In South Africa there are numerous programmes that are designed to prevent the spread of HIV/Aids. Unfortunately many of these seem to be more concerned with transmitting HIV knowledge and less so with enabling behaviour change — and the fact that people continue to contract and spread HIV seems to indicate that traditional methods of raising awareness are not working.
There remains an urgent need to reduce the spread of HIV, especially among young people who remain the most vulnerable group for sexually transmitted illnesses.
Many NGOs involved in educational interventions dealing with HIV and Aids have shifted their focus to engage more with the realities of young people’s lives. They recognise the need for their work to be informed by an understanding of the factors that inhibit young people from abstaining or engaging in safer sexual behaviour and practices. These include social, economic, cultural and religious factors.
For example, the World Health Organisation found that in some communities men may refuse to use condoms and women may be threatened or endure physical violence and rape when “attempting to negotiate safer sex through the use of condoms”.
In this social context women and girls are extremely susceptible to HIV infection. It is naive to assume that a woman brought up to believe that her husband is the “boss” will suddenly say no to unsafe sex simply because she has new information about HIV and Aids or because she believes that her husband has the virus.
Given that male domination and control — and related socio-economic factors — frequently continue to expose women and girls (as well as marginalised men and boys) to sexual experiences that could result in HIV infection, prevention, treatment and care programmes must engage with hegemonic gender norms and relations. These need to understand how sexism and gender ideologies maintain the vulnerability of certain groups of women and men to the disease and how they can best minimise the personal and social impact that HIV infections has on these people.
Unless women and girls (and marginalised men and boys) are empowered to take control of their bodies and negotiate safer sex or abstinence, HIV and Aids prevention education programmes may not result in a change of sexual behaviour.
As dominant ideas about “masculinity” may also make it difficult for many men and boys to support women and girls’ empowerment, HIV education programmes should engage actively with men and boys and their masculinity and enable them to unlearn “macho” behaviours and attitudes and support gender equity. This is a huge challenge, of course, but the research is clear: gender mainstreaming is vital if HIV and Aids education programmes are to make a difference.
At the same time HIV education programmes need to enable people to make wise choices when faced with opportunities to engage in sexual relations. Acting wisely requires what the author, Charles Taylor, has termed “strong evaluation”.
HIV education interventions that do not move beyond awarenessÂraising do not enable people to develop their capacity for making ethical judgements without reference to their own immediate feelings or personal desires. So when faced with the opportunity to have sex without a condom, a person may not stop himself because he links what is good with what is desired. It is a bit like someone deciding not to stop at the red traffic lights because his desire to keep going is stronger than his desire not to break the law.
On the other hand the strong evaluator judges the worth of a particular course of action from the very depths of his being. He is aware of the strength of his feelings or desires, but may decide to refrain from having unsafe sex with someone because he recognises that it clashes with his values or is dishonourable or unworthy of him. He may decide that engaging in mutual masturbation is the wiser option given the circumstances.
Strong evaluation therefore involves a critical reflection of one’s personal interests and values, which consciously or unconsciously influence one’s actions. It also results in a person articulating more clearly and trying to be the kind of person he really is or wants to be.
To enable people to be strong evaluators, HIV education interventions need to contribute to increasing their knowledge, understanding and ability to think critically.
They also need to influence people’s beliefs about themselves and others so that they develop positive attitudes towards another’s right to say no to sex, or to negotiate safer sex.
By engaging with people’s attitudes and enabling them to recognise what they value and what kind of people they aspire to be in our democracy, interventions can influence participants’ behaviour and their relations with others.
Eric Richardson is managing director of Themba Interactive and an international author and speaker. He is an Investing in the Future judge