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School managers' understanding of HIV/AIDS in Gauteng, South Africa Uchenna B Amadi-Ihunwo Published online: 11 Nov 2009.

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ISSN 1608–5906 EISSN 1727–9445 doi: 10.2989/AJAR.2008.

School managers’ understanding of HIV/AIDS in Gauteng, South Africa Uchenna B Amadi-Ihunwo

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Division of Education Policy and Leadership, School of Education, Faculty of Humanities, University of the Witwatersrand, 27 St. Andrew Road, Box 2193, Parktown, Johannesburg, South Africa Author’s e-mail: [email protected] This paper presents the diverse understandings of HIV/AIDS and people living with HIV (PLHIV) revealed by school managers in a selection of public schools in Gauteng Province, South Africa. Discussions with school managers emerged as part of a larger investigation into the interplay of culture and gender in people’s experience of HIV. The respondents from five public schools comprised head teachers, school board members, educators and adult learners. The data were assembled from semi-structured interviews, focus group discussions, comments on rumours and gossip, and informal conversations. Mary Douglas’s (1966) analysis of the theory of cultural risk has provided the main approach for explaining the prevailing understandings of HIV and AIDS among the South African educators. Despite good knowledge of HIV and AIDS, the respondents’ understanding of the disease and the experiences of PLHIV were commonly drawn from six categories of meaning: biomedical, cultural, religious, witchcraft, race, and eschatology. Social constructs were strong in terms of the ways HIV/AIDS and PLHIV were understood in these South African education workplaces. The findings imply that new strategies are required from the government and agencies that are involved in developing responses to the HIV epidemic, especially in the education sector. Keywords: administration and planning, eschatology, perceptions, policy issues, school health education, socio-cultural factors, teachers

Introduction When Elizabeth Kubler Ross (1987, p. 5) wrote: “Not only do people with AIDS have to go through the ‘stages of dying,’ [but] they are faced with issues the world never had to deal with to such an extent, in massive numbers, and from every direction. AIDS has become our largest socio-political issue, a dividing line for religious groups, a battleground for ambitious medical researchers, and the biggest demonstration of man’s inhumanity to man, even far exceeding the treatment of leprosy patients in Damien’s days,” she was reflecting on the many challenges that complicate the understanding and management of HIV and AIDS and how sociological and political issues undermine the contending factors in this global health crisis. In South Africa, public school managers’ inconsistent knowledge and appreciation of HIV/AIDS seems due to varied cultural understandings of the epidemic and how to manage it. Assorted factors, such as cultural diversity, economic disparity, and racial, gender and age differences (UNAIDS, 2004), persistently inhibit people’s understandings of the HIV epidemic across the nation. Attempts to understand perceptions of HIV/AIDS and people living with HIV or AIDS (PLHIV) among persons involved in South Africa’s public schools have revealed the unrelenting complexity associated with the country’s epidemic. Understanding differs from province to province, and between and within ethnic groups. Racially and culturally influenced understandings of HIV and AIDS in South Africa

are generalised in populations of school managers who have had little training about HIV (Matthews et al., 2006). So far, educators’ misperceptions and lack of adequate knowledge have taken a toll on effectively implementing the national HIV/AIDS policy and has caused inefficient management of HIV-related issues in some schools. In a review by Piot et al. (2001), 60% of 277 secondary-school principals acknowledged that learners were at moderate or high risk of HIV infection, while the remaining 40% said they were uncertain about how the learners and educators under them perceive the magnitude, impact, understanding and challenges of the epidemic. Stein (2003) reported that instead of being eliminated, stigma towards PLHIV has changed its appearance in South Africa. Although HIV affects all sectors of society, perhaps the most profound effects occur in the education sector — despite the high hopes placed on education in responding to the epidemic (UNICEF, 2000). In general, punitive and ambivalent cultural and religious perceptions dominate how school managers make meaning of the epidemic and those who are infected (Adamchak, 2005). In South Africa, as many as 280 000 children under 15 years old were living with HIV at the end of 2007 (UNAIDS, 2008). With no significant reduction in HIV prevalence (despite the many interventions in place), South African public schools managers’ poor understanding of both the epidemic and PLHIV presents public schools as a risk environment in relation to the racial and cultural influences that can climax as instances of indirect stigmatisation

