An assessment of students' perceptions of the ABC prevention strategy: Toward students ...

167 Pages·2008·0.78 MB·English

“An assessment of students’ perceptions of the ABC
prevention strategy: Toward students’ participation in
HIV/AIDS message design at the University of KwaZulu-
Natal.”

Eliza Melissa Moodley

Submitted in partial fulfillment for Master of Arts degree
Culture, Communication and Media Studies
University of KwaZulu-Natal, Durban
South Africa
2007
Contents
Acknowledgements iv
Abstract v
Preface vi

Chapter One: Introduction
Background to study: The South African response to HIV/AIDS among youth 3
The South African Universities response to HIV/AIDS 3
Research questions this study addresses 6
Structure of Dissertation 7

Chapter Two: Literature Review
The origin of the ABC message 8
Controversy and debate around the ABC message 9
Students’ perceptions and responses to the ABC message: Young people
as a sexually active target audience 13
A new HIV/AIDS message 15
The role of students in designing HIV/AIDS messages 16
Challenges of other health communication theories and models 18
Conclusion 23

Chapter Three: Conceptual Framework
Communication for Social Change in context for this study 25
Communication for development theories 26
Theorizing HIV/AIDS in Development Communication over last 20 years 26
Development Communication theories in HIV/AIDS Programmes:
Modernization Paradigm 28
Dependency Paradigm 29
Development Support Communication 30
Another Development 31
Behaviour Change Communication vs. Social Communication 33
Origin of Communication for Social Change:
Background to the development of Communication for social change 34
Origin of Communication for social change 37
The Communication for social change approach:
The main variables in CFSC 38
Characteristics of communication for social change 39
Key principles of communication for social change 40
Four main components of communication for social change applied in this study 41
Communication for social change – the process 41
Main variables this research investigates 44
Critiques of communication for social change 47
Conclusion 48

Chapter Four: Research methodology
Research design 49
Qualitative and quantitative research 51
II
Pilot study 52
Main research:
Sampling frame and techniques 53
Data collection and questionnaires 56
Focus groups 57
Survey 59
Ethics in research 60
Data analysis 60
Conclusion 63

Chapter Five: Quantitative Data Analysis
Introduction 64
Students’ knowledge of HIV/AIDS and effectiveness of the ABC strategy 66
Student involvement 70
Conclusion 77

Chapter Six: Qualitative Data Analysis
Introduction 78
Catalyst ignites the focus group discussion 80
Is the ABC strategy effective? 81
Student involvement through dialogue 83
Effectiveness of the ABC strategy 90
Emerging themes:
The role of the government in HIV/AIDS 96
Pregnancy indicates failure of the condom 99
Effects of long term relationships 100
Early marriage as a solution 101
Change sexual behaviour 102
The university as a contributing factor to HIV/AIDS 103
Religious groups can promote HIV/AIDS prevention 105
Open heart to communication (face to face strategy) 106
Communication for social change: Students participation through dialogue 106
Communication for social change: A new wave for development communication 109
Conclusion 111

Chapter Seven: Conclusion 112

Bibliography 115

Appendices
Appendix 1 - Workshop Programme 122
Appendix 2 - Informed Consent 123
Appendix 3 – Questionnaire 125
Appendix 4 - Focus group Discussion Guide 138
Appendix 5 - Howard College Focus Group Transcript 29 May 2007 141
Appendix 6 - Westville Focus Group Transcript 30 May 2007 151
Appendix 7 - Westville Focus Group Transcript 12 June 2007 156
III
Acknowledgements

This research was made possible with funding provided by (USAID) the United States Agency
for International Development through (JHHESA) Johns Hopkins Health and Education in South
Africa.

