African Journal of AIDS Research 2010, 9(3): 307–313 Printed in South Africa — All rights reserved

Copyright © NISC (Pty) Ltd

AJAR

ISSN 1608–5906 EISSN 1727–9445 doi: 10.2989/16085906.2010.530189

HIV/AIDS knowledge among adolescent sign-language users in South Africa Victor de Andrade* and Bontle Baloyi University of the Witwatersrand, School of Human and Community Development, Department of Speech Pathology and Audiology, Private Bag 3, Wits 2050, Johannesburg, South Africa *Corresponding author, e-mail: [email protected] People with hearing impairment may have difficulty accessing information about HIV/AIDS, especially those who use sign language. Because adolescence is characterised by sexual maturation, it is important to gauge levels of HIV/ AIDS awareness and knowledge in this age group. For this scoping study, we interviewed seven adolescent South African Sign Language (SASL) users (aged 15 to 21) who were attending a school outside Johannesburg which caters for hearing-impaired learners from limited socioeconomic backgrounds. The responses were transcribed and themes were clustered to extract the essence of what was conveyed. The participants appeared to have basic knowledge about HIV and AIDS (e.g. prevention through the use of condoms); however, gaps in their knowledge included misperceptions about contracting HIV infection (e.g. through touching people with HIV or AIDS, or rejecting a person who was possibly HIV-positive as a preventive measure) and confusing HIV disease with other illnesses (e.g. cancer). Overall, the adolescents appeared to have insufficient information about HIV transmission and did not appear to fully understand the consequences of infection. The findings correlate with other research in Africa showing the difficulties experienced by people with disabilities, including hearing impairment, in accessing HIV/ AIDS information. The article advocates for policymakers to include people with hearing impairment, particularly sign language users, in HIV-prevention programmes. Keywords: communication, disability, disability studies, hearing impairment, qualitative research, scoping study

Background The high number of people with HIV infection in South Africa has dramatic and far-reaching effects at the individual, family, community and national levels, thereby affecting the social wellbeing of individuals and the economy of the country (Van Dyk, 2001; Barnett & Whiteside, 2006). Adolescents today are considered vulnerable to HIV due to prevailing early sexual debut and tendencies to have older sexual partners and to engage in transactional sex (Department of Health, 2007). Moreover, deaf adolescents, who may be engaging in relatively early sexual activity, may be at a greater risk of contracting HIV because they may not be able to access HIV prevention, testing and treatment programmes (Hanass-Hancock, 2009). As a result, a population with hearing disability in a country with high HIV prevalence suggests that there is a group of people whose needs require special consideration. Adolescents’ knowledge and perceptions with regards to HIV/AIDS especially need to be explored during this stage of sexual development. Deaf and hearing people may be differentially exposed to HIV/AIDS information campaigns. HIV-prevention campaigns can be broadly divided into communication programmes, peer-education programmes, and the provision of information, education and counselling (IEC) materials (Department of Health, 2007). Ongoing HIV/

AIDS-awareness programmes in South Africa include loveLife, Soul City and Khomanani, as well as the lifeskills courses offered at schools as per the Revised National Curriculum Statement (Department of Education, 2002; Johnson, Schierhout & Matabeni, 2006). These programmes are reported to have different levels of efficacy as research has demonstrated that a combination of programmes yielded a significant increase in condom usage between experimental and control groups among participants aged 15–30 years (Johnson et al., 2006). However, the generalisation of findings to include assumptions about individuals with physical disabilities is questionable. For instance, such participants were not included in the First National HIV and AIDS Communication Survey, 2006, which was conducted to gauge the impact of the Khomanani campaign (Johnson et al., 2006). Likewise, Watermeyer (2006) criticised the efficacy of the 2005 loveLife programme in terms of not portraying or including people with disabilities. The majority of HIV/ AIDS-education programmes in Africa have “targeted apparently normal adolescents” (Osowole & Oladimeji, 2000, p. 94). The Khomanani campaign, for example, has acknowledged that not enough has been done to meet the needs of people with disabilities as stigmas still persist where such individuals may be viewed as sexually inactive (Wazakili, Mpofu & Devlieger, 2006; Department of Health, 2007).