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(Amadi-Ihunwo, 2008). However, the insistence by some educational management researchers that education is presently the ‘social vaccine’ for HIV confers special importance on the education sector in responding to the epidemic (Coombe, 2001). Due to diverse perceptions and practices surrounding HIV/AIDS and PLHIV, the National Policy on HIV/AIDS for Learners and Educators in Public Schools, and Students and Educators in Further Education and Training Institutions was designed in terms of Section 3(4) of the National Education Policy Act, 1996 (No. 27 of 1996), in August 1999. A well-developed strategic and operational plan, which includes official definitions of the epidemic and PLHIV, were covered. School managers are expected to align their understanding following this policy. Against this background, this paper presents various understandings of HIV/AIDS uncovered among school managers in selected public schools in Gauteng Province, South Africa; the presence of these diverse perceptions may help to explain the failure to achieve the expected reduction in HIV infection rates in South African public schools as a result of failure to implement established policy for the education sector. The paper explores the public school managers’ individual and collective ways of making meaning of HIV/AIDS and the experiences of PLHIV. Consequently, educational management researchers may see a need for a paradigm shift in the search for solutions. Identifying the ways that public-schools stakeholders make meaning of the disease may also help explain the persistence of indirect stigma towards PLHIV in public schools, despite school managers’ relatively good knowledge of the disease. Arguments relevant to the article Implementation of an HIV/AIDS education programme as a way to deal with the HIV epidemic in South Africa may be marred by cultural factors, particularly people’s beliefs systems (Stadler, 2003). HIV/AIDS research in Africa has not sufficiently utilised a cultural perspective (UNICEF, 2000). The most common argument about HIV and its impact on education is that schools in an HIV pandemic cannot be the same as schools in an HIV-free world (Kelly, 2000; Bennuel, 2005). Similarly, Coombe (2001), a leading commentator who has written extensively on the issue, states that education systems (in Africa) will collapse unless we change our understanding of the epidemic and change how ‘we’ in education respond to it. Bennuel (2005) concluded that the African continent remains ill-prepared to deal with the effects of HIV on education in this century. Incorporating all stakeholders in management decisions in public schools is central to dealing with HIV and AIDS in the education workplace. In South Africa, according to the Department of Education, there is policy provision for new patterns of school ownership and governance. Essentially, parents, teachers, and representatives from the broader community (in regard to primary schools) and similar ‘stakeholders’ (with the inclusion of students, in regard to secondary schools) form the basis for these new governing bodies (Parker, 2004). Considering this, understanding how the epidemic is perceived by all public-schools stakeholders is a worthwhile means to appreciate the failure on the part of the education sector to contain the challenges of HIV.


At the top of the list of strategies that are expected to influence people’s understanding of the HIV epidemic in South African public schools are appropriate policy designs, implementation plans and HIV-related education programmes. An ethnographic study by Matthews et al. (2006) investigated factors influencing high school teachers’ implementation of the HIV/AIDS-education curriculum in all 193 high schools in Cape Town, in 2003. The study revealed that many teachers (especially female teachers) had implemented the HIV/AIDS education curriculum. The teachers’ understanding of HIV/AIDS was found to be influenced by previous training on HIV/AIDS, self-efficacy, the centeredness of affected students, belief about controllability and the outcomes of HIV/AIDS education, and their sense of responsibility. The existence of schools’ HIV/AIDS policy, a climate of equity and fairness, and good school– community relations were the school characteristics most associated with teaching the HIV/AIDS curriculum and teachers’ understanding of HIV/AIDS. An ethnographic study by Visser et al. (2004) focused on the implementation of a school-based HIV/AIDS and lifeskills training programme to prevent the spread of HIV among the young people in secondary schools. They postulated that, in South Africa, HIV/AIDS awareness programmes that focus on the delay of sexual activity and on behavioural change towards safer sexual practices are priorities and remain the only approaches to structure public school managers’ understanding of HIV-primary-prevention strategies. In summary, the findings of Visser et al. (2004) and Matthews et al. (2006) were consistent in identifying that school-based educational programmes are used to mediate the perceptions of the HIV epidemic in South African schools. With regard to how schools’ education programmes influence school managers’ understandings of HIV, an ethnographic study in Uganda (Mirembe & Davies, 2001) aimed to understand what makes young people fail to apply their HIV-related knowledge in higher-risk situations. The findings provided valuable insights into the cultural influences on perceptions of HIV and AIDS; cultural issues emerged as a large contender in determining the various understandings of HIV/AIDS, response efforts and HIV/AIDS programmes that were present in the schools. Matthews et al.’s (2006) findings were also original and consistent in trying to link culture to significant and contemporary dimensions in order to understand how the HIV epidemic is perceived and dealt with in public schools. Based on their research, they described the situation as constituting a risky environment for pupils, and, to some extent, this annulled the radical curriculum interventions meant to improve perceptions of HIV/AIDS and PLHIV in schools. From the argument thus far, understanding HIV/AIDS in South African public schools by reviewing educational programmes may have become directly or indirectly less important, as people’s understanding is often dominated by other dynamics, such as culture and belief systems. In addition, Matthews et al. (2006) postulated that besides psychosocial concepts, the broader institutional environment and school climate are likely to affect how teachers understand HIV/AIDS education and will thus affect how they present information on the epidemic to students. As

African Journal of AIDS Research 2008, 7(3): 249–257

part of psychosocial theory, considering environmental factors implies that the environment/society in which a school is located and the school’s culture have relevance when exploring how school managers understand the epidemic and PLHIV.


and practices did not identify nor represent HIV/AIDS, the participants resorted to various descriptions and treatment analyses of HIV/AIDS that were devoid of biomedical knowledge.

