Deficiencies in how HIV/Aids is tackled

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The first National Student Sexual Health HIV Knowledge, Attitude and Behaviour Survey has highlighted some complacency in how HIV-Aids is tackled at higher education institutions in the country among certain groups, reports The New Age. The survey looked at the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) students’ knowledge, attitudes, perceptions and behaviours relating to sex, HIV and alcohol and substance use.

The survey, carried out at 14 higher education institutions across South Africa, focuses on student men who have sex with men (MSM) and their sexual pattern in relation to HIV.

The study has found that MSM are no different to other young people in their pattern of risk-taking in relation to sex and HIV, but that while other students have extensive resources at their disposal, not much has been done to provide the same support and resources to MSM. The lack of adequate and dedicated education and health services have as a result left MSM more exposed to the risk of infection.

Speaking at the launch of the survey, Deputy Minister of Higher Education and Training Mduduzi Manana said: “We appreciate that the youth population is diverse. In the context of the HIV, TB and STI epidemics, it is important to recognise the multiplicity of sexual orientations among students and the behaviours associated with various sexual orientations. This report provides a glimpse of the diverse ways in which young people experience sex, relationships and intimacy and it explores the implications of this diversity for sexual health.”

Dr Ramneek Ahluwalia, director of the Higher Education and Training HIV-Aids Programme (HEAids), said the findings of the survey would inform further research and programmes aiming to protect students of all sexual orientations from HIV.

The survey conducted by Stellenbosch University with the Higher Education & Training HIV/AIDS Programme (HEAIDS) was commissioned by NACOSA as part of its Global Fund grant precisely to unpack the complex and interlinked issues surrounding sexual behaviour and risk on campus.

The study was the first of its kind to address the issues faced specifically by men who have sex with men (MSM) and young people who identify as lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) at higher education institutions across the country. While all students engage in sexual behaviours which place them at elevated risk, understanding the factors that contribute to specific behaviours will help us design interventions that cater to the sexual health needs of most at-risk populations in the South African student community, such as student MSM.

According to Manana, the report provides “an important glimpse into how different sex, relationships, intimacy and sexual health are for many of our young people”.

Contrary to perception, the research found that MSM behaviours are largely similar to student behaviour in general, suggesting that we need to develop a better understanding of the emerging sexuality and sexual cultures of young people as a whole. Many forms of same and opposite sex behaviours co-exist within individual students and the student population – a quarter of the MSM surveyed did not identify as homosexual when asked to indicate their sexual orientation and about one third of the student MSM also engaged in sex with female sex partners.

It is important, therefore, to understand the various contexts within which students engage in sexual behaviour including gender norms, sexual experimentation, cultural practices, sexual orientation, and perceived group or peer norms. Programmes aimed at reducing risk in the student community need to be careful not to treat men who have sex with men as a single, homogenous group or to confuse sexual behaviour with sexual orientation.

The study supports other findings which identify potential conduits for HIV transmission among student MSM through risky sexual behaviours, including: unprotected anal and/or vaginal sex; low rates of lubrication use for penetrative anal sex; multiple sexual partners; multiple concurrent sexual partners; the presence of sexually transmitted infections; early sexual debut (having sex for the first time); not knowing HIV status; complacency about risk; forced or coercive sex; sexual violence; meeting sex partners through the internet; transactional sex (sex in exchange for goods, favours or money); and substance use before or during sexual encounters.

While some of these risky behaviours are slightly more prevalent amongst the student MSM population, they are nevertheless risk factors amongst the whole student population. Unfortunately, high HIV knowledge amongst students does not appear correlate with the avoidance of risky sexual behaviours. HIV knowledge scores were high among the entire sample (MSM and non-MSM students) and three quarters of the MSM participants had been tested for HIV in their lifetime.

While three quarters of the student MSM indicated that they are comfortable using sexual health services on campus, only one third reported having actually used on-campus sexual health services in the preceding twelve months and more than 40% used off-campus sexual health services in the past year. This points to a clear disconnect between HIV knowledge, the sexual health services offered on campus and the way in which services are accessed by student MSM and LGBTQI.

Sexual violence was one of the most concerning factors highlighted in the study. More than one in 10 of the student MSM sample reported having been forced to have sexual intercourse against their will and 3% indicated that they have threatened to use force to get someone to have sex when they did not want to. Worryingly, just over 10% of the student MSM reported some form of abuse and/or violence based on their sexual orientation at higher education institutions and just under 10% reported having been hit by a current or previous sex partner.

Gender and sexual orientation puts certain student populations at increased risk – not just because of risky sexual behaviours but also because discrimination and homophobic attitudes prevent young LGBTQI people from accessing sexual health services and can make them more vulnerable to sexual coercion and other forms of violence.

The study uncovered some of the things that contribute to health-avoiding or risky behaviours, particularly amongst student MSM who face distinct challenges based on perceptions of their sexual orientation. These included: an unaccepting campus environment; discrimination based on sexual preference; threat of abuse or violence; lower levels of self-esteem; and higher levels of alcohol and drug use.

While regional differences exist, the study uncovered a high level of intolerance within the higher education sector towards MSM and LGBTQI individuals. HIV risk behaviours are prevalent among many students whether they are men with same sex partners or not. The data shows many similarities in risk behaviours across all groups of sexually active students. If programme developers are not aware of the contexts and variety of ways in which student men engage sexually with other men (and, in some cases, women), sexual health messaging to this group will be cumbersome, too generic, overly simplistic and will not achieve a reduction in HIV transmission rates at higher education institutions in South Africa. Furthermore, there are differences between and within institutions which require nuanced, flexible and context-driven interventions which both acknowledge particularities and commonalities in youth sexualities.

When students’ mental health, their social environment, behavioural vulnerabilities and poor access to health care come together the outcome is often increased vulnerabilities to HIV transmission. Innovative ways of reaching the student MSM population are critically important for future risk-reduction interventions in the sector.

 

A new study from Australia suggests that HIV-positive women don’t often talk with their doctors about sexual health and contraceptive use, reports Health24. Researchers who looked at the medical records of 128 women with the human immunodeficiency virus (HIV) found that fewer than a third discussed contraception with their doctors. Sexual activity status was only documented for about half of the women.

“The issue is that many HIV doctors are infectious diseases specialists not trained in women’s health,” said Dr Mona Loutfy, director of the Women and HIV Research Programme at Women’s College Hospital in Toronto. Worldwide, unintended pregnancy rates are as high as 50% to 84% among women with HIV, according to the study.

For the new study, researchers from Monash University and Monash Health, Clayton, Australia, looked at the records of women ages 16 to 49 who were treated for HIV between 2010 and 2012 at two city hospitals in Melbourne. More than 80% of women were on antiretroviral therapy, which is used to stop the virus from replicating.

The medical records showed that doctors discussed the women’s sexual activity in 54% of cases, and relationship status in 76% of cases. About a third of the women had contraceptive discussions recorded in their records.

Women who discussed sexual activity with their doctors were more than three times as likely to use contraception as others. Neither patient age, pregnancy history nor doctor gender was tied to discussions about sexual activity. Eleven women were considering pregnancy or actively trying to conceive, the researchers found.

Full report in The New Age
NACOSA material
NACOSA research report
Full Health24 report
Journal of Family Planning and Reproductive Health Care


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