Discussing Sexuality in Life Orientation Lessons with Learners with Disabilities in KwaZulu-Natal Dr. Jill Hanass-Hancock, Dr. Toyin Aderemi, Liset de Reus, Anna Sophie Henken, Petronella Chirawu,

“It doesn’t matter whether they are in special schools or mainstream school but children have a right to be aware about their rights in terms of sex and sexuality.” Teacher at a special school

Literature indicates that: PWD lack HIV knowledge and are exposed to all known HIV risk factors (Groce 2004 Global survey) HIV prevalence in PWD in Africa might be above average (Shisana 2009, Taegmayer 2008, Touko 2009) PWD lack sexuality education and are at increased risk of sexual abuse and exploitation (Rohleder, Braathen, Swartz and Eide 2009, Collin 2001, Groce and Traci 2004, Kelly et al 2002) Teachers’ attitudes, lack of confidence, lack of skills and materials might be associated with the lack of sexuality education (Roehleder et al 2009, 2010, 2011, Rohleder and Swartz 2009, Phillander & Swartz 2006, Hanass-Hancock 2009) There is a lack of intervention evaluations (Hanass-Hancock 2009)

Study Design A needs assessment conducted using a mixed-method design Framework: Adapted Theory of Planned Behaviour (TPB) Tools: Cross-sectional survey-Scales Knowledge (HIV, sexual rights and vulnerability of PWD), beliefs and practices in teaching sexuality education (29 items), perceived subjective norms, self-efficacy and confidence , material and professional preparation) Sampling: Purposively sampled 100 teachers from special schools in KZN (Covering disability spectrum and urban-rural divide) Analysis: Frequencies, correlations, crosstabs (mean scores presented elsewhere) Validation: Full validation of scales undertaken (results presented elsewhere)

Results Main driving factors of teaching sexuality education to learners with disabilities Associations between teachers’ characteristics, school types and sexuality education Relationships between self-efficacy, subjective norms and attitudes Training and material needs

Driving Factors Correlations 1 2 3 4 5 6 7 8 9 10 11 12 13   1 2 3 4 5 6 7 8 9 10 11 12 13 1. Teach Human Development .430** .254* .369** .548** .104 .155 .182 .213* -.010 .193 .252* .223* 2. Teach Relationships .475** .342** .351** -.034 .312** .244* -.057 .176 .260* .286** 3. Teach Personal Skills .152 .066 -.092 .081 .235* -.022 -.078 -.063 .093 .130 4. Teach Sexual Behaviours .618** .189 .045 .489** .056 .214* .000 .171 5. Teach Sexual Health .073 .195 .049 .453** .250* .126 .291** 6. Beliefs human development .242* .084 .165 .228* .141 .123 .055 7. Beliefs relationships .258* .461** .326** .106 .050 8. Beliefs personal skills .103 .046 .264** .089 9. Beliefs Sexual Behaviours .386** .371** 10. Beliefs Sexual Health .044 .085 .011 11. Self-Efficacy .188 .446** 12. Sexuality and Disability -.002 13. Perceived Subjective Norms **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). Teachers who are strong in one area are likely to be teach other areas of Sexuality Education as well Beliefs predict teaching behavior in particular beliefs about sexual behavior predict teaching practice in regards to Sexual behavior as well as sexual reproductive health Self-Efficacy in relation to teaching sexuality education is strongly associated to perceived subjective norms and to a lesser degree to beliefs about sexual health and teaching of issues related to sexual behavior and sexual reproductive health Beliefs around relationships are strongly associated to beliefs around sexual behavior These findings might be similar to mainstream schools. So why is this so important in the context of disability and HIV: Children and young people with disabilities are more likely to be socially isolated and experience barriers to access sexuality and HIV information and education – so school is often the only source of information Children and people with disabilities are at increased risk of sexual abuse and exploitation – hence they need targeted awareness-raising programs Adolescent with disabilities may experience sexual dysfunction and lack of confidence related to the nature of their disability Learners with intellectual disabilities may need clear instructions and simplified knowledge to express sexual behaviors in the acceptable context and process (e.g. masturbation not in public) Learners with disabilities need safe spaces to discuss disability, sexual health and sexual-fulfillment

Teaching Beliefs and Practices vs. Religion Xtian Hindu p-value Agree (%) Yes (%) Relationships Dating Marriage Raising children 23.7 24.1 48.4 54.8 0.02 <0.01 Personal skills Values Communication 79.3 81.0 96.8 0.03* 0.05* Sexual health Contraception Abortion 71.7 48.3 90.3 77.4 0.04 Bivariate analysis presented here are based on cross-tabs. Only statistically significant associations are shown in the tables Only ‘Agree’ and ‘Yes’ responses (in %) are shown in the tables. The tables do not show the proportions of participants with negative responses Bold values indicate the direction of the association i.e. are more likely to belief or teach sexuality topics indicated P-values = Pearson’s Chi-square = Fisher’s Exact Test Religion was associated with beliefs as well as teaching practice. Teachers who practised Hinduism were more likely to have positive attitudes towards discussing contraceptives or abortion with their learners. They were also more likely to discuss dating, marriage and raising children with their learners. There were also more likely to teach values and communication/negotiation skills to the learners (e.g. being able to say yes or no)

Teaching Beliefs and Practices vs. Gender/Types of School Female Male p-value SMH / MH DHH/BVI/HICP/C. Agree (%) Yes (%) Yes (%) Human development Reprod. anat/physiol. Human reproduction Puberty 23.4 31.3 51.0 48.9 52.1 70.8 0.01 0.04 0.05 Relationships Families Marriage Raising children 74.1 75.3 100.0 0.02* 0.20* 28.8 52.9 89.8 71.4 0.02 Sexual behaviours Sexuality thr. lifespan Masturbation Human sexl. response Sexual dysfunction 62.2 45.7 75.0 52.4 88.2 76.5 21.3 27.8 47.1 58.8 0.04* Only ‘practices’ are reported under ‘types of school’ because no statistically significant associations were found for ‘beliefs’ Male teachers were more likely to have more positive attitudes towards certain parts of sexuality education and were also more likely to indicate that they discuss marrigae, sexuality through the lifespan as well as human sexual response with their learners. Teachers at schools for learners with intellectual disabilities were less likely to indicate that they discuss reproductive anatomy and physiology, reproductive processes and changes during puberty with their learners.

Self efficacy, subjective norms and attitudes Negative attitudes towards ‘disability and sexuality’ and perceived subjective norms were negatively associated with teaching about or discussing human anatomy (0.01), body development (0.03) and different relationships (0.11).

Materials and professional preparation

Conclusions Teachers’ beliefs/attitudes determine how they discuss sexuality education concepts in class Teachers’ characteristics (gender, religion) and type of school influence content of sexuality education Teachers’ self-efficacy and perceived subjective norms need to be considered Teachers indicated their need for training, skills and materials to better integrate sexuality education within Life orientation lessons

Recommendations Development of a training and resource toolkit for teachers of PWD within the South African Life Orientation Curriculum Training needs to include focus on values and norms around disability and sexuality to change beliefs and attitudes, increase teachers knowledge and self-efficacy Further research in particular evaluations of interventions targeting teachers as well as learners with disabilities (classroom implementation)

Thank you www.heard.org.za