague term with different

meanings, depending on the context in which it is used. It can be used for experimental

27

purposes, but it is mostly used in the Social Sciences. According to Denzin and Lincoln

(2018:19-20 and 98), constructivism is one of the five paradigm models which connects

many realities. It also allows for an understanding between the researcher and the

participants in the natural world, through a set of methodological procedures. Transactional

information is valued by constructivists because it is built on anti-foundational dialogues.

According to Schwandt (2007), as cited by Bazeley (2013:23), constructivists maintain that

knowledge is not discovered but constructed and produced through experiences,

interactions, practices and opinions by human beings. In this research, constructivism was

relevant, because students, as individuals, acquire risky behaviours through their own

experiences in their natural settings. The students were able to share, construct and

contribute their experiences amongst themselves in their own world. In this case, the

environment was the two main campuses. The researcher was able to focus on gathering

knowledge and gain insight and understanding of the students’ way of life in their own

setting.

The researcher, as a professional interacting with youth at her workplace, has always

enjoyed listening to the stories of her clients and enjoyed analysing these stories. Hence,

she embarked on a qualitative study. Qualitative research empowers researchers socially.

It gives one the opportunity to associate with the diverse group of people (Silverman,

2013:120-122). There are many techniques in qualitative research that could be used to

extract data from participants. Hence, qualitative methodologies are what attracted the

researcher to engage with this method (Silverman, 2013:120-122). However, Mohan

(2013:139), revealed that a qualitative approach relies on a researcher’s ability to be able

to remain neutral whilst interacting with participants. This is referred to as bracketing. The

researcher endeavoured to bracket herself outside of her subjects at all times, throughout

the research process and the duration of this study (Schutz, 1899-1956, as cited by

Schwandt, 2015:22).

3.2.2 Bracketing

According to Jooste (2018:346), bracketing was established so that the researcher would

control her or his bias. This would assist the researcher to set aside her thoughts and rather

focus on what was perceived about the phenomenon. In this research, the focus group

discussions (FGDs) were used and the researcher was able to suspend all her thoughts by

being neutral during the entire process of data collection. This helped the researcher to

realise the real experiences of the participants in their own world. Participants were able to

talk freely and expressed their thoughts without being judged and without the researcher’s

personal views. The researcher became more interested in the study phenomenon after

working with youth during Clinical Trials. The researcher remained objective through-out

the data collection process.

3.3 RESEARCH DESIGN

A descriptive, exploratory and contextual qualitative design was applied to this study to

collect data. This design is mostly used to direct the growth of future research and to

understand the circumstances better. In this research, the researcher was using focus

groups. The researcher was exploring the thoughts and ideas of the participants in detail,

as this method suited the situation (Clow & James, 2014:4-5). The researcher used this

design to find out what the participants know about the phenomenon and their perceptions.

This design assisted the researcher to get rich and detailed information from the

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participants. This would enlighten the researcher and other participants about the current

situation. It is essential that the research design must fit in with the selected topic and

research questions. Descriptive research was used to explore fresh parts of this research

and define circumstances as they existed (even globally), as discovered during the literature

review. In this particular research, it was used to explore the potential health risk factors

amongst students at a higher education institution (HEI) in the Western Cape with regard

to sexuality and HIV/AIDS. The researcher interacted with both genders and tried to probe

as much as she could (Grove et al., 2013:20). However, Holloway and Galvin (2017:12)

emphasise the fact that researchers need to handle the research participants with care and

sensitivity, as their behaviour is the result of their lifestyle. The researcher was conscious

of this throughout the research process.

3.3.1 Descriptive design

According to Clow and James (2014:6), a descriptive design describes the characteristics

of a participant or other phenomenon in answering the questions of how what, who, when

and where. They continue to explain that with descriptive research, researchers do have an

understanding of the topic, but the researchers want more information in order to conclude

on the knowledge. Furthermore, Mohan (2013:136) reveals that descriptive research is

intended to respond to questions that are interrogative. This will assist the researcher to be

able to thoroughly discover opinions, attitudes and situations about the participants. This

research was intended to assist the participants to make more informed decisions in their

personal experiences. The participants would be able to equip their peers and communities

with ample information. The students would be more equipped to discuss freely the

potential health risks and the risk factors that could negatively impact their future.

3.3.2 Exploratory design

According to Clow and James (2014:4-5), an exploratory design starts by outlining the

problem itself or it will involve an initial inspection of the situation or the issue so that it

can recognise the limitations that need further investigation. When little is known about the

phenomenon in a big community, the first thing that the researcher thinks about, is how to

explore and discover more about certain phenomena. This is typical of qualitative research.

This will assist the researcher to prepare or to find out more about the phenomenon.

Qualitative research is aimed at exploring what is not known (Green & Thorogood,

2018:18). In this research, the researcher used exploratory research to try and find out the

participant’s own understanding of their perception of factors that may increase health risk

behaviours. The researcher was also exploring their knowledge and attitudes towards

potential health risks, with regard to their sexuality and HIV/AIDS. According to Grove et

al. (2013: 370), exploratory research is intended to bring more understanding situations or

issues. In this research, the researcher intended to empower the participants, should they

be faced with similar situations in their communities. The students would be able to

discover and understand the reasons of their risky behaviours. Once these reasons are

discovered, then it would be easy to implement innovative methods. Educating youth and

communities about their rights, would assist them to be able to negotiate in their sexual

relationships, understanding their economic, social, health and education positions around

society (Svanemyr et al., 2015:S8).

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3.3.3 Contextual design

According to Schwandt (2015:41), contextualism is an opinion that focuses on specific

events within some background of beliefs and practices. According to Silverman

(2014:345-347), qualitative social research regards the issue of context as a very crucial

matter. He further emphasises that researchers must try to be observant on how participants

create some context for their actions and not make assumptions. A contextual design was

used because the researcher wanted to understand and describe the real experiences of the

participants in the context of their natural environment. The FGDs of this research were

conducted in the natural setting at both of these campuses. The researcher spent more time

on these campuses to interact with the participants in their social activities and in their own

environment.

3.4 RESEARCH SETTING

The institution of higher education under study was formally recognised on the 1 January

2005. This merger was the culmination of the Cape Technikon and Peninsula Technikon

that became one institution. This unification was part of the national transformation process

that transformed the higher education landscape in South Africa (CPUT website, 2015). It

enrols approximately 30, 000 students per year and has six faculties. It has six campuses

and four service points. It offers a range of undergraduate and postgraduate programmes

from different faculties. The university offers qualifications ranging from a National

Diploma, Bachelors, Masters and Doctoral degrees in Technology. The university is

broadly diverse, comprising Blacks, Coloureds, Indians, Whites and students from abroad.

Some students stay onsite in campus residences while others live outside the campuses, in

rented residences. Some students are still staying at home with their families (CPUT

website, 2015).

3.4.1 Cape Technikon

In 1920, it was a Cape Technical College. Later, in 1960, it became a college for Advanced

Technical Education. The College was forced to serve a certain race during the apartheid

era, therefore it was for white students only. In 1990, it became a Cape Technikon in the

new era, where it now is open to all races (CPUT website, 2015).

3.4.2 Peninsula Technikon

It was a Peninsula Technical College in 1962. It was formed to accommodate a certain

number of coloured apprentices in different trades and was situated in Cape Town until its

relocation to Bellville in 1967. In 1970, it became a College of Advanced Technical

Education. It was renamed Peninsula College of Advanced Technical Education and it was

designed for coloured people only. In 1987, it became the Peninsula Technikon, which then

served all races. Only two campuses within the university were selected (conveniently)

because of financial and practical constraints. The participation in the research was

voluntary.

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3.5 POPULATION

According to Brink (2006:123), as cited by Jooste (2018:334), population is defined as a

group of individuals whom the researcher wants to research. Additionally, the research is

unable to reach the entire population. The researcher focused on a certain group of

individuals that made up the population. It was obligatory that the researcher outlined the

target population, bearing in mind the sampling criteria (see 3.6.3) (Grove et al., 2013:351;

Mohan, 2013:190). In this research, the population was university students on the two main

campuses of a university in the Western Cape. The target populations were females and

males from a HEI in the Western Cape. This selected university is broadly diverse,

therefore all the different cultural, racial, religious affiliations and genders were included

in this research.

3.6 SAMPLING

Sampling is the process of collecting a fixed group of individuals from the whole

population. A sample represents the group of people that are selected for the study from

this entire population (Grove et al., 2013:351). There are two types of sampling techniques,

namely probability and non-probability sampling. This research has used non-probability

purposive sampling because participants were chosen due to their relevance to the research

question and to the problem that needed to be addressed (Schwandt, 2015:277). According

to Polit and Beck (2017:254 and 736), non-probability is when participants are selected

from the population by means of non-random technique. They continue to mention that

non-probability sampling would remain predominant because of its practicality. According

to Sidani (2015:130-131), non-random sampling techniques are mostly used in health

intervention evaluation research because they are reasonable and stress-free. Sidani

(2015:130-131) further explains that no matter what method is used to recruit, ethics

procedures must always prevail. The researcher has used non-probability purposive,

convenience sampling from the two techniques, as it is usually employed in qualitative

research. Convenience sampling, also called ‘accidental sampling’, was selected (Grove et

al., 2013:364). An example of convenience sampling could be a classroom of students or

a group of people that are attending a clinic. Convenience sampling is self-explanatory.

This means that the researcher gathered information from the participants that were freely

available. They met the inclusion criteria and they were willing to read the information

letter and sign the consent form (refer Appendix A). This particular research was using

students from the two main campuses at an HEI that were readily available (Holloway &

Galvin, 2017:147).

The researcher selected the participants for the research from the population successfully

and the individuals that were selected formed the sample population. The research

participants were students who were staying inside and outside of the selected campuses.

Their ages varied between 18 and 26 years. These students also came from different

provinces. They were also all studying towards different qualifications across the six

different faculties. The year level of studies also varied (Grove et al., 2013:351-354;

Holloway & Galvin 2017:143).

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3.6.1 Convenience sampling

Table 1: illustrating students who were conveniently sampled for the study

Participants

Campus A

Campus B

Males

9

4

Females

12

6

Age

19 – 26

18 – 26

Year of study

7 second years

13 third years

1 fourth year

5 first years

2 fourth years

3 third years

Home town

2 WC

13 EC

4 KZN

2 Gauteng

1 WC

7 EC

1 KZN

1 NW

WC - Western Cape

EC - Eastern Cape

KZN - Kwa-Zulu Natal

NW - North West

3.6.2 Recruitment

According to Butterfield et al. (2003) cited by Sidani (2015:124-125), recruitment is a

method of discovering and enlightening potentially eligible people to be included in a

specific research study, to meet the aim and objectives of the study. After ethical approval

was obtained from the Research and Ethics Committees from the Health and Wellness

faculty at CPUT (refer to Appendix H), the researcher embarked on the recruitment

process. Support letters were also obtained from Student Health and Counselling Services

from CPUT (refer to Appendix E). This was a pre-causative action taken, should any

participant react sensitively to any of the interview questions, they could be referred for

counselling assistance. The researcher started to connect with all the Head of Departments

(HODs) on both these main campuses to ask permission to address students about this

research. This was a process that was time-consuming, but rewarding, as all the HODs in

the various faculties that were approached, were supportive and cooperative. Hence, the

recruitment process was successful. Students were recruited from the two main campuses

and they could belong to any faculty.

Prior to the commencement of the research, while waiting for ethical clearance, the

researcher got involved with several workshops held on these two campuses. These

workshops were facilitated by the staff of the HIV Unit of the HEI. This gave the researcher

exposure to observe the students and, later, to interact with them. This was important in

order to establish relationships with students and discuss the importance of taking part in

this research study (Sidani, 2015:125). The current director of the HIV/AIDS unit, as well

as the peer educators, was very helpful in also recruiting students to participate in the

research. The peer educators invited the researcher to their group discussions at the

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residences where she could also interact with all students. The researcher also visited the

selected university during times when students were mulling about in the student centre or

visiting the library, in order not to disrupt their study programmes too much. All students

that were available to participate voluntarily and were willing to read the information letter

and sign the consent form, participated (refer to Appendix A). The FGDs took place by

arrangement with all students at a time and place that suited them. The researcher and

students would meet at an arranged convenient time and venue inside the selected

campuses for the FGDs. The FGDs took approximately 70 minutes. Patton (2015:477)

revealed that FGDs focused on various views and in an hour’s time, the researcher could

collect enough information.

3.6.3 Inclusion and exclusion criteria

This research had sampling criteria which had involved both inclusion and exclusion

criteria. Sampling criteria also called eligibility criteria, involve essential characteristics

that are going to determine the target population. The sample was chosen from the target

population. Criteria are very important as they are going to assist in guiding essential

features (Grove et al., 2013:352-353; Schwandt, 2015:46-47). The criteria were as follows:

3.6.3.1 Inclusion criteria

The researcher selected university students that were currently registered with this selected

HEI. The university is greatly diverse, therefore all genders were included. Students could

stay inside or outside the campus. These students could be at any level of education and 18

years and older, in order for them to sign consent to participate in the study.

3.6.3.2 Exclusion criteria

The researcher took note of exclusion criteria as well. This criterion stipulated features that

the target population does not have (Polit & Beck, 2017: 728). Students below 18 years of

age, were not considered to participate in this research. Students who were not registered

with the selected university in 2017, were excluded.

3.7 METHOD OF DATA COLLECTION

3.7.1 Focus group discussions (FGDs)

Focus group discussions are a method of collecting qualitative data from participants.

Recruited focus groups usually consist of five to ten people. It is a specific style of group

interview where a researcher or facilitator would ask the specific questions to produce

different views about a particular matter. In focus group interviews, participants

communicated amongst themselves and to the interviewer about the particular issue. The

conversations became more free-flowing because they were expressing their experiences

and their feelings (Silverman, 2014: 206-207).

