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Knowledge, attitudes and beliefs of Christian African university students

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Knowledge, attitudes and beliefs of Christian African university students

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Content KNOWLEDGE, ATTITUDES & BELIEFS OF
CHRISTIAN AFRICAN UNIVERSITY STUDENTS
by
Rose Gathoni Maina
A Dissertation Presented to the
FACULTY OF THE ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2001
Copyright 2001 Rose Gathoni Maina
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UMI Number: 3027744
Copyright 2001 by
Maina, Rose Gathoni
All rights reserved.
___ ®
UMI
UMI Microform 3027744
Copyright 2001 by Bell & Howell Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
Bell & Howell Information and Learning Company
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UNIVERSITY OF SOUTHERN CALIFORNIA
School of Education
Los Angeles, California 90089-0031
This dissertation, written by
R. Gathoni Maina
under the direction ofh JSELDissertation Committee, and
approved by all members of the Committee, has been
presented to and accepted by the Faculty o f the School
of Education in partialfulfillment of the requirementsfor
the degree of
D o c t o r o f Ed u c a t io n
March 2 7 , 2001
Bate
'Bean
Dissertation Committee
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Dedication
To my mother,
a strong and brave African woman,
who taught me the value o f keeping Godfirst,
helping others, and persisting.
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Acknowledgements
This has been a collaborative effort of several people to whom I wish to
acknowledge my indebtedness.
• First, I would like to thank the Almighty God, who gave me the
inspiration and strength to start and finish this work. I would also like to
thank my mother, who not only went back to school to get her master’s
degree—thus providing me a challenge—but also worked hard
coordinating my research in Kenya.
• I am especially indebted to Dr. Linda Hagedom, my chair, for her
expertise, advice, and constant encouragement. Her patience and her
willingness to help me out every step of the way will remain with me
forever. I also offer thanks to Dr. Larry Picus and Dr. Stu Gothold for all
their input, insights, and guidance in this work. I was indeed most
fortunate to have a dissertation committee who believed in me and who
had a deep compassion for the AIDS crisis in Africa.
• I extend very special thanks to all the students who participated in this
study for taking the time to fill out the very long questionnaire and
providing invaluable information. I am thankful for my research
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assistants, Dennis, Beryl, and Mike, for working within the short time
frame and doing such an excellent job. I also thank Gregory Nzioka for
the information he gave me on AIDS in Kenya and F. Githigi and Job
Cherutich of the Kenyan Embassy for the help received in developing the
AIDS questionnaire.
• I thank my brother, Ian Gakoi Maina, for his help in counting the surveys
and mailing them to me. I am grateful to Dr. Harold Urman, who assisted
me in the statistical analysis of the data, and to Dr. John Wietting for his
hard work editing the manuscript. Special thanks goes to Heidi Wietting
who helped format my entire dissertation.
• I am profoundly grateful to my friend, Susan La Motte, who spent many
weekends typing my dissertation for me. What a true friend she has
been! I also thank my other friends who helped me in one way or another
during the course of my studies. Special mention is made of Jayne and
Jeff Fairchild and my goddaughters, Brooke and Elizabeth; of Reverend
Evelyn Thiele-Leonard, Reverend Mark Machado and Lou Shinstine; of
Judy Jackson, and of Christine Maitamei.
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T a b l e o f C o n t e n t s
Dedication..........................................................................................................................ii
Acknowledgements......................................................................................................... iii
List of Tables....................................................................................................................ix
List of Graphs............................................................................................................ xi
Abstract............................................................................................................................ xii
CHAPTER 1
INTRODUCTION......................... 1
O v e r v ie w o f t h e P r o b l e m ................................... 1
T h e P r o b l e m D e f in e d ................................................ 3
B a c k g r o u n d ................................................................................................................................................4
Im p o r t a n c e .................................................................................................................................................. 8
R e se a r c h Q u e s t io n s................................................................................................................................9
M e t h o d o l o g y ............................................................................................................................................. 9
L im it a t io n s ................................................................................................................................................ 10
A s s u m p t io n s................................................................................................................ 11
G l o s s a r y o f T e r m s ..............................................................................................................................11
CHAPTER 2
REVIEW OF THE LITERATURE ..... 13
N a t u r e a n d E x t e n t o f A ID S in A fr ic a ............................... 13
Extent o f the Problem in K enya ........... ......................................................................................................................................18
What is Being Done by International Organizations ....................................................................................20
What Is Being Done by Governmental Organizations.......................................................................................23
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O b s t a c l e s F a c e d in A f r ic a a n d Sp e c if ic a l l y in K e n y a ...................................................26
Government.......................................................................................................................................................................................................26
Discrimination Towards People Living With AIDS (PL W As).................................................................. 28
Illiteracy............................................................................................................................................................................................................... 29
Unsanitary Living Conditions.......................................................................................................................................................30
Attitudes o f Medical Personnel................................................................................................................................................... 31
‘ Sugar Daddies ’...........................................................................................................................................................................................32
Migration From Rural to Urban and From Urban to R ural......................................................................33
High Birth Rate .............................................................................................................................................................................................34
Poor Treatment and Dehumanization o f Women.....................................................................................................35
Cultural Patterns o f Sexual Behavior..................................................................................................................................37
Shame and Silence .............................................................................................................................................................. 38
Lack o f Funds..................................................................................................................................................................................................40
Economic Strain o f Treating A ID S ........................................................................................................ ;.............................. 42
Inadequate or No Training..............................................................................................................................................................42
Religion....................................................................................................................................... 44
Inaccurate Perceptions and Beliefs o f What Causes AIDS........................................................................... 45
Africans Orphans........................................................................................................................................................................................46
H is t o r ic a l C h a n g e o f P u b l ic O p in io n in A f r ic a a n d T h o s e R e s p o n s ib l e ..............47
C h a n c e s o f a n Am e r ic a n M o d e l o f A d v e r t is in g C a m p a ig n s S u c c e e d in g in
A f r ic a ........................................................... 51
Reasons Why an American Model Would W ork ...........................................................................................53
Reasons Why an American Model Would Not Work.................................... 54
C lim a t e a n d C u l t u r e o f E d u c a t io n in A f r ic a a n d in K e n y a Sp e c if ic a l l y 58
A ID S E d u c a t io n P r o g r a m s ...............................................................................................................61
Programs in Schools— Successes and Obstacles................................................... 61
AIDS Education Programs That Are W orking...............................................................................61
Obstacles That Hinder AIDS Education Program s......................................................... 62
Socio-linguistic restrictions on language use..........................................................................................................62
Issue o f who should teach AIDS education............................... 63
Teaching model...................................................................................................................................................................................64
Lack o f and possible misappropriation offunds................................................................... 65
Religious resistance............................... 65
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Role o f Artists and M usicians............................................................................................................................................. 65
Aids Education Is Desperately Needed...............................................................................................................................68
C o n c l u s io n ................................................................................................................... 69
CHAPTER 3
METHODS AND PROCEDURES..... .......... 71
In t r o d u c t io n ............................................................................................................................................ 71
Sa m p l e ..........................................................................................................................................................72
In s t r u m e n t a t io n ................................................................................................................................... 77
P r o c e d u r e s a n d D a t a C o l l e c t io n ...............................................................................................81
D a t a A n a l y s is ..........................................................................................................................................81
M e t h o d o l o g ic a l A s s u m p t io n s ...................................................................................................... 84
CHAPTER 4
FINDINGS AND DISCUSSION............................................. 85
In t r o d u c t io n ............................................................................................................................................ 85
D e s c r ip t io n o f t h e Sa m p l e ................................................................................................................86
F in d in g s ....................................................................................................................................................... 87
Research Question 1 ...............................................................................................................................................................................87
Research Question 2 .................................................................................................................................................... 88
Research Question 3 ...................................................................................................................................... 97
D is c u s s io n o f F in d in g s ...................................................................................................................... 112
CHAPTER 5
SUMMARY, POLICY IMPLICATIONS, AND CONCLUSIONS........................ 115
In t r o d u c t io n ..................................................... 115
Su m m a r y o f Se l e c t e d F in d in g s..................... . 116
C o n c l u s io n s in B r ie f ....................................................................................................................... 118
Immorality and Condom Use.......................................................................................................... 118
H IV Testing..,.,...........................................................................................................................................................................................120
People With A ids ................................................................................................................................................ 120
Awareness and Prevention Programs...............................................................................................................................122
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St u d y C o n c l u s io n s ............................................................................................................................ 124
Im p l ic a t io n s f o r P r a c t ic e ..............................................................................................................125
Su g g e s t io n s f o r F u r t h e r Re s e a r c h ...................................................................................... .128
C o n c l u d in g R e m a r k s ...................................................................................................................... . 129
BIBLIOGRAPHY...................................................................................................................................131
APPENDICES..................................................................................................................146
A pp e n d ix A .............................................. 147
Information Sheet fo r Non-Medical Research .........................................................................................................147
A p p e n d ix B ................................................................................................................................................ 150
Pilot Aids Survey/Questionnaire.............................................................................................................................................150
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L is t o f T a b l e s
Table 1. A TPS Cuts African Life Expectancies...,........................................ 15
Table 2. Scales and Items Used in the Analyses...................................................... 83
Table 3. Gender Demographic Tested With the 6 Factors of Safe Sex,
Govt. Test, Segregation, AIDS Spread, Immorality, and
Education.................................................................................................... 89
Table 4. Teaching Status Demographic Tested With the 6 Factors of
Safe Sex, Govt. Test, Segregation, AIDS Spread, Immorality,
and Education............... 90
Table 5. Gender and Teaching Status Demographics Tested Against the
6 Factors of Safe Sex, Govt. Test, Segregation, AIDS Spread,
Immorality, and Education........................................................................91
Table 6. Tests of Between-Subjects Effects—Dependent Variable:
SAFESEX Safe Sex Score ........................................... 92
Table 7. Tests of Between-Subjects Effects—Dependent Variable:
GOVTTEST Government Testing Score............. 93
Table 8. Tests of Between-Subj ects Effects—Dependent Variable:
SEGREG Segregation Score.....................................................................94
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Table 9. Tests of Between-Subj ects Effects—Dependent Variable:
AIDSPRD How AIDS Is Spread Score............... 95
Table 10. Tests of Between-Subjects Effects—Dependent Variable:
IMMORAL Immorality Score.................................................... ............. 96
Table 11. Tests of Between-Subj ects Effects—Dependent Variable:
EDUCATE Education Score..................................................................... 97
Table 12. Get Information on AIDS.........................................................................98
Table 13. How AIDS Spreads............................ 99
Table 14. Students Who Tested for HIV—Q19 Tested HIV/AIDS..................... 101
Table 15. Means of Responses From Students to AIDS Statements Using
the Likert Scale.........................................................................................103
Table 16. What If You Had AIDS/HIV........................... 104
Table 17. How AIDS Can Be Prevented......................... 105
Table 18. People with AIDS Should.......................................................................108
Table 19. Major Problems of People With AIDS.................................................109
Table 20. What Should Be Done for People With A ID S..................................... 110
Table 21. Services That Should Be Provided for People with AIDS.................. I ll
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L is t o f G r a p h s
Graph 1. Age of Students.........................................................................................73
Graph 2. Parents’ Educational Level.......................................................................74
Graph 3. Parents’ Total Annual Income..................................................................75
Graph 4. Students’ Year at the University...............................................................76
Graph 5. Students Who Know People With AIDS.................................. 100
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Abstract
Background
Acquired Immunodeficiency Syndrome (AIDS) has become a serious
catastrophy in sub-Saharan Africa, claiming the lives of 17 million Africans since the
1970’s when it began, leaving over 12 million children orphaned. The age groups
most affected by AIDS are 15-19 and 20-35 years. This has left several African
nations without their most productive citizens, thus devastating the economies of this
region.
Purpose
Since no cure for AIDS has been found, prevention remains the best strategy
for curbing further Human Immunodeficiency Virus (HIV) infection. Though
governments and international organizations have conducted many prevention
campaigns, obstacles of culture, religion, lack of finances, illiteracy, and others
continue to limit their impact. The policy value of the study is to help university
leadership design effective AIDS prevention and education programs.
Methodology
This study focuses on the knowledge, attitudes, and beliefs of African
Christian University students towards AIDS and investigates the knowledge, attitude,
and belief differences towards HIV/AIDS between Christian African male and
female university students, and between teaching majors and non-teaching majors.
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The study used the KABP questionnaire framework similar to the World Health
Organization’s (WHO) health research. The study surveyed 519 African University
students who were studying in Kenya and who attended a Fellowship of Christian
Unions (FOCUS) conference. The research compared the responses of male and
female university students, and the responses of teaching and non-teaching students
towards AIDS-related questions and statements.
Results
Results indicated that women disagreed more than men on statements that
immorality causes AIDS and that people with AIDS (PWA) should be segregated.
There were no differences between teaching and non-teaching majors in their
attitudes or beliefs towards HIV/AIDS.
Conclusions
The researcher recommended that AIDS education courses be taught as part
of the general studies requirement at universities, especially to teaching majors, who
will teach young students about AIDS and how it can be prevented. Further research
should include surveying the knowledge, attitudes, and beliefs of African faculty and
university administrators towards HIV/AIDS and conducting in-depth studies to
explore issues of gender bias and empowerment of women.
Dissertation Committee
Dr. Linda Hagedom
Dr. Larry Picus
Dr. Stu Gothold
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Chapter 1
In t r o d u c t io n
Overview of the Problem
The first cases of Human Immunodeficiency Virus (HIV) infection and the
associated Acquired Immunodeficiency Syndrome (AIDS) were reported in the early
1980’s. In the United States, the first hundreds of people diagnosed with AIDS were
homosexual men (Essex et al., 1994). Though it was primarily thought to be a
homosexual disease, it soon became a global one as AIDS was found in several
developing countries amongst heterosexual populations. Sub-Saharan Africa has
been hit the worst by the AIDS epidemic, causing it to overwhelmingly dwarf the
rest of the world. A whopping 7 out of 10 people are infected with HIV, and the
number of new infections is continually rising in the region. In 1999, there were 4
million (UNAIDS & WHO, 2000). Current statistics show that the total number of
adults and children living with HIV/AIDS globally is 34.3 million. Africa has 24.5
million of them. The HIV/AIDS epidemic has claimed almost 19 million lives over
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the past two decades, including almost 4 million children. Over 13 million children
have been left orphaned, with Africa having 95% of all AIDS orphans.
The HIV virus has hit all African countries, but some are worse off than
others. The bulk of the new infections continues to be concentrated in Eastern Africa
and Southern Africa. A multi-site study done by UN AIDS (1998a) of four countries,
two in West Africa with low HIV prevalence and two in Central and East Africa,
with high HIV prevalence, found that more women were affected by HIV than men,
especially teenage girls between 15-19 years as compared to boys of the same age.
Over 50% of all new infections in the sub-Saharan Africa were reported to have
come from South Africa (UNAIDS & WHO, 1998). One out of five persons in the
population is HIV positive, and over 4 million people are living with AIDS in South
Africa, which has the largest number of people living with AIDS (PLWA) in the
world. With exception to Cote d’Ivoire, which is numbered among the 15 worst
affected countries in the world, West Africa has been less affected by HIV than
countries in sub-Saharan Africa.
According to Miller and Rockwell (1988), the African age group with the
highest risk of infection is between the ages of 20 to 40 years of age. Not only are
they the most sexually active but they are also the most productive sector of African
populations, comprising 50% of the young and supporting children under 15 years of
age and the over-60 age group, both of whom depend on them. During 1998, Africa
held 5,500 funerals a day for people dying of AIDS which, in 1998, accounted for
1.8 million deaths in sub-Saharan Africa, making it the largest killer when compared
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to 1 million malaria deaths and 209,000 tuberculosis deaths. Every day an additional
11,000 people in Africa are infected with HIV, one every 8 seconds (White House
Report, 1999).
Since there is yet no cure, prevention is the only hopeful strategy to curb
further spread of the HIV infection (Piot & Merson, 1995). Contraction of the HIV
virus is through sexual behavior, unclean or unsterilized drug injecting equipment,
and prenatal transmission from mother to child. All these transmission modes
indicate that individuals are able to make a choice, so prevention approaches aimed
at changing individual or human behaviors are seen as the most effective in
curtailing the further spread of HIV.
The Problem Defined
In order to develop effective prevention programs that involve the change of
human behaviors, it is important to look deeper at the knowledge, attitudes, and
beliefs people hold towards the AIDS epidemic. University students are viewed as
Africa’s future leaders, and several African governments have invested funds to
educate their young with this potential hope. What these future leaders know of
AIDS and what their attitudes and beliefs are towards it become important as they
will be developing and implementing policies.
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Background
In Africa, the spread of the AIDS epidemic has reached catastrophic levels
wiping out several million of people and annihilating many development efforts in
the region over the past decades. There are many factors that have caused
HIV/AIDS to spread like a ravenous wild bush fire in Africa, but the predominant
reason is poverty. Other factors range from gender bias to religious and government
constraints. Each of these is discussed in greater depth in the literature review in
Chapter 2.
Several AIDS prevention campaigns have promoted condoms as an effective
method to prevent AIDS. However, due to the high cost and resistance towards this
foreign technology, condoms remain underutilized. Poverty has been cited as an
agent in the spreading of the AIDS epidemic. Many women and youth are forced
into an exchange of sexual favors to obtain food and other basics for survival.
Richard Wilkerson (1996) states how low wealth and low social cohesion causes
individuals to be more susceptible to HIV and AIDS. Analyzing the poverty and
inequality within societies, Farmer (1999) determined that many impoverished
communities are at risk of contracting infectious diseases. He also disagreed with
many research efforts that focus on risk behaviors rather than focusing on how
poverty has contributed to the massive spread of the AIDS epidemic. Martha Ward
(1993a) in agreement emphasized the importance on not focusing on the ethnicity of
a person. When one is collecting data on the number of people living with AIDS
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(PLWA), race should not be the issue, but the poverty level of these people as this is
what puts them more at risk for HIV.
It is evident that changes must take place within African communities and
nations in order to fight against AIDS and preserve human life. Changing the
behavior of a people is difficult and takes time. Gold (1995) said that even though in
white gay male communities where HIV prevalence is high, they still engage in high
risk behaviors so awareness of high HIV prevalence does not necessarily foster risk
preventive behaviors. The Global AIDS prevention strategy has predominantly
focused on encouraging people to use condoms and to “stick to one partner.”
According to Bledsoe (1990), people often interpret advice or policy
directions regarding sexually transmitted diseases like AIDS and their protection
against such diseases through their own cultural lenses. At times they may deny, or
avoid or even reject such advice. Twumasi (1975) reports that health and sickness in
African societies is attributed to supernatural powers. He gives an account of
sanitary inspectors, who threw out water jugs infested with mosquito larvae at
African residences. The people, however, had a different view, saying that the water
was not poisoned since the larvae were present. When it comes to AIDS, the dangers
and advice given to curtail its spread are subject to people’s interpretations.
Prostitutes, or commercial sex workers, a group considered at high risk for HIV, also
have resisted advice on condom use.
In a study done of interviews with 131 prostitutes living in Accra, Kumasi,
and Abidjan (cities in West Africa), prostitutes revealed several ways they ward off
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the threat of HIV infection (Ampofo, 1995). Many sex workers refuse to use
condoms for fear that they may prolong or make the sex act dull, resulting in a loss
of clients. Some even profess to use vitamins, including birth control, as antidotes to
preventing HIV infection, after having engaged in unprotected sex. Urinating after
the sex act is also regarded as a form of purification from AIDS. This exemplifies
what Schutz (1962) said about people developing their own reasoning that may not
conform to scientific or medical explanations.