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Research design Theoretical conceptions In discussing the social-construction process of reality, Berger & Luckmann (1966) point out that a society embodies both subjective and objective reality. They theorise that people form subjective views and establish an inter-subjective world, which becomes a foundation of knowledge in everyday life. Since the context of society precedes the birth of each individual, social norms and tradition will normalise people’s perceptions and behaviour imperceptibly (Yeh, 2007). Internalisation is another concept of social reality that expedites the process of attaching meaning to concepts. Yeh (2007) illustrates this ideology by explaining that because people live in a particular society, they play roles according to its social norms. From objective and habitual traditions, people extract and absorb rules that become part of their personal knowledge, thus causing them to perceive and behave according to social norms (Yeh, 2007). With an understanding of how diverse phenomena can acquire meaning, exploring Mary Douglas’s (1966) theory of cultural risk assists this study in providing possible explanations about what types of meaning could be attributed to HIV/AIDS and why. Douglas (1966) believed that no particular classification of meanings or understandings can be understood in isolation, but there can be hope of making sense of them in relation to the total structure of classifications in the culture in question. Therefore, in order to understand the perceptions of public school managers, it is vital to consider the total structure of the culture in which their perceptions are classified. Drawing from Douglas’s (1966) theories, the notions of inspired fear and confusion with defilement are significant to understanding how people make meaning of disease (such as AIDS) in a culturally influenced society. The source of such fear and confusion is traceable in part to belief in horrible disasters that can overtake those who inadvertently cross some forbidden line (in this case, HIV-related socialisation risk practices) or who develop some impure condition. Douglas (1966) argues that as fear inhibits reason, it can be held accountable for other peculiarities in people’s thoughts, notably the notion of defilement. Belief systems are at the root of cultural influences. Thus, Mary Douglas’s theories of purity and danger have helped to unequivocally focus this paper’s discussion of how meanings were attributed to HIV/AIDS and PLHIV by the South African public school managers. Forsyth’s (1907) philosophical conceptions of the known and unknown became apt in interpreting ‘why’ and ‘how’ the experiential descriptions can be used to express understanding of HIV/AIDS by the supposed elites. Drawing from Forsyth (1907) concepts, the evident argument is that the participants understand HIV/AIDS based on their background knowledge, assumptions and beliefs about what defines disease, and also on their attitudes towards disease. Unfortunately, when a transfer of these definitions

As an exploratory study, I began with no presuppositions, assumptions or hypotheses. However, I was guided by the existing literature that suggested the importance of paying close attention to the informal processes of data collection and to participants’ comments that are not said publicly or officially (see Stadler, 2003). I also carried with me the same expectations embedded in official policy documents regarding HIV/AIDS in South African public schools. As a study that is interested in understanding the meanings attached to HIV/AIDS and PLHIV by public school managers, a qualitative approach was adopted. Critics of the qualitative approach (see Schratz, 1993; Johnson, 1995) opine that it is primarily concerned with processes rather than outcomes or products, and that it emphasises the subjective experiences of respondents. The underlying assumption here is that people are most likely to practice or implement HIV/AIDS policies based on their personal understandings (Stadler, 2003). My research goal was not to evaluate the implementation and practice of HIV/AIDS policies in the education system, but rather to provide insights, in light of ongoing research debates, about how culture mediates people’s overall experience with HIV/AIDS in South African schools. A better understanding of this will facilitate more effective management of the epidemic in schools, and so help to achieve the United Nations’ goal of ‘education for all.’ To justify my choice of modified method of case study, it is necessary to distinguish between two types of research: hypothesis-testing and hypothesis-generating. I ignored the hypothesis-testing approach, which according to Neuman (2000) can be conducted when one knows exactly what one is looking for and when one is able to define and measure designed variables of interest prior to the research. Rather, I adopted the hypothesis-generating approach, which applies when one is working in an under-explored area, where one does not know exactly what one is looking for or how best to define the variables of interest (in this case, those cultural features that might influence public school managers’ understanding of HIV/AIDS). The goal of such research, according to Bromley (1986), is to describe the case in as much detail as possible, in the interest of mapping out future research areas. For an issue as complex and complicated as HIV/AIDS, a case-study approach alone will not generate rich data. Thus, I adopted a modified approach by combining the case study with some ethnographic research to compare and contrast understandings (meanings) and individual narrations in their actual settings. The use of informal conversations and comments on rumours and gossip to garner data complimented the data gathered from interviews and documentary evidence. The aim of using these methods was to capture data that cannot be ordinarily and easily accessed through formal data instruments (Stadler, 2003).

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Vignettes (interviews based on scenarios) and semi-structured interviews were used to interact with the managers, educators and adult learners, drawing from groups whose views and actions likely impact on PLHIV in South African public schools. These included: head teachers and their deputies, educators (teachers), school governing board members, and students’ representatives. Informal conversations occurred mainly with adult learners and educators, while adult learners only participated in the focus group discussions. The participants had diverse cultural backgrounds, diverse educational and work histories, and varied socio-economic circumstances. It was assumed that the school managers would perceive HIV/AIDS and PLHIV in various ways due to their different backgrounds. Discourses in The National Policy on HIV/AIDS for Learners and Educators in Public Schools, and Students and Educators in Further Education (Department of Education, 1999) and Gauteng Province’s Guidelines on the Implementation of Sexuality, Life Skills and HIV/AIDS Programmes in Schools (Department of Education, 2001) formed the official (background) understanding that guided the data collection.

handwritten in cases where the participant opposed voice recording. To represent the diverse cultures of the participants, the racial representations noted were Black African, White, Indian and Coloured (Table 2). Religious belief systems were denoted as atheist, Hindu, Moslem, African traditional beliefs, or Christian (Table 3). Almost all the participants, but especially the educators (teachers), had attended HIV/ AIDS counselling training or workshops with non-governmental organisations or the South African-based Treatment Action Campaign (TAC).

Study sites and characteristics of the respondents This study was conducted in five public schools in Gauteng Province, South Africa. Apart from one school in Auckland Park, which is home to middle-class South Africans, the rest were located in Alexandra, Thembisa, Jeppes Town and Hillbrow — locations characterised by high population density, low-income earners and relatively large migrant populations.

Data analysis The data were first translated into constructs and then inspected to visualise theoretical patterns and frames. Thematic analysis enabled the general lines of data to be discerned easily. This analysis did not consider differences between the schools or the race or belief systems of the individual respondents but was particular in extracting the various understandings prevalent in their responses.

Instrumentation HIV/AIDS-related perceptions were assessed using selected items from the national HIV/AIDS policy for public schools (Department of Education, 1999). This research was informed by Mary Douglas’s (1966) theory of cultural risk, which highlights how culture impacts people’s understanding and experiences of phenomenon that are complicated and intricate. Cultural sources include: knowledge (perceptions or understanding), attitudes, beliefs and practices. Based on this conceptual framework, the study explored the extent to which the cultural background of the school managers was likely to enhance or mar their understanding of HIV/AIDS and the experiences of PLHIV. The items assessing their understanding were: ‘What informs the understanding and responses of school management on HIV/AIDS?’ and ‘What are the factors influencing the management of HIV/AIDS in public schools?’ These questions were asked in English, and a research assistant interpreted where necessary. Sample selection During the eight months of data collection, a total of 99 adults (42 males, 57 females), aged 18 to 55, voluntarily participated in the data collection processes. Fifty-eight of the participants were directly or indirectly responsible for dealing with HIV/AIDS policy implementation or education programmes or PLHIV at a managerial level (Table 1). The participants responded to open-ended questions. Some of their comments were tape recorded and some were

Data collection The data were collected from the respondents through interviews, focus group discussions (5 groups of six members), and informal conversations or comments on rumours or gossip. Although the study examined a wide range of social and anthropological issues affecting perspectives on HIV/AIDS and PLHIV in public schools in South Africa, the research focused on how the respondents understood or made meaning of the epidemic and the experiences of PLHIV (Tables 4 and 5).

Table 1: School roles of the respondents (n = 99)

Adult learner Educator Principal or deputy School board member Expert informant

No. 44 41 9 4 1

Table 2: Breakdown of the respondents by race (n = 99)

Black African Coloured White Indian

No. 46 24 21 8

Table 3: Breakdown of the respondents by belief system (n = 99)

Christian Moslem African traditional religion Atheist Hindu

No. 33 24 19 17 6

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African Journal of AIDS Research 2008, 7(3): 249–257


Thematic analysis of the data focused on illustrations of arbitrary understandings that were identified from the descriptions and narrations of the participants. Considering that the data were, by imposition and design, confined within the content of the national policy and everyday practices in the school, the purpose of the analysis was to code the understandings of HIV/AIDS and PLHIV according to the concerns of the national policy. This paper explores one fundamental area of HIV/ AIDS-related challenges — people’s understanding of HIV/ AIDS. ‘Understanding’ was chosen because it can help clarify the reasons for poor implementation of HIV/AIDS policies in schools. It also helps explain the persistence of stigma despite the wealth of knowledge that has been availed to public school managers. Cultural (which includes religious beliefs, eschatology and witchcraft) and racial perceptions were identified and discussed using content analysis. I followed the prescription by Mouton (2001) to put recorded texts into word, and look for the many meanings that may emanate from it, using cultural and racial competence and critical discourses. I examined how the cultural discourses constitute different meanings, and then grouped them and analysed them accordingly. These groupings were made possible through the participants’ narratives on HIV treatment and prevention, and their attitudes towards HIV/AIDS and PLHIV. A narrative style of data analysis ran parallel to the data collection (following the identified themes) because each data collection approach was expected to inform and drive subsequent data-collection activities. Finally, the findings are related here to existing debates, arguments and the literature to illustrate the themes and subject matter of the study. Findings The participants’ understandings of HIV/AIDS and PLHIV were based on individual experiences of the disease, personal belief systems and cultural backgrounds. However, Table 4: Respondents (n = 58) contributing informal conversation or comments on rumours or gossip Respondent’s role Adult learner Support staff Educator School board member

No. 28 15 14 1

% 48.3 25.9 24.1 1.7

Table 5: School role of the respondents (n = 36) participating in semi-structured/vignette interviews Respondent’s role Educator Learner Principal or deputy School board member Expert informant

No. 15 9 8 3 1

% 41.7 25.0 22.2 8.3 2.8

not all the participants shared the same perceptions, but the extent to which their individual understandings of the epidemic differed is based on some cultural practices or beliefs. The findings are presented thematically, in the following categories of understanding: biomedical, cultural, religious, witchcraft, race, and eschatology. Biomedical understanding The primary understanding of the HIV epidemic by many respondents was biomedical. All the participants were knowledgeable about the globally promoted ‘ABC’ prevention strategies. The participants who shared this primary perception confined their understanding to the available medical information about modes of HIV transmission, recommended precautions, and HIV/AIDS management/ treatments. These perceptions were products of HIV/AIDS education sessions, mass media reports, and life-orientation lessons they had been exposed to in the school or at home. ‘With due respect, ma’am, we have been taught by AIDS agencies and I am sure we have relatively good knowledge of HIV/AIDS. What we do with the knowledge may be different but we have been taught’ (head teacher). I describe this response as ‘administrative symbolism’ on the way to the management of HIV/AIDS, considering that the phrase ‘what we do with the knowledge may be different’ may suggest a reflection of not appropriating the biomedical knowledge in practice, despite the wealth of such knowledge that educators are exposed to. Cultural understanding Although most participants claimed to know a great deal about HIV/AIDS and how a PLHIV should be medically looked after, some supplemented that knowledge with cultural beliefs. All participants were all aware that HIV infection and AIDS illness presently have no cure, but that aspect of ‘no cure’ provoked alternative understandings of the disease and PLHIV. This could be judged as a contradiction between what individuals have culturally known or understood as disease and what is conventional in the case of HIV and AIDS. Forsyth (1907) suggests that individual understanding of new concepts or challenges are based on one’s prior knowledge of similar issues. Transferring the authentic cultural knowledge of disease directly to HIV or AIDS only complicated the participants’ perceptions of the disease and PLHIV: ‘For us, a disease is something that inflicts pain to the human beings or animals. It usually has a cure either by the izangomas [traditional medicine men and women], inyangas [herbalists], religious leaders [ufundisi] or the medical doctors. It can kill you but at least there must be cure for it’ (female educator). ‘The worse thing about this disease is that sex is involved. Why sex? How can people stop having or always wear condoms to have sex? It is not real and that means to me that there is no more real world. This disease is going to wipe all of us out because we must have sex’ (male educator). Thus, two concepts made HIV/AIDS mystifying: these involve death and sex. Douglas (1966) suggests that in cultural philosophy, death and sex are sacred topics seen

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as taboo to discuss. The perception that HIV/AIDS is transmitted through sex, combined with the attitude ‘no cure but death’ and the fear attached to dying, impeded these individuals’ willingness to practically and satisfactorily accept available biomedical knowledge. Based on this cultural formation, this study opines that Douglas’s (1966) conception of symbolic boundary maintenance illustrates the HIV/AIDS management approach taken in these public schools. In maintaining boundaries, it does not matter how much the sick (now ‘unclean’) individual struggles to relate to the healthy (‘clean’) individuals in the education system that they all once shared (before the disease). What is eminent is that they ‘understand’ that those with an incurable disease should be dealt with from a distance. Although some researchers believe that stigma towards PLHIV has drastically reduced, Stein (2003) believes that only the face of stigma has changed. In terms of cultural discourse, the participants believed that it is better and more convenient for male educators to teach boys about HIV/AIDS while the female teachers should educate girls: ‘For me as a female educator, not that I cannot discuss HIV/AIDS with the learners but I must admit that I will not be comfortable talking about sex with the boys. I will feel they will be undressing me while I talk with them on that. It is better for the male teachers to teach the boys, and females the girls.’ ‘Such issues as in HIV/AIDS are not easy to discuss with the opposite sex, be it the learners or adults. I will also not be free to discuss sex-related issues with the girls. I may be accused of sexual harassment, even when I do not intend it. I can easily talk to the boys about sex anytime, but not girls’ (male educator). This understanding strengthens the argument for boundary maintenance. Gender constructs also create a boundary that must be maintained: men versus boys and women versus girls. It may be fair to judge this boundary maintenance as a result of complications arising from dealing with the unknown (Forsyth, 1907) especially when it culturally touches constructs considered taboo. This suggests that people with this understanding could indirectly perceive PLHIV as persons who must be set apart because they could pollute or infect others. Unfortunately, this understanding strengthens discourses of stigmatisation relating to the epidemic. Religious understanding Another way in which the public school managers made meaning of the epidemic was through religious perceptions. Those with religious views felt that HIV/AIDS is a product of the supernatural — ‘a curse from God.’ This introduces a new factor in the concept of stigma attached to PLHIV and even to people affected by HIV. They could no longer be regarded as suffering from contagious disease (a cultural understanding), which was supposed to separate them from others (as in the old stigma channel), but they were now understood as ‘sinners who are cursed.’ The following extracts are taken from direct responses that illustrate religious understandings of the epidemic:


‘The disease is a curse from God’ (educator). ‘I do not claim to know all, but one thing I know and strongly believe is that HIV/AIDS is a curse from God’ (educator). ‘This is a curse, because if one is faithful he/she will not get it. Even when a couple have the disease and they want to make babies, the doctors will help and protect the baby from being infected. This is just to prove that the disease is a result of fornication or adultery and that the unborn baby is innocent’ (school board member). ‘Though I regretted treating that teacher the way we all did, I still believe that those with the sickness are cursed from the gods. That is why there is no cure’ (educator). ‘…Sins have repercussions. You pay for your sins, after all the wages of sin is death’ (educator). ‘How would you explain that a baby conceived by the couple who are [HIV-]positive may be protected from being positive?’ (educator). This relatively new category of perception of HIV/AIDS and PLHIV has the potential to increase stigma. Yet, in this context, stigmatisation may not be apparent because it is disguised as spiritual belief. Thus, those with HIV infection are perceived as ‘paying for their sins’ (as a result of sex outside marriage or with someone who is not your partner), since, after all, ‘the wages of sin is death,’ and those affected by the epidemic are understood to be suffering from ‘the curses’ of their deceased parents. To these individuals, ‘sex is only for the married.’ They portray the relation of sex and HIV/AIDS as sex-pollution, drawing from Douglas’s (1966) theory of cultural risk. Thus, sex is regarded as pollution-free within marriage but as polluting when experienced outside marriage. Deviation from this would be punishable by God — such as through the ‘curse’ of HIV or AIDS. From this perspective, the ideal order of society is safeguarded by the dangers of the epidemic, which threatens transgressors. From this perspective, nature (sex) is implicated in order to sanction the moral code, hence the belief that HIV and AIDS is caused by adultery and fornication. In this way, the whole universe may be harnessed to people’s attempts to force one another into good citizenship. Thus, we find that certain moral values are upheld and certain social rules are defined by a belief in dangerous contagions — as happens when sex is acceptably void of pleasure, yet tied to marriage, or else likely to bring HIV/AIDS, inflicted by God on people (Amadi-Ihunwo, 2008). Individuals with HIV infection (who according to religious views are cursed by God) are expected to seek purification as a means of treatment. This may explain the use of ‘blessed water, tea and soap’ by some of the respondents as an approach to treatment. In trying to search for purity, the infected may become governed by anxiety in order to escape disease (Douglas, 1966), while at the same time confidently reordering their environment (by living optimistically) to make it conform to an ideal. Such an ideal may be embodied as a strict sexual discipline that is advocated throughout the community to reinforce social order. Faith-based treatments such as prayer were understood by some participants as an HIV-treatment strategy: ‘When

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African Journal of AIDS Research 2008, 7(3): 249–257

I become sick, I go to the ufundisi [priests] and they pray for me. My faith and theirs — remember, I said my faith and theirs — make me well’ (educator). Durkheim (1947) considered prayer a religious rite. The effect of the rite of prayer is to create and control experience (see Douglas, 1966, p. 65). If I agree with Durkheim’s opinion that prayer modifies experience, the participants’ perception of using prayer to ‘mediate’ the effects of HIV or AIDS can be better understood. This means that by praying to God about their health, their situation will not only be controlled, but at a certain stage (with consistent prayer) their health conditions will be modified. While this religious rite (prayer) was understood by the respondents as able to avert death from AIDS because it commands confidence (Amadi-Ihunwo, 2008), its instrumental efficacy is not the only kind to be derived from this symbolic action by the users. Douglas (1966) also believes that the other kind of efficacy achieved in prayer itself is in the assertion it makes and the experiences that bears its imprinting on them. One respondent perceived that it is ‘faith’ that heals her when she is sick, and not prayer, thereby justifying Douglas’s opinion. A product of witchcraft Some respondents understood HIV/AIDS as a product of witchcraft. Forsyth (1907) posits that when some aspects of any phenomena are unknown or unclear, people will interpret the concept in different ways. Positioning HIV/AIDS in the conception described by Forsyth (1907), Ashforth (2002) states that the witchcraft discourse forms one of the various interpretations to the HIV epidemic in some South African communities. Managers who understand the epidemic according to this concept do so because of ‘the fear of dying’ and ‘the culture of blame’ associated with HIV and AIDS. Ignorance and fault-finding could be blamed for contributing to this perception. Some people may be unable to accept their mistakes and bear the consequences of the behaviour that exposed them to infection. One participant said: ‘You may not believe it, but I know it is from the witches. They use it to either eliminate any one who seems to be coming out of poverty. They also use it to punish the family they hate very much. You see, when someone is hated by the neighbour, the only way to show that is by sending isidliso [AIDS]. The last way I know they do it, is to use it to punish a man or woman who goes out to have sex with another person outside their marriage. Both men and women are guilty of that’ (educator). Respondents who held this perception also believed that the umtakathis (witches) have solutions to HIV and AIDS. This understanding implicates some myths associated with cures, such as having sex with a virgin, which has been associated with an increase in the incidence of rape in South Africa (Leclerc-Madlala, 2005). Individuals with this understanding believe that protection from the epidemic is to be gained through witchcraft. For instance, the use of ikhubalo (charms claimed to be able to ‘lock’ sex partners from having sexual intercourse with other people) is seen as a plausible solution, potent enough


to protect a partner. Although individuals with this perception may understand that condoms protect people from contracting the virus, they may also believe that ikhubalo is more effective than using condoms. Racial understanding Some controversial racial perceptions were present among the participants. Here, race is simply defined as an obvious difference between individuals. Sellers & Shelton (2003) note that race has been a way to separate people throughout history (and, historically, it has almost always been non-whites who have been discriminated against by whites; Black Africans were, and in some cases still are, seen as inferior). Participants who perceived HIV/AIDS through racial-conspiracy discourse understood HIV/AIDS in South Africa as ‘a black disease.’ The offshoots of apartheid were blamed by these respondents for the epidemic’s racial narrative: ‘These people chased us out of our land and made us carry passports when attempting to enter what they called South Africa. How can such people be trusted with lives and things such as HIV/AIDS education? Though we coexist, deep inside, we are yet to develop true trust in them. These policies you are asking us about were drafted by them and those they believe will protect their interest. I do not trust them and that is why you hear people say that HIV/ AIDS is a black disease. What else can they do to us?’ (deputy head teacher). ‘Although we know how it is transmitted and that there is no cure, in our school, one thing that is clear among my colleagues is that it is a black disease. They think it is only the blacks that are sick of AIDS’ (deputy head teacher). Some respondents combined their cultural understandings of the epidemic with racial controversy. This understanding was shared mostly among the black participants. UNESCO (2003) stated that there is pre-existing distrust concerning HIV (and towards whites in general), which affects people’s perceptions. Among South Africans, HIV/AIDS information is understood to reside more in the hands of whites: ‘I guess we all know, but one question I always ask is — How much does this knowledge help the blacks and coloured in South Africa? I said this because we often do not see the white communities orphaned by HIV/AIDS. Somewhere inside of me, I think they have better knowledge than other racial groups in South Africa and this knowledge is hidden from the others’ (deputy head teacher). The executive summary of the Nelson Mandela/HSRC Study of HIV/AIDS (HSRC, 2002) recognises that all South African races are affected by HIV, although differences in prevalence exist between different races. The summary states that such disparities are largely due to social, economic and behavioural determinants, such as living in informal settlements, poverty, access to the kind of information and education necessary for HIV prevention, associations with people who have HIV infection or have died of AIDS illness, and having multiple partnerships, as well as having a sexually transmitted disease.

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Eschatological understanding An interesting understanding of the epidemic related to doctrines about death and its aftermath, or eschatology. Some individuals perceived HIV/AIDS based on biblical exegesis of the New Testament, focusing on the idea of the holiness of God, which men could recreate in their own lives. With this understanding, society appears as a universe in which people prosper by conforming to holiness, or else they perish when they deviate from it (see Douglas, 1966, p. 50). Specifically, some individuals understood HIV/AIDS as one of the beasts from the Bible’s Book of Revelation. Individuals with this perspective believed that the presence of HIV, the lack of a cure, and the fact that the virus is contracted through a natural yet sinful act (sex) is a symbol that ‘the world is coming to an end.’ To these people, HIV/AIDS is one of the ‘beasts’ that will come and claim as many people as possible before the Second Coming of Christ. One participant surmised: ‘With the present-day troubles where nations are against themselves and siblings against each other, now with this disease without cure, these are telling us that the world is coming to an end…’ (educator). Douglas (1966) characterises such opinions by saying that the idea of holiness is given an external physical expression in the wholeness of the body, seen as a perfect container. Therefore, the body should not be defiled by sex before marriage or with someone who is not your life partner. If one agrees (consistent with primitive cultures) that bodily discharges are defiling, then it is apt to assume that the participants with an eschatological perspective, and also a good understanding that HIV is transmittable through bodily discharges, would perceive persons with HIV infection as defiled. Discussion The diverse understandings of HIV/AIDS and PLHIV by educators in South Africa can be a considerable impediment to the successful implementation of the national HIV/AIDS policy in public schools (Amadi-Ihunwo, 2008). It is evident from the interviews that the personal experiences and cultural backgrounds of the school managers significantly influenced their understanding of the HIV epidemic and PLHIV. Until now, no other empirical study has attempted to understand how and what meanings of HIV/AIDS and PLHIV are conceived by public school managers in South Africa. The interviews conducted for this study revealed that cultural and racial issues dominated the school managers’ understandings as they journeyed from a national HIV/AIDS policy environment — in which there is almost no room for cultural and racial discourses — to carrying out their tasks in the school system. Despite having a generally good HIV/AIDS education policy in place in South Africa, implementation challenges public school managers as a result of their culturally and racially influenced perceptions of HIV/IDS and PLHIV. Accordingly, the educators in this study expressed diverse understandings of the epidemic and PLHIV, which enhanced the symbolic boundary-maintenance (see Douglas, 1966) management approach in these public schools.


Some of the school principals, deputy principals, teachers, school board members, and learner’s representatives ignored the understanding of HIV/AIDS and PLHIV advanced by the national policy. While many understood the epidemic culturally, others combined two or three thematic understandings. Very few (but mostly head teachers) appeared to understand the disease or the experience of PLHIV based primarily on biomedical knowledge. In the absence of other empirical studies about the understandings of HIV/AIDS in South African public schools, it is difficult to corroborate these findings. Conclusions The diverse understandings among the educators suggest the negative effects of cultural and racial understandings of HIV/AIDS and PLHIV on practice and implementation of the national HIV/AIDS policy in South African public schools. The symbolic boundary-maintenance management strategies in these schools can be partly linked to these variously authentic and contrived understandings of the epidemic and PLHIV. The diverse ways in which South Africa’s public school managers make meaning of HIV/AIDS and PLHIV fits into cultural, religious, witchcraft, racial and eschatological perceptions, which tends to contradict the policy discourse. Considering that these understandings are void of biomedical knowledge, the findings suggest a clear cultural response on matters concerning HIV/AIDS, with implications for effective implementation of education policies. Most of the categories of understanding among the educators have a tendency to escalate stigmatisation. It is important to provide a friendly and culturally supportive environment for school managers struggling with their cultural backgrounds in mediating HIV/AIDS (and also for PLHIV in the school system) in order to achieve management of the epidemic in the education sector. The school managers’ diverse perceptions of HIV/AIDS, which variously reflect the belief systems of the participants, suggest a masking of the ways the disease is managed in public schools. The presence of the different understandings raises the question — How can those that share these understandings effectively implement national policies for managing HIV/AIDS in schools? This paper posits that by equipping educators with only biomedical instruction about HIV and AIDS — as officially endorsed in government policies — relatively little will be achieved in the long run. It is recommended that other beliefs and practices that prevail in the understandings of educators should be considered in formulating and implementing HIV/AIDS management policy for the education system. Acknowledgements — I am grateful for supervision received from Professor Brahm Fleisch. Funding for the preparation of this paper was received from the organisers of the 2nd Wits HIV/AIDS in the Workplace Research Symposium, where this paper was first presented. The author — Uche Amadi-Ihunwo is a doctoral degree candidate at Wits School of Education. Her research interests are educational management, leadership, policy, and the interplay of culture and gender in relation to HIV and AIDS.

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References Adamchak, S.E. (2005) Findings of a Survey of Teachers: Strengthening HIV/AIDS Partners in Education (SHAPE 2). World Education, Ghana, May 2005. Amadi-Ihunwo, U.B. (2008) Culture and HIV/AIDS management in South African public schools. The International Journal of Learning 15(3), pp. 253–260. Ashforth, A. (2002) An epidemic of witchcraft? The implications of AIDS for the post-apartheid state. African Studies 61(1), pp. 121–143. Berger, P.L. & Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. New York, Anchor Books. Bennuel, P.S. (2005) The impact of the AIDS epidemic on teachers in sub-Saharan Africa. The Journal of Development Studies 41(3), pp. 440–466. Bromley, D. (1986) The Case-Study Method in Psychology and Related Disciplines. Chichester, UK, Wiley. Coombe, C. (2001) A Humanitarian Response to HIV and AIDS in Education? Short-term Interventions to Save Lives and Sustain Quality. Think-piece prepared for the Swedish International Development Cooperation Agency Poverty Conference, Stockholm, Sweden, November 2001. Department of Education [South Africa] (1999) HIV/AIDS Guidelines for Educators. Pretoria, South Africa, Department of Education. Department of Education [South Africa] (2001) Gauteng Province Guidelines on the Implementation of Sexuality, Life Skills and HIV/AIDS Programmes in Schools. Johannesburg, South Africa, Department of Education. Douglas, M. (1966) Purity and Danger: An Analysis of Concepts of Pollution and Taboo. London, Routledge. Durkheim, E. (1947) The Division of Labor in Society. Glencoe, UK, Free Press. Forsyth, T.M. (1907) The conception of the unknown in English philosophy. Mind, New Series 16(61), pp. 101–117. Human Sciences Research Council (HSRC) (2002) Nelson Mandela Foundation/HSRC Study of HIV/AIDS: South African National HIV Prevalence, Behavioural Risks and Mass Media Household Survey 2002: Executive Summary. Cape Town South Africa, HSRC Press. Johnson, D. (1995) Developing an approach to educational management development in South Africa. Comparative Education 31(2), pp. 223–241. Kelly, M. (2000) Challenging the challenger: understanding and expanding the response of universities in Africa to HIV/AIDS. Paper prepared for ADEA Working Group on Higher Education. Kubler-Ross, E. (1987) AIDS — The Ultimate Challenge. New York, Macmillan. Leclerc-Madlala, S. (2005) ‘Rethinking virginity testing.’ Gender Links Commentaries, Johannesburg, South Africa, 2 December 2005.


Matthews, C., Boon, A., Flisher, A.J. & Schaalma, H.P. (2006) Factors associated with teachers’ implementation of HIV/AIDS education in secondary schools in Cape Town, South Africa. AIDS Care 18(4), pp. 388–397. Mirembe, R. & Davies, L. (2001) Is schooling a risk? Gender, power relations, and school culture in Uganda. Gender and Education 13(4), pp. 401–416. Mouton, J. (2001) The Practice of Social Research. Cape Town, South Africa, Oxford University Press. Neuman, W.L. (2000) Social Research Methods: Qualitative and Quantitative Approaches (4th edition). Boston, Massachusetts, Allyn and Bacon. Parker, B. (2004) Roles and responsibilities, institutional landscapes and curriculum mindscape: a partial view of teacher education policy in South Africa, 1999 to 2000. In: Lewin, K., Samuel, M. & Sayed, Y. (eds.) Changing Patterns of Teacher Education in South Africa: Policy, Practice and Prospects. Sandown, South Africa, Heinemann. Piot, P., Bartos, M., Ghys, P.D., Walker, N. & Schwartländer, B. (2001) The Global Impact of HIV/AIDS. Geneva, UNAIDS. Schratz, M. (1993) Voices in educational research: an introduction. In: Schratz, M. (ed.) Qualitative Voices in Educational Research. London, Falmer. Sellers, R.M. & Shelton, J.N. (2003) The role of racial identity in perceived racial discrimination. Journal of Personality and Social Psychology 54(5), pp. 1079–1092. Stadler, J. (2003) Rumours, gossip and blame: implications for HIV/ AIDS preventions in the South African lowveld. AIDS Education and Prevention 15(4), pp. 357–368. Stein, J. (2003) HIV/AIDS Stigma: The Latest Dirty Secret. CSSR Working Paper No. 46, October 2003. Cape Town, South Africa, Centre for Social Science Research (CSSR). UNAIDS (2004) 2004 Report on the Global AIDS Epidemic/UNAIDS 4th Global Report. Geneva, UNAIDS. UNAIDS (2008) Report on the Global AIDS Epidemic. Geneva, UNAIDS. UNESCO (2003) Nairobi Cluster Report of a Consultation on HIV/ AIDS and Education, 4–6 March 2003. Compiled by Susan Nkinyangi, Kigali, Rwanda. UNICEF (1999) The Progress of Nations 1999. New York, UNICEF. UNICEF (2000) The Progress of Nations 2000. New York, UNICEF. Visser, J.M., Schoeman, J.B. & Perold, J.J. (2004) Evaluation of HIV/AIDS prevention in South African schools. Journal of Health Psychology 9(2), pp. 263–280. Yeh, N.-C. (2007) A framework for understanding culture and its relationship to information behaviour: Taiwanese aborigines’ information behaviour. Information Research 12(2) January 2007, electronic journal. Online at: paper303.html.

AIDS in Gauteng, South Africa.

This paper presents the diverse understandings of HIV/AIDS and people living with HIV (PLHIV) revealed by school managers in a selection of public sch...
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