Copyright © NISC (Pty) Ltd
African Journal of AIDS Research 2014, 13(4): 361–369 Printed in South Africa — All rights reserved
AJAR
ISSN 1608-5906 EISSN 1727-9445 http://dx.doi.org/10.2989/16085906.2014.985235
Racing risk, gendering responsibility: a qualitative study of how South African students talk about sexual risk and responsibility Mary van der Riet* and Tamaryn Jane Nicholson Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, South Africa *Corresponding author, email: [email protected] Individuals’ perceptions of risk have implications for whether and how they engage with protective strategies. This study investigated how sexual risk, specifically HIV and pregnancy and responsibility for these risks were constructed in discussions across five groups of youth in KwaZulu-Natal, South Africa. The qualitative study used focus groups and interviews with a sample of 28 tertiary level students and 7 peri-urban youth. The constructions of risk intersected with raced and gendered narratives around sexual risk and responsibility. These constructions were used by the participants to assign and displace responsibility for the risks of HIV and pregnancy, rendering some groups immune to these risks. This constitutes a form of stigmatisation and also has implications for participants’ prevention practices. Keywords: gender, HIV, race, social constructionism, unplanned pregnancy
Introduction The dominant risks in sexual activity are HIV, sexually transmitted infections and unplanned pregnancy. How such risks are perceived is theorised to play an important role in the adoption of protective behaviour (Macintyre et al. 2004). Regarding HIV, risk perception is an indicator of perceived susceptibility, an understanding of transmission and “willingness to consider behavioural changes” (Macintyre et al. 2004: 237). The relationship between risk perception and risk behaviour is proposed to be reciprocal and to therefore constitute an important area of study (Anderson et al. 2007). This study took a social constructionist approach to the topic, focusing on how participants constructed, framed and prioritised the risks of HIV and unplanned pregnancy in talk around sexual practice. We argue that constructions of risk establish the conditions for action in relation to these risks. Unplanned pregnancy as risk Pregnancy is defined as unplanned in cases where women do not make a conscious decision to become pregnant, whether using family planning methods or not (Barret and Wellings 2002). The risk of unplanned pregnancy is tied to behavioural factors such as the use of adequate contraceptive measures (Barret and Wellings 2002). An unplanned pregnancy has a significant negative impact through the loss of education and subsequent potential for career and financial development (Varga 2003). For young men who take on their responsibilities of fatherhood educational opportunities and subsequent potential career development are also affected (Swartz and Bhana 2009). However, South Africa has a high rate of father absence and many men do not share the burden of parenting on emotional
or financial levels (Posel and Devey 2006, Richter 2006) meaning that unplanned pregnancies potentially place a greater burden on women than on their male partners. Women might also have to suspend their education whilst assuming responsibility for the child (Posel and Devey 2006). Whilst abortion is legal in South Africa, it is discouraged on both social and religious grounds (Harries et al. 2007). Limited avenues for recourse mean that the burden of the risk of pregnancy in sexual activity is thus weighted for women. The management of contraception and the risk of unplanned pregnancy are thus not equally distributed and typically women take responsibility for both (Kaufman 2000, Varga 2003). HIV as risk HIV/AIDS carries a high human and socio-economic toll and has been identified as a national priority in South Africa (Shisana et al. 2014). Risk for contracting HIV is seen as tied to behaviour in the form of unsafe sex practices, particularly through sex with multiple concurrent partners and a lack of condom use (Whiteside 2008). In South Africa, HIV prevalence is higher amongst Black South Africans than any other race group (15%). For Coloured people it is 3.1%, for Indian or Asian people it is 0.8%, and for white people it is 0.3% (Shisana et al. 2014). Black South Africans from rural and peri-urban areas are more vulnerable to HIV risk (Shisana et al. 2009). In contemporary literature, this is largely attributed to socio-economic status and lack of access to resources such as testing and condoms (Wingood and DiClemente 2000, Wojcicki 2005, Seely et al. 2012, Tan et al. 2014). Women are positioned as physically and socially vulnerable to HIV (Parker and Colvin 2007, Chersich and Rees 2008) particularly in South Africa where levels of coercive
African Journal of AIDS Research is co-published by NISC (Pty) Ltd and Routledge, Taylor & Francis Group
362
sex and intimate partner violence are high and women often have little capacity to negotiate safe sex practice within relationships (Dunkle et al. 2004, Jewkes and Morrell 2012). Shisana et al. (2014) comment that in South Africa women have a significantly higher HIV prevalence than men (14.4% for women versus 9.9%). Young women are also more vulnerable to contracting HIV, both biologically and socially (Dunkle et al. 2004; Leclerc-Madlala 2008, Higgens et al. 2010). For example, Pettifor et al. (2005) found that young women in South Africa aged between 15 and 24 years were significantly more likely to be infected with HIV than young men (15.5% versus 4.8%), and 24.5% of women aged 20–24 were likely to be infected with HIV compared to 7.6% of men in the same age group. The risks of unsafe sex are thus not neutrally or equally distributed. Women are more affected by unplanned pregnancy than men, and women and Black people are disproportionately vulnerable to HIV infection. Gender, race and responsibility This form of asymmetry has implications for how risk is perceived which in turn has an impact on protective behaviours (Skinner and Mfecane 2004, Nduna and Mendes 2010). Perceptions of invulnerability to risks of HIV, for example, redirect both responsibility and blame onto others (Finchilescu 2002). Skinner and Mfecane (2004) argue that distancing and denial reduce the need to adapt, and negatively affect behaviour change. Constructing sexual risk as a real and proximal threat to the self or one’s group will likely result in higher levels of protective behaviours, whereas constructing HIV as a problem of the ‘other’ or another group