A study done in Nigeria revealed that a majority of male respondents (76%)
refused to tell their wives if they were HIV sero-positive but would wish to be told if
their wives were (Soyinka et al., 1999). Many patients fear physician disclosure of
their HIV status even to closest family, due to discrimination, social rejection,
segregation, abandonment, and job loss. Doctors and nurses have fear of contracting
HIV from their patients and refuse to treat them. Though they have knowledge of
how AIDS is transmitted, physicians and medical personnel continue to refuse to
treat several AIDS patients.
Africa’s cultural extended family network is fast disappearing from AIDS.
Family members and relatives are abandoning members with AIDS due to the
stigmatization by society and lack of sufficient resources to care for them. This
makes community care of PWA very difficult and the old proverbial slogan that it
takes a village to raise a child has become a thing of the past. AIDS takes the lives
of most productive adults leaving the very young and old to care for each other.
Several television and print media reports have documented young children, some as
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young as four, going without food and basic needs for days, due to the death of their
parents who had AIDS.
Hampton (1990) states that one of the agonizing worries for people dying of
AIDS is who will care for their children. According to Dr. Kevin de Cook of the
Centers of Disease Control and Prevention in Atlanta, Georgia, there are more than
12 million orphans in Africa and their number continues to rise. These orphans
undergo the struggle to survive physically, to get basic education, to have love and
affection and to find protection from being exploited, abused, and discriminated
against. Before children become orphaned, they usually take care of their dying
parents and stand the risk of getting infected themselves. They go through much
psychological trauma watching their parents die. Counseling services need to be
included in the AIDS prevention and education strategies, not only to help orphans
cope with the loss of their parents, but also to help those taking care of PWA and the
PWA themselves.
Illiteracy coupled with poverty and deprivation causes people to treat PWA
harshly by abandoning and stigmatizing them (Soyinka, 1999). Governments, local
NGOS, and International Organizations helping to fight against AIDS in Africa need
to work at promoting societal acceptance towards PWAs and thus alleviate the
psychological traumas inflicted by rejection and shunning. There is much to be done
in eradicating and curtailing the spread of AIDS. Prevention, education, and
awareness continue to be the most effective anti-AIDS strategies, especially because
there is no cure and many medications are too expensive for the majority of Africans.
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Chapter 2 further outlines the AIDS prevention strategies that have worked and the
process of how change has occurred in Africa.
Importance
AIDS is wiping out several million people in African countries, mostly in the
economically producing and sexually active age bracket of 15-35 years, leaving
children and older age groups to cope with survival. This study will help African
governments develop effective educational prevention programs for their university
students and younger age groups so that they will be able to survive and AIDS won’t
continue to steal Africa’s next generation of productive citizens.
The purposes of the study are the following:
1. To understand and determine the knowledge, attitudes, and beliefs (KAB)
of university students and to design AIDS educational programs that truly
address issues and that are effective in changing unsafe sexual behaviors.
2. To discover whether there are differences between male and female
university students and teaching and non-teaching majors in their KAB,
so as to tailor AIDS prevention programs to specifically target their
special needs.
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Research Questions
This study focuses on the knowledge, attitudes and beliefs of African
Christian University students towards AIDS and answers the following questions:
1. Are there any knowledge, attitude, and belief differences towards
HIV/AIDS between Christian African male and female university
students?
2. Do students of teaching majors differ from students of non-teaching
majors in their knowledge, attitudes, and beliefs towards HIV/AIDS?
3. What policies and practices do Kenyan universities need to develop and
implement to curtail the spread of HIV?
Methodology
The study used a researcher-designed questionnaire, which utilized similar
questions for similar KAB studies done by the World Health Organization. The
questions were altered and tailored to be sensitive to the cultural makeup of students
studying in Kenya, some of whom are from other African nations. The questionnaire
sources include the Kenyan embassy and university students studying in Kenya. The
responses from the questionnaires were tabulated and analyzed to assess the
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knowledge, attitudes, and beliefs of the university students as well as address the
research questions.
Limitations
In this study the researcher investigated the knowledge, attitudes, and beliefs
of African University students towards HTV/AIDS. The sample is limited to
Christian University students. Therefore, the study cannot be generalized to other
African regions that may have homogenous populations. Non-Christian students
were not included in this study, and the results can only be generalized to Christian
University students enrolled in African universities.
Self-administered questionnaires were used in this study asking students to
participate voluntarily. In studies of this nature, participants are known to inflate
their knowledge, give socially accepted answers, or chose not to answer certain
questions. However, self administered surveys are less personal than oral interviews
and students are more willing to answer questions honestly. Though validity of the
results was dependent on truthful answers, there is no way to know whether students
were candid or whether they gave socially accepted responses.
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Assumptions
The study assumes that the information from all sources is accurate, that all
participants in the study were honest in their responses on the questionnaires, that the
information used in the analysis was accurate, and that the statistical analysis of data
was accurate.
Glossary of Terms
AIDS: This acronym stands for Acquired Immunodeficiency Syndrome, a disease
caused by HIV retrovirus, described as a set of diseases by Gordon and
Klouda (1989). Not all people who develop AIDS suffer the same illnesses.
This is why it’s unusual as other related diseases develop with it. It affects
the immune system causing it to weaken so the body can no longer fight
infections and becomes susceptible to many diseases.
Attitudes: Are how people feel or react towards people, things, or events (Kubiszn
& Borich, 1987). According to Kubiszyn and Borich, attitudes are fairly
consistent and stable ways that people feel and behave. Thorndike and
Hagen (1977) define attitudes as ways people accept or reject others,
organizations, or ideas. Attitudes may be measured by observations and
rating scales. In this study, the Likert scale of agreement to disagreement has
been used for both statements and open-ended questions.
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Beliefs: Are the perceptions of what an individual holds to be true. Deep
convictions, beliefs in this study were twofold, i.e., whether the individual
felt AIDS was an important problem and whether he/she felt they were at risk
of HIV infection.
HTV: HIV stands for Human Immunodeficiency Virus (Gordon & Klouda, 1989).
When the HIV enters the blood, it attacks the body’s immune system. HIV
attacks the white blood cells that are responsible for fighting infections,
causing the body’s immune system to disintegrate. There are at least two
variants of human immunodeficiency virus, HIV-1 and HIV-2 (Keeling,
1993), and no effective method has been devised to eliminate it once it
invades the body.
Knowledge: The New Merriam- Webster’ s Dictionary (1989) defines knowledge as
an understanding gained by experience, a range of information that is learned
and kept in mind. Knowledge in this study refers to the respondents’
knowledge of HIV transmission, the infectious status of affected individuals,
fatality, cure, and so on.
NGOs: An acronym that stands for Non Governmental Organizations
PLWA: An acronym that means people living with AIDS.
PWA: An acronym that means person or people with AIDS.
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Chapter 2
R e v ie w o f t h e L it e r a t u r e
Nature and Extent of AIDS in Africa
The AIDS epidemic in sub-Saharan Africa has killed more people than the
“total of all wars of the 20th century combined” (White House, 1999). It has been
predicted that by the year 2005, there will be 13,000 Africans dying daily of AIDS
and in that year there will be five million AIDS deaths. Several recent media reports
have documented the AIDS crisis in Africa both on television with Pat Harvey
(2000) of KCAL news reporting on families struggling with AIDS and Time
magazine (McGeary, 2001) account of “Death stalks a continent.” There have been
17 million deaths since AIDS began in 1970’s with 3.7 million of them being
children, leaving 12 million children orphaned.
Seven countries report one out of every five people living with HIV. These
are Swaziland, Zimbabwe, South Africa, Namibia, Lesotho, Botswana, and Zambia.
Way and Stanecki (1993) reported inadequate HIV surveillance where many AIDS
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cases go underreported. There is a possibility that these figures are higher as a result
of underreporting. Mann and Chin (1988) developed the typology framework for
World Health Organization’s (WHO) Global AIDS program, which describes
patterns of infection around the world. Africa falls into pattern 2 region, where
AIDS is predominantly transmitted heterosexually and vertically, mother to child.
Over 50% to 75% of new infections come from Eastern and Central Africa which
both have higher HIV prevalence rates than Western Africa.
Life expectancy and child survival rates have plummeted in some of the
worst affected countries, and AIDS is having a major impact on social and economic
development. In Botswana, almost 36% of the adult population is infected. The
WHO Report on Infectious Diseases (WHO, 1999) found that by the year 2010, sub-
Saharan Africa will have 71 million fewer people because of AIDS. The projected
population declines are the following: Nigeria will have 11.7 million fewer people;
Kenya, 6.7 million fewer people; South Africa, 5.6 million fewer people; Zimbabwe,
4.4 million fewer people; and Uganda, 4.2 million fewer people.
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Table 1. AIDS Cuts African Life Expectancies
Country Cut In Life Expectancy (Years)
Zimbabwe from 65 to 39
Botswana from 62 to 40
Burkina Faso from 55 to 46
Burundi from 55 to 46
Cameroon from 59 to 51
Central African Republic from 56 to 49
Republic of Congo from 57 to 47
Congo from 54 to 49
Ethiopia from 51 to 41
Ivory Coast from 57 to 46
Kenya from 66 to 48
Lesotho from 62 to 54
Malawi from 51 to 37
Namibia from 65 to 42
Nigeria from 58 to 54
Rwanda from 54 to 42
South Africa from 65 to 56
Swaziland from 58 to 39
Tanzania from 55 to 46
Uganda from 54 to 43
Zambia from 56 to 37
Source: U.S. Census Bureau, 1999.
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In sub-Saharan Africa, HIV-infected women outnumber infected men by a
ratio of more than 6-to-5 (Moshi, 1999). According to UN AIDS (1998a), life
expectancy for both sexes in southern Africa is expected to drop from age 59 to 45,
sometime between 2005 and 2010, because of the AIDS epidemic. Young women
and girls become infected at younger ages than do boys. A recent community-based
study in one area of Kenya showed that 22% of 15-19 year-old girls in the general
population were already infected with HIV, compared with just 4% of boys of the
same age. In a Zambian study of young city-dwellers in the same age group, HIV
infection was reported in 12.3% of the girls and 4.5% of the boys. In the next higher
age bracket, 20-24 years, a study in Ethiopia found that 35.4% of young women were
infected—three times higher than the 10.7% rate among the men (UNAIDS, 1998c).
Over time, new infections shall increasingly be concentrated in the youngest
age groups. In a recent study in Malawi, HIV prevalence had built up to high levels
in older age groups, but the bulk of new infections was occurring in younger women.
Millions of adults are dying young or in early middle age. They leave behind
children grieving and struggling to survive without a parent's care. Many of those
dying have surviving partners who are themselves infected and in need of care.
Their families have to find money to pay for their funerals, and their employers—
schools, factories, hospitals—have to train other staff to replace them at the
workplace (Roberts & Rau, 1997).
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The AIDS epidemic has further impacted African national economics.
Though there has been much upheaval caused by civil wars, foreign aid debt, and
corruption within governments, AIDS has detrimentally affected businesses. Deaths
of senior executives working for foreign companies in Africa cost companies a great
deal in retraining and finding adequate replacements. Many of these senior
executives were solely responsible for the entire operation, and the loss their
unwritten knowledge of running the entire operation has been a tragic loss to some
enterprises.
In Zambia and Tanzania, large companies have reported that in 1995, their
costs from AIDS illness and death of employees exceeded their total profits for the
year. In Zimbabwe, life insurance premiums quadrupled in just two years because of
AIDS deaths. Some companies report a doubling of their health bills. In Botswana,
companies estimate that AIDS-related costs will soar from under one percent of the
wage bill now to five percent in six years’ time because of the rapid rise of infection
in the last few years. Prevention programs for workers have proved to cut costs and
infections in Africa. While costs vary significantly between countries, it is estimated
that a worker with AIDS costs a business in southern Africa around US$ 200 a year
in lost productivity, treatment, benefits, and replacement training. Some companies
have taken the stance of hiring two people per job to keep the productivity high.
Obviously, the costs for senior and skilled staff are far higher.
A study in Tanzania demonstrated that treatment of other sexually
transmitted diseases costing as little as US$ 2.11 per case can reduce the number of
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people getting HIV by over 40%. Thus the importance of companies not only
providing on site AIDS awareness programs but also encouraging employees to get
tested for STDs cannot be overrated (Collins & Rau, 2000).
Extent of the Problem in Kenya
President Moi has declared AIDS a national disaster (President speaks
against AIDS, November 26, 1999). In his speech to Members of Parliament at the
opening of the AIDS awareness symposium, he said that AIDS needed to be brought
under control as it threatened the lives of the people and the social and economic
development of the country.
Later that same week, during World AIDS Day on December 1st, the Kenyan
Minister of Health revealed that 500 Kenyans were dying daily because of AIDS
(World’s AIDS Day, December 1, 1999). In its world AIDS Day Supplement, The
East African Standard indicated that deaths arising from the AIDS epidemic cost the
government of Kenya close to 200 million shillings per day (US $2.5M). The article
revealed the following facts about the AIDS epidemic in Kenya:
• 13-14 per cent HIV prevalence—adults.
• 1.9 million people HIV positive.
• 700,000 dead.
• 500 new infections every day.
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• Cost to economy is 200 million shillings per day.
• Life expectancy declining.
• Infant mortality rate increasing
According to Mati (1997), Kenyans between the age of 15-45 years are most
affected by the AIDS epidemic. In 1996 over 65,647 AIDS cases and 1.1 million
HIV infections were reported by the Kenyan National AIDS and Sexually
Transmitted Diseases (STDs) Control Program (NASCP). Mati (1997) also
predicted that by 2000, about 2 million Kenyans will be infected with the HIV virus
and that AIDS related deaths will reach 90,000.
One study of about 10,000 Kenyan schoolgirls between the ages of 12 and 24
reported that on average, girls lose their virginity when they are between 14 and 15
years old. However to date, no reproductive health education in schools exists to
prepare girls to avoid early sex or to adopt safer sexual practices (UNAIDS, 1998c).
The Kenyan Educational system cannot afford to ignore the AIDS problem because
it affects all those attending the schools and universities as well as all those related or
associated with them. The AIDS crisis continues to grip Kenyan communities to rob
it of its parents, teachers, productive professionals, youth, infants, children, church
members, and leaders.
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What is Being Done by International Organizations
There are several international organizations working in Africa helping out
with the AIDS crisis. A few of the key organizations are listed with a brief
description of the work they are doing. Since it’s inception, the United Nations has
always played an important role in Africa, especially in healthcare. The United
Nations launched an initiative to lower HIV infections among young people in
Africa, with Secretary-General Kofi Annan calling for a response to the epidemic
"that makes humanity live up to its name." The United Nations held a two-day
meeting attended by officials from Africa and UN agencies, non-governmental
organizations, and private companies. The aim of the meeting was to draw up a plan
to reduce infection rates among Africans age 14 to 25 by 25% before 2005. Arman
advocated for the international community to break the “conspiracy of silence” and
stigma that surround the AIDS virus. He also said it is important to speed up vaccine
development and make treatment affordable for Africans (Kenyan Embassy, 2000).
The World Health Organization (WHO) is another organization that has been
most instrumental in providing technical and monetary assistance to African
countries to help them with health issues. WHO’s global program on AIDS created a
Special Program on AIDS (SPA) on February 1987 with three major goals: (1) to
prevent HIV transmission, (2) to take care of HIV infected persons, and (3) to unify
national and international AIDS control efforts. Jonathan M. Mann (1987) of WHO
believes AIDS prevention aimed at changing sexual behaviors is possible because
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HIV is transmitted by conscious actions of sexual intercourse, blood transfusions,
and injection. He also said that because AIDS knows no social, economical,
political, or cultural barriers or borders, effort must be unified at the national and
international levels. He advocates for international leadership, coordination, and
cooperation which are essential for the effective use of resources, minimize
duplication, and ensure the rapid and widespread sharing of critical information.
African Medical and Research Foundation (AMREF) has field headquarters
in Nairobi, Kenya and works with the rural people in Africa in areas of public health,
research, and health education material development. It has collaborated with other
organizations to do joint research studies on the high-risk behaviors that spread HIV
in Africa.
AFRICARE has offered several health-related educational workshops to
developing countries. It has focussed on work-related issues surrounding the AIDS
epidemic in Kenya, Uganda, and Rwanda. Other organizations include AIDSTECH
Project that is involved with surveillance, blood screening, and training of health
workers concerning the containment of the AIDS epidemic. The AIDSCOM Project
has been focused on high risk behaviors that advance the spread of AIDS, plans
media campaigns, provides training and counseling to those at high risk, and engages
in condom promotion campaigns. Youth Against Aids (YAA) holds workshops to
empower youth and formulate AIDS action plan with heads of state to help change
youth attitudes towards AIDS and to foster longevity.
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The Centre for African Family studies (CAFS) was founded by the
International Planned Parenthood Federation and has been serving in Africa for the
last twenty-five years. Headquarters are in Nairobi, Kenya with a regional office in
Lome, Togo. They offer a range of training and offering technical assistance to
government institutions and African-based NGOs in some of the following areas:
• Caring of PLWAs
• HIV/AIDS sensitivity training for managers
• Managing HIV/AIDS in the workplace
• Sexual and Reproductive Health programs for youth
Other international organizations work in Africa to prevent the spread of
AIDS by supplying condoms, offering training and education to women groups,
supplying clean syringes to clinics, and carrying out HIV testing as well as other
related services. There is a danger of “donor fatigue” where international
organizations get overwhelmed and tired of the constant “giving of funds.” This
emphasizes the urgent need for African governments to take up the action of
prevention more aggressively and seriously, not solely depend on help from
international organizations, and initiate and generate their own solutions.
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What Is Being Done by Governmental Organizations
Lesotho doubled its AIDS budget, and Namibia's Cabinet approved
implementation of its national AIDS program. Zambia involved religious leaders
and all sectors from health to education in their HIV prevention program. Over the
last six years, this resulted in reducing by half the percentage of pregnant girls, aged
15-19, infected with HIV. Studies of sexual behavior done in 1990, 1992, 1992, and
1998 showed that fewer young Zambian women were having sex before marriage in
1996 compared to 1990 (UNAIDS 1998c).
In the early 1990’s, Uganda had an AIDS prevalence rate of 14% but has
brought that down to 8% with strong prevention campaigns led by the president who
recognized the danger of the epidemic on national development. Religious leaders
and community development organizations carried out prevention campaigns. Over
an eight-year period, the HIV prevalence rate among 13-19 year old girls fell
significantly, according to a large community-based study. A large increased use of
condoms contributed to the lower prevalence and a decline in teenage pregnancies
(Bondet. al, 1997).
Uganda has made significant progress in curbing the spread of HIV. In urban
Uganda, HIV rates were cut in half. The United States invested $46 million (26 % of
the donor contributions to AIDS in Uganda) in partnership with the Ugandan
government and other donors. Under the leadership of President Museveni, the
government required every government ministry to develop, implement a plan to
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reduce the AIDS stigma, educate people about HIV transmission and support the
sick. Consequently, a National Committee for the Prevention of AIDS (NCPA)
came to being, comprised of healthcare workers, educators, administrators, political,
and church leaders who together, developed priorities and set national policies to
educate (Sittitrai, 1999).