In commercial market research, focus groups are also used as a major tool. All standard

ethical procedures were adhered to and maintained throughout the research process

(Silverman, 2014:206-207). In this specific research, the researcher conducted five FGDs

in English. The number of the research participants in each FGD was between five and

eight. The focus group discussions and recordings lasted for approximately 70 minutes

each. A digital recorder was utilised to do the recordings. All interviews were transcribed

33

afterwards. The interaction was well managed between the researcher and the participants.

There was no remuneration offered. This was clearly stated in the consent form and

explained to the participants.

3.7.2 Advantages of FGDs

FGDs can be used even if the researcher has minimum resources. One of the advantages of

focus groups is that they are well-organised (Polit & Beck, 2017:511).

FGDs are gatherings where people are sharing their experiences, beliefs and cultural

values. In this research, the researcher was able to build an understanding which made the

participants comfortable to tell their stories. The questions and answers were established

through verbal interaction. FGDs do not depend on the thoughts of the researcher, or of the

individual. Everyone is entitled to his or her opinion (Holloway & Galvin, 2017:125-127).

Many authors have confirmed that focus groups are popular data collection methods in

social, health and assessment research. Furthermore, Schwandt (2015:122) and Stewart and

Shamdasani (2015:3-6) state that focus groups have been used for almost 100 years for

influential communication studies. In many behavioural science disciplines, the researchers

depended on focus groups for the collection of key data. They can be used as a method on

its own to collect data and they can be mixed with other methods as well (Schwandt,

2015:122; Stewart & Shamdasani, 2015:3-6). In this research, the researcher had used the

focus group as a primary data collection method.

3.7.3 Disadvantages of FGDs

A disadvantage of focus groups is that some participants become quiet and uncomfortable

to express their opinions in front of others (Polit & Beck, 2017:511). The other

disadvantage of focus groups is that the researcher might be biased and ask leading

questions (Jooste, 2018:344).

3.7.4 Interview schedule and probing questions

The interview schedule was used to collect data for this study (Refer to Appendix F). The

following questions were included in this schedule:

• What is your perception of youth sexual health?

• What are some of the risky sexual behaviours young people engage in?

• What in your opinion are Sexually Transmitted Infections (STIs) and

Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS)?

• Who do you think is at risk of contracting HIV and why? (Probing).

• What does the community think of people living with HIV/AIDS?

• Why? (Probing)

• What is your role in the community with regards to HIV/AIDS?

• What do you think are the factors that may contribute to the increase of health risks

to students at Higher Education Institutions (HEIs)?

• Do you think students have enough knowledge regarding potential health risks

relating to sexuality?

• Why? (Probing)

• What are the attitudes that students at HEI’s have towards health risks regarding

HIV/AIDS and sexuality?

34

• What factors would influence young people to make informed decisions with

regards to sexuality and HIV/AIDS?

• Where can you go if you have STIs when you are around the campus?

• What do you think of the staff and facilities?

Do you have any suggestions how the staff and facilities can improve to minimise health

risks?

3.7.4.1 Probing

In order to extract rich data, probing questions were also included and used when required,

for example, “why are you saying ‘Yes’?”. In questions such as “Do you think students

have enough knowledge regarding potential health risks relating to sexuality?”, the

participants would describe the knowledge they have and their experiences.

3.8 PROCESS OF DATA COLLECTION

Data were collected from March to June 2017, during different weeks, because the

researcher did not want to interfere with the student’s examination timetable. FGDs lasted

approximately 70 minutes. These FGDs were conducted with those students that agreed to

meet with the researcher. These students were willing to participate voluntarily after they

had read and signed the consent form. The aim and the purpose of the research were

explained in advance to the participants (refer to Appendix A). The researcher obtained

written permission to record all interviews. This recording was emphasised and highlighted

in the information letter and consent form as well. The venues and times for these FGDs

were organised by the researcher. The venues that were used to do the FGDs, were normally

utilised for audiometry purposes, hence it was not so visible and privately situated. This

assisted the researcher to prevent threatening environments.

Five FGDs were conducted in English. During these FGDs, only the researcher,

participants and the moderator were in the room so that the participants could participate

voluntarily and freely. The researcher reminded the participants that they could withdraw

at any stage during the interview process, if they felt uncomfortable. The researcher

reassured them that their responses would be confidential. They did not have to mention

their names. The researcher addressed them as P1, P2 etc. After each FGD, the researcher

summarised and thanked the participants for participating in the research.

Schwandt (2015:66) emphasises the importance of gathering data correctly. Data collection

needs proper planning by evaluating your purpose and what needs to be answered. This

study used one of the approved methods to collect data in qualitative research focus groups.

It was an appropriate tool to use as it helped the researcher answer the research question

and it was relevant for the purpose of the research.

3.8.1 Recording of FGDs

According to Silverman (2014:43-45 and 330-331), audio recordings and other graphic

images have gradually become a significant part of qualitative research. Additionally, they

give the researcher the actual details of the conversation about their social life. The

researcher has the responsibility of asking permission to record the discussions from the

35

participants. In this research, the researcher had a separate permission consent page (refer

to Appendix D) that explained the purpose of the project. The researcher clarified to the

research participants the reason for the recorder as it would be impossible to remember

everything or to note overlaps. It was also explained to the participants that if they were

uncomfortable with the recording, the researcher would respect that decision. The

participants read and signed the consent for the audio recording separately. The researcher

used the Olympus Digital Voice Recorder to record the FGDs. The recordings assisted in

the transcription of the data as they could be replayed and improved the quality of the typed

transcripts (Silverman, 2014:330). The data that was collected, was transcribed by a

professional transcriber. The researcher and the supervisor listened to the recordings,

comparing them to the transcripts. This was done to check for any discrepancies and to

perform the necessary corrections.

3.8.2 Data saturation

Interviews were conducted until the same information appeared several times and there

was no more new information coming forth from the participants. This meant that data

saturation had taken place (Jooste, 2018:353; Silverman, 2014:124). According to Denzin

and Lincoln (2018:812), saturation is not about looking for repetition only, it can put

together the same thoughts and developments in different experiences, events, context and

instances.

3.8.3 Moderator’s role

During data collection, the moderator was present to assist by observing and listening to

the process. The moderator also ensured that the research participants were given respect

and treated fairly. The researcher introduced the moderator to the participants prior to the

commencement of the FGDs. It was important for the researcher to create this mutual

relationship. The researchers and research assistants are expected to treat the research

participants with respect and fairness (Holloway & Galvin, 2017:98). In this study, the

moderator was an experienced journalist, who was used to doing interviews. She was calm,

and the participants were participating freely.

3.9 DATA PROTECTION AND MANAGEMENT

Papanikitas (2013:18-19) reveals that confidentiality is used to protect the data collected.

This data might be medical records or other personal information. Papanikitas further

explains that this data could be in hard copies or it could be computer records. Furthermore,

Jooste (2018:310) states that there must be no trace of the identity of the participant or

health care institution. In this research, the data was transcribed, organised, developed into

categories and coded by the researcher, with the help of the supervisor. The researcher and

the supervisor listened to the recordings and compared the recordings to what was

transcribed, to ensure trustworthiness. All the recordings and transcribed data that were

collected, are kept in a locked safe in the Nursing Department of the selected HEI where

the researcher was a registered student for the duration of her studies. The supervisor is the

only person who has access to the key for the safe. The supervisor would give the researcher

access to the data on request, particularly during the publication of these results, in an

article format. This data included all the recordings of the FGDs, the transcribed documents

and the consent forms that were signed by the research participants. The data will be stored

for five years. The researcher informed the research participants about the storage of the

36

data, as Papanikitas (2013:19) stated that the participants have the right to be told about

how the data would be stored and the reasons for storing the data.

3.10 DATA ANALYSIS

Data analysis involves the process of questioning the data collected whilst reducing the

bulk of information collected by organising it and providing meaning to the data. This

included the researcher doing member checking to verify the information. During data

analysis, it was important that the researcher took the purpose of the research into

consideration, so that the research did not lose its focus (Grove et al., 2013:46; Holloway

& Galvin, 2017:287). Member checking is when the researcher goes back to the

participants to confirm or verify the information. This is very important for qualitative

research because it relates to credibility (Jooste, 2018:351-352). Denzin and Lincoln

(2018:811-812) describe member checking as a verification method rather than a validation

method. They continued to say it was for confirming the trustworthiness of the data and

the analysis.

In qualitative research, the details of information are gathered through focus groups and

individual interviews, as well as observations. This information can be collected and

analysed at the same time. The data analysis process goes through different stages

(Holloway & Galvin, 2017:288). In this particular research, the researcher collected the

data using FDGs as a tool. Thematic content analysis was employed to analyse the data

that was collected. According to Gibson and Brown (2009:138), as cited by Bazeley

(2013:190-191), thematised analysis comprises working out the connections amongst code

categories and the significance of such connections. These connections assisted the

researcher to understand the thinking and statements of the research participants. All the

FGDs were audio-taped. The researcher listened and re-listened to the voice recordings.

The researcher familiarised herself with the recordings as the professional interviewer was

going to transcribe them. This process was an initial stage of the data analysis and ensured

accuracy. The data was transcribed by a professional transcriber. The transcribed

documents were thoroughly checked by the supervisor and the researcher against the

recordings, to ensure the accuracy of the information. Jooste (2018:346) states that it is

important to do data collection and data analysis simultaneously, as this enables the

researcher to concentrate and shape the study as it progresses.

The researcher organised and categorised the data with the help of the supervisor. Themes

were generated through data collected from the participants’ responses in the FGDs. The

coding process involved identifying data as belonging to a theme and beliefs. From the

coding process, the researcher wanted to get the ideas, perceptions and the tones of the

participants. Descriptive keywords were grouped together, reorganised and linked in order

to combine meaning (Grbich, 2013, as cited by Saldana, 2016:9). The categories were

further broken down into themes. Themes are the results of the coding, categorisation and

critical reflection (Saldana, 2009:13, as cited by Bazeley, 2013:190). The themes were

considered as part of the findings and the results will be discussed in Chapter Four.

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3.10.1 Transcribing data

According to Schwandt (2015:306), transcription is a process of transcribing what was said

by the research participants. Schwandt (2015:306) further explains that the participants

were responding to what was asked by the researcher or to each other. In this research, the

data was transcribed by a professional transcriber. The data was transcribed according to

what was said by the research participants through the recordings in the FGDs (refer to

Appendix G1). The recordings of the FGDs were transcribed at the end of each FGD. The

data were transcribed verbatim into Microsoft Word documents. After each and every

transcription, the researcher would print the transcripts and listen to them, comparing them

to the recording. In this way, the researcher was able to listen to the FGDs transcripts and

make any corrections if necessary. In one of the FGDs, there was a participant who spoke

isiXhosa because he was more comfortable in his mother tongue and he was eager to

participate in the research. Both the moderator and the researcher are IsiXhosa speaking,

hence the researcher allowed the participant to participate in isiXhosa, as the university is

diverse and all the students fortunately in that group, understood IsiXHOSA. The

researcher was applying the ethical issue of justice, as stated by Papanikitas, (2013:7) (see

Justice, Section 3.12.3). That part of the interview was translated into English by the

interviewer as the interviewer is fluent in isiXhosa and English. The researcher checked

the accuracy of the translation, as the researcher was a Xhosa speaking person and she was

fluent in English. This assisted the researcher to engage more with the recorded data and

was able to listen, read and make corrections when it was necessary.

3.10.2 Ordering and organising data

In this research, the researcher put together the information from the FGDs and the

information from the moderator’s observations. All this data was collected, transcribed and

coded. The researcher put the data in an orderly manner so that it could make sense and it

could be dealt with in manageable steps (Papanikitas, 2013:159-160).

3.10.3 Coding

According to Jooste (2018:344), coding is an easy type of bookkeeping duty where the data

that was collected, are documented as numbers on a well-controlled record sheet. Similarly,

Denzin and Lincoln (2018:424) agree by saying that coding marks sections of data with

terms to conclude, classify and account for these segments. Bazeley (2013:125) reveals

that in qualitative analysis, coding is an essential skill, as it is used as an instrument to

investigate data, for trying statements and making conclusions. In this research, coding

would assist the researcher to determine whether the topic was familiar to the research

participants. The researcher created a table so that the responses of the participants could

be spread into themes, categories and sub-categories for analysis. This simplified the

process for the researcher to sort and assess the responses of the participants. Denzin and

Lincoln (2018:424-425) state that at the beginning of coding, the researcher must focus on

the data and be able to explore what the data means. They continued to elaborate that the

researcher must be able to read and analyse the data by wording, paragraphs and incidents.

The researcher was assisted by the supervisor to read and analyse the data in this research

and to do the coding. During coding, the researcher and the supervisor highlighted those

38

statements that had important comments and similar descriptions in the transcripts with

different colours (refer to Appendix G2). These comments and descriptions were the

reflections of what was said by the participants. The highlighted statements were

formulated by the researcher to make sense. The researcher formulated these meanings into

clusters of themes. Thematic content analysis was applied with colour coding to interpret

the data. According to Saldana (2016:4), the coding process can range in size from a single

to a full paragraph or an entire page of text. The researcher used Word and typed the data

on the left two-thirds of the page and the right margin was used to write codes. This assisted

the researcher to organise and cluster the comparable coded data into categories. The

themes were compiled into a final list of all the FGDs. Coding is a “critical link”, it links

the data collected and the interpretation of meaning (Charmaz, 2001, as cited by Saldana,

2016:4). All the relevant extracts from each transcript, were placed under the appropriate

heading on the final list of themes. This final list formed the basis of the results in Chapter

Four.

3.10.4 Reflexivity

According to Diaz (2002), cited by Denzin and Lincoln (2018:160), reflexivity is a way of

acknowledging what has been done by the participants and the researcher in a study. Diaz

(2002) in Denzin and Lincoln (2018) continued to elaborate by saying that reflexivity

replicates how the research was directed. In this research, it reflected the involvement of

the researcher amongst the participants. The researcher participated in many workshops

with the HIV/AIDS Unit in this selected HEI. This gave the researcher enough time to

familiarise herself with participants. The researcher was visiting the HEI during weekends

to observe the lifestyle of students. Some students would invite the researcher to their

health education discussions. This made the researcher work closely with participants.

