2008-06-11Staff Report 2 "A recent study conducted by the NawaLife Trust, through the Centre for AIDS Development, Research and Evaluation (CADRE), revealed information and statistics pertaining to HIV/AIDS. The study was conducted to, among other issues, track knowledge, attitudes, behaviour and practices relating to HIV/AIDS. The current research involves mid-term surveys conducted in the following three communities in Namibia: Gobabis, Grootfontein and Omaruru. Here is a summary of the report, as highlighted by CHARLES TJATINDI. WALVIS BAY - More and more young people are engaging in sexual activities earlier compared to older generations. The study revealed that current 15-24-year-olds are far more likely to have had sex at 15 or younger than respondents in older age groups. For example, for males, 31 percent of those aged 15-24 report having had sex at 15 or younger, compared to 19 percent for males currently aged 25-34, and only 12 percent of males aged 35-49. A similar pattern is found among females. In Gobabis and Omaruru, more than two thirds of 15-24-year-olds have had sex (70 percent and 73 percent) in comparison to less than half in Grootfontein (45 percent). According to the report, youths who have sex with partners more than 10 years older than them are exposed to a higher HIV/AIDS prevalence age group, and thus the risk of infection is higher than if their sexual partners were within the same age range. One in 10 young males and nearly one in five young females who had had sex reported that their last sexual partner was more than 10 years older than them. This pattern was similar among teenagers and young people in their early twenties. The study ventured into finding out why most people engaged in sexual activities. Both males and females predominantly cited love and satisfying sexual needs as the main reasons, while 'satisfying expectations of others' and being 'forced to' were also mentioned by only small proportions of both sexes. 'Satisfying expectations of others' was, however, considerably higher in Omaruru. One in 10 respondents in Gobabis (11 percent) and Omaruru (13 percent) had concurrent partners. In Grootfontein, levels were lower at one in 20 (4 percent). Concurrent sexual partnerships have a high risk of HIV transmission as a product of a higher likelihood of individuals being part of densely clustered sexual networks. Individuals who have recently been infected with HIV have a high viral load and as a result HIV spreads rapidly through the network. Respondents who had more than one partner were mostly males. When analyzed by age group, concurrency varied by site: in Gobabis concurrency predominantly occurred. Having sexual partnerships that overlap in time is referred to as having concurrent sexual partners. Partner concurrency is a significant factor for HIV infection as it produces densely interlinked sexual networks, which, when combined with high viral loads associated with recent HIV infection, result in rapid HIV incidence in a community. There were many names mentioned for relationships where people had multiple concurrent partners. These included names that framed the relationships as less important than those with one's main partner - for example, 'second class lover', 'second in charge', 'temporary', 'part-time', 'spare wheel', a 'happie' (bite) and 'entertainment'. Names were also linked to aspects of material transaction - for example, 'triple C' (car, cash, and cellphone), 'sugar daddy', 'sugar mommy', 'coffee mommy', 'money makers', 'kamboroto' (bread), and a 'sponsor'. A one-night stand was also referred to as a 'missed call', and was explained as: ""you just grab her for one night and then the next morning, you don't see each other - you see each other, you are no more interested"". While males who had multiple partners were referred to more positively as casanovas and players, females were referred to disparagingly as whores, bitches and prostitutes. Men who paid money for sex, and insisted on sex without condoms were referred to as 'B1 Butchers' because they were involved in killing through HIV. Concurrent relationships were understood as being risky in the context of HIV, but that AIDS was not a deterrent for such practices, the study found. While it was acknowledged that people in communities had concurrent partners, such relationships were seen as being secretive and frowned upon. At the same time, however, it was recognised that such relationships might be legitimised on the basis of economic need as a product of people in poor circumstances 'not having a choice'. For example, when the facilitator asked: ""So why do you think they accept those kind of relationships?""