The government provided health education to healthcare workers focusing on
prevention of transmission, clinical diagnosis, and supportive therapy. Measures
were taken to reduce the risk of transmission through blood transfusions, injections,
and surgery. Research efforts were supported and carried out. Public education
campaigns were disseminated in urban areas and through schools (Sittitrai, 1999).
Radio Uganda carried frequent messages with “love carefully” messages
describing transmission of AIDS through sex, and the importance of condoms, and
the need to reduce the number of sexual partners. Church and political leaders also
encouraged rural folk to have only one sexual partner. Condoms were made
available and free. Uganda has also been effective in educating their young about
safe sex and through a hip-hop weekly radio program discussing sexual matters. The
broadcasts have reached more than 1.5 million young people, and the comments
made by the youth show openness and change in their sexual choices (Hunter-Gault,
1999).
Senegal joins Uganda in becoming one of the few sub-Saharan Africa
countries that has succeeded in containing the spread of HIV. Early in the mid-
1980’s when the first cases of AIDS were identified, a nationwide campaign to
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modify sexual behavior was launched. The focus was to increase use of condoms
and to delay the age young girls have sex. The religious leaders, predominantly
Muslim, made HIV/AIDS a regular part of the Friday service at the mosques and
discussed the issue on TV and radio. AIDS education was incorporated into
religious education and though there was dissention about the morality of using
condoms outside marital relations, both the Muslim and minority Catholic religious
leaders referred people needing condoms to other service providers (UNAIDS,
1999).
By 1995, Senegal had 200 non-governmental organizations (NGOs) involved
in AIDS prevention and care services. These women groups had over half a million
enrolled members. Sex education programs were provided in schools, and
provisions were made for youth not in school to get the same programs. Prostitutes
were mandated to register and have regular health checks. They were urged to use
condoms with their clients. Prevention messages were preached at local markets
where transport and migrant workers frequented. The outcomes of these prevention
efforts yielded an improvement of sexually transmitted intervention treatment
services. Increased condom use went from 800,000 in 1988 to 7 million distributed
in 1997. Men’s use of condoms before AIDS was 1%, but by 1997 it had increased
to 67%. In 1997, Senegalese women were no longer having sex before age 19 but,
unlike their mothers’ generation who had sex before age 16, were waiting (Sittitrai,
1999).
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In Zimbabwe, people are rising to the challenge of the orphan crisis. Many
village heads have designated land for cultivation by all villagers to feed orphans and
families of those suffering from debilitating illnesses, usually AIDS-related. In some
areas, NGO church groups have begun orphan-visiting programs. Women are
trained to identify the neediest orphan households in their area, which they visit on a
regular basis, providing guidance and emotional support and helping with basic
necessities. These programs are affordable because they are community-based
costing an average of just 68 US cents per child per month. Plantations have also
begun to look into helping the orphans left behind by parents who have died of AIDS
(Bartholet et. al., 2000).
Obstacles Faced in Africa and Specifically in Kenya
Government
BBC News (Standley, 1999) reported that in the South African province of
Western Cape, which is not controlled by the African National Congress (ANC),
government agencies distributed free antiretrovirals to pregnant women and rape
victims. They were doing this against the ANC ruling that prohibits antiretrovirals
due to the effectiveness of the drug not being proven and lack of funds to distribute
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them countrywide. The international organization Doctors Without Borders helped
with the distribution.
In 1991, due to major civil unrest and looting in Kinshasa, Zaire,
international AIDS projects such as CONNAISSIDA were shut down (Garrret,
1994). HIV can spread silently in the victim for many years before the infection
develops into symptomatic AIDS and becomes a cause of recurring illness and,
finally, death. As a result, some governments in sub-Saharan Africa have tended not
to take the disease seriously, as in the case of Nigeria, where the government was
slow in instituting practices to prevent HIV infection. In 1993, it found that blood
screening had not been carried out properly leading to blood being erroneously
labeled ‘screened’ (Effa-Heap, 1997).
The old colonial and Apartheid systems of government left scars on the
psyche of African populations. These old government systems used force and
control causing Africans to attribute the AIDS epidemic as external, something they
could not control. Even educated Africans felt that AIDS had come from the West to
once again control them.
In Sudan the government that is run by the ruling Arab Muslim elite who live
in the North treat AIDS as a non-Muslim disease. They firmly believe that it comes
from the refugees and Southerners that include south Sudan and African countries to
the south of it. The Muslim elite monopolize the media channels to declare AIDS as
non-Muslim and say they need to fight it, but they give low priority to doing so.
Even though the budget for health and TV broadcasting is equal, spreading the
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message of Islam is a higher priority. Sudan has been known for risky HIV
behaviors amongst the Muslim societies, such as homosexuality, several wives or
sexual partners, female circumcision, and certain cultural Sudanese practices. One
practice is a brother or the son of another wife inheriting a widow. Yet AIDS
continues to be a low national priority (Hussein, 1992).
CNN News {African AIDS summit ends with appeal to leaders, September
17, 1999) reports of how conference participants expressed disappointment with
African Heads of State who failed to show up at a 4-day AIDS conference held in
Lusaka, Zambia. Not even the Zambian president made an appearance at the
conference that was attended by more than 6,300 officials, activists, traditional
healers, and scientists. The lack of involvement by African leaders in eradicating
AIDS continues to be an obstacle.
Discrimination Towards People Living With AIDS (PLWAs)
Even though there have been organizations set up in Africa to defend people
with AIDS, like African Network on Ethics, Law, and HIV established in 1991,
unjust treatment towards PLWAs is still occurring. People who had AIDS were
collectively gathered and confined to an area by a Nigerian naval officer who did not
want the disease to continue its spread in his state. Zimbabwean women with AIDS
have been denied access to health, jobs, and education {Discrimination against
positive women in Zimbabwe, 1996a). Miles (1991) states that HIV/AIDS is viewed
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as the disease of “the impure.” This attitude has resulted in several PWAs being
stigmatized by the society in which they live. Many are abandoned and not cared for
further traumatizing the effects they already suffer physically. Martin (1996)
mentions how women who discover they are HIV positive often keep it to
themselves for fear of being violently abused or isolated from their family and
children.
Illiteracy
Huge populations in several African countries remain illiterate. This creates
a huge obstacle for preventing the spread of AIDS as resources are often in the
dominant languages such as English and French. Prevention strategies are much
more difficult where basic literacy skills are absent. At the same time, efforts to
increase literacy have become an uphill struggle in many countries (WHO, 1999)
where HIV has devastated the workforce. Illiteracy has also affected the way PWAs
have been treated by others, often in a humiliating and degrading manner (Soyinka,
1999).
Women in particular have higher rates of illiteracy due to the male dominated
culture and are often barred from attending school by their families and
communities. Many research studies have indicated higher levels of HIV infection
among the women compared to the men and have blamed this primarily on illiteracy.
Women have fewer economic options and, as a result, are forced into working as
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prostitutes, hence increasing the risk of HIV infection (Adomako-Ampofo, 1995;
Buckner, 1999).
Unsanitary Living Conditions
In many countries, lack of funds and inadequate use of existing cost-effective
tools to fight infectious diseases are compounded by a failure to take into account the
health impact of other sectors. All too often the key determinants of health and the
solutions to better health lie outside the direct control of the health sector. They are
rooted in sanitation, water supply, environmental and climate change, education,
agriculture, trade, tourism, transport, industrial development, and housing. Yet many
countries lack the capacity to measure the impact of other sectors on health. Unless
these issues are addressed, it can be difficult to prevent or even control some
infectious diseases. The link between environmental quality and health, for example,
is critical. Over 10% of all preventable ill health today is due to poor environmental
quality. Conditions such as bad housing, overcrowding, indoor air pollution, poor
sanitation, and unsafe water, bad housing, and poor environmental conditions have
the greatest impact on acute respiratory infections and diarrhea diseases. These
conditions facilitate AIDS gaining more of a stronghold and killing many more
people (WHO, 2000).
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Attitudes of Medical Personnel
It is bad enough that AIDS victims are thrown out of their homes, abandoned
by family and the communities they lived in but, when they are also not admitted or
discharged right after their blood is drawn for test purposes, it crushes the little bit of
hope left in them. A study surveying 193 Nigerian nurses’ attitudes towards caring
for HTV/AIDS patients found that the nurses were scared more about getting infected
with AIDS but not about caring for the patients. They were found to be reluctant to
do basic nursing duties that involved AIDS patients primarily due to lack of basic
supplies needed to protect them as they worked (Effa-Heap, 1997).
The AIDS situation has placed African physicians in a precarious situation
where they face dilemmas of how to impart the news of HIV infection to their
patients. Some doctors believe it should be the nurses who should break this news to
the patient, and others believe they should tell the senior member of the family. In
African family networks, the senior member is the one who, together with other
members, decides how to handle the situation. However, this breaches
confidentiality, especially when so many patients have been abandoned after they
learn they have AIDS. It is also common for doctors to decline treating AIDS
patients, and some doctors do this because they are concerned for themselves, and do
not want to contract the disease. Doctors also admitted to being distant and
unfriendly to their patients and disclosed their feelings of helplessness in a working
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environment where resources needed to be effective in caring and helping their
patients were nonexistent (Soyinka, 1999).
( Sugar Daddies ’
Many young girls get infected through sex with older men. “Sugar Daddies”
is a term used in Kenya to refer to older men who pursue young girls using gifts,
money, or other favors to attract them. Some young girls have been powerless to
resist as they have been forced to have sex or been raped, and they fail to report these
incidences because of fear and shame. One out of four young women has reported
loss of virginity due to forced rape. In the Democratic Republic of the Congo, the
proportion is close to a third of the young women. Unwilling sex with an infected
partner carries a high risk of HIV infection for young girls. No lubricants or
condoms are used; hence the vagina is dry and the force used can cause abrasions
and cuts which facilitate the HIV virus entering the bloodstream (Goodwin, 2001).
World Bank (2000) states that young girls are dying earlier due to AIDS than
boys of their age. In the age group of 15-19 in the countries Zambia, Zimbabwe,
Tanzania, Malawi, and Ethiopia, there are 5 girls infected for every one boy infected
with HIV. Girls must be made aware that they run an enormous risk of becoming
infected with ulcerative STDs, HIV, or both during their first few exposures to sex,
especially with older men who are far more likely to be infected than boys their own
age. Girls should leam the necessary life-skills to stand up to demands for early,
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unwanted, or unsafe intercourse. Above all, since men still play the dominant role in
deciding whether and under what circumstances sex will take place, priority must be
given to sexual behavior change programs aimed at them. Social pressure should be
put on older men to avoid forcing or coercing young girls into sex, or enticing them
with sugar-daddy gifts (Akeroyd, 1997). Cross-generational sex exposes girls to
lethal risks and helps drive the HIV epidemic.
Migration From Rural to Urban and From Urban to Rural
Urban migration of the male work force has facilitated the spread of AIDS.
The urbanization of cities in African countries has led to more men leaving rural
areas to look for more lucrative jobs. Often the wives and children are left behind,
and the man takes temporary lodging in the cities where he is able to enjoy multiple
sexual relations with the city women, who often have no other means of supporting
themselves, and resorted to prostitution. In Zaire, multiple sex relationships exist
along trading routes where women often seek travelling traders for extra income to
meet their economic needs (Schoepf, 1992).
AIDS spread rapidly amongst these migrant men who occasionally visit their
wives back in the rural areas, hence spreading the disease in the rural villages. HIV
has spread also by lorry or truck drivers who buy sex at truck stops on their way
across the continent. Miller and Rockwell (1988) both agree that these urban
dwellers are the highest risk social group because they are geographically mobile.
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These include government elites, commercial businessmen, military personnel,
police, truckers, and prostitutes. Women traders who are in need of favors to trade in
other countries also form regular sexual relationships with officials (MacGaffey,
1986).
The World Health Organization (WHO) states,
Tourism, international travel, and migration all help AIDS to
spread. The number of refugees and displaced people has
increased nine fold over the past two decades. In 1996, as
many as 50 million people worldwide had been uprooted
from their homes— 1% of the world's population. Refugees
and displaced persons living in overcrowded, unsanitary
conditions are at risk of outbreaks of cholera and other
waterborne diseases that also promote HIV infections.
(Report on Infectious Diseases, 1999)
High Birth Rate
High birth rates dominate several African nations increasing the prenatal
transmission of the AIDS disease as many of the women in child-bearing age are
HIV infected. The African cultural belief of having children is dominant, and not
having children or infertility leads to stigmatization. The US Census Bureau (1998)
estimates that every year in sub-Saharan Africa babies are bom to 14% of young
women aged 15-19, compared with 6% of young women in other less developed
countries and just 3% in the industrialized world. Many women have these births
outside of marriage.
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A recent Namibian study showed that close to 40% of births were to
unmarried women. It is interesting to note that many of these single mothers, about a
third of them in the study, had secondary level education or beyond, compared with
just over a quarter of married mothers. Consequently, it is not illiteracy or lack of
education that is causing high levels of teen pregnancy and pregnancy outside of
marriage, but possibly the inequalities that exist towards women in a male-
dominated society. Further, the study also reveals that young people are very
sexually active, and few of them use condoms. Thus, unprotected sex is rampant and
not just causing high birth rates but possibly causing infection with sexually
transmitted diseases, including HIV (Matthews et al. 1990 & Elkonin et al. 1993).
Pediatric AIDS is also becoming an issue with babies bom to infected
mothers who pass the disease at birth or through breast feeding (Decosas &
Pedneault, 1992)
Poor Treatment and Dehumanization of Women
Dr. Neal Nathanson, retired head of the National Institute of Health’s Office
of AIDS, made the statement, “If I had $1 billion to slow AIDS in Africa, I’d spend
every penny on empowering women” (Senterfitt, 2000). Female genital mutilation,
or female circumcision, increases the risk of HIV transmission. HIV risk increases
because scar tissue and a small vaginal opening are prone to laceration during sexual
intercourse or as a result of anal intercourse when the male is unable to penetrate the
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vagina. HIV may also be transmitted when groups of young girls are simultaneously
mutilated with the same unsterile instruments.
Female circumcision continues to be practiced in many African countries. In
Kenya, a total of 7,050 women underwent circumcision, according to a 1992 survey
done by Maendeleo Ya Wanawake (translated from Kiswahili as “Women of
Progress”). Though this practice is decreasing in urban areas, it remains strong in
rural ones. A total of 23,240 Ethiopian women underwent circumcision according to
a 1995 UNICEF-sponsored survey in five regions and an Inter-African Committee
survey in twenty administrative regions (WHO, 1996). Circumcision of women is
widely practiced by Muslims, Coptic Christians, and the Ethiopian Jews, most of
whom now live in Israel. In Gambia, a limited study revealed that a total of 450
women who underwent circumcision gave the following reasons why female
circumcision is done: custom and tradition; religious demand; purification; family
honor; hygiene (cleanliness); aesthetic reasons; protection of virginity and prevention
of promiscuity; increased sexual pleasure for the husband; a sense of group
belonging; enhanced fertility; and increased matrimonial opportunities (WHO,
1996).
Many women believe that female circumcision is necessary to ensure
acceptance by their community, and they are unaware that female circumcision is not
practiced in most of the world. In fact, one Sudanese woman insinuated that the
reason for the researcher’s unmarried state was due to being uncircumcised (Maina,
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1999). Female circumcision leaves wounds from incisions that facilitate the HIV
virus entering the bloodstream and thus infecting the women.
In contrast, circumcising men reduces the risk of HIV. A multi-site study
was done in four African cities to determine causes of different prevalence rates
between West and East Africa. The former tended to have low prevalence as
compared to East Africa. The study found large differences between the sites in the
percentage of circumcised men. In Cotonou and Yaounde, West African cities, over
97% of the men were circumcised, and lower HIV rates were found than in Kisumu
and Ndola, East Africa, where the percentage of circumcised men ranges from 10%
to 30% and higher HIV rates (UNAIDS, 1998a).
Cultural Patterns of Sexual Behavior
Another obstacle is cultural. One cultural practice is inheriting the deceased
(who died of AIDS) brother’s wife, thus contracting AIDS through sexual relations.
Another cultural practice is breast feeding the deceased sister’s or daughter’s child.
If the one breastfeeding has AIDS, the baby will get infected. Cultural beliefs
continue to impede AIDS prevention efforts (Allard, 1989). These cultural practices
may soon end as AIDS continues to take more lives. The African culture allows men
to have multiple sexual partners under the umbrella of polygamy. The wealthier the
man, the more wives he can have, even with westernization in Africa, polygamy still
exists, but AIDS is forcing monogamous relations.
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Oyekanmi (1999) discussed the burial rites of some Ugandan tribal groups.
Upon death of her husband, the widow is cleansed or purified by the junior brother
having intercourse with her to exorcise the dead man’s ghost. Amongst the Maasai
tribe in Kenya, when the husband of the woman is away on a hunt, other men in the
community can have sex with her to maintain high fertility. Even when he returns, if
the man’s spear is in the ground by his wife’s hut, he has to wait until that kinsman
leaves. Among the Yagba in Nigeria, a man’s friendship to another is demonstrated
by allowing his friend to have intercourse with his wife.
According to the New Internationalist (1988), female circumcision presents
an HIV risk due to the unsterilized tools used in incision. Many young girls have
been raped during cultural practices that allow foreplay between adolescent boys and
girls.
All these avenues of unprotected sex can be detrimental and fatal in the wake
of the AIDS epidemic. These cultural sexual practices and behaviors maximize the
spread of AIDS, and it should be carefully considered whether they should be
allowed to continue in the face of death.
Shame and Silence
South African Deputy President Thabo Mbeki told his country in October
1998,
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For too long we have closed our eyes as a nation, hoping the
truth was not so real. At times we did not know that we were
burying people who had died from AIDS. At other times we
knew, but chose to remain silent. (White House, 1999)
His speech was well received by the international and local communities as
he launched the South African Partnership against AIDS campaign. He stressed the
need to demystify AIDS and advocated discussions about safe sex to be held
everywhere from the classroom to the boardroom.
Zambian President Kenneth Kaunda said that leaders may be ashamed to talk
of AIDS because it is sexually transmitted. He stressed the importance of leaders
doing more to fight AIDS, adding and shame comes not from the method of how it
spreads but by them doing little or nothing at all about curtailing its spread (Kaiser
HIV Update, Being Alive, 2000).
Despite leaders advocating that the code of silence be broken, many Africans
continue to hide their shame and people with AIDS continue to be shunned and
mistreated. Even though women go for testing for HIV, many do not return for the
result. Pregnant women (50%) in a Cote d'Ivoire study (UNAIDS, 2000), did not
return to know their HIV status. Primary health clinics also reported of secrecy and
the refusal of medical staff to report needlestick injuries according to clinic policy
that stipulates HIV testing for staff who have been injured. Many chose to be silent
primarily because of the societal rejection and torture that people discovered with
AIDS endure. Fewer relatives taking care of those sick with AIDS, acknowledged
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that their loved ones were suffering from AIDS and chose to say it was just diarrhea
or pneumonia. In Kenya, people call AIDS the big malaria (Kenya Embassy, 2000)
Lack of Funds
Dr. Robert Janssen of the Centers for Disease Control in Atlanta mentioned
lack of resources for why African countries cannot get necessary medication to fight
AIDS (CNN, 1999). Zambian President Kenneth Kaunda, whose son died of AIDS
in 1986, said, “We cannot win a fight of this magnitude. We require massive funds
to put a dent on the scourge” (Kaiser HIV Update, Being Alive, 2000).