However, reflexivity stresses the self-reflection on one’s biases in the investigation

(Schwandt, 2015:268). The researcher professionally worked on Clinical Trials and she

was aware of the ethical issues and biases that might occur. This assisted the researcher to

be able to bracket herself outside of the research during data collection (refer to Section

3.2.2).

3.11 RIGOUR IN QUALITATIVE RESEARCH

According to Jooste (2018:350), rigour incorporates all strategies, namely trustworthiness,

validity and reliability. According to Denzin and Lincoln (2018:797-809), rigour in

qualitative and in quantitative research had been a long debate between researchers.

However, the debate was settled by Guba (1981) and Guba and Lincoln (1985) by

presenting the term trustworthiness. Guba and Lincoln (1985:328) as cited by Denzin and

Lincoln (2018:801), revealed that trustworthiness entails credibility, transferability,

dependability and confirmability. They further explained that with these four criteria,

trustworthiness can be established in qualitative research. Guba and Lincoln (1985) cited

by Schwandt (2015:308-309) emphasised methods that could be used to establish these

criteria. They mentioned member checking and peer debriefing would be suitable for

credibility and auditing would be useful for dependability and confirmability.

Trustworthiness is very important in qualitative research, as it is significant to prove the

quality of the research and its findings (Schwandt, 2015:308-309). In this research,

trustworthiness assisted the researcher to be more consistent when the data was collected

and analysed. The researcher had to ensure that there are no threats that can affect the

findings of the research. The researcher needed to know that qualitative research is directed

39

by trustworthiness and its precise methods. Trustworthiness replaced validity and

reliability, which are used in quantitative research. This helped the researcher to understand

that rigour could be recognised differently in qualitative and in quantitative studies. During

the research, the measures that were taken to ensure rigour are seen as valid scientific

knowledge (Jooste, 2018:350-357). The data that was collected by the researcher for this

study is kept in the Nursing Department. All the data is in a locked safe and only the

supervisor and the researcher, with permission of the supervisor, will have access to the

key, should she require some of her data for publication purposes. In this way, the

researcher maintained trustworthiness throughout the study. The researcher will now

elaborate further on strategies of trustworthiness below.

3.11.1 Credibility

According to Polit and Hungler (1997:304-305) cited by Jooste (2018:351), the credibility

of a study includes the performance of examining in such a way that the acceptability of

the results is improved, and credibility is demonstrated. Jooste (2018:35) further explains

that the credibility can be shown by lengthy meetings and determined observations. The

researcher spent numerous hours at the selected university to engage with students.

Prolonged engagement made it uncomplicated and easier for the researcher to collect the

data and to do member checking, as she was already a familiar face on these two campuses,

having interacted with students at various levels before. The researcher ensured that the

participants’ views were accurate as portrayed by them. The credibility of the study was

ensured through the findings that were traceable backwards from the data collection to

show accuracy. Schwandt (2015:309) states that credibility focuses on how the researcher

has portrayed the experiences of the participants. Schwandt (2015) continued to say that

credibility focuses on the confidence in the true reflection of what really happened. In this

study, the researcher maintained credibility by using the member checking technique.

3.11.1.1 Member checking

Member checking has been described by many researchers as a way of confirming the truth.

This is done by going back to the research participants to critically discuss and confirm

what they have said and comparing it to the researcher’s findings (Polit & Hungler,

1997:306; Botes, 2003:181; Brink et al., 2012:172, as cited by Jooste, 2018:351-352).

According to Guba and Lincoln (1985) cited by Schwandt (2015:309), member checking

is one of the most appropriate techniques to establish credibility in the research. The

researcher maintained member checking by going back to the participants to interact with

them, whilst confirming what they had said during the FGDs.

3.11.2 Transferability

According to Lincoln and Guba (1985) cited by Bazeley (2013:410), transferability is the

substituting of generalisation. They directed this term precisely to be able to transfer

knowledge from incident to incident. The researcher’s responsibility was to offer the

participants enough knowledge about the topic so that they could be able to apply the

information in their own experiences in real life (Schwandt, 2015:309). The quality of the

results of this research would be able to help HEI students to make informed decisions

about their social and sexual life in their experiences (Jooste, 2018:353). In this research,

the peer educators of the selected HEI were part of the FGDs. This meant that knowledge

40

would be transferred in all directions on campus, to all faculties and departments and later

to their communities where they live and come from.

3.11.3 Dependability

According to Polit and Hungler (1997:306) as cited by Jooste (2018:354), dependability

refers to how constant the findings obtained are, should the same research be repeated.

Guba and Lincoln (1985) as cited by Schwandt (2015:309), agree by stating that

dependability focuses on the methods to confirm that these procedures were consistent,

traceable and documented. Dependability in this study was achieved by including

appropriate research questions, aims and a research design. Guba and Lincoln (1985) as

cited by Schwandt (2015:309) further confirms that auditing procedures could establish

dependability in this research. The researcher maintained dependability in this research by

being consistent when the data was collected. The same questions and probing were done

with all the FGDs. The researcher provided all the techniques used to collect and analyse

the data. As stated, the data will be kept at the Nursing Department in a locked safe for

audit purposes for five years with only the supervisor who has access to the key.

3.11.4 Confirmability

According to Guba and Lincoln (1985), as cited by Schwandt (2015:309), confirmability

focuses on establishing the fact that the data and interpretation of an investigation could be

confirmed. They explain the methods that could be used to do the confirmation. They

mention auditing and triangulation as suitable methods for confirmability (Schwandt,

2015:309; Polit & Hungler 1997:307, as cited by Jooste, 2018:355). For this research, the

researcher obtained confirmability by aligning the objectives and the FGDs questions.

Lincoln and Guba (1985) further concur that confirmability was similar to objectivity. The

findings of this research could be confirmed by the audio recordings, transcripts and by the

participants through member checking. The researcher, with the permission of the

supervisor, would be the only people who can access this data.

3.12 ETHICAL CONSIDERATIONS

Every researcher has to be aware of ethical issues when planning to conduct a study. A

research proposal should be submitted and approved by the relevant authorities. This

approval is the allowance for the researcher to be able to conduct the research (Jooste,

2018:309). This research proposal was approved by the Cape Peninsula University of

Technology’s (CPUT) Health and Wellness Sciences Faculty Ethics Research Committee

(refer to Appendix H). Support and permission letters were obtained from the Student

Counselling and at the HIV Unit, respectively (refer to Appendix E; Appendix B). After

ethical approval was obtained, the researcher commenced with the data collection. Ethical

principles were adhered to according to the Declaration of Helsinki, as discussed in Section

1.18.1. and upheld throughout this study.

3.12.1 Autonomy

Autonomy is the principle of respect. It is a self-rule, meaning that the participant must be

able to make a free and informed decision to participate in the research (Papanikitas,

41

2013:6). Jooste (2018:311) agrees by saying that nobody should pressurise the research

participants in their decisions. All the participants in this research gave their consent of

their own volition. Each participant signed the consent form before the commencement of

the FGDs. It was the researcher’s obligation to maintain respect throughout the research.

They signed a separate consent for recording of the FGDs (refer to Appendix D).

Anonymity and confidentiality were maintained throughout the research process, by not

using their names during the focus group discussions. Each FGD was numbered as FGD1,

2 etc.

3.12.2 Beneficence

According to Papanikitas (2013:6), beneficence is the principle of a good deed.

Beneficence means that there are no harmful physical or psychological experiences for the

research participants. It was the researcher’s obligation to execute the research in such a

way that the research was more beneficial to participants than the research itself (Jooste,

2018:311). In this research, the researcher obtained a letter from the student counselling

department (refer to Appendix E). This was to ensure that if there are any discomforts, the

participants would be referred for counselling. The participants were informed that

anonymity and confidentiality would be respected at all times. They were informed that the

results of the research would be presented to them, should the faculties require this from

the researcher. Individual groups of students were also encouraged to contact the

researcher, should they wish to read more of the results and the outcomes. The researcher

informed them that the data collected would be kept in a locked up safe in the Nursing

Department. Nobody would have access to the data except the supervisor and the researcher

with the permission of the supervisor. In this research, no participant was harmed or reacted

negatively during the focus group interviews and discussions, therefore no referrals for

counselling were necessary.

3.12.3 Justice

The principle of justice includes participants’ right to fair treatment and privacy

(Papanikitas, 2013:7). The researcher should ensure that participants are treated fairly and

the right to justice should prevail. In this research, all the participants were treated equally

and with respect. In this study, the researcher explained to the participants that there would

be no reimbursement for participating. The researcher and the participants had a mutual

agreement about their participation in the study, which was totally voluntary. The

researcher provided participants with her contact details, as well as that of the supervisor,

should they need to discuss any concerns about the study (Jooste, 2018:311). All the data

that would be collected, would be made available if they needed it. All of this information

was clearly explained in the informed consent form (refer to Appendix A).

3.12.4 Non-maleficence

According to Papanikitas (2013:6), non-maleficence is a principle of not doing any harm

if it can be avoided. This was confirmed by Jooste (2018:311) stating that non-maleficence

is essential. This means avoiding or minimising unnecessary harm or risk, directed to

research participants. In this research, the researcher obtained a letter from the Student

Counselling Department (refer to Appendix E). This was to prevent any kind of harm

directed toward research participants that could avail itself during data collection.

Participants in this research were not exposed to any harm or risk throughout the study.

42

None of the participants reacted sensitively or in a negative way to any of the interview

questions.

3.12.5 Right to privacy and confidentiality

According to Papanikitas (2013:17-18), confidentiality is a cornerstone of the calming

connection between a doctor and the patient. He continues to state that the right to

confidentiality originates from the right to autonomy. Participants were assured about the

privacy by the researcher. Confidentiality was kept and respected throughout the research.

A private, quiet room was utilised for the FGDs. Jooste (2018:310) mentions that besides

the researcher and the supervisor, no additional people should have access to the

information or identities of the participants. Jooste (2018:310) continues to emphasise that

the participants should be aware of any information that was gathered during the research

process. The researcher asked for separate permission from the participants to record the

discussions (refer to Appendix D). No names were mentioned during FGDs and there were

no names documented anywhere. The participants were informed that there would be no

link between them and the recordings. The researcher protected the privacy of the

participants by making sure that no information was shared to any third party.

Confidentiality was maintained throughout the research process.

3.12.6 Informed consent

According to Jooste (2018:312), informed consent is a communication of acceptance in the

need for truthful and respectful give-and-take between the researcher and the people whom

they study. According to Sidani (2015:131), the consent process is divided into three steps.

The major purpose of informed consent is to notify the person about the aim or the intention

of the research. Sidani (2015:131) continues to explain the three steps by saying that,

firstly, the researcher needs to inform the potential participants about the purpose, the risks

and the benefits of the research. The second step is to ensure that the participants

understood all the processes and concerns and that they were clarified. The third step is to

ask the participant to sign the consent form, to show that all the information has been given

and clarified. If the participant agreed voluntarily, then the participant could sign.

Neethling (2001) as cited by Jooste (2018:83-84) supports Sidani by saying that by signing

off the consent form, the participant is consenting to injury and risk of injury. However, it

must not be intentional. It was further explained that the consent form must be free,

voluntary and have full knowledge of the level of the potential pre-judgment. In this

research, the researcher obtained written consent from all the students that participated.

They were informed that their participation was voluntary, and they could withdraw at any

time if they were not comfortable. Participants were above 18 years of age, therefore

eligible to sign their own consent form. Confidentiality was emphasised by the researcher.

Students agreed to sign the consent form (refer to Appendix A).

During the FGDs, the permission was requested from students to do audio recording. The

purpose of the audio recording was to assist to capture all the details of the FGDs for data

analysis later. This was explained in detail to all the students. The researcher informed the

students about the formal ethical permission from the university (refer to Appendix H). The

consent form was critical because research participants have the right to know that they are

being researched and what they are being researched on (Schwandt, 2015:156-157).

43

3.13 SUMMARY

This chapter has concentrated on the research methodology and design used in the research.

The research setting, and sampling technique were described. The method of data

collection and the method employed to analyse data, were discussed as well as the ethical

considerations applicable to the study. Trustworthiness, reflexivity, rigour, credibility,

transferability, dependability and confirmability, which are all important aspects in

qualitative research, were also considered. The next chapter will discuss the findings of the

interviews.

44

CHAPTER 4

RESULTS

4.1 INTRODUCTION

This chapter presents the findings from the focus group discussions (FGDs) conducted in

this study. This section demonstrates the experiences and thoughts of the participants based

on the research questions that were answered. It will be presented in different themes. This

research was conducted on two campuses of the selected Higher Education Institution

(HEI) in the Western Cape (refer to Chapter Three). Five FGDs were conducted. A

summary is provided at the end of the chapter.

The aim of this research was to investigate potential health risk factors amongst students

at an HEI in the Western Cape regarding sexuality and HIV/AIDS. The objectives of the

research were to:

• Explore the factors that may increase health risk behaviours amongst students at an

HEI.

• Explore and describe knowledge of university students regarding potential health

risks related to sexuality and HIV/AIDS.

• Explore attitudes students have towards health risk behaviours, regarding

HIV/AIDS and other sexuality- related behaviours.

4.2 BIOGRAPHICAL DATA

The biographical background that was revealed during the FGDs in this project consisted

of the participant’s gender, age, year of study. It was also explored whether students were

living inside the campus residence or in off campus accommodation, privately or with their

families. Students were also asked about their hometowns. The total number of research

participants was 31 students from both campuses. There were 18 females and 13 males.

The participants were at different levels of their undergraduate education. The study

included seven (7) second years from campus A, and one (1) fourth (4) year from campus

A, and thirteen (13) third years from campus A. There were five first years in campus B.