I wish to acknowledge the following people who made this thesis possible:

Archbishop Denis Hurley Fund for a post graduate research scholarship;

The University of Oslo for a fully paid scholarship for the duration of my stay in Norway;

My supervisor Professor Keyan Tomaselli and advisor Professor Lynn Dalrymple for their
supervision, remarkable patience and outstanding mentorship;

Professor Ruth Teer-Tomaselli for being instrumental in my application for the University of
Oslo scholarship;

Professor Helge Ronning, for his hospitality and supervision at the Institute for Media and
Communication (IMK), University of Oslo;

The staff of HIVAN, in particular Deborah Heustice, for their ongoing support;

My colleague and friend, Bren Brophy for all his moral support, patience and managing the
Cultural Arts Programme in my absence whilst in Norway;

Abraham Mulwo, I am forever indebted to him for his academic support, mentorship and
encouragement throughout this process;

Sarah Chiumbu who motivated and accompanied me during our 24 hour shifts at IMK offices in
Olso;

My friend, Fathima Abdulla, for her continuous care, support and encouragement;

My dad, Balan Moodley, and twin brothers Darren and Darrean, for their moral support and
keeping me in high spirits,

My fiancé Jerry Govender, for his warmth, love and support, our stimulating discussions, ongoing
motivation and valuable advice during the process of writing;

My mum, Elizabeth Moodley, who took the role of an international alarm clock with her endless
calls all parts of the night to ensure that I did not fall asleep on the job in Oslo, and for her
dedication and love in paving the way for my privileged education. I dedicate this thesis to her;

And finally, to Jesus Christ for renewed blessings and added strength to complete the tasks set
before me each day.

Disclaimer: The opinions expressed herein are those of the author and do not necessarily reflect
the views of the United States Agency for International Development.

IV
Abstract

In South Africa there are general studies that aim to understand HIV prevalence and
specific surveys for target groups. However there is a gap in research that relates
particularly to university students active participation in HIV/AIDS prevention
messaging. This study explores the use of the Communication for Social Change (CFSC)
theory with students at the University of KwaZulu-Natal, Durban. The study takes the
form of a survey, using researcher administered questions with 400 students at the
Westville and Howard College campus to understand their perceptions of the
‘Abstinence, Be faithful and Condomise’ prevention strategy. Two focus groups were
conducted at both campuses to further analyse the survey findings, with a particular
reference to the use of dialogue to actively engage students in discussions about
HIV/AIDS prevention messages. The study traces the origin of CFSC through a review of
the development communication theories (which include modernization theory,
dependency theory, development support communication and another development). The
survey revealed that students were not supportive of programmes with a top-down flow
of communication. Students at both campuses welcomed the role that dialogue could play
to encourage student participation in the design of a new HIV/AIDS prevention message.
Some of the findings from the survey showed that 91% of students at both campuses
motivated in favour of students as active participants in HIV/AIDS communication
processes. The findings from the focus group also revealed that students did not find the
ABC message effective, and strongly promoted a revision of this message which should
include ‘accountability’ and ‘responsibility’ as part of the HIV/AIDS prevention strategy.

I acknowledge that this is my own work and duly referenced.

Eliza Moodley
9 April 2007
V
Preface

While undertaking this research I worked at HIVAN, The Centre for HIV/AIDS
Networking as a Culture and Arts Consultant. My work includes the research,
development and facilitation of participatory and developmental workshops for trainers,
HIV positive children and young people. These workshops train and empower
community representatives in participatory techniques such as role playing, art making,
drama, storytelling, puppetry and music to educate and entertain their community on
issues concerning HIV and AIDS. I have designed various educational programmes for
infected children which create awareness of HIV/AIDS, build resilience and promote life
skills development. The first book in this series called “Hi Virus,” addresses in
participatory way issues of diagnosis, disclosure, treatment literacy and adherence. I
have extensive experience in writing funding proposals for workshops and publication of
children’s educational books and toolkits for caregivers.

Central to all my work in community development and empowerment is the use of the
Communication for Social Change approach. In all instances, participants are always
extensively consulted before the design and development of any workshop. The
community plays a pivotal role in working with the HIVAN team to design educational
programmes and the publication of all resource material. The approaches used have
always empowered the community through education and entertainment but a vital
component through this process was actively engaging community representative in all
phases on development and implementation. This study aims to further explore the role of
Communication for Social Change in communities but in particular how this can be
implemented with tertiary students at the University of KwaZulu-Natal where I have
studied, taught and worked.