Lack of funds leads to inadequate and scarce resources in medical facilities to
treat AIDS patients such as water, electricity, oxygen, gloves, antibacterial hand
wash, incinerators, and other equipment needed to dispose infected materials.
Nigerian nurses felt they were unable to give full care to their AIDS patients because
of the fear of getting infected due to unavailable resources to do their work (Effa-
Heap, 1997).
Another cause of infection spreading is reusing needles in African health care
institutions. Many of these health care centers have inadequate medical supplies,
including clorox, needed to sanitize medical equipment (Triano, 2000). In
agreement, Haq (1988), in a case of management of AIDS patients in Uganda,
reported that health care workers have the following concerns:
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• Fear of contracting AIDS when providing health care to AIDS patients
because exposure to blood is frequent, surgical gloves are scarce and
reused several times, and antiseptics and fuel for sterilization are in short
supply.
• Healthcare workers in clinics in rural areas are unaware that their patients
have AIDS in its early stages. Because AIDS presents itself in a variety
of ways, it may go unnoticed even by trained personnel.
• Caring for the patients is limited due to a lack of drugs to treat the disease
and trained health care workers.
• Diagnostic testing for HIV positive and other diseases is generally
unavailable.
Inadequately sterilized equipment is also a major cause for the spread of
infectious diseases. Surveying health clinics in United Republic of Tanzania, a
survey discovered that some 40% of presumed sterile reusable needles and syringes
were contaminated with bacteria. Inadequate training, monitoring, and education on
basic hygiene have serious implications, not only for the hospital population itself,
but also for the community at large (WHO, 2000).
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Economic Strain of Treating AIDS
High costs of providing medical insurance and health care benefits have led
to economic strain of public and private companies. The San Francisco Chronicle
(Gough, 2000) reported of companies terminating several HIV infected workers from
their jobs. In 1996, Nairobi City Council of Kenya did away with its free medical
health care coverage for its employees after realizing it was spending about $5000 to
$7000 per employee from diagnosis to death in health services. Health services for
the general public dwindled severely. The legal eagles of the Kenyan law system
said that the city council’s decision was discriminatory and in direct violation to the
Kenyan Constitution that bans all forms of discrimination. Many workers in this
predicament failed to take legal action because of societal condemnation caused by
the widespread fear of the disease. Decosas & Adrien (1999) also report that HIV
death has placed many high level industries in jeopardy through decreased skilled
labor and high costs due to absenteeism and high turnovers due to death.
Inadequate or No Training
Millions of teachers and students in Malawi and Zambia are infected with
AIDS and are leaving school due to death or to take care of family (World Bank,
2000). Primary school teachers in Zambia experienced stress dealing with the HIV
epidemic that has affected their lives and their pupils. It is clear that there is a need
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for support and training to help them cope with this aspect of their work and that
AIDS prevention must be taught at all levels in schools.
In developing nations, patients must rely on their own judgement, or that of
underqualified doctors, paramedics, and other health care workers due to an acute
shortage of qualified health care workers. Many drug dispensers are under educated
and underinformed. WHO reports on a study of 40 randomly selected healthcare
facilities in Ghana, only 8% of the drug dispensers had received formal training. At
most clinics surveyed, there was an absence of trained dispensers, and many patients
bought medicines without visiting a health worker first (WHO, 2000).
Prostitutes were found to take vitamins, antibiotics, and other drugs they
purchased directly from a pharmacy. Some of these women even believed that
Secure, a form of contraceptive given to them by the pharmacist, would keep AIDS
away and clean out any diseases that they may have caught while servicing their
clients (Adomako-Ampofo, 1999). This reveals that pharmacists may not give
accurate information to these commercial sex workers. Another study found that
drug retailers in seven sub-Saharan African nations often advised consumers to
purchase non-essential drugs without adequate explanation and they did not suggest
that their customers consult a health worker prior to their purchase. This
combination of poverty and ignorance is the perfect spawning ground to spread HIV
(WHO, 2000).
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Religion
Africa is a continent of several religions including Catholicism, Islam,
African religious societies, even Hinduism. Regarding massive condom distribution
and the youth receiving sex education, religion stands as an obstacle because leaders
see them as advocating sexual immorality and devaluating chastity and monogamous
relations. The religious obstacle has caused AIDS patients to suffer discrimination
and isolation due to their illness that is erroneously believed to be a punishment from
God for immoral acts. The people of one village stoned to death one woman who
declared she was infected with HIV (White House, 1999). Villagers did not want the
curse to be on them, or the bad omen to enter their lives.
In Sudan the elite Arabic ruling class have monopolized the media to spread
Islamic ideology. They see Islam as the cure of all evil and further declare AIDS to
be a non-Muslims disease. This helps the epidemic to spread within the Muslim
society where sexual matters tend to be hidden. Promiscuity is rampant in Muslim
communities where men have sexual relations with several partners. Also due to the
strict religious segregation rules between men and women, homosexuality is
widespread, and incest between close relatives is evident (Hussein, 1992). Map
International, a non-denominational Christian organization, noticed a lack of
involvement of church leadership towards the AIDS epidemic. Part of their work in
Kenya and other African countries is to sensitize local church leadership to take an
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active part in utilizing their resources to fight against further spreading of the HIV
(Kiiti et. al. 1995).
Inaccurate Perceptions and Beliefs of What Causes AIDS
The AIDS Support and Educational Trust (ASET) that offers safe sex classes
and AIDS information to residents of Cape Town found that the Xhosa clients they
served blamed witchcraft and poisoning for causing AIDS (Crawhall, 1992). A 1995
study done among some of the Zairian tribal communities by five Zairians using the
KABP (Hunt, 1996) revealed what the people thought AIDS was and what caused it.
Following are some of the mentioned causes of AIDS:
• a form of biological warfare created by American scientists
• an imaginary disease invented by corrupt doctors who go after women in
bars
• a disease caused by human sorcerers and angry natural and ancestral
spirits
• the work of Satan
• an imported sickness created in the laboratories of white men
• a new manifestation of an ancient deathly diarrhea provoked by a spirit
that lives in the anthills and attacks thieves
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• a disease caused by married women working with doctors to keep their
husbands from committing adultery
• a punishment for accepting the colonial occupation of Zaire by Europeans
• a disease caused by white tourists sleeping with Zairian girls
It is clear that Zairian tribal communities see the cause and origin of AIDS as
something caused by external forces. This blaming external causes has been linked
to colonialism and the Apartheid systems of government, which were external
control forces on the people, and thus AIDS is perceived from these same external
lenses (Mkhize, 1995). Further, due to traditional beliefs that orphaned children
bring bad luck, orphans have remained destitute.
Africans Orphans
Many media reports have focused on the AIDS crisis and how many millions
of orphans have been left destitute with the death of their AIDS-infested parents. In
Zimbabwe, a fifth of the nation's population live on commercial farms. Many of the
workers immigrated from other places to work on these farms and forsake keeping
any regular contact with their extended families back home. This has left their
children with no one to take them, if their parents should die, and this has become an
increasing problem. This has led to child headed households where children are
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taking care of children and often don’t have the adequate resources to survive. Many
of them took care of their parents before they died and had no adequate protection
from HIV infection. Many have contracted the disease this way. Some initiatives
have been set up on these farms to take care of these children by finding other
families to care for them. However, the magnitude of this problem grows with new
estimates determined by the Zimbabwean government, that by the year 2005 there
will be over 900,000 orphaned children (Parry, 1996; Bartholet et. al., 2000).
Additionally, 20% fewer children attend school because parents are ill or dying as a
result of HIV/AIDS.
Historical Change of Public Opinion in Africa and Those
Responsible
Africa is four times the size of the US with over 900 tribal communities each
having its own distinct language. There are 51 countries in Africa each having a
separate government. These characteristics make Africa highly complex, especially
when its comes to changing how people think.
In the United States and other parts of the developed world change happens
relatively faster than in developing countries where the infrastructures for delivering
communication are not as advanced or developed. Even when compared with other
developing countries on other continents, Africa takes the prize for changing so
slowly compared to the rest of the world.
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The changes that have taken place in Africa have primarily been driven more
by political forces than anything else but, in the wake of the AIDS epidemic, new
ways of coping are beginning to shake the foundations of aged traditional belief
systems. There are three waves of change led by political forces in Africa:
traditional rule, colonial rule, and post-colonial rule. Before colonization most
African communities were locally governed by ethnic leadership councils that were
highly structured, providing education for the young and governing day to day life of
its members, including mitigating war against other tribal communities (Kenyatta,
1938).
During colonization several changes took place. One was the division of land
and movement of men from local communities to urban centers to provide labor to
the colonists. Infrastructures of education, law and government transportation were
set up to facilitate the movement of products grown and manufactured by the
colonies. Many men moved to the urban centers to work as servants and other
menial jobs, leaving their wives and children in the rural areas (Bassett & Mhloyi,
1991). Independence brought about the end of colonialism and ushered in post
colonial rule. African officials and heads of state were chosen to continue to run the
countries, keeping the many infrastructures of transportation, government, and
education as they were set up in the colonial days (Dawson, 1983).
The growth and expansion of new urban cities continued, and the need for
better wages found in these centers caused much migration from the rural areas into
the urban centers. Again many men left their wives and children, seeking the
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company of town women. These town or city women often were unskilled, were
uneducated, or lacked equal opportunity for jobs as the men, so they provided
services for men: food, beverages, and sex (Akeroyd, 1997; Stichter, 1979).
The colonists who were aided by the missionaries, who first came to Africa
to preach Christianity, brought about these three waves of change. From the
traditional way of life to learning the western value system imposed by the
colonialists and missionaries, many Africans not only converted to Christianity but
also progressed forward to achieve Western education. This led to opinion change in
those who followed this route, and it was often met with warnings from traditional
leaders not to forsake the old way of life (Maina, 1998).
Urbanization also contributed to changes in public opinion. Migration
flowed from rural areas where family and communities lived to urban centers where
there were no family or community obligations. This led to the beginning of the
break down of the family and traditional values, which have continued to deteriorate
as westernization and urbanization have increased. Many of today’s African youth
feel frustrated and tom between holding onto values of the old traditional way of life,
which they never lived, and the differing urban westernized cultural values which
they have grown up with (Maina, 1998).
Traditional healers discussed their role in the battle against AIDS at a
conference held in Lusaka, Zambia where more than 6,300 participants from all over
Africa were in attendance: officials, educators, medical personnel, activists, and
female NGOs. Rodwell Vongo, leader of Zambia's 40,000 traditional healers said,
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“We have shown that we can treat some of the opportunistic illnesses. We make no
claim to a cure for AIDS, but our role must be accorded some respect. Western
medicines have not worked so far” {African AIDS summit ends with appeal to
leaders, 1999)..
This account points out two things: First, the traditional healers’ role has
changed with the introduction of western medicine into Africa. Second, people still
seek them out for advice, especially when Western medicine hasn’t succeeded, as in
the case of the AIDS epidemic for which no cure has yet been found.
The AIDS epidemic is an agent of change and a potential force of change.
AIDS has taken the lives of millions in Africans and has been described as a real
threat with the potential of wiping out the entire African race on the continent. Many
governments cannot afford the expensive antiretroviral drug therapy for HIV/AIDS
that is still way beyond the financial means of most developing countries.
Effectively targeted, low-cost HIV prevention and care strategies are the only ways
to have a major impact on the spread of HIV. According to WHO (1999), millions
of new infections can be prevented through low-cost interventions:
1. Access to cheap condoms
2. Safe drug injecting equipment and promotion of safe injection practices
3. Use of essential drugs to treat other sexually transmitted infections
(which amplify the risk of subsequent infection with HIV)
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4. HIV testing and counseling (which can lead to safer sex)
5. Counseling and support for HIV-positive mothers along with
antiretroviral drugs and counseling on safe alternatives to breastfeeding
5. Sex education at school and at all levels in the communities
Chances of an American Model of Advertising Campaigns
Succeeding in Africa
Mass campaigns against polio were conducted in the 1980’s in United States.
Parents were educated about the need for their children to be immunized, and school
policies were enforced to regulate proof of immunizations upon entry into
Kindergarten and fist grade (WHO, 1999). Another social mobilization effort was
the car seat belt campaign where several television and radio commercials advocated
buckling up. Law enforcement policies were tightened to penalize those who refused
to buckle up. These American models of change and the safe sex campaigns offer
blueprints for other countries to follow.
The American model of advertising through billboards and mass media, using
influential figures in politics and entertainment, has worked in some parts of Africa,
like Uganda and Senegal, which are the best examples of prevalence rates of AIDS
having been lowered using the American model of advertising. In West Africa,
Guinea, a small, low-income country controlled the spread of TB through
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government implementation of a TB control program. The case detection rate
doubled, and almost 80% of patients were being cured (WHO, 1999).
The TB program operates through primary health care clinics and home visits
to patients living in rural areas. There were only 15 laboratories when Guinea
launched its TB program in 1990. Today, 67 laboratories exist for diagnosis and
research. Meanwhile in Senegal, the condom distribution rate increased from
800,000 a year in 1987 to over 7 million in 1998. This is due to the leadership
providing sex education at primary and secondary schools, aggressively promoting
condom use and providing treatment to those with STDs. It is no wonder that
Senegal is known for it’s low HIV prevalence rate (WHO, 1999).
In Kenya, governments worked with NGOs to promote AIDS campaigns.
They published articles on AIDS, held drama skits, and offered concerts (Kimani &
Obanyi, 2000). AIDS awareness was also promoted through the use of billboards,
some of which were written in the native languages to reach rural populations and
grass root levels. MAP International, an NGO, communicated their AIDS awareness
programs through churches and produced a video for public viewing (Greeley,
1988).
The American model of key celebrities speaking on critical issues, such as
Magic Johnson who contracted AIDS and recently and Michael J. Fox who has
Parkinson’s disease, helps the promotional message effectively because people tend
to identify with them. Even in Africa some key individuals have come forward to
declare their HIV status, for example famous musician Franco in Zaire and President
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Kaunda of Zambia, whose son died of AIDS, and this has helped spread the
prevention message (Ewens, 1994).
Reasons Why an American Model Would Work
An American model of mass campaigns can work in Africa because mass
media reaches a larger audience than any other medium. Radio is particularly more
effective than pamphleteering, because literacy rates are lower and broadcasts are in
the languages of the people.
The American model has a chance of working in Africa as literacy levels
increase. Literacy rates are slowly increasing, helping more people become aware of
AIDS. Nathan Geffen (Being Alive, 2000) reports that some NGOs have taken up
the task of offering literacy classes for women as protective behaviors rise by more
than 100%. Many women who could not read or write are becoming literate,
generating more income opportunities for them.
It has also been confirmed in a study of 188 Ghanaian prostitutes of differing
ages that use of condoms was consistently and predominantly found in older women
ages 31-45 (Adomako-Ampofo, 1997). This was partly due to consistent
information education and communication (IEC) outreach to this group of women
over a period of time that helped reinforce the prevention message. Women under
25 who were part of the study were more concerned about earning more money with
non-condom use and felt powerless in enforcing condom use by rationalizing that
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they would buy medicines to combat their illness. African women are overall less
educated than the men, so they often have no access to prevention information.
Raising their literacy levels through outreach definitely enhances their lives.
The American model of using influential celebrities or political leaders to
promote worthy causes can succeed in Africa. In Africa, political leaders have been
instrumental in facilitating AIDS awareness, using their influence to persuade their
people to be careful and use protection. People in African countries tend to fear,
respect, and obey their leaders, so this attitude does facilitate AIDS awareness
campaigns as people pay attention. This emphasizes the importance of leaders
giving the correct information regarding the AIDS epidemic. President Museveni of
Uganda has been commended for his visionary leadership in developing and
implementing strategies that helped curtail the fiery spread of AIDS in his country.
Many African countries send their key staff, often policy makers, to
workshops and conferences and, in turn, train and communicate the knowledge
gained to local NGO chapters. This is another reason why the American model of
utilizing workshops and conferences to get the message out amongst the
professionals works.
Reasons Why an American Model Would Not Work
Advertising costs for the antismoking campaigns in United States are
astronomical. According to Yang (2000), “Antismoking campaigns throughout the
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nation soon will receive a $52 million financial boost thanks to a new grant from
what's known as the “SmokeLess States National Tobacco Prevention and Control
Program.” Most African nations spend less than $15 per capita per year on health
care and prevention of disease. The cost to pay for prevention campaigns, education,
and awareness programs; for condoms, gloves, disinfectants, and clean needles for
medical workers; and for treatments and death and burial costs is extremely high.
Prevention campaigns based on the high costing American model cannot be done,
especially because in some of these countries over half of their populations are
infected with HIV.
Some of the poorest countries have no more than $7 a head to spend on
health care annually, making it difficult to ensure that even the most basic health
needs are met. On average, health expenditures in 1994 in low-income countries
were $16 per capita. Comparatively, average health expenditures in high-income
countries were more than $1,800 per capita. Low-income countries spend 4% of
GDP per capita on health, half the amount spent by wealthier countries. In many
poor countries, spending is even lower. In Cameroon and Nigeria, for example, it is
less than 2% of their GDP (World Bank, 2000).
For people still holding onto their traditional beliefs, like associating the
AIDS epidemic with supernatural causes such as witchcraft and divine punishment,
misinformation on the nature of AIDS hinders the American model fully succeeding
in Africa. The United States is a relatively young nation compared to countries in
Africa, and in Africa deep-seated beliefs of supernatural forces from ancient
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civilizations have continued to prevail as they have been passed down from
generation to generation.
The high rates of illiteracy and lack of education facilitate and perpetuate
these beliefs. Traditional beliefs like amulets, charms, fetishes, protection rituals,
and practices continue to hinder and hamper effective prevention (Mongo, 1995).
However, it is controversial as well as disheartening to see educated African
university students ascribe to some of the same reasons for the origin and cause of
AIDS. A study surveying 400 Nigerian University students found that an
overwhelming 70% of them believed that AIDS was invented by Western countries
to confine Africa. About 30% of these students didn’t believe AIDS existed or that it
was a problem (Anugwom, 1999).
Another reason why an American model won’t work in Africa is that sexual
matters are not discussed in a public forum. Discussing sex publicly is taboo and can
be taken as offensive. Africa has over 900 languages in existence and each has
particular informal and formal registers for discourse that are gender and age-
sensitive. America has succeeded in perpetuating an American way of life that is
heavily media-orientated. Foreign immigrants soon learn the American way, and
their young emulate it in every possible way, sometimes to the alarm of their
traditional cultural parents. But, like other Western countries, America has three
languages for conversation on sexual matters, one that is more technical and
scientific, one that is socially polite, and one that is more vulgar like or profane
(Crawhall, 1992).
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Thus, the situation in Africa rests in finding the appropriate register or
language to enter into discourse on sexual matters where the cultural terminology
and language rules used by the target audience must be adhered to. This is fairly
complicated and requires socio-linguistic and socio-cultural resources that are not an
integral and dominant part of the American model.
Second, language in the United States, is mostly monolingual. English is the
dominant unifying language, whereas in Africa, though the colonists’ languages
remain the official ones, languages are numerous, ranging from English to
Portuguese. Many rural people don’t speak the official languages or understand
them, hence complicating the matter of a multiplicity of languages that needs to be
used in AIDS campaigns for the message to prevail.