may have a negative impact on protective behaviours. How individuals interact with and manage the ‘realities’ of vulnerability to sexual risk in talk around sexual practice is therefore important, as it is through this form of social action that blame and responsibility are assigned. In this study, we compared constructions of risk and responsibility across gender and race groups to explore how risk is managed by these groups in talk. We looked at how they are used and what is accomplished by using them in this way. This examination might assist in addressing some of the consequences of these constructions, for example, stigmatisation and lack of engagement with protective practices. Methodology This study followed a qualitative research design to allow for the production of detailed data in the form of participants’ accounts of their own sexual practices as students. A social constructionist stance was taken, as it allowed for an examination of how participants constructed risk and risk management. Ethical approval for the study was obtained from the University of KwaZulu-Natal Humanities and Social Sciences Research Ethics Committee. Sample Twenty-eight tertiary level students volunteered for the study in response to recruitment drives and advertisements on campus. Nine of the respondents were Black
van der Riet and Nicholson
female students, five were Black male students, six were White female students and eight were White male students. A further seven Black male participants in a peri-urban context were recruited using a key informant and snowball sampling. Only men were recruited from this peri-urban sample as an exploratory measure to gauge whether comparisons could be made between this group and male students of a similar age. Participants were included on the basis of being between 18 and 25 years of age, having engaged in sexual activity and having experience in negotiating safe sex. After recruitment participants were scheduled to take part in one of five focus groups which were separated across race and gender. Participants were also given the option of taking part in an individual interview and eight participants volunteered for these interviews. The interviewers, a team of postgraduate students, were matched to these groups and interviews according to race and gender. Several authors comment on the value of gender and race segregation in research groups, and on the matching of interviewer and participant characteristics (race, gender and age) to build rapport and encourage openness (Breakwell 1995, Sikweyiya et al. 2007, Nduna and Mendes 2010). In total, two Black female students, three White female students, one White male student, one Black male student and one Black male peri-urban participant were interviewed. Five focus groups were conducted, one each for Black female students, White female students, White male students, Black male students and Black male peri-urban. Data collection Focus group discussions were used to investigate general attitudes and understandings (Morgan 1997) of safe sex practice. Interviews were used to access personal accounts and experiences (Kvale and Brinkmann 2008) of safe-sex negotiation. Before each of the focus group discussions and interviews, the aims and purpose of the research were explained to the participants and they were given a detailed information sheet. To ensure confidentiality participants were assigned pseudonyms and before taking part in the focus groups were asked to sign a pledge to maintain the confidentiality of the group discussion. For the focus groups, a semi-structured schedule of questions was developed to generate conversation about the norms of sexual practice on campus (or for the peri-urban male participants, in their community) and participants’ views of such practices. The schedule included questions about sex, risks and forms of protection. The one-on-one setting in the interviews allowed for an in-depth discussion using a semi-structured interview schedule of sensitive topics such as individual experiences of sex, and contraceptive and condom use. The student interviews and focus groups were conducted in English. Those conducted in the peri-urban area were conducted in isiZulu by the student interviewer. The focus group discussions and interviews were audio-recorded. All the data were transcribed by the interviewers using simplified Jeffersonian (see Table 1 for transcription conventions). The isiZulu discussions were translated into English by the interviewer while they were being transcribed. The
African Journal of AIDS Research 2014, 13(4): 361–369
363
Table 1: Transcription conventions Annotation [ ]. (word). () ((description ))
Meaning of transcription annotation Square brackets indicate overlapping speech. Round brackets indicate a possible transcription. Empty round brackets show complete inability to distinguish the word. Double round brackets indicate a description, rather than a transcription.
(.3) (.) = _______ CAPS :::: .hhhh Hhhh ↑ ↓ °word° Ha ha He he
Indicates the timed number of seconds elapsed between speech. Indicates a short pause, or an untimed pause. Indicates there was no time lapse between speakers. Indicates that the word or syllable was stressed. Words in capital letters indicate an increase in volume. Shows that a syllable was elongated. The number of colons indicates how long the sound was held for. Indicates an audible in-breath. Indicates an audible out-breath or sigh. Indicates rising intonation, where a question was not asked. Indicates lowered intonation. Shows that the word was spoken more quietly than surrounding speech. Indicates loud laughter. Indicates softer laughter.
validity of all translations was checked through a process of back translation (Brislin 1970) by an independent isiZulu-speaking researcher. To ensure that an adequate representation of the interactions which took place was retained, the data were transcribed as heard and not edited or cleaned up for language or grammar during the transcription process (Silverman 2005). All place names mentioned in the transcripts were also changed to maintain confidentiality.
demonstrative of participants’ actual concerns about sexual activity, but do provide an indication of how participants from different contexts framed their constructions of risk and responsibility. Direct quotes from the transcripts are presented to illustrate how these constructions of the risks of HIV and unplanned pregnancy in talk around sexual practice worked, and what was accomplished by using them in this way. The source of each extract is indicated in brackets for example, focus group (FG).