There were two fourth (4) years from campus B, three (3) third years from campus B. The

age of these students varied between 18 and 26. They were from different provinces across

South Africa. There were three from the Western Cape, twenty from the Eastern Cape, five

from KwaZulu Natal, two from Gauteng and one from the North West Province. There

were fifteen students that were staying inside the campus residence and the others were

staying in rented communal flats whilst some were living with families and relatives.

4.3 THEMES

The five FGDs were conducted and recorded. The data that were collected were transcribed

by a professional transcriber. Thematic content analysis was employed to analyse the data.

Coding was done by the researcher with the help of the supervisor and data were

categorised and arranged into themes and subthemes. This was achieved when the

researcher was revisiting, re-reading and re-analysing the transcripts. The following themes

and subthemes emerged from the data analysis according to the objectives and research

question that were set out to be achieved in this study.

45

Table 2: Themes and subthemes

Themes

Subthemes

1. Contributing factors to

risky behaviour

•

New-found freedom

•

Reckless behaviour

•

Alcohol and drugs

•

Peer pressure

•

Multiple partners

•

One-night stands of sexual contact

•

Early-stage sexual engagement

•

Transactional sex

•

Unprotected sex

•

Lack of communication with parents

•

Knowing the status of a sexual partner

•

Socio-economic background

2. Knowledge

•

Ignorance

•

Misconceptions

•

Information needed

•

Education needed

•

Uninformed decision

•

Partner testing

•

Teen pregnancies

•

Condoms

•

Abstinence

3. Attitude

•

Towards HIV/AIDS awareness campaigns

on campus

•

Poor service delivery at on-site student

health services

•

Health risks

•

Health services Referrals

•

Stigma and judgmental

4.4 THEME 1: CONTRIBUTING FACTORS TO RISKY BEHAVIOUR

The HEIs are challenged by the risky behaviour of the students and are striving to do all to

support them. Doctor (Dr) Blade Nzimande, revealed in his 2014 speech that poverty and

financial suffering of the HE students were amongst the priorities of government, as these

are some of the most important factors that are contributing to the high risk behaviour of

the students (Nzimande, 2014).

46

4.4.1 New-found freedom

All the participants who attended FGDs agreed that being away from home gave them a

sense of freedom at HEIs:

I think another thing that plays a role is that like the whole transitioning because when you

are at home, there’s like all these your parents and your family that’s like guiding you and

when you come to university especially if it’s like away from all of that and then there’s

none of that, protection and then that’s like only thing you prefer. (FGD1)

Other participants agreed with what was said about new-found freedom and being away

from home:

And also it’s a freedom you know when you were in high school you were under the

protection of your parents. They would guide you and they were watching you and you did

not have freedom but when you come to university you get freedom you are free you get to

do things that you were unable to do then back at home you just irrationally we do not

think before we do things we tend to forget things that our parents taught back and we just

ignorant as she said. (FGD3)

When you actually get to varsity you are more advanced in terms of now I am open I am

not home I do not have to be sneaking out of the window all of those things here I have my

own place to stay no one will tell me what time to come in what time to do this and that.

(FGD4)

4.4.2 Reckless behaviour

Some participants described the reckless behaviour of students as follows:

I think in these days we as youth we are careless when it comes to sexual health and those

kind of staff and the thing is we like I do not know how to put this but some people they say

we like to be wild we like to do things without even thinking which is sometimes a risk.

(FGD3)

We act so recklessly we do not think before we do that is how I see it. (FGD5)

I think university is actually a platform for sexual intercourse. (FGD4)

4.4.3 Alcohol and drugs

Participants revealed that there are many consequences related to alcohol and drug abuse

at HEIs:

In nowadays they get involved in group sex by actually think it’s cool they get drunk in a

group and do group sex and I do not think condoms, and everything is involved in

that…(FGD2)

47

For instance now there's clubs, there's bashes there is a lot of stuff that youth attend to

those social events, the thing is when we attend those events we sometimes especially if

there is alcohol, when we attend those things we tend to be drinking too much and we end

up doing things that we did not want to do like, for instance, end up doing unprotected

sexual intercourse or something or engaged in taking drugs like those kind of

things…(FGD3)

It is very bad in res, people sleep around a lot and those Friday’s nights where people go

out and drink when they come back with those Ubers they find themselves sleeping in some

other people’s rooms nobody thought of a condom it’s very bad in res. (FGD5)

4.4.4 Pressure from peers and influence

All the participants have mentioned pressures and influences from peers as one of the most

significant factors that affect their behaviour:

If you are not involve in a sexual activity then that means (wena meaning you) are living

in the old days, you don’t fit in in this generation that we are living in now so it it’s also

comes to a matter of whether you want to fit in that certain group so it comes to that that

pressure. (FGD1)

If you do not have a girlfriend or you do not have sex you are seen as someone who is not

in the right trend so all societies we are now living has improved that it is cool for you that

you can have sex. (FGD2)

And also peer- pressure, following friends doing wrong things so you do things without

thinking for yourself. (FGD3)

.

..know that back then it was the thing to do and if you were not doing it then you are not

part of the crew, you not cool. (FGD4)

It goes with the influence friend’s influence, friends influence when you have a broke

boyfriend you do not need a boyfriend most of them they will go to the blessers. (FGD5)

4.4.5 Multiple partners

Participants articulated multiple partner relationships as a fashion (statement). They

revealed that it is not a certain gender that is doing it, but rather ‘everyone’:

…I was chatting to my cousin the other time she had three sim cards I was asking what are

you doing with these sim cards and then she was like noo…. I have three partners and each

one of them has her own sim card. (FGD1)

I think 2017 there is this new trend that is going around which is "pause life" so I think

that is the major problem because first of all we as youth are not protecting ourselves

enough with one partner so there is "pause life" which is multiple partners it’s okay to

jump to the next person it’s a norm now the thing with this you are not protecting yourself

48

with this one and the next one and the next one. You trust all these people, but you do not

necessarily know these people. (FGD3)

Some participants also added to this by saying that there is nothing wrong with having

more than one partner:

I think, it’s just cool having more than one boyfriend or having more than one girlfriend.

(FGD4)

4.4.6 One-night stands of sexual contact

Participants revealed that when they attend parties on campus or visiting nightclubs, they

end up with a casual sexual partner for the night:

And at times we people have one night stands and it has become a trend not really it should

not be motivated but somehow it is done and the next thing you said I do not know what I

was doing and we forget about it and you never really think about the cause or the fall of

it or whatever comes out of it. (FGD4)

People tend to just sleep with people they like casual I do not know what they call they call

the one-night stands or the cookies at the bash you see all those things. (FGD2)

…the thing is when we attend those events we sometimes especially if there is alcohol,

when we attend those things we tend to be drinking too much and we end up doing things

that we did not want to do like, for instance, end up doing unprotected sexual intercourse

or something or engaged in taking drugs like those kind of things. (FGD3)

4.4.7 Early-stage sexual engagement

The participants revealed that sexual engagement at a young age is trending, starting in

high school. Some further highlighted this by stating that it started even before they enter

HEIs:

…with my experience I know losing my virginity at young age. For me I know that back

then it was the thing to do and if you were not doing it then you are not part of the crew,

you not cool. (FGD4)

… for me like what I have noticed about today’s youth is that sexual interactions are

happening like quite at early stage than before. You’d find out that children aged thirteen

to fourteen are engaging in sex. (FGD1)

I would like to also add on that I feel like we brag about being sexual active I feel like it’s

a competition. (FGD2)

…when it comes to youth of today’s generation, compare to that generation, I think they

are reaching their puberty in early stage, I am not sure what is their reasons behind it

though, because if its food do the changing in dieting by this I clear remember when in

primary of that time when you remember I don’t even know..so, what a girl is, or to get a

kiss from a girl is something else or a big hug or something else you go jump and celebrate

49

but nowadays hey when I look at them, the ones that I remember now kiss for them is just

like it’s nothing… (FGD1)

…when you were youth from 13-15 years old upwards to 21-22 you were very sexual

active…(FGD5)

4.4.8 Transactional sex

Participants revealed the fashion of transactional sex at our HEIs and the reasons and

circumstances why they indulge in transactional sex:

When you actually get to varsity you are more advanced in terms of now I am open I am

not home I do not have to be sneaking out of the window all of those things hear I have my

own place to stay no one will tell me what time to come in what time to do this and that I

can actually date someone older no one will care…(FGD4)

You want to have lace weave but you won’t afford a lace wave, so the better way for you is

to go and have someone to be your blesser and that…because most of the time, these people

that you are dating as a blesser people, that’s not dating it’s an exchange, so they give us

money and we sleep with them, so if someone is going to buy me an iPhone 6 for R14 000,

of course he can tell me to sleep without a condom and actually I won’t feel guilty. (FGD1)

Some participants were against transactional sex, viewing it as prostitution, whilst others

were saying that circumstances force them to involve themselves in transactional sex. This

is how they described it:

And also doing like having sex for money it’s not good it is part of prostitution as well.

(FGD3)

the trend of sugar mamas and sugar daddies who exploit students by promising them lavish

life you see the best cars being parked at res. (FGD5)

Sometimes students know but there are social factors like poverty you know somebody

would like in residence hungry and this guy would just come and you know I can buy you

airtime here is 200 and you know you have been eating nothing you will just go buy yourself

food so it will end up being like that because you want money for food and you know that

HIV is there and all that but because of the situation. (FGD2)

4.4.9 Unprotected sex

Participants acknowledged that their sexual activities are not protected. This is how they

explained their thoughts:

My view is that the youth of today is not really safe. They do not take care of themselves in

terms of sexual relationships or in any sexual activity that they participate in. (FGD3)

We are irresponsible, the youth of today refuse I do not know whether they refuse or they

do not want to use protection. There is this thing of have you seen anyone eating sweets in

50

a wrapped paper or whatsoever and it has become the new trend where people do not want

to use condom. (FGD4)

Some students mentioned that sex with protection, is an obstacle:

Another thing is that safe sex and unprotected sex is not the same, laughing, if you are

doing sex without a condom you are enjoying. That it’s a fact we cannot run away from it

you enjoy it and when you are doing it with a condom eish…there is that thing there is a

difference…tasteless. (FGD5)

4.4.10 Lack of communication with parents

Participants said that their parents and even the teachers at school, are still avoiding

communication regarding issues related to sexuality and sex:

I think it all start at home because I think in a black society like lately parents if if if like

most of the time ok, most of the time in my high school some of the girls when you reach

like let’s say twelve or thirteen, your parents they take you to clinic for contraceptive, so it

came to my mind that ok, our parents, they are scared of us getting pregnant, they are not

scared of us getting HIV. (FGD1)

you know even the teacher we try and rush- rush just to get away from it anything that have

to be explained will rush it not like really be like you know what you need to know this

because in future you will need this so I think it starts from the top-down or as the bottom

up that is where we lacking everywhere. (FGD4)

Other participants revealed that religion and culture inhibit sexual talks and education

between youth and parents:

Also religion and culture play a part on that (sexuality). Just to emphasize I was watching

this video in Zimbabwe in rural areas and I forgot what the name of it and there was this

kid and I forgot what the name of the kid in the video. (FGD2)

And also some if they do have access to them because there is stigma so if there are

condoms here the brother or the sister will be curious to know why condoms so you end up

hiding things or you do not speak freely about sexuality based on (ukoyika) being scared.

(FGD2)

Some students also reveal that because their parents are very strict with them, they tend to

pretend as if they do not know anything:

We still want to be angels to our parents even though we are doing our things aside but we

want to be seen as innocent face whenever my mom sees me does not know I am the devil

inside. (FGD4)

4.4.11 Knowing the status of a sexual partner

Most FGDs members divulged that students sleep around without even finding out the

status of their partners. They also mentioned that some partners do indeed go and test,

however they do not wait for the window period, instead they trust their partners:

.

51

I think people should respect the word “trust” it’s a big word, you don’t give it to anyone,

even if you go and test every month every time, I don’t know what you are doing and this

thing called window period because most of the people if we can go and test now and then

we negative okay fine we can do it, what about the window period, people don’t wait for

that they just take the first results and then they are happy with that I think trust should be

respected, it’s not a word to give it to anyone…(FGD1)

…..You know there is this thing that you have to go and test after 3 months so they have

this question that "what if have what if I go back and have so they do not want to know if

they have or not. (FGD3)

I would also like to agree with you in terms of ignorance when it comes to sexual

behaviours ignoring that we might actually run the risk of contracting HIV/AIDS and the

system we talked about that if my girlfriend is negative I am also negative of which is

incorrect you cannot test by somebody else you have to go by yourself and find out that you

are really negative so in that sense I would say that you really negative. (FGD2)

4.4.12 Socio-economic background

Participants pointed out that family background contributes to uninformed decisions, as

some of the students are coming from poor backgrounds and others are coming from rich

or middle-class backgrounds:

Poverty is key, its number one factor that actually drives everything, if you know where

you come from, its different when you coming from better family. The family is poor and

so forth and so forth, now you come from a community where you know for sure there is

nothing there it’s not a matter of saying that I’m poor, yes you are poor but at the same

time you are also poor in the sense that you are not equipped with enough information.

(FGD1)

Sometimes students know but there are social factors like poverty you know somebody

would like in residence hungry and this guy would just come, and you know I can buy you

airtime. Here is R200 and you know you have been eating nothing you will just go buy

yourself food so it will end up being like that because you want money for food and you

know that HIV is there and all that but because of the situation. (FGD2)

…you do not know what that person has been through you do not know if that person has

HIV /AIDS you tell yourself that I am there just to chow his or her money you do not know

whether you are going to chow that money in hospital or something...(FGD3)

...so whatever community you are from people expect you to dress well as the university

student to behave the same do not know the financial conditions are not the same and those

are the biggest and peer pressure and the fact that we are not from the same homes maybe

my parents will be able to buy me this and your parents will be able to buy you that and

you also you want to be in the same level so you make sure that you have a blesser. (FGD5)

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4.5 THEME: 2 KNOWLEDGE

The knowledge has been described as vital information that is learned. It can be learnt by

different ways that include personal experiences and role modelling. Hence, the HEIs

provide not only academic knowledge, but programmes that are supporting students in all

areas of their lives (Grove et al., 2013:8-9).