The American model is also very open and explicit. Generally, parents and
children are able to discuss sex within that context or have a variety of resources to
help them. In Africa, especially with the breakdown of several traditional
communities due to advents of colonization and urbanization, rites of passage
mechanisms that taught sexual matters no longer exist (Ntukula, 1994). Parents do
not discuss sex with their children, and it continues to be improper to do so. Parents
see the need to do so but find themselves silent (Tumbo-Masabo & Liljestrom,
1994). In fact, one study done in Kenya (Ahlberg, 1991) found that parents felt
uncomfortable about discussing sex with their children, and with the threat of AIDS
that may take the lives of their children, some considered breaking the code of
silence to breach the subject with their children.
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The accessibility to media is much less in Africa than in the United States.
Most of Africa, predominantly rural, does not have electricity, or access to radio and
TV or computers. In the United States most people own radios, TVs, and computers
with accessibility increasing constantly. The American model would be effective in
urban areas in Africa but only in the homes of middle and high-class communities.
Climate and Culture of Education in Africa and in Kenya
Specifically
The educational system in Kenya has undergone much upheaval and criticism
from the time of the colonists to modem times. In his book, Facing Mount Kenya,
Kenyatta (1938), the first president of Kenya describes the Gikuyu tribal system of
education that existed before the missionaries or the colonists came to Kenya. It was
one where stories of tribal laws and ways to behave as a member of the group were
passed on from generation to generation.
All this was stopped by the coming of the Western school system. Western
civilization values were taught to the young causing them to separate from their
traditional ways of perceiving the world and themselves. These were often in
conflict with the educational traditional values taught by the tribal communities.
Many parts of Africa experienced the changes that Kenyatta writes of where the
young were alienated from their culture by the systemic acculturation of western
values by the colonial educational institutions.
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The Kenyan Minister of Education, the Honorable Kalinzo Musyoka, noted
the need for AIDS awareness to be taught in both primary and secondary schools
throughout Kenya. However, both Catholic and Muslim leaders opposed the
minister’s recommendation on the basis that AIDS awareness would contribute to a
rise in youth immorality and promote AIDS (Kenya Embassy, 2000).
Social education is currently taught in the form of social ethics. However it’s
not a compulsory course in the current 8-4-4 system of education. Other forms of
social education exist in the form of science symposiums and musical festivals to
expose students to various cultures that make up Kenyan society. Students are
taught how to make things needed for basic living like soap (Kenya Embassy, 2000).
Teacher education emphasizes theory-based instruction. Thus, teachers tend
to be very lecture-orientated. The teaching model is, therefore, more teacher-
centered than learner-centered which is in harmony with the old traditional methods
of teaching where the adult was the main dispenser of knowledge and the one who
knew it all. Recent western models of teaching are heavily learner-centered where
students are encouraged to participate in their learning process. In Kenya, this is not
advocated, as the adults are the revered elders of old time, and today the teachers fill
that same role. The teacher- student relationship is hierarchical, the teacher is the
boss, the authority figure, and the student is the humble subject (Maina, 1998).
Many women experience gender bias in the labor force of Tanzania. They
are at the bottom of the occupational ladder and receive lower Wages, on the job
training, and advancement as compared to their male counterparts even though they
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have the same or at times higher qualifications (Tanzania Gender Networking
Programme, 1993). The same gender bias has led even educated women to take up
work as prostitutes to support their children. This probably explains why education
doesn’t lower HIV infection rates among women because studies have found higher
rates of HIV in women with secondary education than with women of less education
(Moshi, 1999).
Gender differences are part of the Kenyan system of education where there
are still are more boys attending school than girls. No campaigns are done to heavily
recruit girls to school as done by American colleges when recruiting minorities. It is
still a practice and preference of parents to send the boys to school over the girls who
they utilize as domestic help at home. More female teachers dominate the ranks than
male teachers, who prefer administrative roles or jobs that pay more in the business
sector. Kenya here is similar to the United States in this regard. Women continue to
be passed over in favor of men for administrative positions at schools even though
they have served longer and perhaps are better qualified.
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AIDS Education Programs
Programs in Schools—Successes and Obstacles
AIDS Education Programs That Are Working
Prevention efforts also seem to have a greater chance of success among
younger people than among people whose sexual habits are well ingrained. Active
condom promotion and education campaigns at schools and among youth groups
have dramatically lowered infection rates among teenagers in Tanzania and Uganda
(Hunter-Gault, 1999). Using music, videos, radio, and newspapers to spread the
message of safe sex has been instrumental in teaching younger audiences in Uganda.
Straight Talk Foundation, a nonprofit group established in 1994 produce a hip,
weekly radio program that reaches more than 1.5 million young people, often going
where young people are and letting them speak their minds. At the Straight Talk
office, Director Ann Akia Fiedler says, “one of the biggest challenges is debunking
some of Africa's sexual myths.” One common myth is that staying a virgin for so
long causes the hymen to become hard as a rock. One for guys says, if one doesn’t
have sex right away, the penis will shrink (Hunter-Gault, 1999).
Fiedler says that the foundation can tell by the feedback it gets that the
campaign is working. Fiedler said,
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Many of the letters had that tone like, 'Oh well, this
girlfriend, I want to have sex with her. She doesn't want so
I'm going to get another girl who can have sex with me.’
Other letters tell of couples talking about condom use.
(Hunter-Gault, 1999, p. 1)
Straight Talk helps young people learn how to communicate and negotiate
their way out of difficult sexual situations. The organization works closely with a
number of other organizations and institutions, such as "youth-friendly," one-stop
clinics where teens and young adults can get advice about sex and sexually
transmitted diseases (Hunter-Gault, 1999).
Obstacles That Hinder AIDS Education Programs
Socio-linguistic restrictions on language use
The language and speech registers used by AIDS education programs can
present obstacles because of socio-linguistic restrictions. In Western cultures,
talking about sexual matters is relatively commonplace due to the social changes that
took place in the 1960’s. In Africa, this is not the case. There is a time, place, and
way to discuss such matters. Sex is a private affair, and there is a way to talk of it in
every culture. Sex education is usually done by the parents or an assigned respected
member of that cultural community. The challenge for AIDS education and
prevention is how to make talk about sex public.
Crawhall (1992) mentions that among the Xhosa people of South Africa,
strict rules regarding language and gender are followed. For example, when
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speaking to people who are older or of the opposite sex, the speaker substitutes
nouns to avoid using the husband’s name or his in-laws’. This presents challenges to
HIV prevention and education programs because explicit anatomical language
cannot be used as it may be offensive to the target audience. When explaining what
happens when people have sex in English, one can say, “A man puts his penis in the
vagina of a woman,” but in Xhosa, one says, “A man puts his brother in the sister.”
According to Crawhall, in North America the terminology of brother and sister
would be questioned and explicit terms demanded. However, amongst the Xhosa
and other African cultures this terminology is considered respectful and appropriate.
Issue o f who should teach AIDS education
In a study, done from 1992 to 1996 at Murang’a District in Kenya, 11-17
year olds in primary and secondary schools were asked to write down questions they
were too ashamed to ask their parents, teachers, and older adults (Ahlberg et al.,
1997). Their questions mostly centered on sexuality, especially male and female
circumcision. Misconceptions of circumcision—or the lack of it causing
pregnancy—were prevalent, and so was the enjoyment or the lack of it regarding the
same. It was clear that the old system of the village leader chosen by parents to
instruct their children about sexual matters when they were undergoing the
circumcision rites of passage was non-functioning. In its place were
misunderstanding, confusion, and questioning attitudes from the youth as to why
circumcision was necessary in their lives.
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When the parents of the youth were approached and queried about their
children’s lack of sexual understanding, the researchers were met by parents who
expressed discomfort in discussing such matters with their children, and some felt
the schools should be handling the subject. The teachers and administrators of the
schools felt that youth should discuss sex at home with the parents.
Some female teachers indicated that circumcised youth felt they could have
sex with their teachers now that they were men! Consequently, discussing sex would
only make matters worse according to these teachers. This exemplifies the silent
code between parents and their children, and does not facilitate curtailing the AIDS
epidemic which continues to thrive on misunderstandings and ignorance. There is
also a lack of trained teachers qualified to disseminate information on AIDS. They
may be uncomfortable talking about sexual issues, and also need to be trained to
handle the different age groups.
Teaching model
The old didactic colonial educational system continues to thrive in most
African countries. It is primarily teacher-centered rather than student-participatory-
driven. Many Western AIDS prevention and education models are participant-
orientated that illicit inquiries and questions from participants. Colonialism left its
stigma of fostering an “accepting without questioning mentality” on people. For the
AIDS education programs to succeed they may need to start where the people are as
Mkhize (1995) recommends. It means getting to know the issues that youth are
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confronting and addressing their concerns like the study done in Kenya by Ahlberg
et al. (1997) did.
Lack o f and possible misappropriation offunds
Local leaders entrusted with government or international funds may use them
for their own purposes. Corruption is rampant in Africa, particularly in Nigeria and
Kenya. African governments generally lack funds to implement AIDS programs,
and borrowing constantly to pay Foreign Aid debts further decreases the possibilities
of having funds to run effective outreach AIDS education programs. Besides, many
governments need the money to fund other expenses such as transportation, defense,
and other governmental sectors.
Religious resistance
Islamic and Christian beliefs and perceptions are against AIDS education
programs because they do not want immorality to be practiced amongst their youth.
Role of Artists and Musicians
Famous celebrities, like musicians, athletes, and others have often taken the
role of speaking up on critical issues, particularly on the health-related ones. Magic
Johnson went public supporting AIDS when he found out he was HIV positive. In
Africa, though there are fewer celebrities and perhaps not as outspoken as their
Western counterparts, they have played a part in spreading the AIDS message.
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Zaire’s famous and popular musician, Franco Luambo, contracted and died of AIDS.
In his song about AIDS, he sings,
Those who used to eat and drink with me have started to
ignore me.
They say I have got the AIDS sickness.
All my friends are cutting me off...
AIDS has made us forget all other illnesses.
If a person is sick, they say it is AIDS.
If a person has fever, they say it is AIDS...
All my family has run away from me.
(Ewens, 1994)
Franco also warned people to protect themselves by protecting their bodies by using
condoms. In his lyrics, he also urged women who had AIDS not to get pregnant, as
their children could die young. In fact, people are afraid of singing or saying the
AIDS word “sida” since Franco died for fear that they too may get it and die.
Cheri Samba, a Zairian world-acclaimed artist, painted a man committing
suicide because people said he had AIDS. Samba was known to always exhibit his
work first in Kinshasa before exhibiting it anywhere else, but with one key painting
he broke that tradition. It was a painting of condoms being thrown out of a popular
hotel in Kinshasa and the children playing below picking them up to use as balloons
(Jewsiewicki, 1995). It was a bitter, satirical, mocking depiction of his views of
what was happening in Kinshasa with the AIDS crisis. It is probably why he didn’t
exhibit this painting there.
Since African celebrities are known by the general populous, they should be
more utilized in AIDS education programs aimed at young audiences. It’s well
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established be that famous Western celebrities do influence the opinions of their
younger audiences. Britany Spears has influenced the dress style of young girls
between the ages 5 to 9 years in the United States. Using their paintings or songs
and their lives in AIDS, artists and celebrities can make school programs influential
in showing the seriousness of the epidemic.
Theatres for development groups have largely contributed to spreading AIDS
awareness and encouraging audiences to participate in identifying the problem and
forming solutions. Impact on HIV (Kimani & Obanyi, 2000) reports that in Kenya
HIV theatre groups have grown from 35 to 270 in the last five years. They promote
an understanding of the epidemic and encourage behavior change by using the
African storytelling style of metaphor, strong symbolism, and imagery. One image
in use is a pen that is used for writing one book. However, if one chooses to make
copies, he needs carbon paper. Hence, to have more sex with one partner one needs
carbon, in this case, condoms.
Another powerful image in use is cars, where a man driving a BMW (be my
wife) decides the next day he’ll drive a Japanese model and other types of cars
making him the envy of his friends. But he neglects to buckle up, so is involved in a
serious accident leaving him with many wounds. “Buckle up” is the message. Use
safety belts, in this case, condoms. The audiences are taught the ABC’s of safe sex,
abstinence, being faithful to one partner, and using a condom. Audiences have
freedom to discuss through acting and participating in the performances what they
are afraid to in real life. These Kenyan theatre groups have reached 400,000 people
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in both rural and urban communities and have helped with the distribution of
condoms.
Aids Education Is Desperately Needed
An AIDS education program needs to be in schools because it will be a huge
benefit to the 15-24 age group which has half of all new HIV infections worldwide
(UNAIDS, 1998c). However, HIV prevention efforts are being thwarted in some
countries by failure to implement some of the key measures that would make a
difference. In many countries, HIV prevention campaigns are not targeted at young
people, one of the highest-risk age groups. In some countries sex education cannot
be taught in schools. In others, girls often miss out on school health programs
because they are unable to complete secondary education due to unwanted
pregnancies or early marriages.
To make matters worse, there is little provision in many countries for
adolescent health services that are both accessible and confidential. In Zambia, one
of the worst affected countries, young people cannot have an HIV test without
parental consent until they are 18. Yet almost one in two teenage girls has had sex
by the age of 16, and many teenagers are infected with HIV (UNAIDS, 1998c).
According to Maina (2001), the successes to be enjoyed from AIDS education
programs are manifold:
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• Longevity and life expectancy levels
• Manpower that is educated and able to really contribute to economic
development
• Curtailing the AIDS epidemic, so there are fewer orphans and
traumatized individuals and less AIDS victims for extended families to
care for
• Doing away with harmful, erroneous misinformation about AIDS,
including traditional beliefs
• Understanding and compassion towards PWLA
• Practice of safe sexual relations and other health practices that reduce
illnesses
• More woman able to attend school and be treated with respect and care
• Help breaking the code of silence and stigma surrounding the AIDS
epidemic
Conclusion
There is no cure for AIDS. However, a comprehensive package of
prevention and care strategies that are based on firm political commitment can have a
major impact on the burden and spread of HIV/AIDS (WHO, 1999).
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Effective measures include
• Accessible, inexpensive condoms
• Immediate treatment of other sexually transmitted infections (STIs)
• Voluntary counseling and testing (VCT)
• Prevention of mother-to-child transmission
• Promotion of harm reduction to reduce HIV infection in drug users
• Sexual health education in school and beyond
• Accelerating access to care, support, and treatment, including
psychosocial support, home and community-based care, and innovative
new partnerships to provide sustainable and affordable supplies of
medicines and diagnostics.
The fight to curtail the spread of AIDS in Africa must continue, and efforts to
understand and work within the socio-cultural framework must be undertaken by
international and governmental organizations to be make an transforming effective
and lasting impact.
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Chapter 3
M e t h o d s a n d P r o c e d u r e s
Introduction
To date, no cure for AIDS has been found and, though much research for an
effective vaccine to prevent HIV infection is underway, the primary strategy for
preventing HIV infection is education (Batchelor, 1984). The research of this study
surveyed Christian African University students who attended schools in Kenya to
gain an understanding of their AIDS-related knowledge, attitudes, and beliefs.
Insights gained from this study will be useful in assessing and developing effective
and appropriate AIDS prevention programs.
The chapter has three main sections. The first describes and identifies the
characteristics of the sample population. The next section contains the description of
the data collection instrument and the procedure used for data collection. The final
section summons the techniques used for data analysis and the methodology
assumptions pertinent to answering these research questions:
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1. Are there any knowledge, attitude, and belief differences towards
HIV/AIDS between Christian African male and female university
students?
2. Do students of teaching majors differ from students of non-teaching
majors in their knowledge, attitude, and beliefs towards HIV/AIDS?
3. What policies do Kenyan universities need to develop and implement to
curtail the spread of HIV?
Sample
The population from which the sample was obtained for this study included
Christian university students enrolled at five campuses located in Kenya. The four
government-run universities (Kenyatta, Moi, Nairobi and Jomo Kenyatta) have a
Kenyan student body. Day Star University, which has students from Kenya and
other African nations, is an American Christian college.
As Graph 1 indicates, the majority of the students (85%) were between the
ages of 18 and 26 with more than one-half of them within the age group of 21 to 23
years. Relatively equal groups of males and females responded to the survey, 57%
and 43%, respectively. About 55% of the respondents said their parents lived in
rural parts of Kenya and other African countries, and 43% said their parents were
urban dwellers.
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300
250
= 200
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Age
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Graph 1. Age of Students.
Half of the parents had a diploma and had attended a university as shown in Graph 2.
Over 70% of the parents had an annual income of less than 180,000 Kshs as Graph 3
illustrates.
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140
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informa1 Education Degree
Graph 2. Parents ’ Educational Level.
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Q .
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200
180
160
140
120
100
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0- 24,000 25,000- 180,000
lncome in Kshs
Over 180,000
Graph 3. Parents’ Total Annual Income.
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Students enrolled at these five universities came from 46 different ethnic
groups or tribes, with more than one-third, or 39% of them, from the Kenyan Gikuyu
ethnic group, followed by 12% from the Luhya ethnic group. It thus follows that
about one-fourth of the respondents spoke Kikuyu as their mother tongue and more
than one-half of the respondents spoke Kiswahili. It should be noted that the
language of instruction at these five universities was English and that more than two-
thirds of the student body spoke more that two languages. The other important
characteristic of the population surveyed is that 95% of them were Protestant with
the remaining 5% Catholic and Seventh Day Adventist.
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Graph 4. Students’ Year at the University.
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Graph 4 shows that more than one-half of the students were in their 2n d and
3rd years at the university. There were 62 different majors that ranged from
accounting to zoology. About a one-third of them indicated that they were going to
be teaching and the remaining two-thirds are non-teaching. The questionnaires were
distributed to university students who were attending the Fellowship of Christian
Unions (FOCUS) 2000 Millennium Conference. Students were given a week to
answer the questions and return them to the research assistants. A completed and
returned questionnaire served as consent to participate in the research study.
Instrumentation
The instrument used to collect data was designed similar to the one used by
the World Health Organization (WHO). WHO has carried out several knowledge,
attitude, belief and practice (KABP) health studies in many developing countries. In
the 1970s, Knowledge, Attitudes, and Practices (KAP) studies were used in family
planning efforts. The studies’ success was undermined by the lack of acceptance and
understanding of concepts regarding contraception. The AIDS prevention effort
required researchers to investigate people’s attitudes and behaviors, so WHO
modified the traditional KAP instrument to include the category of beliefs since
people respond to information based on their value and belief system (Twumasi,
1975).
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A KABP study conducted by Mathews et al. (1990), who surveyed South
African township high school students, found that the students had a lot of
misconceptions, particularly concerning the modes of HIV transmission. Many were
unaware that there is no cure for AIDS and they expressed intolerance and rejection
of people with AIDS. Though most were sexually active, they did not practice safe
sex. Two other KABP studies done in South Africa (Eagle and Bedford, 1992;
Schlebusch et al., 1991) surveyed health care professionals. Findings indicated that
the professionals had high AIDS knowledge. Elkonin et al.’s (1993) KABP study of
students enrolled at the Universities of Port Elizabeth and Vista (Port Elizabeth
campus) found that they possessed high levels of knowledge about AIDS, had
diverse attitudes toward AIDS and AIDS victims, and engaged in frequent sexual
activity. Again, there was little evidence of safe sexual practices.