... The response was: ""Poverty. That man is coming with groceries to the house"". This endorsement also occurred in a family context. Economic need was seen as being more typical of relationships where people were not married, whereas extra-marital relationships were seen mainly as a product of lack of sexual satisfaction within marriage: ""The husband will just go out and look for another one who can satisfy him sexually. I think it all has to do with sex. The main reason why they always cheat is because of sex. That's all."" The main partner was the person who was loved, whereas a second partner was not loved but who was used through sex to secure other aspects of need, particularly financial needs. Mobility was noted to play a role in fostering conditions that are conducive to concurrent sexual partnerships. In some contexts, peer pressure fostered unfaithfulness. For example, where friends were out together, a person wanting to stay faithful to his/her partner was teased and said to be a coward. Tradition was also invoked as a justification for these types of relationships - specifically traditions of men having many wives, with the suggestion being made that even in the era of AIDS, tradition offered strong justification for concurrent sexual partnerships. While some participants said they were aware of messages about concurrent sexual partnerships, others felt that the secretive nature of such relationships meant that it was difficult to communicate about the issue. According to the report, messages about multiple partners that were known were seen as lacking emphasis in comparison to more prominent messages about condoms, and were infrequent. Availability and abuse of alcohol was seen as pervasive, and this was partly attributable to a general lack of recreational facilities. Alcohol was noted to inhibit control over behaviour and in particular, influencing the likelihood of not using a condom. The study also explored issues pertaining to abstinence, and found that around one in 10 respondents who had previously had sex reported not having sex in the past year (secondary abstinence) - Gobabis (7 percent), Grootfontein (7 percent) and Omaruru (10 percent). Secondary abstinence occurs in all age groups, but is more common amongst respondents aged 50 years and older. Slightly more females reported secondary abstinence than males. Males were more likely to report having two or more partners in the past year, with around a quarter reporting more than two partners - Grootfontein (18 percent), Omaruru (33 percent) and Gobabis (54 percent). Of respondents who had sex in the past year, 77 percent in Grootfontein and 64 percent in Omaruru reported having had one partner in the past year compared to just over half (51 percent) in Gobabis. Having two or more partners in the past year was very high in Gobabis (43 percent), followed by Omaruru (26 percent) and Grootfontein (16 percent). In Gobabis, more than half of youth aged 15-24 (58 percent), and more than a third of respondents in the 25-49 year age group also had two or more partners in the past year. Knowledge on HIV/AIDS and the availability of such information was also tested during the surveys. According to the report, while some acknowledged that HIV/AIDS information was available in most languages, concerns were also voiced about perceived lack of availability in all languages, and that for some audiences, literacy was a problem. Apart from the mass media, face-to-face interaction was seen as useful, particularly if it included 'doctors and nurses' and 'pictures'. Another possibility was involvement of People Living With HIV/AIDS (PLWHA) in community-level promotion activities. Songs were also mentioned as a powerful medium and one participant recalled how a song that was previously broadcast on television was sung by 'kids in the street'. The most prominent sources of HIV and AIDS information in the past year were the mass media - radio, television and newspapers - which include information disseminated by formal campaigns, but also news and other information not directly disseminated by campaigns. While radio was most likely to be a source (82 percent-96 percent), television and newspapers were also proportionally high (76 percent-87 percent). The range for other media including magazines, booklets and pamphlets was 67 percent-78 percent. The reports states that most respondents listened to the radio four days a week or more (82 percent-89 percent), and two thirds or more watched television four days a week or more (56 percent-85 percent). Listenership and viewership were highest in Grootfontein. Newspapers and magazines were accessed four days a week or more by around half of all respondents (42 percent-55 percent), with lowest levels occurring in Omaruru. Exposure to specific media channels varies considerably between communities. In the case of television, most respondents viewed NBC (69 percent-90 percent) with less exposure to the other channels. Local language stations were most prominent. The Namibian newspaper was most widely read on average, although other publications achieved high ratings in specific communities. Among interpersonal sources, health care workers were prominent (49 percent-69 percent) as were friends (76 percent-89 percent). Community organisations including local AIDS organisations were sources for around a third of respondents, with the highest mention being in Gobabis (36 percent) and the lowest in Grootfontein and Omaruru (both 24 percent). Religious groups and community