4.5.1 Ignorance

Some participants confirmed that they do not take time to find out what is happening around

the campus. Others prefer to ignore activities that are happening around them:

You know what there are lots of things that we don’t know, because the minute we see T-

shirts and tents, we know that they are testing and you don’t want to know because the

testing is done publicly, and you are scared of your reaction. I wish they can be strategic,

no testing rather encourage us to go to the clinic for testing. (FGD1)

I think my perception of today's youth or youth's sexual health is that we know the things

that we supposed to do but then sometimes we I cannot say we choose not to do them but it

does not happen we ...like in terms of care what I mean by that things like protected sex,

abstinence, contraception we know all those things it’s not like we do not know but we get

statistics that the youth is continuously getting infected but there is so much information

there is so much you can do to protect yourself….(FGD3)

Some participants confirmed that to engage in sexual activity is a priority and it is more

important than having a disease. They would rather risk their lives, than not have sex:

I am trying to say is that people do not see having a disease as something that is wrong

because everyone seems to have disease it does not matter what type of disease so the issue

of HIV is mostly in something that we like which is sexuality. So people are saying it is

better to have HIV than not to have sex. (FGD2)

I would say a lot of us don’t want to unlearn and learn, that’s the major problem, especially

amongst us as youth, that’s why we are dying of HIV/AIDS, people don’t want to learn,

people will only learn once they are in the dead end. Something has to happen in order for

them to learn, that is the problem ignorance kills. (FGD1)

4.5.2 Misconception

Participants shared stories about misconceptions amongst students. These are some of their

stories:

I heard something somewhere that it takes men 8 times to have sex with infected woman to

be infected with HIV I do not know if that is true or not. (FGD4)

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I am sure that out of 10 people there is one person who has heard that you can sleep with

someone who is HIV positive and don’t get it and you will be like let me try this because of

the spur of the moment and then consequently you will get the virus thinking that you would

not get it so it’s the ignorance and also that ego that I do not know where it’s coming from.

(FGD5)

…I think another one that we not taking into consideration is the one of heee… I don’t

know if but it’s more particurlaly on men it’s called that if you are circumcised, that

cultural thing yes it goes to that point that of if you are circumcised then you have got a

low risk of infecting HIV, so as well it’s part of those hee…. risk factors, it’s not maybe I

am not sure if I could bring this to this platform for men not go through circumcision, jaa,

jaa…. (FGD1)

4.5.3 Information needed

Some participants were voicing out that more information at a departmental level would

help to empower students and to avoid or minimise risks:

I also think that if we would have proper channels to follow we would make informed

decisions like apparently, I also myself do not know like if you one of those people who

struggles financially as in like anything whatever there are places to go to make a provision

for

…Youth is not well informed in regard to health and when it comes to sex because what we

do we just do for the fun of it not the consequences that might happen after. (FGD4)

Some participants were still blaming their families and their high schools, claiming that the

information was inadequate for them:

…if there was someone to say that if you engage yourself in unprotected sex you going to

have such and such not just pregnant, people know the common ones even sometimes when

you are labelled to be the outcast, you know when you are not sexually active yourself, you

will be labelled as outcast. (FGD1)

..if I particularly back then seriously well informed maybe my decision in life would have

been different towards the decision that I have already taken regarding the subject at hand.

If the teacher was teaching me at the time with more forceful in terms of you need to know

this and you know…even if we were writing exams because I do not remember us writing

like this being included or something serious other than that…(FGD4)

Another participant, who was a peer educator, revealed that there is still more work that

needs to be done around our HEIs:

Yes I feel as maybe as peer educators we do our best but not as peer educators only but the

whole campus we are doing our best there is internet, these key people of high intelligence

they know how to use computers they know that even on TV I think there is enough

knowledge but the problem is the practise I think that is where the problem is so we feel

that there is enough information even though the practise is not taking place that is the

biggest issue here especially for me as a peer educator. (FGD5)

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4.5.4 Education needed

Participants were open about the fact that they want fun, educational activities and flexible

approaches to sexuality. Some participants suggested the introduction of health and sexual

education in departments to avoid boredom. This would assist them to make better choices

in life:

…I think when you open a dialogue to talk about issues and then you realise no man I was

actually I had fear of nothing and you do not know you are scared of something that you

do not know so if you don’t know anything about something then you will be scared of

because you don’t know, but now if there’s dialogue, no man you can’t. (FGD1)

I think we should make it more fun like we have activities and educational ones not too

formal or serious also people if you approach them too seriously you already turning them

off. (FGD2)

…I think more awareness is needed and also awareness that are not too serious because

people get bored with these serious kinds of awareness, come with the awareness that will

make them interested and squeeze in this one because it is a reality that we can never run

away from. (FGD5)

It was better if we had a corner in the commerce building about raising HIV awareness I

think people would take more interest when we notice that something like that is going on.

(FGD4)

… it’s like maybe introduce more activities to the youth….and maybe try to engage with

them and maybe keeping our youth busy… (FGD1)

Some participants acknowledged the role of social media in assisting with education and

communication. This is how they elaborated on this issue:

I also think the media played a big role in terms of like combating the stigma because

they’ve realise that many black households we don’t speak about such staff so they bring

those into our homes through watching the soapies and scenarios so that we can talk about

HIV/AIDS and whole lots of telly topics that gets the conversation going one way or the

other. (FGD1)

There were some participants who were still confused about sexually transmitted

infections:

And you cannot get like STI through sexual intercourse only some of them you can get them

through like the toilet something like that. (FGD1)

Okay HIV is in the immune system and infections are not in the immune system. (FGD2)

4.5.5 Uninformed decisions

There were many reasons that were raised by participants that contributed to their

uninformed decision-making:

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Definitely alcohol abuse, drug abuse, the numerous events that take place the social events

I guess also being free the concept of being free no parents no one is telling you what to

do at certain time you do anything anytime you want no one is guarding you I think those

are the contributors. This not caring about one’s health and trying to be cool about the

next person or people I think these are contributors…(FGD3)

Also the university students especially those who stays at res we know what happens there

we know how exposed we are and today’s youth want to experiment and experience

everything so it goes back to the three some and what-what. (FGD2)

..if you know that you don’t have a IPhone or you don’t have that thing let alone the

material things, they must leave you…..if you are here, don’t accept any favour because of

sexual favour…or you must go through a sexual process and then those people must abuse

you, no man, so if you are accepting your situation and you know that you are poor and

you are working towards having your own things…….then go through that process…just

accept your situation, let the material benefits go. (FGD1)

4.5.6 Partner testing

The participants themselves confirmed that talking about testing with your partner, is a

delicate issue:

And also like it’s not easy you cannot just say to someone lets go test some people are very

sensitive on such issues so it’s easy for them to feel that you disrespect them you do not

trust them and trust is another thing in a relationship…(FGD5)

...I hear a lot of people saying whenever they ask their partners to go and test with them

they like is there anything like if I were to ask my boyfriend if I had a boyfriend lets us go

and test together he will ask why do you want to be tested are you not sleeping with me

alone or is there anything you hide and it is not because you do not trust yourself but it is

you guys be both on the better position of knowing each other's status. (FGD3)

The participants confirmed that partners do not want to test but rather, they rely on their

partner’s status to determine theirs:

I would also like to agree with you in terms of ignorance when it comes to sexual

behaviours ignoring that we might actually run the risk of contracting HIV/AIDS and the

system we talked about that if my girlfriend is negative I am also negative of which is

incorrect you cannot test by somebody else you have to go by yourself and find out that you

are really negative so in that sense I would say that you really negative. (FGD2)

Some participants revealed that the students do go and test but only if there is an incentive.

This is how they discussed the issue:

At the beginning of the year there is usually at the student centre I do not know if it's there

now I usually hear at the beginning of the year, there are people who test HIV and this

year they were giving away R50 voucher so people went to test because they were receiving

something in return not to test to see if they have HIV or not but because of something they

are getting. (FGD3)

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Some went to test to get a USB. (FGD3)

4.5.7 Teen pregnancy

Participants revealed that being sexually active started at lower grades and have advanced

to HEIs, hence the increase in the teen pregnancy rates:

…the core of everything starts to primary in high school I get to see this guy everyday I’m

dating someone who is in class or it’s more ja…(FGD4)

In my first year here my friend was already pregnant in March first year at university but

everywhere you go there are condoms it is really have to do with ignorance. (FGD3)

these past days I saw an article of a Ten- year- old girl with a child, she is having a child

and I was wondering a Ten-year-old-child with a child that means that the youth today is

more reckless they just want to explore these things. (FGD2)

4.5.8 Condoms

Some participants voiced that some young people do not want to take ownership of using

condoms:

What I am saying is that we know there is female condom there is a male condom if a lady

feel like want to practise safe sex and they want to be healthy its either you carry a male

condom and you encourage your partner to use a condom or you use your female condom

I am sure you have been taught on how to use that and I am not talking to you ladies I am

not specifically talking to ladies in general but they just do not use them. (FGD3)

Some participants pointed out that they do not trust condoms:

In my opinion I think that everyone who is sexually active is at risk that is how I see not

necessarily say it is like this I see it as everyone who is sexually active being at risk of

getting HIV because we can never be too sure about anything even the use of condoms can

never be sure because anything can happen so everyone is at risk. (FGD2)

I mean we are all not safe and we cannot trust condoms they are not 100% either so ja.

(FGD4)

There were some participants who still have confidence in condom use:

I think there is a change with these flavoured condoms because most of the students are

using them and if you can get in the unit there is a box there on weekends that box is empty,

so they are using them now but when there was no flavoured condoms that box was always

full, but I think there is a change now. (FGD5)

Some participants pointed out that condoms bring about trust issues in the relationship:

..if you propose a condom to a guy he will think you do not trust him.(FGD5)

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4.5.9 Abstinence

The participants have revealed that they knew about the A, B, C Education, A (Abstinence),

B (Be faithful) and C (Condomised); although they are still not practising it. This is how

they remembered abstinence education:

I’m thinking about another thing now, when we were growing up, when we first heard

about these things of HIV/AIDS, they used to say there was something called “A, B and

C”, therefore I think it was that “B” that spoiled everything, because they would teach you

whilst you are still young to be faithful. (FGD1)

I abstain only when I feel like I am ready then I will go on contraception. (FGD3)

…if ABC were introduced Abstain, Be faithful and Condomise, this did not work people

are not faithful you try by all means but they are not but you know that condom is always

a choice…(FGD5)

4.6 THEME 3: ATTITUDE

There is so much evidence that norms and attitudes towards gender and sexuality are

shaped during childhood and during teenage years. Hence, an attitude has been described

as a learned tendency to assess effects in a certain way. These norms and attitudes are the

drivers of sexual behaviours amongst youth (Kambole, 2007:4; Svanemyr et al., 2015:13).

4.6.1 Towards HIV/AIDS awareness campaigns on campus

The participants acknowledged that there are campaigns around the campus, but they

choose not to attend them. Students think that they will be forced to test to find out their

HIV status. One of them stated that:

…every time there are awareness’s we always ignore them because of testing, here at

varsity, they have been talking about testing, but we do not care. (FGD1)

Some participants were saying that awareness campaigns are not well marketed.

Sometimes they hear about them but they still miss out because they did not know about

them in advance:

“No, we are not informed but I went to the other one at res it was about HIV”. (FGD4)

Some of the peer educators, who were part of these FGDs, stated that when they try to

speak to some students about health issues around the campuses, there is always an

assumption that they are HIV positive. This is how the peer educator explains it:

Pregnancy, HIV, STI those are...I think maybe if I am speaking to them they see a peer

educator they think I am speaking about HIV whereas you could have flu and need to go

to the clinic but because she is talking about this so obvious people will think that I have

HIV. (FGD3)

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4.6.2 Poor service delivery at on-site student health services

Participants have raised concerns of not being accommodated at campus clinics in terms of

their health issues and their time tables. Doctors come on certain days and they must wait

to be referred:

I never tried to find the reason for this because the doctor that is there only comes for

certain hours and she leaves so I think they must try and get a permanent person there for

that post because I think that is the problem. (FGD2)

There is a suggestion box and I also feel that when you write something there and see you

dropping it immediately they open it and see it it's a student she said this and that so it is

not confidential or anonymous so they should put it outside not inside so that when you

outside you should write something and drops it there. (FGD1)

Some participants were concerned about the older health care givers, as they felt that they

cannot relate to them. Older doctors or nurses are chastising them. In men’s clinics, male

students prefer male doctors or male nurses:

…also you find that the doctor is very old (age) we would like to be seen by younger people

because the older ones in any clinic they always shout at you but if it’s a young person at

least you will also relate and down and sometimes end up talking about something else

whereas an older person will just shout at you so I think if they can bring younger staff that

will be great. (FGD5)

Some participants tend to differ with other participants in terms of the service delivery at

the clinic and the respect they receive. This is how they elaborated:

I would go to the campus clinic if you suspect you have an STI you would go to the campus

clinic and if you have an STI they will give you treatment and at some point they would or

might refer you to student counselling then you can be able to make informed decision or

they might refer you to peer educator if you are uncomfortable to speak with the counsellor

you are referred to Peers then you can choose who are you comfortable with…(FGD3)

The confidentiality is good because they assure you that even if you are here whatever you

are here for it won’t…nobody will know about it they even restrict friends coming together

the way they are confidential. (FGD4).