Data analysis
Risks in sexual activity All the participants identified HIV and unplanned pregnancy as risks central to sexual activity. Although contracting sexually transmitted infections was mentioned by participants, it was not addressed as a major concern. All the participants knew how to prevent unplanned pregnancies and how to prevent HIV transmission. In addressing the risk of pregnancy participants differentiated between hormonal and barrier contraceptives and their uses. Further, all participants cited condom use as the best way to prevent HIV transmission. When asked which risks were the most concerning responses differed across gender and race groups. White male (WM) students, White female (WF) students and Black male (BM) participants from the peri-urban area cited HIV as a primary risk, and Black female (BF) students and BM students cited unplanned pregnancy as a primary risk.
Thematic analysis was used to identify points of similarity and divergence across the data collected. The data were analysed by looking at and eliciting common themes across the five groups (Braun and Clarke 2006). The analytic process was closely aligned with the five steps for analysis laid out by Terre Blanche et al. (2006). This included an initial period of immersion in which the transcripts were read and re-read. This was followed by coding the transcripts first in the terms of the participants and then in the terms used by the study. Similar ideas were grouped together and areas of convergence and divergence were noted. The final stage of the process consisted of a verification phase in which all themes and codes were checked for accuracy and to ensure that they remained close to the data collected. Findings Overall, constructions of risk did not function independently of one another but intersected to produce HIV and unplanned pregnancy as gendered and raced phenomena. These constructions intersected with contemporary narratives around sexual responsibility positioning some groups as more responsible for both protective practices and risks than others. In this section we first discuss the participants’ perceptions of risk, and then their perceptions of responsibility for these risks. From a constructionist perspective, the data presented are not necessarily
HIV as primary risk The peri-urban male participants constructed HIV in terms of lethality and danger, stating ‘it’s just that HIV/AIDS kills’ (FG 5). This construction was echoed in the WM students’ discussion in which HIV was contrasted with pregnancy. These students argued ‘you can take care of a pregnancy you can’t take care of AIDS in a sense there’s a bunch of options but there’s only one with AIDS and that’s get sick and die’ (FG 4). Pregnancy was cited as a risk which, unlike HIV transmission, could be managed. These participants argued that pregnancy could be dealt with, or ‘take[n] care
364
of’ through for example termination. However, HIV was seen as having only one outcome, illness and death. WF students in the focus group contrasted the manageability of other sexual risks with the risk of contracting HIV and framed sexually transmitted infections and emotional trauma as manageable risks. They also spoke about pregnancy in terms of options like termination, adoption or keeping a baby. These constructions were contrasted with that of HIV which ‘you can’t do anything about’ (FG 2). Pregnancy as primary risk In contrast, BM and BF students both talked about unplanned pregnancy as their primary concern in sexual activity. Although both groups mentioned HIV they justified their dismissal of HIV as a primary concern differently. In the focus groups and interviews, BF students constructed pregnancy as a more visible, physical and therefore detrimental outcome of sex. This was contrasted with HIV which was framed as invisible or ‘not gonna be written on your face’ (FG 1). These students also argued that the immediacy and visibility of pregnancy meant that it was more of a threat to female students’ studies than HIV and stated that a pregnancy would likely bring their tertiary education to a halt. BM students also constructed pregnancy as more visible than HIV and as a more immediate and financially detrimental outcome of sex. They noted that the primary risk ‘should be HIV’ (FG 3), but is in fact pregnancy due to the immediacy of its consequences and its direct effect on their future potential financial circumstances. This construction of primary risk was bound to their position as students and some participants implied that this would change once they were able to support a child. Risk responsibility in sexual activity HIV risk as raced White male and female students ranked HIV as the greatest risk in sexual activity when asked directly in the focus groups. However, they did not do so in individual interviews. Instead, they framed HIV as a predominantly raced problem which was not applicable to them. The construction of HIV as not being a white problem was often done implicitly rather than explicitly. Some of these race-oriented extracts are discussed in the following section. Extract 1 is taken from an interview with a WF student and follows on from a discussion about condom use and testing. Before this, Christina had stated that she had never been tested for HIV, was not using condoms with her current partner, but was certain of her HIV-negative status. Extract 1 Researcher 1: ‘um is HIV a big concern for you?’ Christina: ‘ (.) °Not really°.’ Researcher 1: ‘Okay, um why?’ Christina: ‘Okay, um to be honest uh (.) I’m gonna go with the whole racial thing I haven’t really met a lot of white people with AIDS (.) and I (.) don’t do inter-racial relationships so that wouldn’t be a big risk for me (.) I that that’s a really racist thing to say that only other colours have HIV and AIDS but that’s not true I mean white people do have AIDS but I
van der Riet and Nicholson
