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 millionlive in sub-Saharan Africa. In South Africa, the disease has increased rapidlyin the last decade, a crisis that is compounded by the lack of available antiretroviraldrugs and other medicines. Under these conditions it is even more important tounderstand the behavioural response of individuals and communities to attemptsto control sexually transmitted infections (STI) and to inform and change highrisk sexual behaviour.

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

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

• Knowledge about HIV grew in Carletonvilleas 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 whenhaving casual sex increased in every social group with a two to threefoldincrease in use overall. However, men still showed a reluctance to use them andwomen were in many cases unable to insist on their use.

Changes in behaviourdid 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. Followingthese mixed results, the researchers suggest that policy-makers should:

• invest greater levels of human and financialresources into these types of interventions
• fully engage in the fight against HIV/AIDS on a nationallevel by responding to the demand for positive action across South Africa
• pursue extensive HIV and STI preventionprogrammes which include interventions such as condom distribution andvoluntary counselling and testing
• continue to monitor theeffectiveness of prevention strategies and changes in behaviour at the localand national levels.

The programme in Carletonville wasnot successful in significantly changing sexual behaviour. With an increase incurable STI, policy-makers must respond to the community's need for effectiveaction and implement a broad ranging prevention programme supported bycomplimentary interventions such as antiretroviral therapy.