1. HIV knowledge, sexual behaviours and risk perceptions of high school learners in Gauteng and North West Provinces- South Africa.
Mathildah Mokgatle (MPH, PhD)
Sphiwe Madiba (MPH, DrPH)
18th Asia-Pacific Conference (IUSTI)
November 2014

2. Orientation of provinces

3. Introduction
The purpose of our study was to assess the acceptability of HCT in school.
We also identified dearth of data on sexual behaviour of learners in school in South Africa.
As a result we assessed the sexual behaviours of learners because of evidence that a small proportion of young people start having sex before the age of 15 years (Shisana et al. 2009).
There is also limited data on HIV related knowledge among learners in South Africa.
When learners have the correct knowledge about all aspects of HIV, they are more likely to understand the need for HIV testing.
HIV Counselling and Testing (HCT) implementation in schools is one of the few interventions that will contribute towards promoting uninterrupted schooling and may be an effective method to prevent early pregnancy and HIV amongst the schooling population.
The on-going debate on the provision of HCT in schools has been among authorities with little considerations of the learners who will be users of the school HCT services. Understanding acceptability of HIV testing at schools from the perspective of learners is essential to inform planning and decision making about program implementation in schools.

4. Methods and Materials Design
This was a formative evaluation of the opinions of grade learners about HCT at school.
The study used quantitative and qualitative research methods.
The study settings consisted of 17 high schools in the Bojanala district in North West province and the Tshwane North district in Gauteng province.  
Data was collected between August and September 2013.

5. Methods and Materials Two stage sampling Participation was voluntary.
Schools were randomly selected with the assistance of the officials from the districts.
The life orientation (LO) periods were randomly assigned for the administration of the questionnaire.
Participation was voluntary.
Informed consent was obtained.
Anonymity was ensured by not gathering learners personal information.
A two-stage sampling method was used; schools were selected with the assistance of the officials from the educational district and sub-districts. In the second stage of sampling life orientation (LO) periods were randomly assigned to the research team and learners in those classes were recruited using convenient sampling techniques. In most schools, only LO periods in grade classes were selected because grade 12 learners were preparing for the final year exams. Students were informed that participation was voluntary and that they could withdraw from the survey at any time should they wish.

6. Data collection
A researcher-assisted self-administered semi-structured instrument was used.
On sexual behaviour, learners were asked if they ever had sex, age of sexual debut, number of sexual partners, condom use, and risk perceptions.
On HIV knowledge, they were asked for the meaning of HIV, AIDS, and ABC slogan, modes of HIV transmission, and HIV prevention.
The questionnaire took about 20 minutes to complete.
The questionnaire was adapted from the Australian Secondary Students and Sexual Health Survey (Smith et al. 2009).

7. Data collection
Ethical clearance was received from the Medunsa Campus Research and Ethics Committee.
Permission was granted from the Gauteng Department of Education and Bojanala Educational District in North West province and school principals.

8. Demographic profile of learners
Frequency
Percent
Gender
Female
1632
55.0
Male
1338
45.1
Age groups
14-19 years
2741
92.3
20 years and more
229
7.7
Mean age 17.4 years
Grade
Grade 10
1223
41.2
Grade 11
1345
45.3
Grade 12
402
13.5
Have sexual partner No
600
20.2
Yes
2370
79.8

9. Sexual behaviour Frequency Percent Ever had sex No 1157 39.0 Yes 1810
61.0
Mean age at sexual debut 15.6 years
Had sex past three months  
837
44.7
1035
55.3
Condom use at last sex
439
24.1
1382
75.9
Number of sexual partners in past year
One partner
1278
50.2
Two partners
600
23.5
More than two partners
671
26.3

10. Sexual practice by gender
Female
Male
Total
P-value
Have boyfriend or girlfriend  No
321 (19.7)
279 (20.9)
600 (20.2)
0.424
Yes
1311 (80.3)
1059 (79.2)
2370 (79.8)
Ever had sex 
753 (46.2)
404 (30.2)
1157 (39.0)
0.000
878 (53.8)
932 (69.8)
1810 (61.0)
Had sex past three months
437 (26.8)
400 (29.9)
837 (28.2)
471 (28.9)
564 (42.2)
1035 (34.9)
Condom use at last sex
219 (13.4)
220 (16.5)
439 (14.8)
662 (40.6)
720 (53.9)
1382 (46.6)

11. Reasons for not using a condom
Frequency
Percent
I trust my partner
437
39.7
It just happened, we did not plan to have sex
352
32.0
I don’t like condoms
143
13.0
I did not have a condom
118
10.7
I did not ask my partner for a condom 26
2.4
My partner does not like condoms 24
2.2
Attitudes towards condom use
Condom use prevent HIV transmission
2688
90.6
Condoms are easily available for the youth
1972
66.4
Condom creates doubt between partners
1098
37.0

12. Risk perceptions The likelihood to get STIs
Likely
Unlikely
Never
The likelihood to get STIs
357 (12.0)
788 (26.5)
1825 (61.5)
The likelihood to get HIV infection
325 (10.9)
868 (29.2)
1777 (59.8)
The likelihood to fall pregnant
420 (14.2)
529 (17.8)
2020 (68.0)
The likelihood to make a girl pregnant
524 (17.6)
477 (16.1)
1969 (66.3)
Likelihood to ask partner to use condom
2071 (69.7)
250 (8.4)
649 (21.9)
Refuse sex if partner does not want to use a condom
1436 (48.4)
569 (19.2)
964 (32.5)
Discussing HIV testing with partner
2060 (69.6)
461 (15.6)
441 (14.9)
Ask partner to go for HIV testing with
2131 (71.8)
415 (14.0)
424 (14.3)

13. Risk perception by gender
Female
Male
The likelihood to get STIs
Never
1048 (64.2)
777 (58.1)
The likelihood to get HIV infection
969 (59.4)
808 (60.4)
Likelihood to ask partner to use condom
324 (19.9)
250 (18.7)
Refuse sex if partner does not want to use condom
470 (28.8)
516 (38.6)

14. Learners’ knowledge of HIV
Correct response
HIV is the virus that causes AIDS
2758 (92.9)
A person who is HIV-positive has AIDS
2222 (74.8)
There is no cure for AIDS currently
2278 (76.7)
There is no vaccine against HIV currently
1106 (37.3)
Having an STI can increase a person’s risk of getting HIV
2539 (85.5)
You can tell by looking at the person that they are HIV-positive
2587 (87.1)
Having multiple sexual partners increases the risk of getting HIV
2618 (88.2)
Meaning of HIV
2442 (82.2)
Meaning of AIDS
2059 (69.3)
Meaning of ABC slogan in HIV prevention
1206 (40.6)

15. Knowledge about modes of HIV transmission
Correct response
A pregnant HIV-positive woman can transmit HIV to her baby
1873 (63.1)
By an HIV-positive mother through breastfeeding
2355 (79.3)
HIV can be transmitted by sexual intercourse
2886 (97.2)
HIV can be transmitted by sharing needles or syringes
2573 (86.6)
HIV can be transmitted by blood transfusion
2760 (92.9)
By shaking hands with HIV-positive person
2887 (97.2)
By drinking from the same glass of HIV-positive person
2775 (93.4)
By sharing a toilet with an HIV-positive person
2853 (96.1)
By HIV-infected person while sneezing or coughing
2569 (86.5)
By hugging an HIV-infected person
2927 (98.6)

16. Knowledge about HIV prevention
Correct response
HIV can be prevented by using a condom
2688 (90.6)
HIV transmission can be avoided by remaining faithful
2178 (73.4)
HIV can be prevented by AIDS education
HIV/AIDS can be controlled by taking ARVs
2828 (95.2)
Abstinence is the HIV prevention measure I should follow
1969 (66.3)

17. Discussion and conclusions
We found that two thirds of learners had a sexual experience, over half had sex in the past three months.
The mean sexual debut age is relatively high (15years) as compared to a mean of 13 years in Namibian study.
More boys were more sexually active than girls.
Learners had low risk perception but high risk behaviour.
Compared to girls, boys have more risky behaviors and low risk perception
Multiple sexual partners, will have sex without a condom, and are more sexually active.
Learners had high levels of HIV-related knowledge but knowledge for HIV prevention was relatively low.

18. Discussion and conclusions
About 40% of learners were not sexually active, there is a need for interventions to assist them to delay sexual debut.
Condom use of 75% is relatively high-interventions to increase their self efficacy to negotiate condom use for consistent use of condoms.
High levels of HIV-related knowledge with some gaps in knowledge.
High knowledge might be attributed to the HIV-related education offered in the LO program which has a crucial role to play in reversing some of the gaps.
The school remains the best place to implement specific and focused educational programs to empower learners to adopt safe sexual behaviour.

19. Acknowledgements
Funding from UL office of the DVC academic and research.
Dedicated team of fieldworkers.
The district officials, school principals and LO teachers who supported the researchers and gave their time towards our accomplishment.
The learners who participated in the study. OR

20. Thank you!