4.6.3 Health risks

Some group members were of the opinion that because they are newcomers, they do not

know what is happening around the campus:

I would not know because we still fresh and do not know other students but ourselves ja I

do not know. (FGD4)

…. the youth of today is not really safe they do not take care of themselves in terms of

sexual relationships or in any sexual activity that they participate in, they always trying to

be liberal everyone is trying to be liberal in nowadays…(FGD3)

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Other students acknowledged that young people are more vulnerable to risks, than any

other people:

I think even the reason that there were units like HIV/AIDS, student counselling was

because the statistics have shown that at university at primary or high school they noticed

that is where the rate is higher at young people and there is a certain age of young

people…(FGD5)

… I think today’s youth has been more reckless in terms of their conduct with respect to

sex and whatever. (FGD2)

4.6.4 Health services referrals

Students showed a negative attitude towards the referral system and appointment system

of the campus clinic. Students do not understand that the referral system can only be done

by a doctor. Emergencies at the clinic depend on the severity of the problems:

Like if you go there like in the morning let's say at half past eight in the morning and you

have a class they will book you for your free time let's say you are free at 11:30 they will

book you that time rather than seating there for the whole day at the end of the day you are

not getting what you wanted to get. (FGD3)

Sometimes you find that you have classes and you say what if I book at two, then they said

that no you can’t book at two……it can’t be like……you show them your timetable and I’m

very busy I won’t have time to come here, can I make bookings for tomorrow, they say no

you can’t book for tomorrow you supposed to book for today I don’t understand why can’t

you book for tomorrow the students are busy just like everybody else you can’t exactly

eemmm……predict when are you going to get sick, the first thing that they are going to ask

you is that do you have an appointment? You don’t have an appointment come back at

seven o’ clock, that’s a problem for me. (FGD1)

In terms of I think if the university can make more resources available to our clinic and not

have only a certain doctor who will tell you that I am not specialising in this area you can

go to another clinic at least it can have different doctors and have own x-rays in the campus

because now if we are sick we go for an x-ray in Groote Schuur and you take the whole

day there and sometimes they will tell you to come back or they will admit you of which if

they have those equipment’s here in school they can check you and only refer you for

traditional hospitals but already identified what is the problem, so I think in terms of

resources more staff and make the venue bigger than it is now I think that will kind of assist.

(FGD5)

4.6.5 Stigma and judgement

Students are still afraid of being seen entering the campus health clinic:

My thing is within that building there is student development, student affairs, counselling,

financial aid, so why the clinic have to stand out what if you are going to counselling or

financial aid, so when you hear such talk clearly there is something deeper than what she

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is saying maybe they say I saw so and so going to the clinic for ABCD that is why we draw

the conclusion that if I go to the clinic they will think I go for HIV or I am pregnant it is

really weird that it stick out on its own while there are other offices in the building. (FGD3)

I also think the media played a big role in terms of like combating the stigma because

they’ve realise that many black households we don’t speak about such staff so they bring

those into our homes through watching the soapies and scenarios so that we can talk about

HIV/AIDS. (FGD1)

Some students revealed that, although communities have been taught, there is still more

education needed around stigma, when people hear about HIV/AIDS:

I would like to say people act for me honestly because people in the communities they

pretend that they understand and in the public they understand but you cannot confirm that

sometimes people act like they understand it but they not for instance if my child would

have HIV and now I tell the school for safety other parents would have an issue with it and

they would not say direct to me or teacher they will probably take it to the SGB to say we

do not want the child here and they will make up and they will not say directly that the

child is going to infect other kids and they try to make means so I feel for me that

communities in my personal opinion for now they are acting they know it is there but they

are acting. (FGD5)

4.7 SUMMARY

This chapter presented the results that were obtained from the data collected in the FGDs.

The biographical data of the participants was summarised. The themes and subthemes

which emerged from the transcribed data were presented. The following chapter will

discuss and report on the results from the study and it will be relating the findings of this

study to the literature review and the theoretical framework.

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CHAPTER 5

DISCUSSION OF RESULTS

5.1 INTRODUCTION

This chapter will be discussing the results of the focus group discussions’ (FGDs)

responses of this study. The aim of this study was to explore potential health risk factors

amongst students at an Higher Education Institution (HEI) in the Western Cape with regard

to sexuality and HIV/AIDS.

5.2 THEMES

The five FGD’s were conducted and recorded in English. The numbers of the research

participants in each FGD were between five and eight. The following themes emerged from

the data analysis according to the objectives and research question that were set out to be

achieved in this study.

5.2.1 Theme: 1 Contributing factors to risky behaviour

The risky behaviours of the students in the HEIs are greatly influenced by many social

factors. Among their responsibilities and priorities as students, they are faced by

interpersonal processes like succumbing to peer norms, socio-economic background, social

status and other factors.

5.2.1.1 New-found freedom

The students, who were the participants, revealed that being away from home gave them a

sense of freedom at HEIs. Other students indicated that they could not wait to be away

from their parents so that they could be on their own. They also wanted to be autonomous

and free in order to make their own decisions. This relates to the individual student

perceptions relating to the HBM, as the model states that behavioural changes take place

by shifting potential risk producing situations, risk perceptions, beliefs and outcome

expectations (King, 1999, as cited by Tarkang & Zotor, 2015).

According to Myer et al. (2012:9), universities have the tendency to give this freedom and

autonomy to students during this transitional stage. Parents are not there to guide and

reprimand them. When these students arrived at these HEIs, they feel that sense of

adulthood, although they are not adults yet. Status Update (2018:2-3) reveals that these

students are supported as they begin their vision and journey into HEIs, regarding

academia, socialising and making new friends and acquaintances and adjusting culturally

and mentally. Hence, orientation programmes at HEIs play a major role in assisting these

students to adapt to their new surroundings and new-found freedom (Status Update, 2018).

However, it also reminds them about this freedom without experience and how it can

impact their future at university. Additionally, it reminds them that this new-found freedom

comes with responsibilities as a young adult (HEAIDS, 2017:4-5; Status Update, 2018:2-

3).

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Dube, Hallett, Gregson and Garnett (2005) as cited by Myers, Kelly, and Motuba (2012:9),

agree by stating that this new-found freedom is full of prospects. Nevertheless, these

opportunities can include sexual activities, alcohol and drugs, which could impact their

future negatively, if they are not mature enough to handle the pressures from fellow

students. Brook, Fergie, Maeorg and Michell (2014:3), state that universities are seen as

places of multiple, complex and diverse social relations, identities and communities. As a

student, you have all these freedom and choices in front of you, followed by consequences.

5.2.1.2 Reckless behaviour

Students admitted in the FGDs that they do act recklessly and engage in activities that put

them at risk of contracting HIV/AIDS and other STIs. According to HEAIDS (2017:4), life

in the HEIs comes with the logic of being carefree. As a student, the only responsibility is

to concentrate on your academic studies and learn to be professional whilst your future is

crafted. Furthermore, they do not have to think before they do things, as one participant

expressed himself. Students in one group believed that HEIs are the right platform for

sexual activities. This is confirmed by LatifnejadRoudsari, Javadnoori, Hasanpour,

Hazavehei and Taghipour (2013) as cited by Hedayati-Moghaddam, Eftekharzadeh-

Mashhadi, Fathimoghadam, and Pourafzali (2015), people at age 15-24 (mostly secondary

and university students), involve themselves in high-danger activities, particularly high-

risk sexual activities, without considering consequences. LatifnejaRoudsari et al. (2013)

added by saying that if these behaviours are not contained, they can contribute to the STI

and HIV/AIDS epidemics in HEIs.

This is in line with the HBM, as these behaviours are promoted by modifying factors like

demographics and socio-economic factors. These students are coming from different

provinces, which in turn can also be divided in rural and urban communities. For some of

the first years, entering HEIs means their first time of being in a city or urban town. This

is all too overwhelming, hence they have individual uncertainties of how they would be

treated by their fellow students, if they do not conform to what everyone is doing at HEIs

(Wirtz, Kamba, Jumbe, Trapence, Gubin, Umar, Stromdahl, Beyrer, and Baral, 2014). The

likelihood of perceived benefits in taking preventative action, instead of succumbing to

peer pressure, is perceived as a barrier. HBM’s perceived risk and effect are individual’s

views or beliefs with regard to the risk of developing a health problem and the potential

negligence and consequences of the health problem based on their background, for example

age, sex and geographical location (Janz & Becker, 1984;11:1-47, as cited by Wirtz et al.,

2014). In some of these students, these are new behaviours as they are away from home

and they have peers to please. SCT regards learned behaviours through witnessing, as some

of these students are imitating their friends (Bandura, 1986). Bandura thus concurs with

the modifying factors of the HBM, that advice from peers in similar situations and

information from media, adds to the psycho-social variables that make students indulge in

high-risk behaviours (Tarkang & Zotor, 2015).

5.2.1.3 Alcohol and drugs

According to Burke (2010:26) as cited by Mbatha and Ally (2013:2), when alcohol is

abused, it may have many consequences such as crime, accidents, unprotected sex,

unplanned or unwanted pregnancies, contracting STIs and HIV. High-risk behaviours

because of alcohol and drug abuse in HEIs, were cited many times by students. Some

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students acknowledged that when there is alcohol, they have a habit of drinking too much.

This causes them to end up doing things that they did not want to do. These included

unprotected sex, group sex and drug use. These risky behaviours were unplanned, but

because they were intoxicated with drugs or alcohol, they lose all inhibitions and do not

realise the seriousness of the implications of these high-risk behaviours, which are

perceived threats of STIs and HIV and AIDS (Skinner, Tiro, and Champion, 2015:75). This

leads to uninformed decisions because the judgement is diminished by alcohol and drugs

and constitutes major barriers to preventative action or measures.

The HBM cues to actions requiring motivation from the individual to conform with the

prescribed remedy, be it to be involved in health education activities or peer support groups

(Tarkang & Zotor, 2015). Bandura (1986) talks about perceived self-efficacy, referring to

people’s judgement of their ability to arrange and perform specific behaviours that are

required to deal with different forthcoming situations. This “self-belief” about the student’s

capacity, influences how they behave and how much effort will be spent in changing their

behaviour (Bandura, 1977, as cited by Tarkang & Zotor, 2015).

Burke (2010:26) as cited by Mbatha and Ally (2013:2), further revealed that absenteeism

is rife amongst students and the failure rate at HEIs is high. This further leads to high drop-

out rates of students at HEIs. This contributes to the psycho-social factors of poverty and

depression, as these drop-outs becomes a burden to their already impoverished families, as

well as the tax payer. According to McCormarck (1999) and Onega (2000) as cited by

Tarkang and Zotor (2015), HBM’s modifying factors involve socio-psychological factors

like peers and socio-economy. Furthermore, they mentioned that these variables can

influence the individual’s perception which leads to one’s health-related behaviour. The

socio-psychological factors, for example, would influence the student’s perception of

vulnerability to HIV and the seriousness of getting HIV due to alcohol’s influence. These

students then develop no sense of agency and credibility, as they have a low self-esteem

(SCT-Bandura, 1989). Alcohol and drugs are a serious public problem, when someone is

addicted to them. The person might need professional help, because the problems can be

clinical, psychological and physical. Amongst young people, it is associated with negativity

and it is commonly followed by high-risk behaviours (Abbasi-Ghahramanloo, Fotouhi,

Zeraati, and Rahim-Movaghar, 2015:5) and (HEAIDS, 2017:50).

5.2.1.4 Peer pressure

The students quoted the impact of peer pressure and influences when arriving at HEIs.

Students mentioned that having a sexual partner or an older sexual partner (blesser), is the

requirement to ‘belong’. They also stated that if you do not adhere to these requirements,

you are regarded as someone who is living in the ‘olden days’. The HEIs’ environment has

made the students rely on their peers for advice. That advice would be such as “it is cool

to have multiple partners or group sex”. Tildesley et al. (1993:28(9):853-80) as cited by

Abbasi-Ghahramanloo et al. (2015:5) revealed that pressure from peers and friends to

conform, are the most common factors that can influence high-risk behaviours amongst

young people. Tildesley et al. (1993:28(9):853-80) describe youth as people who can be

influenced by their peers easily. This is a result of wanting to be part of the group. They

often advise each other inadequate information and make uninformed decisions based on

the information from a friend. Most of the time, these decisions lead to high-risk

behaviours.

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Vember (2013:115) concurs with Tidesley et al. (1993:28(9):853-80) that young people

get 70% of their sexual information from their peers, whether correct or uninformed. It was

evident that through this advice, the students were witnessing other behaviours (right or

wrong) and imitating their friends. This is in line with one of the concepts of SCT, namely

role modelling. Participants cited transactional sex as a common practice amongst the

students. Some of them confirmed that they could not resist it because everyone was doing

it and there were expensive gifts attached to it.

5.2.1.5 Multiple partners

All the students who participated in the FGD’s, expressed that having multiple sexual

partners was a fashion in HEIs. They also mentioned that it was not just a certain gender

that is doing it, but everybody. Some students added by saying that there is nothing wrong

with having multiple sexual partners. There was even a term that students were using to

refer to multiple partners “Pause life”. According to Caetano, Linhares, Pinotti, Maggio da

Fonseca, Wojitani and Giraldo (2010:43-46) as cited by Min-Chen, Liao, Liu, Fang, Hong,

Ye, Li, Tang, Pan. and Liao (2016:6-8), having multiple sex partners is one of the greatest

significant causes in acquiring HIV infections and STIs. A survey that was done in 2000

by the Ethiopian Demographic Health amongst unmarried individuals showed that multiple

sexual contact amongst single people is very common, particularly amongst young people

aged 20 and above (Mengistie, Wolie, Abawa, Ebre, Aderan, 2015:597). Vember

(2013:117-118) revealed that the HEIs peer educators are trained and are well equipped

with information and knowledge that is related to multiple sexual partners. Yet, in a study

done by her in 2012, 14% of these trained peer educators at HEIs still engaged in multi-

partner sexual activities. HEIs offer different workshops where students participate in

numerous awareness programmes across all campuses. However, they do not practice safe

sex and still have multiple sexual partners.