This research study utilizes the same KABP framework. However, the
researcher added items of direct interest to this specific sample. The researcher also
carried out a pilot test. Items that were found to be objectionable or unclear were
omitted. The Education and Finance officials at the Kenyan Embassy in Washington
D.C. helped make the questionnaire more culturally sensitive to the ethnic groupings
represented in Kenya. They provided appropriate monetary income values and they
gave readability and clarity pointers for the population being surveyed (See
Appendix A).
Ferry et al. (1995) said that the primary goal of WHO’s KABP research
studies was to collect the data required to provide descriptive information about the
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knowledge, attitudes, and beliefs of the population under investigation with regard to
HIV/AIDS and to generate the data required for a clearer understanding of the
information and education needs of that population. This study attempts to fulfill the
same goals for this population of university students.
The questionnaire included 50 items, covering a wide range of areas
concerning general demographic information: factual HIY/AID-related knowledge,
attitudes, beliefs, and sources of information including opinion questions based on
needs and treatment of people with AIDS (PWAs). Section A asked questions about
general demographic information based on 11 items of age, gender, parents’
residence, parents’ educational level, total annual income, respondent’s ethnicity,
languages spoken, religion, year at university, major, and teaching or non-teaching
status.
Section B dealt with their knowledge of HIV/AIDS and how they had
obtained that information. Nine items asked questions on sources of information,
how A TPS was transmitted, if they knew someone with AIDS, and their relationship
to them. The respondents were asked how they would identify a person with AIDS,
whether they knew anyone with AIDS who had died and their relationship to that
person, and whether they had been tested for HIV. The last question was based on
what they would do if they had AIDS and choices were given such as seek western
medicine, await God’s judgement, or indicate an option “other” giving them a
chance to explain an alternative to the choices given.
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Section C included statement items that focussed on students’ attitudes and
beliefs. Students were given 17 statements to indicate how much they agreed or
disagreed with each statement on a 5-point scale, using the traditional Likert scale of
5 choices of agreement to disagreement (strongly agree, agree, undecided, disagree,
and strongly disagree). In this study, 1 indicated strongly disagree, and 5 indicated
strongly agree. Some examples of statements that were used were
• HIV/AIDS is a major problem in Kenya.
• AIDS is a disease created by scientists.
• AIDS is caused by immoral behavior.
• Condoms are the best way to stop the spread of AIDS.
The last three questions of Section C were opinion type questions asking
students about major AIDS problems and what should be done for people with
AIDS.
Section D dealt with AIDS prevention and awareness. It had 6 statements
asking students to use the Likert scale of agreement to disagreement to indicate their
attitudes and beliefs regarding prevention and education or awareness. Questions
included whether the government should test all students for HIV, whether sex
education should be taught in schools, and so on. One question dealt with how AIDS
can be prevented, and the remainder of questions dealt with the respondents’
opinions of what services should be provided to people with AIDS, whether AIDS is
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a punishment, and whether the old traditional education storytelling method was an
effective tool to teach AIDS awareness.
Procedures and Data Collection
Approval to conduct the study was obtained from the University of Southern
California’s Institutional Review Board and Human Subjects Research and
Information Committee. A meeting between the Kenyan Embassy education official
and researcher took place, and permission was granted. An information sheet that
explained the purpose of the research study and the students’ right not to participate
was attached to the questionnaire surveys. The researcher hired 3 research assistants
to help distribute the questionnaire surveys and to collect them. The senior research
assistant obtained permission from the FOCUS Conference leadership to distribute
the surveys. The research was introduced and explained at the opening general
session of the conference. Seven hundred surveys were distributed to interested
students. They were given a week to fill it out and return it to the research assistants.
There was a 74% return rate of the surveys that were mailed back to the researcher.
Data Analysis
As the researcher received the mailed questionnaires, she
and entered the responses into the computer using the statistical
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checked, coded,
Package for the
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Social Sciences (SPSS) 10.0 software. Frequencies on demographic data as well as
on AIDS related knowledge, attitudes, and beliefs were produced. For some items
means were tabulated. Alphas or reliability analysis was run to measure the internal
consistency of the scales of the questionnaire survey.
As seen in Table 2, the six factors were safe sex, government test,
segregation, transmission or spread, immorality, and education. Most factors had an
alpha coefficient of at least 0.6; however, due to the small sample size, alphas as low
as 0.4 were considered acceptable.
Demographic data and AIDS-related knowledge, attitudes, and beliefs were
compared by gender as well as teaching and non-teaching majors. To test for group
differences (by gender and teaching status), a multivariate analysis of variance
(MANOVA) was performed to measure the level of significance, using p < 0.05 to
be statistically significant.
In addition, tests of interaction (gender x teaching status) were also
performed. Opinion-based questions with open-ended responses were coded and
placed in categories to facilitate quantitative analysis.
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Table 2. Scales and Items Used in the Analyses
Value
(Measures of
consistency)
Question
1 Safe Sex
(.6620)
Q 42 Young people should be taught how to have safe sex.
Q 25 Condoms are the best way to stop the spread of AIDS.
2 Govt. Test
(.8604)
Q 32 The government should test everyone for AIDS.
Q 46 The government should test everyone for AIDS.
3 Segregation
(.6487)
Q 34 People with AIDS should be kept away from those who don’t have it.
Q 36 People who have AIDS should not be allowed to work because it provides risk to
the rest of the employees.
4 AIDS Spread
(.4902)
Q 28 Mothers can pass HIV/AIDS to their babies.
Q 29 HIV/AIDS can be spread by unsterilized needles.
5 Immorality
(.4929)
Q 27 People who abstain from sexual relations do not get AIDS.
Q 33 AIDS is caused by immoral behavior.
Q 37 People who have AIDS got it because they were irresponsible and not careful.
Q 24 One can avoid getting infected with AIDS.
6 Education
(.4677)
Q 43 Parents and teachers are the best persons to educate young people about AIDS.
Q 44 Sex education should be taught in schools.
Q 26 Education and awareness of AIDS will reduce the number of people dying of AIDS.
Q 45 The Kenyan government should provide resources for people living with AIDS.
7 Single Item Q 23 AIDS is a disease created by scientists.
8 Single Item Q 31 Tribal medical treatments can eradicate AIDS.
9 Single Item Q 30 AIDS is a judgement from God.
10 Single Item Q 22 There is no cure for AIDS.
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Methodological Assumptions
In conclusion, the chapter disclosed the methodological approach used in the
study with a description of the population samples the instrumentation used. It
further presented the procedures for data collection and analysis. The
methodological assumptions determined to be significant for this study were the
following:
• All participants gave time and honest responses on the questionnaire.
• All the input of the raw data was done accurately.
• The statistical analysis procedures were done correctly.
• All procedures for this study were appropriate for answers to the research
questions.
• The conclusions drawn from the statistical analysis of data were accurate.
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Chapter 4
F in d in g s a n d D isc u ssio n
Introduction
The catastrophic dimensions of the AIDS epidemic in sub-Saharan Africa, is
an economical, social, and cultural threat to the lives of millions of Africans.
Rethinking how to cope with the devastation posed by AIDS and curbing it’s further
spread are critical to the future of African nations. This study sought to assess and
examine the knowledge, attitudes, and beliefs towards AIDS of Africa’s future
leaders, their university students.
This chapter has three sections. The first section briefly describes the study’s
population sample. The next section addresses the three research questions,
accompanied by the compiled data that specifically pertains to them. The last
section provides discussion of key findings that resulted from this study as they
relate to the literature review.
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Description of the Sample
The population under study was comprised of university students who were
enrolled at four Kenyan government-run universities and one American college
located in Kenya, and who attended a FOCUS 2000 (Fellowship of Christian
Unions) Conference. Over three-quarters of them were between the ages of 18 and
26 years of age and there was an even distribution of male and female students who
responded to the questionnaire.
About one-third of them students were teaching majors, and the remainder
were non-teaching majors, with more than one-half of them in their second or third
year of university. They came from various ethnic groups, and this study sample
documented 46 different ethnic groups with the predominant one-third of them from
the Gikuyu tribe. Most students spoke Kiswahili and were multilingual speaking two
or three other languages, including English.
Concerning where their parents lived, there was an even distribution between
rural and urban locations. Over two-thirds of their parents had a total annual income
of less than 180,000 Kshs, which after taxation, is not enough to pay a mortgage for
a home in urban Kenya, including food, school fees, bus fare for children to go to
school and parents to go to work. More than half of students indicated that their
parents had a post-secondary education.
Most students (95%) surveyed in this study also had an extensive knowledge
of how AIDS was transmitted and how to identify a person with AIDS. A quarter of
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the student body knew someone with AIDS and more that two-thirds of the students
knew someone who had died of AIDS.
Findings
An analysis of variance was performed on some demographic variables to
determine how they relate to items of the questionnaire regarding students’
knowledge, attitudes, and beliefs towards AIDS. The demographic variables of
gender and teaching were then compared to determine their interaction and statistical
significance. Tables 3-11 show the results from the analysis.
Research Question 1
Are there any knowledge, attitudes, and belief differences towards HIV/AIDS
between Christian African male and female university students?
As mentioned in Chapter 3, for statistical analysis p < 0.05 was defined as
statistically significant for inferential statistical procedures. Table 3 shows the
dependent variables of safe sex, government test, segregation, aids spread,
immorality, and educate. Each variable was tested with the gender demographic to
determine how and whether there was any significance in this relationship.
When tested with gender, safe sex, government test, AIDS spread, and
educate variables, there showed no significance. There was no difference between
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males or females on their rating of these variables. However, the segregation and
immorality variables showed significance, namely p = .001 and p = .047,
respectively. There was a difference on rating segregation and immorality variables
between males and females (see Tables 8 and 10).
For the segregation variable, the mean score, on the agreement to
disagreement scale (5 being in agreement to 1 being disagreement) was 1.8 for males
and 1.5 for females, showing that females disagreed more with the suggestion of
segregating AIDS-infected people and not allowing them to work (see Table3). For
the immorality variable the mean score for males was 3.40, and the female mean
score was 3.26 on the agreement to disagreement scale (see Table 3). Once again,
this revealed that female university students disagreed more than the male students
on the statement that people contracted AIDS from immoral and irresponsible
behaviors.
Research Question 2
Do students who are going to teach differ from non-teaching students in their
knowledge, attitudes, and beliefs towards HIV/AIDS?
Each of the six factors of safe sex, government test, AIDS spread,
segregation, immorality, and education was tested against the teaching and non
teaching demographic variables to determine if there was any significance. There
was no significant difference between non-teaching and teaching majors on their
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rating of these dependent variables (see Tables 6-11). This is good news for
university policy makers because they do not have to design a different AIDS
prevention program for teachers but can develop one program for both non-teaching
and teaching majors, thus cutting or lowering costs. According to Tables 4 and 5,
there was not much difference in the means or standard deviations between the
teaching and non-teaching students.
Table 3. Gender Demographic Tested With the 6 Factors of Safe
Sex, Govt. Test, Segregation, AIDS Spread, Immorality, and
Education
q 2
Gender
SAFESEX
Safe Sex
Score
GOVTTEST
Government
Testing Score
SEGRKG
Segregation
Score
AIDSPRD
How AIDS Is
Spread Score
IMMORAL
Immorality
Score
EDUCATE
Education
Score
1
Male
Mean 2.2864 3.0510 1.8576 4.3593 3.3997 4.1658
N 295 294 295 295 295 294
Std.
Deviation
.9976 1.2146 .8893 .5098 .6940 .5228
2
Female
Mean 2.1854 3.1425 1.5814 4.4347 3.2613 4.2425
N 222 221 221 222 222 222
Std.
Deviation
.9826 1.0845 .6254 .5373 .6365 .4879
T
Mean 2.2431 3.0903 1.7393 4.3917 3.3403 4.1988
N 517 515 516 517 517 516
Std.
Deviation
.9915 1.1603 .7983 .5226 .6728 .5090
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Table 4. Teaching Status Demographic Tested With the 6 Factors
of Safe Sex, Govt. Test, Segregation, AIDS Spread, Immorality, and
Education
TEACH
SAFESEX
Sate Sex
Score
GOVTTEST
Government
Testing Score
SEGR1G
Segregation
Score
AIDSPRD
How AIDS Is
Spread Score
IMMORAL
Immorality
Score
EDUCATE
Education
Score
.00 Not
teach
Mean 2.2102 3.0698 1.7244 4.3935 3.3000 4.1963
N 352 351 352 352 352 352
Std.
Deviation
.9799 1.1941 .7877 .5223 .6392 .5231
1.00
Teach
Mean 2.3131 3.1341 1.7713 4.3879 3.4263 4.2043
N 165 164 164 165 165 164
Std.
Deviation
1.0153 1.0869 .8221 .5248 .7340 .4789
Total
Mean 2.2431 3.0903 1.7393 4.3917 3.3403 4.1988
N 517 515 516 517 517 516
Std.
Deviation
.9915 1.1603 .7983 .5226 .6728 .5090
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Table 5. Gender and Teaching Status Demographics Tested
Against the 6 Factors of Safe Sex, Govt. Test, Segregation, AIDS
Spread, Immorality, and Education
TEACH
<32
Gender
SAFESEX
Safe Sex
Score
GOVTTEST
Government
Testing
■Score
SMGREC
Segregation
Score
AIDSPRD
How AIDS
Is Spread
Score
IMMORAL
Immorality
Score
EDUCATE
Education
Score
M 2.2614 3.0051 1.8579 : 4.3655 3.3646 4.1679
1 N 197 196 197 197 197 197
SD .9941 1.2598 .8836 .4907 .6658 .5423
M 2.1452 3.1516 1.5548 4.4290 3.2177 4.2323
.00 Not
teach
2 N 155 155 155 155 155 155
SD .9609 1.1040 .6072 .5596 .5957 .4971
M 2.2102 3.0698 1.7244 4.3935 3.3000 4.1963
T N 352 351 352 352 352 352
SD .9799 1.1941 .7877 .5223 .6392 .5231
M 2.3367 3.1429 1.8571 4.3469 3.4702 4.1615
1 N 98 98 98 98 98 97
SD 1.0080 1.1192 .9053 .5487 .7461 .4836
M 2.2786 3.1212 1.6439 4.4478 3.3619 4.2662
1.00
Teach
2 N 67 66 66 67 67 67
SD 1.0325 1.0454 .6666 .4857 .7168 .4685
M 2.3131 3.1341 1.7713 4.3879 3.4263 4.2043
T N 165 164 164 165 165 164
SD 1.0153 1.0869 .8221 .5248 .7340 .4789
M 2.2864 3.0510 1.8576 4.3593 3.3997 4.1658
1 N 295 294 295 295 295 294
Total SD .9976 1.2146 .8893 .5098 .6940 .5228
2
M 2.1854 3.1425 1.5814 4.4347 3.2613 4.2425
N 222 221 221 222 222 222
Notes. 1 = male students; 2 = female students; T= Total; M = Mean; N = Number; .SD = Standard Deviation.
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Table 6. Tests of Between-Subj ects Effects—
Dependent Variable: SAFESEX Safe Sex Score
Source
T\pe JU Sum of
Squares
d f
Mean Square F Sig.
Corrected Model
2.497a
3 .832 .846 .469
Intercept 2,220.440 1 2,220.440 2,256.548 .000
Q2 .830 1 .830 .843 .359
TEACH 1.189 1 1.189 1.208 .272
Q 2 * TEACH .092 1 .092 .094 .760
Error 504.791 513 .984
Total 3,108.500 517
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
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Table 7. Tests of Between-Subj ects Effects—
Dependent Variable: GOVTTEST Government Testing Score
Source
Type 111 Sum
of Squares
Mean Square F Sig.
Corrected
Model
2.339a
3 .780 .578 .630
Intercept 4179.870 1 4179.870 3096.818 .000
Q2 .422 1 .422 .313 .576
TEACH .312 1 .312 .231 .631
Q2*TEACH .766 1 .766 .568 .452
Error 689.712 511 1.350
Total 5610.250 515
Corrected Total 692.051 514
a R Squared = .003 (Adjusted R Squared = -.002)
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
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Table 8. Tests of Between-Subj ects Effects—
Dependent Variable: SEGREG Segregation Score
Source
Type HI Sum. of
Squares
d f
Mean Square P Sig.
Corrected Model
10.0053
3 3.335 5.366 .001
Intercept 1295.991 1 1295.991 2085.402 .000
Q2 7.225 1 7.225 11.626 .001
TEACH .212 1 .212 .341 .560
Q 2 * TEACH .219 1 .219 .352 .553
Error 318.187 512 .621
Total 1889.250 516
Corrected Total 328.191 515
a R Squared = .030 (Adjusted R Squared = .025)
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
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Table 9. Tests of Between-Subj ects Effects—
Dependent Variable: AIDSPRD How A ID S Is Spread Score
Source
Type 1 1 1 Sum of
Squares
4 f
Mean Square F Sig,
Corrected
Model
,758a
3 .253 .925 .428
Intercept 8,439.826 1 8,439.826 30,887.130 .000
Q2 .737 1 .737 2.697 .101
TEACH .000 1 .000 .000 .999
Q2 * TEACH .038 1 .038 .139 .710
Error 140.176 513 .273
Total 10,112.250 517
Corrected Total 140.934 516
3 R Squared = .005 (Adjusted R Squared = .000)
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
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Table 10. Tests of Between-Subj eets Effects—
Dependent Variable: IMMORAL Immorality Score
Source
Type IIS Sum of
Squares
‘ V
Mean Square F Sig,
Corrected Model 4.1313
3 1.377 3.079 .027
Intercept 4,909.002 1 4,909.002 10,976.857 .000
Q2 1.777 1 1.777 3.972 .047
TEACH 1.702 1 1.702 3.806 .052
Q 2 * TEACH .041 1 .041 .091 .763
Error 229.421 513 .447
Total 6,001.910 517
Corrected Total 233.552 516
3 R Squared = .018 (Adjusted R Squared = .012)
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
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Table 11. Tests of Between-Subj ects Effects—
Dependent Variable: EDUCATE Education Score
Source
Type 1 1 1 Sum of
Squares
#
Mean Square F Sig,
Corrected Model .800a
3 .267 1.030 .379
Intercept 7,702.906 1 7,702.906 29,735.528 .000
Q2
.777 1 .777 2.998 .084
TEACH .021 1 .021 .079 .778
Q 2 * TEACH .044 1 .044 .171 .680
Error 132.632 512 .259
Total 9,230.493 516
Corrected Total 133.432 515
3 R Squared = .006 (Adjusted R Squared = .000)
Note. For Tables 6 to 11, each factor was tested against both the gender and teaching status demographic to
determine their interaction and statistical significance.
Research Question 3
What policies and practices do Kenyan universities need to develop and
implement to curtail the spread o f HIV?
Table 12 describes how students got their information on AIDS. The three
dominant ways were newspaper, television, and radio. The least likely sources of
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getting AIDS information were local leaders and school teachers. It is clear that
schoolteachers and leaders need to become actively involved in promoting AIDS
awareness and education.
Table 12. Get Information on AIDS
(Value tabulated =1)
Dichotomy Label Count
% of
Responses
" ........
% of Cases
Radio 375 14.4 73.0
Television 407 15.6 79.2
Newspaper 407 15.6 79.2
Family 185 7.1 36.0
Friends 300 11.5 58.4
Church 228 8.8 44.4
Public mtg 166 6.4 32.3
Billboards/posters 272 10.5 52.9
School teachers 154 5.9 30.0
Local leaders 107 4.1 20.8
Total responses 2601 100.0 506.0
Note. 5 missing cases; 514 valid cases.