have never (.) personally met a white person with AIDS.’ Although she had to do a lot of discursive work to make her point, Christina produced an account which indicates whiteness is a protective factor against HIV. She used not having ‘met a lot of white people with AIDS’ and her not ‘do[ing] inter-racial relationships’ to justify her lack of concern for contracting HIV. She framed her own account as racist, but then shifted back to discussing not having personally interacted with ‘white person with AIDS’, producing an account in which HIV is framed as problem of ‘other colours’. This type of othering is also evident in Extract 2, taken from the WF focus group discussion, where HIV status was discussed in relation to testing. Extract 2 Kirsty: ‘And also ( ) find out about that HIV if aren’t being tested regularly.’ Group: ‘Ja.’ Kirsty: ‘And you can spread it.’ Genna: ‘Also I think I won’t call it race I’ll call it more class I think maybe for our sort of middle class pregnancy is more the thing but then with the lower class and there’s more lower class then I think it’s the HIV that’s the big thing (.) I don’t know it just seems like (.).’ Here, Genna distances the risk of HIV from herself and other focus group participants whom she constructs as a middle class ingroup, or ‘our sort’. She begins by referencing race, but saying that she ‘won’t call it race’. The rest of her account is dedicated to positioning HIV as more of a risk for ‘the lower class’ whose numbers are higher than those of the middle class. References to a lower class majority typically indicate that race is being spoken about, and here Genna is in fact constructing HIV as a lower class, Black problem. In Extract 3, taken from the WM focus group, references to HIV not being a White problem are more explicit. Extract 3 Researcher 5: ‘Abstain (.) be faithful (.) condomise (.) isn’t that the little motto.’ Sam: ‘Ya he he.’ Researcher 5: ‘ABC (..) so you don’t think many guys (.) let’s talk white guys in particular (.) you don’t think they use the three.’ James: ‘No (.) because we have more knowledge (.) because in society (.) generally the people who (.) like the Africans here (.) they know very (.) not very taught about it (.) and in white culture (.) like (.) when you young you learn about all this (.) so (.) like (.) you can accept (.) ya (.) it’s consequences to my like (.) actions(.) whereas in the African culture (.) they don’t really see it as (.) oh (.) like they (.) like they do the deed and suddenly they stuck with it (.) but they don’t realise that there’s ways to stop.’ John: ‘On that point (.) I think times have changed though (.) there’s lots of sex ed going around (.).’ James: ‘But still (.) the people are clueless [( )].’ Paul: ‘ [( ) a bro]thel(.) it was wrong (.) the guy didn’t even know what aids was (.) he thought that going to a brothel three times a week was normal.’
African Journal of AIDS Research 2014, 13(4): 361–369
When asked if ‘White guys’ use the fundamentals of the ‘abstain, be faithful and condomise (ABC)’ campaign, James frames White South Africans as more knowledgeable than Black South Africans, constructing Blacks as ignorant and implicitly more at risk of HIV. He also uses the concept of accepting consequences for one’s actions to distinguish between ‘White’ and ‘African’ culture, framing Blacks as unable to stop or unthinking when it comes to sex, as people who ‘do the deed and [are] suddenly stuck’ with HIV. John challenges this but is overruled by James and Paul, with James framing ‘the people’, Blacks, as ignorant despite educational interventions and Paul backing him up with anecdotal evidence of a Black student who regularly visited a brothel. Overall, this account works to portray Whites as knowledgeable and therefore less vulnerable to HIV. The possible impact of this othering of risk was also evident in White participants’ accounts of their sexual behaviours. All Black participants who took part in the individual interviews reported regular testing. The fairly detailed focus group discussions of Black participants which took place around testing indicated that testing was of concern to these participants who also constructed themselves as being at risk of contracting HIV. In the White sample, however, reports of both testing and condom use were low. Only one female participant reported going for regular HIV tests; another had only been tested once at the explicit request of her medical practitioner. All White male participants reported never being tested for HIV, with the White sample as a whole stating that they were certain of their HIV-negative status. While HIV risk was constructed as raced by White students, responsibility for both HIV and pregnancy risks was gendered. Feminising responsibility For the most part, the students constructed themselves as sexually responsible with regard to contraceptive use but not with regard to condom use and HIV testing. This responsibility was, however, constructed in a distinctly gendered manner. Both male and female participants constructed women as responsible for managing the risks of unplanned pregnancy and, to a lesser degree, HIV transmission, either by making them responsible for ensuring that condoms were used, or ensuring that they did not fall pregnant. Extract 4 was taken from an interview with a participant from the male, peri-urban focus group and relates to responsibility for condoms in relationships. Extract 4 Researcher 3: ‘So it’s not expected to be a man or a woman that goes and get the [condom].’ Sipho: ‘ [we all] have to get a condom but most of the times women should look out for themselves.’ Researcher 3: ‘Mmm.’ Sipho: ‘Most of the times women should look out for themselves because we usually say we don’t like it.’ Here, Sipho talks about condom procurement as something that both men and women should be responsible for. However, he constructs condoms as a predominantly female responsibility by repeating that ‘women should look
365
after themselves’. He does this with reference to men who are constructed as not liking condoms. His overall message is that women need to protect themselves from risk, as men will not. Extract 5, taken from the BF focus group, presents a similar message in a different way. Extract 5 Nicky: ‘I think girls have power to influence the guy to use the condom.’ Lisa: ‘↑And like er okay I’ve never actually sat down and like okay every time I have sex we need to use condoms (.) when when I see that okay this is leading to something you know. >I’m like hey dude take out the condom
African Journal of AIDS Research 2014, 13(4): 361–369 Printed in South Africa — All rights reserved
AJAR
ISSN 1608-5906 EISSN 1727-9445 http://dx.doi.org/10.2989/16085906.2014.985235
Racing risk, gendering responsibility: a qualitative study of how South African students talk about sexual risk and responsibility Mary van der Riet* and Tamaryn Jane Nicholson Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, South Africa *Corresponding author, email: [email protected] Individuals’ perceptions of risk have implications for whether and how they engage with protective strategies. This study investigated how sexual risk, specifically HIV and pregnancy and responsibility for these risks were constructed in discussions across five groups of youth in KwaZulu-Natal, South Africa. The qualitative study used focus groups and interviews with a sample of 28 tertiary level students and 7 peri-urban youth. The constructions of risk intersected with raced and gendered narratives around sexual risk and responsibility. These constructions were used by the participants to assign and displace responsibility for the risks of HIV and pregnancy, rendering some groups immune to these risks. This constitutes a form of stigmatisation and also has implications for participants’ prevention practices. Keywords: gender, HIV, race, social constructionism, unplanned pregnancy
Introduction The dominant risks in sexual activity are HIV, sexually transmitted infections and unplanned pregnancy. How such risks are perceived is theorised to play an important role in the adoption of protective behaviour (Macintyre et al. 2004). Regarding HIV, risk perception is an indicator of perceived susceptibility, an understanding of transmission and “willingness to consider behavioural changes” (Macintyre et al. 2004: 237). The relationship between risk perception and risk behaviour is proposed to be reciprocal and to therefore constitute an important area of study (Anderson et al. 2007). This study took a social constructionist approach to the topic, focusing on how participants constructed, framed and prioritised the risks of HIV and unplanned pregnancy in talk around sexual practice. We argue that constructions of risk establish the conditions for action in relation to these risks. Unplanned pregnancy as risk Pregnancy is defined as unplanned in cases where women do not make a conscious decision to become pregnant, whether using family planning methods or not (Barret and Wellings 2002). The risk of unplanned pregnancy is tied to behavioural factors such as the use of adequate contraceptive measures (Barret and Wellings 2002). An unplanned pregnancy has a significant negative impact through the loss of education and subsequent potential for career and financial development (Varga 2003). For young men who take on their responsibilities of fatherhood educational opportunities and subsequent potential career development are also affected (Swartz and Bhana 2009). However, South Africa has a high rate of father absence and many men do not share the burden of parenting on emotional
or financial levels (Posel and Devey 2006, Richter 2006) meaning that unplanned pregnancies potentially place a greater burden on women than on their male partners. Women might also have to suspend their education whilst assuming responsibility for the child (Posel and Devey 2006). Whilst abortion is legal in South Africa, it is discouraged on both social and religious grounds (Harries et al. 2007). Limited avenues for recourse mean that the burden of the risk of pregnancy in sexual activity is thus weighted for women. The management of contraception and the risk of unplanned pregnancy are thus not equally distributed and typically women take responsibility for both (Kaufman 2000, Varga 2003). HIV as risk HIV/AIDS carries a high human and socio-economic toll and has been identified as a national priority in South Africa (Shisana et al. 2014). Risk for contracting HIV is seen as tied to behaviour in the form of unsafe sex practices, particularly through sex with multiple concurrent partners and a lack of condom use (Whiteside 2008). In South Africa, HIV prevalence is higher amongst Black South Africans than any other race group (15%). For Coloured people it is 3.1%, for Indian or Asian people it is 0.8%, and for white people it is 0.3% (Shisana et al. 2014). Black South Africans from rural and peri-urban areas are more vulnerable to HIV risk (Shisana et al. 2009). In contemporary literature, this is largely attributed to socio-economic status and lack of access to resources such as testing and condoms (Wingood and DiClemente 2000, Wojcicki 2005, Seely et al. 2012, Tan et al. 2014). Women are positioned as physically and socially vulnerable to HIV (Parker and Colvin 2007, Chersich and Rees 2008) particularly in South Africa where levels of coercive
African Journal of AIDS Research is co-published by NISC (Pty) Ltd and Routledge, Taylor & Francis Group
362
sex and intimate partner violence are high and women often have little capacity to negotiate safe sex practice within relationships (Dunkle et al. 2004, Jewkes and Morrell 2012). Shisana et al. (2014) comment that in South Africa women have a significantly higher HIV prevalence than men (14.4% for women versus 9.9%). Young women are also more vulnerable to contracting HIV, both biologically and socially (Dunkle et al. 2004; Leclerc-Madlala 2008, Higgens et al. 2010). For example, Pettifor et al. (2005) found that young women in South Africa aged between 15 and 24 years were significantly more likely to be infected with HIV than young men (15.5% versus 4.8%), and 24.5% of women aged 20–24 were likely to be infected with HIV compared to 7.6% of men in the same age group. The risks of unsafe sex are thus not neutrally or equally distributed. Women are more affected by unplanned pregnancy than men, and women and Black people are disproportionately vulnerable to HIV infection. Gender, race and responsibility This form of asymmetry has implications for how risk is perceived which in turn has an impact on protective behaviours (Skinner and Mfecane 2004, Nduna and Mendes 2010). Perceptions of invulnerability to risks of HIV, for example, redirect both responsibility and blame onto others (Finchilescu 2002). Skinner and Mfecane (2004) argue that distancing and denial reduce the need to adapt, and negatively affect behaviour change. Constructing sexual risk as a real and proximal threat to the self or one’s group will likely result in higher levels of protective behaviours, whereas constructing HIV as a problem of the ‘other’ or another group may have a negative impact on protective behaviours. How individuals interact with and manage the ‘realities’ of vulnerability to sexual risk in talk around sexual practice is therefore important, as it is through this form of social action that blame and responsibility are assigned. In this study, we compared constructions of risk and responsibility across gender and race groups to explore how risk is managed by these groups in talk. We looked at how they are used and what is accomplished by using them in this way. This examination might assist in addressing some of the consequences of these constructions, for example, stigmatisation and lack of engagement with protective practices. Methodology This study followed a qualitative research design to allow for the production of detailed data in the form of participants’ accounts of their own sexual practices as students. A social constructionist stance was taken, as it allowed for an examination of how participants constructed risk and risk management. Ethical approval for the study was obtained from the University of KwaZulu-Natal Humanities and Social Sciences Research Ethics Committee. Sample Twenty-eight tertiary level students volunteered for the study in response to recruitment drives and advertisements on campus. Nine of the respondents were Black
van der Riet and Nicholson
female students, five were Black male students, six were White female students and eight were White male students. A further seven Black male participants in a peri-urban context were recruited using a key informant and snowball sampling. Only men were recruited from this peri-urban sample as an exploratory measure to gauge whether comparisons could be made between this group and male students of a similar age. Participants were included on the basis of being between 18 and 25 years of age, having engaged in sexual activity and having experience in negotiating safe sex. After recruitment participants were scheduled to take part in one of five focus groups which were separated across race and gender. Participants were also given the option of taking part in an individual interview and eight participants volunteered for these interviews. The interviewers, a team of postgraduate students, were matched to these groups and interviews according to race and gender. Several authors comment on the value of gender and race segregation in research groups, and on the matching of interviewer and participant characteristics (race, gender and age) to build rapport and encourage openness (Breakwell 1995, Sikweyiya et al. 2007, Nduna and Mendes 2010). In total, two Black female students, three White female students, one White male student, one Black male student and one Black male peri-urban participant were interviewed. Five focus groups were conducted, one each for Black female students, White female students, White male students, Black male students and Black male peri-urban. Data collection Focus group discussions were used to investigate general attitudes and understandings (Morgan 1997) of safe sex practice. Interviews were used to access personal accounts and experiences (Kvale and Brinkmann 2008) of safe-sex negotiation. Before each of the focus group discussions and interviews, the aims and purpose of the research were explained to the participants and they were given a detailed information sheet. To ensure confidentiality participants were assigned pseudonyms and before taking part in the focus groups were asked to sign a pledge to maintain the confidentiality of the group discussion. For the focus groups, a semi-structured schedule of questions was developed to generate conversation about the norms of sexual practice on campus (or for the peri-urban male participants, in their community) and participants’ views of such practices. The schedule included questions about sex, risks and forms of protection. The one-on-one setting in the interviews allowed for an in-depth discussion using a semi-structured interview schedule of sensitive topics such as individual experiences of sex, and contraceptive and condom use. The student interviews and focus groups were conducted in English. Those conducted in the peri-urban area were conducted in isiZulu by the student interviewer. The focus group discussions and interviews were audio-recorded. All the data were transcribed by the interviewers using simplified Jeffersonian (see Table 1 for transcription conventions). The isiZulu discussions were translated into English by the interviewer while they were being transcribed. The
African Journal of AIDS Research 2014, 13(4): 361–369
363
Table 1: Transcription conventions Annotation [ ]. (word). () ((description ))
Meaning of transcription annotation Square brackets indicate overlapping speech. Round brackets indicate a possible transcription. Empty round brackets show complete inability to distinguish the word. Double round brackets indicate a description, rather than a transcription.
(.3) (.) = _______ CAPS :::: .hhhh Hhhh ↑ ↓ °word° Ha ha He he
Indicates the timed number of seconds elapsed between speech. Indicates a short pause, or an untimed pause. Indicates there was no time lapse between speakers. Indicates that the word or syllable was stressed. Words in capital letters indicate an increase in volume. Shows that a syllable was elongated. The number of colons indicates how long the sound was held for. Indicates an audible in-breath. Indicates an audible out-breath or sigh. Indicates rising intonation, where a question was not asked. Indicates lowered intonation. Shows that the word was spoken more quietly than surrounding speech. Indicates loud laughter. Indicates softer laughter.
validity of all translations was checked through a process of back translation (Brislin 1970) by an independent isiZulu-speaking researcher. To ensure that an adequate representation of the interactions which took place was retained, the data were transcribed as heard and not edited or cleaned up for language or grammar during the transcription process (Silverman 2005). All place names mentioned in the transcripts were also changed to maintain confidentiality.
demonstrative of participants’ actual concerns about sexual activity, but do provide an indication of how participants from different contexts framed their constructions of risk and responsibility. Direct quotes from the transcripts are presented to illustrate how these constructions of the risks of HIV and unplanned pregnancy in talk around sexual practice worked, and what was accomplished by using them in this way. The source of each extract is indicated in brackets for example, focus group (FG).
