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Knowing and doing? HIV awareness and sexual behaviour in South Africa

An HIV prevention programme was introduced in a South African mining community in order to investigate changes in sexual behaviour and the prevalence of sexually transmitted infections. Although there was evidence of increased knowledge about the dangers of HIV, the prevalence of infection increased during the period of study from 1998 to 2000. Success stories from other studies in the region suggest that a broad range of interventions can be effective and should pursued.

The global HIV/AIDS pandemic shows no signs of fading. Of the 40 million global sufferers, 28 million live in sub-Saharan Africa. In South Africa, the disease has increased rapidly in the last decade, a crisis that is compounded by the lack of available antiretroviral drugs and other medicines. Under these conditions it is even more important to understand the behavioural response of individuals and communities to attempts to control sexually transmitted infections (STI) and to inform and change high risk sexual behaviour.

The research, carried out with the collaboration of the South African Institute for Medical Research, focused on a major two-year long HIV intervention programme in the mining community of Carletonville. The project trained peer health educators from amongst sex workers, miners and young people, as well as specialist health staff and traditional healers. Monthly treatment for STI was made available to sex workers and condoms were distributed.

The study carried out two surveys (in 1998 and 2000), to establish both the prevalence of HIV and STI in different population groups. Participants were interviewed using questionnaires, and blood and urine samples were also given for testing. In addition to testing for infection, the researchers aimed to understand the community’s knowledge and attitudes towards HIV as well as their sexual behaviour. The research found that:

Knowledge about HIV grew in Carletonville as a result of the intervention.
The prevalence of curable STI (Chlamydia, syphilis, gonorrhoea), increased during the period of study in every group surveyed, particularly among young people.
The proportion of people who used condoms when having casual sex increased in every social group with a two to threefold increase in use overall. However, men still showed a reluctance to use them and women were in many cases unable to insist on their use.

Changes in behaviour did occur amongst a number of the groups surveyed, but this was not universal. The prevalence of curable STI increased in the population as a whole. Following these mixed results, the researchers suggest that policy-makers should:

invest greater levels of human and financial resources into these types of interventions
fully engage in the fight against HIV/AIDS on a national level by responding to the demand for positive action across South Africa
pursue extensive HIV and STI prevention programmes which include interventions such as condom distribution and voluntary counselling and testing
continue to monitor the effectiveness of prevention strategies and changes in behaviour at the local and national levels.

The programme in Carletonville was not successful in significantly changing sexual behaviour. With an increase in curable STI, policy-makers must respond to the community's need for effective action and implement a broad ranging prevention programme supported by complimentary interventions such as antiretroviral therapy.

Source(s):
'Changing patterns of knowledge, reported behaviour and sexually transmitted infections in a South African gold mining community', AIDS 17: 2099-2107, by B.G. Williams et al, 2003
'Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa', AIDS 17: 2245-2252, by M. Lurie et al, 2003
'Relative risk of HIV infection among young men and women in a South African township', International Journal of STD and AIDS 13: 331-342, by C. MacPhail, B. Williams and C. Campbell, 2002

Funded by: UK Department for International Development; USAID; UNAIDS; SIDA; UNAIDS

id21 Research Highlight: 1 March 2004

Further Information:
Brian G. Williams
16 rue de la Canonniere
Geneva 1202
Switzerland

Tel: +41 22 791 4680
Contact the contributor: williamsbg@who.int

National Health Laboratory Services, South Africa (formerly the South African Institute for Medical Research)

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