meetings were mentioned by less than half of the respondents (38 percent-46 percent), and very few mentioned traditional healers (2 percent-3 percent). Educational institutions and teachers were important sources for the vast majority of full-time students (86 percent-96 percent). In workplaces, the response was more varied, ranging from 35 percent in Gobabis to 50 percent in Omaruru. When asked about services available to people living with HIV/AIDS without prompting, around three quarters or more of respondents mentioned medicines to fight HIV (63 percent-90 percent); fewer mentioned financial support from government (24 percent-30 percent), services from community NGOs (14 percent-21 percent) and post-test clubs (7 percent-16 percent). Legal support, counselling and nutritional support were least mentioned. AIDS is being spoken about at religious gatherings to varying degrees in communities, with respondents reporting levels of around half to a third - Grootfontein (46 percent), Omaruru (39 percent) and Gobabis (37 percent), the study found. Less than half of the respondents reported attending a community meeting about HIV/AIDS (24 percent-37 percent). Personalised exposure to AIDS was high in most communities with over a quarter to over half of respondents reporting a person they know who had said they were HIV positive (23 percent-61 percent). Personally knowing someone who has died of AIDS and attending the funeral of someone who had died of AIDS ranged from just under half to around three quarters of respondents (43 percent-76 percent). Personalised involvement was explored through a number of questions including wearing clothing with a red ribbon or AIDS messages, attending a training workshop on AIDS, volunteering at an HIV/AIDS organisation, helping care for children of people who had died of AIDS, or caring for a person sick with AIDS. Between one in six and half of respondents reported such involvement. On average, community-level exposure and responses were highest in Omaruru (49 percent), lower in Gobabis (33 percent) and lowest in Grootfontein (27 percent). The study found that the fact that condoms were a primary means for HIV prevention was well known. Referring to common discussions amongst friends, participants mentioned concerns about condoms being 'not one hundred percent safe'. Reference was made to myths perpetuated by a 'certain church' that condoms contained the virus, which was evidenced by putting a condom into hot water and 'then you will see the virus moving in the water'. One participant reported hearing a radio show where condoms were said to have holes in them. When discussing condom use, it was noted that condoms were less likely to be used in a long-term relationship with a person that one loved. Respondents mentioned newspaper articles that suggested circumcision prevented HIV infection, although this was treated cynically by some. Others mentioned the preventive effect of circumcision citing percentages they had heard about, including '60 percent' and '80 percent' protection. There was a high level of overall awareness of anti-retroviral therapy. Many participants knew friends or acquaintances that were taking ARVs, and the general experience was that people went from being ill to being healthy once they were on treatment. Nevirapine was mentioned as an anti-retroviral drug for use during pregnancy, although few details were known about how the drug worked. Some participants mentioned alternative treatments and treatment approaches including praying, faith healing, 'muti' from Zimbabwe, traditional herbs (kamaku), African potatoes, 'Goka 11', and Aloe Vera. Most participants saw HIV/AIDS and stigma as interconnected and pervasive in Namibian communities, with HIV infection being linked to shame. In particular, there was a sense that some families would not support family members who were HIV positive because they had brought the disease into the household. With regard to beliefs, the vast majority of respondents disagreed that witchcraft could protect one from acquiring HIV (86 percent), and a similar proportion said that they were not aware of people who had acquired HIV through witchcraft (85 percent). However, a lower proportion disagreed that Christian healers could cure AIDS (75 percent). The vast majority of respondents hold positive and supportive attitudes towards people living with HIV/AIDS. There was a strong commitment to caring for a family member sick with AIDS (75 percent-90 percent) and also towards allowing HIV positive children to attend school (65 percent-78 percent). In Omaruru, over 80 percent of respondents said that an HIV-positive teacher should be allowed to continue teaching (86 percent), although this view was less widely held in Grootfontein and Gobabis (68 percent, 71 percent). Around half of all respondents (41 percent-61 percent) did not see the need to keep the HIV positive status of a family member secret. While this might suggest a fear of family stigmatisation, it may also be related to respect for confidentiality of the individual concerned. " 2008-06-11Staff Report 2