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Many students were clear on the ways HIV is contracted with most choosing
sexual intercourse, blood transfusions, and unclean needles as indicated in Table 13.
This is a good sign for policy makers as it shows that students’ knowledge of how
AIDS and HIV spread is accurate. Thus, prevention strategies can get to deeper
levels rather than focusing on knowledge to deal with behavioral changes.
Table 13. How AIDS Spreads
(Value tabulated = 1)
Dichotomy Label Count % of
Responses
% of Cases
Kissing 72 3.6 14.0
Mosquitoes 1 .1 .2
Sexual intercourse 509 25.7 98.8
God's punishment 10 .5 1.9
Unclean needles 375 19.0 72.8
Injecting drugs 236 11.9 45.8
Curses 5 .3 1.0
Blood infusions 457 23.1 88.7
Body fluids 313 15.8 60.8
Total responses 1978 100.0 384.1
Note. 4 missing cases; 515 valid cases.
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200
180
160
140
M
e
120
m
'S
100
in
80
I
60
40
20
0
none lto 2 3 to 5 6 to 10
Number of PWAs Known by Students
more than 10
Graph 5. Students Who Know People With AIDS.
Graph 5 shows that more than one-quarter of the students know someone
with AIDS. This is important because most students (80%) indicated their
relationship with the person with AIDS (PWA) was as a relative, close friend, or
fellow students, fellow worker or village mate. This indicates that AIDS is a very
real problem in Kenya and Africa and cannot be ignored. An overwhelmingly 98%
of the respondents knew that a blood test was the way to find out if someone had
AIDS, and some mentioned AIDS-related symptoms such as the weakening of the
immune system and the susceptibility to opportunistic diseases. When asked
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whether they knew someone who had died of AIDS, 85% of the respondents
indicated “yes,” and the majority indicated that it was a relative or acquaintance so
the relationship was not distant. This finding contrasts with Graph 5 which shows
that 25% of students indicated that they knew someone with AIDS. This could mean
that either people with AIDS were hiding it or calling it another disease.
Table 14 shows that 41% of the respondents had been tested for HIV/AIDS.
That is close to half of the student body surveyed, which implies that there may have
been mandatory or free testing offered by the universities or by government unction
to get tested. Many employers are requiring prospective employees to get tested.
This has led to legal examination regarding confidentiality of HIV status by AIDS
activists.
Table 14. Students Who Tested for HIV—
Q19 Tested HIV/AIDS
Frequency Percent Valid Percent Cumulative Percent
Valid
1 Yes 213 41.0 41.5 41.5
2 No 300 57.8 58.5 100.0
Total 513 98.8 100.0
Missing 0 6 1.2
Total 519 100.0
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The means tested for HIV/AIDS are in Table 15. Most students agreed that
AIDS is a problem in Kenya and that there is no cure. There was also agreement that
sex education was needed, and parents and teachers needed to be part of
disseminating information. This finding is congruent with Table 12 findings, which
indicated that schoolteachers and families were the least likely people from whom
students obtained AIDS information. Most students agreed that AIDS spreads
prenatally and by unclean needles, indicating a high level of knowledge. The final
point of agreement was that the government needed to supply resources to people
with AIDS, making it clear that this is an action item that government officials need
to address.
Indicated by a mean score of 2 or less, strong disagreement centered around
not segregating people with AIDS, witchcraft, causing AIDS, condom use, and tribal
medicine’s ability to eradicate AIDS. Even though offered free for many Christian
students, condoms are seen as advocating immorality, and 20% of the students also
indicated that condoms break. Policy makers need to make great effort to address
deeper issues, such as beliefs individuals hold against condom use and begin shifting
the negative connotation of immorality linkage to condoms. In addition, they must
address the need of getting a better grade of condoms to reduce the likelihood of
breaking during intercourse.
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Table 15. Means of Responses From Students to AIDS Statements
Using the Likert scale
N Minimum Maximum Mean Std. Deviation
Q21 Aids problem Kenya 506 1 5 4.82 .47
Q22 No Cure 516 1 5 4.18 1.02
Q23 Created by scientists 514 1 5 2.40 1.12
Q24 Avoid AIDS 515 1 5 4.53 .71
Q25 Condoms prevent AIDS 515 1 5 1.77 1.00
Q26 Education 512 1 5 4.24 .75
Q27 abstain sex 511 1 5 2.82 1.25
Q28 HIV mother to baby 515 1 5 4.36 .61
Q29 unsterilized needles 512 1 5 4.42 .67
Q30 God's judgement 510 1 5 2.71 1.19
Q31 Tribal medicine 514 1 5 1.98 .96
Q32 Govt testing 504 1 5 3.14 1.22
Q33 Immoral 511 1 5 3.63 1.16
Q34 segregate PWA 515 1 5 1.68 .92
Q35 Witchcraft 512 1 5 1.84 .95
Q36 PWA not to work 514 1 5 1.80 .94
Q37 Irresponsible 515 1 5 2.39 1.11
Q41 provide condoms 501 1 5 2.41 1.29
Q42 teach safe sex 502 1 5 2.56 1.45
Q43 Parents & Teachers 501 1 5 4.32 .73
Q44 Sex education 503 1 5 4.07 .86
Q45 Govt. Resources 495 1 5 4.19 .87
Q46 test all for AIDS 500 1 5 3.03 1.26
Valid N (listwise) 435
Note. Table 15 utilizes the L ikert scale o f disagreem ent to agreem ent w here 1 is strongly disagree, 2 is disagree,
3 is undecided, 4 is agree and 5 is strongly agree, to show the m eans o f student responses to AID S related
statem ents.
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Policy makers should also look into developing ways of including people
with AIDS in the mainstream of normal life. A majority of the students were against
segregation which means people with AIDS are more or less likely to be segregated
at work and public places. Table 16 indicates that a majority (over half of the
students) who answered the question of what they would do if they had AIDS said
they would consider other alternatives. A majority of responses were of a spiritual
nature, such as repenting and living for God. Other reasons included, being involved
with telling others to avoid AIDS and living positively.
Table 16. What If You Had AIDS/HIV
(Value tabulated =1)
Dichotomy Labei Count
% o f
Responses
% of Cases
Western medicine 115 21.2 24.0
Tribal medicine 12 2.2 2.5
Transmit to other 3 .6 .6
God's judgement 91 16.8 19.0
Other reasons 322 59.3 67.2
Total responses 543 100.0 113.4
Note. 40 missing cases; 479 valid cases.
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Table 17 once again indicates that the students’ level of knowledge of how to
prevent AIDS is high. Over half cited abstaining from sex and the use of sterilized
needles as being the best ways. When asked whether they felt AIDS was a
punishment, 58% felt it was not and the remaining 42% felt it was.
Table 17. How AIDS Can Be Prevented
(Value tabulated =1)
Dichotomy Label Count % o f
Responses
% of Cases
Prevent abstain sex 463 27.0 94.3
Prevent with condoms 195 11.4 39.7
Prevent with diet 53 3.1 10.8
Prevent not touch PWAs 7 .4 1.4
Use mosquito net 8 .5 1.6
Use sterilized needles 425 24.8 86.6
No kissing PWAs 175 10.2 35.6
Educate safe sex 269 15.7 54.8
Govt, enforced safe sex 118 6.9 24.0
Total responses 1713 100.0 348.9
Note. 28 missing cases; 491 valid cases.
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An overwhelming number of students, 79%, felt that the old traditional
method of story telling to pass on information and educate the young was an
effective way to educate and spread AIDS awareness. This is important for
policymakers when developing culturally sensitive and effective prevention
programs that are not only enlightening but also entertaining for audiences just as the
stories told by the story tellers of old.
The questions that were opinion-based were coded and categorized to
facilitate a quantitative analysis of the responses given by the students. One open-
ended question asked “people with AIDS should...?” Table 18 shows that 14% of
the students indicated that people with AIDS should abstain from sex and
immorality, and 12% of them said that people with AIDS should live their lives fully
and positively (See Table 18). Once again, this finding is congruent with the
religious beliefs of this population who often link contraction of AIDS to immorality.
Policymakers need to be aware of this, so that this idea is thoroughly debunked.
When asked what problems people with AIDS had, the majority of the
students (44%) indicated as Table 19 reveals that being shunned, ostracized, and
rejected was a key problem, followed by 19% of them stating that people with AIDS
have psychological problems.
This is again congruent with the fact that people with AIDS will obviously
have psychological problems, if rejected, abandoned, or shunned. Policy makers
need to look into helping people with AIDS be accepted and treated as members of
the society. Tables 20 and 21 indicate what should be done for people with AIDS
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and what services should be provided for them. Societal acceptance of people with
AIDS was very important to one-quarter of the survey respondents who indicated
that many people with AIDS are rejected and abandoned by family, friends, and
society members. Home-care, and basic needs, and counseling were identified by
18% and 16% of the respondents as what people with AIDS need.
Medical services was identified by 36% of the respondents to the survey as a
key support to be provided for people with AIDS, followed by 27% of the students
stating that counseling was also a key service that should be provided. Policy
makers need to be sure that both medical and counseling services are provided to
people with AIDS.
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Table 18. P eo p le with AIDS Should...
.........................................................................~ ......................................
Dichotomy Label Code % of Count % of
Responses
% of Cases
Medical l 65 8.4 13.8
Counseling 2 87 11.2 18.5
Homecare, love, & basic needs 3 90 11.6 19.1
Nutrition/food 4 39 5.0 8.3
Govt and laws 5 7 .9 1.5
Jobs 6 3 .4 .6
Finances 7 5 .6 1.1
Training 8 7 .9 1.5
Societal acceptance 10 85 11.0 18.1
Tell others 11 82 10.6 17.4
No help/euthanasia/segregation 12 7 .9 1.5
Abstain from sex & immorality 13 110 14.2 23.4
Seek God for forgiveness 14 89 11.5 18.9
Live positively & fully 15 98 12.7 20.9
Total responses 774 100.0 164.7
Note. 49 missing cases; 470 valid cases.
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Table 19. Major Problems of People With AIDS
Dichotomy Label Code % of Count % of
Responses
% of Cases
Lack of funds 1 64 8.0 13.4
Lack medical attention/neglected 2 50 6.2 10.4
Poor care/diet 3 29 3.6 6.1
Stigmatization rejected, shunned 4 196 24.5 40.9
Abandonment, ostracized 5 153 19.1 31.9
Weak immune system 6 89 11.1 18.6
Not allowed to work 7 25 3.1 5.2
Fear of death, other fears 8 15 1.9 3.1
Malicious spread of disease 9 25 3.1 5.2
Psychological problems 10 155 19.4 32.4
Total responses 801 100.0 167.2
Note. 40 missing cases; 479 valid cases.
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Table 20. What Should Be Done for People With AIDS
Dichotomy Label Code % of
Count
% of
Responses
% of
Cases
Medical 1 51 6.3 10.8
Counseling 2 131 16.1 2 7 .6
Homecare, love, & basic needs 3 146 17.9 3 0 .8
Nutrition/food 4 2 4 2 .9 5.1
Govt, and laws 5 2 2 2 .7 4 .6
Jobs 6 3 0 3 .7 6.3
Finances 7 8 1.0 1.7
Training 8 4 8 5 .9 10.1
Social service/recreational 9 3 .4 .6
Societal acceptance 10 196 24.1 4 1 .4
Tell others 11 2 2 2 .7 4 .6
No help/euthanasia/segregation 12 12 1.5 2.5
Abstain form sex & immorality 13 27 3.3 5.7
Seek God for forgiveness 14 6 6 8.1 13.9
Live positive & fully 15 28 3 .4 5 .9
Total responses 8 14 100.0 171.7
Note. 45 missing cases; 474 valid cases
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Table 21. Services That Should Be Provided for People with AIDS
Dichotomy Label Code % of Count % of % of Cases
Responses !
i
Medical 1 270 35.7 59.2
Counseling 2 204 27.0 44.7
Homecare, love, & basic needs 3 114
i
15.1 | 25.0
Nutrition/food 4 60 7.9 1 13.2
(
Govt and laws 5 8 1.1 ' 1.8
Jobs 6 16 2.1 3.5
Finances 7 21
i
2.8 4.6
Training 8 29 3.8 ! 6.4
i
Social service/recreational 9 13 1.7 2.9
Societal acceptance 10 11 1.5 2.4
Tell others 11 4 .5 .9
No help/euthanasia/segregation 12 6 .8 ! 1.3
Total responses 756 100.0 | 165.8
1
Note. 63 missing cases; 456 valid cases.
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Discussion of Findings
The following key themes surfaced when reviewing the literature and
considering the results of the study.
Concerning the variable AIDS is due to immorality, female students
disagreed more with this statement than the male students. In Africa, men have
several freedoms afforded to them by the culture and get away with child abuse and
rape charges (Tutu, 1996). Women who are not thought of as ‘’’commercial sex
workers” find themselves needing to exchange sex for money or goods on an
occasional basis and poverty becomes an enabler for spreading HIV/AIDS. Poverty
is also a compelling reason to accept a client who refuses to use a condom.
Anthropologist Martha Ward (1993b) observed, “For poor women AIDS is
just another problem they are blamed for and have to take responsibility for. They
ask, “How am I going to take care of my family? I have to put food on the table
now.” “You think AIDS is a problem! Let me tell you-1 got real problems” (p. 61).
The way women are treated is maybe the reason these female students disagreed
more that their male counterparts. Gender bias is experienced when it comes to
discovering HIV status. Over 60 % of the married women had only one sex partner
most of their lives, had become infected with HIV, and had been blamed for it by
their partners (Cohen & Reid, 1999). Many women and children during the 1994
genocide in Rwanda were raped by the militias. Soldiers are known as a high risk
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group for HIV, coupled with the act of violence makes rape a mode of transmission
of HIV in Africa. Further, there are several instances of child abuse and rape within
African families by older men. The victims never contracted it by immorality.
AIDS education at school is necessary and needs to be integrated into a
comprehensive school health and education program that facilitates the students
being free to discuss issues that they are concerned about (Ahlberg, 1997; Sy,
Richter, & Copello, 1989). Teachers and parents need to take on the responsibility
of discussing sexual matters with children and young adults. Many university
students cited parents and teachers as the least sources of information on AIDS.
Baylies et al. (1999) said that parents because of their discomfort explaining
sexuality to their children parents feel that the schools should take on this
responsibility. However, this notion is limited to the openness and willingness of the
teachers. Teaching sex in mixed classes of both boys and girls makes this harder,
when boys make fun of the girls, as Ahlberg (1997) pointed out, young circumcised
boys feel they can sleep with their female teachers. However, sex education needs to
be taught because many youth have engaged in sex before their seventeenth birthday.
Data show that HIV infection is highest in the 15-19 age group with high numbers of
girls being more infected more than their male age-mates (UNAIDS, 1998c). Moshi
(1999) advocates that government ministries should take the responsibility of sex
education and foster lengthening the time of first sex encounters, delay pregnancies,
and enable young women to control their sexual lives. However, there is too much
emphasis placed on the women changing, and there needs to be talk of helping men
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change since they are the ones causing the rapid spread of AIDS. Effective AIDS
control will require providing more economic opportunities for women and elevating
their social status (Collins & Rau, 2000).
Treatment of PWAs stood out with many respondents speaking of
abandonment, shunning, and societal rejection of HIV/AIDS victims. Employers
have fired employees who have revealed their HIV status depriving them of much
needed income needed to support their families and buy the needed medications.
Relatives and friends, even close family members, have deserted PWAs leaving them
destitute (Mupedziswa, 1998). Many have committed suicide and others have
avenged themselves by spreading it maliciously to others. Governments are lacking
in their leadership role by not providing free medical services and basic provisions
for PWA, especially as AIDS victims are totally left helpless without much support
from society.
Overall the students had a high knowledge of how AIDS was transmitted and
how to identify those who had AIDS. These findings are similar to a study done by
Elkonin et al. (1993), who found that university students enrolled at University of
Port Elizabeth, in South Africa, possessed high levels of knowledge about AIDS.
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Chapter 5
Su m m a r y, P o l ic y Im pl ic a t io n s, an d
C o n c lu sio n s
Introduction
The purpose of this study was to investigate and gain understanding of the
knowledge, attitudes, and beliefs held by Christian African University students
towards the AIDS epidemic. The study described in this dissertation focussed on
Christian students enrolled at four government-run universities and one Christian
American university, all five located in Kenya. In the absence of a cure for AIDS,
the primary strategy available to control and hopefully reduce the spread of
HIV/AIDS is prevention. Intervention programs that foster awareness and educate
for behavioral changes must be done at national, regional, district, and local levels.
The findings from the study further emphasize that the government must
become actively involved in providing a range of services for the millions of people
living with AIDS. This chapter has three sections. The first section provides a
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summary of selected findings linked to the research questions and conclusions that
resulted from the study linked to the literature review. The second section provides
implications gleaned from the study for legislative or policy purpose along with
recommendations. The third section concludes with suggestions for further research.
Summary of Selected Findings
The following is a summary of the study’s selected findings that are more
relevant to the policy issues discussed in the 2n d section of this chapter.
1. The study finds no significant differences between the male and female
attitudes regarding beliefs towards safe sex, government testing, AIDS
spread or transmission, and AIDS education or awareness.
2. There was significant difference between male and female attitude and
belief ratings towards immorality and segregation of people with AIDS,
and women disagreed more than their male counterparts on these issues.
3. There were no significant differences between the attitudes and beliefs of
students who were going to teach and those who were not-teaching
majors on all the six factors of safe sex, government testing, AIDS
spread, segregation, immorality, and AIDS education or awareness.
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4. The predominant ways AIDS knowledge was obtained were through
newspapers, television radio, and friends. Schoolteachers, local leaders,
and family were the least likely ways to obtain AIDS knowledge.
5. AIDS knowledge was very high amongst the students. They knew the
primary ways it was transmitted: sexual intercourse, unclean needles and
prenatal. Less than 1% said curses or witchcraft caused AIDS. They
knew that blood tests were the way to find out if one had the HIV virus or
not.
6. Students knew more people who had died of AIDS than people with
AIDS.
7. Over 50% of the students had been tested for HIV.
8. The students felt society and government needed to provide services for
AIDS victims.
9. There was strong disagreement from 70% of the students concerning the
use of condoms.
10. Using the old traditional method of education, storytelling, to teach AIDS
awareness and education was favored by 79% of the respondents.
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Conclusions in Brief
Conclusions derived and based on these summarized selected findings
follow.
Immorality and Condom Use
Condoms have been linked to facilitating immorality and are discouraged,
especially among the youth. Religious individuals unfavorably view condoms as a
prevention strategy for curtailing AIDS and favor sexual abstinence as an alternative.
Respondents surveyed in this study did not favor condom use claiming that it
facilitated immorality and should only be used between married couples. Further,
some stated that condoms broke during sexual intercourse indicating that stronger
and higher quality condoms are needed.
This finding is consistent with a study that surveyed Nigerian University
students’ attitudes towards condoms. Those who used condoms complained of the
inferior quality causing breakage during intercourse (Anugwom, 1999). This has
caused much distrust and disgust from many African nationals regarding the use of
condoms as a successful AIDS prevention strategy (Finger, 1993). Odebiyi (1992)
reports that among undergraduate male students at the University of Ife, condoms
were not favored even though they knew condoms helped prevent AIDS.
Regarding the finding of immorality causing AIDS, women respondents in
this study tended to disagree more than the men did. Both Reid (1994) and Akerod
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(1994) agreed that women are often victimized and blamed for spreading AIDS.