VI
Chapter One: Introduction

HIV/AIDS is one of the biggest challenges facing South African young people today. By
2005 approximately 5.54 million South Africans were estimated to be living with HIV,
18.8% of the adult population (15-49 years) and an estimated 12% of the general
population are affected (HIV and AIDS Strategic Plan for 2007-2011: 7). Over 60% of
HIV infections in South Africa occur before the age of 25. Hence South African youth
are among the highest risk groups for HIV infection in the world (Leclerc-Madlala 2002:
21). The South African National Behaviour and Communication Survey in 2005 shows
that HIV prevalence rates for youth in the age groups 20-24 were 23.9 % for females and
6% for males. Almost all young people, especially young women, are indirectly affected
by HIV/AIDS with 15-16% of young people between the ages of 15-19 being infected
with HIV. This locates South Africa as one of the most heavily affected countries in the
world (UNAIDS 2006). The findings of this survey indicate that HIV prevalence is still
increasing despite current preventative and educational programmes and interventions.
New and innovative approaches need to communicate HIV/AIDS prevention messages to
this age group to reduce infection rates.

Extensive resources and information are available on basic HIV/AIDS information, but
there still remains a gap in research conducted with young people, particularly students at
tertiary institutions. Campaigns and programmes are mainly directed at orphans and
vulnerable children (OVC), women, disadvantaged communities and those infected and
affected by HIV/AIDS. A dire need for effective programmes and campaigns exists for
young people; however these campaigns must ensure that the message is applicable to its
target group. Higher Education (HE) is a critical pillar for human development playing a
fundamental role in developing leaders who will shape the country’s future economy,
communities and government (HESA 2006). This study is aimed at exploring students’
perceptions of the Abstain, Be Faithful and Condomise (ABC) strategy with a
view of understanding students’ responses to the pandemic. In acquiring knowledge
about students’ perceptions of this strategy, focus will be directed at how the use of
dialogue with students’ can stimulate discussions and collective action based on their
sexual practices.
This study will explore how students can share their ideas and perceptions about
HIV/AIDS prevention strategies, and through active participation and dialogue, negotiate
ways in which the HIV/AIDS messages can reach students more effectively. When
students are actively involved in the development, design, implementation and
monitoring of a project, the studies that underpin this thesis suggest that they will take
ownership of the intervention, eliciting better adoption to messages among the receivers
and makers (cf. Parker 1994). For example,
Research and ongoing evaluation undertaken by loveLife, Project Phakama, the
South African Human Rights Commission and the Media Monitoring Project
indicate that radio, TV, newspapers and magazines exert some degree of influence
on social norms and on public perceptions on specific issues. However, the same
findings suggest that communication strategies that focus on participation, the use
of popular culture and examination, of the underlying causes for socio-economic
inequality, unequal power, gender and race relations provide more opportunities
for community and youth empowerment (Stadler and Hlongwa, 2002:374).

Communication for Social Change (CFSC) theory is one of the participatory theories, and
will be used in this study to assess how students can actively engage in the horizontal
flow of information, where there is an exchange of information through dialogue, towards
collective action. Health promotion programmes are more effective when planners
consider multiple levels of influence on health problems (NCI: 2005). CFSC will be used
to explore the involvement of students in HIV/AIDS prevention messages and even
campaigns within their campuses.