Vember (2013) and Mengistie et al. (2015) research relates to the modifying factors in the

HBM of knowledge and support. Even though knowledge is being imparted through

various peer education training programmes, VCT and other HIV/AIDS related campaigns,

students still put themselves at risk by indulging in these high-risk behaviours. Students

still fail to see the perceived benefits of preventive action, versus the high-risks that they

take all the time (Tarkang & Zotor, 2015). The students revealed that when they attend

parties at HEIs, or visiting nightclubs, they end up in a one-night stand with a casual sexual

partner. They have also mentioned that when they attend these places, they do not plan to

get casual partners or one-night stands of sexual contact, it just happens. According to Myer

et al. (2012:10), A HEAIDS’ study discovered that sexual contact and especially casual sex

partners are triggered by alcohol and drugs. Once again, students tend to ignore the cues to

action in taking preventative measures but put themselves at risk of contracting STIs and

HIV/AIDS (Wirtz et al., 2014).

According to the South African Department of Social Development as cited by HEAIDS

(2017:50) people who are using substances are suffering from serious health and socio-

economic difficulties. They added that in South Africa, young people aged 15 and older

consumed more alcohol than any other African countries. This leaves the students in

vulnerable spaces, where unplanned casual sex happens, as stated by participants during

this research. Furthermore, experimentation, boredom, peer pressure, lack of recreational

facilities and poverty, were mentioned as contributing factors in most of the focus group

discussions. Spending time with people who are substance abusers can lead students to the

same behaviour, as young students easily succumb to peer pressure (HEAIDS, 2017:50).

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SCT alludes to credibility (Bandura, 1988) and young students seek this from their friends,

as was clearly revealed in this study. So, in order to be regarded as credible, one needs to

be ‘in with the crowd’, hence participating in high-risk behaviours, sometimes knowingly

and other times, unknowingly, as some of the participants shared in the group discussions.

5.2.1.6 Early-stage sexual engagement

Another group of students revealed that sexual engagement happens very early in their

lives and that it all started even before they entered the HEI. Some students agreed by

saying that it was like a competition to be sexually active at 13- and 14-years-old. Mengistie

et al. (2015) is in agreement by saying that sex experimentation starts with teenagers. This

stage is characterised by reckless, risk-seeking behaviours. Denno, Hoopes and Chandra-

Moulie (2014) state that compared to the past years, boys and girls reach puberty

prematurely, hence these young people start experimenting at an early stage with sexual

activity and put themselves at risk of contracting HIV and other sexually related infections.

Their bodies developed much faster and physically they feel more mature, hence they think

they are ready for sexual activity. Additionally, they mentioned that risky sexual

behaviours and reproductive health problems amongst teenagers can have serious

permanent consequences in their adulthood. They further added by saying that those

problems could even affect their generations negatively (Denno et al., 2014:2; Seloilwe et

al., 2015).

The ecological model states clearly that the relationships should be improved amongst

individuals, families and sexual partners, to assist these students to make informed

decisions regarding their sexuality (Svanemyr et al., 2015:S8). It reveals that to improve

and build strong healthy relationships, a focus should be on supporting these students

psychologically and creating enabling environments for them to establish their own

identities and to develop into responsible young adults, who will take responsibility for

their own sexuality. This could be done by giving realistic advice either in support or

disapproval of their relationships.

Participants mentioned in the FGDs that parents and guardians tend to chastise them, when

they disapprove of friendships, instead of having an open conversation with them.

Furthermore, creating comfortable and relevant conversations around sexuality, would

promote positive attitudes, create positive social norms and safe sexual behaviours. This

could include partners, parents, peers, HEIs and other sexual partners because these are the

people that influence their sexual experiences (Krug et al., 2000, as cited by Svanemyr et

al., 2015:S8).

5.2.1.7 Transactional sex

Transactional sex was cited by most students during the interviews as a common practice

in HEIs. Some students said that circumstances around them force them to do it. Poverty

and hunger in HEIs residences, were mentioned as a reason. Some students indicated that

transactional sex is not only about monetary value that is exchanged. It also involves the

buying of food, gifts, lace weaves and expensive cell phones. Myer et al. (2012:11) agree

that the incidences of multiple and simultaneous partnerships are influenced by poverty.

This concurs with the modifying factors of the HBM (Tarkang & Zotor, 2015), as it cites

poverty as one of the major factors as to why young people find it difficult to take

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preventative measures in contracting diseases like HIV/AIDS and STIs and put themselves

at risk to health factors.

Students also do not perceive the seriousness of these diseases, as they are so focussed to

get out of the poverty trap and to be in line with their peers (Tarkang & Zotor, 2015). In

these occurrences, older sexual partners (blessers, ‘sugar daddies’ or ‘mamas’) take

advantage as they are aware that some of these students are beautiful and needy. They

entice them with expensive gifts in exchange for sex. According to McCoy, Watts and

Padian (2010:1281-1282); Yan, Chen and Wu et al. (2009) and Yan, Li, Bi, Xu, Li and

Maddock (2010:767-782) as cited by Min-Chen et al. (2016:8), even recently, there is a

surprising number of female students from Chinese high schools and in universities that

are involved in transactional sex with older men during their spare time. Minister

Motsoaledi, the Minister of Health refers to these men as “evil men”, as they entice students

with a luxury lifestyle (Motsoaledi, 2018:4). However, there were some students who were

against transactional sex during the interview session. They stated it as prostitution.

According to the Minister of Higher Education and Training, Dr Blade Nzimande (2014),

a lack of skills, training and financial distress of HEI students, were some of the priorities

for the government. The minister was pledging, with all the stakeholders including National

Student Financial Aid Scheme (NSFAS), to assist in improving the life of the students,

financially (Nzimande, 2014).

5.2.1.8 Unprotected sex

The students acknowledged that their sexual life is endangered, and they are not taking

responsibility for their own lives. This is in line with the unlikelihood of taking

recommended preventative health action, despite having the knowledge and support

systems on HEIs. The HBM cues to action require motivation from the individual to

conform with the prescribed remedy, be it to be involved in health education activities or

peer support groups (Tarkang & Zotor, 2015).

Other students uttered that safe sex is uninteresting. They described it as “tasteless”. Some

described protected sex as “someone who is eating a sweet with a wrapped paper”.

According to Navarro-Cremades et al. (2016:8), female students prefer not to practice safe

sex because they want to reach an orgasm in a natural way. Furthermore, they revealed that

these women want the sensation of better contact during sexual interaction. However, the

unsafe sex leads to the risk of STIs and HIV.

According to Kelly (2001:1-4), students in African universities are not practising safe sex.

Kelly further mentioned that high-risk activities are rife in HEIs. Hedayati-Moghaddam et

al. (2015) concur with Kelly (2001) by revealing that there is a high rate of unprotected sex

in different countries amongst university students. The students are experimenting with

casual sex and multiple partners without condoms. The participants in the FGDs also

mentioned that the students discuss the misconceptions amongst themselves and they tend

to go and practice these misconceptions to prove them. In this process of proving them, the

delusions of the unprotected sex are practised. The students also mentioned that sex with

condoms, was boring and the condoms are not 100% safe. On the contrary, Brown et al.

(2012:48 & 98), has clearly explained that condoms are effective in preventing STIs and

unplanned pregnancies and their quality is tested for the strength, leakage and lubrication.

This clearly shows that there is a crucial need of continuous sexual education amongst these

students, to remove the misconceptions and to support the growing education about the use

of condoms.

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5.2.1.9 Lack of communication with parents

According to the students who participated in the FGDs, parents and teachers are sceptical

to talk about sex, sexual health and reproductive issues with their children and

learners/students. According to Vember (2013:115), it was discovered that 70% of the

students received most of the information about sexuality from their friends. There were

nearly 50% of students that reported that they do receive information from home

(parents/guardians). Only two per cent of these young people reported their lectures as a

source of information. Vember (2013) added by stating the alarming concern about the

truth of the information from the friends. Furthermore, the lack of these communications

could impact negatively on the integration of sexuality and HIV/AIDS into mainstream

curricula in HEIs. The students highlighted that even at their high schools, teachers would

always try to avoid these issues. Some students also mentioned religion and culture as a

blockade, when it comes to sexual talks. Culture, tradition and gender issues are also stated

by the HBM as a barrier for important role players, like parents and teachers, to

communicate to children on these important issues of sexuality and HIV/AIDS. Tung et al.

(2015:879) reported that in Taiwan, family members and health professionals talk about

sexual issues with their youth the least because of their culture. However, teachers are

regarded as reliable sources of information because they are respected as part of Taiwanese

traditional ethics. This is in line with SCT when it refers to role models. These students

saw their teachers as role models.

However, at HEIs, peers look at each other as role models. According to Seloilwe et al.

(2015), parents are supposed to be the first line of communication with their children with

regard to sexuality. This communication would assist in avoiding unwanted pregnancies,

contracting STIs and other early sexual activities. According to Kim (2007), and Kim

(2009) as cited by Seloilwe et al. (2015:5), there are some parents who initiate these sexual

talks with their children. Most of the time, it is those families who are knowledgeable and

well-educated. One of the barriers of sexuality talks between young people and their

parents, is the lack of information. With regards to school teachers, there are beliefs and

opinions that if you are teaching sex issues, you are encouraging sex (Bastien et al.,

2011:8:25, as cited by Svanemyr et al., 2014:S9).

Students in these FGDs also referred to their lecturers (academics) who were not

comfortable talking about sexuality and HIV/AIDS in the classroom. Orientation

programmes during these students’ first year at HEIs, should include all topics related to

sexuality and HIV/AIDS. Within the HEI, where this study took place, an extensive

compulsory “first-things-first” programme is conducted throughout the first term for all

first-year students. The programme aims at ensuring that taking care of one’s health, is the

first priority of every South African. It encourages health seeking behaviours and

enhancement of quality of life of young people through regular testing and screening of

HIV, STIs, TB, cancer and cardio vascular risks (HEAIDS, 2018:1). This programme also

includes extensive walkabouts and discussions with other support services on HEIs like

Campus Health Services, Counselling and other support services. However, this study

revealed that many students were unaware of such services on their respective campuses.

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5.2.1.10 Knowing the status of sexual partner

Most of the participants indicated that students were sleeping around with their partners

without knowing or finding out their status of HIV. Some students alluded that some

partners would go and do testing. However, they would not go back after three months for

a re-test. It was pointed out by the students that they trust their sexual partners. There were

assumptions that if your sexual partner was HIV negative, it means that the other partner

was HIV negative. Once again, it was clear that these students subjected themselves to

high-risk behaviours. Greene and Gary (2011), as cited by Svanemyr et al. (2015:S12),

revealed that there are gender norms and attitudes that are related to masculinity that are

disadvantaging girls and young women when it comes to discussing safe sex issues with

their partners. This finding concurs with the gender and culture issues discussed in the

HBM (Minugh & Rice, 1998:485). In this case, boys and men force these girls and women

to indulge in sex, without knowing their HIV status. Myer et al. (2012:) adds by stating

that increased HIV vulnerability, is as a result of intimate partner violence, rape and other

forms of gender-based violence.

5.2.1.11 Socio-economic background

According to the Minister of Higher Education and Training, Dr Blade Nzimande (2014),

the lack of skills and training and economic suffering of HEI students were of great

concern. The government pledged to improve the life of students financially (Nzimande,

2014). The effects of socio-economic background were cited many times by students. The

students revealed that coming from a poor background and for example, being expected to

dress a certain way, has made them vulnerable. The participants revealed that the students

were making uninformed decisions based on material things in exchange for sex. The

blessers (older sexual partners) were cited as a source of financial refuge and material

supplies. The blessers could be older men or older women. The students also reported that

students were not concerned about the HIV status of these blessers. All they wanted was

financial stability in order to live comfortably and above the bread line. Sallar (2009:3)

revealed that in regions where there is financial steadiness and all-inclusive implementation

of sex education policies, students tend to tolerate each other. In addition, the ecological

model, Svanemyr et al. (2015:S8-S9) ascertain the role of the communities among these

students. The community could assist to create positive social norms and promote safe

sexual behaviours. Access to sexual reproductive health education, involving institutions,

schools, neighbourhoods and work places, are of the utmost importance. Furthermore,

several interventions that focus on economic empowerment and reduction of poverty, could

assist in reducing vulnerability of these young people, whilst improving their financial

status and negotiation skills (Svanemyr et al., 2015:S8-S9).

5.2.2 Theme: 2 Knowledge

The HEIs are not only providing academic curricula, in order for students to achieve a

diploma or a degree but they also provide awareness programmes regarding HIV and

sexuality. This is one way to empower students with knowledge and life-skills to take care

of their lives socially. However, the students do not show interest to participate in these

awareness programmes, although they do not have insight or enough knowledge about their

social and sexual issues (Turnbull et al., 2016:9).

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5.2.2.1 Ignorant

The participants in the FGDs acknowledged that they did not show interest in any activities

that are happening around the campus. Some students revealed that they are aware of some

activities, however they choose to ignore them. Both males and females reported that

students desire sex so much that they do not care about having infections. Young people

generally enjoy a good life more than any other age groups. Hence, they ignore all these

educational and awareness activities around the HEIs. They are not thinking about the

potential health risks or the threat of diseases. Although they are equipped with knowledge,

the HBM cues to action require motivation from the individual to conform with the

prescribed remedy, be it to be involved in health education activities or peer support groups

(Tarkang & Zotor, 2015).

The students do not realise that these behaviours can affect not only their academic future,

but the rest of their lives negatively (Chandra-Mouli, 2015; Steinberg, 2008:5). Amongst

these students there were peer educators who were emphasising that students do not want

to learn, although there is so much that they are doing as peer educators.

According to Vember (2013:157-158), peer educators are trained and are well equipped to

impart valuable knowledge to their fellow students/peers. Peer educators engage in various

discussions on topics such as sexuality, HIV/AIDS and life skills on the residences, where

they attract a large number of students (Vember, 2013). Vember (2013) also revealed that

students enjoyed these discussions with their peers and requested that it should happen

more frequently. This concurs well with SCT.