African Journal of AIDS Research is co-published by NISC (Pty) Ltd and Routledge, Taylor & Francis Group

308

Kirby, Laris & Rolleri (2006) critically reviewed 83 curriculum-based sex-education and HIV/AIDS-education programmes implemented among youths (ages 9–25 years) worldwide and found that the programmes had a positive impact in changing youths’ behaviour. The areas where change was measured were in delaying sex initiation, increasing condom use and the use of contraceptives, reducing the frequency of sex and sexual risk-taking, and reducing the incidence of pregnancy and sexually transmitted infections (STIs). Most of the programmes reviewed by Kirby et al. (2006) were found to be highly replicable and had been implemented among youths from diverse racial and socioeconomic backgrounds. But it was noted that only one of the programmes had addressed marginalised or vulnerable groups. According to Statistics South Africa (2005), approximately 20% of the country’s population has a significant or permanent hearing loss, which means that a substantial portion of the South African population may be at risk of exclusion from HIV/AIDS-intervention programmes because of a hearing disability. Based on the findings of Kirby et al. (2006), which showed general positive behaviour changes in the general population, it can be assumed that programmes geared specifically at people with disabilities, including those with hearing loss, may yield similar results. The South Africa Demographic and Health Survey 2003 (Department of Health, Medical Research Council & ORC Marco, 2007) estimated HIV/AIDS knowledge and awareness among hearing men and women aged 15 to 49 years; the survey sought information from respondents regarding ever having heard of HIV/AIDS, frequency of condom usage, different HIV-prevention measures, and number of sexual partners during the past year. The study revealed that in general South Africans were aware of HIV/ AIDS, but knowledge about prophylactics was poor among adolescents aged 15 to 19. In addition, educational level and ethnic background were associated with level of HIV/ AIDS knowledge, and black and coloured respondents presented with low levels knowledge as did individuals who had received little or no formal education. However, the survey’s findings cannot be generalised to the entire population of South Africa since people with disabilities, including deafness, were not included. Given that discrepancies in levels of HIV/AIDS knowledge are seen among groups in the hearing population, it can be supposed that inconsistencies may be present in the hearing-impaired population as well (as those individuals are likely to encounter barriers in accessing health information according to the degree of hearing impairment as well as age and socioeconomic background). The South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey (Shisana, Rehle, Simbayi, Parker, Zuma, Bhana et al., 2005) also did not include input from people with disabilities. A recent study by Shisana, Simbayi, Rehle, Zungu, Zuma, Ngogo et al. (2010) does make small mention of persons with hearing impairment, included in a subgroup called ‘other,’ but has not specifically considered this population. The progressive HIV and AIDS and STIs Strategic Plan for South Africa 2007–2011 (Department of Health, 2007) advocates for HIV prevention, treatment, care and support,

De Andrade and Baloyi

and HIV/AIDS-related research, monitoring and surveillance, as well as the human rights and access to justice aspects of HIV/AIDS, yet it recognises that “to date the national response has not addressed the special needs of the various categories of people with disability in terms of prevention, treatment, care and support programmes” (Department of Health, 2007, p. 37). This vision resonates with that of UNAIDS (2008), which emphasises the inclusion of individuals with hearing impairment in HIV-prevention programmes. Issues related to disability need to be considered and highlighted as it has been reported that HIV may be about 14% more prevalent among people with disabilities than it is in other populations (Hanass-Hancock, 2009). There has been a global increase in research on the topic of HIV/AIDS and people with disabilities, with 36 studies having been conducted since early 2000 in Africa alone (Hanass-Hancock, 2009). Of these 36 studies, 10 concerned adolescents with disabilities, including deafness (Hanass-Hancock, 2009). Studies have shown that people with deafness are as much at risk for HIV infection as their hearing counterparts as research suggests that the prevalence of HIV in persons with hearing impairment in Kenya (Taegtmeyer, Hightower, Opiyo, Mwachiro, Henderson, Angala et al., 2008) and in Cameroon (Touko, 2008), is estimated at 7% and 4.4% in those countries, respectively. Some research has shown that deaf persons are at increased risk of exposure to HIV because they have limited access to health information due to the linguistic barriers that accompany hearing loss (e.g. Peinkofer, 1994; Doyle, 1995; Osowole & Oladimeji, 2000; Bat-Chava, Martin & Kosciw, 2005; Groce, Yousafzai, Dlamini, Zalud & Wirz, 2006; Groce, Yousafzai & Van der Maas, 2007; Bisol, Sperb, Brewer, Kato & Shor-Posner, 2008). Also, Touko (2008), among others, debunked the myth that deaf persons are not sexually active, by demonstrating that deaf persons, especially girls, are at high risk for STIs. The current study suggests that deaf adolescents may be indeed marginalised in terms of access to information about HIV/AIDS, and therefore communication strategies need to account for their particular needs. To date, South Africa has purported to include people with disabilities in its HIV/AIDS-intervention programmes (Department of Health, 2007). It appears as though only three studies have been undertaken in South Africa with regard to disability and HIV/AIDS (i.e. Dawood, Bhagwanjee, Govender & Chohan, 2006; Philander & Swartz, 2006; Hanass-Hancock, 2009); and these focused on individuals with specific disabilities — namely, intellectual disability and visual impairment. Dawood et al. (2006) found that adolescents with intellectual disability had inadequate information about HIV/AIDS, while some of the youths had already engaged in sexual activity. This finding highlights that this minority group is at increased risk for HIV infection, which may be primarily as a result of lack of knowledge about transmission and prevention. Philander & Swartz (2006) found that individuals with visual impairment were concerned about their level of HIV/AIDS knowledge, having insufficient IEC materials on HIV/AIDS, as well as their perceived increased risk for HIV infection due to being a minority group that is vulnerable especially to sexual abuse

African Journal of AIDS Research 2010, 9(3): 307–313

and rape. Kvam (2004) suggested that deaf children are two- to three-times more likely to suffer sexual abuse than hearing children, which suggests they face an increased risk of STIs and have a large need for sexual health education. Wazakili et al. (2006) used a focus group discussion with physically disabled individuals (including those with cerebral palsy, polio paralysis, spina bifida, spinal cord injury and stroke), aged 15–24, to investigate the perceptions and HIV/AIDS knowledge among persons with disability. Their findings show that individuals with physical disability were stigmatised, often viewed as nonsexual, and received less information about HIV and AIDS. Adolescence is characterised by hormonal, physical and socio-emotional changes; this developmental period may increase adolescents’ vulnerability as a result of sexual experimentation, potentially putting them at risk for contracting STIs, including HIV (Brooks-Gunn & Furstenberg, 1993; Craig, 1996; Papalia, Olds & Feldman, 1998; Hook, 2002; Santrock, 2003). Therefore, hearingimpaired adolescents will be at higher risk for HIV infection as communication barriers might exclude them from information-sharing programmes about HIV and AIDS. In South Africa, the Department of Health (2007) stated an intention to implement HIV/AIDS-related care, support, and treatment programmes to meet the needs of the disabled population in at least 70% of district-level municipalities by 2011, but its plans regarding how this goal could be achieved were nonspecific. The researchers’ daily interactions with deaf adolescents and anecdotal reports about issues relating to HIV/ AIDS within that group suggested the need to focus on deaf adolescents’ social awareness pertaining to HIV/AIDS. We wished to conduct research within a social constructivist paradigm so as to explore the complex meanings in deaf adolescents’ worldviews, which in turn could lead to an advocacy paradigm championing the needs of deaf learners with regard to HIV/AIDS education. There is a need for research that gauges the level of HIV/AIDS awareness and knowledge among adolescents who use sign language because, in South Africa, they especially will have difficulty accessing HIV/AIDS information as it is most commonly conveyed to the general public and the general adolescent population. Hanass-Hancock (2009) pointed out that issues surrounding disability need to be researched in order to more effectively implement HIV/AIDS-intervention programmes across different sectors of the population. Therefore, we set out to explore the HIV/AIDS awareness and knowledge of deaf, in-school adolescents who may be at a stage of sexual exploration. Methods A qualitative research design using a purposive sample was adopted for gathering the data (see Clark-Carter, 1997; Henning, 2004). Through this qualitative research, we aimed to understand broader issues around hearingimpaired adolescents’ HIV/AIDS knowledge by exploring the study participants’ experiences in terms of commonalities with regard to a particular phenomenon — in this instance, deafness and HIV/AIDS. This phenomenology promotes the

309

development of “a composite description of the essence of the experience for all the individuals” (Creswell, 2007, p. 58). Ethical clearance to conduct the research at a school outside Johannesburg catering for hearing-impaired learners from a limited socioeconomic background was obtained from the University of the Witwatersrand Ethics Committee, the provincial branch of the Department of Education, and the school’s executive committee. Consent from parents and agreement from the participants was also sought. Thus, the researcher was given permission to talk with the adolescent learners and to video-record them for the study. Information and instructions pertaining to the study were communicated with the aid of a South African Sign Language (SASL) interpreter who had signed a nondisclosure form, and the participants were informed of the confidentiality of their involvement. Data collection One-on-one interviews were conducted in SASL with the aid of the SASL interpreter based at the school. This method of data collection enabled the participants to use SASL in communicating with the researcher without compromising the validity and reliability of their responses as a result of communication barriers and different literacy levels (see Peinkofer, 1994; Doyle, 1995; Bat-Chava et al., 2005). The interviews were video-recorded for later transcription of the SASL. An interview guide sought to explore the hearingimpaired adolescents’ HIV/AIDS awareness and knowledge, specifically in relation to HIV transmission and prevention, the consequences of HIV/AIDS, and treatment and management. Site and participant selection Seven school-going, deaf adolescents (three females and four males), aged between 15 and 21 and currently in Grade 9 at an urban school for the deaf in a township just outside Johannesburg, took part in the study. The school reported to have life-orientation classes that included education about sexual health. The HIV status of an individual was not routinely disclosed at the school; hence it was difficult to ascertain information about the rate of STIs and pregnancies among the learners. The inclusion criteria stipulated that the participants had to be adolescents with hearing impairment, enrolled at a school for the deaf, and who used SASL as their main mode of communication. The sample size was limited due to the exclusion criteria, which included concomitant disability, such as visual impairment or intellectual disability, and by the number of learners whose parents or caregivers consented to their participation. The number of deaf people in South Africa is a small subset of the general population who attend school, and the class sizes are generally smaller at schools for the deaf; thus, this sample appeared to mirror the situation at other schools for the deaf and, therefore, to reflect the situation for many deaf adolescents who are attending school. Data analysis The participants’ responses were lexically transcribed by