Background to Study
South African responses to HIV/AIDS among youth
The 2005 Human Science Research Council (HSRC) survey reveals that youth are one
the largest groups affected by the epidemic, but there is a largely marginalized group, the
tertiary or college population of young adults who have not been recipients of systematic
special programmes and interventions designed to address their sexual practices. Various
campaigns are based on the transferal of knowledge and information to young people, to
2
make informed choices, but new knowledge does not always lead to behaviour change.
The LoveLife 2003 poster campaign was found to be ineffective, as it used branding as
instrument to change behaviour without taking account of significant variances in culture,
religion, belief systems and socio-economic contexts in South Africa (Jordaan,
2006:111). While students may be knowledgeable about HIV/AIDS, this does not make
them less vulnerable than other populations. Students need to experience a holistic
approach with regard to educational interventions dealing with HIV/AIDS. This includes
information about HIV/AIDS prevention but more importantly, their involvement and
contribution to the prevention strategies. The combined efforts of many AIDS
communication campaigns in South Africa showed positive impacts on HIV prevention
behaviours, increased positive attitudes towards people living with HIV and AIDS, and
increased community involvement in response to the epidemic, according to a new
nationwide survey in the hard-hit country.1

The South African Universities response to HIV/AIDS
The findings of the largest representative survey of youth released in early 2006 by the
Reproductive Health Research Unit at the University of Witwatersrand illustrate the need
for more youth prevention projects. The study found that one in every 10 young South
Africans aged 15 to 24 is HIV-positive and that 77 percent are women. The study
concludes that young people are immersed in a culture that does not accept women's
sexual rights (IRIN). “What has been acutely recognized in the South African epidemic is
that sex is closely interconnected with systems of power. Vulnerability to HIV infection
is strongly linked to disempowerment” (Parker: 2006). Messages have been designed to
promote abstinence, be faithful and condomise, however contextual factors need to be
considered in HIV messaging. This thesis examines audience involvement through
dialogue as one of the ways in which young people can actively contribute to increase the
effectiveness of HIV/AIDS messages.

The South African Universities Vice Chancellors Association (SAUVCA) met in 2000 to
discuss institutional responses to HIV/AIDS in the university sector. Their findings at the

1 New South African Survey Demonstrates Positive Impact of Multiple Communication Campaigns
Promoting HIV Prevention Behaviors: http://www.hcpartnership.org/Press/press2006-11-06.php (accessed
on 20 September 2007)
3
time reflected an inadequate response by universities towards the epidemic and the need
to take a stronger institutional form (SAUVCA; 2000). Dhianaraj Chetty estimated HIV
infection in 2000 as 22% for university undergraduates, 11% for postgraduate university
students and 25% for technikon undergraduates (Chetty, 2000: 9). The Association
established that HIV/AIDS was not only a health but also development issue therefore
affecting the social, economic and psychological wellbeing of the institution and its
students. HIV/AIDS also affected human resource development as: The life-blood of
universities is the crop of students they enroll every year. These 18-30 year olds are the
most capable and promising members of societies. They represent the future corps of the
highly skilled base of any economy. They are also the age group at the highest risk of
contracting the HIV-virus (SAUVCA: 2000). The committee acknowledged that
universities are instrumental in teaching, learning and generating new knowledge and
should therefore be key players in shaping the attitudes and practices of future decision
makers.

Some of the shortfalls found in mid-2000 regarding the institutional response to
HIV/AIDS were that commonly these initiatives were driven by individuals or small
groups with ad hoc activities and no institutional framework. There was also a lack of
policy and programmes with further lack of capacity, resources and leadership. Seven
years later, the current status of the institutional response to HIV/AIDS reflects that some
institutions have made significant development, building partnerships and strategies to
become vehicles of communication and change for students on various campuses.

South Africa’s only survey of HIV prevalence among college students, conducted at the
University of KwaZulu-Natal, Westville Campus (formerly University of Durban-
Westville) by ABT Associates in 2000 revealed infection rates of 26 percent in women
and 12 percent in men aged 20-24. Those findings are consistent with the latest numbers
from UNAIDS, which reported that a quarter of South African women in their 20s carry
the virus that causes AIDS. The majority of South Africans are under the age of 25 and
this group accounts for over 60% of the new infections (Uys et al, 2001; Stremlau and
Nkosi, 2001). A survey conducted at Rhodes University in 2001 showed that students had
a considerable level of HIV/AIDS awareness. They were knowledgeable of ways to
4