Data analysis
Risks in sexual activity All the participants identified HIV and unplanned pregnancy as risks central to sexual activity. Although contracting sexually transmitted infections was mentioned by participants, it was not addressed as a major concern. All the participants knew how to prevent unplanned pregnancies and how to prevent HIV transmission. In addressing the risk of pregnancy participants differentiated between hormonal and barrier contraceptives and their uses. Further, all participants cited condom use as the best way to prevent HIV transmission. When asked which risks were the most concerning responses differed across gender and race groups. White male (WM) students, White female (WF) students and Black male (BM) participants from the peri-urban area cited HIV as a primary risk, and Black female (BF) students and BM students cited unplanned pregnancy as a primary risk.
Thematic analysis was used to identify points of similarity and divergence across the data collected. The data were analysed by looking at and eliciting common themes across the five groups (Braun and Clarke 2006). The analytic process was closely aligned with the five steps for analysis laid out by Terre Blanche et al. (2006). This included an initial period of immersion in which the transcripts were read and re-read. This was followed by coding the transcripts first in the terms of the participants and then in the terms used by the study. Similar ideas were grouped together and areas of convergence and divergence were noted. The final stage of the process consisted of a verification phase in which all themes and codes were checked for accuracy and to ensure that they remained close to the data collected. Findings Overall, constructions of risk did not function independently of one another but intersected to produce HIV and unplanned pregnancy as gendered and raced phenomena. These constructions intersected with contemporary narratives around sexual responsibility positioning some groups as more responsible for both protective practices and risks than others. In this section we first discuss the participants’ perceptions of risk, and then their perceptions of responsibility for these risks. From a constructionist perspective, the data presented are not necessarily
HIV as primary risk The peri-urban male participants constructed HIV in terms of lethality and danger, stating ‘it’s just that HIV/AIDS kills’ (FG 5). This construction was echoed in the WM students’ discussion in which HIV was contrasted with pregnancy. These students argued ‘you can take care of a pregnancy you can’t take care of AIDS in a sense there’s a bunch of options but there’s only one with AIDS and that’s get sick and die’ (FG 4). Pregnancy was cited as a risk which, unlike HIV transmission, could be managed. These participants argued that pregnancy could be dealt with, or ‘take[n] care
364
of’ through for example termination. However, HIV was seen as having only one outcome, illness and death. WF students in the focus group contrasted the manageability of other sexual risks with the risk of contracting HIV and framed sexually transmitted infections and emotional trauma as manageable risks. They also spoke about pregnancy in terms of options like termination, adoption or keeping a baby. These constructions were contrasted with that of HIV which ‘you can’t do anything about’ (FG 2). Pregnancy as primary risk In contrast, BM and BF students both talked about unplanned pregnancy as their primary concern in sexual activity. Although both groups mentioned HIV they justified their dismissal of HIV as a primary concern differently. In the focus groups and interviews, BF students constructed pregnancy as a more visible, physical and therefore detrimental outcome of sex. This was contrasted with HIV which was framed as invisible or ‘not gonna be written on your face’ (FG 1). These students also argued that the immediacy and visibility of pregnancy meant that it was more of a threat to female students’ studies than HIV and stated that a pregnancy would likely bring their tertiary education to a halt. BM students also constructed pregnancy as more visible than HIV and as a more immediate and financially detrimental outcome of sex. They noted that the primary risk ‘should be HIV’ (FG 3), but is in fact pregnancy due to the immediacy of its consequences and its direct effect on their future potential financial circumstances. This construction of primary risk was bound to their position as students and some participants implied that this would change once they were able to support a child. Risk responsibility in sexual activity HIV risk as raced White male and female students ranked HIV as the greatest risk in sexual activity when asked directly in the focus groups. However, they did not do so in individual interviews. Instead, they framed HIV as a predominantly raced problem which was not applicable to them. The construction of HIV as not being a white problem was often done implicitly rather than explicitly. Some of these race-oriented extracts are discussed in the following section. Extract 1 is taken from an interview with a WF student and follows on from a discussion about condom use and testing. Before this, Christina had stated that she had never been tested for HIV, was not using condoms with her current partner, but was certain of her HIV-negative status. Extract 1 Researcher 1: ‘um is HIV a big concern for you?’ Christina: ‘ (.) °Not really°.’ Researcher 1: ‘Okay, um why?’ Christina: ‘Okay, um to be honest uh (.) I’m gonna go with the whole racial thing I haven’t really met a lot of white people with AIDS (.) and I (.) don’t do inter-racial relationships so that wouldn’t be a big risk for me (.) I that that’s a really racist thing to say that only other colours have HIV and AIDS but that’s not true I mean white people do have AIDS but I
van der Riet and Nicholson