310

De Andrade and Baloyi

both of the researchers, and the data were analysed using thematic content analysis (see Wilkinson, 2004). Through ‘horizonalization’ (see Moustakas, 1994), quotations were highlighted to give insight into how the participants experienced the phenomenon of HIV/AIDS information as deaf learners, after which their statements were clustered into themes (see Creswell, 2007). Themes were identified by looking for repetitions, conflict and contradictions (see Denzin & Lincolin, 2000). To ensure the quality of the data analysis, individual reviews of the data were conducted by the authors and the coded transcripts were compared to verify the themes; consensus on the themes identified was sought in cases where disagreement occurred. Follow up information session for participants On completion of the study, a feedback and information session for both the teachers and the learners was held at the school. The information session for the learners was facilitated by an HIV/AIDS counsellor proficient in SASL. Results and discussion Knowledge about HIV transmission The participants mentioned various modes of HIV transmission; Table 1 outlines common themes derived from their responses. Three participants correctly mentioned unprotected sex and two mentioned blood transfusion as modes of HIV transmission. Only one of the seven participants related the risk of having multiple sexual partners. Those adolescents who reported that unprotected sex is a common mode of HIV transmission described HIV as acquired and transmitted ‘out of having sex without a condom, you can have AIDS’ and ‘because those men or women don’t use condoms.’ These responses correctly reflect the fact that HIV can occur in blood, semen and vaginal secretions (Barnett & Whiteside, 2006). One participant said: ‘Hmm, if a girl, I will tell her we must go somewhere; I can ask a girl to sleep with me or to have sex. Ok, if I don’t tell the person that I have AIDS, that’s when the other person will get AIDS [sic] because I will sleep with her.’ Research has shown that the probability of HIV transmission depends on the “type of sexual practice, the frequency of the practice, and the HIV status of the sexual partner” (Fan, Conner & Villarreal, 2007, p. 126). This correct knowledge was apparent in the comment of one participant who stressed: ‘Maybe if the man is sleeping with many partners, then the man can give other women HIV.’ With regard to having multiple partners, a striking comment was made by Participant 6:

Table 1: Themes in the adolescents’ responses pertaining to HIV acquisition/transmission (n = 7) Common themes pertaining to HIV acquisition/transmission Unprotected sex Contaminated blood transfusion Transmission myths Multiple sexual partners Inaccurate knowledge

n 3 2 3 1 3

‘Maybe a person, for instance maybe my brother who likes to go to parties and drink alcohol, will get drunk and won’t be able to walk, and my brother will ask girls to have sex with him, and because he didn’t know some of the girls, he just slept with the girls, so the girls who are also sleeping with him, their lives will be destroyed because they will be having AIDS also. So we need to prevent AIDS and protect ourselves.’ Two participants mentioned misconceptions about HIV transmission: ‘Maybe you touch that person who is having blood, that‘s how you get it’ and ‘They [people who are HIV-positive] will cough, and, if maybe I am coughing, it will spread to another person.’ Groce et al. (2007) found that deaf participants in Nigeria believed that one could get HIV or AIDS from ‘dirty places’ or from touching and hugging. That study reported a significant difference in HIV/ AIDS knowledge between the hearing and deaf populations, suggesting that deaf people are at increased risk for acquiring HIV. However, this discrepancy between deaf and hearing groups may not be specific to HIV/AIDS information, but may reflect a generalised restricted access to health information because of the communication barriers encountered as a result of hearing loss. Also, the deaf participants’ responses may reflect HIV stigma, which is likewise common in the hearing population (Davis, Noel, Chan & Wing, 1998). Two participants related insufficient knowledge about HIV transmission: ‘I do not know their lives, how they get it. I don’t have any information on how they get it’ and ‘It’s from the inside.’ Previous research has asserted that “lack of knowledge and misconceptions about HIV and AIDS are key factors in the lack of prevention” (Johnston & Hopkins, 1990, cited in Davis et al., 1998, p. 662). Knowledge about the consequences of HIV/AIDS The participants generally showed an awareness of the physical consequences of contracting HIV or AIDS, such as by mentioning tuberculosis, cancer, weight loss and death. There was a suggestion of opportunistic infections when a participant said: ‘You can’t be well, you’ll be sick, you’ll have more diseases from that.’ Table 2 summarises the participants’ knowledge about the consequences of having HIV or AIDS. The responses reflect the sobering knowledge that some people may not live very long after acquiring HIV or AIDS. Participant 5 said: ‘They’ll die…after nine months or one year.’ It was previously thought that people would live for six to eight years after becoming infected, but current understanding is that the life duration of an individual is

Table 2: Themes in the hearing-impaired adolescents’ responses pertaining to the consequences of having HIV or AIDS (n = 7) Common themes pertaining to the consequences of HIV/AIDS Death Physical changes (e.g. weight loss) Opportunistic infections (e.g. tuberculosis) and cancer Decision to not disclose one’s HIV status

n 3 3 3 1

African Journal of AIDS Research 2010, 9(3): 307–313

often related to the disease environment and the availability of healthcare; hence the lifespan of people with HIV in poorer countries is often shorter due to not receiving treatment early and not having access to good nutrition (Barnett & Whiteside, 2006). Thus, the participant may have been intimating the conditions with which the participant was familiar (e.g. limited access to healthcare facilities and antiretroviral medications [ARVs]). Other physical changes were (correctly or incorrectly) reported; for example, Participant 6 mentioned that ‘the eyes [of an HIV-positive person] will be white’ and ‘the body will develop sores.’ Participant 7 said: ‘It starts from water and then it will be blood. It means your blood will be watery, it won’t be that thick.’ Participant 6 recounted: ‘My brother will ask girls to have sex with him, and you get HIV/AIDS and cancer’ and ‘if he goes to the doctor or the hospital, he will find that he has HIV and cancer.’ Although they can be co-occurring, the participants may have mistakenly thought that HIV/AIDS and cancer are not actually separate conditions, which may cause confusion with regard to treatment regimens. The social consequences of having HIV or AIDS were also highlighted during the interviews, especially with regard to disclosure. Participant 5 stated: ‘When you are HIV, you don’t want to disclose, you just want to keep quiet and not tell anyone…. You don’t have to be involved with that person anymore. You must leave the person because he will die after a while.’ Such beliefs about HIV and AIDS are common, especially in South Africa, where people often do not want to know or to disclose their HIV status due to fear of discrimination (Brown, Macintyre & Trujillo, 2003). Such beliefs may have dire consequences for individuals with hearing impairment while they fear taking an HIV test and, if HIV-positive, may not be appropriately counselled about taking ARVs due to communication barriers. Also, as highlighted in the National Strategic Plan (Department of Health, 2007, p. 37): “People with disability suffer double stigma arising from discrimination as result of their disability status and their HIV status.” The participants may have been reflecting anxiety about this ‘double’ stigmatisation and fear of additional discrimination. As a result, this anxiety may preclude them from engaging in voluntary testing for HIV, more so than a hearing peer. Knowledge about HIV prevention, treatment and management Table 3 summarises the participants’ knowledge regarding HIV prevention, treatment and management; their responses reflect some generally accurate knowledge (e.g. the benefits of abstinence and the use of condoms), but also show significant gaps in their HIV/AIDS knowledge (e.g. rejection of a person who has HIV or AIDS as a preventive measure). Three participants described condom usage as a preventive measure. This finding is reassuring since it shows correct basic knowledge. Knowledge, attitude, practices and behaviour (KAPB) interventions include the promotion of safer sexual practices, such as abstinence, monogamy and condom use (Barnett & Whiteside, 2006; Fan et al., 2007), which are promoted in the national campaigns. However, individuals need to have accurate knowledge about HIV

311

prevention to enable them to change their attitudes about HIV and thus reduce their higher-risk behaviours (Barnett & Whiteside, 2006). Also, for condoms to be effective, individuals need to learn their correct usage (Fan et al., 2007). Participants 1 and 2, respectively, mentioned monogamy and abstinence as preventive measures, which implies that the participants had information that enabled them to realise the high risk of sexual HIV transmission, especially through having multiple sexual partners: ‘It’s people who do not use condoms when they have sex.’ ‘If you [are] with a partner who has HIV/AIDS, we must control ourselves.’ ‘Ha, it’s so difficult. It’s difficult…how do you get it? Maybe a person who doesn’t use a condom, and out of having sex without a condom you can have AIDS. You have to use a condom to be safe.’ The participants referred to a variety of HIV prevention and management options (Table 3). However, it was of concern that some participants had superficial ideas about how to prevent HIV infection: ‘No, it’s only condoms; there are no pills’; ‘No, there’s no treatment, you can’t be healed…you just need to get the vegetables and the fruits, the healthy food and then you’ll be fine’; ‘If the person [has] been having sex without a condom…just give advice… there’s nothing you can do.’ Participant 2 had a fatalistic outlook: ‘Ok, but you cannot be healed, but after that you’ll die.’ Similar findings were reported by Groce et al. (2007), where 42 participants in a sample of 50 deaf people reported ‘eating healthy’ as a preventive measure for HIV infection. Again, the gaps in knowledge that need to be filled with regards HIV/AIDS are evident, especially since it has been suggested that, in order to maximise health in persons with HIV or AIDS, a three-pronged focus is necessary (see Barnett & Whiteside, 2006), whereby people must: 1) stay healthy, reduce stressors, and maintain a nutritious diet while their CD4 cell count is high; 2) take prophylactic treatments to prevent opportunistic infections, such as tuberculosis, when their CD4 cell count drops; and 3) take ARVs to directly fight the HIV infection. Some responses regarding the treatment of persons with HIV or AIDS were extreme. When asked how HIV or AIDS is treated or managed, Participant 5 said: ‘You don’t have to be involved with that person anymore. You must leave that person because he will die after a while.’ Such misinformation can be attributed to the ‘deaf grapevine,’ which refers to ‘stories’ and gossip within a community tied together by Table 3: Themes in the hearing-impaired adolescents’ responses about HIV prevention, treatment and management (n = 7) Common themes pertaining to HIV treatment and management Abstinence Use of condoms Medication Having one partner Adequate nutrition Nondisclosure of one’s HIV status Reject the person with HIV or AIDS No treatment

n 2 3 2 1 2 1 1 2

312

a common language (Groce et al., 2006). Even so, such myths centred on HIV/AIDS stigmas also exist in the hearing population (Brown et al., 2003). Conclusions and implications This scoping study sheds light on the HIV/AIDS awareness and knowledge of South African adolescents with hearing impairment, revealing them as a vulnerable population that is not necessarily well informed about HIV and AIDS, despite the spread of HIV/AIDS-related information to the general population. The learners in this study had basic information regarding HIV/AIDS (e.g. the use of condoms and abstinence to limit HIV transmission; taking medication and healthy eating as management strategies for HIV and AIDS; and the vulnerability of persons with HIV or AIDS to develop opportunistic infections). Gaps in their knowledge with regard to HIV transmission, prevention, and management comprised inaccuracies, myths and common stigmas (e.g. contracting HIV through touching; rejecting a person who was possibly HIV-positive as a preventive measure; confusing HIV infection with other illnesses). This study suggests a great need for increased HIV/AIDS education for people with disabilities, and deaf adolescents especially. Already, the National Strategic Plan has pointed out that people with disabilities have “been particularly neglected in the AIDS response” (Department of Health, 2007, p. 37). Meanwhile, other research in Africa has reported that HIV prevalence in the deaf population may be double that in the hearing population (Hanass-Hancock, 2009). Limitations of the study It is not possible to generalise these findings to the population of hearing-impaired adolescents in schools for the deaf across South Africa as the study was confined to a small sample from one school and did not include out-of-school youths who may be at even greater risk for contracting HIV. Also, this study did not explore the HIV/AIDS awareness and knowledge of age-matched hearing adolescents, which may have yielded valuable comparisons. In addition, levels of hearing impairment were not considered (all the participants were first-language SASL users who did not use residual hearing for communication). Furthermore, the school was not multiracial, with most of the learners being from Zulu or Southern Sotho backgrounds. And since most IEC materials, including school books on HIV/ AIDS, are published in English, and English was used for the interviews, this linguistic feature could have limited these learners’ ability to efficiently express their perceptions and knowledge. Also, although the use of a sign-language interpreter meant that the participants’ comments were more-or-less accurately expressed, it must be acknowledged that because the interpreter was known to them the participants may not have disclosed some personal information; thus influence or bias may have crept into the responses due to the role of the interpreter. Implications of the study People with disabilities have been rarely considered in studies or intervention programmes relating to HIV/AIDS,

