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An exploratory study of the individual determinants of students’ sexual risk behaviour at a South African university a

a

Given Mutinta , Kaymarlin Govender , Jeff Gow

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& Gavin George

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Health Economics and HIV/AIDS Research Division (HEARD) , University of KwaZuluNatal , Westville Campus, Private Bag X54001, Durban , 4000 , South Africa b

School of Accounting, Economics and Finance, Faculty of Business and Law , University of Southern Queensland , Toowoomba , QLD , 4350 , Australia Published online: 12 Dec 2012.

To cite this article: Given Mutinta , Kaymarlin Govender , Jeff Gow & Gavin George (2012) An exploratory study of the individual determinants of students’ sexual risk behaviour at a South African university, African Journal of AIDS Research, 11:4, 353-359, DOI: 10.2989/16085906.2012.754836 To link to this article: http://dx.doi.org/10.2989/16085906.2012.754836

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African Journal of AIDS Research 2012, 11(4): 353–359 Printed in South Africa — All rights reserved

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ISSN 1608-5906 EISSN 1727-9445 http://dx.doi.org/10.2989/16085906.2012.754836

An exploratory study of the individual determinants of students’ sexual risk behaviour at a South African university Given Mutinta1*, Kaymarlin Govender1, Jeff Gow1,2 and Gavin George1 Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa 2University of Southern Queensland, School of Accounting, Economics and Finance, Faculty of Business and Law, Toowoomba, QLD 4350, Australia *Corresponding author, e-mail: [email protected]

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The prevalence of sexual risk behaviour is high on campuses at South African universities, putting many students at risk of HIV infection. This study explores individual influences on students’ sexual risk-taking behaviour at the University of KwaZulu-Natal. The study collected cross-sectional data obtained between late 2008 and early 2010. A total of 80 in-depth interviews and four focus group discussions were conducted, allowing for an equal representation of males and females and a mix of different races (black, white, Indian and coloured) among students at two campuses (Howard College and Pietermaritzburg) and at different levels of study (undergraduate and postgraduate). The data were analysed using thematic analysis to identify factors associated with the students’ sexual risk behaviour. Sexual risk behaviour was found to be influenced by a range of individual factors, especially: personal beliefs about long-term relationships; attitudes towards sex for variety; a drive for material wealth; a lack of satisfaction in relationships; levels of trust and attention; pursuit of the long-term goal of marriage; and HIV denialism. As young adults, university students lack experience in assessing influences on their risk-taking behaviour, thus they require education on the individual risk factors that put them at risk of acquiring HIV infection. Likewise, the nature of these factors pose significant challenges to reducing sexual risk behaviour among university students. Keywords: attitudes, HIV/AIDS, interviews, qualitative research, risk perceptions, sociodemographic factors, University of KwaZulu-Natal

Introduction As a population of young adults, university students are at greater risk of acquiring HIV than the general public. This is attributed to students’ higher level of sexual experimentation and sexual practices that put them at higher risk of exposure to HIV (World Health Organization [WHO], 2007; Lengwe, 2009; Mulwo, 2009; Mutinta & Govender, 2012). It is estimated that more than 300 000 university students in southern Africa are infected with HIV, and that 15% will experience unwanted pregnancies during their studies (WHO, 2007) while an estimated 60% of unplanned pregnancies around the world occurs among university students (UNAIDS, 2008). Estimated HIV prevalence in South Africa in 2008 was 17% among those aged between 15 and 49 (Shisana, Rehle, Simbayi, Zuma, Jooste, Pillay-Van Wyk et al., 2009). HIV prevalence among South African youths aged 15–24 years is higher than that for other age groups (Pretorius & Raijmakers, 2006). Despite HIV/AIDS interventions targeted at university students, sexual practices that place this group at risk of HIV infection, other sexually transmitted infections (STIs), as well as unintended pregnancy continue to be

a serious health concern (Moodley, 2007; Eleazar, 2009; Lengwe, 2009; Mulwo, 2009). However, there is a dearth of studies on the reasons why students engage in sexual risk behaviour. Breier (2010) argued that living with parents or guardians with conservative sexual attitudes could influence students to engage in sexual risk behaviour once they relocate to university and obtain their freedom. Mulwo (2009) found that students might engage in transactional sex to meet their needs for food and shelter after arriving at university with little funding (cf. Higher Education HIV and AIDS Programme [HEAIDS], 2010). Lengwe (2009) found that the desire of some students to experiment with sex and drugs amounts to HIV risk behaviour. The prevalence of sexual risk behaviour among students at South African universities was estimated at 68% among those reporting to be in a heterosexual relationship (HEAIDS, 2010). Behaviour that makes students susceptible to HIV infection is widespread and takes place on all campuses (Mulwo, 2009; HEAIDS, 2010). The sexual risk behaviours identified include having multiple and concurrent sexual partners, non-use of barrier contraceptive methods, and casual sex.

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This article reports on a detailed investigation of sexual risk behaviour among students at two campuses of the University of KwaZulu-Natal (UKZN), in Durban, South Africa. In-depth interviews and focus group discussions (FGDs) were used to question students on their sexual risk behaviour in order to provide insight into the individual factors that influence sexual risk-taking behaviour among university students.

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Methods A qualitative methodology was used to investigate individual factors that influence students’ sexual risk behaviour. This approach is inherently cross-sectional and descriptive. Data were collected using in-depth interviews and FGDs. Group dynamics were observed to ascertain individuals’ and group thinking and to obtain the majority view of the normative behaviour of students. Interviews were conducted in a quiet environment to provide a confidential atmosphere in which informants could share sensitive, personal information. Each FGD was recorded and lasted about one hour; the data were transcribed within a few hours of collection. FGDs use interactions between researchers and participants to generate data. As suggested by Crabtree & Miller (1999), the dynamic nature of the interaction enables the generation of insights which provides comprehension of how people view a situation. Higgs (2001) emphasises the use of FGDs to understand the social construction of sensitive issues that are otherwise characterised by taboos or silence. Denzin & Lincoln (2000) claim that FGDs afford the researcher privileged access to in-group conversations, which often include everyday language and local terms, thereby uncovering variety, group dynamics, and stimulating conversations and reactions. All standard ethical procedures were followed, with particular sensitivity to issues of confidentiality and anonymity, given the focus on sexual behaviour and the link with HIV. Ethical clearance was obtained through the UKZN research ethics committee. All participants were provided with information sheets detailing the aims of the research and the research process. These information sheets were provided to the participants directly. All participants were given the opportunity to ask questions about the research, and were made aware that they could withdraw from the research at any time without negative consequences. There were no existing power relations between the researchers and the participants which could be perceived as coercive. A verbal explanation was also provided to all the students. In addition, written consent was obtained from the participants before commencement of the data collection. Confidentiality has been maintained through the use of pseudonyms in the research reporting and by changing specific contextual details which could have revealed a participant’s identity. Study setting and sample size KwaZulu-Natal Province is a hub of the HIV epidemic in South Africa, with HIV prevalence at 17.8% (UNAIDS, 2010). This province has the second largest provincial population (10.8 million) and is one of the poorest provinces in the country (Statistics South Africa, 2012).

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UKZN was formed in 2004 following the merger of the University of Natal and the University of DurbanWestville. It has five campuses: Howard College, Westville, Pietermaritzburg, Edgewood, and the Nelson Mandela Medical School, and enrols about 40 000 students. The demographics of the campuses vary. The campuses are multicultural, comprised of black, Indian, coloured and white students, with students coming from within South Africa, other African countries, and other continents. Some students live on campus and others live in rented houses off-campus, often in neighbourhoods that are closely joined, with varying mixes of racial groups. Two of the five campuses were purposively selected for the study as financial and technical constraints made it impossible to cover all the campuses. A list of students in the selected schools was obtained from the university’s Department of Management Information (DMI). Using purposive sampling, 80 students (40 males and 40 females) from each of five levels of study (first-, second-, third- and fourth-year and post-graduate) were selected for in-depth interviews, and each of four FGDs included eight participants representing various levels of study. The sample was distributed to reflect the racial diversity of the study population. This distribution was informed by the results of a survey by Mulwo (2009) which showed that the majority (68%) of the students at the university were black, 20% Indian, 8% white, and 4% coloured. The researchers selected participants based on these statistics, but the numbers of white and coloured participants were adjusted slightly to give more meaningful results. Data analysis A qualitative thematic analysis was conducted on the transcripts, which were transcribed verbatim from the audio recordings. The analytical software package NVivo 8 was used to process and analyse the data. Qualitative research is concerned with making sense of human experience from within the context and perspective of human experience (Kelly, 2006) and has been widely applied in the pursuit of rich data within socially engaged research for the purpose of generating a deeper understanding of the particular phenomenon being researched. Drawing on the work of Braun & Clarke (2006), our analysis involved identifying patterns or themes across the dataset (see Ajjawi & Higgs, 2007). We were concerned with the multiplicity of HIV-risk factors evident in students’ perceptions rather than making an attempt to ascertain the ‘truth’ about actual factors. Patterns of similarities and differences in the participants’ responses were identified and catalogued into themes and sub-themes. These themes form the starting point of the discussion. Findings and discussion Individual factors exert their influence in the context of a complex and dynamic multi-factor system. Common themes concerning individual factors that influenced the students’ sexual risk behaviour included: students’ pursuit of long-term goals of marriage; personal beliefs; attitude towards sex; drive for material wealth; lack of sexual satisfaction; nagging and arguing in relationships; lack

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of trust and attention in relationships; and HIV denialism. The next sections are a descriptive and explorative discussion of these individual factors. Our general observation is that students across the campuses easily engaged with the research themes. This is attributed to the fact that the primary researcher was also a student, thus the participants were cognisant of his position and felt at ease to participate. All names used here are pseudonyms. Pursuit of long-term goals of marriage It was found that the process of striving for the long-term goals of marriage, though positive in itself, can influence young people to engage in sexual risk behaviour. One participant put it well when she said: ‘I have same-age boyfriends and older men simultaneously because older men are more serious and better potential marriage partners than same-age boyfriends who are not stable. Many male students are not ready to commit to supportive relationships. Most of them are Vasco da Gamas. [The students laughed and the interviewer asked what the participant meant by saying some males are ‘Vasco da Gamas.’] I mean Vasco da Gama the Portuguese explorer because they still want to explore with many girls. To be in a relationship with a same-age boyfriend is chasing after the wind and investing in the wrong place. Therefore, having many sexual partners is good because it gives me an opportunity to carefully choose a life partner’ (Lyabonga, female undergraduate, Pietermaritzburg). In agreement with this account, some participants (especially males) explained that one needs to ‘experience’ a partner before marrying her or him: ‘I try on shoes to see if they fit before I buy them, or test drive a car, so why not do the same with relationships as I seek a lifelong partner? (Mark, male undergraduate, Howard College) In a conscious search for lifelong partners students engage in sexual practices that expose them to HIV, especially given that the search time to finding a ‘compatible partner’ is likely to be in years. The participants articulated that it is not easy to find a compatible partner: ‘I had more than seven sexual relationships before settling down for marriage and I was not consistent in using condoms with my partners’ (Winfridah, female postgraduate, Pietermaritzburg). The students’ responses suggest that the long time spent searching for permanent partners allows them to learn about compatibility issues, since they do not want to commit to marriage and then realise that they are not the best fit for each other. The majority interviewed mentioned that one would have more than seven sexual partners on average before meeting the ‘suitable’ partner. The students explained that by the time one had found a suitable partner they may have also acquired HIV for not being consistent in using condoms. Personal belief: ‘Why should I stick to one person?’ According to Jessor (1991), young people’s ideas, beliefs, perceptions and feelings influence their risk-taking behaviour. Jessor (1991) argues that young people tend to follow new ideas without comprehending how that may affect their life.

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The majority of participants explained that students believe that permanent unions with one person are outdated: ‘Why should I stick to one person when I do not intend to get married? Marriage is old-fashioned; today people get married, tomorrow they are signing divorce papers. I would rather live like a wicked person, rather than get into a marriage that will end quicker than it started. Spare us from the prisons of permanent relationships’ (Motsamai, male undergraduate, Howard College). More than half the participants said they believed that not being in a permanent relationship is better than marriage where most people are not happy. The majority of students, especially females, said that the potential for heartache, pain, stress and psychological disturbance caused by the breakdown of a marriage made them view ‘fluid’ relationships as a better option: ‘It is unreasonable to expect couples to stay together in relationships for a lifetime in this day and age. There is more social pressure than ever before to be happy and this outweighs the necessity to make permanent relationships work. For instance, there is already too much unfaithfulness going on in permanent relationships [marriages]. Why should we make people continue to be unfaithful by encouraging them to stick to one person? Society has long accepted that marriage is out of fashion, therefore fluid sexual relationships are fine’ (Susan, female postgraduate, Pietermaritzburg). Interestingly, the participants argued that it is old-fashioned to think permanent relationships are the only alternative to being single. They declared that society offers options to suit the temperaments of individuals who do not wish to stay single yet do not wish to commit to one person for life. Thus, permanent marriage relationships were seen to have lost their meaning: ‘Till death do us apart on campuses has been replaced by as long as I am happy with you’ (Anna, female undergraduate). For this reason students said that they opt for what they call live-in relationships that by their very nature imply a lower level of commitment. They said that the most important thing in live-in relationships is the freedom that couples have. Some students prefer live-in relationships because the individuals do not surrender any rights or accept any responsibilities, as there is an attitude of: ‘You scratch my back, I scratch yours, and both of us enjoy while it lasts’ (Sibusiso, male postgraduate, Howard College). This means that live-in relationships last as long as both partners are happy with each other. Thus, the shared belief holding the relationship together is ‘happiness,’ which can be interpreted differently. Some find happiness in pursuit of their sexuality; to others happiness means drinking, having outings and ‘live sex’ or unprotected sex with many partners. The majority of participants argued that permanent relationships limit their freedom to express themselves sexually. Therefore, students want sexual relationships that allow greater freedom, offering much of the sexual and emotional closeness of marriage while retaining the autonomy of singleness. This makes most student relationships short-lived because the partners are free to walk away at any time. This lack of restriction makes students

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care less for their partners — which might influence their frequency of condom use. This attitude may explain why sequential monogamy is common among students; unfortunately, it appears that many students do not perceive serial monogamy and inconsistent condom use as sexual risk behaviour. Sex for the sake of variety Kotchick, Shaffer, Forehand & Miller (2001) found that experiences and perceptions of sex are strong underlying factors to sexual risk behaviour. In the same vein, Lengwe (2009) argued that in South Africa young people’s unguided experiences and perceptions account for much higherrisk sexual behaviour. Findings from both the individual interviews and FGDs show that students engage in sexual risk behaviour as they try to gain sexual experience and have fun with different people. When asked why students engage in sexual risk behaviour, one female (who reported being in sexual relationships with many partners, but declined to specify the number) replied: ‘I think sexual risk behaviour, especially unprotected sex is also part of not having really grown up, you know, and just want to experience the different things with different people’ (Susan, female postgraduate, Pietermaritzburg). A similar view was presented by a male who said he started having casual sex because he wanted to try out variety: ‘You find that you are doing it the right way by having one girlfriend, but suddenly you meet another Cinderella [attractive girl] and you are overwhelmed by how different and beautiful she is from your main Cinderella. You find that she has nice features, such as milky eyes, small chin, full lips, nice back view, and other attractive features, you know what I mean [group laughter]. So you are made to think that sex with her would be thrilling. So, you make a move and get her as well. At the end of the day I am engaging in risky sexual behaviour for fun, you know’ (Paul, postgraduate, Howard College). The majority of black female participants explained that they engaged in sexual risk behaviour because they are influenced by a notion that international students are better partners than local students. This is based on the perception that international male students prefer permanent relationships that lead to marriage as compared with local male students who do not want commitment or to be married soon. This perception could influence local female students not to use condoms with international student partners as they believe relationships with them might be more permanent. A drive for material wealth A passion for material wealth encouraged the students to engage in sexual risk behaviour. This desire for material wealth encourages female students to share boyfriends, especially those with money. One male explained: ‘My friend has an open relationship and we actually live in the same area where he has another girlfriend. All the girls know that this guy has many girlfriends, but they cannot leave him because he has money and drives beautiful and

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high-performing cars’ (Bongile, male postgraduate, Pietermaritzburg). According to Bongile, the willingness to share a man emerges out of a woman’s desire for a man’s material wealth, including cars, clothes and money. The participants explained that if a guy has got fancy cars, clothes or works in a well-known company or organisation, many girlfriends would like to share that guy and even have unprotected sex with him to ‘strengthen’ their bond. This finding demonstrates that some individuals care more about fulfilling their desires for material wealth than about avoiding the risk of HIV infection. The finding bolsters the explanation by Mutinta & Govender (2012) that the individual perception of socioeconomic status is a strong instigator of young people’s HIV-risk behaviour. Likewise, Lengwe (2009) asserted that students’ sexual risk behaviour cannot be dealt with without addressing their subjective perceptions of structural economic issues on campuses (cf. HEAIDS, 2010). Lack of satisfaction in relationships Mulwo (2009) states that lack of gratification or rather failure to receive what is desired in life, influences students’ sexual risk behaviour. This is attributed to the finding that young people’s failure to achieve their desired outcomes in an effective and systematic manner makes them distressed and unstable in their behaviour (Mulwo, 2009). In this study, the participants discussed at great length, and with passion, the subject of dissatisfaction in relationships. It was explained that after a while, especially in age-disparate relationships, students get bored and look for other partners. Lack of sexual gratification due to partners who are not sexually adventurous, might instigate sexual risk behaviour: ‘It happened that I was going out with an older partner. After a while I realised that I was not enjoying sex as I used to do when going out with same-age boyfriends and this made me miss good live sex. As a result, I ended up having another relationship with a younger partner to experience the sexual satisfaction I was missing’ (Tsole, female undergraduate, Pietermaritzburg). This comment suggests that when students realise they are not sexually satisfied they tend to seek other partners. In seeking sexual satisfaction, condoms may not be consistently used because they are perceived to interfere with the natural rhythm of sex. This promotes a culture where students have unprotected sex with sexual partners who satisfy them sexually. Nagging and arguments in relationships This study found that abusive relationships encourage rebellious behaviour (cf. Jessor, 1998; Parry, 2000). In particular, the students’ identified nagging and arguments as instigators of sexual risk behaviour. The participants described how nagging and arguments in relationships can be exhausting, such that they opt to look for other partners for solace. Interestingly, some individuals would not leave partners who are irritating but would simply begin additional relationships where condom use might be inconsistent: ‘The problem is that sometimes we tend to nag each other or argue a lot over silly things. Because

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of this you end up stopping treating each other well, you know. You then start going out with someone else because you tend to feel that there is something missing, and that maybe someone out there can love you better, and that is how we end up having sex, even unprotected sex out of frustration’ (Zihle, female undergraduate, Pietermaritzburg). The majority of students in the FGDs reported that arguments and nagging are incidental factors that make them engage in sexual risk behaviour. But abuse in primary relationships was identified as a significant reason that students engage in sexual risk behaviour. Participants said that in cases where they are abused by their partners they feel encouraged to start additional relationships where condom use may be irregular: ‘You will find that your partner is abusive and that is his personality; and when you tell another guy about your situation he feels pity and comforts you. In that way a relationship can start, because he is giving you the attention and love you need. Obviously, you will not tell your boyfriend that there is a student out there who comforts and sleeps with you when you have been abused [group laughter]. So that it how we end up in risky sexual behaviour’ (Malibokwe, female undergraduate, Howard College). More than half the participants said that physical, sexual, material and emotional abuse is common in relationships. As compared with the females, only a few males said they had been encouraged to have other partners because they felt abused by their partners who were demanding monetary and material support. Therefore, some male students preferred to spend time and engage in unprotected sex with girlfriends who were less demanding, financially or materially. Lack of trust for partners The notion of trust, which was mainly associated with serious relationships, was seen as a determining factor in choosing whether to be faithful to one partner or to use condoms with other sexual partners. In this account, ‘trust’ seemed to carry an ambivalent meaning. On one level, trust was associated with the partner’s fidelity; on another level, trust was associated with the partner’s commitment to a long-term relationship. A sexual partner could be trusted only when he or she was considered prepared for future marriage. Those who were not considered serious about the future of the relationship were not trusted, hence there was no reason to be faithful to them or to use condoms when having sex with other partners. In fact, practicing fidelity with such partners was considered a risk by some: ‘By sticking to one partner you are actually endangering your life because you do not even know what the other person is getting up to’ (Malibokwe, female undergraduate). The danger here seems to refer to the possibility of a sexual relationship breaking up, in which case, a concurrent sexual relationship in which condom use is not consistent was considered a fallback option. Lack of attention in relationships The study found that a perceived lack of ‘warmth’ in sexual relationships influenced the students to seek out other

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partners. The majority of females reported that a lack of attention from a partner influenced them to look for another to fulfil their need to be appreciated and loved. Students, especially females, said that they were influenced to engage in casual sex when their partners stopped being loving and caring: ‘You find that she or he no longer pays attention to you and stops saying ngiyakuthanda kakhulu [I love you so much], and you will think maybe he or she no longer loves you’ (Mulilo, female undergraduate, Howard College). This perception illustrates that concern or love and care for one’s partner was perceived (especially among the females) as an important component in their relationships. It seems that it was not enough for females to be in relationships that allowed for sex but that they also needed to feel appreciated and loved. Generally, the male students’ responses show that they wanted partners who could give them sex, especially unprotected sex. This finding indicates that female students treasure emotional satisfaction, such that its lack would be enough reason to end a relationship and look for another partner. Unlike their male counterparts, female students more often expressed a preference to leave an uncaring lover to find another one, without engaging in concurrent sexual relationships. Denialism: ‘HIV and AIDS is not for me’ This study found that the majority of students engaged in unprotected sex because they perceived themselves not at risk of acquiring HIV. The participants believed that HIV and AIDS is largely a problem for other people outside the university; hence, a perception of low risk meant that they did not bother to know their HIV status: ‘HIV and AIDS is for people outside varsity, not us here on campus; we are at peace and safe here, and I like it this way because it makes us even to have unprotected sex’ (Kau, male postgraduate, Pietermaritzburg). Trust of their partners was the most recurrent theme the students used to justify their perceived health safety: ‘I trust him so much, he is a good guy and I feel secure’ (Castridah, female postgraduate, Howard College). The participants also downplayed their HIV risk by arguing that they did not have concurrent sexual partners. The majority simply argued that they were not sick: ‘I do not have AIDS’ (Emmanuel, male undergraduate, Pietermaritzburg). Thus, many students perceived themselves as safe from HIV. Interestingly, the majority reported that university life had more pressing issues for them and that these needed more urgent attention than the issue of engaging in safer sex. One student explained: ‘Students here do not perceive HIV and AIDS as a big problem because we have not lost many students due to HIV and AIDS. If we were losing many students it probably would be of concern to us to think of using condoms consistently’ (Thobeka, female undergraduate, Pietermaritzburg). Within the student population, the existence of HIV and AIDS was not readily visible; this allowed students to feel comfortable with engaging in unprotected sex. The majority said they did not perceive HIV as their immediate problem

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as they were preoccupied with buying books and satisfying basic needs that they sometimes could not afford: ‘As long I am not sick I cannot start worrying myself about condom use or HIV and AIDS. Moreover, I have other major fears of more immediate concern, such as beating deadlines for my essays, proposals, chapters, and failing course work, tests, and final exams. So, I can only think of HIV and AIDS if I was to develop symptoms for AIDS. Otherwise, HIV and AIDS is not an issue to me, never’ (Ken, male postgraduate, Pietermaritzburg). Deducing from the responses, it seems that few students had ever died of AIDS during their time on campus. However, the participants said that students withdrew from the university if they discovered they had an HIV-related illness. This was attributed to stigma and discrimination on campuses. Discussions in the interviews show that students perceived unplanned pregnancy as a more serious problem than HIV. To them the unplanned pregnancy ‘that can be seen by parents and friends’ is more real than contracting HIV. One female substantiated this perspective: ‘When I have unprotected sex the only thing that worries me the next day is whether I am pregnant. Once I have my next menses, then I am relieved that we did not create life. The whole issue of whether I am HIV-positive normally does not actually come into my mind; it is actually the last thing I would ever think about unless otherwise’ (Ndlela, female postgraduate, Pietermaritzburg). This feeling of invincibility was also commonly supported by the view that AIDS was a disease for ‘ordinary’ or poor people: ‘One thing you should know is that many students do not take HIV and AIDS seriously enough. It is something we know about, but we think we can never get it. HIV and AIDS is for other people but not us. It is their issue, not ours’ (Hlato, male, Howard College). To further elaborate this perception, the majority cited the high number of pregnancies as evidence of low levels of condom use. Sbu (male, third-year student) pointed out that the number of pregnancies on campuses was an alarming indication that students do not practice abstinence, do not use condoms, and do not take HIV and AIDS seriously. Deducing from the data collected from interviews, the students’ perception of low HIV risk was also influenced by the discourses of HIV denialism promoted by some South African leaders, such as former South African President Thabo Mbeki. As indicated in Hlato’s response, above, students seem to believe that HIV is for ‘other people.’ Some students engage in unprotected sex because they do not believe in the existence of HIV and AIDS: ‘Many students when you talk about AIDS, they say go away Mr Pessimist, there is nothing like that’ (Ndlela, male postgraduate, Pietermaritzburg). This view was relatively common among the black males and females, but the Indian, coloured and white students largely did not share the view. Some participants said that many students have heard so much about HIV and AIDS that the epidemic no longer scares them. Others said that they engage in sexual risk behaviour because they do not

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care given that death is inevitable; hence they feel there is no need to worry about acquiring HIV and so they can enjoy sex now. Implications for HIV-prevention programmes The findings contribute to a better understanding of the underlying factors leading to students’ sexual risk behaviour. The majority of the students’ responses demonstrated that individual factors play a significant role in influencing their sexual risk-taking behaviour. Adolescence and young adulthood are experimental periods and students are likely to be susceptible to individual influences contributing to HIV risk. In this regard, South African universities are an important site within which these factors can be highlighted and dealt with. Our study found that influences on students’ sexual risk behaviour included personal beliefs about long-term relationships, pursuit of the long-term goal of marriage, attitudes towards sex for the sake of variety, a drive for material wealth, lack of satisfaction in relationships, trust and attention in relationships, and HIV denialism. We recommend that HIV-prevention initiatives must include educating students on the HIV risk originating from individual factors in order to encourage young adults to protect themselves. Furthermore, HIV-prevention initiatives ought to use comprehensive models that take into account, among other factors, the perceived individual influences and their combined effects on students’ sexual risk-taking behaviour. HIV-prevention messages that comprehensively address individual factors are likely to be more effective in promoting desired behaviour change on campuses. The findings clearly indicate that the risk of acquiring HIV is caused by contextual factors, including individual factors impacting sexual risk behaviour; thus, certain messages, such as condom promotion and sexual abstinence, should address the context within which sexual decisions are made. Conclusions This research draws attention to the role of the individual factors influencing university students’ sexual risk behaviour, using data gathered on two South African campuses. The findings are not exhaustive in exploring the factors that shape students’ sexual behaviour, but provide a good basis for understanding the key factors that expose students’ to HIV through sexual risk-taking behaviour. These findings can serve as a conceptual basis for HIV-prevention initiatives to address these factors and so help such initiatives keep pace with the dynamics of influences on students’ sexual risk behaviour and thereby lessen the HIV epidemic. References Ajjawi, R. & Higgs, J. (2007) Using hermeneutic phenomenology to investigate how experienced practitioners learn to communicate clinical reasoning. The Qualitative Report 12(2), pp. 612–638. Braun, V. & Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), pp. 77–101. Breier, M. (2010) Dropout or Stop-out at the University of the Western Cape. Cape Town, South Africa, HSRC Press. Crabtree, F. & Miller, L. (1999) Doing Qualitative Research.

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An exploratory study of the individual determinants of students' sexual risk behaviour at a South African university.

The prevalence of sexual risk behaviour is high on campuses at South African universities, putting many students at risk of HIV infection. This study ...
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