have never (.) personally met a white person with AIDS.’ Although she had to do a lot of discursive work to make her point, Christina produced an account which indicates whiteness is a protective factor against HIV. She used not having ‘met a lot of white people with AIDS’ and her not ‘do[ing] inter-racial relationships’ to justify her lack of concern for contracting HIV. She framed her own account as racist, but then shifted back to discussing not having personally interacted with ‘white person with AIDS’, producing an account in which HIV is framed as problem of ‘other colours’. This type of othering is also evident in Extract 2, taken from the WF focus group discussion, where HIV status was discussed in relation to testing. Extract 2 Kirsty: ‘And also ( ) find out about that HIV if aren’t being tested regularly.’ Group: ‘Ja.’ Kirsty: ‘And you can spread it.’ Genna: ‘Also I think I won’t call it race I’ll call it more class I think maybe for our sort of middle class pregnancy is more the thing but then with the lower class and there’s more lower class then I think it’s the HIV that’s the big thing (.) I don’t know it just seems like (.).’ Here, Genna distances the risk of HIV from herself and other focus group participants whom she constructs as a middle class ingroup, or ‘our sort’. She begins by referencing race, but saying that she ‘won’t call it race’. The rest of her account is dedicated to positioning HIV as more of a risk for ‘the lower class’ whose numbers are higher than those of the middle class. References to a lower class majority typically indicate that race is being spoken about, and here Genna is in fact constructing HIV as a lower class, Black problem. In Extract 3, taken from the WM focus group, references to HIV not being a White problem are more explicit. Extract 3 Researcher 5: ‘Abstain (.) be faithful (.) condomise (.) isn’t that the little motto.’ Sam: ‘Ya he he.’ Researcher 5: ‘ABC (..) so you don’t think many guys (.) let’s talk white guys in particular (.) you don’t think they use the three.’ James: ‘No (.) because we have more knowledge (.) because in society (.) generally the people who (.) like the Africans here (.) they know very (.) not very taught about it (.) and in white culture (.) like (.) when you young you learn about all this (.) so (.) like (.) you can accept (.) ya (.) it’s consequences to my like (.) actions(.) whereas in the African culture (.) they don’t really see it as (.) oh (.) like they (.) like they do the deed and suddenly they stuck with it (.) but they don’t realise that there’s ways to stop.’ John: ‘On that point (.) I think times have changed though (.) there’s lots of sex ed going around (.).’ James: ‘But still (.) the people are clueless [( )].’ Paul: ‘ [( ) a bro]thel(.) it was wrong (.) the guy didn’t even know what aids was (.) he thought that going to a brothel three times a week was normal.’
African Journal of AIDS Research 2014, 13(4): 361–369
When asked if ‘White guys’ use the fundamentals of the ‘abstain, be faithful and condomise (ABC)’ campaign, James frames White South Africans as more knowledgeable than Black South Africans, constructing Blacks as ignorant and implicitly more at risk of HIV. He also uses the concept of accepting consequences for one’s actions to distinguish between ‘White’ and ‘African’ culture, framing Blacks as unable to stop or unthinking when it comes to sex, as people who ‘do the deed and [are] suddenly stuck’ with HIV. John challenges this but is overruled by James and Paul, with James framing ‘the people’, Blacks, as ignorant despite educational interventions and Paul backing him up with anecdotal evidence of a Black student who regularly visited a brothel. Overall, this account works to portray Whites as knowledgeable and therefore less vulnerable to HIV. The possible impact of this othering of risk was also evident in White participants’ accounts of their sexual behaviours. All Black participants who took part in the individual interviews reported regular testing. The fairly detailed focus group discussions of Black participants which took place around testing indicated that testing was of concern to these participants who also constructed themselves as being at risk of contracting HIV. In the White sample, however, reports of both testing and condom use were low. Only one female participant reported going for regular HIV tests; another had only been tested once at the explicit request of her medical practitioner. All White male participants reported never being tested for HIV, with the White sample as a whole stating that they were certain of their HIV-negative status. While HIV risk was constructed as raced by White students, responsibility for both HIV and pregnancy risks was gendered. Feminising responsibility For the most part, the students constructed themselves as sexually responsible with regard to contraceptive use but not with regard to condom use and HIV testing. This responsibility was, however, constructed in a distinctly gendered manner. Both male and female participants constructed women as responsible for managing the risks of unplanned pregnancy and, to a lesser degree, HIV transmission, either by making them responsible for ensuring that condoms were used, or ensuring that they did not fall pregnant. Extract 4 was taken from an interview with a participant from the male, peri-urban focus group and relates to responsibility for condoms in relationships. Extract 4 Researcher 3: ‘So it’s not expected to be a man or a woman that goes and get the [condom].’ Sipho: ‘ [we all] have to get a condom but most of the times women should look out for themselves.’ Researcher 3: ‘Mmm.’ Sipho: ‘Most of the times women should look out for themselves because we usually say we don’t like it.’ Here, Sipho talks about condom procurement as something that both men and women should be responsible for. However, he constructs condoms as a predominantly female responsibility by repeating that ‘women should look
365
after themselves’. He does this with reference to men who are constructed as not liking condoms. His overall message is that women need to protect themselves from risk, as men will not. Extract 5, taken from the BF focus group, presents a similar message in a different way. Extract 5 Nicky: ‘I think girls have power to influence the guy to use the condom.’ Lisa: ‘↑And like er okay I’ve never actually sat down and like okay every time I have sex we need to use condoms (.) when when I see that okay this is leading to something you know. >I’m like hey dude take out the condom