De Andrade and Baloyi

and they are often stigmatised as being not sexually active (Wazakili et al., 2006; Department of Health, 2007; Bisol et al., 2008; UNAIDS, 2008). However, it is hoped that this research prompts greater consideration for improving the level of HIV/AIDS knowledge among adolescents who use SASL. Likewise, HIV/AIDS stigma needs to be addressed in this group as rigorously as it is in the hearing population. The study has implications for policymakers to include individuals with disabilities, especially youths with hearing impairment, in HIV-prevention programmes (see UNAIDS, 2008). Barriers which impede the transfer of health information to the hearing-impaired population should be considered when establishing HIV/AIDS intervention programmes. A study conducted among hearing-impaired secondary-school learners in Nigeria revealed that peer education may prove a valuable strategy in this regard (Osowole & Oladimeji, 2000). In South Africa, such an intervention programme is reportedly in place at a facility in Cape Town, where deaf counsellors have been trained to address the needs of hearing-impaired individuals (pers. comm., J. Meletse, coordinator with the Deaf Oral History Project and Outreach Programme for Gay and Lesbian Archives, 3 April 2009). The findings of this scoping study support the training of HIV/AIDS counsellors specifically for persons with hearing impairment. Acknowledgments — The authors thank the adolescents who spoke very candidly about a very sensitive topic, and the school for granting the researchers access to the learners. J. Meletse’s input is also gratefully acknowledged. The authors — Victor de Andrade is a lecturer in the Department of Speech Pathology and Audiology at the University of the Witwatersrand and a clinical supervisor at the university’s Speech and Hearing Clinic; his particular interests are the psychological, cultural and emotional aspects of hearing loss. Bontle Baloyi is a student in the Department of Speech Pathology and Audiology at the University of the Witwatersrand whose research interest has focused on HIV and AIDS.

References Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century: Disease and Globalization (2nd edition). New York, Palgrave Macmillan. Bat-Chava, Y., Martin, D. & Kosciw, J.G. (2005) Barriers to HIV/ AIDS knowledge and prevention among deaf and hard of hearing people. AIDS Care 17(5), pp. 623–634. Bisol, C.A., Sperb, T.M., Brewer, T.H., Kato, S.K. & Shor-Posner, G. (2008) HIV/AIDS knowledge and health-related attitudes and behaviours among deaf and hearing adolescents in southern Brazil. American Annals of the Deaf 153(4), pp. 349–356. Brooks-Gunn, J. & Furstenberg Jr., F.F. (1993) Adolescent sexual behaviour. In: Gauvain, M. & Cole, M. (eds.) Readings on the Development of Children. New York, Scientific American Books. Brown, L., Macintyre, K. & Trujillo, L. (2003) Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention 15(1), pp. 49–69. Clark-Carter, D. (1997) Doing Quantitative Psychological Research: From Design to Report. Hove, UK, Psychology Press. Craig, G.J. (1996) Human Development (7th edition). Upper Saddle River, New Jersey, Prentice Hall.

African Journal of AIDS Research 2010, 9(3): 307–313

Creswell, J.W. (2007) Qualitative Enquiry and Research Design: Choosing Among Five Approaches (2nd edition). Thousand Oaks, California, Sage Publications. Davis, C., Noel, M.B., Chan, S.F. & Wing, L.S. (1998) Knowledge, attitudes and behaviours related to HIV and AIDS among Chinese adolescents in Hong Kong. Journal of Adolescence 21, pp. 657–665. Dawood, N., Bhagwanjee, A., Govender, K. & Chohan, E. (2006) Knowledge, attitudes and sexual practices of adolescents with mild mental retardation. African Journal of AIDS Research (AJAR) 5(1), pp. 1–10. Denzin, N.K. & Lincolin, Y.S. (eds.) (2000) Handbook of Qualitative Research (2nd edition). Thousand Oaks, California, Sage Publications. Department of Education [South Africa] (2002) Revised National Curriculum Statement Grades R–9: Life Orientation. Pretoria, South Africa, Department of Education. Available at: [Accessed 16 March 2009]. Department of Health [South Africa] (2007) HIV and AIDS and STI Strategic Plan for South Africa 2007–2011. March 2007. Pretoria, South Africa, Department of Health. Department of Health [South Africa], Medical Research Council & ORC Macro (2007) South Africa Demographic and Health Survey 2003. Pretoria, South Africa, Department of Health. Doyle, A.G. (1995) AIDS knowledge, attitudes and behaviours among deaf college students: a preliminary study. Sexuality and Disability 13(2), pp. 107–134. Fan, H.Y., Conner, R.F. & Villarreal, L.P. (2007) AIDS: Science and Society (5th edition). Sudbury, Massachusetts, Jones and Bartlett Publishers. Groce, N.E., Yousafzai, A.K., Dlamini, P., Zalud, S. & Wirz, S. (2006) HIV/AIDS and disability: a pilot survey of HIV/AIDS among a deaf population in Swaziland. International Journal of Rehabilitation Research 29(4), pp. 319–324. Groce, N.E., Yousafzai, A.K. & Van der Maas, F. (2007) HIV/AIDS and disability: differences in HIV/AIDS knowledge between deaf and hearing people in Nigeria. Disability and Rehabilitation 29(5), pp. 367–371. Hanass-Hancock, J. (2009) Disability and HIV/AIDS — a systematic review of literature on Africa. Journal of the International AIDS Society 12, p. 34. Henning, E. (2004) Finding Your Way in Qualitative Research. Pretoria, South Africa, Van Schaik Publishers. Hook, D. (2002) Erikson’s psychosocial stages of development. In: Hook., D., Watts, J. & Cockcroft, K. (eds.) Developmental Psychology. Cape Town, South Africa, University of Cape Town Press. Johnson, S., Schierhout, G. & Matebeni, Z. (2006) National HIV and AIDS Communication Survey 2006: Impact of the South African Government Khomanani Campaign [PowerPoint presentation]. Available at: . [Accessed 26 October 2010]. Johnston, W.B. & Hopkins, K.R. (1990) The Catastrophe Ahead: AIDS and the Case for New Public Policy. New York, Praeger. Kirby, D., Laris, B.A. & Rolleri, L. (2006) The Impact of Sex and HIV Education Programs in Schools and Communities on Sexual Behaviors among Young Adults. Research Triangle Park, North Carolina, Family Health International. Kvam, M.H. (2004) Sexual abuse of deaf children. A retrospective analysis of the prevalence and characteristics of childhood sexual abuse among deaf adults in Norway. Child Abuse and Neglect 28(3), pp. 241–251. Moustakas, C.E. (1994) Phenomenological Research Methods.

313

Thousand Oaks, California, Sage Publications. Osowole, S.O. & Oladimeji, O. (2000) Effect of peer education on deaf secondary school students’ HIV/AIDS knowledge, attitudes and sexual behaviour. African Journal of Reproductive Health 4(2), pp. 93–103. Papalia, D.E., Olds, W.S. & Feldman, R.D. (1998) Human Development (7th edition). Boston, Massachusetts, McGraw-Hill. Peinkofer, J.R. (1994) HIV education for the deaf: a vulnerable minority. Public Health Reports 109(3), pp. 390–396. Philander, J.H. & Swartz, L. (2006) Needs, barriers, and concerns regarding HIV prevention among South Africans with visual impairments: a key-informant study. Journal of Visual Impairment and Blindness 100, pp. 111–115. Santrock, J.W. (2003) Psychology (7th edition). Boston, Massachusetts, McGraw-Hill. Shisana, O., Rehle, T., Simbayi, L.C., Parker, W., Zuma, K., Bhana, A., Connoly, C., Jooste, S., Pillay, V. et al. (2005) South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005. Cape Town, South Africa, HSRC Press. Shisana, O., Simbayi, L.C., Rehle, T., Zungu, N.P., Zuma, K., Ngogo, N., Jooste, S., Pillay-Van Wyk, V., Parker, W., Pezi, S., Davids, A., Nwanyanwu, O., Dinh, T.H. & SABSSM III Implementation Team (2010) South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008: The Health of Our Children. Cape Town, South Africa, HSRC Press. Statistics South Africa (2005) Prevalence of Disability in South Africa. Pretoria, South Africa, Statistics South Africa. Taegtmeyer, T., Hightower, A., Opiyo, W., Mwachiro, L., Henderson, K., Angala, P., Ngare, C. & Marum, E. (2008) A peer-led HIV counselling and testing programme for the deaf in Kenya. Disability and Rehabilitation 31(6), pp. 508–514. Touko, A. (2008) Sexual behaviour and HIV prevalence among the young deaf population in Cameroon. XVII World AIDS Conference, Mexico City, Mexico, 3–8 August 2008. UNAIDS (2008) Disability and HIV in Jamaica. September 2008. Geneva, UNAIDS. Van Dyk, A. (2001) HIV/AIDS Care and Counselling: A Multidisciplinary Approach. Cape Town, South Africa, Pearson Education. Watermeyer, B. (ed.) (2006) Disability and Social Change: A South African Agenda. Cape Town, South Africa, HSRC Press. Wazakili, M., Mpofu, R. & Devlieger, P. (2006) Experiences and perceptions of sexuality and HIV/AIDS among young people with physical disabilities in a South African township: a case study. Sexuality and Disability 24(2), pp. 77–88. Wilkinson, S. (2004) Focus group research. In: Silverman, D. (ed.) Qualitative Research: Theory Method and Practice (2nd edition). London, Sage Publications.

Copyright of African Journal of AIDS Research (AJAR) is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.