Bandura (1986) talks about people learning from their own different understandings and

practices. The theory also reveals that people can learn from witnessing other people’s

behaviours around them. This puts young people in a perilous position regarding equipping

themselves with the relevant knowledge, as the theory foresees that with enough

knowledge of sexuality, young people are able to defend themselves from risky situations

(Bandura, 1986). However, despite intensive orientation and awareness programmes

regarding sexuality and HIV/AIDS, students still engage in risky behaviours, as was

evident in this study. According to Svanmeyr et al. (2015:S8), students can be involved in

high-risk situations but they do have the ability to control the high-risk behaviours, when

they are equipped with necessary resources, skills and knowledge.

5.2.2.2 Misconceptions

The students also reported misconceptions that are held around the campus. Some students

indicated that they have heard that for men to get HIV, they must indulge in unprotected

sex with someone who is HIV positive at least eight times. Other students added by saying

that they have heard that you could have unsafe sex with an HIV positive person, however

you could still not be infected. They revealed that if you are circumcised, you have a low

risk of infecting others with HIV. According to Majelantle et al. (2014:6), misconceptions

about the spread of HIV amongst learners exist and they vary according to their gender and

the level of education. They further added that more education is needed amongst these

students. Tung et al. (2015:878-879) was in agreement with the misconceptions and added

that students still believe that mosquitoes are a mode of transmitting HIV. The students

acknowledged that out of these misconceptions, students still do go and experiment as

illustrated in the following quote:

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I am sure that out of 10 people there is one person who has heard that you can sleep with

someone who is HIV positive and don’t get it and you will be like let me try this because of

the spare of the moment and then consequently you will get the virus thinking that you

would not get it so it’s the ignorance and also that ego that I do not know where it’s coming

from. (FGD5).

This response could mean that students are still not fully equipped and have inadequate

knowledge regarding sexuality and HIV/AIDS issues. These misconceptions are therefore

still not dispelled amongst students. These confusions may result in unprotected sex,

leaving them vulnerable. This is in line with HBM’s individual perceptions. An

individual’s perception that a health problem is personally relevant, will contribute to

taking vital action to prevent the health difficulty. The student’s motivation to take action

against a health-risk related issue, would be to understand the health risk. This would assist

them to make a health-related goal decision (Tarkang & Zotor, 2015). The modifying

factors also influence the student’s decision-making as some students do not know where

to find the correct information to clarify the misconception at hand. Sometimes the students

would walk around with a health problem, not wanting to disclose it, as they are afraid of

stigma. Janz and Becker (1984) as cited by Wirtz et al. (2014) has stated that HBM suggests

that the possibility of adopting the preventative action, is influenced by the individual’s

perception, modifying factors, cues to action and self-efficacy. Accessing information and

educational health activities as students suggested, would promote healthy behaviours.

5.2.2.3 Information needed

Nearly all students that participated in the FGDs, shared that they do not know where to go

on their campuses, when they needed advice. This included financial, health and social

advice. Some students were still blaming the inadequate information regarding health and

sexuality they have received from their families and from their school teachers for their

current ignorance. Amongst the participants, we had peer educators who were reporting

that as much as they themselves are working hard to assist all over the campuses, there is

still some more that is needed to be done, regarding awareness and orientation to assist

students on campuses. Some students admitted that they were not aware of student health

and counselling services on their campuses. They also revealed that the lack of information

is leading students to risky behaviours, such as transactional sex, multiple sexual partners,

unprotected sex, etc. According to Vember (2013:44), student life in the HEIs usually

creates social circumstances where the students find themselves in high-risk situations or

environments. In addition, Svanemyr et al. (2015:S7), describe the sexuality of young

people as strongly influenced by many factors. Factors such as social, cultural, political,

inequalities and economical, play a major role in affecting the lives of students at HEIs.

These contribute majorly to the students’ weaknesses.

The ecological model regards building an enabling environment for the youth, involving

different stakeholders, such as families, community members, leaders, as well as policy-

makers. This is crucial towards the empowerment of young people in order for them to

understand their human rights. This will assist them to be able to negotiate their sexuality

and make informed decisions (Krug et al., 2000; Turmen, 2000; Gupta et al., 2008;

Brofenbrenner, 1979; Garbarino, 1985, as cited by Svanemyr et al., 2015: S7-S8). Seloilwe

et al. (2015) agree that parents are supposed to be the first line of communication with their

children with regards to sexuality. Although the universities provide this information, they

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need to identify that even adult students do not have enough knowledge on these issues

(Turnbull et al., 2016:9).

5.2.2.4 Education needed

Students requested fun educational activities to relieve their boredom and to occupy some

of their new-founded freedom. Students requested that more innovative approaches should

be embarked upon to educate them on sexuality on their campuses. They are ignoring the

usual awareness programmes and do not visit the mobile clinic as they find it boring and

rhetoric. The students revealed that some sexual issues are still difficult to talk about.

However, if there are dialogues and focus group discussions, where students can participate

in discussing the real issues around high-risk behaviours and sexuality, then it will be more

fruitful and worthwhile attending. Some students reported that they wish they can have

these discussions in their faculties. These educational activities would assist to eliminate

the boredom and promote informed decision-making. Tung et al. (2015:878-879) approves

the educational programmes, declaring that they would assist in decreasing stigma, whilst

promoting safe sexual decisions amongst these students. According to Rehle et al. (2010)

as cited by Myer et al. (2012:14), health communication programmes should be

trustworthy. They further added that these programmes should be relevant and be able to

create interchanges amongst the HEI students. In this way, students will easily engage with

their peers effectively, even in their lectures. Gacoin (2014) and James et al. (2004) as cited

by Ngidi et al. (2016:102), add that there is a need for the circulation of updated, accurate

education around sexuality and HIV/AIDS issues to empower the students and their

communities. The community mobilisation can nurture intergenerational statements in

support of young people. This can be done by involving communities in public education

efforts, inviting church leaders, traditional leaders, neighbourhood watches and other

different stakeholders. Engaging all these leaders in sexuality issues, will assist in

promoting positive attitudes, positive social norms and it can generate community support

(Kesterton & Cabral de Mello, 2010:7; Denno et al., 2015:56:S22-41, as cited by

Svanemyr, 2015:S12). SCT discusses experiences of people that are taught from their own

life lessons, as well as from others. The theory also reveals that people can learn from

witnessing other people’s behaviours around them, therefore young people can also learn

from older students’ experiences. According to SCT (Bandura, 1986), young people need

to have enough knowledge and experience in order to safeguard themselves against peer

pressures and risky situations (Bandura, 1986).

5.2.2.5 Uninformed decisions

All the participants reported many reasons that led them to make uninformed decisions.

Alcohol and drug abuse were cited many times by the students. The freedom of being away

from home and being allocated your own room, gave them a sense of being independent

and feeling like a real adult. This allows them to make their own decisions, without any

parents advising or reprimanding them. The peer pressures were also mentioned as they

were desperate to belong and to be wanted. Students want to be trusted by their peers. This

was leading the students to behave in certain ways, like dating an older man for material

gifts and transactional sex.

As HEAIDS (2017:50) stated, alcohol and drug abuse lead to serious health and socio-

economic complications. These problems lead these students to make uninformed

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decisions, because they are not sober-minded. The students are away from the supervision

of parents. They are exposed to other female students who are surviving by transactional

and unprotected sex for financial security. They were likely to join in as most of their

friends were doing it. The casual sex was happening unexpectedly, as a result of alcohol

and drugs and these one-night stands with casual partners, were unprotected sex as, they

were not planned.

Amongst some students, it was evident that although the parents were not there, their

parenting style had a substantial influence in the way the students were behaving and

carrying themselves at the HEI and amongst other students. Some of them said that they

were quite happy to be spectators. According to Bandura (1989), SCT speaks about learnt

behaviours through observations. The participants expressed that during weekends at their

campus residences, they would watch the beautiful cars that were visiting students. They

uttered that these cars belong to the blessers (older, rich sexual partners) and the students

would come back with expensive gifts. The participants revealed that it was difficult to

resist the temptation, as some would have expensive cell phones and weaves, hence,

‘everyone’ started to have a blesser.

Bandura (1986) adds that role modelling plays a vital part in the empowering of the

individual in new situations where one needs to make a decision. During the FGDs, the

students voiced that amongst themselves, it was easy to notice those that were raised well

and those who had role models. They were not easily influenced by peer pressure or the

circumstances at the HEI. As Tildesley et al. (1993:28(9):853-80) cited by Abbasi-

Ghahramanloo et al. (2015:5), stated peers and friends affect one another and contribute to

the most important factors regarding indulging in high-risk behaviours amongst young

people.

5.2.2.6 Partner testing

The students acknowledged that it was difficult to discuss the HIV testing with their sexual

partners. Some participants disclosed that it was a sensitive issue as the partner would bring

up issues of ‘trust’ and ‘disrespect’. Other participants revealed that some partners do not

test but rather rely on the other partner’s results. There is an assumption that if my partner

is HIV negative, then I am also HIV negative; forgetting the sleeping around without using

condoms. The students also revealed that they are scared to talk about testing, as they might

lose their sexual partners and the benefits attached. According to Montaner (2011), as cited

by Myer et al. (2012:13), most people do not want to go and do HIV testing, especially

men and those who are aware that they might be infected with HIV. This is a serious risk

behaviour, as it put students in vulnerable situations as some of these students depend on

certain individuals financially. Some students revealed that they are scared of knowing

their HIV status, that is why they rather ignore the campus awareness programmes, as

stated in the quote below:

You know what there are lots of things that we don’t know, because the minute we see T-

shirts and tents, we know that they are testing, and you don’t want to know because the

testing is done publicly, and you are scared of your reaction. I wish they can be strategic,

no testing rather encourage us to go to the clinic for testing. (FGD1).

It was evident in the response that these students are misunderstanding the facts. They do

want the information, but they want it in strategic ways. Hence, they were suggesting

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dialogues, focus group discussions and fun educational activities. The lack of information

is placing these students’ health in a compromised position.

5.2.2.7 Teen pregnancies

The students said that the prevalence of teen pregnancies is the result of early sexual

interactions amongst the youth. They have confirmed that their sexual interactions were

not a sudden development at HEIs. It all started at the lower grades, prior to entering the

university. Participants shared that there are young people from primary schools who gave

birth already. Although condoms are free and are everywhere, they are not used. They have

confidently recognised that the youth is irresponsible. This is confirmed by Mengistie et

al. (2015), who said that youthful age is the stage where young people experiment with sex.

Whilst they are experimenting, they are confronted with many high-risk situations, such as

contracting HIV, STIs, unplanned pregnancies and illegal abortions. Patton et al.

(2012:379:1665-75) as cited by Chandra-Mouli et al. (2015:S2), reported that most of the

adolescent births happen in developing countries. They added by saying that Latin America

is faced with 18% of these births, while sub-Saharan Africa is dealing with 50% annually.

According to Turnbull et al. (2016:13-19), the students have been given sexual knowledge

and contraception through education and orientation. However, these young people were

complaining that the information that they were given, was insufficient. Additionally,

Turnbull et al. (2016:9) also stated that in this century, the rate of unplanned pregnancies

and STIs, have increased drastically. Therefore, sex and relationship education provided at

schools, is not enough. This means if this knowledge can be integrated into curricula by

allowing students to participate in group discussions, projects and assignments, students

would learn and benefit more. In this way, credibility would be demonstrated through

determination, reflection and observations. The students want these discussions in their

faculties. This education would assist them to make informed sexual decisions, together

with their families and their communities. Some students shared in the groups that there

are no such information sessions happening in the rural areas where they are coming from.

They suggested that this kind of information would be easily transferred amongst the peers

and in work places as some of them are full-time employees (Polit & Hungler,1997:304-

305, as cited by Jooste, 2018:351).

5.2.2.8 Condoms

It was pointed out that young people do not want to practise safe sex. The participants

testified that the students do not want to use condoms as students stated that condoms are

unreliable. They cannot be trusted 100%. Although some students still believed in the use

of condoms, they were saying that it brings trust issues in their sexual relationships. Other

students revealed that they have noticed an increase in the use of condoms and that the

students use flavoured condoms. Even in the bathrooms, the boxes of condoms do not last

for a long time, meaning that if an individual believes that condom use will help to prevent

HIV or taking a test will assist in early diagnosis, he/or she would benefit (Tarkang &

Zotor, 2015).

HBM relates to individual perceptions about health. It will assist to understand what

influences the participant’s perceptions, their beliefs, behaviour, knowledge and attitudes

towards HIV/AIDS and related sexuality issues. The significant psycho-social factors

about condom use, are the student’s willingness to use a condom and the support from

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parents about condom use. This might help in personal responsibility and choices that the

participants make to prevent themselves from contracting HIV and STIs or putting

themselves at risk to acquire these infections. This would be a benefit to students and to

families as it will be a preventative measure (Tarkang & Zotor, 2015). Skinner et al.

(2015:75), have confirmed that the HBM has been used to foresee preventative health

behaviours and it has worked for sexual behaviours, respectively. It is important for HEIs

to understand that students do have a social life. When health behaviour is addressed,

students need support and encouragement without judgement. The HBM is relevant for this

research because it deals with individual behavioural changes.

5.2.2.9 Abstinence

The students remembered that when they were still young, they were taught about the

abstinence (A), be faithful (B) and condomise (C) premise, although they were saying that

they did not understand it because they were too young at the time. Some students reported

that they do have choices if they do not want to abstain. They said that they can just use

contraception. Abstinence was perceived as prevention from unwanted pregnancies. There

was still confusion between abstinence and contraception amongst the students. The

students stated that there are messages about abstinence, but they ignore them. Ngidi et al.

(2016:102) articulated that the students are confronted by these sexual abstinence

messages.

However, peer pressure and the new-found freedom, have played a role in their sexuality.

Students need safe sexual education and support, instead of addressing them with

abstinence. Bawa (2018:16), agrees by stating that an inclusive sex education will play a

great role amongst these young people. It will influence them in making informed

decisions. Egger