Even though many of the women were married and only had one regular partner,
their husbands, They were still blamed (Cohen & Reid, 1999).
Studies showing the incidences of high prevalence amongst high risk groups
have indicated that rural-urban migration of men to cities for work has contributed to
the spread of AIDS. Often these men have left their wives and children to seek out
female companionship, hence entering into sexual relations with multiple partners
(Miller & Rockwell, 1988). It’s no wonder that the female respondents disagreed on
the immorality issue as in the case of the married women; they contracted AIDS
from their husbands who occasionally returned home for visits. There are also
multiple cases of women being raped. In Swaziland, 496 cases of rape were reported
in 1993. Even close close relatives or fathers raped their children (Zwane, 1996).
Further explained in other research studies of why women become prostitutes
is favored by women is the lack of job opportunities for women in urban areas
resulting in them giving sexual favors in order to survive. One fifteen-year-old
woman queried what would she eat if she didn’t work as a prostitute (Baylies et al.
1995). Women are further powerless to negotiate any decisions concerning their
sexual experiences, especially when it comes to the use of condoms with a regular or
infrequent partner (Heise & Elias, 1995).
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H IV Testing
In this study over one-third of the students, close to half of the student body
of respondents, had been tested for HIV/AIDS. Upon consultation with the Kenyan
Embassy in Washington, D.C. and the senior research assistant, this researcher found
that a lot of testing had taken place with the AIDS issue being publicized nationally
and internationally. Campaigns advocating that “it’s better to know that not” led to
many getting tested.
Institutions of higher learning took precautions and recommended students to
get tested by providing free HIV testing. Many employers insisted that those
applying get tested. This is also consistent with the literature review where
employers have been accused of discriminating against people with AIDS and also
having to train 2 people for every job so as to handle the loss of potential workers
dying from AIDS (Tembo, 1999).
People With Aids
On the finding of segregation of people with AIDS from the workplace and
society as a whole, women respondents disagreed more than men with this factor.
Both Barnett & Blaikie (1992) agreed that AIDS victims are socially stigmatized and
are often seen as untouchable and dangerous. Even doctors have been known to
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withhold telling patients who test HIV positive because of the discrimination their
patients will face (Soyinka, 1996).
Respondents indicated that the key problems that people with AIDS face are
societal rejection and non-acceptance even by family members and friends.
“Shunning,” “abandonment,” and “neglect” were words that were recorded by more
than one-third of the respondents. Seidel and Vidal (1997) report that women who
disclose their experiences are rejected, beaten, and made homeless. Psychological
problems of fear, stress anxiety, and suicidal thoughts were cited as the next key
problem coinciding with Kubler-Ross’ (1982) comments. Individuals and their
families feel a sense of hopelessness when confronted with AIDS due to the guilt,
blame, shame, and stigmatization associated with the disease.
Key services that respondents indicated that should be provided to people
with AIDS were medical services, counseling, and home care, indicating that people
with AIDS are not receiving much assistance from the government. Much of the
care is left to the families of the individual with AIDS causing a huge strain of
family resources leading to poverty (Oyekanmi, 1994a).
Another issue is that many people with AIDS hide the fact that they have the
disease and do not report it due to fear of non-acceptance. This facilitates further
spread of the disease as 3% of the respondents indicated some people with AIDS
maliciously spread the disease so they wouldn’t die alone. Hiding the disease is
congruent to this study’s findings that though only 25% of the student body knew
someone with AIDS, over 85% of them knew someone who had died of AIDS. This
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further substantiates that hiding and non-reporting of AIDS are taking place,
facilitated by the very nature of the disease’s 10-year incubation period for full
blown AIDS.
Awareness and Prevention Programs
Respondents predominantly found out about AIDS from newspapers,
television, and radio. The least utilized sources of AIDS information were parents,
teachers, and local leadership. Ntukula (1994) comments on the uncomfortableness
that parents feel towards teaching their children about sex and how some oppose sex
education, especially the use of condoms, as they think it contributes to a rise in
immorality. Though parents relegated the teaching of sex matters to schools, this
approach was limited due to religious ideologies of the schools where teachers were
open and comfortable to talk about such matters with their students. Baylies et al.
(1999) reported that teachers felt parents should be the ones to address sexual
matters. It’s no wonder that young people are left to learn about sex from their peers
or watching television and films.
Another finding from the study indicated that respondents’ AIDS knowledge
was fairly high which is a good sign and differs from the study done of Nigerian
University students (Anugwom, 1999). Anugwom seemed to blame the AIDS
epidemic on “white propaganda to control Africa.” Most students in this study
determined that AIDS was caused by immoral sexual relations.
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The method of how AIDS awareness and education should be disseminated
was another key finding of this study. The old traditional education method of
storytelling was determined by 79% of the respondents to be an effective method for
AIDS education programs. Before western education came into Africa difficult
issues were discussed informally through stories in which a combination of satiristic
humor and irony were used to enlighten both young and old audiences. Some theatre
groups like regional based AIDS drama initiatives in Ethiopia teach AIDS education
through music and theatre {AIDS Awareness drama show by Tesfa Theatre and
music enterprise-Ethopia, 1999).
Findings from this study further indicate that one program for both teaching
and non-teaching majors can be developed by the university administration, but
separate programs may be needed for males and females. Findings indicated
different attitudes, particularly on the issue AIDS being caused by immorality.
Female students disagreed more than male students on this issue largely because that
women are often victimized for “causing” the disease. In Africa, AIDS is known as
a “female disease” where levels of HIV prevalence in some regions of Africa show
more women than men are infected (Adomako Ampofo, 1997). Women need to be
empowered to take control over what happens to them during sexual encounters
(Heise & Elias, 1995), particularly in negotiating the use of condoms with partners.
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Study Conclusions
Women differed from male students on the key issue immorality. Women
disagreed more than men that AIDS is caused by immoral behavior. This finding is
congruent with literature that emphasizes having high AID- related knowledge is not
enough for women, as many have no control over their sexual lives. Women are still
dependent on men economically and often have to result to giving sexual favors.
Negotiations regarding condom use are dependent on men, and there are reports of
many young girls being raped by older men. Rape is often done unprotected and
forced, the men using no lubricants which further facilitates the spread of HIV
through bleeding abrasions. Another study revealed that the highest rates of HIV
infection are among more educated women (Kapiga et al. 1993), but women with no
formal education have the lowest rate of HIV infection. One would expect the more
education, the lower the HIV infection, but this was not the finding in the Kapiga et
al. (1993) study.
The inhumane treatment of people with AIDS clearly came across in this
study, especially the gross lack of basic medical and counseling services. This
creates a problem of facilitating further spread of the disease because not only are
people with AIDS afraid to tell they have it but they are also persecuted and left
unattended when they do. Those taking care of them also run the risk of contracting
AIDS and should receive training on how to care for people with AIDS. The
stigmatization and societal non-acceptance cause many people with AIDS to have
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additional emotional and psychological stresses. These can be alleviated with more
societal AIDS awareness and education.
Though there was no determined significance between the attitudes of non
teaching majors and teaching majors, the need for a comprehensive AIDS education
program cannot be overstated and would be highly beneficial.
Implications for Practice
In light of the limitations of the study, the following is a list of
recommendations which can be generalized to similar populations, specifically
students studying at African universities.
1. It is strongly recommended that a comprehensive AIDS education course
be made a part of the General Studies or Foundation studies courses at
African universities. Students can then take the AIDS education course
as part of the requirements needed to graduate.
2. Students who are teaching majors should be required to take additional
AIDS education courses to enable them to teach about AIDS to their
future students. Upon graduation many of these university students return
to their home towns to teach at local schools in rural and urban locations.
They can be effective partners in disseminating AIDS education and
awareness to their students and to the communities in which they live.
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Equipping them with strategies and adequate sound knowledge of AIDS
transmission and prevention can be highly beneficial to curtailing the
spread of AIDS. These AIDS education courses can address ways to
teach prevention to various audiences (student bodies and the
communities) and how to effectively counsel those who have AIDS.
They should also be trained in how to integrate AIDS into every subject
level as they teach.
Teachers already in the field can be called into attend in-service
workshops on how to teach students about AIDS. A training-the-trainer
approach can be utilized so teachers can attend and obtain certification
and help train others in the field.
3. Educating university faculty and administration on making condoms
readily accessible to students is critical. University students are known to
be sexually active, so they are considered a high-risk group for HIV
infection. University faculty and administrators need training on the
realities of the AIDS crisis and how condoms can reduce the risk of
becoming infected with HIV. Hopefully, this will cause them to provide
condoms to students at university health clinics and in restrooms.
4. It is recommended that universities become involved with providing
outreach programs to the surrounding communities of the campuses.
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University outreach programs can be instrumental in promoting AIDS
awareness and education. Since AIDS is a critical problem in Kenya and
other sub-Saharan African countries, universities can facilitate the
following:
a. Free workshops offered to those suffering from AIDS to help
them cope with their situation
b. Utilization of mass media sources, such as have student-run radio
broadcasts which utilize poetry, storytelling, drama, music to
promote AIDS awareness and education:
c. Presentations at national forums to discuss the need to break the
silence of the disease and promote societal acceptance of people
with AIDS;
d. Offering in services for professionals and others to learn about
AIDS and how to prevent it;
e. Development of national AIDS education programs that can reach
different language groups in both rural and urban locations and
these can be implemented by students moving back to these areas
after graduation.
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5. University development of no-tolerance policies to deal with protecting
women from sexual harassment on campuses.
6. The need for universities to provide intensive counseling services to
students who are suffering psychologically from the loss of a close friend
or relative to AIDS.
Suggestions for Further Research
In light of the limitations of the study, the following is a list of areas that can
be further researched to assess and gain further insights into university students
underlying knowledge, attitudes, and beliefs to develop effective AIDS education
programs for them:
1. Future research to explore the issue of gender bias and facilitate
empowerment of women.
2. Additional research to explore knowledge, attitudes, and beliefs of faculty
and university administrators towards AIDS, especially regarding the
issue of condom accessibility and use.
3. A needs-assessment study of surrounding communities around the
universities to facilitate appropriate AIDS outreach and intervention
programs.
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4. Research done to gain a deeper understanding of underlying beliefs of
university students, especially towards condom use.
5. Finally, further longitudinal research must be considered to access the
impact and effectiveness of training teachers to promote AIDS education
in the schools, and communities, and work and thus curtail the further
spread of AIDS.
Concluding Remarks
AIDS is an immediate threat for this group of Africa’s future leaders. Since
many of them are sexually active, this places them at high risk of HIV infection.
AIDS education and prevention programs are a matter of urgency and priority and
should be developed by the universities in conjunction with the Ministries of
Education and Health. In agreement with Batchelor (1984), until a reliable cure is
found, prevention remains to be the most effective method to curbing AIDS.
Students, faculty, university administration, community members, government
officials, and leadership need to be involved in the development of a culturally
sound, gender sensitive, and effective AIDS education and prevention program.
From this study, it is evident that university students require such a program
especially one that incorporates acceptance condom use to help curtail the spread of
HIV/AIDS. Now that it’s here and taking the lives of so many,the question should
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not remain and where HIV/AIDS came from but how to be rid of it. A well known
African proverb says, “If there is a snake in your house, you don’t ask where it came
from; you get it out, you kill it.” AIDS is a snake, and we must kill it!
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A ppe n d ic e s
Appendix A: Information Sheet for Non-Medical Research
Appendix B: Pilot Aids Survey/Questionnaire
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Appendix A
Information Sheet for Non-Medical Research
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University of Southern California
INFORMATION SHEET FOR NON-MEDICAL RESEARCH
Knowledge, Attitudes & Beliefs o f Christian African University Students Towards
AIDS
Completion and return o f the questionnaire w ill constitute consent to participate in
this research project.
You are asked to participate in a research study conducted by Linda Hagedom, Ph.D., and R. Gathoni
Maina, M.A., from the Rossier School of Education EDPA at the University of Southern California.
The results from this study will contribute towards the completion of a doctoral dissertation. You
were selected as a possible participant in this study because you are from Africa, the continent most
affected by the AIDS crisis and, as a university student, not only do you fall in the high risk of HIV
infection but you are also Africa’s hope for a better future.
We ask you to take part in a research study because we are trying to learn more about what you know
about AIDS: How it is contracted and spread, as well as find out some of your beliefs regarding the
origin of the disease, what should be done to curtail AIDS spreading, and your attitudes towards
people with AIDS (PWA).
You will be asked to answer as truthfully as you can the questionnaire handed to you. The
questionnaire takes about 15 minutes to complete at the most and, once you have completed it,
please hand it back to the administrator who gave it to you. This is all that is required of you.
These questionnaires are anonymous. Please, do not write your name on them, as we would like
to maintain confidentiality.
There are no foreseeable repercussions of any kind to you or anyone participating in
this research. It serves purely as a resource of information for those who want to
develop educational programs to promote AIDS awareness and prevention. You
will not benefit directly from this research. You also will not receive payment for
participation in this research.
Any information that is obtained in connection with this study and that can be identified with you will
remain confidential and will be disclosed only with your permission or as required by law.
148
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When the results of the research are published or discussed in conferences, no information will be
included that would reveal your identity. Since these are anonymous questionnaires, your identity
will not be known.
Each questionnaire received will be numbered to facilitate data entry. Only the two researchers, Dr.
Hagedom and Ms. Maina, are authorized to access the individual questionnaires. All questionnaires
will be kept under lock and key in a cabinet at Ms. Maina’s, the secondary investigator’s, office.
After one year when the dissertation is published, all questionnaires shall be destroyed.
You can choose whether to be in this study or not. If you volunteer to be in this study, you may
withdraw at any time without consequences of any kind. You may also refuse to answer any
questions you don’t want to answer and still remain in the study. The investigator may withdraw you
from this research if circumstances arise which warrant doing so.
If you have any questions or concerns about the research, please feel free to contact Ms. Maina, the
Secondary Investigato, at
Phone: (213) 393-8747,
Email: bemabold@hotmail.com
Address: PO Box 1996, Norwalk, CA 90651
You may withdraw your consent at any time and discontinue participation without penalty. You are
not waiving any legal claims, rights or remedies because of your participation in this research study.
If you have questions regarding your rights as a research subject, contact the University Park IRB,
Office of the Vice Provost for Research, Bovard Administration Building, Room 300, Los Angeles,
CA 90089-4019 (213) 740-6709 or upirb@usc.edu.
Thank you for considering participating in this important research concerning AIDS in Africa.
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Appendix B
Pilot Aids Survey/Questionnaire
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PILOT AIDS SURVEY/QUESTIONNAIRE
SECTION A: Questions About You
1 . What is your age? 18 to 20
21 to 23
24 to 26
Over 26
2. What’s your gender? Male
Female
3. Where do your parents live? Rural area
Urban area
4. What is your parent's educational level?
Traditional/informal education
Primary
Secondary
Diploma
University degree
5. What is your parent’s total annual income?
0 to 24,000 Kshs
25,000 to 180,000 Kshs
Over 180,000 Kshs
6. What is your ethnicity?_____
7. What languages do you speak?
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8. What is your religion? Muslim
Catholic
Protestant
Other (please specify)
9. What year are you in university? 1s t
2n d
3r d
4th
10. What is your major? ________________________________
11. What educational level are you going to teach?
Secondary schools
Primary colleges
Other (please specify)
*
SECTION B: Your Knowledge of AIDS/HIV
12. Where do you get most o f your information on AIDS? (Check all that apply)
Radio
Television
Newspaper
Family
Friends
Church
Public meetings
Billboards/Posters
School teachers
Local leaders
13. How does AIDS spread from one person to another?
Kissing
Mosquitoes
Sexual intercourse
God’s punishment
Unclean needles
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Injecting drugs
Curses
Blood transfusions
Body fluids
14. How many people do you know with AIDS?
None
1 to 2
3 to 5
6 to 10
More than 10
15. Please list their relationship to you.
Immediate family
Close friend
Relative/extended family
Fellow worker
Other (please specify)___
16. How does a person know that he/she has AIDS?_____________
17. Do you know someone who died o f AIDS? Yes
No
18. Please list their relationship to you.
Immediate family
Close friend
Relative/extended family
Fellow worker
Other (please specify)___
19. Have you ever been tested for AIDS/HIV? Yes
No
20. Imagine if you found out that you had AIDS/HIV, what would you do? I would:
Seek Western medicine
Seek Tribal medicine
Transmit it to someone else
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Await God’s judgement
Other (please explain)_
SECTION C: YOUR ATTITUDES AND BELIEFS
Respond to the following statements by checking whether you:
Strongly agree [SA],
Agree [A],
Undecided [U],
Disagree [D],
Strongly disagree [SD]
21. HIV/ AIDS is a major problem in Kenya.
22. There is no cure for AIDS.
23. AIDS is a disease created by scientists.
24. One can avoid getting infected with AIDS.
25. Condoms are the best way to stop the spread o f AIDS.
26. Education and awareness o f AIDS will reduce the number o f people dying o f AIDS.
27. People who abstain from sexual relations do not get AIDS.
28. Mothers can pass HIV/AIDS to their babies.
29. HIV/AIDS can be spread by unsterilized needles.
30. AIDS is a judgement from God.
31. Tribal medical treatments can eradicate AIDS.
32. The government should test everyone for AIDS.
33. AIDS is caused by immoral behavior.
34. People with AIDS should be kept away from those who don’t have it.
154
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35. People practicing witchcraft has caused AIDS.
36. People who have AIDS should not be allowed to work because it provides risk to the rest
o f the employees.
37. People who have AIDS got it because they were irresponsible and not careful.
Please write your comments for the following questions in the space provided.
38. People with AIDS should...______________________________________________________
39. What are the major problems o f people with AIDS?
40. What in your opinion should be done for people with AIDS?
SECTION D: AIDS PREVENTION & AWARENESS
Respond to the following statements by checking whether you:
Strongly agree [SA],
Agree [A],
Undecided [U],
Disagree [D],
Strongly disagree [SD]
41. People should be provided with condoms to prevent the spread o f AIDS
42. Young people should be taught how to have safe sex
43. Parents and teachers are the best persons to educate young people about AIDS
44. Sex education should be taught in schools
155
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45. The Kenyan government should provide resources for people living with AIDS
46. The government should test everyone for AIDS
Please write your comments fo r the following questions in the space provided.
47. AIDS can be prevented by: (check all that apply)
Abstaining from sex
Using condoms
Healthy diet and exercise
Not touching those with AIDS
Using a mosquito net
Using sterilized needles
Not kissing those infected with AIDS
Education young people about safe sex
Government enforcing safe sex practices
48. What services should be provided to those with AIDS?
49. Is AIDS a punishment?
50. Is the storytelling method o f educating used by our ancestors an effective way to spread
knowledge and awareness o f A ID S?_______________________________________________
Thank you for answering this questionnaire.
156
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Asset Metadata

Creator Maina, Rose Gathoni (author)

Core Title Knowledge, attitudes and beliefs of Christian African university students

Degree Doctor of Education

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, health,education, higher,health sciences, public health,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Hagedorn, Linda Serra (committee chair), Gothold, Stuart (committee member), Picus, Lawrence O. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-101932

Unique identifier UC11326910

Identifier 3027744.pdf (filename),usctheses-c16-101932 (legacy record id)

Legacy Identifier 3027744.pdf

Dmrecord 101932

Document Type Dissertation

Rights Maina, Rose Gathoni

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA