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How to cite this thesis
Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujdigispace.uj.ac.za (Accessed: Date). Evaluation of an HIV/AIDS prevention programme at a South African University
Evaluation of an HIV/AIDS prevention programme at a South African university
by
Jenika Gobind
A thesis submitted in fulfilment of the Degree Philosophiae Doctor in EMPLOYMENT RELATIONS
Faculty of Management UNIVERSITY OF JOHANNESBURG
Supervisor: Professor Wilfred I. Ukpere
2014
Evaluation of an HIV/AIDS prevention programme at a South African University
ACKNOWLEDGEMENTS
To my Lord and Saviour, the Glory is Yours
This journey would not have been possible without the following people who contributed to the completion of my thesis. I wish to thank:
Professor Wilfred Ukpere, my supervisor, mentor and guru, whose guidance, support and encouragement I will always cherish. My husband Sudesh Gobind who has been my compass, my son, Sidharr Gobind who spent endless hours as my editor, and my daughter, Subha Gobind, who has an amazing ability to turn words into pictures. My mother, Sithara Ramdarie, for her patience. My late father, Rabby Ramdarie, whom I will always miss. My sister, Amrika Abrahams, for her support. Professors Anita Bosch, Jos Coetzee and Rene Van Wyk, thank you for your encouragement and support. Amanda Ferreira, for listening to me. Adam Martin, for his support, statistical expertise and friendly ear. Henri Benedict, a new and talented friend, thank you for direction. My friends, for prayer and encouragement.
My IPPM colleagues and administrators, for supporting me when the journey slowed down.
I thank you all for giving me the space to realise my dream.
~*~
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Evaluation of an HIV/AIDS prevention programme at a South African University
DEDICATION
This thesis is dedicated to my family: Sudesh, Sidharr, Subha, Sithara, Rabby and Amrika
~*~
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Evaluation of an HIV/AIDS prevention programme at a South African University
ABSTRACT
Extensive research has been conducted within the field of HIV/AIDS, most of which has been epidemiological, as scientists work towards finding a cure. In the interim, social scientists continue to investigate ways to address social and behavioural aspects that encourage the spread of HIV/AIDS. Employment Relation practitioners are no different as they are sensitive to the impact of HIV/AIDS in the workplace. Programmes and policies are measures that have been established by Employment Relation and Human Resource practitioners in order to reduce the influence of the disease on the workforce. Higher Education Institutions (HEIs) face similar challenges. Therefore, Higher Education HIV/AIDS Programmes (HEAIDS), together with the South African government, have developed a framework to guide HEIs in developing HIV/AIDS programmes and policies that are institution specific. Various HEIs within South Africa have developed their unique programmes based on the HEAIDS framework. However, none of these institutions at the time of commencement of this study have evaluated the effectiveness of their individual HIV/AIDS programmes.
The main objective of this study was to evaluate an HIV/AIDS prevention programme at a South African university. The study investigated the university’s HIV/AIDS programme by comparing the programme against the HEAIDS framework. In order to ascertain programme effectiveness, stakeholders for whom the programme was designed were questioned on their experiences and perceptions of the university HIV/AIDS programme. Participants were asked to participate in a survey and were also interviewed.
The study adopted a mixed method approach, which used a dominant explanatory sequential approach. The quantitative phase of the study was conducted with a sample size of 739 respondents. The survey included four sections: Section A included demographic- related questions; Section B included questions on programme awareness; Section C comprised of questions relating to health management; and Section D focused on HIV/AIDS programme content. The qualitative phase of the study was conducted with a sample of 14 participants.
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The results of the findings revealed that attendance and awareness of Voluntary Counselling and Testing (VCT) has been confused with knowledge of the programme. Irrespective of participants’ awareness of VCT, results of the study revealed that the university under study showed a 68% participation in 2010. However, in 2013 the same university, through the current study, showed a drop in VCT participation from 68% to 40.9%. Qualitative responses confirmed that first year students enter the university HIV negative and exit HIV positive. The study further revealed that 65.4% of academics, 74.8% of administrative staff and 82.6% of students knew of the availability of VCT. However, these percentages, when compared to attendance at a voluntary counselling and testing session, revealed that 81.3% of academics did not attend voluntary counselling and testing, compared to 58.9% of administrative staff and 53.2% of students. Research suggests that students, administrative staff and academics in particular were not accessing VCT sessions at the university. HEIs should be concerned, while HIV/AIDS institutional offices, in particular, should revisit VCT with the intention of re-attracting student and staff participation. Overall, most participants were not aware of the programme, which suggests that the programme was ineffective.
This study contributes further knowledge to the emerging field of research, which relates to the evaluation of HIV/AIDS prevention programmes within universities and the presumption that having an established HIV/AIDS programme does not suggest that the programme is effective until evaluated. These findings may be utilised by programme co-ordinators to improve the current programme. The survey questionnaire, methodology and findings are the study’s contributions that would enable future researchers to investigate similar evaluations at other institutions within South Africa, and possibly Africa.
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TABLE OF CONTENTS Acknowledgements ii Dedication iii Abstract iv Chapter 1: Introduction to the study 1 1.1 Introduction 1 1.1.1 Background of the study 2 1.1.2 Statement of the research problem 5 1.1.2.1 Research question 5 1.1.2.2. Sub-questions 6 1.1.3 Objectives of the study 6 1.1.4 Motivation for the study 6 1.1.5 Delimitations of the study 7 1.1.6 Significance of the study 8 1.1.7 Current level of knowledge of the problem 8 1.2 Research design 13 1.2.1 Research approach 13 1.2.2 Theoretical framework 14 1.2.3 Research methodology 15 1.2.4 Research method 15 1.3 Data collection 16 1.3.1 Sampling 16 1.3.2 Ethical considerations 16 1.3.3 Data collection/procedure 16 1.3.4 Limitations 17 1.4 Quality assurance criteria 17 1.5 Summary 17 Chapter 2: Conceptualising HIV/AIDS 19 2.1 Introduction 19 2.1.1 Early spread of HIV 21 2.1.2 Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) 24 2.1.3 Symptoms related to HIV 25
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2.1.4 HIV and AIDS: fact or fiction 26 2.1.5 HIV prevalence in South Africa 40 2.1.6 Individuals living with HIV and AIDS 42 2.1.7 Significance of the HIV/AIDS stigma 44 2.1.8 HIV/AIDS and health care systems 50 2.1.9 HIV/AIDS and business 51 2.2 Summary 52
Chapter 3: HIV/AIDS within a higher education environment 54
3.1 Introduction 54 3.2. Workplace defined 54 3.2.1 Impact of HIV/AIDS in the workplace 55 3.3 HIV prevalence at the evaluated university 59 3.3.1 Higher education response to HIV/AIDS 60 3.3.2 Current level of HIV/AIDS awareness at the focussed university 63 3.3.3 Higher Education Institutions and HIV 65 3.4 HEAIDS submissions to avert the impact of HIV/AIDS within the university 67 3.4.1 Interventions undertaken by the university 69 3.4.2 An overview of an HIV/AIDS workplace programme 75 3.4.3 Higher education HIV and AIDS Programme (HEAIDS) 79 3.4.4 HIV/AIDS policy programme compared 81 3.4.5 Distinction between HIV/AIDS workplace programme policy 82 3.5 HEAIDS policy framework 84 3.5.1 Purpose and objectives of HEAIDS framework for HIV and AIDS workplace programmes 86 3.6 HIV/AIDS workplace programme 91 3.6.1 Institutional performance area 92 3.6.2 Effectiveness of HIV/AIDS programmes in HEI 94 3.6.3 Challenges that face HIV/AIDS programmes in HEI 95 3.7 Summary 98 Chapter 4: Research design and methodology 99 4.1 Introduction 99 4.2 Research approach 99 4.2.1 Theoretical framework 101
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4.2.2 Research methodology 104 4.2.3 Quantitative research method 105 4.2.3.1 Advantages and disadvantages of quantitative research method 106 4.2.3.2 Research methods in quantitative research 106 4.2.3.3 Paradigms in quantitative research 108 4.2.4 Qualitative research 109 4.2.4.1 Advantages and disadvantages of qualitative research 110 4.2.4.2 Research methods in qualitative research 111 4.2.4.3 Paradigms in qualitative research 112 4.2.5 Evaluation research 113 4.2.5.1 Purpose of evaluation 114 4.2.5.2 Importance of evaluation 115 4.2.5.3 Need to evaluate 116 4.2.5.4 Programme evaluation 116 4.2.5.5 Types of evaluation 117 4.2.5.6 Evaluation most suited to the research 119 4.2.5.7 Process/implementation programme evaluation 120 4.2.5.8 Advantages and disadvantages of selecting process/implementation evaluation 125 4.2.5.9 Paradigms in evaluation research 126 4.2.5.10 Research methods in evaluation research 126 4.2.6 Mixed method research 127 4.2.6.1 Advantages and disadvantages of mixed method research 127 4.2.6.2 Paradigms in mixed method research 128 4.2.6.3 Research methods in mixed method research 129 4.2.6.3.1 Explanatory sequential design 132 4.2.6.3.2 Rationale for choosing explanatory sequential design 136 4.2.6.3.3 Mixed method design 138 4.3 Research process 139 4.3.1 Research methodologies 139 4.3.2 Triangulation 140 4.3.2.1 Advantages and disadvantages of triangulation 142 4.4 Data collection 142
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4.5 Analysis 144 4.6 Data collection procedure 145 4.7 Questionnaires 145 4.8 Pilot study 147 4.9 Interviews 148 4.10 Document review 149 4.11 Population 149 4.12 Sampling 152 4.13 Ethical considerations 154 4.13.1 Quality assurance 155 4.14 Summary 156 Chapter 5: Data analysis 157 5.1 Introduction 157 5.2 Explanation of data 157 5.2.1 Frequency distribution 158 5.2.2 Cross tabulation 158 5.2.3 Chi-square test 159 5.3 Reliability and validity of data 159 5.4 Research results of the survey questionnaire 160 5.4.1 Demographic data 161 5.4.1.1 Gender representation of respondents 162 5.4.1.2 Number of respondents who participated in the programme 163 5.4.2 Respondents’ perceptions of the university’s HIV/AIDS programme 165 5.4.2.1 Availability of voluntary counselling and testing at the university 165 5.4.2.2 Attendance of voluntary counselling and testing sessions at the university 166 5.4.2.3 Availability of targeted programmes, practices or facilities 168 5.4.2.4 Practices or facilities outlined by the university’s HIV/AIDS programme 171 5.4.2.5 Practices or facilities effectively dealt with by the programme 172 5.4.2.6 Gender sensitivity and confidentiality 176 5.4.2.7 Peer support for HIV/AIDS infected academic, administrative staff and students 177
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5.4.2.8 Frequency of voluntary counselling and testing sessions 179 5.4.3 Respondents’ awareness of the university’s HIV/AIDS programme 181 5.4.3.1 Visibility of HIV/AIDS posters at the university 182 5.4.4 Effectiveness of the university’s HIV/AIDS programme 184 5.4.4.1 Reason to engage with the programme directly 184 5.4.4.2 Improvement of HIV/AIDS programme 185 5.4.5 Cross tabulation 187 5.4.5.1 Number of respondents who have participated in the programme and the availability of voluntary counselling and testing at the university 187 5.4.5.2 Number of respondents who have participated in the programme and gender sensitive and confidentiality 190 5.4.5.3 Number of respondents who have participated in the programme and had reason to engage with the programme directly 193 5.4.5.4 Reason to engage with the programme directly and attendance of voluntary counselling and testing sessions at the university 196 5.5 Analysis of interviews 198 5.5.1 Participants’ perceptions of the content of the university’s HIV/AIDS programme 199 5.5.2 Participants’ awareness of the university’s HIV/AIDS programme 200 5.5.3 Effectiveness of the university’s HIV/AIDS programme 205 5.5.4 Extent of the university’s HIV/AIDS programme conforming to HEAIDS programme 209 5.5.5 Qualitative data visualisation 210 5.6 Analyses of reviewed institutional documents 211 5.6.1 University’s HIV/AIDS workplace programme 214 5.6.2 HR wellness report 215 5.6.3 University’s IOHA policy booklet 215 5.6.4 University’s wellness programme for HIV infected students and staff 216 5.7 Summary 217 Chapter 6: Discussion of findings 218 6.1 Introduction 218 6.2 Demographic data related issues 218 6.3 Stakeholders’ perceptions of the university’s HIV/AIDS programme 219
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6.4 Awareness levels of HIV/AIDS at the university 226 6.5 Effectiveness of the university’s HIV/AIDS programme 229 6.6 University’s HIV/AIDS programme evaluated/compared 233 6.6.1 Compliance with the HEAIDS policy and strategic framework on HIV and AIDS for higher education 233 6.6.2 University’s HIV/AIDS workplace programme 235 6.6.3 HR wellness report 236 6.6.4 University’s IOHA policy booklet 237 6.6.5 University wellness programme for HIV infected students and staff 239 6.7 Limitations of the study 240 6.8 Significance of the findings 242 5.9 Summary 243 Chapter 7: Recommendations and conclusion 245 7.1 Introduction 245 7.2 Addressing the research objectives 245 7.3 Overview of findings 246 7.4 Recommendations 248 7.5 Conclusion of the study 252 References 261
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LIST OF TABLES
1.1 Research approach 14 2.1 Number of people living with HIV and AIDS in South Africa 42 3.1 HIV/AIDS workplace programme 2012 University of Johannesburg 69 4.1 Difference between research design and research methodology 100 4.2 Elements of worldviews and implications of practice 102 4.3 Alternative strategies of inquiry 105 4.4 Evaluation type 119 4.5 Steps and decisions in mixed methods data analysis explanatory sequential design 144 4.6 Student head count 151 4.7 Full time staff totals (University of Johannesburg, 2013, HEDA portal) 151 5.1 Percentage of respondents 161 5.2 Gender representation of respondents per category 162 5.3 Number of respondents per category who participated in the programme 164 5.4 Availability of voluntary counselling and testing at the university 165 5.5 Attendance of voluntary counselling and testing sessions at the university 167 5.6 Availability of targeted programmes, practices or facilities 169 5.7 Practices or facilities outlined by the university’s HIV/AIDS programme 171 5.8 Practices or facilities effectively dealt with by the programme 173 5.9 Gender sensitivity and confidentiality 176 5.10 Peer support for HIV/AIDS infected academic, administrative staff and students 178 5.11 Frequency of voluntary counselling and testing sessions 180 5.12 Awareness of the University HIV/AIDS programme 182 5.13 Visibility of HIV/AIDS posters at the university 183 5.14 Reason to engage with the programme directly 184 5.15 Improvement of HIV/AIDS programme 186 5.16 Number of respondents who have participated in the programme and the availability of voluntary counselling and testing at the university 188 5.16.1 Chi-Square 188 5.17 Number of respondents who have participated in the programme, and gender sensitivity and confidentiality 190 5.17.1 Chi-Square 191
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5.18 Number of respondents who have participated in the programme and had reason to engage with the programme directly 193 5.18.1 Chi-Square 194 5.19 Reason to engage with the programme directly and attendance of voluntary counselling and testing sessions at the university 196 5.19.1 Chi-Square 197 5.20 Frequently used words per category 211 5.21 Comparison of HEAIDS policy and strategic framework and the university’s HIV/AIDS workplace programme 213 5.22 Comparison of HEAIDS policy and strategic framework and the IOHA policy booklet 216
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LIST OF FIGURES
3.1 Impact of HIV/AIDS in the workplace 58 4.1 Horizontal organisational chart of the research process 101 4.2 Stages in questionnaire design 107 4.3 Theory of Change HIV/AIDS workplace programme pre- evaluation 121 4.4 Explanatory sequential design 130 4.5 Explanatory sequential design 131 4.6 Exploratory sequential design 131 4.7 Embedded design 132 4.8 Research process 140 5.1 Number of respondents 162 5.2 Respondents who participated in the programme and those who stated that voluntary counselling and testing was available at the university 189 5.3 Respondents who have participated in the programme and those who indicated that the programme addresses gender sensitive issues without compromising confidentiality 192 5.4 Respondents who participated in the programme and those who had reason to engage with the programme directly 195 5.5 Respondents who had reason to engage with the programme directly and those who attend voluntary counselling and testing sessions at the university 197 5.6 Interview word cloud 210 6.1 Limitations of the study 242 7.1 A glimpse of the journey covered 253 7.2 Theory of change HIV/AIDS workplace programme post evaluation 258
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LIST OF APPENDICES
Appendix A: Ethics approval 294 Appendix B: Request to assist with survey 295 Appendix C Questionnaire academic staff 296 Appendix D: Questionnaire administrative staff 304 Appendix E: Questionnaire students 312 Appendix F: Interview schedule for academic and administrative staff 320 Appendix G: Interview schedule for Programme Co-ordinators 325 Appendix H: Interview schedule for Students 330 Appendix I: Analysis of interviews 335 Appendix J: Analysis of interviews across participants 359 Appendix K: Published articles related to study 364 Appendix L: Conference presentations 409 Appendix M: Unpublished articles 415 Appendix N: Articles published under Professor Wilfred I. Ukpere’s supervision 478
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CHAPTER 1 Introduction to the study
1.1 Introduction It has been established (for now) that Acquired Immune Deficiency Syndrome (AIDS) has no cure. AIDS is caused by the Human Immunodeficiency Virus (HIV), which is a virus that gradually attacks the immune system. As the virus progressively damages the immune system, the body becomes vulnerable to opportunistic infections (Avert, n.d). It is only at the stage of progressive HIV infection that a person is diagnosed with AIDS. If left untreated, it can take up to a decade before HIV can develop into full blown AIDS (Avert, n.d, p1).
In 2010 approximately 280 000 South Africans died of HIV/AIDS according to Statistics South Africa (STATSSA) (2010, p.8). In the decade leading to 2010, between 42% and 47% of all deaths among South Africans were HIV/AIDS-related (STATSSA, 2010, p.8). According to the Human Science Research Council (HSRC), prevalence of HIV among South Africans who are over the age of 20 has increased (Setswe, 2009, p.20). Increased HIV prevalence rates amongst South Africans aged 20 years and above raises a concern regarding the prevalence rate of the epidemic in a similar age group within Higher Education Institutions (HEIs).
MacGregor (2009, p.1) points out that that South Africa had a gross higher education participation rate of 15.9% in 2007. Of the total 6.8 million young people in South Africa, 2.4 million, namely 35.3%, were studying. The highest proportions of students were 18-year-olds at 67.1% and 19-year-olds at 55.1% in 2011. Within this period the education participation rate increased by 0.1% (MacGregor, 2009, p.1; MacGregor, 2012, p.1). However, should the South African government’s Green Paper on Post-School Education and Training become a reality, the government’s six fold increase over current enrolment figures could pose a challenge to the management of HIV/AIDS within HEIs.
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Marwitz and Were-Okello (2010, p.5) and Saint (2004, p.8) agree that HIV/AIDS does pose a threat to students and employees alike, as illness and absenteeism affect productivity. The International Labour Organisation (ILO), through their research, has made the following predictions. There will “be about 24 million fewer workers in hard hit countries alone in the year 2020 as a result of the AIDS epidemic” (Marwitz & Were-Okello, 2010, p.5). The labour force will be “10-22% smaller in those countries with prevalence rates higher than 10% than it would have been if there had been no HIV/AIDS by the year 2020” (Marwitz & Were-Okello, 2010, p.5). Years earlier, the ILO issued the Code of Good Practice (ILO/AIDS, 2001, p.15) in consultation with business, worker organisations and governments around the world. The recommended practice is that an HIV/AIDS workplace policy and programme would assist in the mitigation of the epidemic. South Africa, being a member of the ILO, has established a similar code, namely the Code of Good Practice on Key Aspects of HIV/AIDS and Employment (Employment Equity Act 55 of South Africa, 1998). The South African Code of Good Practice complements the ILO code and confirms the need for organisations to implement an HIV/AIDS workplace policy and programme.
A well planned HIV/AIDS policy outlines or describes how a particular organisation, institution or business will manage HIV/AIDS within the workplace. Conversely, the HIV/AIDS workplace programme outlines how the different principles of the policy will be transformed into practice (Africa Centre for HIV/AIDS, 2007, p.11). The intention of the HIV/AIDS workplace programme is to implement an action plan within an organisation to prevent new infections, provide care and support for infected or affected employees, and manage the impact of the epidemic on organisations (Africa Centre for HIV/AIDS, 2007, p.11).
1.1.1 Background of the study
Higher Education Institutions (HEIs) are a replication of a larger society, and consist of academic and administrative staff, including students who reside and study at the institution (Saint, 2004). The unique infrastructure of HEIs allows for greater interaction amongst students, academics, administrative staff (admin staff) and external stakeholders. “University campuses constitute a potentially fertile
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environment for the spread of HIV/AIDS. They bring together, in close physical proximity devoid of systematic supervision a large number of young adults at their peak years of sexual activity and experimentation. Combined with the ready availability of alcohol and perhaps drugs, together with divergent levels of economic resources, these circumstances create a very high risk environment from an AIDS perspective” (Saint, 2004, p.6).
These interactions pose both a challenge and an opportunity to the management of HIV/AIDS. The challenges arise in the maintenance of low HIV/AIDS prevalence within the university. This is often influenced by the nature and sexual behaviour of students. The opportunity lies in the possibility for such a workplace to participate in building the capacity of trained personnel who can “drive local economies, support civil society, teach children, lead effective governments and make decisions that affect society”, and address national issues (Higher Education South Africa (HESA), 2006, p.1). The potential risks to students at HEIs, according to Phaswana-Mafuya and Peltzer (2005, p.2), are intensified by the liberal atmosphere, which is characterised by HEI campus cultures, which is open to practices and lifestyles that may facilitate the spread of HIV/AIDS. The HEIs are not only teaching institutions. To a large degree, the role of universities also extend to research and the distribution of findings. Therefore, HEIs have a twofold role to protect students’ health, as well as conduct research that will contribute to an increased understanding of the epidemic.
Essentially, the commitment to address the spread of HIV/AIDS in the HEI environment is based on two important facts. Firstly, “there is reason to believe that the epidemic may claim lecturers, researchers, managers, and a significant number of employees from HEIs” (Chetty & Michel, 2005, p.77). Secondly, HIV/AIDS has a direct influence on student development, as students represent a source of future skills, and a knowledge base. An HIV prevalence and knowledge, attitude, behaviour and practice study was undertaken by the Higher Education HIV/AIDS Programme (HEAIDS), which involved 17062 students, 1880 academics, and 4433 dministrative and service staff at 21 of the 23 public HEIs. The study revealed that “HIV
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prevalence rate increased as students grew older. Other findings reveal a link between HIV prevalence and sex with older partners” (Dell, 2010, p1).
According to Dell (2010, p, 1), “the study found students' lack of knowledge of some aspects of HIV prevention. ‘Inadequate’ answers were given to questions relating to transmission of HIV through breastfeeding, availability of drugs for post-exposure prophylaxis in the case of rape and the legality of sex with partners younger than 16. Universities of South Africa have identified five important reasons why tertiary institutions should explicitly engage the challenge of HIV/AIDS”. Saint (2004, p.8) concurs that these reasons are fitting for other African tertiary institutions as well, and include the following: HIV/AIDS is a development issue, and not merely a health issue; it affects the communal, economic, and emotional wellbeing of individuals and communities; it affects a country’s ability to cope with economic and political development; it is, therefore, a pertinent topic for university inquiry; and HIV/AIDS affects not only individuals, but institutions as well. Tertiary education institutions are susceptible to the negative impact of HIV/AIDS on their functions as managers, teachers, researchers’, and community care givers.
HIV/AIDS directly impacts the need and possibilities for human resource development. Tertiary level educators are supposedly the most skilled individuals within most economies, and tertiary students are particularly susceptible to infection. The loss of the most intellectually valuable and productive citizens in the economy are in danger (Saint, 2004). The response to HIV/AIDS requires new understanding and knowledge. Universities are mandated with the mission to produce new technologies, practices, and knowledge by using research as a tool. These offerings are necessary when assisting African countries to avert and manage HIV/AIDS. The AIDS response requires better governance. Leadership is traditionally generated at tertiary level academics, and their students are among the pool of future leaders of their communities, hence their active involvement is necessary when considering development, action planning and responses related to the HIV/AIDS epidemic.
In addition to the five reasons identified by Saint (2004, p.7), the Association of Commonwealth Universities (ACU) has observed that practical financial reasons
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should motivate institutional managers to recognize and tackle the threat of HIV/AIDS. The ACU (2001) has documented that one university from Southern Africa reported spending 10% of its recurrent budget on AIDS-related expenses such as funerals, death benefits and health care (ACU, 2001; Saint, 2004, p.7). The indirect costs unbeknown to the university can be substantial. They include lost productivity owing to staff illness and absenteeism, loss of human resources through death or prolonged illness, loss of institutional and academic expertise, and the cost of recruiting, training and inducting replacement staff. Similarly the death of students increase financial burden on universities, as shown in the following text: “financial losses when student loans are not repaid due to illness or death, the loss of public and family investment when a student is forced to drop out of school for AIDS- related reasons, higher insurance premiums, and increased death benefits and funeral expenses for staff” (Bollinger & Stover, 1999; ACU, 2002). Hence, the above reasons comprise a compelling argument in favour of a clear involvement with HIV/AIDS challenges, which HEI face.
1.1.2 Statement of the research problem The emergence of the need for workplace policy has resulted in a barrage of HIV workplace policies, which have saturated the workplace. HIV consultants are liable for vending HIV tool kits and ‘Do It Yourself’ (DIY) policy bundles, which overwhelm policymakers. The ILO has made recommendations about points, which policy and decision makers should consider in the development of national policies and programmes on HIV/AIDS. Policy makers have yet to question why a model HIV policy has not been agreed upon. Over-saturation of ineffective HIV policy may cause delay and prevent the implementation of an effective policy. Higher Education HIV/AIDS Programme (HEAIDS), in conjunction with HEIs and the government, have undertaken to implement HIV/AIDS workplace programmes within universities in South Africa. However, policymakers have not yet been able to establish the effectiveness of most of the policies and programmes.
1.1.2.1 Research question The above statement led to the main research question below:
How effective is the university’s HIV/AIDS programme?
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1.1.2.2 Sub-questions
What are the current types of HEAIDS HIV/AIDS programmes at the university?
Does the university’s HIV/AIDS programme conform to the HEAIDS programme?
What are stakeholders’ (students, academic and administrative staff) perceptions of the content of the university’s HIV/AIDS programme?
Are stakeholders aware of the university’s HIV/AIDS programme?
1.1.3 Objectives of the study The main objective of the study is:
To determine the effectiveness of the university’s HIV/AIDS programmes. Subsidiary objectives of the study are:
To examine and evaluate the university’s HEAIDS HIV/AIDS programmes.
To compare the extent that the university’s HIV/AIDS programme conforms to the HEAIDS programme.
To understand stakeholders’ perceptions of the content of the university’s HIV/AIDS programme. To critically examine stakeholders’ awareness of the university’s HIV/AIDS programme.
1.1.4 Motivation for the study The motivation for the study is to gain insight into the complexities of existing university HIV/AIDS workplace programme/s and to evaluate the effectiveness of such a programme. Motivation for the study is further supported by the following three reasons. Firstly, it is to create greater awareness of HIV/AIDS in the workplace, with special emphasis on the HEIs. Growing evidence suggests that education is one of the best preventative methods against HIV infection, as it enables young people with invaluable tools that increase self-confidence, and life and negotiation skills to improve earning potential and family well-being, which in
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turn, fights poverty and promotes economic and social progress. Creating greater awareness of the epidemic would help to decrease HIV/AIDS infections within the university.
Secondly, it is to improve stakeholders’ (staff and students) awareness of the HIV/AIDS programme and to move from superficial awareness to non-superficial awareness (Ossimitz, 2000, p.4). Stakeholder awareness is imperative, by empowering stakeholders with information pertaining to HIV/AIDS programme content, stakeholders would be equipped with a resource that informs them about the consequences of the disease and support structure that is available within the university. Improving stakeholder non-superficial awareness about the HIV/AIDS programme would facilitate stakeholder awareness regarding possible recourse in the event of infection.
Thirdly, it is to evaluate the HIV/AIDS programme at the university; and as a means to determine the contribution of the programmes to reduce the impact of the epidemic. Evaluation is an important part of any workplace HIV/AIDS programme, as it enables an organisation to measure its progress against its specified goals and, therefore, make informed decisions about the effectiveness of various interventions. Effective evaluation of HIV/AIDS programmes would inform policymakers about the efficacy of the programme, which should allow for improvement.
1.1.5 Delimitations of the study The study was undertaken at one of the 23 universities in South Africa. According to the Southern African Regional Universities Association (SARUA) (2006), this university has established an HIV/AIDS programme. The programme has been described by SARUA (2006) as socially responsible, as it includes an informed definition of HIV/AIDS, consideration of methods of transmission, support for condom distribution, counselling at a campus clinic, and consideration of education and changes to the curriculum. The university has an established on-site VCT service, which is offered to both staff and students for counselling and testing. “The initial consultation is free. There is also an established Student Peer Education programme that is run by the institution and overseen by Student Services. The
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institution launched its workplace programme in September 2003. The target audience includes academic, administrative and support staff” (SARUA, 2006).
1.1.6 Significance of the study Evaluation is too often an afterthought in the process of programme implementation (Whetten, 1989). Policymakers should answer three simple but important questions, which follow. Are they addressing the concern effectively? Are they implementing the programme satisfactorily? Are they undertaking the programme on a large enough scale to make a difference? Answering these questions will allow programme managers to decide how and when to modify existing programmes, or to design new ones.
As society moves into the third decade of this epidemic, it is incumbent upon policymakers to demonstrate their efforts. Evaluating HIV/AIDS programmes is important to improve current HIV/AIDS programme interventions. This may help to enhance the success of future initiatives. Programme evaluation enables policymakers to systematically collect, analyse and use information to answer questions based on the programme, particularly programme effectiveness and efficiency. Programme evaluation is intended to advise policymakers, programme formulators, implementers and evaluators of the most effective information to improve their programme. This in turn informs stakeholders who will want to know if the programme that they are funding, implementing, electing, receiving or challenging, is indeed having the envisioned effect. Therefore, the significance of programme evaluation is to evaluate the programme and to determine if the programme had the desired outcome. Hence, this should “clearly demonstrate the newness of its contribution; argue the impact that its contributions would have on research practice and provide compelling logical or empirical evidence for the new explanations provided” (Whetten,1989, p.494).
1.1.7 Current level of knowledge of the problem In 2006 the Southern African Regional Universities Association (SARUA) commissioned a study on institutional responses to HIV/AIDS from institutions of higher education in the Southern African Development Community (SADC). The
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report compared, analysed and summarised findings on institutional responses to HIV/AIDS from public institutions. SARUA reported that of the 23 HEI in South Africa, 22 institutions had some variation of an HIV/AIDS programme. These programmes in most instances, were voluntary counselling and testing (VCT) initiatives, which were attached to wellness centres based within the institution. Of the 23 institutions that were surveyed, nine institutions had established a skeletal HIV/AIDS programme, whilst the remaining 13 had established VCT initiatives. One of the institutions had not established a policy (SARUA, 2006).
Current level of knowledge as at 2011 suggests that “globally, while knowledge about HIV and safer sexual behaviour among young people has improved, only 34% of young people have comprehensive and accurate knowledge of HIV” (United Nations Educational, Scientific and Cultural Organisation (UNESCO), 2011, p.11). Besides having knowledge about HIV/AIDS, no HEI in South Africa can claim to have an all-inclusive workplace programme, although all have established some components (HEAIDS, 2010). Following a situational analysis, which was later validated during consequent institutional planning workshops in 2009 (HEAIDS, 2010), analysts gathered that firstly, “no formal coordinated workplace programme actually existed in any HEI”. Elements that may be considered as an aspect of a workplace programme were typically disjointed across different departments and individuals at the other end of the scale, while several HEIs have almost no functioning programme for employees. Secondly, and more importantly, there is a scarcity of data in most HEIs because of the weakness or complete absence of any monitoring and evaluation system. “There is little evidence that the programmes are sufficiently supported or resourced and there is very little monitoring and evaluation occurring” (HEAIDS, 2010a).
Therefore, the way forward according to HEAIDS (2010a), is that each HEI should develop a monitoring and evaluation strategy, including a set of reporting lines. HEAIDS’ (Soudien, 2012, p.5) core purpose is to “develop and strengthen the capacity, systems and structures of all Higher Education Institutions (HEIs) to prevent, manage and mitigate the causes, challenges and consequences of HIV/AIDS” . HEAIDS advocates that Higher Education (HE) in South Africa has a
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vital role to play in mitigating and managing the effects of the HIV/AIDS epidemic through all facets of its core operations of teaching, learning, research and community engagement. With this purpose central to its initiative, HEAIDS has identified the components of a comprehensive HIV response in relation to the teaching, training, research, community engagement and service functions of HEIs. The list of comprehensive responses, as set out by HEAIDS, includes the following initiatives: outlining the roles and responsibilities for the development of HIV/AIDS policy; human resource capacity; and development of human resource systems and guidelines of rules and standards to acquire funding. This would include recognizing and clarifying the roles of educators and teachers within education faculties. This would also include the identification and replication of benchmarks with respect to prevention, behavioural change, care and support, gender and curriculum integration. This would be accompanied by the support and reinforcing of new knowledge, integration and dissemination of this knowledge with respect to HIV and AIDS.
HEAIDS asserts that HEIs must, as employers, “recognise the potential impact of HIV/AIDS on both infected and affected employees and design policies and programmes to prevent/reduce infection rates and mitigate its impact on employees and the institution. Secondly, as institutions of teaching, learning, research and knowledge generation contributing to the next generation of future workers, managers and business leaders, HEIs need to develop proactive strategies focusing on prevention and on prolonging life through quality treatment, care and support to protect the investment capital that institutions are expending in preparing potential graduates for the open labour market” (Soudien, 2012, p.6).
The University of Cape Town (UCT), for instance, has adopted these core initiatives, categorising each response within four criteria: the first criterion involves, leadership, policy, management and service provision, the second criterion involves, curriculum responsiveness; the third criterion involves, research development; and the fourth criterion involves, social responsiveness, consulting and materials development. The purpose of the 2011 survey of HIV and AIDS initiatives at UCT was to establish a comprehensive record of the institutions response to the epidemic. Findings have
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been summarised from an annual planning exercise, which was conducted by the HIV/AIDS Institutional Coordination Unit (HAICU), which is part of the Transformation Services Office (TSO), based within the Office of the Vice- Chancellor (OVC). This comprehensive exercise affirms UCT’s commitment to the HEAIDS’ core responses by effectively addressing HIV/AIDS within the institution.
Between 2008 and 2009 HEAIDS conducted a study with the objective to reinforce HIV/AIDS prevention in the public higher education sub-sector in South Africa by recognising and disseminating benchmarks, HIV/AIDS prevention models and interventions. 23 HEIs were stratified into Universities and Technical Universities. Of the 23 HEIs, nine potential Good Practice institutions was purposefully selected (6 Universities and three Technical Universities). The selected HEIs included six universities: Stellenbosch University (SU), University of Johannesburg (UJ), University of Venda (UNIVEN), University of the Western Cape (UWC) and University of Witwatersrand (WITS), plus University of Pretoria (UP), which was described separately; and three Universities of Technology: Cape Peninsula University of Technology (CPUT), Durban University of Technology (DUT) and Tshwane University of Technology (TUT). In all the selected HEIs, except one, the foundation of HIV prevention was Peer Education (PE) and Voluntary Counselling and Testing (VCT). At WITS and PE VCT plays a far less noticeable role; VCT is used mainly to create awareness. It was also found that there is no directly academically led, large scale behaviour change counselling programme at any HEI; and Life Skills and Resiliency Training are mostly basic, limited, and undertaken by peer educators. VCT, undoubtedly, is of a high quality and the Campus Health Centres are well equipped (HEAIDS, 2010a, p.19).
The study concluded that VCT campaigns that were carried out at most HEIs seem mostly effective in attracting students. Thus the majority of VCT are undertaken during campaign periods. PE is also of a high quality at many of the selected HEIs (HEAIDS, 2010a, p.20). Most HEIs report that there are too few resources available for monitoring. Monitoring primarily consists of recording attendance at VCT, condom distribution, STIs, pregnancies and emergency contraceptives, as well as recording some PE activities. HEAIDS reported that little social science research
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into prevention activities, the student population, or the population in the surrounding community was reported (HEAIDS, 2010a, p.21).
Some universities embark on community activities, but they generally institute minor aspects. These are in-school activities such as the UWC’s school programme and other types of linkages, for example, those, that were established by the Link Project at UJ (HEAIDS, 2010a, p.21). The University of Zululand (UNIZL) places great emphasis on community outreach activities. The HIV programmes “recognises the great importance of the social norms of the community from which the students come” (HEAIDS, 2010a, p.27). At the University of The Free State (UFS) Community Focused Support is one of six key components of its HIV/AIDS strategy, which the farming community. The University of Pretoria-based Centre for the Study of AIDS (CSA) is an exception to the study, as the centre has been applauded for its initiative as a pioneer, or rather the face of HIV/AIDS work in South Africa. UP’s initiative is far more advanced than many other HEIs, which in many ways sums up the ideological position of the CSA regarding the conceptualisation and implementation of interventions for the prevention and management of HIV/AIDS (HEAIDS, 2010a, p.23).
Community involvement, according to HEAIDS (2010, p.31), is necessary for Higher Education Institutions to impact communities and make contributions with regard to HIV/AIDS awareness and social development. Good practices in community outreach were found at UFS and UNIZL. The HEAIDS (2010a, p.38) research has shown a fairly consistent approach to HIV prevention at the selected HEIs in which peer education and VCT are important components, and where curriculum integration is also gradually being introduced. Efforts at counselling for behaviour change, life skills and resiliency training, were lacking, as these components, according to HEAIDS (2010a, p.38), are important and necessary for a prevention programme. “By applying international good practices, it has been shown that such interventions are most effectively undertaken if guided by theory, including both individual-focused models and sociocultural theories, and carried out by professionals with backgrounds and experiences in behaviour change” (HEAIDS, 2010a, p.38). The study identified areas that HEIs should consider to improve their
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HIV/AIDS initiatives through theory-driven programming, which is equipped with well-trained staff that will result in improvements, enhancements, and expanded programmes (HEAIDS, 2010a, p.39). Stronger monitoring and evaluation systems will result from a more theory based approach, which is an area that is lacking in most institutions. A National HEI monitoring system should be established. Student counselling units and community involvement should be strengthened; this could take on a more important role in HIV prevention.
HEIs are gradually implementing HIV/AIDS workplace programmes (Marwitz & Were-Okello, 2010). On completion of an HIV/AIDS prevalence study, which was conducted in 2008-2009 at the university under study HEAIDS suggested that a comprehensive evaluation of the university’s HIV/AIDS policy should be undertaken. The current level of knowledge regarding the university being researched is that the university has an established HIV/AIDS programme, which has not been evaluated.
1.2 Research design A research design is a procedural plan that is adopted by the researcher who intends to base the investigation on the supposition that collecting varied categories of data best provides an understanding of the research problem. The research design, therefore, answers questions that would determine the path that a researcher would take during the research journey (Kumar, 2010, p.389). There are three questions that are central to research design that informs the approach to the research. “What knowledge claims are being made by the researcher? What strategies of inquiry will inform the procedures? What methods of data collection and analysis will be used?” (Creswell, 2003; Creswell, 2013, p.244). These questions, in turn, are translated into approaches in the research design.
1.2.1 Research approach
The research approach is guided by questions, which are set out under the heading research design. The table below sets out the approach that was followed.
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Table 1.1: Research approach
Objective Question Methodology Method Analysis
1 To examine and evaluate the Qualitative Content Content analysis university’s HEAIDS HIV/AIDS review, programme at the university (programme,
policy and additional literature)
2 To compare the extent that the Qualitative One-on-one Thematic analysis, university’s HIV/AIDS programme interviews, Content analysis, conforms to the HEAIDS Content programme. review , (programme, policy and additional literature)
3 To understand stakeholders’ Mixed Survey SPSS (descriptive perceptions of the content of the (quantitative questionnaire statistics, thematic university’s HIV/AIDS programme. and , one-on-one analysis qualitative) interviews
4 To critically examine Mixed Survey SPSS (descriptive stakeholders’ awareness of the (quantitative questionnaire statistics, thematic university’s HIV/AIDS programme and , one-on-one analysis qualitative) interviews
1.2.2 Theoretical framework
The knowledge claims, also known as the research paradigm or worldview (Lincoln & Guba, 2000; Creswell, 2013 (as seen in Creswell, 2003); Rocco, Bliss, Gallagher & Perez-Prado, 2003; and Mackenzie & Knipe, 2006) are the researcher’s beliefs about reality, and knowledge and values that guide and frame the research methods (Rocco et al., 2003). The paradigm that is most influenced by the research question is the pragmatism paradigm. The pragmatism paradigm, as stated by Creswell (2003), is not committed to any one system of philosophy and reality. Therefore,
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making pragmatism suitable for mixed methods research allows the researcher to draw liberally from both quantitative and qualitative methods. Pragmatism approves freedom of choice. Researchers are free to choose the method, techniques, and procedures of research that best meet their needs to answer the research question. Thus, in mixed methods research, researchers use both quantitative and qualitative data because they work to provide the best understanding of a research problem (Creswell, 2013; (as seen in Creswel, 2003, p.13). Pragmatism is conducive to multiple methods, different worldviews, and different traditions, as well as to different forms of data collection and analysis within a mixed methods study. The researcher intends to rely on the pragmatism paradigm as a framework for the research design.
1.2.3 Research methodology Research methodology may be described as the path to finding answers to the research question (Kumar, 2010, p.18). Thus, when a researcher talks of research methodology the researcher not only considers the research method that will be used, but also the appropriateness of the chosen method. The type of methodology that is selected, for example, a mixed methodology, would determine the choice of method and techniques, which are required in the collection and analysis of data. Therefore, a method unlike research methodology and design is more specific.
1.2.4 Research method Research methods include techniques of data collection and analysis such as a quantitative standardised instrument or a qualitative theme analysis of text data (Creswell, 2003). The method that was used is a mixed methods approach: “pragmatic knowledge claims, collection of both quantitative and qualitative data sequentially” (Creswell, 2003, p.21). The study began with a broad survey in order to generalise findings to a population and then focused on a second phase, namely detailed qualitative, semi structured interviews, which were used to collect detailed views from participants within the sample population.
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1.3 Data collection Data collection consists of several phases. These phases include sampling procedures, authorisations, type of statistics collected, forms to record the data and activities involved in managing the data collection. Each phase is discussed individually for both qualitative and quantitative data collection prior to discussing mixed methods data collection in its entirety.
1.3.1 Sampling In order to address the research question, the researcher should decide on which group of individuals and research sites can best provide information, which is required to answer the research question. This enables a sampling procedure that will determine the number of individuals that will be needed to provide data (Creswell, 2003, p.112). In a quantitative research method, the intent of sampling is to choose individuals who are representative of a population so that the findings can be generalised to the population. The university that was evaluated in this instance is the identified population. The researcher relied on random sampling. This type of sampling involved randomly choosing individuals from within the nine faculties. In qualitative research, the researcher will purposefully select individuals that can provide the necessary information. Purposive sampling means that researchers purposefully select participants who have knowledge with regard to facets that are studied or explored (Creswell, 2003).
1.3.2 Ethical considerations
The University Ethics Committee has granted the researcher permission and authorised the proposed research, which permitted the quantitative survey that was conducted at the university (see appendix A). Qualitative interviews were conducted in confidence by assuring the interviewees’ anonymity. The interview schedule prescribed interviewee rights, and each interviewee was informed of his or her rights regarding confidentiality before commencement of the interview.
1.3.3 Data collected/procedure
In the sequential explanatory approach the quantitative data is first collected, while the findings inform the second qualitative form of data collection. In this type of data
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collection the quantitative and qualitative data collections are related to each other and are not independent. One, therefore, builds on the other. The quantitative data collection relied on the survey questionnaire. The qualitative data collection depended on a semi-structured questionnaire that was utilised within focus groups and one-on-one interviews. This phase would serve as both a triangulation and validity tool.
1.3.4 Limitations Sequential data collection raises some issues. For instance, the researcher had to decide if the “same individuals should be sampled in the qualitative and quantitative phases, if the sample sizes should be the same, the criteria for selecting results to use in the follow-up phase, and how to design an instrument that will yield valid and reliable scores from initial qualitative data” (Creswell, 2003, p.126), which was anticipated as a possible limitation. The researcher overcame this limitation by piloting questionnaires with a smaller sample within the larger quantitative sample. This ensured that the same individuals were sampled in the qualitative and quantitative phases of the study.
1.4. Quality assurance criteria
A quality assurance criterion in research comprises all the techniques, strategies and resources that are utilised to afford assurance about the care and control with which the research has been conducted. These may include the responsibilities that are involved in the transparent research planning, documentation of procedures and methods of handling questionnaires and data. Strategies, which ensure quality, were implemented to further the commitment to quality assurance. Quality assurance was supported by triangulation of methods and content validity
1.5. Summary
As HIV/AIDS targets the most vulnerable, the increase in prevalence rates among young adults is disturbing. Despite the profusion of prevention initiatives, individuals continue to be infected by HIV. The epidemic, which originally raised concern when it first surfaced among middle class gay men in the United States of America has since entrenched its presence in sub-Saharan African (Parker & Aggeleton, 2000).
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The destruction effected by the epidemic has shifted towards the young and working age population (Phaswan-Mafuya & Peltzer, 2005). This concern has transcended households and permeated workplaces and institutions of learning. The age group, which is most affected by the epidemic feeds into the workplace, including institutions of higher education. This introductory chapter focused on the background of the study, the research problem, objectives’ of the study, motivation for the study, research design, data collection and quality assurance. Increases in prevalence rates are resultant to a lack of awareness regarding the disease. This has a direct impact on the youth which in turn impacts the economy. Increased absenteeism in the workplace results in a drop in productivity. Increased absenteeism within HEIs results in a needless strain, which is placed on academic and administrative staff, and results in inefficient HEIs with fewer professionals entering the workplace. Indifference towards the existence of HIV/AIDS within the workplace and HEIs amounts to cultivating a potentially poor and weak workforce.
Implementation of a workplace programme, as suggested by ILO, UNAIDS and the government is introduced as a shroud for compliance. Programme implementers affect programmes with the intention to comply rather than to impact change. This study presents an opportunity to evaluate an HIV/AIDS programme in a university in order to determine the effectiveness of institutional HIV/AIDS programmes, and to contribute to the implementation of similar evaluation at other HEIs. Although implementing prevention programme efforts at HEIs directly reaches only a small proportion of the total adult South African population, however, every student who is made aware is one less student who can become infected. The study’s focus now shifts to the literature review in Chapter 2, entitled: Conceptualising HIV/AIDS.
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CHAPTER 2 Conceptualising HIV/AIDS
2.1. Introduction HIV/AIDS or HIV and AIDS, which should it be? These terms are often used synonymously. Language shapes beliefs and may influence behaviours based on this concern UNAIDS’ (2011, p.4) preferred terminology has been developed for use by staff members, colleagues in the Programme’s 10 Co-sponsoring organisations, and other partners who are working in global response to HIV. Considered use of suitable language has the power to effect positive change. The suggested use of the preferred terminology HIV/AIDS and HIV and AIDS is to “use the term that is most specific and appropriate in the context to avoid confusion between HIV (a virus) and AIDS (a clinical syndrome). Examples include ‘people living with HIV’, ‘HIV prevalence’, ‘HIV prevention’, ‘HIV testing and counselling’, ‘HIV-related disease’, ‘AIDS diagnosis’, ‘children orphaned by AIDS’, ‘AIDS response’, ‘national AIDS programme’, ‘AIDS service organisation’ both ‘HIV epidemic’ and ‘AIDS epidemic’ are acceptable, but ‘HIV epidemic’ is a more inclusive term” (UNAIDS, 2011, p.5).
UNAIDS (2011, p.6) recommends that AIDS should be understood as an epidemiological definition based on clinical signs and symptoms. AIDS is often referred to negatively as a ‘deadly, incurable disease’; this may often create distress and increase stigma and discrimination. “It has also been referred to as a ‘manageable, chronic illness, much like hypertension or diabetes’, but this may lead people to believe that it is not as serious as they thought. It is preferable to use the following description: AIDS is caused by HIV, the human immunodeficiency virus. HIV destroys the body’s ability to fight off infection and disease, which can ultimately lead to death. “Antiretroviral therapy slows down replication of the virus and can greatly enhance quality of life, but does not eliminate HIV infection” (UNAIDS, 2011, p.6). The use of the term ‘immune deficiency’ is not recommended as it harbours negative connotations that often lead to stigma. Human immunodeficiency virus (HIV) is the virus that weakens the immune system, therefore, referring to the disease as the HIV virus is redundant, hence, one should simply refer to the disease as HIV.
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The expression HIV/AIDS, according to UNAIDS (2011, p.14), should be avoided whenever possible because it can cause confusion. “Most people with HIV do not have AIDS. The expression ‘HIV/AIDS prevention’ is also unacceptable because HIV prevention entails correct and consistent condom use, use of sterile injecting equipment, changes in social norms, etc., whereas AIDS prevention entails cotrimoxazole, good nutrition, isoniazid prophylaxis (INH), excreta” (UNAIDS,2011, p.14). Hence, it is appropriate to use the term that is unambiguous and suitable within the context. Examples include people living with HIV, HIV prevalence, HIV prevention, HIV testing, HIV associated disease, as well as “AIDS diagnosis, children made vulnerable by AIDS, children orphaned by AIDS, AIDS response, national AIDS programme, and AIDS service organisation. Both HIV epidemic and AIDS epidemic are acceptable, but HIV epidemic is a more inclusive term” (UNAIDS, 2011, p.14).
A similar type of word confusion may arise with the use of the terms epidemic and pandemic. A large-scale epidemic across entire regions, continents, or the whole world is sometimes called a pandemic, but this term is imprecise. “Preferred usage is to use ‘epidemic’ while being specific about the scale that is being considered: local, country, regional, and global” (UNAIDS, 2011, p.22). “An epidemic is an unusual increase in the number of new cases of a disease in a human population” (UNAIDS, 2011, p.10). The population may include the entire populaces of a given geographic area, the population of a school or similar institution, or everyone of a certain age or sex such as the children or women of a region. According to UNAIDS (2011, p.10), deciding whether an escalation in the number of cases constitutes an epidemic is somewhat subjective; depending in part on what the usual or expected number of cases would be in the observed population. An epidemic may be restricted to one local outbreak, may be a more general epidemic, or be a global pandemic. “Common diseases that occur at a constant but relatively high rate in the population are said to be ‘endemic’. Widely known examples of epidemics include the plague of mediaeval Europe known as the Black Death, the influenza pandemic of 1918–1919, and the current HIV epidemic, which is increasingly described as a pandemic made up of distinct types of epidemics in areas across the globe”
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(UNAIDS, 2011, p.10). For the purpose of commonality, the researcher uses the term HIV/AIDS, unless referring to either HIV or AIDS specifically. With the clarification of terms in place, it is necessary that one understands the origin and spread or direction of the virus.
2.1.1 Early spread of HIV
One of the first documented cases of HIV was in the United States of America (USA). HIV, the virus, was first labelled in 1981 among two groups, one in San Francisco and the other in New York City. Many young homosexual men showed signs of opportunistic infection, which in the 1980’s were characteristically associated with severe immune deficiency: Pneumocystis Pneumonia (PCP) and aggressive Kaposi Sarcoma (Morbidity Mortality Weekly, 1981, p.305). HIV the virus, which is commonly known today, was yet to be identified for another 2 years. During the two year gap at the time, various other causes for the so-called disease were considered, including lifestyle factors, chronic drug abuse, and other infectious agents (Ascher, Sheppard, Winkelstein, & Vittinghoff, 1993, p.103). The indiscriminate aggressive HIV epidemic spread swiftly and silently in the absence of testing and awareness.
However, no clear clinical inferences were made before the disease became known to communities, prior to the recognition of HIV, and only one case of Pneumocystis Pneumonia, which was not clearly associated with immune suppression, was diagnosed in the United States between January 1976 and June 1980 (Ascher et al., 1993, p.103). In 1981 alone 42 cases were established, and by December 1994, 127 626 cases of Pneumocystis Pneumonia with HIV infection were identified as the only cause of immune suppression that had been reported to the Centres for Disease Control and Prevention (CDC). This included Kaposi Sarcoma, which is up to 30 000 times more likely to develop in persons with HIV infection than in immune competent persons (Ascher et al., 1993, p.103).
In Africa the spread of HIV was, in hindsight, shown to follow trucking routes. “Logging camps, and the bush-meat trade combined with aggressive logging and improved transportation in the mid-20th century may have allowed what was likely
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occasional cross-species transmission events to propagate across the country and, eventually, the globe” (Korber, Muldoon, Theiler, Gao, Gupta, & Lapedes, 2000,p. 1789-1796; Timberg & Halperin, 2012, p.31). Timberg and Halperin (2012, p.30) confirm Korber’s et al., (2000) theory and adds that strains of HIV migrated from Cameroon down into other parts of central Africa and then into Leopoldville, which is now called Kinshasa. Leopoldville was a Belgian territory and by 1920 had become the capital of the Belgian Congo (Belgian Congo, 2012, p.1; Buelens, 2012, p.16). With the onset of World War II, the Belgian Congo experienced an increase in imports, which triggered an increase in the need for raw material. Subsequently, as imports increased, wages and consumption began to increase. The arrival of industrialisation attracted new manufacturing activities and the establishment of factories, shipyards, railways and single-sex dormitories for workers who were thrust into urban living conditions (Timberg & Halperin, 2012, p.54; Buelens & Cassimon, 2012, p.16).
In 1960 the Belgians left Congo, returning independence to the Congolese. Timberg and Halperin (2012, p.64) estimate that at the end of colonisation about 1 000 to 2 000 people were likely to have been infected with HIV. The manner in which HIV mimics other common viral infections (Fan, Conner, & Villarreal, 2011, p.56) often confuses the untrained, allowing for the virus to pass undetected. Measures for early detection were non-existent. Pepin (2001, p.166) expounds on Timberg (2012) and Buelens’(2012) theory that once the virus reached Leopoldville-Brazzville, conurbation the virus would have found a perfect opportunity for its intensification through non-sterile syringes and needles at the Dispensaire Antivenerien in the Barumba district of Leo-East. “The unknowingly infected inhabitants of Kinshasa mingled with U.N. aid workers who were flown over from Haiti to work as physicians and civil servants” (Timberg & Halperin, 2012, p.64). Timberg and Halperin (2012, p.64) believe that one of the Haitian aid workers contracted HIV in Leopoldville and then flew back to Haiti.
From Haiti the number of incidences increased over a few years, finding its way to the United States, and from the United States the virus made its way to Europe. This theory, which is supported by virological evidence that “every HIV virus in the United
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States or Europe or the Caribbean can be traced to a single ancestor, a single virus that came over from Kinshasa in the 1960s" (Timberg & Halperin, 2012, p.65). Epidemiologists who have studied the development of the pandemic suggest that by the 1960s about 2 000 people in Africa may have had HIV, which was as yet unnamed (Timberg & Halperin, 2012). By 1980, closer to 1 million people were infected, and the virus was named a year later (Sample, 2006, p.1). Once HIV was established, rapid transmission rates in the eastern region of Africa, particularly in areas bordering Lake Victoria, made the epidemic far more devastating in West Africa. Uganda in the east was first to succumb, followed by Gabon, Congo- Brazzaville and Cameroon in the west (Delaport, 1996, p.1). Truck drivers, migrants, soldiers, traders, miners and sex workers have been identified as groups, which enabled the initial rapid spread of HIV. In the 1980s, 35 percent of tested Ugandan truck drivers were HIV positive, as were 30 percent of the Ugandan military (Carswell, Lloyd, & Howells, 1989, p.1).
In 1988 the second highest prevalence rate of HIV in all of Africa was found on the Tanzam Road linking Tanzania and Zambia (Avert, 2011, p.1). As the years progressed, so did the epidemic, which moved south through Malawi, Zambia, Mozambique, Zimbabwe and Botswana (Avert, 2011, p.1). The virus may have arrived relatively late, but by the end of the 1980s the southern African countries of Malawi, Zambia, Zimbabwe and Botswana were on the threshold of overtaking East Africa as the epicenter of the global HIV epidemic (Avert, 2011, p.1). Ras (1983, p.140) documented what was thought as the first case of HIV in South Africa was in a white, homosexual air steward from the United States who died of pneumonia in 1982. The first South African was diagnosed with AIDS in 1987 (Ras, 1983, p.140). The cause of the transmission in this instance was suspected to have occurred among mine workers who interacted with Africans from other parts of the continent, predominantly Malawi, who had a higher occurrence of the virus. Recurrent contact with other Africans living with HIV permitted the virus to spread throughout the country (Avert, 2011, p.1).
By 2012 the “1.9 million people who became newly infected with HIV in 2010 in sub- Saharan Africa represented 70% of all the people who acquired HIV infection
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globally” (UNAIDS, 2011, p.24). South Africa’s HIV epidemic remains the largest in the world, with an estimated 5.6 million people living with HIV in 2009 (UNAIDS, 2011, p.24). This figure equals the total number of people living with HIV in all of Asia (UNAIDS, 2011, p.24). The virus has left a path of confusion. The early stages of HIV infection mimics common viral infection, resulting in the virus being undetected or ignored, while understanding of the virus is essential for the purposes of early detection and responsive treatment.
2.1.2 Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) HIV and AIDS are closely related to a point that they are considered the same and are often referred to as synonymous. However, according to UNAIDS (2011, p.14) HIV and AIDS are dissimilar, and the expression HIV/AIDS should be avoided whenever possible because it can cause confusion. Most people with HIV do not have AIDS (UNAIDS, 2011, p.14). The following inflection intends to unpack the terms HIV and AIDS.
The Human Immunodeficiency Virus (HIV) is a blood-borne, sexually transmissible virus that infects cells of the immune system. “The infection results in the progressive deterioration of the immune system, breaking down the body's ability to fend off infections and diseases. Acquired Immune Deficiency Syndrome (AIDS) refers to the most advanced stage of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or cancers” (CSA, 2013, p.1; Bennett & Greenfield, 2012, p.1). HIV can be transmitted in numerous ways. There are only four body fluids that carry a sufficient amount of HIV to be infectious: blood, vaginal fluid, semen and breast milk. Breast milk has a lower amount of HIV than the others, but as babies are usually breast fed for months, the increased dose of breast milk increases the risk of HIV transmission. There are several ways in which infection may occur. For infection to occur, three facts should be considered. Firstly, there should be a sufficient quantity of the virus in the fluid. These fluids can transmit HIV, however; the viral quantity in these fluids can fluctuate. Research confirms (CSA, 2013, p.2) “that a newly infected person (in the window period) or someone in the AIDS stage has a higher viral load (concentration of HIV), so this will affect risk of
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infection”. An infected person who is on an HIV management programme will have a lower viral load if the treatment is working and the patient continues to adhere to their treatment regime, which should make their bodily fluids less communicable (CSA, 2013, p.2).
Secondly, infection can be caused by contact via the bloodstream, for example, through a cut or scratch on the outside of the body, an abrasion, a wound inside the body or a puncture in a vein through a shared needle during drug use. A blood transfusion may also be unsafe, provided the blood has been tested or treated before transmission. Thirdly, the longer the duration of exposure to infected bodily fluids, the more the risk of infection increases for example, during sexual intercourse, the larger surface area in the vagina or the anus and the longer time the virus remains in this area allows the virus greater access to the bloodstream (WHO, 2013). Conversely, vaginal fluid or “blood from the anus can only infect a man during sex through the relatively small opening of the penis, or through cuts, abrasions or sores on the head of the penis. The virus does not survive for long outside of the body, the longer the virus remains outside the body the less viable it is” (WHO, 2013). However, once infected, symptoms, which relate to HIV may take a while before they occur.
2.1.3 Symptoms related to HIV A useful way to understand HIV symptoms is in terms of the different stages of the infection. During stage one, the person is HIV positive but shows no symptoms, except for flu-like symptoms, which may occur within a few weeks of infection. Stage one may last for several years during which the person might have no HIV-related illnesses (WHO, 2013, p.3). It is important to remember that HIV is unlike cancer, as the virus does not lie dormant. It is constantly replicating. Basic nutrition, exercise and proper hygiene are essential to maintain optimum health. In stage two the HIV infected individual begins to acquire minor illnesses. Ear infections, frequent flu and skin problems can be expected during this stage. These symptoms can be treated by adhering to a balanced diet, exercise and stress management. While it is difficult to generalise, it is often best to consult a well-informed doctor. The doctor may prescribe a treatment plan based on the patient’s CD4 count and viral load. The
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decision to start treatment at the most appropriate time can make an enormous difference in managing the infection.
During stage three the person may lose weight and experience prolonged illnesses, which may include thrush in the mouth, pneumonia, a fever, which lasts more than a month, and tuberculosis (TB) of the lungs. This stage of the infection demands treatment. Stage four occurs when the person’s immune system has been severely compromised, and may include symptoms of chronic diarrhoea, toxoplasmosis, meningitis and TB in other parts of the body. It is at this stage that a person’s CD4 count may be reduced to 200 or below, and once this level has been reached a person is said to have AIDS. It is recommended not to reach this stage. Treatment can nevertheless make a huge difference. The important message regarding symptoms is to take them seriously, have them examined, test for HIV and acquire treatment as soon as possible (WHO, 2013).
There are numerous means to prevent HIV/AIDS transmission. Some of the ways to prevent HIV/AIDS transmission may include the practice of safe sexual behaviour such as using condoms; getting tested and treated for sexually transmitted infections, including HIV; avoiding injecting drugs, and if this cannot be avoided it is advisable to always use new and disposable needles and syringes; and ensuring that any blood or blood products that you may need have been tested for HIV (WHO, 2013). Nonetheless, knowledge about the transmission of HIV appears to have had very little impact on South African prevalence rates (HSRC, 2009, p.45). The shroud of myth and misbelief has further contributed to the transmission of HIV, and has thus hindered acquiring accurate prevalence data.
2.1.4 HIV and AIDS: fact or fiction
HIV and AIDS in South Africa have been entwined in myth and fiction. A fairly recent study, which was undertaken by the Human Science Research Council (HSRC), suggests that between 2005 and 2008 there has been little change in peoples’ observance of various myths that are associated with HIV and AIDS (Jurno-AIDS, 2013, p.1). When asked whether the following statements were true or false, only “63.8% of South Africans interviewed could answer all four correctly. HIV does not
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cause AIDS. Having sex with a virgin cures AIDS. There is a cure for AIDS and AIDS is caused by witchcraft” (Journ-AIDS, 2013, p.1). The survey revealed a 2.2% improvement in rejection of all four myths when compared with the 2005 survey (Journ-AIDS, 2013, p.1).
There are several reasons for South African’s indulgence in these myths and mistaken beliefs. Adherence may be the result of “conflict between traditional, cultural ideas of disease and Western notions of science and medicine, or could be traced back to the inequality fostered by the apartheid system. Or, in some cases it could be a result of simply not knowing” (Journ-AIDS, 2013, p.1). The paragraphs which follow examine the most common and malevolent myths and mistaken beliefs about the conception of the disease and attempts to dismiss myths by relying on fact rather than misbelief. It is often believed that taking dietary supplements such as immune boosters can cure HIV and AIDS, however, there is no cure for HIV and AIDS. Dietary supplements may be taken in conjunction with HIV/AIDS medication or therapy, but they cannot cure HIV or AIDS. Immune boosters are said to stimulate the production of white blood cells, which are the cells of the immune system, which fight off invading bacteria and viruses (Barron, 2013, p.1). However, what should be noted is that there are different types of white blood cells, each with a different function, while HIV targets only one type of these cells, namely the T helper cell. T helper cells are immune cells, which are central to the activity of the entire immune system. Garlic is said to increase the activity of the T-helper cells (Barron, 2013, p.1) however; there is much discussion about whether or not immune boosters such as garlic and beetroot actually work.
Supplements such as vitamins provide the body with micronutrients, which are the minerals and vitamins that the body needs to function efficiently. “It has been shown that HIV-positive persons have lower levels of vitamins A, B12, C and D, as well as carotenoids, selenium, iron and zinc” (Avert, 2013, p.1). According to Avert (2013, p.1), knowledge of how effective supplements are to maintain the health of HIV- positive persons is inadequate. “A trial involving a thousand HIV positive pregnant women in Tanzania found that daily multivitamins benefited both the mothers and their babies, compared to taking a placebo. After four years, multivitamins were
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found to reduce women’s’ risk of AIDS and death by around 30%. A large trial in Thailand also found that multivitamins led to fewer deaths, but only among people in the advanced stages of HIV disease, a third, smaller trial in Zambia found no benefits from multivitamins after one month of use” (Avert, 2013, p.1). Advice regarding which minerals or vitamins accelerate or decelerate HIV progression is also varied. Large doses of particular vitamins can in fact be dangerous.
It is always advisable to consult a medical practitioner before taking vitamin supplements and/or immune boosters if HIV positive, especially if anti-retrovirals (ARVs) are being taken as part of the treatment (NAM AIDSMAP, 2013, p.1). “There is evidence that taking multivitamins can help slow the rate of HIV disease progression in settings where HIV treatment is not available. However, vitamins and supplements are not a replacement for HIV treatment and are, at best, a useful support. It's known that certain supplements, such as large doses of garlic, can stop some anti-HIV drugs working properly. Most HIV specialists would advise that a healthy, balanced diet is enough to meet your nutritional needs” (NAM AIDSMAP, 2013, p.1). Huge doses of dietary nutritional supplements are not advised, as large doses of vitamin A can cause liver and bone damage, as well as other side effects such as vomiting and headaches.
Vitamin C doses above 1000mg per day can cause kidney stones, diarrhoea and hardening of the arteries, and have been shown to reduce concentrations of the now rarely used protease inhibitor indinavir (Crixivan) (NAM AIDSMAP, 2013, p.1). “Zinc doses above 75mg per day have been associated with copper deficiency as well as a shortage of white and/or red blood cells. Selenium doses of 750 micrograms or more per day have been associated with immune suppression. Vitamin B6 doses above 2g per day can cause nerve damage, but doses as low as 50mg per day have been known to cause peripheral neuropathy (painful nerve damage), particularly in the feet” (NAM AIDSMAP, 2013, p.1). The type of dietary supplement that is taken should be influenced by factors such as age, gender and lifestyle. There is also evidence that some supplements may inhibit the absorption of certain Anti-retro-viral treatment (ART) from working properly (Avert, 2013, p.1). “Based on these and other less rigorous studies, many experts recommend multivitamins for people living with
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HIV, particularly those who are undernourished and have advanced disease” (Barron, 2013, p.1).
The second myth is that many people rely on traditional healers (sangomas) and traditional medicines to treat the symptoms and to cure HIV and AIDS. These claims are totally unfounded, as no treatment, including antiretroviral medicines (ARVs), has been proven to cure HIV and AIDS, while there has also been evidence that several common traditional medicines do more harm than good (Smith, 2013, p.1). The virus that causes the disease remains in a person’s body indefinitely once the person is infected. ARVs function by targeting the virus and preventing it from replicating. The infected person may feel better as the virus count is reduced. It is important to remember that ARVs do not eradicate the virus from the body; as soon as a person discontinues taking the ARVs, the viral count starts to increase once again. Most herbal treatments may help by disenabling the virus directly, or help to build a person’s immune system. However, there is little scientific evidence regarding the safety and usefulness of these herbal treatments. “It is, therefore, important, that these medicines are properly researched, first so that the safe and effective ones can be identified and used, and the ones that can harm people are withdrawn” (Smith, 2013, p.1).
The third myth is that one can test negative once you have tested HIV positive and that it is possible to obtain a negative test result after testing positive. This, however, does not imply that the person is HIV negative. Whilst an HIV/AIDS test might not have identified the virus, it is undeniably still in the person’s system. Testing negative after testing positive can be the consequence of various factors. It is necessary to note that most HIV tests do not test for the actual virus, but for the antibodies that make up the virus (AVERT, 2013, p.1). If the time since infection has been recent, little or no antibodies may be detectable in their system. It may take between three weeks to six months for the immune system to produce antibodies before they are detectable. This period where the antibodies are undetectable is called the ‘window period’. “Testing for HIV too soon after potential exposure to the virus may not give an accurate result due to what is known as the window period. A window period refers to the period of time during which HIV is not detected by tests
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even if the virus has entered the body. During this time, a test may give a ‘false negative’ result. Different types of tests have varying window periods. To be sure of how long a person needs to wait, they should also always discuss the nature of the HIV test with a healthcare worker before getting tested. If a person is not sure of the date or time of their potential exposure to HIV, a healthcare worker will be able to advise appropriately on their HIV testing” (AVERT, 2013, p.1).
Other commonly used tests measure the viral count in the body’s system rather than the HIV antibodies. The viral load or count increases by the first three to twelve weeks of infection, which is when an HIV-positive person is most likely to infect a sexual partner (Journ-AIDs, 2013, p.1). A negative result may also be an indication of possible Anti-retroviral treatment (ART), which reduces the viral load (Journ-AIDS, 2013, p.1). “It is possible for an individual to test positive for HIV even though they are, in reality HIV-negative. However, this may only occur in certain cases such as if the person has been the subject of an HIV vaccine trial and, therefore, has HIV antibodies in their system. Positive tests are always followed up with a second test in order to confirm the positive result” (Journ-AIDs, 2013, p.1).
The fourth myth is that mosquitoes can transmit HIV. There are a number of reasons why mosquitoes cannot transmit HIV. The myth concerning the likelihood of mosquitoes transferring AIDS was a common concern when the disease was first recognised. The topic, according to Crans (2010, p.1), originated from reports that were made by a community in southern Florida, where initial evidence suggested that mosquitoes may be responsible for the higher than average number of incidences of HIV/AIDS within the local population, in spite of despite scientific findings of the National Centres for Disease Control (CDC) that clearly established that mosquito transmission of AIDS was unlikely. Yet many people assume that mosquitoes may transmit HIV from one person to another. “There are three reasons, which would allow blood-sucking insects such as mosquitoes to transmit HIV. First, a mosquito would initiate the cycle by feeding on an HIV positive carrier and ingest virus particles with the blood meal. For the virus to be passed on, it would have to survive inside the mosquito, preferably increase in numbers, and then migrate to the mosquito's salivary glands. The infected mosquito would then seek its second blood
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meal from an uninfected host and transfer the HIV from its salivary glands during the course of the bite. This is the mechanism used by most mosquito-borne parasites, including malaria, yellow fever, dengue, and the encephalitis viruses” (Crans, 2010, p.1; Journ-AIDS, 2013, p.1).
In the second instance, a mosquito would commence the cycle by feeding on an HIV carrier and be disturbed after it had drawn blood. Instead of resuming the partial blood meal from its original host, the mosquito would then need to select an HIV negative host to continue feeding. It is assumed that as it penetrates the skin of the new host, the mosquito would transfer the virus from the previous host into the second host. This method of transmission is not common in mosquito-borne infections, but equine infectious anaemia is transmitted to horses by biting flies in this manner (Crans, 2010, p.1). The third theoretical explanation could involve a mosquito that is disturbed while feeding on an HIV positive host and recommences the partial blood meal on an alternative host. In this instance, the AIDS’ negative host squashes the mosquito as it attempts to feed and smudges HIV contaminated blood into an open wound (Crans, 2010, p.1). “In theory, any of the mosquito-borne viruses could be transmitted in this manner providing the host circulated sufficient virus particles to initiate re-infection by contamination. Each of these mechanisms has been investigated with a variety of blood sucking insects and the results clearly show that mosquitoes cannot transmit AIDS” (Crans, 2010, p.1).
The typical person is still not convinced that mosquitoes are not involved in the spread of the disease that occurs in the blood of an infected person, which may be infected by persons that share hypodermic needles. There are a few reasons why studies show that mosquitoes cannot transmit AIDS. Firstly, mosquitoes ingest the virus that causes AIDS. Unlike, “malaria parasites, which survive inside mosquitoes for 9-12 days and actually go through a series of necessary life stages during that period. Encephalitis virus particles survive for 10-25 days inside a mosquito and replicate enormously during the incubation period. Studies with HIV clearly show that the virus responsible for the AIDS infection is regarded as food to the mosquito and is digested along with the blood meal. As a result, mosquitoes that ingest HIV- infected blood consume the blood which is digested within 1-2 days and completely
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destroy any virus particles that could potentially produce a new infection” (Crans, 2010, p.1). Since the virus is unable to survive and replicate within the salivary glands, because of the process that most mosquitos use to get from one host to the next, it is not possible for the virus to remain viable. Secondly, mosquitoes do not consume enough HIV of the virus in order to transmit HIV by contamination. In order for an HIV negative free recipient to supposedly be infected by an HIV carrier mosquito, the recipient would have to be bitten by almost 10 million mosquitoes that had been feeding on an HIV/AIDS infected host in order to receive one unit of HIV from an HIV carrier mosquito. Using the same argument as above, crushing a fully engorged mosquito that contains HIV positive blood would still not initiate infection (Crans, 2010, p.1; Journ-AIDS, 2013, p.1). The mode of transmission of HIV by HIV contaminated mosquitoes appears to be well beyond the limits of probability. Therefore, the myth that mosquitoes are flying hypodermic needles, is unfounded.
The fifth myth is that condoms do not work. Using a condom has been proven to be one of the most effective ways of preventing the transmission of HIV and other sexually transmitted diseases. It is recommended that condoms should also be used in combination with other HIV prevention methods such as male circumcision, whilst adhering to monogamous relationships. Condoms, when correctly used, are also known to be effective in preventing unwanted pregnancies (Journ-AIDS, 2013, p.1). Condoms are effective as disease pathogens, which are transmitted during sexual intercourse and are far too small to pass through latex. Incorrect condom use and the myth that surrounds the ineffectiveness of condoms is generally the reason why condoms are not used as often. Wearing a condom incorrectly or a lack of proper lubricant can cause the condom to tear, exposing either or both partners to HIV infection or Sexually Transmitted Infections (STIs). Water-based lubricants are recommended when using a condom as oil based lubricants can alter the durability of the condom (Journ-AIDS, 2013, p.1). “It is vital to remember that both partners can become infected with HIV even if the male partner (or the insertive partner in male homosexual sexual relationships) has not ejaculated inside of his partner’s vagina or anus. Before ejaculation the penis is lubricated by pre-ejaculate which can also contain HIV and other pathogens, which cause STIs. The vagina also produces bodily fluids, which can contain HIV and STIs” (Journ-AIDS, 2013, p.1). The
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incorrect use of a condom does not amount to the ineffectiveness of condom usage. The embarrassment to find out how to use a condom is best concealed by the myth, rather than the inability to use one.
The sixth myth is that having intercourse with a virgin will cure HIV. It is widely established that this belief is entirely untrue, however, the myth persists. The concept of “having sex with a virgin will cure venereal disease predates the advent of HIV and AIDS. Although very little research has been done to establish the exact origins of this belief, the ‘virgin cure’ myth is thought to have originated sometime in the 16th century, widely manifesting itself in the Victorian era (19th century) as a “cure” for syphilis and gonorrhoea” (Earl-Taylor, 2002, p.1). South Africa’s earliest case of virgin rape can be recorded as early as the end of the Second World War when returning soldiers prompted an epidemic of venereal disease in the Eastern Cape (Earl-Taylor, 1999, p.1). An increase in reported cases of infant rapes in the late 1990s and early 2000s resulted in greater attention being placed by media and the public to the issue of virgin cleansing (Earl-Taylor, 1999, p.1). Inspired by the widespread myth that sex with a virgin is a cure for HIV and AIDS, carriers began to target children younger than eight years. In 1999 a Camperdown magistrate based “in the KwaZulu-Natal Midlands told the South African Times that at least five child rape cases were being dealt with every day, which the paper attributed to this myth” (Nevitt, 2013, p.1).
According to SA-people.com (2011, p.1), it is estimated that females born in South Africa have a greater chance of being raped than acquiring an education. SA- people.com (2011, p.1) quotes a survey that was conducted amongst 1 500 Sowetan school children, where it was discovered that a quarter of all boys said that jackrolling (colloquial term for gang rape) was fun. The devastating statistics remain a concern as a quarter of South African men who participated in the survey, which was conducted by the Medical Research Council (MRC) admitted to raping someone. It is estimated that half a million rapes are committed each year in South Africa. “A study by Interpol (the international police agency) shows that South Africa has the highest rate of rape in the world. A woman is raped in South Africa every 17 seconds. The highest increase in attacks has been against children under
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the age of seven, largely due to the myth that sexual intercourse with a virgin will cure a man of HIV or AIDS” (SA-people.com, 2011, p.1). Fact or fiction, medical evidence dictates that sex with a virgin does not cure HIV or AIDS, and the myth has no medical ground. It is abuse and ignorance fuelled by a patriarchal society that dictates such brutality.
The seventh myth is that HIV was conceived to rid the world of Black people and homosexuals. The notion that HIV was deliberately invented or created to purposefully rid the world of Black people and homosexuals is widely known as a conspiracy theory. While there are several theories, which claim to explain the origin of HIV, there is only one theory, which is scientifically credible (previously discussed). The eradication of two commonly marginalised groups is where conspiracy theorists have found ground for intrigue and, therefore, the root to believing that HIV was engineered to rid society of Black people and gay people. “However, the reasons why black people are more likely to be infected with HIV and why gay men were the first to present with HIV are largely due to biomedical, social, political and material factors, not because they were purposely targeted for elimination. The theory that HIV was engineered in order to wage biological warfare on black people originated in the United States and claims that HIV was engineered by the US Special Cancer Virus program (SCVP) with help from the Central Intelligence Agency (CIA)” (Journ-AIDS, 2013, p.1).
Media reports in South Africa have made similar observations that there is extensive falsification amongst the South African populace about HIV, “including popular belief in conspiracy theories, for example that the apartheid-era South African government manufactured HIV as a way of controlling the black population” (Carter, 2008, p.1). This belief was further exacerbated in 2001 when the New York Times reported that the Apartheid government had tried to develop biological weapons by using a strain of bacteria, and viruses, among them HIV (Carter, 2008, p.1).
The consequence of such a conspiracy theory that HIV was introduced by White people as a way to monitor the Black population has led to fewer South Africans testing for HIV (Bogart, Kalichman, & Simbayi, 2008, p.115). Bogart et al., (2008,
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p.115) stress that in order for the South African government to restore “the public’s faith in their response to HIV, they need to present a consistent and strong prevention platform about the importance of testing”. Belief in conspiracy theories about HIV has been shown to be associated with lower levels of condom use amongst African-American men (Carter, 2008, p.1). The idea that HIV is man-made is principally disproved by the resemblances between HIV (Human Immunodeficiency Virus) and SIV (Simian Immunodeficiency Virus). It has been epidemiologically proven that HIV is most likely a pathological descendant of SIV. It is well acknowledged that it is possible for some viruses to skip species animals to humans, as recently seen with avian flu. SIV was reportedly transmitted to humans through consumption of the flesh of SIV infected apes or monkeys. An alternative way in which the virus may have been passed to humans is through contaminated ape or monkey blood coming into contact with an open wound or cut on the human body during consumption. The unfortunate impact of such misbelief has forced individuals to guard against accurate information, for fear that it may well be a conspiracy.
The eighth myth HIV is that it is exclusively a Black person’s disease. HIV does not only affect Black people, as all races are biological susceptible to contracting HIV. Therefore, it is not race or something that is distinctive to a particular race that renders them more likely to contract HIV. It is societal, political and economic factors that ultimately impact the spread of HIV. Social, political and historical factors in a country such as South Africa, which is deeply divided, both in terms of class and race contribute to negative connotations that are associated with Black people. Black South Africans were historically the most disadvantaged people under the Apartheid regime. The remnants of Apartheid continue to unofficially linger into the present. Inequality is still a major feature of South African society. “African people are more likely to occupy the poorest classes, which leaves them exposed to conditions of poverty which, in turn, put them at greater risk of HIV infection. For example, people of the poorer class might have little or no access to education on the transmission and prevention of HIV. Another point of difficulty might arise in accessing preventative measures and methods such as condoms” (Journ-AIDS, 2013, p.1). Black South Africans’ inability to overcome years of suppression and
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abuse has allowed for the disease to silently establish a foothold within communities, spreading undetected and unrestricted, while American and European governments, were quick to address the disease. When the disease was first recognised in post-apartheid South Africa, the threat of the disease had already reached epidemic proportions.
Within the first decade of the new millennium, over 10% of the total South African population of 47 million was expected to be infected with HIV; however, the degree of infection was challenging to measure, since much of the populace did not come into contact with the antenatal system (Yale School of Management, 2013). Women who attended antenatal facilities interacted with the healthcare system for childbirth and postnatal care, and were, therefore, encouraged to test for HIV/AIDS more so than men. In 2005 estimates were that more than 25% of pregnant South African women were supposedly infected with HIV. The varying rates of infection for pregnant women were diverse and varied per region, with the province of KwaZulu- Natal being the highest at 39%, and the Western Cape being the lowest at 16% (Yale School of Management, 2013). The number of individuals that was treated for HIV was far lower than the approximations of infections. In 2005 around 200 000 South Africans were receiving ARVs, hence “around 320 000 deaths were attributed annually to AIDS, the critics felt that the estimate of AIDS deaths was low, since AIDS deaths were often attributed to other causes” (Yale School of Management, 2013).
There were many explanations why the HIV/AIDS epidemic disabled South Africa. HIV/AIDS denialists’ contentions had a damaging political, social, and public health impact on South Africa. The government, under the Thabo Mbeki administration, was sympathetic to the views of HIV/AIDS denialists around the world. “Former President Thabo Mbeki's support for AIDS denialists’ tenets has rightly dominated analysis of South Africa's HIV epidemic. By AIDS denialism, we mean the systematic rejection, deriving from pseudo-scientific premises, and supported by quasi-rational arguments, of evidence establishing that HIV causes AIDS, that ARVs significantly reduce mortality and morbidity associated with HIV infection, and that there are tens of millions of people in Africa living with HIV or dying from AIDS”
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(Geffen & Cameron, 2009, p.2). Critics claimed that HIV/AIDS denialists’ influence was responsible for the relaxed and unsatisfactory governmental response to the country’s massive AIDS epidemic. The South African government at the time was doubtful of the diagnosis and treatment of HIV/AIDS. Thus expressing doubt about testing and banning the use of antiretroviral treatment in state hospitals. Healthcare in South Africa had reached a climax, stretched to its limits, challenged to treat the growing number of critically ill individuals, whilst losing healthcare personnel to the disease. HIV/AIDS did not conform to the requirements of traditional medicine, as this went against many cultural traditions. The then-Minister of Health, Manto Tshabalala-Msimang, promoted the use of vegetables above antiretroviral treatment (Geffen, 2005; Geffen, 2006), and the minister argued that the antiretroviral drugs were harmful, and part of a White conspiracy to eradicate Blacks (Cameron, 2003).
Former president of South Africa, Thabo Mbeki, questioned the link between HIV and AIDS, arguing that poverty and not the HIV virus, was the cause of AIDS (Sildey, 2000; Geffen & Cameron, 2009). During the Mbeki administration the South African government refused to accept contributions and grants to support the use of antiretroviral treatment and banned their use in public hospitals. Their views delayed diagnosis and treatment that could have addressed the epidemic spread of the disease. Mbeki’s view, while dangerous, adversely touches many Black South Africans, “based on their experiences with the racism of Western colonialism and their suspicion of Western agencies and drug companies” (Geffen & Cameron, 2009, p.12; Yale School of Management, 2013). In 2004 the South African government reconsidered antiretroviral (ARV) treatment and gradually began to offer limited treatment. Drug availability gradually rose. By 2008 the country had the world’s largest antiretroviral program, but only 10% of those in need of antiretroviral medications received treatment (Nattrass, 2008). The country’s medical and financial resources continued to be depleted as the scale of the epidemic continued to grow.
It was after the election of Jacob Zuma to the presidency of South Africa in May 2009 that South Africa instituted a sharp turn in parliamentary attitudes, but by then the South African health system was overwhelmed. Nattrass (2008) states that “of
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the University of Cape Town’s estimates that 343,000 excess AIDS deaths and 171,000 infections resulted from the Mbeki administration's policies, an outcome she refers to in the words of, Peter Mandelson, as genocide by sloth”. A 2008 study by Chigwedere used a model to estimate that more than 330,000 lives or approximately 2.2 million years of human life was lost because the ARV treatment program was not implemented in South Africa. Thirty-five thousand babies according to Chigwedere (2008), were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis programme by using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005 (Chigwedere, 2008). This confirmed Nattrass’s (2008) earlier estimates, which suggest that if the national government had used ARVs for prevention and treatment at the same rate as the Western Cape, an estimated 171,000 HIV infections and 343,000 deaths could have been prevented between 1999 and 2007.
The ninth myth is that HIV does not cause AIDS. There is overwhelming evidence that HIV does cause AIDS. However, there is a minority of HIV denialists, who are convinced that HIV and AIDS are not linked, or that HIV does not exist. Once the virus enters the body, HIV begins to attack the immune system, leaving the body vulnerable to opportunistic infections, which are associated with AIDS. HIV and AIDS are distinct from one another; this is why many organisations such as UNAIDS (UNAIDS, 2011, p.14) take concession to the use of the HIV/AIDS combination. Someone who has HIV does not have AIDS, but is at risk of developing AIDS at some point in their lifetime. “The progression from HIV to AIDS can be virtually halted by effective anti-retroviral treatment (ART)” (Journ-AIDS, 2013, p.1). There are several reasons why the statements made by HIV denialists are inaccurate.
Denialists believe that testing positive for HIV increases the chance of premature death or that treatment that specifically targets HIV prevents progression to AIDS. “Studies have shown that effective drug treatment (ART) significantly reduces the amount of HIV in the blood and raises the CD4 count. Those not on treatment or those who are somehow immune to treatment are more likely to develop AIDS and die. Therefore, if drugs that target HIV prevent AIDS then we must conclude that HIV
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causes AIDS” (Journ, 2013, p.1). There are various factors that do not cause AIDS, and yet denialists argue that AIDS is non-infectious. Denialists contend that conditions “associated with poverty, lack sleep, non-intravenous (and intravenous) drug use, stress and anti-AIDS drugs are the causes of AIDS” (Journ-AIDS, 2013, p.
1). Denial does not alter the fact that HIV and AIDS are distinctly separate, HIV being the virus and AIDS the clinical syndrome.
The tenth myth is that circumcision prevents sexual transmission of HIV. Research has shown that circumcised men have a diminished chance of contracting HIV. Circumcision does not protect someone against contracting HIV. However, there is compelling “evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use” (WHO, 2013, p.1). Male circumcision does not reduce transmission; circumcision lowers the risk of contracting HIV.
The eleventh myth is that HIV positive partners cannot have children. HIV positive partners can have children. However, there are different factors and options to consider, which may help to prevent parent to child transmission or partner infection. Serodiscordant partners refer to when one partner is positive and the other is negative. HIV positive female partners may choose artificial insemination in order to avoid risk to the HIV negative partner. HIV positive male partners may choose sperm washing as a procedure to prevent HIV transmission to the HIV negative partner. An alternative example is when either partner is HIV-positive. “A successful Anti-retroviral treatment can also render an HIV positive person non- infectious (although that person is still HIV-positive) and natural conception can then take place. Although this practice significantly reduces the chances of partner infection and parent to child transmission, it is not hundred percent effective” (Journ-
AIDS, 2013, p.1).
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Seroconcordant is the opposite of serodiscordant; in this case both partners have the same HIV status that is, both partners are either HIV positive or HIV negative. In a situation where both partners are HIV positive, it is best to adhere to the prevention of mother-to-child transmission guidelines when deciding on a family (Journ-AIDS, 2013, p.1). Sperm washing and artificial insemination can also be used to avoid each partner re-infecting one another. “All of the above methods of conception provide protection to the HIV-negative partner against contracting the virus. In the case of HIV-positive seroconcordant partners these methods prevent reinfection” (Journ-AIDS, 2013, p.1). Reliance on myth has proven to distort prevalence rates (Bogart et al., 2008, p.115), and accurate assessments are difficult to obtain owing to misconceptions and the fear associated with testing.
2.1.5 HIV prevalence in South Africa The total number of persons living with HIV/AIDS in South Africa increased from an estimated 4.21 million in 2001 to 5.38 million by 2011. According to Statistics South Africa (Statssa) (2011), these estimates indicate that 10.6% of the total population is HIV/AIDS positive (Statistics South Africa (Statssa), 2011, p.5). The ILO estimates that over “20 million employees globally are living with HIV/AIDS. The size of the labour force in high-prevalence countries will be between 10 and 30 per cent smaller by 2020 than it would have been without AIDS. 14 million children have lost one or both parents to AIDS, and many of them will be forced out of school and on to the job market, exacerbating the problem of child labour” (ILO, 2001, p.19). HIV/AIDS has a massive impact on infected individuals and their families, as well as their communities. The repercussions are serious for the old and young dependants of many infected family members.
A total of 34 million people live with HIV/AIDS worldwide. The vast majority are in low- and middle-income countries (Gubatanga, 2011, p.1). An estimated 2.7 million people were newly infected with the virus in 2010. HIV/AIDS is the world’s foremost infectious killer, and about 30 million people have died to date (Gubatanga, 2011, p.1). An estimated 1.8 million people die every year from HIV/AIDS. An estimated 3.4 million children are living with HIV/AIDS (Gubatanga, 2011, p.1). According, to “2010 figures, most of the children live in sub-Saharan Africa and were infected by
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their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Almost 1100 children become newly infected with HIV/AIDS each day. The number of children receiving ART increased from about 75 000 in 2005 to 456 000 in 2010” (WHO, 2011, p.7).
The HIV/AIDS epidemic, according to the National Department of Health (DoH) (2012, p.21), is unfolding at different paces in different provinces. Four health districts, all located in Kwa-Zulu Natal, recorded the highest HIV prevalence rates, which range ranging between 41.1% and 42.3%. Two out of three districts in Mpumalanga recorded high prevalence levels of 37.7% in Ehlanzeni and 38.8% in Gert Sibande. Dr. Kenneth Kaunda was the only district among the four in North West that recorded an HIV prevalence of 37.7%, while the other three districts recorded prevalence of between 24.3% in Dr. Ruth. S. Mompati, 25.9% Ngaka Modiri Molema and 23.3% in Bojanala. The Western Cape for the first time recorded an HIV prevalence rate of 20% (DoH, 2010, p.42).
In 2010 HIV/AIDS incidences ranged from 0.44% in the Western Cape to 2.2% in Kwa-Zulu Natal. Northern Cape had an estimation of 2876 infections in 2010, while Kwa-Zulu Natal had an estimation of 95 896 new infections. Kwa-Zulu Natal also had the highest number of new infections among children under 15 years (14 226), followed by Gauteng (9850) (DoH, 2010, p.85). In 2010 about 5 470 000 adults and children were infected with HIV in South Africa. Of these, 4 030 000 comprised adults aged 15 years and older, and 2 000 000 being females, while 438 000 are children under 15 years of age. An estimation of 194 000 South Africans died of AIDS in 2010; of which 173 000 were adults. These deaths have, resulted in approximately 1 670 000 AIDS orphans. New infections were recorded at 281 000 new adult infections and 54 000 new infections among children under 14 years of age. Most childhood infections were estimated to take place in Kwa Zulu Natal, followed by Gauteng (DoH, 2010, p.85).
HIV AND AIDS estimates for 2011, according to UNAIDS (2012, p.1): “number of people living with HIV is between 5.300.000 to 5.900.000, adults’ aged 15 to 49 prevalence rate17.30%. Adults aged 15 and up living with HIV 5.100.000. Women
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aged 15 and up living with HIV 2.900.000. Children aged 0 to 14 living with HIV 460.000. Deaths due to AIDS 270.000, orphans due to AIDS aged 0 to 17 years 2.100.000”.
Table 2.1: Number of People living with HIV and AIDS in South Africa
6 million
4 million
2 million
0
1990 1995 2000 2005 2010
Source: UNAIDS (2012, p.1)
The above table, as adapted from UNAIDS (2012, p.1), is an indication of the rising trend in the number of people living with HIV and AIDS in South Africa. HIV prevalence figures, according to the 2012 Census, appear to be tapering off (Blaine 2012, p.1). Yet independent data, which was gathered by UNAIDS (2012, p.1) differ. A possible explanation for the inconsistency in data may be attributed to the fear of being identified as living with HIV.
2.1.6 Individuals living with HIV and AIDS
Individuals living with HIV and AIDS are prone to succumbing to other illnesses and infections because of their compromised immune systems, and as a result, the AIDS epidemic has fuelled a surge of opportunistic diseases. HIV/AIDS impacts individuals at various other levels. Individuals experience the immediate impact of HIV/AIDS within their households. Families are the main caregivers for the sick, and suffer AIDS-related financial hardships (Ashford,2006, p.2; Professional Development Programmes for Parliamentarians and Parliamentary Staff, n.d, p.42; Iya, Purokayo, & Gabdo, 2012, p.246; Wagner, Rana, Linnemayr, Balya, & Buzaalirwa, 2012, p.1). An abstract presented at the XIX International AIDS Conference in July 2012 explained that changes in household assets and employment were attributed to HIV/AIDS (Bor, Barnighausen, Tanser, & Newell,
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2012, p.1). Households are forced to sell off assets to sustain their households. The need to provide food, shelter and medication surrenders single parents into employment, which forces children to head their households. One assumes that children living in child-headed households do not have either of their parents alive. Holborn and Eddy (2011, p.3) refer to an article in the journal ‘AIDS Care’ that states that “62% of children are living in child-headed households, in 2006, were not orphans. Altogether 92% of the approximately 122 000 children living in child- headed households, had one or both parents alive. Some 81% of children in child- headed households had a living mother”. HIV/AIDS may impact the child-headed household either directly through the loss of both parents or indirectly by forcing either parent to leave home with the intention of finding employment.
During the prolonged periods of illness caused by AIDS, the loss of income and cost of caring for a dying family member can impoverish households (Bor et al., 2012, p. 1). When a parent dies the household may dissolve and the children are sent to live with relatives, or left to fend for themselves. Holborn and Eddy (2011, p.6) confirm this by adding that the pandemic has resulted in an epidemic of orphan-hood and child-headed households. Some coping strategies, which have been adopted by affected households include the use of savings, or the sale of assets to acquire necessary funds (Bor et al.,2012, p.1); assistance is received from other households; and the composition of households tends to change (UN,2012, p.1) with fewer adults of prime working age in the households (Holborn, & Eddy, 2011, p.3). Findings indicate that poverty is high among households, and yet households with elderly members found their situation aggravated by problems faced by members with HIV/AIDS, and caregiving for grandchildren of infected children (Raniga, & Simpson, 2011, p.83).
Most of the care, according to the UN (2012, p.1), for people living with HIV is provided in the home, and women and girls account for 66% to 90% of all AIDS care givers. Conditions are most difficult and challenging for women and girls in rural areas. The unbalanced share of AIDS-related care giving by women and girls imposes a heavy burden on their own well-being, which often leads to their increased vulnerability to HIV infection (UN,2012, p.1), as the burden shifts to
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women rather than men. A woman’s ability to nurture places her in a precarious position. Abuse and obligation compel women to care for family members who are infected with HIV. Individuals endure the burden of HIV/AIDS in various ways, and HIV associated stigma and discrimination are but a couple of examples. The sacrifices endured by most are unnoticed, yet the stigma that surrounds infected households persists. The stigma associated with HIV/AIDS also suggests that people living with HIV/AIDS are much less likely to receive care and support (Gobind & Ukpere, 2012, p.11120). Stigma does not exclude those who are not infected or associated with the infected such as spouses, children and caregivers who also suffer stigma. Stigma unfairly increases the personal suffering that accompanies the disease.
2.1.7 Significance of HIV/AIDS stigma Archbishop Desmond Tutu remarks “in our African expression we say a person is a person through other persons. None of us comes into the world fully formed. We would not know how to think, or walk, or speak, or behave as human beings unless we learned it from other human beings. We need other humans in order to be human. The solitary, isolated human being is really a contradiction in terms” (Kidd & Clay, 2003, p.1). Isolation and rejection are elements of mistreatment, which are often sustained by individuals who are affected or infected with HIV. These individuals may frequently have the feeling of ‘us and them’. Individuals who are stigmatised are isolated or identified as being different and are blamed for that difference. Stigma attributed to HIV can so often be based on an infection, which many people fear, resulting in prejudice or victimisation. Stigma can result in people with HIV being insulted, rejected, gossiped about, excluded from social activities and blamed for attracting the disease. There are various reasons for callous behaviour. Ignorance about the cause and nature of the disease leads to preconceived ideas (Nam-aidsmap, 2013).
These ideas are often based on myth, prejudice, cultural practices, fear and historical conditioning. Individuals understand that HIV is a serious, life-threatening illness. There is a long history of disease such as cancer, psoriasis, leprosy and, recently HIV and AIDS, being stigmatised (Pappas, 2013, p.1), hence the social
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stigma associated with these diseases forces sufferers to hide their illness. Individuals who do not understand how HIV is transmitted may be afraid of contracting it through social interaction. Some individuals have strong opinions about sexual behaviour. Strong convictions may dictate that sex is wrong or that certain people should not behave in a particular way. In most instances individuals’ perceptions about HIV depends on the way that they think about individuals who are supposedly most affected by HIV. Some individuals have predetermined negative feelings about women, gay men, immigrants, Black people, drug users and others (Nam-aidsmap, 2013a, p.1). Gilbert and Walker (2010, p.140) concur that HIV and AIDS carries a high level of stigmatisation for those individuals living with HIV. The individuals are often blamed for their medical condition and many people believe that HIV could have been avoided if individuals made better ethical decisions.
Gilbert and Walker (2010, p.140) add that the second reason for the disease carrying a high level of stigmatisation is “that although AIDS is treatable, it is nevertheless a progressive, incurable disease, and more so in countries like South Africa where only approximately 28% of those in need of treatment have access to it”. Finally, HIV transmission is poorly understood by some individuals in the general population, which causes them to feel vulnerable by the sheer suspicion of the disease. HIV infection is asymptomatic and can often be masked, however, the symptoms of AIDS-related illnesses cannot be masked as these symptoms are visible and may be seen as repulsive, ugly and disturbing (Gilbert & Walker, 2010, p.140). The UNAIDS (2007, p.9) defines HIV-related stigma and discrimination as a process of devaluation of people who are either living with or are associated with HIV and AIDS.
Discrimination regrettably follows stigma, which is based on the unfair and unjust treatment of an individual founded on an individual’s perceived HIV status. The resulting “discrimination can be as devastating as the illness itself. Abandonment by spouse and family, social ostracism, job and property loss, school expulsion, denial of medical services, lack of care and support, and violence” (UNAIDS, 2007, p.9). These consequences force individuals not to test for HIV, reveal their HIV status, adopt HIV preventive behaviour, or access treatment, and support. In the USA it is
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reported that 2 out of 3 men who have sex with men who were unaware of their HIV status said that HIV related stigma affected their testing decisions (Young, 2010, p.623).
In a separate USA study Young, Hlavka, Modiba, Van Rooyen, Richter, Szekeres and Coates (2010, p.623) add that “38% of adults would be very concerned about HIV stigma if they tested positive and 44% said that stigma influences their testing decisions”. South African studies, according to Young et al., (2010, p.623), confirm these USA studies. In South Africa, for instance, those who have not tested for HIV have shown to hold more negative views about HIV than those who have tested. Results from a South African survey indicate that “18% of respondents were unwilling to sleep in the same room with someone with HIV/AIDS, 26% were unwilling to share a meal with someone with HIV/AIDS, and 6% would not talk to someone who they knew had HIV/AIDS” (Cloete, Strebel, Simbayi, Van Wyk, Henda & Nqeketo, 2010, p.1). These stigmatising emotions and opinions are significant barriers to effective HIV prevention and treatment. When comparing Young et al., (2010) and Cloete et al., (2010) studies, it is clear that decreasing stigma will help to increase testing rates. According to Gilbert and Walker (2010, p.141), there is a significant gap in research regarding testing and stigma and further research should be conducted, particularly in respect of the care and support of People Living with HIV and AIDS (PLWHA).
There are different dimensions of stigma, namely perceived (felt) stigma, enacted stigma, and internalized stigma (Gilbert & Walker, 2010, p.140; Ogaswara, 2009, p.7; and Gobind & Ukpere, 2012, p.11121). Perceived stigma refers to real or imagined fear of social arrogance and possible discrimination, which arise from a particularly unattractive characteristic of a disease associated with a particular group. In some instances individuals think that they are being stigmatised even when they are being treated the same as others. The constant dread of stigmatisation becomes inherent owing to on-going fear. Enacted stigma refers to the real experiences of being stigmatised by actual abuse, which is either physical or emotional. “The effects of enacted stigma are wide-ranging and may include actions taken by the person concerned in response to the stigma, and actions taken against
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the person concerned, which are discriminatory” (Gobind & Ukpere,2012, p.11121). Perceived and enacted stigma can take many forms, which include physical and social segregation from family, friends and community, gossip, verbal abuse, insults and loss of rights and decision-making power. Internalised stigma is manifested in self-blame and self-deprecation, for instance, the fear of HIV and AIDS-related stigma may cause individuals to separate themselves to the degree that they do not feel part of the society that they once belonged to, and as a result they are unable to receive help and care that they may need (Ogaswara, 2009, p.7). Internalised stigma can cause anxiety, depression, withdrawal, self-abandonment and feelings of worthlessness (Ogaswara, 2009, p.7).
In addition to the three dimensions of stigmatisation, Cloete et al., (2010, p.1) mention the term “othering (blaming and stigmatising the “other”, whereas the “other” is defined as someone with a different religion, ethnic group to one’s own, and gay men)” as a concern related to stigma. In 2003 Stein (2003, p.1) reported on AIDS-related stigma in the Western Cape province of South Africa, by stating that othering is when HIV and AIDS is called “ulwazi”, which means ‘that thing’. ‘That thing’ not only suggests that there is no cure, but also suggests that it is a stigmatised illness that cannot be mentioned by name. The labelling of individuals who are infected or affected by HIV and AIDS with a term that in itself sounds derogatory lends to the physical and mental abuse. Stein (2003) comments on South Africans being sensitive of classifications, and yet underlining stigmatisations and name calling persist. Gender, in addition to labelling, plays a significantly strong role in the experience of stigma. AIDS-related stigma of women is exaggerated because of their inferior role in society. Interviews with women in Cloete et al., (2010, p.1) study “revealed that AIDS related stigma is a barrier for women accessing free voluntary counselling and testing (VCT) and prevention of mother-to- child transmission (PMTCT) services. Mothers who are HIV-positive find it difficult to comply with medical advice to formula feed, because of the fear of having their HIV status exposed”. Conversely, some men refer to HIV and AIDS as a woman’s disease, and refuse to be tested or seek medical attention.
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By recognising the role of social practices and control in the construction of stigma, a clearer understanding and meaning of discrimination surfaces. Discrimination focuses attention on the “individual and social producers of stigmatization rather than the recipients of stigma. Discrimination is a consequence of stigma and defined as “when, in the absence of objective justification, a distinction is made against a person that results in that person being treated unfairly and unjustly on the basis of belonging or being perceived to belong, to a particular group” (Mahajan, Sayles, Patel, Remien, Ortiz, Szekers, & Coates, 2010, p.4). The rights of people living with HIV are often violated because of their alleged or known HIV status, causing them to suffer “both the burden of the disease and the consequential loss of other rights” (Office of the High Commissioner Human Rights United Nations Human Rights (OHCHR), 2012, p.1). Stigmatisation and discrimination may obstruct access to treatment, employment, housing and other rights. Stigma related to HIV contributes to the vulnerability of others to infection.
The fear of being associated with the epidemic discourages individuals who are infected with and affected by HIV from contacting health and social services. The fear of being identified prohibits individuals from accessing health care, education and counselling, even where such services are available. Individuals’ rights are further compromised owing to increased vulnerability. Women, and predominantly young women, are more vulnerable to infection if they lack access to information, education and services, which are necessary to ensure sexual and reproductive health and prevention of infection. Failure to address these issues decreases individuals’ inability to overcome the impact of the epidemic. Individuals silently sustain the burden of the epidemic in the hope that there will be a cure.
However, stigma cannot be confined or restricted to a particular environment or geographical location, as the far-reaching notoriety pervades every context. Schools and universities are not excluded. Nkosi Johnson embodied the ravages of stigma. Children with HIV and AIDS or those who are associated with HIV through infected family members have been stigmatised and discriminated against in educational conditions in many countries. Stigma has led to bulling by classmates of HIV- positive children or children who are associated with HIV (Parker & Aggleton, 2002,
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p.5). “Discrimination against HIV-positive children in the USA and Brazil, including exclusion from collective activities or expulsion from school, has led to non- discrimination legislation. However, less concern has been shown for young people who are perceived to be responsible for their HIV infection and who are already stigmatized and discriminated against because they are sexually active, homosexual, or drug users. “In the USA, for example, HIV-positive young gay men have been expelled from school and, in some cases, subjected to violence” (Parker & Aggleton, 2000, p.5).
Susceptibility to stigma is just as high among university students living with HIV or AIDS (Brown, 2009, p.41). Students become extremely aware of their differences when they are confronted by others who do not think as they do, or who do not have the knowledge to leverage conversations of reconciliation and understanding (Brown, 2009, p.41). Cooper and Foster interviewed eleven students from a university in South Africa who are all actively involved in the field of HIV/AIDS (2008- 2009, p.i). The study sought to investigate students’ perceptions of HIV/AIDS in an attempt to assess whether stigma does occur. Through their interviews, Cooper and Foster (2008-2009, p.i) gathered that the participants tended to ‘other’ the epidemic and thus detach themselves from a sense of threat. In line with psychosocial understandings of HIV/AIDS stigma, the results indicated that this ‘atypical’ group of students possess stigmatising tendencies towards the epidemic and, against those who are infected (Cooper & Foster, 2008-2009, p.i). If the HIV and AIDS stigmatising process was shown to occur amongst this somewhat unusual group of socio- politically conscious and progressive White students, Cooper and Foster (2008- 2009,p.34) adds that “it does say, at least something, about what may be occurring amongst other students”.
Secondly, Cooper and Foster (2008-2009, p.35) concluded that “the results from this study have theoretical implications. These highly informed and educated students tended to ‘other’ the epidemic, and associate HIV and AIDS and those infected with a number of derogatory and negative meanings, be it promiscuity, deviance, pollution and blame. This may reveal that HIV and AIDS stigma is not, as Robert Miles indicated when referring to racism, a “bad-apple” problem, produced by
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ignorant and dysfunctional individuals that can be “weeded out” through education”. The results from this study thus indicate that HIV/AIDS may not be the product of a lack of education or unusual thinking. The study, according to Cooper and Foster (2008-2009, p.35), has greater implications. The findings from this sample of students shed light on the fact that challenging HIV and AIDS stigma is highly prevalent among university students. There may be a need to address stigma beyond providing ‘correct’ information and education. Health care systems could shoulder the burden in “providing a space for people to engage with, and be open and honest about the fears and anxieties they may have around the epidemic. “It may require encouraging reflexivity and making meaning of the non-rational parts of ourselves” (Cooper & Foster, 2008-2009, p.35).
2.1.8 HIV/AIDS and health care systems Health care systems face similar challenges as households. Health care systems experience enormous demands as HIV and AIDS and stigma continue to spread. High rates of HIV/AIDS in South Africa has the effect of exasperating the human resource crisis by further draining the health care workforce, and causing increased demand for health services (Rawat, 2012, p.3). Part of the Rural Health Advocacy Project plan that addresses the re-engineering of primary health care (PHC), according to the Department of Health (2011, p.65), calls for attention on “maternal, child and women’s health, maintaining the HIV and AIDS focus and an emphasis on community-based and preventative health care”.
The epidemic has handicapped several health systems in Africa, where health systems were fragile before prevalence rates increased. The cost of medical treatment and other expenses related to the treatment of AIDS and AIDS-related ‘opportunistic’ infections have been rising. Allocating limited resources for HIV/AIDS treatment and care can divert attention from other health concerns, and as public funds for health care are depleted, costs are increasingly borne by the private sector and by households and individuals (Ashford, 2006, p. 2). De Lange (2012, p. 4), in his paper entitled Research or Treatment: Priorities in South Africa’s HIV/AIDS Funding, he reports on research that was conducted in Kwa-Zulu Natal that show that “over the past few years, South Africa has been faced with rising costs for its
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epidemiological response to HIV/AIDS. This has forced the government to reduce the amount spent on research to bolster its treatment response capacity”. As public funds for health are depleted, such scarcity begins to apply undue pressure on business and agriculture.
2.1.9 HIV/AIDS and business
With added pressure on government, businesses are forced to invest in their employees lives. Employers are compromised by the loss of employees, absenteeism, the costs of providing healthcare benefits, and the payment of death benefits (Ashford, 2006, p.4). Squire (2010, p.1) agrees with Ashford (2006) that one of the greatest problems facing organisations today is HIV/AIDS “and the effect it will have on morale, worker retention, productivity and profitability. Employers are faced with the task of addressing the spiralling cost and effect that the illness will exert on business, in general”.
Squire (2010, p.1) cites Carl Van Ardt, Director of Research at the University of South Africa (UNISA) Bureau of Market Research, who states that recent studies challenge the widespread belief that HIV is a disease of the poor, the impoverished, the uneducated and the unemployed. Recent statistics suggest that South Africa could be facing a “third epidemic, due to the increase in HIV infection in the more affluent sectors of society. Statistics as gathered by Van Ardt reflect that a great number of well-off and affluent South Africans are now living with HIV/AIDS. About 6.2% of professional people were infected in 2002. The figure has now escalated to 8.3% or an increase of 34%. The increase in the instances of HIV/AIDS infections of those in permanent employment has also increased by 36% to almost 20% of this group” (Squire, 2010, p.2). Squire adds that a large percentage of those “who are employed, who are capable of investing, and who are in a position to sustain the economy are now infected. This can only have a negative impact on organisations and the country as a whole if not addressed” (2010, p.1).
The concern for business arises when calculating the risk from the time an employee is diagnosed as being HIV positive to the point where the employee has developed full-blown AIDS. During this time an organisation may have many
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infected workers at various stages of infection. This can and may continue to cost organisations in terms of productivity and other direct and indirect costs. Van Zyl and Lubisi (2009, p.214) concur that HIV/AIDS is having a notable impact on industry, and it has been established that HIV/AIDS is beginning to apply adverse impact on the level of firm efficacy, and on firm competitiveness.
Economic stability is, therefore, disrupted as businesses and agriculture suffer. Chicoine’s (2012, p.256) study found evidence that the epidemic has lowered employment in South Africa. “This result is concentrated among those with the lowest levels of education and employment. “Although not large in magnitude, these effects are widespread across a significant portion of the population, contributing to a substantial loss of income throughout the South African economy” (Chicoine, 2012, p.256). The strength of the South African economy is determined by the financial wellbeing and contribution made by organisations within the workplace. These contributions may entail the successful creation of employment, tax compliance and corporate social investments. The workplace and the economy are components that are prescribed for the continuity of economic existence, and the education sector is no exception.
2.2 Summary
In summary, the terminology that is often used to describe HIV and AIDS has been tainted by ignorance and prejudice. UNAIDS has proposed a set of terminology, which is most suited when speaking of the disease. The early spread of the disease seems to have attracted similar attention. HIV and AIDS is often referred to as the ‘gay disease’. However, research has shown that Africa has the largest prevalence rate in the world, and has reported higher prevalence rates amongst heterosexuals than amongst homosexuals. HIV and AIDS are two separate concepts; it is necessary to avoid confusion between HIV (a virus) and AIDS (a clinical syndrome). Poor appreciation of the concepts often leads to misunderstanding of the nature of the disease. The ignorant often believe that HIV and AIDS are synonyms, and being diagnosed as HIV positive suggests AIDS. No person is infected with AIDS, as AIDS describes a syndrome of opportunistic infections and diseases that can develop as a
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result of a compromised immune system. Immunosuppression worsens as the disease range of HIV infection advances from acute infection to death.
Likewise the confusion about the nature and transmission of the disease has initiated an outpouring of unfounded misunderstanding regarding the disease. The spread of myth has resulted in the instilling of discrimination and bigotry. Myths range from the origin of the disease to prescribed treatment and remedies. Women and children are often victims of misbelief and abuse. Families and care givers are victimised merely for being associated with HIV positive persons. HIV prevalence rates are often difficult to determine as most individuals who suspect possible infection are afraid to be tested. HIV prevalence rates in South Africa are based on anti-natal reports. These reports are restricted to individuals who are tested at anti- natal centres. If the need does not arise to visit these centres then individuals go without testing. The consequence of which, results in HIV positive individuals who are unaware of their status, and hence transmit the disease unknowingly. This, in turn, prevents health care workers from gathering relevant data, and results in inaccurate prevalence estimates, which are unworthy of a true reflection of HIV prevalence rates.
Furthermore the chapter looked at the various myths that surround HIV/AIDS, followed by a section on the prevalence of HIV/AIDS in South Africa and people living with HIV/AIDS. The significance of HIV/AIDS stigma was also mentioned with reference to a quote made by Arch Bishop Tutu who emphasised the need for human beings to come together. The chapter examined how health care systems under the auspices of the South African government are overburdened by rising prevalence rates, and an increased demand for health care owing to the rise in opportunist infection such as tuberculosis. Overburdened health care systems are forced to reach out to businesses for support. The burden of the disease has subsequently spilled over into other sectors, demanding organisations to prepare and provide for employees and employers alike, either through the provision of medical aid or wellness centres. The chapter concluded with the impact of HIV/AIDS on health care systems and business. The next chapter delves deeper into an understanding of HIV/AIDS within a higher education environment.
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CHAPTER 3 HIV/AIDS within a higher education environment
3.1 Introduction
About half of all the jobs that were created during the past 15 months were in the public sector, according to the Treasury in its 2011 medium-term budget policy statement (MTBPS), which was tabled in the National Assembly. “Government is the country's largest employer ‘about half of all jobs created over the past 15 months were in the public sector. ‘The document says provincial government accounts for about three-fifths of public-sector jobs, mainly in education and health, national government and local government” (Times Live, 2011, p.1). This statement confirms that the education sector creates jobs and if the sector should create jobs it would need to employ individuals to assume these job/positions. In order to provide such employment, government should establish a workplace for these individuals to perform their assumed jobs/positions. Hence, one should understand what is meant by the term workplace.
3.2. Workplace defined Section 213 of the Labour Relations Act No 66 1995 of the Republic of South Africa (LRA) (Republic of South Africa 1995) states that a workplace can be defined as the place or places where employees work. Finnemore (2009, p.230) defines the workplace as “the place or places where the employees of an employer work. If an employer carries on or conducts two or more operations that are independent of one another by reason of their size and function or organisation, then the place or places where employees work in relation with each independent operation constitute the workplace for that operation. A workplace in the public service is determined by the relevant minister, after consulting with the relevant bargaining council”. The question is: would a University that employs several employees at different levels be considered a workplace? The LRA (Republic of South Africa 1995, Section 213,) states that a workplace can be defined as a place or place where employees work. A university qualifies for this definition, and should the university, owing to its size be extended over more than one campus, each campus would constitute a workplace for that operation. As per the definition set out in the LRA (Republic of South Africa
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1995, Section 213) and Finnemore (2009, p.230), one can conclude that a workplace and a university are similar.
What makes a university similar to a workplace is clear. Individuals are employed at various levels to deliver tasks that they are appointed to perform. The university comprises employees who are employed at different levels from executive management to junior lecturers and administrative assistants. Added to the employee compliment is contract staff who are contracted to the university as independent contractors. Students are recognised as the clients of the university, clientele who acquire a service in training and development. The needs of these individuals are similar to those within any other sector or workplace. The employer is expected to provide a safe and secure or working environment that allows for an efficient and healthy work environment, while employees are required to cooperate with the employer so that this duty or requirement that is placed upon the employer may be complied with.
In addition to providing a safe and secure environment, employers are encouraged to include an HIV/AIDS strategy, which would include a policy accompanied by a programme. Organisations that focus on HIV/AIDS prevention messages as part of their HIV workplace programmes have, shown to contain escalating costs of insured benefits as a result of increasing AIDS mortality (Redribbon, 2010, p.1). Prevention strategies such as condom distribution, peer education and voluntary counselling and testing have proven to be successful. Research has revealed that in the absence of treatment and awareness, most HIV positive employees choose to remain ignorant of their status and continue to spread the disease (Redribbon, 2010, p.1).
3.2.1 Impact of HIVAIDS in the workplace
HIV/AIDS within the workplace pose a grave concern. The macro-economic impact of HIV/AIDS in the workplace targets the working-age population, and affects people in their most productive years of life, which leads to reduced earnings, whilst increasing the need and higher spending on health care and early mortality. Savings and disposable income decline as the disease progresses. In the long term the
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consumer market is depleted, resulting in a drop in commodities that are available for production and investment. For employers, HIV/AIDS has a negative impact on both the business environment and on the businesses directly. By the year 2020, the World Bank estimates that the “macroeconomic impact of HIV/AIDS may be significant enough to reduce the growth of national income by up to a third in countries with adult prevalence rates of 10%” (UNAIDS, 2002, p.7).
The ILO’s projections as eluded to on page 2 reveals that 29 African countries “with prevalence rates above 2% in 1997 indicate that the total population for these countries will decrease by 8% in 2020 as a result of AIDS-related deaths. Many of those infected with HIV/AIDS are experienced and skilled employees in both managerial and non-managerial employment” (The Economist, 2012, p.1). The microeconomic impact of HIV/AIDS in the workplace is reflected in the declining levels of productivity owing to increased absenteeism and organisational disruption. Declining and unstable productivity levels make it difficult for an organisation to meet supply and demand, thus effecting organisations’ overall growth and development.
Absenteeism, which results from HIV/AIDS-related illnesses and care for ailing family members leads to an interruption in the production cycle, as well as the under-utilization of equipment and use of temporary staff. This can directly affect the quality of products and services. Increased absenteeism owing to illness and deaths of loved ones lead to increased inefficiency within the organisation as a result of rising staff turnover, loss of skills, loss of tacit knowledge, declining confidence and replacement costs. These costs are not instantaneously obvious and are difficult to quantify accurately without undertaking a comprehensive impact assessment, which in itself can be costly. One of the simpler ways of mitigating increased disorganisation is through the dissemination of HIV/AIDS information. The lack of accurate information has the potential of disrupting the smooth functioning of an organisation. The fear of becoming infected may result in the refusal to work with an employee who is identified as being HIV positive. False beliefs and stigmatisation result in the employee being victimised and “discrimination in the making of personnel decisions for example, the unjustified discharge of an employee who has HIV/AIDS” (UNAIDS, 2002, p.10).
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This disruption, as outwardly insignificant as it may seem at the time of the occurrence, has the potential of gradually surmounting into an uncontrollable crisis, which leads to increased costs. Increased costs may manifest in a rise in production that in turn, results in a decline of profit margins, future profits by decreasing the investment capability for increasing productivity, expansion, research and development, and workforce training and support (UNAIDS, 2002, p.11). HIV/AIDS increases costs in a number of ways, such as increased staff turnover and loss of skilled employees, raised recruitment and training costs. Organisations may have to employ extra labour to cope with staff fluctuations and losses. Newer staff members often need to be trained and inducted, which increases training costs. “Scarcity of skilled labour not only increases training costs but also results in demand for higher wages” (Avert, 2011, p.1). Insurance cover, company life insurance premiums and pension fund obligations increase as a result of early retirement or death. This is challenging in larger organisations where such benefits are more comprehensive (Lifesense, 2011, p.1).
Considerable funeral costs are incurred by businesses that meet the funeral costs of employees. Traditional or cultural funerals increase the rate of absenteeism, as colleagues often feel the need to attend funeral services. Services tend to expand over several days, often impacting on designated working hours (SABCOHA, 2012, p. 1). In situations where organisations provide health care, the costs of these services increase considerably with rising HIV/AIDS prevalence rates. The strain of providing Anti retro-virals (ARV’s) may hugely impact on an organisation’s profit margins, as in most instances there is often an expectation that the spouse or partner of the infected employee should benefit from the programme. Sharing of ARV’s tends to defeat the purpose of the treatment, compelling organisations to extend treatment to partners and spouses alike. The cost of ARV’s may have dropped, and yet organisations are compelled to provide these services as the benefits of providing ARV’s outweighs the cost and, therefore, the need to continue to provide these services (Buthelezi, 2012, p.1) remain a cost to the organisation. Early interventions that entail education, prevention campaigns and HIV/AIDS programmes have proven to help to diminish the spread of the epidemic among
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employees, their families and communities (Hui, 2012, p.1). The effectiveness of such interventions was noted by Hui (2012, p.1) who states that South Africa’s testing campaign resulted in a drop in mother-to-child transmission from 8 percent in 2008 to 3.5 percent in 2010 and to 2.7 percent in 2011. In-house healthcare provision such as treatment of STIs has shown to help reduce infection rates, whilst HIV/AIDS awareness and management programmes further enable information dissemination.
Figure 3.1: Impact of HIV/AIDS on the workplace
Increased Increased Loss Loss of Decline in absenteeism staff of tacit morale turnover skills knowledge
Insurance cover Increasing demands for training and recruitment HIV/AIDS in Retirement recruitment funds
Health and Declining safety markets, Declining Reduced labour pool intellectual foreign suppliers capital direct investment Medical assistance
Declining Declining Reliability Funeral Re -investment costs
Funeral Costs Declining
Productivity
Declining Profits
Source: adapted from UNAIDS (2002, p.10)
Figure 3.1 above illustrates a possible path that an organisation may take when experiencing a decline in profitability and productivity owing to the impact of
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HIV/AIDS in the workplace. The increase in costs is clearly contributing to the decline in productivity. Organisations are often faced with many challenges; HIV/AIDS is one of the many factors that employers should address. The review of recent HIV/AIDS data and facts pertaining to a particular organisation are valuable tools to identify the organisation’s vulnerability to the disease. HIV prevalence may be a useful indicator when determining the wellbeing of an organisation. Universities, like organisations, are faced with similar challenges.
3.3 HIV prevalence at the university investigated In 2010 “more than 350 000 deaths from tuberculosis occurred among people living with HIV. That is one fifth of the estimated 1.8 million deaths from HIV/AIDS in that year. The majority of people living with both HIV/AIDS and TB reside in sub-Saharan Africa (about 82% of cases worldwide)” (Dell, 2010, p.1). Recent findings suggest that HIV prevalence rates within South African universities are reflective of the nation’s prevalence rates (Dell, 2010, p.1). According a study, which was conducted by HEAIDS and a contracted consortium led by Futures Group Europe, Centre for AIDS Development, Research and Evaluation (CADRE) and Epicentre AIDS Risk Management in 2008-2009, the following findings on HIV prevalence and related factors at the university being evaluated, were established. A total of 1 443 students, 145 academic staff and 327 administration and service staff participated in the study. The response rate for completing questionnaires and providing bloodspots at the university was 77.7%.
The overall prevalence of HIV among students and staff at the evaluated university is 1.8%, namely 34 overall participants. A total of 1.6 % (23 students), 2.7% (4 academic staff), 3.9% (13 administrative staff), and 13.3% (43 service staff) are living with HIV. A majority of the HIV cases occurred among African students and staff. It is estimated that about 628 students, 24 academic staff and 119 administrative/service staff are living with HIV (HEAIDS, 2008-2009). High prevalence rates have motivated universities to respond to the crises (Dell, 2010, p.1).
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3.3.1 Higher education response to HIV/AIDS At a meeting in London in November 1998, the Association of Commonwealth Universities (ACU) was challenged by Professor Brenda Gourley, (then) Vice- Chancellor of the University of Natal and Immediate Past Chair of the ACU Council, to take notice of and respond to the impact of the HIV/AIDS epidemic on universities in southern Africa (Association of Commonwealth Universities (ACU), 2002).
A year later, the development of an HIV/AIDS policy by tertiary institutions was addressed and substantially heightened by the ‘Tertiary Institutions Against AIDS’ conference, which was held on 1 October 1999 and particularly, perhaps, by the speech of Kader Asmal (then) Minister of Education (Martin & Alexander, 2006). Disturbed by the absence of many vice-chancellors, Asmal argued that “we cannot afford to treat our response…as an administrative function that is lightly delegated” (Asmal, 1999). He told the conference that he was not sure whether to be “disappointed or shocked” by the fact that ‘not all’ institutions had policies on HIV/AIDS, though he added that the technikons appeared to have made greater headway than the universities, and acknowledged six such institutions for their “comprehensive policy documents” (Asmal, 1999).
Whilst at the University of Kwa Zulu Natal, Professor Gourley reported that the University of Natal had been asked to organise symposia around the Commonwealth Heads of Government Meeting during the latter stages of 1999. At that meeting it was stated that ACU might participate in co-ordinating at least one conference with HIV/AIDS as the topic. It was suggested that ACU was better positioned “to address issues related to social policy than the medical aspects of HIV/AIDS; and that ACU could fulfil a very useful longer-term role in promoting a response to the epidemic, and in sharing policies and examples of good practice amongst the universities in membership” (ACU, 2002, p.1).
The symposium titled Social, Demographic and Development Impact of AIDS: Commonwealth Universities Respond, was subsequently hosted by The Association of Commonwealth Universities at the University of Natal on the 8 November 1999. During proceedings the ACU and Commonwealth Health Professional Associations
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implored all the Commonwealth Heads of Government to take a leadership role in openly acknowledging the critical implications of HIV/AIDS, and to call for a Global State of Crisis on HIV/AIDS. The ACU, in their deliberation, concluded that universities are workplaces, which employ large numbers of staff. “It is, therefore, likely that, whatever the geographical location, there will be at least some (and probably a growing number of) staff in every university who have HIV/AIDS. It is thus manifestly in the interests of every university to develop a comprehensive HIV/AIDS policy for their staff” (ACU, 1999).
The ACU committee emphasised that the university’s responsibility extends also to providing a safe environment for students, and recommends the suitability of developing an HIV/AIDS policy, which offers support and security for students whilst positioning HIV/AIDS firmly together with a range of other critical issues such as rape, sexual abuse, violence, drug use and the financial concerns of students. Furthermore, universities, according to ACU (1999), have an exceptional opportunity as creators of tomorrow’s leaders to guarantee that all students become conversant with the implications of HIV/AIDS as an employment issue. “If students are made aware of the relevance of managing HIV/AIDS in the workplace, of developing and implementing appropriate programmes, of understanding the legal and ethical issues and of being able to provide counselling and support where required, it will go some way in conjunction with an education and prevention programme that is underpinned by human rights towards ensuring that the way in which HIV/AIDS is dealt with by future generations will challenge prejudice and discrimination and enable society to take effective steps against the spread of the epidemic” (ACU, 1999).
At the conclusion of the symposium, a draft HIV/AIDS policy for staff and students was established and offered to ACU member universities as a framework for consideration, adaptation, adoption or rejection. Consequently, a study was undertaken by SAUVCA and the Association of Commonwealth Universities (ACU), which resulted in two key organisations, assessing the response to the HIV/AIDS crisis in HEIs. However, this study focused mainly on universities and lacked the wealth of knowledge already established by technikons (Martin & Alexandra, 2006).
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The mutual concern highlighted the need to create a sector-wide response to institute and develop capacity at national and institutional levels to collaborate closely with the Department of Education (DOE), and the Committee of Technikon Principals in order to work towards the formation of a strategic plan that would direct the sector’s response to HIV/AIDS (Chetty, 2001). Senior managers in the sector, with the support of the UK Department for International Development, responded positively to the suggestion for a programme to build capacity. SAUVCA took the lead in establishing the first nationally co-ordinated leadership and capacity building programme on HIV/AIDS in Higher Education (HE) (HEAIDS, 2004). The challenge, however, in many instances has been to encourage institutions to approach HIV/AIDS within the workplace through a different lens, and to step away from the conventional pre-occupation off HIV/AIDS prevention programmes as a one-size-fits all approach, and to begin to approach HIV/AIDS as part of management in HE (Chetty, 2005).
The partnership, which was established by the Higher Education AIDS (HEAIDS) programme, created an opportunity for the programme to explore areas, which already demonstrated signs of improvement, and those programmes that were closely linked to the Department of Health’s national strategic plan and the HIV/AIDS priorities identified by the plan (HEAIDS, 2004). Three of the areas that were identified for support included peer education (PE), curriculum integration, and voluntary counselling and testing. A working group was established for each of these areas and two others, for instance, workplace programmes and care and support were identified to access expertise within the sector. In addition, the main objective of the South African HE strategic plan, which was adopted in 2004 was to organise the sector to respond sensitively, appropriately, and effectively to the HIV/AIDS epidemic through its core functions of teaching, research, management, and community service and through a continuum of HIV/AIDS interventions, namely prevention, treatment, care and support (HEAIDS, 2004).
In 2005 HEAIDS was established, followed by the publication of a four year review of the HEAIDS programme. The programme was based on evidence from an audit of responses to HIV/AIDS in higher education, which showed significant progress
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over three years in the provision of prevention services, treatment, care, and support and the establishment of institutional capacity to manage HIV/AIDS programmatically across each institution (HEAIDS, 2010). “The audit established that 26% of HEIs had workplace programmes in place for staff and that even these were primarily focused on information provision and basic prevention services rather than on care and treatment” (HEAIDS, 2010, p.1).
Two years later in 2007 HEAIDS commissioned a ‘Gaps Analysis’ survey of all HEIs. Further to the ‘gaps analysis’, a situational analysis was undertaken of each HEI to determine the state of HIV/AIDS workplace programmes. Subsequently, 22 detailed reports were produced (HEAIDS, 2010, p.1). The findings indicated that a majority of the HEIs, namely 15 of 23 has an established HIV/AIDS programme. Only one university has no policy with six having policies that are in draft stage. Most of these HEIs have not taken workplace HIV/AIDS programmes seriously enough to move beyond generic, institutional policies (HEAIDS, 2010, p.1). HEIs have a significant role to play in response to HIV/AIDS.
3.3.2 Current level of HIV/AIDS awareness at the focussed university
Universities are affected and impacted upon by HIV/AIDS similar to any other organisation or workplace. Universities experience the impact in comparable ways through increased absenteeism, increased staff turnover, loss of skill, loss of tacit knowledge and decline in morale. In November 2007 a national survey was commissioned by the Department of Higher Education of South Africa to establish knowledge, attitudes, behaviours and practices (KABP), which relate to HIV and AIDS, and to measure HIV prevalence levels among staff and students (The Higher Education HIV and AIDS Programme (HEAIDS, 2010, p.8).
On completion of the study, HEAIDS (2010, p.11) concluded with a report that summarised their observations, recommendations and concerns regarding their findings. HEAIDS (2012, p.11) summarised the following: “The university community should be made aware of the potential severity of the HIV epidemic at the institution, especially among the students and service staff. This should be accompanied by an intensive and clearly sequenced campaign to prevent HIV infection and mitigate its
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impact. Among students, emphasis should be on increasing knowledge of sexual risk behaviours, in particular those involving high turnover of sexual partners and overlapping sexual partnerships, with a further emphasis on staying HIV negative throughout university study.
A key emphasis needs to be on disrupting sexual networks by continuously emphasising the importance of not having overlapping sexual relationships and consistently using condoms. Education about living with HIV and managing AIDS needs to be emphasised among all staff and students, and in particular administrative and service staff members, many of whom are living with HIV. The high levels of symptoms of STI infection in females are strongly associated with HIV infection and indicate the need for a strong campaign to identify and treat STIs. Key messages on sexual health and STI prevention should be continuous and systematic. Campus leadership must take heed of the fact that female members of the campus community do not feel secure on campus and feel vulnerable to sexual harassment. It should be a matter of priority to reinstate campus disciplinary procedures, and to create an environment where students feel safe and protected, including from sexual harassment. Different strategies of addressing prevention of HIV and AIDS should be explored including, further strengthening the campus peer education programme and utilising campus media structures like radio and the student newspaper”.
Since 2009 the university has not repeated the HEAIDS HIV prevalence study. It, therefore, cannot be determined whether HIV prevalence within the university has reduced or increased over the last 3 years since first data collection was in 2009. One should not be confused with data that was presented on the University of Johannesburg’s (UJ) archived news site, and assume that a new survey has been conducted since 2009. The title of the document that is archived on the site refers to the HEAIDS (2010, p.11) survey, which was conducted at the university under the title; Institutional Office HIV and AIDS (IOHA), which reveals results of the pro-active HIV and AIDS survey (University of Johannesburg,2010,p.1). Some confusion may arise on first reading the posting, as the sample size on the posting varies from the original HEAIDS (2010, p.11) study, which refers to a sample size of 1443 students
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who participated in the study (HEAIDS, 2010, p.11), as compared to the 1915 (University of Johannesburg, 2010, p.1) sample size referred to in the posting. This sample size includes students, academics and administrative staff. On closer reading one would realise that the breakdown of the data that is presented are identical. Solutions to averting the impact of HIV at the university are briefly mentioned on the posting.
3.3.3 Higher Education Institutions and HIV
The Higher Education sector is the largest public sector employer in most countries. While there is some deliberation about levels of HIV infection and HIV related attrition among education sector employees, it is widely acknowledged that HIV is a serious threat to the health of many employees in this sector in numerous countries (Chetty, 2009; Kelly, 2009; Crewe & Nzioka, 2009). “The epidemic is concentrated in the working age population (15-49 years), and affects HEIs in many ways, resulting in reduction in labour supply and earnings, loss of valuable skills and experience, and a decline in productivity and enterprise profits” (Marwitz & Were- Okello, 2010, p.198).
HIV/AIDS challenges higher education institutions to ensure that there is a lecturer in every lecture room. Educators are succumbing in increasing numbers and at relatively young ages, and it takes time before they can be substituted; educators who are ill are often unavoidably absent, and difficult to replace. Household illnesses and family and community funerals are leading to increases in educator absenteeism. However, educators are not the only ones affected. HIV/AIDS affects employees in other parts of the education system in similar ways. HIV prevalence among administrators, organisers, qualified staff and support staff is likely to be as high as in similar groups in the general population (ACU, 1999; Kelly, 2009).
The effects of the epidemic, according to Marwitz and Were-Okello (2010), add up to a severe weakening in the social capital available to the university, the standards, systems, institutional capital, functionality and organisational procedures that sustain its effective functioning, making it conducive to continue and maintain daily processes. Deprived of this communal strength, cohesive ability to address
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problems that are experienced in higher education institutions, is weakened. At the same time, the problem of attending to these internal needs is of a greater concern to the system, thereby further constraining its ability to respond to the epidemic (Marwitz & Were-Okello, 2010).
According to Kelly (2009), Marwitz and Were-Okello (2010) and Chetty (2009), cost is an important factor in the supply of education. The AIDS epidemic affects the costs of education in numerous ways such as the following: the additional training and posting costs for replacement lecturers and other staff; the payment for salaries to absent or sick personnel; the loss of training costs that are invested in educators; students who die young and hence, frequent payments of death and funeral benefits resulting in premature payment of terminal benefits; the cost of training lecturers in the relatively new curriculum area of HIV preventive education and the improvement and distribution of the necessary material; and additional management expenditures for the formation of HIV/AIDS units or HIV/ AIDS training programmes.
Time, in addition to cost, is a further factor, which guarantees that education responds to known and foreseen needs. There are two notably different areas. Firstly, educational administrators are required to give an increasing amount of their time to responding to HIV/AIDS. In some instances this may amount to lengthy periods away from their other duties, as they participate and develop training sessions or workshops. In addition to their contracted duties, HIV/AIDS places further burden by increasing administrative obligations. Relentlessly, the epidemic increases their burdens and congests systemic capacity to address both on-going and new issues (United Nations (UN), n.d). Secondly, HIV/AIDS corrodes the quality of education. Infected lecturers may be absent or too ill to provide a quality education for their students, and substitute lecturers may be appointed in haste, and often lack in qualifications and experience. The standard and quality of education may be inadvertently affected, should the investment in the education decline, as funds are utilised to fight the HIV/AIDS (UN, n.d).
One way of addressing the impact of the epidemic on HEIs is by allowing institutions to adopt a proactive stance and approach the threat of HIV/AIDS constructively. An HIV/AIDS workplace programme enables an institution or an organisation to declare
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their position in addressing the legal rights and wellbeing of its employees, whilst abating the effect of HIV/AIDS within the workplace (Uys, Martin, Ichharam, Alexander, Els, & Eiselen, 2002; Oyoo,2003; Saint, 2004; Martin, 2006; Crewe & Nzioka,2007; Kelly, 2009; Marwitz & Were-Okello, 2010; HEADIS, 2011; UNESCO, 2011).
3.4 HEAIDS submissions to avert the impact of HIV/AIDS within the university
A possible solution, according to the university’s IOHA, as stated on the posting read as follows: “The university is strengthening its strategies for mitigating the impact of HIV and AIDS, addressing prevention of HIV and AIDS (including HIV integration in the curriculum), up-scaling its care and support strategies and services, as well as further strengthening UJ leadership commitment in the fight against HIV and AIDS” (University of Johannesburg, 2010, p.1).
The HEAIDS (2010, p.59.) study, conversely sets out a comprehensive list of recommendations, which are outlined below.The university as a community should be made aware of the impending impact of the HIV epidemic on academics, administrative staff and students. This should be followed by an extensive and well- coordinated strategy to abate the anticipated impact of HIV/AIDS at the university. “Among students, emphasis should be on increasing knowledge of sexual risk behaviours, in particular those involving high turnover of sexual partners and overlapping sexual partnerships, with a further emphasis on staying HIV negative throughout university study.
Emphasis needs to be placed on discouraging multiple sexual relationships and encouraging the consistent use of condoms. Education about living with HIV and managing AIDS needs to be emphasised among all staff and students, and in particular administrative and service staff members, many of whom are living with HIV. The high levels of STI infection among females are strongly associated with HIV infection and indicate the need for a strong campaign to identify and treat STIs. Campus leadership should consider the need to ensure the safety of female students. This should be undertaken as a priority measure. Different strategies of addressing prevention of HIV and AIDS should be explored including, further
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strengthening the campus peer education programme and utilising campus media structures like radio and the student newspaper” HEAIDS (2010, p.59.).
Further recommendations were made regarding care and support that should be given to staff and students living with HIV and AIDS, for instance. Resources that are utilised for the development and support of HIV and AIDS support groups, and dissemination of information about resources and services for antiretroviral therapy (ART) should be made available to HIV positive staff. Institutional Medical Aid schemes should be approachable and supportive of HIV positive staff who choose to access this service.
Further, there is a need to establish peer support groups, which are led by HIV- positive people. VCT services “should continue to be promoted in the institutional context. Emphasis should be placed on HIV testing and couples counselling. “Wider communication should include emphasis on the importance of disclosure of HIV status to sexual partners in relationships where condoms are not used and/or in marital or long-term partnerships” (HEAIDS, 2010, p.60). Recommendations that were made to management, according to HEAIDS (2010, p.60), entailed the need for an all-inclusive review of all HIV and AIDS programmes and services on campus, which should be comprehensive and result in a better rationalised and cohesive set of services for students and staff. A comprehensive and thorough response is required, which will consolidate a plan for the need to comprise of HIV prevention, stigma reduction, HIV support and care, while a comprehensive impact mitigation plan of services should not exclude family planning. The risk attached to multiple concurrent partnerships should be more actively publicised and a reduction in concurrent partnerships should be encouraged across all campuses. This should be accompanied by the promotion of condom use in new, casual and concurrent sexual relationships with irregular partners.
Campus management at all levels, including student bodies, should “take heed of the perception of a significant proportion of students and staff, that they do not take HIV/AIDS seriously” (HEAIDS, 2010, p.60). This, according to the HEAIDS study (2010, p.60), is a reflection of a lack of reliable, well maintained and visible HIV and AIDS programmes, and a lack of unshakeable vocal champions, including HIV
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positive campus leadership. The study recommends (HEAIDS, 2010, p.60) a need for “strong institutional leadership among students, management, labour unions and other key stakeholders as a necessary foundation for addressing the epidemic. Such efforts should be intensive and collaborative, and include people living with HIV and AIDS”.
Lastly, strong perceptions that HIV/AIDS has not been adequately integrated into the academic curriculum suggest that there should be an appraisal of what is being done, and an undertaking should be initiated to address this need. The university has implemented various interventions that are designed to address suggestions made by the HEAIDS survey.
3.4.1 Interventions undertaken by the university The university produced the first draft of its HIV infection and AIDS policy, programme and services on 17 August 2007 (University of Johannesburg, 2007, p.1) Two years preceding HEAIDS’ 2008 and 2009 data collection process. Since the first draft in August 2007, the university completed their HIV/AIDS workplace programme in February 2010 (HEAIDS, 2010.b). Examples of the goals and interventions, which have been implemented by the university for the year 2012 are set out in the table below.
Table 3.1: HIV/AIDS Workplace Programme 2012 University of Johannesburg Goal 1: To prevent the spread of new HIV infection
OBJECTIVES YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 RESPONSIBILITY
Prevention STI education STI education STI education STI education STI education PHC and treatment of STI’s Condoms Condoms Condoms Condoms Condoms promotion promotion promotion promotion promotion
Availability of Availability of Availability of Availability of Availability of treatment for treatment for treatment for treatment for treatment for STI’s and STI’s and follow STI’s and follow STI’s and follow STI’s and follow follow up up up up up
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Condom Accessibility Accessibility and Accessibility and Accessibility and Accessibility and Cleaning staff, usage and availability availability of availability of availability of availability of monitored by of condoms in condoms in staff condoms in staff condoms in staff condoms in staff IOHA staff and student and student and student and student student bathrooms bathrooms bathrooms bathrooms bathrooms
Accessibility Contract staff Contract staff to Contract staff to Contract staff to Contract staff to PHC of HCT/VCT to be allowed be allowed to be allowed to be allowed to be allowed to Employee services to to access HCT access HCT and access HCT and access HCT and access HCT and Wellness contract staff and VCT VCT services VCT services VCT services VCT services services
Education and Information Training of line Training of line Information Information Employee Training sharing of HIV management on management on sharing of HIV & sharing of HIV & wellness (EW)/ & AIDS to staff procedure for procedure for AIDS to staff AIDS to staff Staff Peer
dealing with HIV dealing with HIV Educators (SPE) infected and ill- infected and ill- Reabua talk Reabua talk health health Reabua talk sessions to sessions to EW/IOHA employees employees sessions to support staff support staff
support staff Information Information Up skilling of Training & sharing of HIV & sharing of HIV & SPE’s Development AIDS to staff AIDS to staff
Training of new SPE’s
Testing HCT & VCT HCT & VCT HCT & VCT HCT & VCT HCT & VCT EW with the help campaigns campaigns 15% campaigns 20% campaigns 30% campaigns 40% of IOHA
10%
Campus Communicatio Communications Communications Communications Communications EW & media ns to assist to assist with all to assist with all to assist with all to assist with all Communications structures with all marketing marketing marketing marketing marketing
Inform staff Communicatin Communicating Communicating Communicating Communicating EW & HR regarding g relevant UJ relevant UJ HIV updated policies updated policies updated policies Business Partners
UJ’s Policy in HIV related related policies relation to HIV policies Departmental Departmental Departmental & AIDS Departmental and Faculty and Faculty and Faculty Departmental and Faculty meetings meetings meetings and Faculty meetings meetings
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Fully Finalize Leadership Fully functional Fully functional Fully functional EW functional strategic commitment ITO SPE program SPE program SPE program HR Business SPE’s document of Partners communicating Monitoring and Monitoring and Monitoring and SPE the strategy Buy in from SPE support SPE support SPE support line management Meetings with
Departments. And Faculties Meetings with Department-s. And Faculties Up skilling of
existing SPE’s
Develop a curriculum for Recruit SPE’s
SPE to implement Train SPE’s
Monitoring and Formal SPE SPE support program
Monitoring and SPE support
Goal 2: To provide treatment, care and support for people with HIV and AIDS
OBJECTIVE YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 RESPONSIBILITY
To avail Contractors to Contractors to Contractors to Contractors to Contractors to PHC
(TB/STI/ARV) access clinic access clinic access clinic access clinic access clinic EWP resources services services services services services and services to all staff Consultation with contractor leadership
Flexible consultation time
Support Encourage Implement Implement Implement Implement EWP with help groups for disclosure of support groups support groups support groups support groups from IOHA staff status by staff for infected and for infected and for infected and for infected and
affected affected affected affected
Utilise HIV infected staff to be champions
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of support group
To have own All infected All infected staff To investigate To investigate To have own treatment staff to have and partners to possibilities of possibilities of treatment accredited easy access to have easy starting own site starting own site accredited site site ARV’s access to ARV’s
on site
To network and partner To investigate with possibilities of Government starting own site
To partner with existing NGO’s
To investigate possibilities of starting own site
Absenteeism Develop an Development of Training Case Case Task team management absenteeism training manual managers on management management (EW/ER/Occ management by accredited incapacity Health/PHC) procedure SETA service management
provider and absenteeism Conduct absence Training awareness managers on Case sessions incapacity management
management and Case absenteeism management
Case management
HIV and Engage Engage medical Engage medical Engage medical Engage medical EWP
AIDS disease medical aid aid broker to aid broker to aid broker to Aid broker to Medical aid Broker management broker to communicate communicate communicate communicate communicate medical aid medical aid medical aid the medical aid medical aid benefits to staff benefits to staff benefits to staff benefits to staff
benefits to staff
Ensure that Ensure that Ensure that
Ensure that uninsured staff uninsured staff uninsured staff Ensure that uninsured staff are directed are directed are directed uninsured staff are directed where to access where to access where to access are directed where to treatment treatment treatment where to access access treatment treatment
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Provision of Ensure that Ensure that Ensure that Ensure that Ensure that Occ Health nutritional AIDS infected AIDS infected AIDS infected AIDS infected AIDS infected support staff are staff are staff are staff are staff are provided with provided with provided with provided with provided with nutritional nutritional nutritional nutritional nutritional supplements supplements supplements supplements supplements
University of Johannesburg HIV Workplace Programme 2012
Key activities Deliverables Status
Peer education program Peer educator activities for 2011 Started and on-going
Staff peer educators meeting Monthly
Staff HIV and AIDS awareness Group information sessions Started and on-going programs
One on one sessions On-going
Encouraging healthy lifestyles On-going
Promoting staff participation
Living with HIV and managing AIDS
Promotion of VCT Encouraging employees to participate in HCT Started and on-going
campaign organized by IOHA
Encouraging disclosure so that we can advocate for treatment
Wellness days and HCT campaign for staff
Campus Health clinic provides services to staff free of charge
Treatment focus on higher-risk Implementation of recommendations from 2009 Started and on-going group KAP survey - Reabua project (bi-monthly let’s talk sessions) with service staff regarding HIV and wellness issues, in general
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World AIDS Day Observing WAD with staff and students in September
Supporting people with HIV and Wellness intervention (One on one counselling). On-going
AIDS
Nutritional assistance Done by campus health clinics On-going
Grief and bereavement Psycho-social counselling by wellness On-going counselling practitioners
Counselling by wellness service provider (24 hours helpline from Access Health)
Counselling by clinic counsellors and PsyCaD
Absenteeism management Educating staff about prevention of sick leave Started & on-going
abuse
On-going Managing ill-health (clinic, wellness office & HRBP’s)
Reasonable accommodation for infected and sick employees (clinic, wellness office & HRBP’s)
Reduction of stigma Creating a safer work environment by educating Started & on-going services staff on HIV policy
Encouraging Infected employees to disclose their status to clinics, wellness office and trusted individuals
Discussing openly and honestly about issues of HIV and AIDS openly and honestly
Treatment of STI Done by campus health clinics. Wellness office On-going encourages staff to make use of the facility
Access to comprehensive Information sharing of benefits by Alexander Started and on-going services related to HIV and AIDS Forbes, through the wellness office for medically insured employees
Equitable access to treatment for Done by Wellness office, Campus Health Clinic Started and on-going non-medical aid staff and Access Health to encourage employees to
access comprehensive HIV and AIDS treatment
from local health authorities
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Referral of HIV infected Referrals done by clinics On-going employees to health facilities
Training of line managers Empower them to handle infected and affected On-going staff, Dealing with ill-health employees, getting buy- in from line managers and encouraging employees to participate in wellness issues (8 training sessions planned)
Up skilling of peer educators A follow on training session on existing peer On-going educators to up-skill them on current issues surrounding HIV and AIDS
Community development and up- Identify a community project to be adopted by On hold liftment HR (resourcing, wellness, clinic) and develop it
Source: Ramafola (2012)
The goals set out in Table 3.2 above are an indication of the university’s HIV/AIDS workplace objectives. As previously established, universities are similar to a workplace or organisation, and that HIV/AIDS poses a great threat to universities as it would with any other type of workplace. It is further documented that integrating HIV/AIDS workplace programmes into a workplace would assist in addressing the impact that the disease may have on the workplace programme. However, it should be noted that establishing an HIV/AIDS workplace would require a greater understanding of the needs and concerns of those employed. The university’s HIV/AIDS workplace programme has a past, which is intertwined with 23 other Higher Education Institutions (HEIs) in South Africa.
3.4.2 An overview of an HIV/AIDS workplace programme
It is necessary that an overview of an HIV/AIDS workplace programme is established in an attempt to create a context of what makes a specific response such as workplace programmes necessary at South Africa’s HEIs. South Africa, as a society, and its higher education institutions, has undergone a fundamental and reflective process of change and re-alignment since 1994. The purpose for change
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was aimed at better service of a democratic, non-racial, quality driven and equitable dispensation (Marwitz & Were-Okello, 2010, p.204). 23 Higher education institutions currently include three primary categories of institutions: universities, universities of technology, and comprehensive institutions/universities. These institutions are legally self-directed, but subject to policy and regulatory controls as set by the National Department of Education (DoE).
Since 1997, three years after the first democratic election, several policy measures and the rise in HIV/AIDS prevalence forced HEI’s to respond to HIV/AIDS. These include the national policy on HIV/AIDS for learners and educators in public schools, and students and educators in further education and training institutions (Marwitz & Were-Okello, 2010, p.204). In 1999 a conference convened under the title ‘Tertiary Institutions Against AIDS’ and “…marked a turning-point in the engagement, by education authorities and higher education institutions, with HIV/AIDS” (Chetty, 2000, p.7). At this early juncture it measures against HIV/AIDS in HE it was apparent that many HEIs had placed some effort, thought and resources into various prevention and education strategies for the years ahead. The impending concern at the time was that the issue was not being dealt with systematically and consistently across the sector.
At the 1999 conference, the then Minister of Education, Professor Kader Asmal, challenged institutional leaders on what they were doing in response to HIV/AIDS, and why they were not doing more (Chetty, 2000, p.7). Addressing the purpose of the conference, Piyushi Kotecha, the Chief Executive Officer (CEO) of South African Universities Vice Chancellors Association (SAUVCA), presented a summary outline of an approach that SAUVCA envisioned as a means to address the issue of HIV/AIDS in HEIs. She observed that “the sector had been out of synch with the degree of intellectual debate on issues of transformation, restructuring, curricula changes, quality assurance, equity and funding, to name but a few of the topical concerns. HIV/AIDS needed to feature prominently in this list” (Chetty, 2000, p.7)
On the 22 February 2000, at a Basic Education Portfolio Committee meeting where the briefing of the implementation of Tirisano was discussed by former Minister of Education, Professor Kader Asmal, briefed the Portfolio Committee on the
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programme, which encompassed the Ministry's priorities for the next five years. The implementation plan was organised into five core areas, and programmes had to be developed around those areas (Parliamentary Monitoring Group (PMG), 2000, p.1). The five core areas are: 1. HIV/AIDS Programme; 2. School Effectiveness and Professionalism; 3. Literacy Programme; 4. Further and Higher Education; and 5. Cooperative Governance (PMG, 2000, p.1). Programme 1: HIV/AIDS entailed addressing the HIV/AIDS emergency with urgency and purpose through the education and training system. Programme 1 was divided into three projects.
The first project, titled Awareness, information and advocacy, was based on a strategic objective that was designed to raise awareness and the level of knowledge of HIV/AIDS among educators, learners and students at all levels and institutions within the education and training system, including departmental employees. A further objective was to promote values, which inculcate respect for girls and women, and to recognise the right of girls and women to free choice in sexual relations.
The outcome of these would encompass an increased awareness of the understanding, knowledge and sensitivity of the causes of HIV/AIDS, and its consequences and impact on individuals, communities and society, in general. The second outcome would include the eradication of non-discriminatory practices against individuals who are affected by HIV/AIDS, and development, of an HIV/AIDS policy for the education and training system. The third outcome dealt with change of attitude and behaviour towards sexuality, including an increased respect for girls and women. Other outcomes within project 1 included the eradication of myths about HIV/AIDS, increased acceptance of the need to practise safe sex and the establishment of non-discriminatory practices in all education and training institutions, including departments of education. Lastly, the finalisation of the HIV/AIDS policy (PMG, 2000, p.1).
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Project 2 of programme 1 of the Tirisano five core plan dealt with HIV/AIDS within the curriculum. The strategic objective was to ensure that life skills and HIV/AIDS education are integrated into the curriculum at all levels of the education and training system. Other outcomes included that every learner understands the causes and consequences of HIV/AIDS. All learners should lead healthy lifestyles and take responsible decisions regarding their sexual behaviour. Project 2 was designed with the intention that life skills and HIV/AIDS education should be integrated across the curriculum. This would increase knowledge of, and change attitudes towards sexuality and HIV/AIDS among learners, and further reduce the incidence of HIV/AIDS among learners within schools and universities throughout South Africa.
Project 3, titled HIV/AIDS and the education system, was to develop planning models to analyse and understand the impact of HIV/AIDS on the education and training system. The second outcome would include plans and strategies to respond to the impact of HIV/AIDS on the sustainability of the education and training system and the human resource needs of the education and training system. Thirdly, the establishment of care and support systems for learners and educators who are affected by HIV/AIDS and, lastly, to conduct impact studies on all aspects related to the education and training system (PMG, 2000, p.1). The Tirisano proposal contained the defining features of the new South African HE landscape. This, according to Marwitz and Were-Okello (2010, p.204), set in motion a process of consolidation and mergers in the system that resulted in a transition from a disparate array of 36 institutions to a unified system of 23 institutions.
In May 2000, after an intensive period of consultations within the higher education sector and with experts in the area of AIDS, “SAUVCA began a process of assessing the extent of responses to HIV/AIDS in the sector in terms of management, policy, planning and programmes” (Chetty, 2000, p.7). A study by the South African Universities Vice Chancellors Association (SAUVCA) indicated a need for a more focused attention to policies, procedures, and programmes that would enable all HEIs to prevent, mitigate and manage the HIV/AIDS pandemic. The study institutionalised the response to HIV/AIDS in the South African university sector: a
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SAUVCA analysis consisted of an appraisal of initiatives that were conducted at the universities; an overview of the literature relating to HIV/AIDS; and HEIs nationally and globally, as well as, a clear set of recommendations on the way forward (Marwitz& Were-Okello, 2000, p.204).
Internationally, the Association of African Universities had incorporated an AIDS component into their core services program for 2000–2005, whilst the Association of Commonwealth Universities produced guidelines for institutional responses (Saint, 2004, p.7). Concurrently, in South Africa, a partnership between three higher education organisations (the National Department of Education, the South African Universities Vice-Chancellors Association, and the Committee of Technikon Principals) launched a nationally coordinated program to improve the capacity of tertiary institutions to prevent, manage and mitigate the impact of HIV/AIDS in 2002 (Saint, 2004, p. 7). Encouraged by these efforts, at least twenty African tertiary institutions from Anglophone countries chose to develop formal institutional policies to manage HIV/AIDS (Saint, 2004, p. 7).
SAUVCA took the lead to establish the first nationally co-ordinated leadership and capacity building programme on HIV/AIDS in HEIs (HEAIDS, 2004, p.1 and Marwitz & Were-Okello, 2010, p.205). In November 2001 the South African Universities Vice- Chancellors Association (SAUVCA), the Committee of Technikon Principals (CTP), and the national Department of Education (DoE) launched the Higher Education HIV and AIDS Programme (HEAIDS) (HEAIDS, 2004, p.1; Chetty, 2000, p.16). The purpose of this programme was to establish the first nationally co-ordinated effort, which was aimed at improving the capacity of higher education institutions (HEIs) in the prevention, management and mitigation of the impact of HIV and AIDS (HEAIDS, 2004, p.1).
3.4.3 Higher Education HIV and AIDS Programme (HEAIDS)
At is inception the HEAIDS programme was focused broadly on four priority service areas (Voluntary Counselling and Testing, Peer Education, Workplace Programmes, and Curriculum Integration) that were deliberately flexible in order to accommodate the wide variations between institutions in their responses to HIV and AIDS. “Such flexibility was also appropriate to the culture of HEIs in which devolved authority and
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institutional autonomy are key principles. Within the broader outcomes, institutions were given the freedom to define an institutional response which best reflected their needs, priorities and capabilities” (HEAIDS, 2004, p.1).
In October 2003 university vice-chancellors from thirteen countries within the Southern Africa Development Conference (SADC) agreed “to take a series of actions intended to establish essential services, promote policies and management practices, and create institutional capacities for easing the impact of HIV/AIDS on their campuses. As a result of these experiences, tertiary education policymakers, leaders, staff and students are gaining an understanding of what is needed as well as what works in the battle against HIV/AIDS” (Saint, 2004, p.7).
The purpose of HEAIDS is to:
Reduce the threat of the spread of HIV/AIDS in the higher education sector;
Mitigate its impact through planning and capacity development; and
Manage the impact of the pandemic in a way that reflects the ethical, social, knowledge transmission and production responsibilities of higher education institutions.
HEAIDS undertakes research that is essential for the development of policy frameworks, the planning of a range of interventions, and the mobilisation of funding for sustained HIV/AIDS programmes across the higher education sector. In addition to research, HEAIDS operates indirectly to strengthen HIV/AIDS programmes at higher education institutions through the development of policy frameworks, the provision of planning expertise, evidence-based advocacy for sustainable funding mechanisms and sharing of good practices (HESA, 2011a, p.1). HEAIDS has developed an HIV/AIDS module for student teachers countrywide. Campus HIV/AIDS programme development, strengthening HIV/AIDS programmes for students and staff and workplace programme development, are a few examples of HEAIDS initiatives (HESA, 2011a, p.1).
However, over the past years the HEAIDS programme found a need to develop a stronger strategic framework with clearer indicators in order to better manage the
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programme over a longer term. A results-based framework with indicators was co- developed with Institutional Offices (IOs) at the institutions (HEAIDS, 2004, p.6). It is important to note that although the term policy and programme are often used interchangeably, a distinction must be made between them.
3.4.4 HIV/AIDS policy and programme compared
National legislation, labour policy, and international guidelines, for instance, the United Nations HIV/AIDS Human Rights International Guidelines (1998), Code of Good Practice on Key Aspects of HIV/AIDS Section 54 (1) (a) of the Employment Equity Act 55 of the Republic of South Africa (1998), and the International Labour Organisation Code of Practice on HIV/AIDS and the World of Work (2001), are key drivers in the formation and implementation of workplace policy in South Africa. The report on good practice HIV/AIDS workplace programmes aims to identify and describe what is considered as ‘good practice’ with regard to workplace HIV programmes (Marwitz & Were-Okello, 2010). The framework is aligned with South Africa’s legislation, which affects and informs employment practices, human resource policies, procedures and practices, as they relate to recruitment, performance management, reasonable accommodation, fair labour practice and employee assistance within HEIs.
In 2001 the ILO issued the Code of Good Practice (ILO/AIDS, 2001) in consultation with business, worker organisations and governments around the world. The recommended practice is that an HIV/ AIDS workplace policy and programme would assist in the mitigation of the epidemic. South Africa, being a member of the ILO, has established a similar code, namely the Code of Good Practice on Key Aspects of HIV/AIDS and Employment (Employment Equity Act 55 of South Africa, 1998). The South African Code of Good practice complements the ILO code and confirms the need for organisations to implement a HIV/AIDS workplace policy and programme/s.
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3.4.5 Distinction between HIV/AIDS workplace programme and policy
It is often assumed that the terms policy and programme are synonymous. As a means of avoiding confusion, it is important to clarify the distinction between a policy and a programme. A policy is a guiding principle, which is used to set direction in an organisation. It can be a course of action to guide and influence decisions. It should be used as a guide for decision making under a given set of circumstances within the framework of objectives, goals and management philosophies as determined by senior management (Bizmanuals, 2005). Conversely, a programme is a particular way of accomplishing something. It is a series of steps that is followed as a consistent and repetitive approach or cycle to accomplish an end result. A programme provides a platform to implement the consistency, which is required to decrease variation from policy, which ensures programme control. Decreasing variation in policy allows for the elimination of disparity in the programme and increases performance.
Like any policy, a workplace policy on HIV/AIDS, according to Chetty (2009), should be understood as a guiding statement of principles and intent. The policy defines an organisation’s strategy to cope with HIV/AIDS and clearly maps out the way/s in which the organisation will deal with the epidemic in the workplace, and how it affects personnel. Like other organisational policies, a workplace HIV/AIDS policy, as mentioned by Chetty (2009), should be an integral part of the organisation’s management system, informing the continuous process of planning, implementing, reviewing and improving the processes and actions that are required to meet the policy’s goals and targets.
Crewe and Nzioke (2009) suggest that wider institutional HIV/AIDS policy should recognize the specific needs of both staff and students, but should remain separate from an HIV/AIDS workplace policy. Students are not employees of institutions of higher learning, and may not be adequately covered under an HIV/AIDS workplace policy. Nevertheless, they are part and parcel of the work environment and there is evidence to suggest that students are just as vulnerable as staff to the epidemic (Saint, 2004, p.8; Dell, 2010, p.1). Therefore, an institutional HIV/AIDS policy should be comprehensive and cover both students and staff alike. For example, an
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institutional HIV/AIDS policy may need to provide for adjustable academic programmes in order to accommodate the needs of students who need time out of their studies because of ill health or to deal with the impact of HIV/AIDS in their families or communities. The institutions may also need to think of ways to develop expanded support services for infected and affected staff and students. One consideration may be to train staff and students as educators and counsellors to support and help their peers and colleagues.
Universities such as Nkumba University in Uganda, the University of Zambia, the University of KwaZulu-Natal in South Africa and a whole host of other universities and tertiary institutions in Sub-Saharan Africa have developed institutional HIV/AIDS policies (Kelly, 2009). These policies, according to Kelly (2009), show that they are broad enough to take account of both staff and students’ needs. Thus, it appears that these institutional HIV/AIDS policies are more comprehensive than a workplace HIV/AIDS policy. Normally, a workplace policy consists of a detailed document on HIV/AIDS within all aspects of the workplace and its staff, setting out prevention programmes, treatment and care for staff living with and affected by HIV/AIDS. It could also be part of or found within the institutional policy or agreement on safety, health and working conditions, or just a short statement of principle (Africa Centre for HIV and AIDS, 2007, p.13).
A workplace policy is a guiding statement of principles and intent. “Policies also capture the legal rights and obligations of the stakeholders and role players. They may also outline modes of implementation” (Chetty, 2009, p.89). A workplace policy provides a context for action to reduce the spread of HIV/AIDS, and to manage its impact. It defines an institution’s position on HIV/AIDS, and outlines activities to prevent the transmission of the virus and provide for care and treatment.
Conversely, a workplace programme is a set of practical plans and systems for implementation. These plans generally follow on from policy development. In some instances aspects of a programme may be developed before policy is finalised (Chetty, 2009, p.89). The HEAIDS policy Framework on HIV and AIDS is a guiding statement of intent regarding the implementation of practical plans and systems that are set out within the Framework for HIV and AIDS Workplace Programmes.
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3.5 HEAIDS Policy Framework
The Policy Framework on HIV and AIDS for Higher Education was adopted by the former Minister of Education, Naledi Pandor, and the 23 public sector higher education institutions in South Africa. It is jointly overseen by Higher Education South Africa (HESA) and the Department of Education (HESA, 2011b, p.1). The Policy Framework recognises that, collectively and individually, higher education institutions must act to prevent new HIV infections and to provide access to treatment, care and support for staff and students who are infected or affected by the pandemic (HESA,2011b,p.1). The Policy Framework was designed to guide and inform higher education institutions as they develop, refine and implement strategies to mitigate the impact of HIV and AIDS at their institutions.
The HEAIDS Programme, according to HEAIDS (2004,p.9), was developed to support institutions with the development of institutional policies, by using the Policy Framework on HIV and AIDS for Higher Education as a guideline (HEAIDS,2010c, p.VI). The policy framework and programme framework were aligned to merge the policy framework outlines that every HEI should have established, the two main focuses, one internal and one external. The internal response refers to what an HEI can do in response to HIV and AIDS in the workplace, and the external response refers to recognizing and exploiting the comparative advantages of the HEI to ‘make a difference’ in the workplace to the nature and course of the epidemic within the sector in which it operates. The Framework for HIV and AIDS Workplace Programmes (Framework) focuses particularly on the internal response and how this should be implemented (HEAIDS, 2010, p.5).
The focus of this Framework was the development of a comprehensive HIV prevention, treatment and mitigation programme for the employees of HEIs. The overall aim was to support the implementation of a comprehensive HIV and AIDS workplace programme within institutions that will prevent and mitigate as far as possible the impact of the epidemic (HEAIDS, 2010c, p.vii).
The fundamental principle of the Framework was set to channel the national response through the mission of the HEIs, namely teaching, research and
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community outreach, and to strengthen and deepen institutional responses whilst simultaneously enhancing a national sector response. Further, it would ensure a broad framework, which engages all national and external actors and partners in an integrated programme relating to HIV/AIDS in HE, and to take cognisance of global developments around HIV/AIDS and to align interventions to these ‘best practices’ (HEAIDS, 2004, p.9; Chetty, 2000, p.19). The focus of the Framework was to provide a guideline for the institutional development of comprehensive HIV prevention, treatment and mitigation programmes for the employees of HEIs. The framework is aligned to the principles of the sector HIV/AIDS policy framework for Higher Education (HE). This Framework was endorsed by the National Minster of Education in 2008 (Marwitz & Were-Okello, 2012, p.205; HEAIDS, 2010c, p.vii).
The Framework was guided by the South Africa National Strategic Plan for HIV/AIDS and sexually transmitted infections (STIs) 2007-2011. This framework has since consolidated the commitment of the higher education sector towards implementation of the 2012-2016 National Strategic Plan (NSP) for HIV, STIs and TB. The Policy and Strategic Framework on HIV and AIDS for Higher Education provides a useful guide for Higher Education institutions in South Africa to develop a comprehensive, effective response to the HIV and AIDS pandemic (HEAIDS, 2013,p.2). It has drawn from the 2008 the Policy Framework on HIV and AIDS for Higher Education in South Africa, which has been revised for realignment with the NSP (HEAIDS, 2012, p.2).
The policy framework on HIV/AIDS for HE in South Africa, which guides and informs this Framework, provides direction to HEIs in the development of a response to the negative impact on vulnerable individuals and society, in general. HIV/AIDS in the workplace report on good practice in HIV/AIDS workplace programmes, both in South Africa and internationally, which aims to identify and describe what is considered ‘good practice’ with regard to workplace HIV programmes. The Framework is aligned with all South Africa’s legislation, which affect and inform employment practices, human resource policies, procedures and practices, as they relate to recruitment, performance management, reasonable accommodation, fair labour practice and employee assistance within an HEI (Marwitz & Were-Okello,
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2012, p.205; HEAIDS, 2010c, p.vii). The purpose of the Framework is to guide and inform HEIs in the development of sustainable HIV/AIDS workplace programmes that will reduce the negative impact of the pandemic on all individuals who are employed by the institutions. The stakeholders include academics, administrative, support and contract staff.
3.5.1 Purpose and objectives of HEAIDS Framework for HIV and AIDS Workplace Programmes
The purpose of the HEAIDS HIV/AIDS workplace programme framework is to provide guidelines for the institutional development of comprehensive HIV prevention, treatment and mitigation programmes for employees at HEIs. The framework is aligned to the principles of the sector HIV/AIDS policy framework for Higher Education. The HEAIDS framework was endorsed by the National Minster of Education in 2008 (HEAIDS, 2010). The HIV/AIDS workplace programme framework embodies the sector and institutions’ commitment to effectively respond to the epidemic in a socially responsible manner, and to integrate the response into the systems and processes of the institution (HEAIDS, 2010).
The HEAIDS HIV/AIDS workplace programme framework is grounded within The South Africa National Strategic Plan for HIV/AIDS and sexually transmitted infections (STIs) 2007-2011, which aims to reduce the rate of new HIV infections by 50%, and to reduce the impact of HIV/AIDS on individuals, families, communities and society by expanding access to appropriate treatment, care and support to 80% of all HIV-positive people and their families by 2011. The HEAIDS framework has since been realigned to consolidate the commitment and contribution of the higher education sector towards the implementation of the 2012-2016 National Strategic Plan (NSP) for HIV, STIs and TB. The Framework provides a useful guide to Higher Education institutions in South Africa to develop a comprehensive, effective response to the HIV and AIDS pandemic. It draws from the 2008 Policy Framework on HIV and AIDS for Higher Education in South Africa, which has been revised for realignment with the NSP (Policy and Strategic Framework on HIV and AIDS for Higher Education, 2012, p.2).
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The 2008 HEAIDS policy framework on HIV/AIDS for Higher Education in South Africa guides, informs and provides direction to HEIs in the development of a response to the negative impact on vulnerable individuals and society, in general (HEAIDS, 2010). The 2012 Policy and Strategic Framework on HIV and AIDS for Higher Education (HEAIDS, 2012) is a well-planned HIV/AIDS policy that outlines or describes how a particular organisation, institution or business will manage HIV/AIDS within the workplace. The HIV/AIDS workplace programme, conversely, outlines how the different principles of the policy will be translated into practice (Africa Centre for HIV and AIDS, 2007, p.11). The purpose of the HEAIDS HIV/AIDS workplace programme framework has been designed to ensure that the HE sector is able to continue to fulfil its mandate, unimpeded by the impacts of the HIV/AIDS epidemic.
More specifically, the purpose of the workplace framework is to provide an all- encompassing sector workplace framework that can strengthen and encourage the sector’s response to HIV/AIDS. Further, it should position the HE sector at the centre of good practice with regards to workplace programmes, and provide leadership to the sector itself as well as to other sectors that share similar values and concerns. It should promote and facilitate the development and implementation of comprehensive workplace programmes across the HE sector that recognize institutional autonomy and difference, but, which attempt to close the gap between advanced programmes and those that are still developing. According to HEAIDS (2004), the benefits of having and implementing a successful HIV/AIDS workplace programme framework are significant.
The objectives of the HEAIDS (2010c, p.5) Framework for HIV and AIDS Workplace Programmes are based on the three objectives and enabling pillars of the sector Policy Framework. These three objectives include: firstly, to provide a framework that facilitates strong internal leadership and governance on workplace programmes; secondly, this objective is to create a healthy and safe environment within institutions for employees, based on ethical principles, legal norms and human rights; and thirdly, to establish a sector response to the impact of HIV and AIDS
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within higher education workplaces by means of coordinated, comprehensive and integrated institutional responses.
The three enabling pillars of the Policy Framework are stated as: the “coherent and consistent communication inside and outside the sector that facilitates co-ordination, collaboration and demonstrable progress in the implementation of the Framework for HIV and AIDS Workplace Programmes, the consistent and appropriate allocation of resources for the effective implementation, management, monitoring and evaluation of the Framework for HIV and AIDS Workplace Programme at sector and institutional levels, the comprehensive monitoring and evaluation systems to ensure effective implementation of the Framework for HIV and AIDS Workplace Programmes at sector and institutional levels” (HEAIDS, 2010c, p.6).
To achieve the objectives set above, HEAIDS (2010c, p.6) has identified six institutional performance areas that should be fulfilled:
1. Strategic Leadership, Decision-Making and Coordination; 2. Research and Analysis; 3. Workplace HIV and AIDS Policy; 4. Workplace HIV and AIDS Prevention Programme; 5. Workplace HIV and AIDS Treatment and Care Strategy; and 6. Monitoring and Evaluation.
However, the 2012 Policy and Strategic Framework on HIV and AIDS for Higher Education has replaced the 2008 Framework for HIV and AIDS Workplace Programmes. The objectives identified in the 2012 Framework differ, as “the focus of this policy is guided by the context provided by the guiding principles. They outline the required action-focused direction of the Policy and Strategic Framework and are in alignment with the national objectives of the NSP” (HEAIDS, 2012, p.22). The objectives, according to HEAIDS (2012, p.22), are directed at “maintaining the sector’s ability to continue functioning in order to prevent HIV and AIDS from undermining its potential to operate and deliver mandated services in a manner, which reflects the mission of the sector in society”.
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The objectives of the HIV and AIDS Policy and Strategic Framework are: “To ensure the comprehensive and appropriate use of the Higher Education mandate of teaching and learning; research, innovation and knowledge generation; and community engagement to effectively respond to the epidemic drivers of the pandemic. To promote the health and well-being of the Higher Education community at individual, group and institutional levels through strengthening capacity, systems and structures responding to the pandemic. To create an enabling environment to ensure a comprehensive and effective response to HIV and AIDS within the Higher Education sector, free of stigma and discrimination” (HEAIDS, 2013, p.22).
Each of the three objectives is supported by components that further unpack each objective. The first objective is to ensure the comprehensive and appropriate use of the Higher Education mandate of teaching and learning; research, innovation and knowledge generation; and community engagement to effectively respond to the epidemic drivers of the pandemic. The objective consists of four components: “component 1: to ensure the comprehensive and appropriate use of the Higher Education mandate and intellectual response. Component 2: Develop and implement appropriate, innovative and effective HIV and AIDS combination prevention strategies for the Higher Education sector. Component 3: Addressing comprehensively the epidemic drivers of HIV and AIDS in the Higher Education Sector. Component 4: Implement a comprehensive social and behavioural change communication strategy that serves to encourage positive attitudes and behaviours and to promote and sustain change” (HEAIDS, 2012, p.24).
The second objective is to promote the health and well-being of the Higher Education community at individual, group and institutional levels by strengthening capacity, systems and structures responding to the pandemic. The objectives consists of two components: “components 1: Develop and implement a comprehensive Health and Wellness HIV and AIDS programme aiming to promote and maintain the physical and mental health of students and staff within the sector. Component 2: Strengthen existing HIV and AIDS Workplace programmes for Higher Education that will reduce the negative impact of the pandemic on all individuals employed by the institutions” (HEAIDS, 2012, p.27).
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The third objective creates an enabling environment to ensure a comprehensive and effective response to HIV and AIDS within the Higher Education sector, free of stigma and discrimination, and the objective consists of six components. “Component 1: Mobilise strategic leadership through all stakeholder participants of the Higher Education Sector. Component 2: Reduce and eliminate acts of stigma and discrimination through the promotion of equity, fairness and respect for self and others. Component 3: Ensure coherent and consistent communication. Component 4: Create strategic partnerships. Component 5: Ensure consistent and appropriate allocation of resources. Component 6: Develop comprehensive Monitoring and Evaluation systems” (HEAIDS, 2013, p.29).
For the purpose of the study greater emphasis would be placed on unpacking objective 1, component 2, which is to ensure the comprehensive and appropriate use of the Higher Education mandate of teaching and learning; research, innovation and knowledge generation; and community engagement to effectively respond to the epidemic drivers of the pandemic, and to develop and implement appropriate, innovative and effective HIV and AIDS combination of prevention strategies for the Higher Education sector, respectively. This is further unpacked to include the following: provide access to comprehensive prevention programmes for staff and students across all campuses and residences. These elements may include:
HIV, AIDS, STIs, and TB awareness campaigns; HIV Counselling and Testing (HCT) programmes; Peer education and health promotion activities; Condom use and distribution; Male medical circumcision; Prevention of mother-to-child transmission (PMTCT); STI treatment; Infection control programmes; and Initial and on-going training.
Choosing not to focus on the remaining two objectives is by no means an attempt to negate their value of the remaining objectives within the Policy and Strategic
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Framework on HIV and AIDS for Higher Education. Institutional performance areas have been prescribed by HEAIDS. HEIs are advised to adhere to the prescribed area.
3.6 HIV/AIDS workplace programme
An HIV/AIDS workplace programme is an action-oriented plan that an organisation can implement in order to prevent new HIV infections, provide care and support for employees who are infected or affected by HIV/AIDS, and manage the impact of the epidemic on the organisation.
Key elements of an HIV/AIDS Workplace Programme include: an HIV/AIDS needs assessment; HIV/AIDS awareness programmes; voluntary HIV testing and counselling programmes; HIV/AIDS education and training and condom distribution; encouraging health treatment for STIs and TB, creating an open accepting environment, wellness programmes for employees affected by HIV/AIDS; the inclusion or provision of antiretroviral treatment; the referral of infected employees to relevant service providers; education and awareness of antiretroviral and treatment literacy programmes; counselling and other forms of social support for infected employees; reasonable accommodation for infected employees; strategies to address direct and indirect costs of HIV/AIDS; and monitoring, evaluation and review of programme (African Centre for HIV and AIDS, 2011).
A well planned HIV/AIDS policy outlines or describes how a particular organisation, institution or business will manage HIV/AIDS within the workplace. The HIV/AIDS workplace programme, conversely, outlines how the different principles of the policy will be translated into practice (Africa Centre for HIV and AIDS, 2007, p. 11).
The function of an HIV/AIDS Workplace Policy defines an organisation’s position on HIV/AIDS and sets out clear guidelines on how HIV/AIDS will be managed within the workplace. This aligns the workplace’s response with the broader legal framework, whilst ensuring fairness. Workplace policy identifies and protects employers and employees’ rights and responsibilities in the context of HIV/AIDS. It sets standards for behaviour, which is expected of all employers and employees, and establishes consistency within the company and sets the standard for communication about
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HIV/AIDS. It provides a good foundation upon which to build an HIV/AIDS workplace programme and informs employees about assistance that is available. It also indicates commitment to dealing with HIV/AIDS and ensures consistency with national and international practices (Africa Centre for HIV and AIDS, 2011).
The goal of the HIV/AIDS workplace programme is to implement an action- orientated plan within an organisation to prevent new infections, provide care and support for employees who are infected or affected by HIV/AIDS, and manage the impact of the epidemic on the organisation (Africa Centre for HIV and AIDS, 2007, p.11). The purpose of the HEAIDS HIV/AIDS workplace programme framework is to guide and inform HEIs about the development of sustainable HIV/AIDS workplace programmes that will reduce the negative impact of the epidemic on all individuals employed by the institutions. The stakeholders include academics, administrative, support and contract staff.
The purpose of the HEAIDS HIV/AIDS workplace programme framework has been designed to ensure that the HE sector is able to continue to fulfil its mandate, unimpeded by the impacts of the HIV/AIDS epidemic. More specifically, the purpose of the workplace framework is to provide an all-encompassing sector workplace framework that can strengthen and encourage the sector response to HIV/AIDS. Further, to position the HE sector at the centre of good practice with regard to workplace programmes, provide leadership to the sector itself, as well as to other sectors that share similar values and concerns. Promote and facilitate the development and implementation of comprehensive workplace programmes across the HE sector that recognize institutional autonomy and difference, but, which attempt to close the gap between advanced programmes and those that are still developing. According to HEAIDS (2004), the benefits, of having and implementing a successful HIV/AIDS workplace programme framework are significant.
3.6.1 Institutional performance area
Institutional performance area Workplace HIV and AIDS Policy highlights the “need for HEIs to mainstream HIV and AIDS and to ensure that the HIV and AIDS workplace programme is aligned to already existing institutional policies as well as
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the Policy Framework on HIV and AIDS for Higher Education in South Africa” (HEAIDS, 2010c, p.9). HIV/AIDS policy must comply with existing and developing South African legislation and code of practice. Policy should align with human resource policies and practices as they relate to the institution. Higher Education HIV and AIDS Policy framework, Institutional Gender Violence Policy and Institutional Occupational Health and Safety Policy recommendations should be adhered to. HEAIDS (2010c, p.9) recommends that in addition to adhering to existing institutional policies. A HIV/AIDS programme should include minimum key response areas, for instance, co-ordination and implementation of programmes, education and training, HIV/AIDS and legal issues, testing and confidentiality, HIV/AIDS and employment, including incapacity, termination of services, alternative employment, promotion of a safe working environment, compensation for occupationally acquired HIV, employee benefits and provision of care and procedures for dispute resolution and grievances related to HIV and AIDS issues.
In addition to the two previously mentioned institutional performance HIV and AIDS workplace policy, is the third area that should take prominence when HEIs develop an HIV/AIDS workplace programme. This should be accompanied by three other areas (HEAIDS, 2010c, p.7), namely a workplace HIV/AIDS prevention programme, a workplace HIV and AIDS treatment and care strategy; and monitoring and evaluation. With regard to a workplace HIV/AIDS prevention programme, each HEI should develop an integrated prevention response to HIV and AIDS by aligning the institutional workplace programmes to both this workplace framework, as well as to relevant individual institutional policies, and thereby promote a level of equity and standardisation (HEAIDS, 2010c, p.7).
A workplace HIV and AIDS Treatment and Care Strategy should be developed by each HEI. The development of a workplace HIV and AIDS treatment and care strategy aligns institutional workplace programmes to the workplace framework, as well as to relevant individual institutional policies, which promote a level of equal access to and standardisation of treatment (HEAIDS, 2010c, p.7). Monitoring and Evaluation is a vital observational and assessment tool that each institution should effect and implement, while a monitoring and evaluation plan and system facilitates
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the management and evaluation of their individual HIV and AIDS workplace programme. At a sectoral level each HEI should be in a position to complete a monitoring and evaluation plan to submit a standardized report against agreed indicators (HEAIDS, 2010c, p.7).
With these key responses in place each HEI, according to HEAIDS (2010c, p.7), should be in an ample position to achieve the purpose of the Framework and further develop their individual HIV/AIDS workplace programme. Ideally, each institution that chooses to be compliant should have the six institutional areas of performance in place. This Framework would act as a measure to evaluate the University of Johannesburg’s HIV/AIDS workplace programme. Bearing in mind that the Framework is a guideline that outlines key response areas, HEIs are encouraged to adapt and change their individual programmes whilst adhering to the basics. This allows for flexibility and innovation, as each HEI is unique and bears characteristics that resemble their geographical location. The effectiveness of a few HIV/AIDS programme in HEI has been documented. Encouraging reports suggest that HEIs are observing key responses, as set in the Framework.
According to the Policy and Strategic Framework on HIV and AIDS for Higher Education (HEAIDS, 2012, p.32), institutional level responsibilities include the development or refinement of a comprehensive institutional policy on HIV and AIDS in alignment with the Policy and Strategic Framework on HIV and AIDS for Higher Education. They ensure the institutionalisation of the comprehensive institutional policy on HIV and AIDS through strategic/operational plans and the attendant development of institutional structures, processes, and facilities and they are responsive to their partners and stakeholders, HESA, the Department of Higher Education and Training and the staff and students that they serve, for appropriate and effective implementation of the Framework.
3.6.2 Effectiveness of HIV/AIDS programme in HEI
In a recent study, which was conducted by Anderson and Louw-Potgieter (2012) who investigated the effectiveness of a component of an HIV/AIDS programme, which dealt with VCT testing, they noted that HIV negative participants found the
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counselling informative and rated it as positive. The two HIV positive participants agreed that the implications of their status were made clear to them. Anderson and Louw-Potgieter (2012) found that the University of Western Cape’s HIV/AIDS programme did effectively improve HIV knowledge and awareness, specifically amongst women. VCT programmes do seem to lead to increased awareness, knowledge about HIV and AIDS and knowledge about the transmission of the disease.
In June 2011 newly appointed HEAIDS programme manager, Dr. Ramneek Ahluwalia, congratulated Walter Sisulu University (WSU) for their aggressive programme in the fight against the HIV/AIDS pandemic. WSU has, over the past two years, launched a series of programmes, one of them being the Testing Campaign where just over 5 000 students, staff members and executive management were tested, including the Vice-Chancellor (Walter Sisulu University (WSU), 2011, p.1). WSU formed a partnership with the University of Fort Hare and they are currently formulating a programme that will be incorporated into the curriculum as a compulsory course. In 2012 just over 4 000 WSU males formed a group called Men in Action, a structure that condemns the manner in which men in our society treat women and children. WSU Unions and management also supported this vision. The structure is on its way to joining Brothers for Life, a national campaign, which is specifically targeted at men and their role in the health and wellbeing of families. HIV/AIDS programmes are proving to be effective (Anderson & Louw-Potgieter, 2012; WSU, 2011), however, challenges are symptomatic amongst most programmes. This research is yet to unpack the effectiveness of the HIV/AIDS programme at the case university.
3.6.3 Challenges that face HIV/AIDS programmes in HEIs
Research conducted by HEAIDS (2010, p.viii) in 2010 suggests that some of the challenges, which face HEIs that implement HIV/AIDS programmes include that peer educators are often first or second-year students with limited life experience and no training in behaviour change theory or techniques, and that realistic, specific and appropriate targets should be set for their interventions with individual students. The HEAIDS (2010, p.viii) report recommended that HEIs include psychologists who
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could assist peer educators with student counselling units, thereby playing a stronger role in life skills training and in counselling. However, to accomplish this, student counselling units would have to be considerably strengthened and HEIs would have to employ additional psychologists in the HIV/AIDS programmes. The lack of resources poses a challenge and, therefore, prevented the effective and consistent monitoring and evaluation of programme components at most HEIs. HEAIDS (2010, p.viii) have recommended that additional resources should be made available to assist programme staff and volunteers to use evidence-based practices and theoretical approaches in their prevention activities, and include monitoring and evaluation as on-going activities to help ensure the effectiveness of the programmes. HEAIDS (2010, p.vii) also “found a lack of a systems approach to HIV prevention programming primarily due to the shortage of resources. Thus little effort was expended on defining the problems of the student population, such as by conducting a thorough situation analysis.” There is a critical need to: establish additional research programmes to further strengthen social science research, and to conduct more research about behaviour change. In HEAIDS’ (2010, p.viii) final analysis, the research team identified the “need to increase advocacy for a larger share of the overall resources allocated to HIV prevention and the Department of Education (DOE) as part of national control efforts”.
The Cape Peninsula University of Technology (CPUT) in their report, as compiled by HEAIDS (2010, p.110), states that human rights and stigma remains a major problem. Monitoring activities are still limited. Research is limited as no research was conducted on students that would increase knowledge and inform prevention activities, hence activities lack funding. Both male and female condoms are distributed, however, the challenge lies with the process of condom distribution and record-keeping, which should be refined. At present, this is partly the responsibility of the HIV peer educators and residence managers who do this on a volunteer basis. The HIV and AIDS Unit ensures regular condom restocking from the DoH. However, condoms are available only at a limited number of sites on campus, as these are bound by human resource constraints.
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Conversely, the Durban University of Technology (DUT) faces social challenges that impact the effectiveness of their HIV/AIDs programme. The location of the university campuses and the increase in crime and composition of underprivileged students allow for greater exposure to HIV/AIDS. Students, when interviewed during the HEAIDS (2010, p.114) study, mentioned sugar daddies, drug abuse, and violent crime in exchange for sex. The understaffed HIV/AIDS Centre is unable to attend to student needs, whilst limited funding exacerbates these challenges. There are no large-scale group counselling activities. The linkage between VCT at Campus Health and peer education activities at the HIV/AIDS Centre, is not optimal.
The University of Stellenbosch (US) is recognised as one of the four top research universities in South Africa. The HIV/AIDS challenges at US were fairly minimal in 2010 upon compilation of the HEAIDS (2010, p.123) report, except that the US peer educator programme lacked sufficient human resources. The university faces human rights and stigma challenges, and some issues in this area, according to the HEAIDS (2010, p.119) report, “are difficult to tackle at US as students take on a politically correct attitude on a number of issues related to race and sexuality. It is also complicated by the different world views of the students from different cultures. Discussions about human rights and stigma form an integral part of communication initiatives conducted by the university”.
Tshwane University of Technology (TUT) have reported that there are challenges with peer educators in the Primary Health Care Centre, where VCT is offered such as students not feeling comfortable using the facilities owing to the presence of their peers. There is thus a need to balance the ethical imperatives of student privacy and confidentiality with the social need to make VCT centres student-friendly by fostering a sense of student ownership. TUT hopes that perhaps dealing with such considerations may shift attitudes to HIV testing and HIV, in general, (HEAIDS, 2010, p.119). The challenges expressed by four of the twenty three universities include a lack of human resources, peer educators and funding. HEAIDS (2010, p. 39) concluded that in addition to the above, “monitoring and evaluation was not undertaken to the extent that was desired at most HEIs”. The research found that monitoring and evaluation was one of the weakest points among current activities.
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3.7 Summary
The education sector, like other sectors, is equally affected by the rising HIV/AIDS prevalence rates, which affect students, administrative and academic staff alike. The current level of HIV/AIDS at the case university was last quantified in 2008-2009, while outcomes of the survey, which was conducted by HEAIDS, resulted in recommendations being made about ways to avert the impact of HIV/AIDS within the university. One of the key interventions suggested by HEAIDS is the implementation of an HIV/AIDS workplace policy and programme. Higher education response to HIV/AIDS was clearly set out followed by the current level of HIV/AIDS awareness at the focussed university. An overview of an HIV/AIDS workplace programme provided a context for the role Higher Education HIV and AIDS Programme (HEAIDS) contributes towards HEIs HIV/AIDS programme with the distinction being made between HIV/AIDS workplace programme and policy. A clearer understanding of the distinction between HIV/AIDS workplace programme and policy affords for a better appreciation of the purpose, objective and recommendations of the HEAIDS Policy Framework. An appreciation of the objectives of the HEAIDS Policy Framework offers HEIs a guideline regarding the formation of a policy and strategy, which is necessary to develop an action plan or programme that, is compliant with the HEAIDS Policy Framework. Institutional performance areas are guided by the framework, which allows for monitoring and evaluation of the programme, which, in turn, may be utilised to determine the effectiveness of newly implemented HIV/AIDS programmes at HEIs. Improved levels of HIV/AIDS awareness at other HEIs offer encouragement in spite of the challenges, which face HIV/AIDS programmes at HEIs. At this stage the focus changes to Chapter 4, namely research design and methodology.
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CHAPTER 4 RESEARCH DESIGN AND METHODOLOGY
4.1 Introduction Research design refers to the plan of action that links the philosophical assumptions to specific methods. The research design thereby links the research question to research evidence in a logical manner. Creswell (2003) speaks of the practice of research involving more than philosophical assumptions, since philosophical ideas should be combined with broad approaches to research (strategies) and implemented with specific procedures (methods). With this statement in mind, one can concur that a framework is necessary. The framework should combine elements of philosophical ideas, strategies and methods into a research approach. The research approach is supported by a research design that details what should be achieved in order to complete a particular project (Vaus, 2001, p.9). The function of the research design is to ensure that the evidence that is obtained enables the researcher to answer the research question as unambiguously as possible. Explained differently, when planning research the researcher should ask: given this research question, what type of evidence is needed to answer the question in a convincing way? Creswell (2006, p.4) refers to the research design as a plan of action that links the philosophical assumptions to specific methods. The research design in this chapter comprises of the research approach, theoretical framework, research methodology and strategies, which were used to ensure quality research.
4.2 Research approach The research design, as explained by Vaus (2001, p.9), is a work plan that follows from the project's research design. The follow up that Vaus (2001, p.9) mentions refers to the research approach. The researcher chose a research approach on the basis of the research design. The research approach involves a theory, which deals with how a research question should be analysed. This research approach is followed by the research method, which is a procedure for collecting, organising and analysing data (Teddlie & Tashakkori, 2009, p.21). The table below provides a clear illustration of the difference between research design and methodology. The
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researcher chose to include the table below as a means to reinforce that a research design focuses on the final product whilst the research methodology focuses on the research process and the types of tools that would be used to arrive at the final product (Babbie & Mouton, 2001, p.75).
Table 4.1: Difference between research design and research methodology
Research design Research methodology
Focuses on the end-product: what kind Focuses on the research process and of research is being planned and what the kinds of tools and procedures to be kind of results are aimed at. used.
Point of departure = research problem or Point of departure = specific tasks (data question. collection or sampling) at hand.
Focuses on the logic of the research and Focuses on the individual steps in the the type of evidence that is required to research process and the most suitable address the research question procedures to be employed. adequately.
Source: Babbie & Mouton (2001, p.75)
The research approach borrows from the expectations set by the research design and research methodology, thereby creating a research approach that speaks of the operationalisation of the research methodology. The researcher has assembled an illustration of the research approach that was followed throughout the research.
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Figure 4.1: Horizontal organisation chart of the research process
Quantitative
Qualiitative Research methodology Evaluation Data analysis
Research Question Research Approach Mixed method Triangulation of Data
Discussion
4.2.1 Theoretical framework
Mackenzie and Knipe (2006) state that the theoretical framework, unlike a theory, is sometimes referred to as the paradigm and influences the way that knowledge is studied and interpreted. It is the choice of paradigm that sets down the intent, motivation and expectations for the research. Therefore, without nominating a paradigm as the first step, there is no basis for subsequent choices regarding methodology, methods, literature or research design. Research methodology serves a purpose of inquiry. Methodology follows from inquiry of the research purpose and questions. A methodology originates from a philosophical framework and the fundamental assumptions of research (Teddlie & Tashakkori, 2009). The philosophical framework, which one uses influences the procedures of research; methodology may be defined as the framework that relates to the entire process of research. Conversely, methods are more specific. They are techniques of data collection and analysis such as a quantitative standardised instrument or a qualitative theme analysis of text data (Creswell, 2006, p.4). The researcher has relied on the richness of a philosophical framework to help guide with the choice of the most appropriate research method.
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Research is always conducted from a specific paradigm or set of beliefs (De Vos, Strydom, Fouche, & Delport, 2005). There are four sets of philosophical assumptions in a paradigm. Mertens and Wilson (2012, p.35) and Creswell (2011, p.41) refer to the four philosophical assumptions as axiology, namely the role that values play in research or the nature of ethics; ontology, the nature of reality when researchers conduct their inquiries; and epistemology is how one gains knowledge of what we know, or “what is the nature of knowledge and what is the relationship between the knower and that which would be known” (Mertens & Wilson, 2012, p.36). The fourth philosophical assumption is the methodology process of research, which relates to are the systematic approaches to gathering information about what would be known (Mertens & Wilson, 2012, p.36). There are four paradigms that are used to examine different philosophical assumptions that are currently being used, namely post positivist, constructivist, transformative/participatory and pragmatic (Mertens & Wilson, 2012, p.36). Each paradigm can be regarded as placing different emphasis on different philosophical assumptions. The table below sets out each of the four paradigms. The researcher thereafter unpacks the paradigm, which was most appropriate to answer the research question.
Table 4.2: Elements of worldviews and implications for practice
Worldview Postpositivism Constructivism Participatory Pragmatism element
Ontology (What is the Singular reality (for Multiple realities (for Political reality (for Singular and multiple nature of reality?) example, researchers example, researchers example, findings are realities (for example, reject or fail to reject provide quotes to negotiated with researchers test hypotheses) illustrate different participants) hypotheses and perspectives) provide multiple perspectives)
Epistemology (What is Distance and Closeness (for Collaboration (for Practically (for the relationship impartiality (for example, researchers example, researchers example, researchers between the example, researchers visit participants at actively involve collect data by ‘what researcher and that objectively collect data their sites to collect participants as works’ to address being researched?) on instruments) data) collaborators) research question)
Axiology (What is the Unbiased (for example Biased (for example, Negotiated (for Multiple stance ( for role of values?) ,researchers use researchers actively example, researchers example, researchers checks to eliminate talk about their biases negotiate their bias include both biased bias) and interpretations) with participants) and unbiased perspectives)
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Methodology (What is Deductive (for Inductive (for example, Participatory (for Combining (for the process of example, researchers researchers start with example, researchers example, researchers research?) test an a priori theory) participants’ views and involve participants in collect both build ‘up’ to patterns, all stages of the quantitative and theories, and research and engage qualitative data and generalisations in cyclical reviews of mix them) results)
Rhetoric (What is the Formal style (for Informal style (for Advocacy and change Formal or informal (for language of example, researchers example, researchers (for example, example, researchers research?) use agreed-on write in a literary researchers use may employ both definitions of informal style) language that will help formal and informal variables) bring about change styles of writing) and advocate for participants)
Source: Creswell (2011, p.42)
The Creswell (2011, p.42) table sets out a synopsis of the elements of philosophical assumptions and implications for practice. The various philosophical assumptions are partnered with the most compatible research paradigm and method. The researcher, when referring to the table, confirms that the mixed method would complement the research questions. Creswell (2022, p.43), Mertens and Wilson (2012, p.89) and Teddlie and Tashkkori (2009, p.88) recommend that the philosophical paradigm most suited to the mixed method is pragmatism. The four sets of philosophical assumptions contained within a pragmatic paradigm are similar to postpositivism, constructivism and participatory, yet slightly varied, as depicted in the table above. The variations are dependent on the elements of each philosophical assumption and implication for practice.
Pragmatic paradigm consists of four assumptions. Axiology is when pragmatists emphasise the ethics of caring as the axiological assumption (Mertens & Wilson, 2012, p.90). Teddlie and Tashkkori (2009, p.90) concur that pragmatic axiology values ethics in interpreting results. For pragmatists “values and visions of human action and interaction precede a search for description, theories, explanation and narratives” (Holmes, 1992, p.13-14). Mertens and Wilson (2012, p.90) add that rather than undertaking research for the sake of an evaluation, pragmatists see the value of the research in terms of how it is used and the results of that use. However,
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with regard to ontology, Tashkkori and Teddlie (2003) assert that pragmatists justify their position by explaining that the value of the research is not based on whether they discover the truth, but on the evidence that the results work with respect to the problem that is being studied. The postpositivist epistemologist, unlike the pragmatic epistemologist, assumes that the removed, impartial observer will collect objective unbiased, untainted data.
A pragmatist is “free to study what interests you and is of value to you, study it in different ways that you deem appropriate, and utilise the results in ways that can bring about positive consequences within your value system” (Mertens & Wilson, 2012, p.90). The pragmatist epistemological stance on the appropriateness of the relationship between the evaluator and the stakeholders is judged on how well the relationship allows the researcher to achieve the purpose of the research. Thus, for the mixed methods researcher, pragmatism opens the door to multiple methods, different philosophical assumptions and worldviews, as well as to different forms of data collection and analysis in the mixed methods research. Research methodology, the fourth assumption within the pragmatist paradigm is identified by some researchers as the philosophical framework that guides their choice of research method.
4.2.2 Research methodology The underlying methodological assumption of pragmatism is that the method should match the purpose of the research (Mertens & Wilson, 2012, p.91). With the paradigm and philosophical assumption explained, the researcher continues with the research methodology. Research methodology includes strategies and a procedure/ approach to implement research design, including sampling, data collection, data analysis and interpretation of the findings. Creswell (2003, p.13) and Johnson, Onwuegbuzie and Turner (2007, p.112) refer to three strategies of inquiry or method, as quantitative, qualitative and mixed method.
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Table 4.3: Alternative strategies of inquiry
Quantitative Qualitative Mixed method
Experimental designs Narratives Sequential
Non-experimental designs Phenomenologies Concurrent such as surveys Ethnographies Transformative Grounded theory Case studies
Source: Creswell (2003, p.13)
Table 4.3 above represents Creswell’s (2003, p.13) example of alternative strategies of inquiry. Each of the above mentioned inquiry or method is expanded on in the sections below. The researcher will unpack each inquiry or method establishing the advantages and disadvantages, the philosophical paradigm and the methods used in executing each method or inquiry. The researcher would like to establish a theoretical basis accompanied by the application of the method. These methods would be employed in answering the research question.
4.2.3 Quantitative research method
Quantitative research is an inquiry into an identified problem, based on testing a theory, measured with numbers, and analysed by using statistical techniques. The goal of a quantitative method is to determine whether the predictive generalisations of a theory hold true. An assumption, which underlies quantitative methods’ reality, is objective, and independent of the researcher. Therefore, reality is something that can be studied objectively. The researcher remains distant and independent of what is being researched and the values of the researcher are isolated from the research. The researcher does not interfere with, or become part of the research. The research is value-free and based primarily on an empirical form of reasoning. Theories and hypotheses are tested in a cause-effect order; and the objective is to develop generalisations that contribute to theory that enable the researcher to predict, explain, and understand some phenomenon (Creswell, 1994; Mason, 1996). However, as with all methods, they each have advantages and disadvantages.
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4.2.3.1 Advantages and disadvantages of quantitative research method
The advantage of a quantitative method is that the observations are used throughout studies (Ford & Gonzales, 2010). Formulating hypotheses allows for speculation about outcomes and the applicable instrument. A quantitative method avoids and minimises or eliminates bias. It predicts correlation between objects whilst employing a systematic data collection and analysis process. Quantitative methods are generalizable to other institutions for further study. It is seen as a recognised criterion for assessment and validity (Ford & Gonzales, 2010). According to Babbie and Mouton (2001, p.368), “quantitative methods lend themselves much more to standardisation and application across many sites. If properly designed, quantitative methods can be controlled for certain kinds of error more effectively. Such methods are less susceptible to the peculiar variability of the field workers and therefore are more likely to avoid observer effects such as selective and biased interpretation of items, leading the respondent in certain ways and in general affecting the data- collection adversely”.
A disadvantage is that quantitative methods can only be used if data can be measured by numbers and if results are quantified. The instrument or the method that is chosen is subjective, and research is dependent on the various tools or statistical software, which is chosen. There is a lack of independent thought by researchers when dependent on instrument or mathematics to extract or evaluate data (Ford & Gonzales, 2010). Individuals may choose not to participate based on their culture or social interactions. Decisions are often made without regard to individual human thought or choice to predict behaviour (Ford & Gonzales, 2010). Participants are measured in the same way by experiences, backgrounds, intelligence, and ability to change decisions at any given point in time, hence there is a certain lack of independent thought.
4.2.3.2 Research methods in quantitative research
The different types of quantitative methods include experiments, which are true experiments characterised by the random assignment of subjects to experimental conditions and the use of experimental controls. Quasi-experimental studies share almost all the features of experimental designs, except that they involve non-
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randomized assignment of subjects to experimental conditions. Surveys include cross-sectional and longitudinal studies, which use using questionnaires or interviews for data collection with the intent of estimating the characteristics of a large population of interest based on a smaller sample from that population (Creswell, 1994; Mason, 1996). Pallant (2011, p.7) claims that there are two main approaches to quantitative research methods, namely the survey and the questionnaire. Pallant (2011, p.9) explains the distinction between a survey and a questionnaire: a survey is administered via an interview or a questionnaire with the intention of determining an overview of opinions. Questionnaire refers to a set format that is completed by respondents at their own pace, allowing adequate time and freedom to answer the posed questions. The respondent is not pressurised into an immediate answer thus, allowing for a more honest response. The current researcher has opted to use a questionnaire. Pallant (2011, p.12) refers to the eight stages in designing a questionnaire. The researcher has adhered to each of these stages in the questionnaire design with the inclusion of two other stages. Therefore, the figure below is an adaptation of Pallant’s (2011, p.12) questionnaire design.
Figure 4.2: Stages in questionnaire design
Stage 8: Re- Stage 9: Combine and Stage 1: determine administer compare both sets of aims of the question questionnaire as analysed data cautionary measure
Stage 2: select Stage 10: Report appropriate question Stage 7: Analyse data style findings
Stage 3: Design Stage 6: Administer questions questionnaire
Stage 4: Pilot test Stage 5: Revise test questions questions
Source: Adapted from Pallant (2011, p.12)
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As shown in Figure 4.2, the researcher included two additional stages. In stage 1 the aims of the question were determined by scrutinising the research question and purpose of the research. The researcher then considered the type of questions that would assist to answer the research questions. Stage 2 involved selecting appropriate question style, hence the questionnaire comprised of open ended questions and questions based on a seven point Likert scale. During stage 3 the researcher attempted to avoid negative, ambiguous, long drawn and offensive questions. Personal questions relating to HIV/AIDS were avoided for reasons of privacy. In stage 4, a pilot test was conducted with academic, administrative staff and students, and recommendations that were made at this stage were incorporated into stage 5, which dealt with a revision of the questionnaires. In stage 6, questionnaires were administered; in stage 7 data was analysed; in stage 8 a second batch of questionnaires were re-administered; in stage 9 both sets of questionnaires were combined, compared and analysed; and in stage 10 results were reported.
4.2.3.3 Paradigms in quantitative research The quantitative ontological assumption (nature of reality) is objective and apart from the researcher. However, the epistemology paradigm in quantitative methodology, according to Creswell (2011, p.42), is about the relationship between the researcher and that, which is being researched. Epistemological assumption (relationship of the researcher) of the researcher is independent of what is being researched. Axiological assumption (role of values) is value free and unbiased, where values are emotive and, therefore, outside the scientific inquiry. Methodological assumption (process of research) is a deductive process, which is unaffected by cause and effect. Rhetorical assumption (language of research) is formal based on a set of definitions reported in an impersonal voice (Creswell, 1994; Creswell, 2011, p.42; Culbertson, 1981).
Quantitative method may have the advantage of being scientific, devoid of bias and representative of larger samples. However, the researcher acknowledges that quantitative method will not adequately answer the research question. Data, which is gathered from a large sample, may not necessarily provide the insights required to
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determine the effectiveness of an HIV/AIDS programme. The researcher, therefore, explores the qualitative method as a complementary approach.
4.2.4 Qualitative research There are three types of qualitative research, namely case studies, narrative research and grounded theory. In a case study the researcher explores a single entity or phenomenon, which is bounded by time and activity. The case study inquiry is a descriptive record of an individual's experiences and behaviours, which is kept by an external observer. An ethnographic study occurs when the researcher studies an intact cultural group in a natural setting over a specific period of time. A cultural group can be any group of individuals who share a common social experience, location, or other social characteristic of interest (Creswell, 1994, p.14; Mason, 1996). This could range from an ethnographic study of prostitutes, to child headed households, to a study of a cultural group.
In a phenomenological study, human experiences are examined through the detailed description of the people that are studied. The objective is to understand the ‘lived experience’ of the individuals that are studied. This approach involves researching a small group of people intensively over a long period of time (Creswell, 1994; Mason, 1996). Narrative research is a form of inquiry in which the researcher studies the lives of individuals and asks one or more individuals to provide stories about their lives. This information is then retold or “re-storied by the researcher into a narrative chronology. In the end, the narrative combines views from the participant's life with those of the researcher's life in a collaborative narrative” (Creswell, 2003, p.14). Grounded theory is a form of inquiry in which the researcher attempts to derive a general, abstract theory of a process, action, or interaction grounded in the views of participants in a research. However, the researcher will not utilise any of the above theories. According to Lincoln and Guba (2000, p.3), qualitative research involves an interpretive and naturalistic approach: “This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret phenomena in terms of the meanings people bring to them”. Qualitative research speaks of research that involves a range of interpretive
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techniques, which seek to describe, decode and translate terms that occur in a social situation (Welman, Kruger, & Mitchell, 2006, p.188). Tools that are utilised in qualitative research enable the researcher to gain deeper insight into social phenomenon. The following are advantages and disadvantages of qualitative research.
4.2.4.1 Advantages and disadvantages of qualitative research An advantage of qualitative method is that the method assists in explaining relationships in detail on an individualistic level. This type of method can help to validate quantitative findings by further investigation and closing the gap between research and practice. Qualitative methods reflect on the needs of the individual study. The researcher is less dependent on instrument. Qualitative methods are detailed and personalised, and examine specific issues within the research (Ford, & Gonzales, 2010). According to Babbie and Mouton (2001, p.368), “qualitative methods allow for more probing and in-depth exploration of a particular perspective. They are also more suited to capture the “insider” of those who are part of the investigation. They come closer to the concepts and self-understandings of the research participants”.
However, a disadvantage in the qualitative research is that there is a strong dependency on the sample population for access to honest and valid information. The time and resources, which are needed for collection and analysis is intensive. The lack of objectivity and bias by researcher inferences made incorrect conclusions (Ford, 2010). Convenience sampling, lack of training or knowledge about methodology, and lack of ability to produce and comprehend research, present a problem that may affect reliability and validity of the research if not recognised. Qualitative research methods collect data about what the selected group of participants feel or think, or how they behave (Ford, 2010). One cannot necessarily use this data to make assumptions beyond the specific group of participants. However, qualitative research may not be seen as a research method that conveniently allows for the collection of statistical data. This may be perceived as a disadvantage if the research question requires statistical data. Therefore, adopting a mixed methods approach is one way to overcome this shortcoming.
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4.2.4.2 Research methods in qualitative research
Qualitative process of inquiry has the goal of understanding a social or human problem from multiple perspectives. Qualitative research is conducted in a natural setting and involves a process of building a complex and holistic picture of the phenomenon of interest. The assumption, which underlies qualitative methods, is that multiple realities exist in any given situation. The researcher studies the sample that is examined, and the reader or audience interprets the results; these multiple perspectives, or voices of informants/interviewee are included in the research. The researcher interacts with those that she studies and actively works to minimise the distance between the researcher and those who are studied. The researcher is explicitly aware and recognises and acknowledges the value-laden nature of the research. The research is context-bound and is based on inductive forms of reason; categories of interest emerge from interviewee or subjects, rather than being identified as a priori by the researcher. The aim of the research is to reveal and determine patterns or theories that help to explain a phenomenon of interest. The pursuit of accuracy involves verifying the information with informants or triangulating among different sources of information (Creswell, 1994, p.13; Mason, 1996).
Theory and methods are intimately linked to qualitative practice. “Methods are the techniques or tools researchers use to collect and interpret data. In qualitative research, there is a range of techniques available based on observation, interaction, interview, narrative and discourse analysis, and unobtrusive modes of gathering knowledge” (Hesse-Biber, 2004, p.3). The researcher has utilised one-on-one interviews, which is part of a qualitative approach. Interviewees were interviewed by using semi-structured interviews, which involve direct interaction between the researcher and a respondent. It differs from traditional structured interviewing in several ways. A key feature of the semi-structured interview is in the partial pre- planning of the questions. Semi-structured interviews consist of a list of open-ended questions. The open-ended nature of the questions provides opportunities for both the researcher and interviewee to discuss questions in more detail. The qualitative data were analysed by identifying coding and categorising patterns or themes that were found in the data.
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4.2.4.3 Paradigms in qualitative research
The qualitative ontological assumption (nature of reality) is subjective and multiple, as seen by participants in the research. Epistemological assumption (relationship of the researcher) means that the researcher interacts with what is being researched. Axiological assumption (role of values) is value laden and biased, and the values are personally relative and need to be understood. Methodological assumption (process of research) is an inductive process, which is mutual while simultaneously shaping factors, and is an emerging design and context bound (Ford & Gonzales, 2010). Rhetorical assumption (language of research) is sometimes informal and evolving qualitative methods are reported in the personal voice (Creswell, 1994; Creswell, 2011, p.42; Culbertson, 1981).
The qualitative method allows for the researcher to gain insight into the lived experiences of the participants and their interaction with the HIV/AIDS programme. However, this type of method, although in-depth, lacks the ability to access a larger sample. The research question necessitates evaluation of the effectiveness of an HIV/AIDS programme. A smaller sample size will not be representative of the university population. The researcher, therefore, examines the practicality of mixing both the quantitative and qualitative methods into a holistic method that would assist to answer the research question. Quantitative and qualitative methods can provide complementary results. Quantitative method provides accurate data collection and analysis and utilisation, whilst qualitative method is a rich description of issues in the field, and this may often lay the groundwork for quantitative studies. The combination of methods is an option, however, the research question points to the evaluation of an HIV/AIDS programme. The researcher has discussed quantitative and qualitative methodology as possible methods to answer the research question. However, the inadequacies of each method have prompted the researcher to consider a mix method. The strengths of both methodologies negated the weaknesses identified in both methodologies. The main research question prompted the researcher to investigate evaluation methodology as a possible method to answer the research question.
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4.2.5 Evaluation research
The most frequently mentioned definition for the term evaluation is the systematic assessment of the worth or merit of some object (Zinovieff, 2008, p.1). The definition is hardly complete. According to Zinovieff (2008, p.1), there are many types of evaluations that do not necessarily result in an assessment of worth or merit, for instance, descriptive studies, implementation analyses, and formative evaluations are but a few. Zinovieff (2008, p.1) postulates a definition that emphasises the information-processing and feedback functions of evaluation, as the systematic acquisition and assessment of information to provide useful feedback about some object.
Alkin (2011, p.9) disagrees and, therefore, adds that evaluation is judging the merit or worth of an entity or rather as the pursuit of value based on merit and worth. Merit refers to the entity being studied. For example, does it have merit, and is it meritorious of value. The worth is clarified as the value of the entity within the context. Simply put, when evaluating an HIV/AIDS awareness programme, for instance, it may be meritorious to consider the role of sanitation within a community, but does the role of sanitation add value/worth to evaluating the effectiveness of an HIV/AIDS programme. Stuffelbeam (2007, p.8) concurs with Alkin (2011, p.9), since an evaluation is the systematic assessment of the worth or the merit of an object. Merit, according to Stufflebeam (2001, p.9) refers to the merit or quality of the evaluand (object of evaluation) in terms of whether the evaluand has merit. By worth, Stufflebeam (2007, p.10) refers to a programme’s combination of excellence in an area of need. An evaluand may have high merit yet may not be worthy; making this distinction in terms of value, is the responsibility of the evaluator. Patton makes a further distinction between merit and worth. Merit, according to Patton (2008, p.113), refers to “the intrinsic value of a programme for example, how effective it is in meeting the needs of those it is intended to help. Worth refers to extrinsic value to those outside the programme”.
Patton's approach to evaluation is centred on the ideal of utilization and practicality. Patton adds that the definition of evaluation is “the systematic collection of information about the activities, characteristics and outcomes of programmes,
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personnel, and products for use by specific people to reduce uncertainties, improve effectiveness and make decisions with regard to what those programmes, personnel or products are doing or affecting” (Patton,1982, p.15). The definition of evaluation appears to be ever changing, and perhaps the definition of the term evaluation can be better understood by unpacking the concept of evaluation. Evaluation offers a method to determine whether an initiative has been valuable in terms of delivering what was planned and anticipated. However, good evaluation can also answer other important questions (International Centre for Alcohol Policies (ICAP), 2012, p.1). Evaluation is a process that critically examines a programme. It involves collecting and analysing information about a programme’s activities, characteristics, and outcomes. Its purpose is to make judgments about a programme to improve its effectiveness, and to inform programming decisions (Patton, 1987). It is essential that the researcher unpacks the purpose of evaluation research.
4.2.5.1 Purpose of evaluation
The evaluation of a programme may fulfil a number of purposes. An evaluation measures a programme’s outcome and impact whilst asking these questions. Did the programme achieve its stated objectives? Did it reach its intended audience? Did the programme have unexpected or unintended consequences? Are outcomes consistent with those of similar programmes? Evaluations may assist in gaining insight into a programme, and thereby provide the necessary insight to clarify how programme activities should be designed to bring about expected changes (Patton, 1987). This may entail determining the strengths and weaknesses of a given approach, thereby resulting in the improvement of the quality, effectiveness, or efficiency of programme. These questions resonate with the purpose of the research. It is for these reasons that the researcher agrees that the purposes of an evaluation research would prove useful when answering the research question.
The purpose of an evaluation may extend to detecting problems, and what implementation problems have emerged. Are measurement criteria appropriate and adequate? To assess effects, examine the relationship between programme activities and observed consequences and encourage participants to use the processes of evaluation to direct those who participate in the inquiry. The systematic
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reflection required of stakeholders who participate in an evaluation can be a catalyst for self-directed change (Zinovieff, 2008, p.1). Evaluation procedures themselves generate a positive influence, for instance, HIV/AIDS programme evaluation. The evaluation process outlines the role of the programme and the contribution made by the programme.
In some instances evaluations provide important internal lessons for those who conduct programmes. For example, evaluations can offer feedback on whether the expenditure of financial and human resources, which are needed for the programme, was justifiable. In addition to the above, evaluations ensure transparency and accountability. Particularly where outside funding has been used on an initiative, evaluations help to provide justification for the project. They can also be used as a form of stakeholder engagement, helping to gain buy-in from local community members, local authorities, and target audiences (ICAP, 2012, p.1). Lastly, evaluations provide broader lessons about good practice and the lessons that can be learned from this approach. Evaluations help to answer questions regarding programme options and the role of the results that support existing evidence (ICAP, 2012, p.1).
4.2.5.2 Importance of evaluation
The importance of evaluation reinforces the researcher’s decision to consider evaluation research as a possible method, as individuals are constantly placed in positions where they need to make decisions. They are constantly forced to choose (Alkin, 2012, p.16). The act of choosing entails comparing and selecting between options. The moments that are utilised on making a choice is inadvertently time that is utilised to evaluate an option. Stuffelbeam (2007, p.4) adds that evaluation is society’s most fundamental discipline. It is orientated to assessing and helping to improve all aspects of society. “Evaluations serve society by providing affirmations of worth, value, improvement, accreditation and accountability” (Stuffelbeam, 2007, p.5). Evaluations can improve programme design and implementation. As it is important to periodically assess and adapt your activities to ensure that they are as effective as they can be. Evaluation can help to identify areas for improvement and ultimately help realise goals more efficiently (MEERA, 2012, p.1).
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Furthermore, evaluations help to demonstrate programme impact. It enables one to demonstrated programme’s success or progress. The information that one collects allows one to better communicate a programme's impact on others, which is critical for public relations, staff morale, and attracting and retaining support from current and potential funders (MEERA, 2012, p.1). “Programme evaluation helps us to make the best use of our resources as we labour to improve the quality of life of our clients,” (Royse, 2010, p.13) and thereby reinforce the need to evaluate.
4.2.5.3 The need to evaluate
The need to evaluate supports the core of the research question, since the HIV/AIDS programme at the university has yet to be evaluated. The reasons for the need to evaluate are set out below, which confirms the use of an evaluation method. According to MEERA (2012, p.1), making evaluation an integral part of a programme means that evaluation is a part of everything that programme implementers do. Implementers design programmes with evaluation in mind, collect data on an on- going basis, and use this data to continuously improve the programme. Developing and implementing an evaluation system has many benefits. These benefits help implementers to better understand target audiences’ needs, and how to meet these needs; design objectives that are more achievable and measurable; and monitor progress towards objectives more effectively and efficiently, and learn more from evaluation, thus increasing a programme’s productivity and effectiveness (MEERA, 2012, p.1). Selecting the ideal evaluation approach can be challenging, hence the researcher has selected programme evaluation, as this conforms to the purposes of the research.
4.2.5.4 Programme evaluation
Programme evaluation concerns “the use of social research methods to systematically investigate the effectiveness of social intervention programmes in ways that are adapted to their organisational environments and are designed to inform social action to improve social conditions” (Rossi, 2004, p.16). Patton (2008, p.39) offers the definition to programme evaluation as “the systematic collection of
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information about the activities, characteristics, and results of programmes to make judgements about the programme, improve or further develop programme effectiveness, inform decision about future programming and increased understanding”.
Weiss (1998, p.4) has posits that programme evaluation is the systematic assessment of the operation and outcomes of a programme or policy, compared to a set of explicit or implicit standards as a means of contributing to the improvement of the programme or policy. The systematic assessment according to Weiss (1998, p.4), recommends a systematic and mutually agreed upon plan that should include the determining of the goal of the evaluation and thereby asking: what type of evaluation question would be used, and what is the purpose of undertaking the evaluation? The research design that will help to answer the evaluation question: What type of methodology will be used? How will the findings be reported so that they can be used by the organisation to make improvements? The type of evaluation in terms of whether it is formative or summative assists in choosing the correct research method.
4.2.5.5 Types of evaluation
Evaluations fall into one of two broad categories: formative and summative. Robert Stake, as quoted by Alkin (2011, p.12), offers the following distinction: when the cook tastes the soup, that is formative, and when the guests taste the soup, that is summative. Formative evaluations are conducted during programme development and implementation, and are useful if the evaluator wants direction on how to best achieve goals or improve the programme. Summative evaluations should be completed once programmes are well established and should inform the evaluator to what extent the programme achieves its goals (MEERA, 2012, p.1). Within the categories of formative and summative, there are different types of evaluation, which are outlined below.
A formative evaluation may include “a needs assessment namely a systematic assessment of the extent to which treatment or outcome needs are being met” (Stufflebeam, 2007, p.11), and determines who needs the programme, how great
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the need is, and what can be done to best meet the need. A needs assessment is formative and can help to determine what audiences are not currently served by programmes and provide insight into what characteristics new programmes should have to meet these audiences’ needs. An example of a formative evaluation is a process or implementation evaluation.
Process or implementation is formative as it examines the process of implementing the programme and determines whether the programme is operating as planned and can be done continuously or as a one-time assessment. Process-based evaluations are useful to assess how an intervention is implemented, or whether it produces the necessary measurements. Findings are used to improve the programme. A process evaluation of a prevention programme, for instance, may focus on the number and type of participants that are reached and determine how satisfied these individuals are with the programme.
Summative evaluation may include an outcome and impact evaluation. Outcome evaluation investigates to what extent the programme achieves its outcomes. Outcome evaluation and impact-based evaluations are best to track the results of an intervention (ICAP, 2012, p.1). These outcomes are the short-term and medium- term changes in programme participants that result directly from the programme. For example, the evaluation may examine improvements in participants’ knowledge, skills, attitudes, intentions, or behaviours (MEERA, 2012, p.1). Which of these evaluations is most appropriate depends on the stage of the programme. The choice of the most appropriate type of evaluation is guided by several factors, including the availability of resources and whether the evaluation is needed for internal or external purposes. Table 4.4, below, sets out the two broad categories of evaluation, offering a guideline as to the type of evaluation most relevant to a particular evaluation question and phase of programme.
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Table 4.4: Evaluation Type
Source: MEERA (2012, p.1)
4.2.5.6 Evaluation most suited to the research Of the various types of evaluation presented, the researcher chose an evaluation type that was most suited to the research. A review of the evaluation aim was undertaken. In terms of evaluation, certain questions should be asked. For example, was the intended evaluation interested in the outcome or the process of the evaluations? Would a developmental evaluation be more suitable than a process evaluation? Lastly, is there a difference between a process and an implementation evaluation? In order to answer these questions, the researcher reviewed various types of evaluation before making a decision.
At the outset developmental evaluation seemed most appropriate, as the intention of the evaluation was to make a contribution to the development of the programme. In delving further into the literature, the investigation pointed to a process evaluation, which is often used interchangeable with implementation evaluation, thus creating the impression that these were two separate types of evaluation. On further investigation it became apparent that process evaluation is also known as implementation evaluation, and focuses on how a specific programme operates and is designed to answer the questions of what is done, when, by whom, and to whom.
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(Centre for Community-Based Health Strategies (CCHS), 2002, p.1). The evaluation process most suited to the research was the process/implementation evaluation. Therefore, process/implementation evaluation is explained and the motivation for the use of this type of evaluation is unpacked below.
4.2.5.7 Process/implementation programme evaluation
Process evaluations help to establish the extent and nature of programme implementation. This is an important first step in studying programme outcomes; process evaluation describes the interventions to which any findings about outcomes may be attributed, quite unlike outcome evaluation that assesses programme achievements and effects. Process evaluations are used to understand how a programme works and delivers its results. This type of evaluation assesses activities that are being implemented and the materials that are used. Process- based evaluations are intended to answer some of the following questions: What is required to deliver the HIV/AIDS programme in terms of resources, products, and services? How are individuals implementing the interventions that are acquired at training? How participants are made aware of the programme? What are considered as the programme’s strengths/weaknesses? What is the feedback from participants about the implementation of the HIV/AIDS programme? (ICAP, 2012, p.1)
For the purpose of this research, the researcher prefers to use the term process/implementation evaluation in the alternative borrowing from literature, where these terms are often used interchangeably. A programme theory or a theory of change identifies programme resources, programme activities, and intended programme outcomes, and specifies a chain of underlying assumptions, which link programme resources, activities, intermediate outcomes, and ultimate goals (Wholey, 1987, p.78). Programme theory maps a picture for the evaluator, providing her with a path into the evaluation itself.
The programmes theory of change provides a guideline and a basis for evaluation. Figure 4.3 presents the activities and the stages of change. As previously stated, the evaluation focuses on the activities that have been decided upon, how they have been implemented, and what their consequences were.
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Figure 4.3: Theory of Change HIV/AIDS workplace programme pre-evaluation
Launch of HIV/AIDS Staff and students Awareness campaigns Programme needs targeted implemented
Staff and students hear Staff and students Increased awareness about programme internalise programme
Staff and students Awareness of HIV/AIDS Staff and students Programme develops acquire awareness as to Programme begin to participate list of activities HIV/AIDS programme content and activities.
Programme co- Staff and students Programme provides ordinators assist staff Staff and students begin to access VCT, access to HIV/AIDS and students with participate in activities programme awareness information programme content and activites
Source: Author’s fieldwork adapted from Weisse (1998, p.59)
The theory of change would be able to articulate how the programme worked to achieve its goals. The evaluation would be able to follow the theory of change and explain the steps and process that led to the results. According to Weiss (1998, p.60), the evaluator uses programme theories to plan areas for data collection and to use data to find out if the programme carried out each stage of the programme plan. Programme process/implementation evaluation “is a form of evaluation designed to describe how a programme is operating and assess how well it performs its intended functions. It builds on programme process theory, which identifies the critical components, functions; evaluation is an on-going function” (Rossi, 2004, p.199). Implementation evaluation, according to Patton (2008, p.308), “focuses on finding out if the programme has all its parts, if the parts are functional, and if the programme is operating as it is supposed to be operating. Implementation evaluation asks the questions, what is the programme, who is participating, what is working, and what is not working?”
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Process evaluations provide an opportunity to explore all aspects of the programme and enable practitioners to investigate how the programme is delivered, including alternative ways of providing programme facilities. By examining the theory that underlines the programme, specifically, it is determined how the programme is administered and ultimately whether the programme is unfolding ‘on the ground’ as intended. It determines whether the programme is reaching targeted populations and whether both the number and frequency of programme activities are adequate; and assesses the reasons for successful or unsuccessful performance, and provides information for potential replication of successful initiatives (Bowie, & Bronte-Tinkew, 2008, p.1).
Rossi (2004, p.171) adds that programme process evaluation is generally directed at one of both questions: is the programme reaching the appropriate target population? and, are service delivery and support functions consistent with programme design specifications or other appropriate standards? Programme evaluation involves the holistic examination of a programme, including its environment, client needs, procedures, and outcomes by using systematic data collection and analysis. Most evaluations also include recommendations to improve the programme and strategies for on-going evaluation.
The strategies for evaluations involve a process of planning, gathering data, and reporting findings based on the theory of change as a guideline. Weiss (1998, p.64) recommends that the evaluator should deliberate on the most appropriate time to undertake the evaluation, the types of questions to ask, whether one or a series of studies will be necessary, and any ethical issues that might be generated by the research. A nine step ‘evaluation action plan’, as described by Wallace (2001, p.4) was considered.
STEP 1 Describe the programme framework Descriptions convey the mission and objectives of the instructional programme and include information about its purpose, expected effects, available resources, programme’s stage of development, and instructional context, for example, HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education.
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Descriptions set the frame of reference for all subsequent planning decisions in an evaluation.
STEP 2 Identify participants/stakeholders and their needs
Stakeholders are the individuals and organisations that are involved in programme operations, and those who are served or impacted by the programme, and the intended users of the assessment or evaluation. Stakeholder needs generally reflect the central questions that stakeholders have about the programme. Determining stakeholder needs helps to focus the evaluation process so that the results are of the greatest utility.
STEP 3 Determine the evaluation purpose Identifying a clear evaluation purpose helps to determine how to conduct the evaluation. Three general purposes for instructional evaluations are to gain insight, change practices, and measure effects. Firstly, to gain insight in order to clarify how instructional activities should be designed to bring about expected changes. Secondly, to change practices in order to improve the quality, effectiveness, or efficiency of instructional activities. Thirdly, to measure effects with the intention to examine the relationship between instructional activities and observed consequences
STEP 4 Identify intended uses
Intended uses are the specific ways in which evaluation results are applied. They are the underlying goals of the evaluation, and are linked to the central questions of the research that identify the specific aspects of the instructional programme to be examined. The purpose, uses, and central questions of an evaluation are all closely related.
STEP 5 Create an evaluation plan
The evaluation plan outlines how to implement the evaluation by identifying; a sponsor and resources available for implementing the plan, what type of information should be gathered, the research method that should be used, and a description of
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the roles and responsibilities of sponsors and evaluators, and a timeline for accomplishing tasks.
STEP 6 Gather data
Data gathering focuses on collecting information that conveys a holistic picture of the instructional programme and can be seen as credible by stakeholders. Data gathering includes consideration about what indicators, data sources and methods to use, the quality and quantity of the information, human subject protections, and the context in which the data gathering occurs.
STEP 7 Analyse data
Data analysis involves identifying patterns in the data, either by isolating important findings (analysis) or by combining sources of information to reach a larger understanding (synthesis), and making decisions about how to organise, classify, interrelate, compare, and display information. These decisions are guided by the questions that are asked, the types of data that are available, and input from stakeholders.
STEP 8 Conclusions and recommendations
Conclusions are linked to evidence, which is gathered and judged against and agreed-upon standards set by stakeholders. Recommendations are actions for consideration that are based on conclusions, but go beyond simple judgments about efficacy or interpretation of the evidence gathered.
STEP 9 Report findings
Factors to consider when reporting findings or dissemination include tailoring report content for a specific audience, explaining the focus of the research and its limitations, and listing both the strengths and weaknesses of the research. It may also include the reporting of active follow-up and interim findings. Reporting interim findings is sometimes useful to instructors or staff to make immediate instructional adjustments (IAR, 2011, p.1).
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4.2.5.8 Advantages and disadvantages of selecting process/implementation evaluation
An advantage of implementation/process evaluation is that the evaluation can be used during the planning stage of a program cycle to test if a program theory translates into reality when implemented on the ground. This can be valuable in the context of piloting new initiatives. Implementation/process evaluations are often used to improve individual program processes. Process evaluations are usually implemented or completed mid-term during program implementation as part of a longer term monitoring process. Mid-term evaluations allow for program managers to make adjustments to a program’s operational processes in a timely manner if it is perceived that the programme will not reach established goals. Furthermore, the process evaluations can be part of evaluation tools, which are used in ‘mixed methods’ evaluations. They can highlight impact evaluation findings by providing information related to the performance of the program’s operational mechanisms. For the purpose of reliability, when process evaluations are conducted for the same program design operating in different contexts, such as a different HEI, a best practice can be drawn out by comparing findings that can be adapted to similar programmes or projects. If the analysis of the evaluations is collected in a systematic manner across other HEIs over time, then this information can be used to complete a meta-analysis of HEI processes, whilst identifying common concerns and areas for improvement.
The other advantage of process evaluation is that it can serve as an important developmental or capacity-building purpose for the organisation as a whole, and for individual members, where it is seen as a form of organisational learning. However, process evaluation is time and labour intensive in comparison to most forms of summative evaluation. It relies primarily on qualitative methods that are heavy in their use of time and evaluation expertise, both at the data gathering stage, as well as in the analysis. Depending on the audience for the formative evaluation findings, the reliance on qualitative methods may fail to meet the expectations of some stakeholders for vigorous quantitative measures of progress.
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4.2.5.9 Paradigms in evaluation research
Pragmatism philosophy is a valuable guide to evaluation research as pragmatist researchers are not committed to any one system of philosophy or reality. Pragmatist researchers focus on the 'what' and 'how' of the research problem (Creswell, 2003, p.11). The pragmatic paradigm places "the research problem" as central and applies all approaches to understanding the problem (Creswell, 2003, p.11). With the research question being ‘central’, data collection and analysis methods are chosen as those that are most likely to provide insights into the question with no philosophical loyalty to any alternative paradigm.
The ontological assumption (nature of reality) in the pragmatism philosophical has singular and multiple realities. For example, researcher test hypotheses provide multiple perspectives (Creswell, 2011, p.42). Epistemological assumption (relationship of the researcher) is practical, as the researcher collects data according to ‘what works’ to address the research question. Axiological assumption (role of values) has multiple stances since the researcher includes both biased and unbiased perspectives. Methodological assumption (process of research) combines quantitative and qualitative data. Rhetorical assumption (language of research) means that the researcher may employ both formal and informal styles of writing (Creswell, 1994; Creswell, 2011, p.42; Culbertson, 1981). Hence, mixed method research is perceived to be the method of choice. Research methods in evaluation research is described next.
4.2.5.10 Research methods in evaluation research
Research methods in evaluation research are known to vary. However, relying on the literature of evaluation research, a mixed method approach was the most appropriate. An advantage of using a mixed method approach, according to Bamberger (2010, p.11), is that it “combines quantitative approaches that permit estimates of magnitude and distribution of effects, generalization and tests of statistical differences with qualitative approaches that permit in-depth description, analysis of processes and patterns of social interaction. These integrated approaches provide the flexibility to fill in gaps in the available information, to use
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triangulation to strengthen the validity of estimates, and to provide different perspectives on complex, multi-dimensional phenomena. When working under real- world constraints, a well-designed mixed-methods approach can use the available time and resources to maximize the range and validity of information”. The next section discusses mixed methods research in greater detail.
4.2.6 Mixed method research The researcher agrees with Creswell (2006, p.5) who defines “mixed methods research as a research design with philosophical assumptions as well as methods of inquiry. As a methodology, it involves philosophical assumptions that guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases in the research process. As a method, it focuses on collecting, analysing, and mixing both quantitative and qualitative data in a single study or series of studies. Its central premise is that the use of quantitative and qualitative approaches in combination provides a better understanding of research problems than either approach alone”. Greene (Johnson, Onwuegbuzie &, Turner 2007, p.119) confirm Creswell’s (2006) statement that a mixed method inquiry is an approach that investigates the social world that ideally involves more than one methodological tradition and thus more than one way of knowing, along with more than one kind of technique for gathering, analysing, and representing human phenomena, all for the purpose of better understanding.
4.2.6.1 Advantages and disadvantages of mixed method research
Some of the advantages of mixed method inquiry are that it can answer a broader and more complete range of research questions because the researcher is not confined to a single method or approach. The researcher can use the strengths of an additional method to overcome the weaknesses in another method by using both methods in a single research. Mixed method research can provide stronger evidence for a conclusion through convergence and corroboration of findings. “Mixed method research can add insight and understanding that might be missed when only a single method is used. Words, pictures, and narrative can be used to add meaning to numbers. Numbers can be used to add precision to words, pictures
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and narrative” (Migiro, 2011, p.3763). Possible flaw in the mixed method inquiry is that the researcher should learn about multiple methods and approaches and understand how to mix them appropriately. Methodological purists contend that one should always work within either a qualitative or a quantitative paradigm. The application of mixed methods in a single research is a difficult issue since the rationales for methodological decisions are often justified by the questions, which are addressed and the way that data should be analysed.
Johnson, Onwuegbuzie and Turner (2007, p.193) summarise the definition of mixed methods research as the “research paradigm that partners with the philosophy of pragmatism, follows the logic of mixed methods, relies on qualitative and quantitative viewpoints, data collection, analysis, and inference techniques combined according to the logic of mixed methods research to address one’s research question and is cognisant, appreciative, and inclusive of local and broader socio-political realities, resources, and needs”. Paradigms in mixed method design are discussed blow.
4.2.6.2 Paradigms in mixed method research Quantitative and qualitative methods both belong to a specific paradigm with separate and unique ontological, epistemological, axiological, methodological and rhetorical assumptions (Creswell, 2011, p.42). Guba and Lincoln (1994, p.105) note that “qualitative and quantitative methods may be used appropriately with any research paradigm”. Guba and Lincoln (2005, p.200) reiterate that “within each paradigm, mixed methodologies (strategies) may make perfectly good sense”. They add that although the paradigm wars continue, Guba and Lincoln (2005, p. 201) and Johnson, Onwuegbuzie and Turner (2007, p.117) declare that it “is it possible to blend elements of one paradigm into another, so that one is engaging in research that represents the best of both worldviews?” Simply explained, the mixed methods paradigm may combine the best of both worlds. Guba and Lincoln (2005, p.201) add “especially if the models (paradigms) share obvious elements that are similar, or that resonate strongly between them”. The researcher, therefore, combined paradigms in order to exploit the most effective paradigm mix that would assist to answer the research question.
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4.2.6.3 Research approaches in mixed methods research
Over the years methodologists who write about mixed methods research have found nearly 40 different types of mixed methods designs in the literature (Creswell, 2011, p.59). In later years, Creswell summarised the range of these classifications. The strategy of inquiry of a mixed method approach is one in which the researcher will collect, analyse, and integrate both quantitative and qualitative data in a single research or in multiple studies (Traynor, n.d). There are six strategies around the procedure within the mixed method approach. These procedures are guided by the research question and whether the data is collected sequentially (exploratory and explanatory), concurrently (triangulation and nested), or with a transformative lens (sequential or concurrent) (Creswell, 2003). One of the six strategies that will inform the procedure within this mixed method approach is the sequential explanatory approach. Sequential procedures (Creswell 2003; Leech & Onwuegbuzie, 2007, p. 27; Teddlie, & Tashakkori, 2009, p.143) are applied by the researcher when the researcher seeks to elaborate on or expand the findings of one method with another method. This may involve beginning with a qualitative method for exploratory purposes and following up with a quantitative method with a large sample so that the researcher can generalise findings to a population (sequential exploratory strategy). Alternatively, the research may begin with a quantitative method in which theories or concepts are tested, to be followed by a qualitative method, which involves detailed explanations with a few cases or individuals (sequential explanatory strategy) (Creswell, 2003).
For the purposes of this research, the researcher will rely on the sequential explanatory strategy or procedure. The sequential explanatory strategy is the most straightforward of the six major approaches. It is characterised by the collection and analysis of quantitative data, followed by the collection and analysis of qualitative data. The one method is more dominant than the other in the case of sequential explanatory design, and the quantitative method is most often more dominant (Teddlie, & Tashakkori, 2009, p.143). The qualitative results assist in explaining and interpreting the findings of the primary quantitative research (Creswell, 2003, p.219). The two methods are then integrated during the discussion of findings phase of the research.
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The concurrent mixed design refers to the mixed method design where the phases of the research occur in consecutive order, with one strand emerging from or following the other. For instance, quantitative followed by qualitative or vice versa. The research questions and procedures for one strand depend on the previous strand. Qualitative and quantitative phases are related to one another, but may evolve as the research unfolds (Teddlie & Tashakkori, 2009, p.143). The conclusion based on the results of the first strand lead to the formulation of design components for the next strand (Tashakkori & Teddlie, 2003, p.715). The final inferences are based on the results of both strands of the research. “The second strand of the study is conducted either to confirm or disconfirm inferences from the first strand or to provide further explanation for its findings” (Tashakkori, 2003, p.715). Sequential mixed designs answer explanatory and exploratory questions in a pre-specified order.
Figure 4.4: Explanatory sequential design
Quan Results Qual Results
Source: Mertens and Wilson (2012, p.344)
The explanatory sequential design occurs in two distinct interactive phases (see Figure 4.4 and 4.5). “This mixed method design starts with the collection and analysis of quantitative data, which has the priority for addressing the study’s questions. This first phase is followed by the subsequent collection and analysis of qualitative data. The second, qualitative phase of the study is designed so that it follows from the results of the first, quantitative phase. The researcher interprets how the qualitative results help to explain the initial quantitative results” (Creswell, 2011, p.71; Mertens & Wilson, 2012, p.343). Creswell sets out his sequential design contrarily to Mertens and Wilson (2010, p.344) in Figure, 4.4 above. Figure 4.5 below illustrates the variation in design.
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Figure 4.5: Explanatory sequential design
Quantitative Qualitative Data Data Collection Collection and and Analysis Follow up Analysis Discussions of with findings
Source: Creswell’s (2011, p.69)
Creswell (2011, p.71) describes his design in some detail and the quantitative process is followed by the qualitative process, resulting in the discussion of findings. The Mertens and Wilson (2012, p.344) design can be further elaborated upon to show that the results are not independent, but interpreted at the end once data has been collected.
Figure 4.6: Exploratory sequential design
Qual Quan Discussion based on Qual -> Quan results
Source: Creswell’s (2011, p.76)
The exploratory sequential design, as shown in Figure 4.6, also uses sequential timing. In contrast to the explanatory design, the exploratory design begins with and prioritises the collection and analysis of qualitative data in the first phase. Building from the exploratory results, the researcher conducts a second, quantitative phase to test or generalise the initial findings. The researcher then interprets how the quantitative results build on the initial qualitative results (Creswell, 2011, p.71).
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Figure 4.7: Embedded design
Quantitative (or Qualitative) Design Quantitative (or Qualitative) Design data collection and analysis Discussion of Quantitative (or Qualitative) Design data findings collection and analysis (before, during or after)
Source: Creswell (2011, p.70)
The embedded design occurs when the researcher collects and analyses both quantitative and qualitative data within a traditional quantitative or qualitative design, as depicted in Figure 4.7. “In an embedded design, the researcher may add a qualitative strand within a quantitative design, such as an experiment, or add a quantitative strand within a qualitative design, such as a case study. In the embedded design, the supplemental strand is added to enhance the overall design in some way” (Creswell, 2011, p.71). Mertens and Wilson (2012, p.343) refers to the embedded design as when one data set is collected to support the larger data set in a research, although dialogue occurs between the two sets of data.
The rationale behind the embedded design is the belief that a single data set is not sufficient, that different questions need to be answered and that each type of question requires different types of data (Creswell, 2011, p.91). The purposes for adding either the quantitative or qualitative strand are related, but different from the primary purpose of the research. The reason for inclusion is to possibly assess whether the added strand made a significant difference to the outcome of the research. Of the four types of mixed method design discussed above, the explanatory sequential design has been found to be the most suitable design for this research and is, therefore, discussed in further detail below.
4.2.6.3.1 Explanatory Sequential Design
Several texts on mixed methods designs have emphasised sequential approaches by using design names such as sequential model, sequential triangulation, and
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iteration design (Creswell, 2011, p.81). Although these names apply to any sequential two-phase approach, Creswell introduced specific names to distinguish whether the sequence begins quantitatively or qualitatively (2011, p.81). The explanatory design is a mixed methods design in which the researcher begins by conducting a quantitative phase of the research, following up on explicit results with a second phase (refer to Figures 4.4 and 4.5). The second qualitative phase is implemented for the purposes of explaining the initial results in detail, and it is owing to this focus on explaining results that is reflected in the design name (Creswell, 2011, p.81).
According to Creswell, the sequential explanatory design is “characterized by the collection and analysis of quantitative data followed by the collection and analysis of qualitative data” (2003, p.223). The steps in this design are illustrated in Figures 4.4 and 4.5. In this design priority is generally given to the quantitative data, and then the two methods are integrated during the interpretation phase of the research (Jeanty, 2011, p.639). The objective of the sequential explanatory design is “typically to use qualitative results to assist in explaining and interpreting the findings of a primarily quantitative study” (Creswell, 2003, p.227). Morse, as quoted by Jeanty (2011, p.639), states that this method can be particularly useful when unexpected results arise in a quantitative research. The qualitative data is useful in examining unexpected results in greater detail. The simplicity of this design is one of its main strengths (Jeanty, 2011, p.639).
This design has also been called a qualitative follow-up approach. The overall purpose of this design is to use a qualitative strand to explain initial quantitative results (Creswell, 2003).The explanatory design is well suited when the researcher needs qualitative data to explain quantitative significant or non-significant results, positive-performing exemplars, outlier results, or unanticipated results. This design can also be used when the researcher wants to form groups based on quantitative results and follow up with the groups through subsequent qualitative research or to use quantitative results about participant characteristics to guide purposeful sampling for a qualitative phase. This design is most useful when the researcher wants to assess tendencies and relationships with quantitative data, but also be able
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to explain the mechanism or reasons behind the resultant trends. Other important considerations, according to Creswell (2011, p.82), is that “the researcher and the research problem are more quantitatively oriented. The researcher knows the important variables and has access to quantitative instruments for measuring the constructs of primary interest. The researcher has the ability to return to participants for a second round of qualitative data collection. The researcher has the time to conduct the research in two phases. The researcher has limited resources and needs a design where only one type of data is being collected and analysed at a time. The researcher develops new questions based on quantitative results, and they cannot be answered with quantitative data”. The philosophical assumptions behind the explanatory design rest with the fact that the research begins quantitatively, hence the research problem and purpose often call for a greater importance to be placed on the quantitative aspects. Although this may encourage researchers to use a postpositivist orientation to the research, the researcher should consider using different assumptions within each phase. By this Creswell explains “since the study begins quantitatively; the researcher typically begins from the perspectives of postpositivism to develop instruments, measure variables, and assess statistical results. When the researcher moves to the qualitative phase that values multiple perspectives and in-depth description, there is a shift to using the assumptions of constructivism. The overall philosophical assumptions in this design change and shift from postpositivist to constructivist as researchers use multiple philosophical positions” (2011, p.82).
The explanatory design procedure is relatively straightforward, and Figures 4.4 and 4.5 provide an overview of the procedural steps that used to implement a typical two-phase explanatory design. During the first step the researcher designs and implements a quantitative strand that includes collecting and analysing quantitative data. In the second step the researcher follows a second phase, namely the point of interface for mixing by identifying specific quantitative results that call for additional explanation, and then using these results to guide the development of the qualitative strand (Creswell, 20111, p.81). Specifically, the researcher develops or refines the qualitative research questions, purposeful sampling procedures, and data collection protocols so that they follow from the quantitative results. Hence, the qualitative
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phase depends on the quantitative results. In the third step the researcher implements the qualitative phase by collecting and analysing qualitative data. Finally, the researcher interprets to what extent and in what ways the qualitative results explain and add insight to the quantitative results and what is learned overall in response to the research’s purpose.
The explanatory sequential design has many advantages, as it is the most straightforward of the mixed methods designs. Hence, the explanatory sequential design was adopted as the design appeals to quantitative researchers, because it often begins with a strong quantitative orientation. Its two-phase structure makes it simpler to implement, because the researcher conducts the two methods in separate phases and collects only one type of data at a time. This means that solitary researchers can conduct this design; a research team is not required to carry out the design. The final report can be written with a quantitative section, followed by a qualitative section, which makes it easier to write and provides a clear explanation for readers. This design lends itself to allow for the development of the second phase, which can be designed based on what is learned from the initial quantitative phase.
As straightforward as it may appear, researchers who choose this approach still need to anticipate challenges that are specific to this design. The explanatory design has many challenges as it requires a lengthy amount of time to implement the two phases. Researchers should be aware that the qualitative phase takes more time to implement than the quantitative phase. Although the qualitative phase can be limited to a few participants, adequate time must still be allocated for the qualitative phase. Fewer participants do not help the researcher to decide, which quantitative results should be further explained. This can only be determined precisely until after the quantitative phase is complete, while options such as selecting significant results and strong predictors should be considered once the quantitative results are interpreted. The researcher must decide who to sample in the second phase and what criteria to use for participant selection. Creswell (2011, p.82) explores approaches “to using individuals from the same sample to provide the best explanations and criteria options, including the use of demographic characteristics,
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groups used in comparisons during the quantitative phase, and individuals who vary on selected predictors”.
There are two options, according to Creswell (2001, p.82), namely the prototypical follow-up explanations option where the researcher places the priority on the initial, quantitative phase and uses the subsequent qualitative phase to help to explain the quantitative results. The second yet less common option is the participant-selection variant, which arises when the researcher places priority on the second, qualitative phase instead of the initial quantitative phase. “This variant is used when the researcher is focused on qualitatively examining a phenomenon but needs initial quantitative results to identify and purposefully select the best participants” (Creswell, 2011, p.82). In terms of these options, the researcher relies on the prototypical follow-up explanations option when selecting participants for the qualitative phase of the research. The rationale for selecting the explanatory sequential design is set below.
4.2.6.3.2 Rationale for choosing explanatory sequential design
Of the various mixed methods suggested by authors such as Creswell (2011), Mertens and Wilson (2012), Teddlie and Tashakkori (2009) and Tashakkori and Teddlie (2003), the choice of design was based on strategically combining qualitative and quantitative methods in a way that produces complementary strengths and non-overlapping weaknesses. Consideration of the strengths and weaknesses of different approaches was thought out. The choice of design was not limited to triangulation. The complementary strengths elements of the data were collected in order to provide all of the information that is hypothetically relevant to the purpose of the research. Choice of design was based on an attempt to eliminate potential design weaknesses by combining methods that have different weaknesses. Mixing quantitative and qualitative methods can enhance research that is suitable to both paradigms. Jeanty and Hibel (2011, p.27) quote Johnson and Onwuegbuzie who add that the principle of “mixed methods research is that researchers should mindfully create designs that effectively answer their research questions”. In this research, the qualitative method was used in the second phase to explain meanings that are associated with the effectiveness of the HIV and AIDS programme within
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the focused university. The quantitative approach was also employed in the initial phase to establish empirical data, which relate to the effectiveness of the HIV and AIDS programme.
Qualitative research has been increasingly used as a methodology largely owing to its ability to generate rich descriptions of complex occurrences that help to illuminate the experience and interpretation of events by research participants. “Qualitative inquiry allows for initial explorations to develop theories and to generate and even test hypotheses while moving towards explanations” (Jeanty & Hibel, 2011, p.635). In contrast, the quantitative approach emphasizes the measurement and analysis of causal relationships between variables, not processes”.
Mixed methods have in recent years risen in popularity owing in part to recognizing some inherent limitations and strengths of both qualitative and quantitative approaches (Tashkkori & Teddlie, 2003). Quantitative research has been regarded by some as the standard of “quality” research (Jeanty & Hibel, 2011, p.635). “Quantitative purists have argued that “social observations should be treated as entities in much the same way that physical sciences treat physical phenomenon” (Johnson & Onwuegbuzie, 2004, p.14). Conversely, the quantitative method of inquiry, although burdened by limitations, has several strengths, namely “testing and validating already constructed theories; generalising a research finding when it has been replicated on many different populations and subpopulations; research results are relatively independent of the researcher” (Johnson & Onwuegbuzie, 2004, p.19). Qualitative research is limited in its ability to create findings that generalise to larger populations, though it benefits from its ability to bring meaning and accounts of lived experiences that typically do not arise from quantitative research. The unique strengths of both qualitative and quantitative paradigms can be effectively combined to minimize their respective limitations while accentuating their strengths in a mixed method design (Jeanty & Hibel, 2011, p.635). “The final rationale for this approach is that quantitative data and their subsequent analysis provide a general understanding of the research problem. The qualitative data and their analysis refine and explain those statistical results exploring participants views in more depth” (Creswell, 2011, p.104). This rationale reiterates the words of Johnson and Onwuegbuzie (Jeanty &
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Hibel, 2011, p.627) who add that the principle of “mixed methods research is that researchers should mindfully create designs that effectively answer their research questions”. The explanatory sequential mixed method design impacts the data collection process for various reasons, which is discussed below.
4.2.6.3.3 Mixed method design
When deciding on a mixed method, Greene, Caracelli and Graham (1989) postulate that often the purpose for choosing a mixed methods design is not made clear to many researchers, potentially leading to confusion in the design phase of the research. Patton (1988) adds that some studies may not be considered to have employed mixed methods at all since they do not recognise to the full contribution of each method. However, where the purpose of the research is made clear, and the research method is well-defined, one may conclude that the methods have the potential of being mixed. According to Bazeley (2002, p.3), much of the writing about mixed method designs (Creswell,1994; Morgan,1998) have focused on the use of component (parallel or sequential) designs in which the different elements are kept separate, thus allowing each element to be true to its own paradigmatic and design requirements. This research has adopted an explanatory mixed method design, whereby the quantitative and qualitative methods are kept separate. The gaps in the first research (in this case the quantitative study) are investigated in the second (qualitative) research. The findings of each research are independently analysed. The findings are then merged and reported as a single research (Bryman, 2007, p.9). Bazeley (2002, p.3) argues that this may raise the issue of whether, in such a case; these really do constitute a mixed methods research or whether they are two separate studies, which happen to be about the same topic. However, this is not the case, as most mixed methods studies report either parallel or sequential component designs. Triangulation is an outcome of the mixing of these methods. The rationale for choosing a mixed method was not determined by the need for triangulation. The researcher chose to adopt a sequential mixed method as it informed and guided the research process.
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4.3 Research process
The purpose of the research was to evaluate the HIV/AIDS programme at a South African university. Patton defined evaluation as “the systematic collection of information about the activities, characteristics and outcomes of programmes, personnel, and products for use by specific people to reduce uncertainties, improve effectiveness and make decisions with regard to what those programmes, personnel or products are doing or affecting” (1982, p.15). The HIV/AIDS programme is a product of the institution under study. The use of primary data enabled the researcher to obtain an accurate picture of what academic, administrative staff and students views and opinions are regarding HIV/AIDS programme. The purpose for choosing to evaluate the HIV/AIDS programme was to explore the world of everyday life (Babbie & Mouton, 2001, p.138) within the context of the university, and involved people who had been exposed to the programme, as well as related activities. Qualitative interviews allowed for an opportunity to pose and ask relevant questions that lead to desired results and broader evidence. The research process considered a systematic review of literature and documents accompanied by quantitative and qualitative inquiry. The research plan, as suggested by Wallace and Van Fleet (2001, p.4), in page 122 above, was used as a guideline. The next section unpacks research methodology.
4.3.1 Research methodologies
In order to examine the effectiveness of the HIV/AIDS programme, a combination of both qualitative and quantitative research methods were utilised. The purpose of combining the two approaches was to understand the research problem from a subjective and objective point of view. This combination of research approaches is known as mixed methods. A methodological sequential triangulation was followed at each stage of data collection. The rationale for using methodological triangulation is to collect data in a single research (Johnson, Onwuegbuzie, & Turner, 2007; Yeasmin & Rahman, 2012), with the view that the variety of methods that are employed will increase the validity and reliability of findings.
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Figure 4.8: Research process.
Research and design •Pilot study
methodology •Survey questionnaires •Research methodology and design Theory •Research method: •Sequential Triangulation •EvaluationTheory and quantitative, qualitatitive, •Semi structured type chosen evaluation method, mixed interviews method •Sample size •Research design: explanatory •AnalysisApplication of data of Theory sequential theory and practice
4.3.2. Triangulation
Triangulation is the use of more than one research method when carrying out a piece of research so that the different kinds of data will complement each other. Denzin (1970) states that triangulation is a term, which is used to assess the validity and reliability of research methods and data. Validity is the ability of a research method to measure what it set out to measure, and reliability is said to occur when research can be repeated by using exactly the same methods to produce similar results. Therefore, by using different research methods a greater depth of information can be obtained and the data that is collected is more likely to be valid and reliable. Triangulation is used in sociological research to overcome the weaknesses, which are associated with each research method. In other words, “triangulation' is a process of verification that increases validity by incorporating several viewpoints and methods. In the social sciences, it refers to the combination of two or more theories, data sources, methods or investigators in one study of a single phenomenon to converge on a single construct” (Yeasmin & Rahman, 2012, p.156). Morse (1991) outlined two types of methodological triangulation, namely simultaneous or sequential. According to Morse (1991), simultaneous triangulation represents the simultaneous use of qualitative and quantitative methods in which there is limited interaction between the two sources of data during the data collection stage, but the findings complement one another at the data interpretation stage.
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Conversely, sequential triangulation is utilised when the results of one approach are necessary to plan the next method (Johnson, Onwuegbuzie, & Turner, 2007, p.117). However, in 1978, Norman Denzin identified four basic types of triangulation: “data triangulation: the use of multiple data sources in a single study; investigator triangulation: the use of multiple investigators/researchers to study a particular phenomenon; theory triangulation: the use of multiple perspectives to interpret the results of a study; and methodological triangulation: the use of multiple methods to conduct a study” (Denzin, 2010, p.14). The researcher relied on methodological triangulation, which is similar to sequential triangulation. Methodological triangulation is the use of multiple methods to a study, the intention of which is to decrease the deficiencies and biases that come from any single method study. In other words, methodological triangulation relies on the strength of one method, whilst compensating for the weaknesses of another.
This type of triangulation is similar to the mixed method approaches, which are used in social science research, “where the results from one method are used to enhance, augment and clarify the results of another. It is also a variation on data triangulation, with an emphasis on using data collected by different methods”, (Denzin, 2010, p.14) unlike sequential triangulation, which is regarded as a method, and not a combination of methods, as suggested by Yeasmin and Rahman (2012) and Sieber (1973).
The researcher has explored triangulation in terms of the mixed method design. Triangulation was further relied on during the analysis of stakeholders’ (academic, administrative staff and student) responses. Triangulation in these instances assisted to determine validity and reliability of the research process. Three additional reasons include first, to enable confirmation or corroboration of each research method, second, to enable or to develop analysis in order to provide richer data and third, to initiate new modes of thinking by attending to inconsistencies that emerge from the two data sources (Rossman, & Wilson, 1985; Johnson, Onwuegbuzie, & Turner 2007, p.115).
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4.3.2.1 Advantages and disadvantages of triangulation
The primary advantage of triangulation designs in research studies lies in the ability to find agreement and validation of results through a variety of research methods. If different research methods reach the same conclusion, the researcher can be confident that the results are truly a reflection of what is actually happening, and not a reflection of the method of testing that is used to gather the data. “Triangulation minimises the inadequacies of single-source research. Two sources complement and verify one another, which reduces the impact of bias. This provides richer and more comprehensive information because humans share more candidly with an independent third party than they do with someone they know or think they know. Using several methods together also helps to rule out rival explanations” (Yeasmin, & Rahman, 2012, p.159). Triangulation allows research strategies to be developed and this avoids the problems associated with using only one method.
However, one of the many disadvantages of triangulation is that it is time consuming and expensive. However, triangulation does not completely eliminate problems that are associated with a research method. It merely covers the weaknesses by utilising other methods with strengths in the areas of weakness in the first method. Triangulation may also pose a problem since researchers are often trained in either qualitative or quantitative methods and may not have adequate training in the opposite methods to implement a valid and effective study. Thurmond (2001, p.256) adds that the disadvantages of triangulation may also include: “the increased amount of time needed in comparison to single strategies, difficulty of dealing with the vast amount of data, potential disharmony based on investigator biases, conflicts because of theoretical frameworks, and the lack of understanding about why triangulation strategies were used”.
4.4 Data collection
The mixed methods approach involves collecting data from both the qualitative and quantitative source. The data collection procedure is dependent on the type of mixed methods design. As mentioned earlier, the mixed method design in this research comprises of a sequential explanatory design. In the explanatory sequential data
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collection, there are two forms of data collection, namely quantitative and qualitative phases. In-between these two phases “resides a new phase of research in which the researcher decides how to use the results from the first phase and build on it in the second phase” (Creswell, 2006, p.125). In this design quantitative and qualitative data collections are related and not independent of each other. In the sequential explanatory design, data collection involves collecting data in three stages. “This design starts with the collection and analysis of quantitative data. This first stage is followed by the subsequent collection and analysis of qualitative data. The second, qualitative stage of the study is designed so that it follows from (or connects to) the results of the first quantitative stage” (Creswell, 2011, p.72). The third stage entails the interpretation, discussion and analysis of both sets of data. In the third stage, the data collection and results built on the initial stage.
The first phase determines the type of questions that would be posed during the qualitative interviews. This phase helps to answer questions that cannot be answered by the quantitative phase alone. For example, do participants’ views from interviews and survey questionnaire merge or deviate? Or what explains the quantitative results of research that uses qualitative data to explain the quantitative results? Data was collected by using questionnaires and interviews as research instruments to solicit information from academics, administrative staff and students. The HIV/AIDS programme and other programme related documents were reviewed to authenticate the information that was obtained from interviews and questionnaires.
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Table 4.5: Steps and decisions in mixed methods data analysis in explanatory sequential design
Type of Mixed Type of Mixed Data Analysis Steps in the Design Data Analysis Decisions method Design Method Data Analysis
Explanatory Connected data 1. Collect the quantitative data. design analysis to explain 2. Analyse the quantitative data quantitatively results using analytic approaches best suited to the
quantitative research question.
3. Design the qualitative strand based on the quantitative results. Decide what participants to 4. Collect the qualitative data. follow up with and what 5. Analyse the qualitative data qualitatively using results need to be explained. analytic approaches best suited to the qualitative and mixed methods research
question.
6. Interpret how the connected results answer the quantitative, qualitative, and mixed Decide how the qualitative method questions. results explain the quantitative results
Source: Creswell (2011, p.217)
Table 4.5 above demonstrates the explanatory design, the type of mixed method data analysis, the data analysis steps in the explanatory design and the data analysis decisions that are required within the explanatory design. This illustration provides a visual appreciation of the data collection sequence, as explained above.
4.5. Analysis The data that was collected from the survey questionnaires were analysed by using the Statistical Package for Social Science (SPSS). The analysis occurred within both forms of approaches, namely the quantitative and qualitative approach. The quantitative approach is where the questionnaires were analysed by using descriptive statistics. The qualitative approach is where semi-structured interviews were analysed by using themes and codes (Creswell, 2003, p.220). The analysis of the interviews included narrative excerpts. On completion of the analysis of the interviews, the commonalities in participants’ statements are presented by using two types of data visualisation techniques. The first being a word cloud, which provides a
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visual presentation of word counts from one or more texts, where the more frequent word appears larger within the word cloud display (Viégas, & Warrernberg, 2008; Henderson, & Segal,2013, p.57). The first presentation is complemented with a table or so called “data sprawl” (Erwin, 2008, p.3), which visually plots the interviewee’s statements per selected category (Erwin, 2008, p.4).
4.6 Data collection procedure In sequential explanatory mixed methods research, the report of the data collection procedure and analysis were set out according to each approach and stage of collection and analysis. The quantitative data and analysis were followed by the qualitative data and analysis. The researcher presented the two stages separately under separate headings. The findings in the first stage, (quantitative stage) was reported in the formal scientific voice, whilst the second stage (qualitative stage) was reported in the narratives with individual quotes in a personal voice by using a literary style. The third stage, which involves the interpretation, discussion and analysis, is where the researcher explained how the qualitative findings, helped to elaborate and extend on the quantitative findings as gathered from the questionnaires.
4.7 Questionnaires A self-administered questionnaire was formulated and respondents were asked to complete them. The aim of using a self-administered questionnaire was to obtain staff and student opinions on issues, which relate to the effectiveness of the HIV and AIDS programme within the university. The questionnaire was compiled in a user friendly manner and was limited to only closed-ended short questions and statements in order to ensure that relevant data was obtained.
The statements included a list of answers that academic, administrative staff and students could choose from, which made it less repetitive and tedious. A seven point Likert scale was used for this purpose, as Likert scales are often used to measure attitudes or perceptions in quantitative data collection. Questionnaires were printed and collated. E-mail and telephonic calls were made to respondents a week earlier
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to help to facilitate the distribution of questionnaires. E-mails were sent to request permission and to help to complete the questionnaire (see Appendix B Request to assist with survey). The purpose, relevance and importance of the research were also made clear in the e-mail and telephonic correspondence. Nine hundred and seventy (970) questionnaires were distributed to a combined total sample of academic, administrative and students. Questionnaires were bundled into thirty six bundles of twenty. Gatekeepers were identified at each of the four campuses (Auckland Park Bunting campus, Auckland Park Kingsway campus, Soweto campus and Doorfontein campus), and bundles were distributed in the care of gatekeepers at the nine faculties on each campus. Gatekeepers were instructed to distribute questionnaires among academic, administrative staff and students. Questionnaires were collected a week later and in some instances two weeks later. The length of time was awarded as a means to negate any inconvenience caused to gatekeepers. All questionnaires were hand delivered in the care of gatekeepers. This form of distribution ensured a higher completion rate and target audience response.
The questionnaire began with profile questions and then moved to specific questions, which addressed the research objectives. The survey questions focused on research questions that have dependent and independent variables of the research problem. Five hundred and forty two out of seven hundred and fifty questionnaires were completed in the first distribution phase, which yielded a response rate of 72.3%, which was a satisfactory response rate. In the second distribution phase two hundred and fifty questionnaires were distributed, and one hundred and ninety seven responses were collected with a yield of 78.8%. The second set of self-administered questionnaires was distributed to academic, administrative staff and students in order to yield a larger sample and to prevent any gaps in the data.
A cover letter outlined the purpose of the survey; privacy and anonymity of respondents were maintained. The cover letter assured that data was for research purposes. The main advantage of choosing to use questionnaires was to accelerate the dissemination and collection of responses, since electronic responses are often deleted or ignored. Self-administered anonymous questionnaires were useful in the
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instance of dealing with a sensitive topic such as HIV/AIDS. However, a disadvantage of questionnaires is that respondents may feel helpless because they are restricted to a particular response. Respondents do not also read to understand the questions before answering. Closed-ended questions lack depth and variety, but provide more reliable information. Some respondents were frustrated owing to the inability to answer certain, questions which lent to the fact that they knew little about the programme that was evaluated. Many respondents appreciated the research topic, some of whom requested feedback on completion of the research. The aim was to obtain a numerical figure from the views of staff and students to complement it with interviews in order to generalise the findings. The large sample size proved to be supportive.
4.8 Pilot study
The purpose for conducting the pilot study was to gather information prior to a larger research in order to improve the quality and efficiency of the data collection process. A pilot study is a valuable tool as it can reveal deficiencies in the design of a proposed questionnaire, and these can then be addressed on time before resources are expended on large scale studies. The intention of the pilot test enabled the researcher to refine the interview questions and questionnaire by testing them within a true-life context. On completing the first draft of the questionnaire, a pilot study was electronically disseminated among academic and administrative staff and hard copies were distributed among students for logistical reasons. Completed questionnaires with comments were later collected. Electronic and hard copies were examined for suggestions and feedback. Suggestions were incorporated in the final questionnaires with the aim of addressing the quality and validity of questions before distribution. On completion of the quantitative phase, a second pilot study was conducted for the qualitative data collection phase. An interview guide was developed and piloted with three participants. The intention of the pilot test was to assist the researcher with the refinement of research questions. Recommendations and suggestions were incorporated in the refinement of the questionnaires, which were later used in the interview stage of the qualitative data collection.
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4.9 Interviews
The interview phase is a signature process of data collection within the qualitative research design. The interviews process provides in-depth information pertaining to participants’ experiences and viewpoints on a particular subject. Often the interview process, as in this type of research, is coupled with other forms of data collection in order to provide the researcher, with a well-rounded collection of information for analyses. As is common with quantitative analyses, there are various forms of interview design that can be developed to obtain thick, rich data by utilising a qualitative investigational perspective (Creswell & Tashakkori, 2007; Turner, 2010, p.754). Interview design has attracted much debate between unstructured and structured interviews. There are three formats for interview design, according to Patton (2002) and Turner (2010, p.754), namely informal conversational interview, which is unstructured and a general interview guide approach, and standardised open-ended interview which is semi-structured. An informal conversation is “entirely based on the spontaneous generation of questions in a natural interaction, typically one that occurs as part of on-going participant observation fieldwork” (Turner, 2010, p.754).
This type of interview process may appear advantageous owing to the lack of structure, which allows for flexibility during the interview. However, many researchers view this type of interview as unstable or unreliable because of the inconsistency in the interview questions, which makes it difficult to code data (Turner, 2011, p.755; Creswell & Tashakkori, 2007). The general interview guide approach consists of semi-structured questions that are explored in the course of the interview. The interview guide provides topics or subject areas about which the interviewer is free to explore, probe, and ask questions that will elucidate the particular topic. The issues in the outline do not have to follow a particular order; the interview guide merely serves as a basic checklist to make sure that all the relevant topics were addressed. The standardised open-ended interview consists of questions, which are carefully worded and arranged for the purpose of taking each interview through the same sequence and asking the same set of questions. An interview guide approach design was utilised, and semi-structured questions were
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developed on completion of quantitative data analysis phase. Areas that required further clarity with regard to lived experiences were isolated and formulated into semi-structured questions. The interview questions were piloted before the interview phase commenced.
4.10 Document review
The documents that were reviewed are documents, which are developed by HEAIDS as guideline and working documents that were published for the purpose of providing assistance to the various HEIs in South Africa. These documents include HEAIDS Development and Implementation Support for HIV and AIDS Workplace Programmes, Policy and Strategic Framework on HIV and AIDS for Higher Education, HEAIDS Framework for HIV and AIDS Workplace Programmes for Higher Education, HEAIDS Prevalence and Related Factors Higher Education Sector Study, South Africa 2008-2009 Guide to Implementing an HIV and AIDS Workplace Programme - Higher Education South Africa, HIV and AIDS prevention Good Practice: Strategies for Public higher education institutions (HEIs) in South Africa, Norms and standards for HIV and AIDS prevention, treatment, care and support for Higher Education institutions in South Africa, International and Local Good Practice in Workplace HIV and AIDS Programmes - A Desktop Review, University of Johannesburg HIV and AIDS wellness programme for staff and students, University of Johannesburg HIV and AIDS workplace programme 2012, Durban University of Technology HIV and AIDS workplace programme, University of Cape Town HIV and AIDS programme, and various other HEI HIV and AIDS programmes. The next section discusses the population and sampling procedure, which was undertaken prior to the data collection processes.
4.11 Population A research population is generally a large collection of individuals or objects that is the main focus of a scientific inquiry. However, owing to the large sizes of populations, researchers often cannot test every individual in the population because these often have time or funding constraints. A research population is also known as a well-defined collection of individuals or objects known to have similar characteristics (Castillo, 2009). All individuals or objects within a certain population
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usually have a common, binding characteristic or trait. Usually, the description of the population and the common binding characteristic of its members are the same. For example, senior academics are a well-defined group of individuals, which can be considered as a population and all the members of this population are indeed academic staff within a specific university. There are two types of population in research, according to Castillo (2009). The first type is the target population, which refers to an entire group of objects or individuals to whom the researcher is interested in generalising the conclusions. The target population usually has varying characteristics and is known as the theoretical population. The second type is known as the accessible population. The accessible population is the population in research to which the researchers can apply their conclusions. This population is a subset of the target population and is also known as the research population. It is from the accessible population that researchers draw their samples.
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Table 4.6: 2012 Student head count
Source: University of Johannesburg (2013, HEDA portal)
Table 4.7: Full time staff totals (University of Johannesburg, 2013, HEDA portal)
Source: University of Johannesburg (2013, HEDA portal)
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Tables 4.6 and 4.7 represent the total target population in this research, which comprised of academic, administrative staff and students (48 000) at the University of Johannesburg. The University of Johannesburg is one of the twenty three higher education institutions in South Africa, which has a population of five thousand seven hundred and thirty nine (5 739) staff members, including students. With a fairly large university population, the ideal sample size should be established to ensure a generalised representation of the original population. Sample size is discussed in the subsequent section.
4.12 Sampling
A sample is simply a subset of the population. The concept of sample arises from the impracticability of the researchers to test all the individuals in a given population. The sample should be representative of the population from which it was drawn. The main function of the sample is to allow the researcher to conduct research among individuals from the population in order to establish that the findings of the research can be used to derive conclusions that may apply to the entire population. The sequential data collection raises some issues regarding sample size: whether the same individuals should be sampled in the qualitative and quantitative phases, whether the sample sizes should be the same, the criteria for selecting results to use in the follow-up phase, and how to design an instrument that will yield valid and reliable scores from the initial qualitative data (Creswell, 2006, p.122). Mixed method design poses an interesting dilemma, should the same individuals be sampled in phase 1 and phase 2. This depends on the original choice of design. In an explanatory design with a follow-up, the same individuals should be included in both data collections. The intent of these designs, according to Creswell (2006, p.123), “is to use qualitative data to provide more detail about the quantitative results and to select participants that can best provide this detail”. Leech and Onwuegbuzie (2007, p.283) identify 24 sampling schemes that are available to both qualitative and quantitative researcher. These sampling schemes fall into one of two classes, namely random sampling and non-random sampling. These sampling schemes encompass methods to select samples that have been traditionally associated with
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the qualitative paradigm (non-random sampling) and random sampling, which are associated with the quantitative paradigm.
The type of sampling scheme chosen for this research consisted of non-random purposive sampling for the qualitative phase and random sampling for the quantitative phase. It is recommended that the choice of sampling scheme should be determined by the objective of the research (Leech, & Onwuegbuzie, 2007, p.284). The objective of this research is to generalise the quantitative findings to the population from which the sample was drawn. Random sampling is the least biased of all sampling techniques, while there is no subjectivity as each member of the total population has an equal chance of being selected (Babbie, & Mouton, 2007, p.199). It emphasises selecting a large size of samples to generate and ensure the representativeness of the characteristic of population.
Each of the nine faculties within the University of Johannesburg comprises of academic, administrative staff and students. These faculties represent a homogeneous group with one or more characteristics and, therefore, a random sample from each faculty was selected. Eight participants were randomly selected in the qualitative phase of the research, while the intention of the research was not to generalise but to obtain insights into participants’ awareness of the effectiveness of the HIV/AIDS programme within the university and further understand their experiences or non-experience of the programme. The researcher purposefully selected participants for this phase with the intention of maximising the understanding of the participants’ interaction with the programme. A number of purposeful sampling strategies are available, each with a different purpose. The maximal variation sampling was used in this instance, as individuals were chosen based on who holds different perspectives on the central phenomenon (Creswell, 2003, p.113). The criteria for investigating the differences depended on the outcome of the quantitative survey. It may have been race, gender, level of schooling, or any number of factors that would differentiate participants. The central idea is that if participants are purposefully chosen to be different in the first place, then their views will reflect this difference and provide a good qualitative study (Creswell,2003, p.113), whilst being mindful of the various ethical considerations.
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4.13 Ethical considerations
The researcher followed ethical standards to ensure that the research did not harm participants or abuse the privilege of access to participants. Ethical considerations were of the highest concern, especially confidentiality, in mixed methods evaluation where qualitative strategies such as interviews have been a key investigative data gathering method. Anonymity of participants was preserved during the survey and interviews phases, which was guaranteed as part of the conduct of the research. The nature of the research, although not pertaining to individuals’ personal experiences of HIV and AIDS, immediately raised concerns of confidentiality and anonymity. Participants were reassured of their anonymity during one-on-one interviews. One-on-one interviews were chosen instead of focus group interviews and the rationale for this decision was to guarantee the privacy of each participant. Participants’ names or designations were not referred to during the qualitative phase. Participants were generally referred to as academic, administrative staff or student. The level of tenure was not referred to without the permission of the participant. Ethical guidelines, as stipulated by the university, provided a moral compass during this process.
4.13.1 Quality assurance
Strategies that were used to ensure quality assurance include replicability, validity, generalisability and reliability. Each strategy is discussed below. The need to adhere to ethical constraints were paramount during the research as the views of participants, the university and the credibility of the research were a constant concern. The different quantitative steps, for example, the research design, data collection, data analysis, and data interpretation stages were scrutinised for areas where internal and external validity may be compromised. Reliability refers to consistency, stability, or repeatability. The research is considered reliable if the results of the study can be replicated. The researcher would rely on the research design throughout the research process in order to ensure that should the research be duplicated elsewhere, the results would be replicable, and thus reliable (Hesse- Biber, 2010, p.100). Replicability is vital to the research, and the present researcher shows that the empirical evidence can be replicated beyond the research at hand.
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Generalisability asks the question: can the results of this research be applied to individuals other than those who participated in the research, in other settings, at different times, using different but related outcome measures, and with variations in administration of the treatment? If the answer is yes, then complete generalisation exists (Christensen, 2007, p.306). Therefore, the researcher attempted to ensure that the sample group is as truly representative of the whole population, and that the size of the group allowed for the statistics to be safely inferred to an entire population. The researcher further strived to develop evidence with high validity and integrity, which is a precondition to any generalizability goal (Polit, 2010, p.147). Validity suggests the accuracy, meaningfulness and credibility of the research project as a whole. The researcher ensured that meaningful and defensible conclusions have been drawn from the data, thereby answering the question: does the research have sufficient controls to ensure that the conclusions that are drawn are supported by the data? Can the researcher use what has been observed in the research situation to make generalisations about the world beyond the specific situation, which was researched?
Internal validity makes reference to the length to which the research design and the data allows the researcher to draw accurate conclusions about cause and effect and other relationships within the data. To ensure internal validity, the researcher took necessary precautions to eliminate other possible explanations for the results that were observed. Internal validity ensures that the explanations are the most likely ones for the observations made. Therefore, those who read and rely on the research outcome would be convinced that the research is valid and has led to truthful outcome. External validity would reflect on the extent that the research design and data apply to situations beyond the research itself.
Concern for how reliable and accurate the research methods and techniques were for data collection remained with the researcher. In the qualitative phase the need to capture authentically the lived experiences of participants was confirmed during the recording of the one-on-one interviews. Participants were given an opportunity to choose between a taped or written record of their interview. In order to maintain a high degree of reliability, the same set of questions was asked and interviews took
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place in the staff members’ offices to ensure that there were no distractions and that reliable information was obtained. Final transcripts were then forwarded to the participants or made available for participant inspection.
4.14 Summary
In summary, this chapter encompassed three core areas of the research, namely the research approach, research methodology and data collection. These three areas defined the progression of the research. Had any of these been lacking, the nature and purpose of the research would be indefinable and futile. Evaluation as a research area was clearly demarcated; the purpose, importance and need for evaluation were discussed in much detail. Evaluation approaches were explained with the purpose of dovetailing the evaluation approach with the overall background of the research approach, research methodology and data collection. Types of evaluation were unpacked, clarifying the distinction in the different types of evaluation, namely process evaluation, outcomes-based evaluation and impact based evaluation. The evaluation type most suited to the research was explicated. This was further supported with a motivation for the choice of evaluation type. The evaluation type directed the choice of research methodology. Research paradigm and philosophical assumptions provided a theoretical foundation for assessing the most appropriate research methodology as per the type of evaluation that was chosen. The research methodology discussed quantitative method, qualitative method, and mixed method research design. Of the mixed method designs, explanatory sequential design was chosen. The rationale for choosing explanatory sequential design was explicated. This was followed by the data collection sequence as proposed by the explanatory sequential design. This set out the chronological sequence of the data collection process. Quantitative data collection preceded the qualitative data collection stage, which was preceded by a pilot study in each instance. Questionnaire formulation was discussed, followed by interviews and review of documents. The nature of population and sample size were further explicated. Lastly, a detailed explanation of ethical considerations, and quality assurance were undertaken. The next chapter focuses on the data analysis.
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Chapter 5 Data Analysis
5.1 Introduction This chapter presents the results of the data analysis. The data was collected and processed in response to the problem statement and research questions, which were posed in Chapter 1. Data analysis is the process of transforming raw data into usable information in order to add value to the statistical output of the study. This chapter has taken raw data and transformed the data into usable information that answers the main research question, namely how effective is the university’s HIV/AIDS programme and the sub-questions as they appear in Table 1.1. Data from questionnaires and interviews were obtained, and institutional documents were reviewed. SPSS statistical package was utilised to analyse the questionnaires. Content analysis was used for the institutional documents and interviews were interpreted. For the purpose of clarity, the research questions in Chapter 1 are restated below.
Main research question
How effective is the university’s HIV/AIDS programme? Sub-questions
What are the current types of HEAIDS HIV/AIDS programmes at the university?
Does the university’s HIV/AIDS programme conform to the HEAIDS programme?
What are the stakeholders (students, academic and administrative staff) perceptions of the content of the university’s HIV/AIDS programme?
Are stakeholders aware of the university’s HIV/AIDS programme?
5.2 Explanation of data
The following section explains how the questionnaires’ data was analysed by using descriptive statistics, frequency distribution and cross tabulation. Descriptive statistics, according to Singleton and Straits (2005, p.457), describe and organise
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the data at hand, making it more intelligible, thereby providing the researcher with a synopsis of the data (Norusis, 2005). Descriptive statistics entail summarising the degree of association between dependent and independent variables in the sample. Cross tabulation and frequency distribution was used to analyse data from various responses.
5.2.1 Frequency distribution Frequency distributions, according to Singleton and Straits (2005, p.458), is a way of displaying data in an organised manner. A frequency distribution is a table, which displays the frequency of a response that occurs in a data set and then calculates the frequency to give a total value in that particular variable (Singleton & Straits 2005, p.458). The values are presented in a table format, which is called a frequency table. The total values were computed to give a percentage of the responses. These provide a clearer picture of the responses. Singleton and Straits (2005,p.458) note that an analysis, “…which uses frequency distribution of responses to the closed-ended questions and statements, shows a valuable indicator of attitudinal preferences of responses on issues mentioned in the questionnaire”. In other words, a frequency distribution allows the researcher to appreciate a set of scores. This may show if the scores are high or low and whether they are spread or confined to one area across the scale. This is confirmed by King, Rosopa and Minium (2011, p.19) who add that a “frequency distribution shows the number of observations for the possible categories or score values in a set of data”. This display provides an organised description of the data, which allows the reader to see “the location of any individual score relative to all of the other scores in the set” (Gravetter, & Wallnau, 2012, p.39). Cross tabulation and chi-square are discussed next.
5.2.2 Cross tabulation
Cross tabulation, which is also known as a contingency table is a cross tabulation of two non-metric or categorical variables in which the entries are the frequencies of responses that fall into each cell of the matrix (Hair, Black, Babin, Anderson, & Tatham, 2010). Norusis (2010) adds that when a table has counts of the number of
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cases with particular combinations of values of the two variables, the table is known as a cross tabulation. The observed counts and percentages in a cross tabulation describes the relationship between the two variables in a sample. A chi-square test for independence followed the cross tabulation.
5.2.3 The chi-square test
A chi-square test for goodness of fit, according to Pallant (2007, p.212) is a test, that is also referred to as the one-sample chi-square. The chi-square test is often used to compare the proportion of cases from a sample or with cases previously gathered from a comparison population. Pallant states that “…all that is needed in the data file is one categorical variable and a specific proportion against which the researcher wishes to test the observed frequencies” (2007, p.212). A chi-square test for independence is utilised when there is a need to explore the relationship between two categorical variables (Stamatis, 2012, p.50). “This test compares the observed frequencies or proportions of cases that occur in each of the categories, with the values that would be expected if there was no association between the two variables being measured” (Pallant, 2007,p.214). It is based on a cross tabulation table with cases classified according to the categories in each variable.
5.3 Reliability and validity of the data
The first objective of the data analysis is to confirm reliability of the data. As stated previously in section 3.6.2, the researcher has explored triangulation in terms of the mixed method design. Triangulation was further relied on during the analysis of the stakeholders’ (academic, administrative staff and student) responses. Triangulation in these instances assisted in determining validity and reliability of the research process. Denzin (2010, p.18) notes that “…triangulation can and should play a major role in monitoring and evaluation. In general, triangulation can enhance the validity and reliability of existing observations about a given situation. If findings converge, it can also generate new, credible findings about a situation or phenomenon and can create new ways of looking at a situation or phenomenon. Most importantly, it can provide a better understanding of a situation or phenomenon.”
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Combining quantitative and qualitative methods enriches the ability of the researcher to rule out rival explanations of change and improves the validity and reliability of change-related findings. “For example, qualitative findings may help explain the success of an intervention when the quantitative data and the numbers do not provide any corollary information. Many experts believe that across-method and within method triangulation provide far richer findings than reliance on a single method” (Denzin, 2010, p.22). Patton (2001) states that “triangulation strengthens a study by combining methods. This can mean using several kinds of methods or data, including using both quantitative and qualitative approaches” (2001, p.247). Of the four methods of triangulation mentioned by Denzin (2010, p.14), Marschan- Piekkari (2004, p.160) and Flick (2011, p.181), the methodological triangulation was selected as a method, which was most suited to the study (see section 4.6.2).
Methodological triangulation involves the use of qualitative and quantitative methods (Tashakkori, & Teddlie, 1998, p.18). The results from surveys and one-on-one interviews were used to confirm the results. Should the deductions of each method be the same, then validity and reliability would have been attained. The data analyses of both qualitative and quantitative methods have been harmonised as a means of remaining true to the purpose of triangulation. In addition to the confirmation of qualitative and quantitative methods, data was triangulated by corroborating stakeholder responses, which is also known as “respondent validation” (Gomm, 2004, p.188). Cross tabulation of stakeholder responses was included in the analysis (as reflected in section 4.6) in order to enhance the reliability and validity of the study (Weyers, Strydom, & Huisamen, 2011, p.208). The research results of the survey questionnaire are explained below.
5.4 Research results of the survey questionnaire
The research results of the survey questionnaires are unpacked below, beginning with demographic data, and followed by the analysis of research questions.
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5.4.1 Demographic data
From the 970 questionnaires that were distributed to academics, administrative staff and students, 739 responses were received, which showed a relatively good response rate of 76.2%. Demographic data was collected to establish the numbers in terms of gender, age and type of the various stakeholders (academic, administrative staff and students). This was gathered in order to quantify the responses of the academics, administrative staff and students. These results have been graphically represented in Figure 5.1 below.
Table 5.1: Percentage of respondents
Questionnaire
Count %
Academics 130 17.5
Administrative staff 116 15.7
Students 493 66.8
Total 739 100
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Figure 5.1: Number of respondents
500 450 400
350 300 250 200 150 Total count per categoryper count Total 100 50 0 Academics Administrative staff Students Stakeholder category
Table 5.1 and Figure 5.1 above represent the number of respondents that participated in the survey. Respondents were randomly selected from the nine faculties within the university. A total of 970 questionnaires were distributed with a response rate of 739 (76.2%), namely 130 (17.6%) academics, 116 (15.7%) administrative staff and 493 (66.7%) students. The gender representations of respondents are set out below.
5.4.1.1 Gender representation of respondents
The motivation for this data was to present the gender distribution of respondents who participated in the survey.
Table 5.2: Gender representation of respondents per category Gender Academics Administrative Students Total staff
Male 62 34 178 274
Female 68 82 315 465
Total 130 116 493 739
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Table 5.2 addresses the gender count of the respondents. Of the questionnaires that were disseminated 274 (37.1%) respondents are male; this number included 62 (8.4%) academic staff, 34 (4.6%) administrative staff and 178 (24.1%) students. Whereas female respondents 465 (62.9%) comprised of 68 (9.3%) academic staff, 82 (11%) administrative staff and 315 (42.6%) students. The number of student responses was indicative of the university’s population, as students formed a larger proportion of the sample, as compared to academic and administrative staff. The respondents’ perceptions of the HIV/AIDS programme’s content are analysed next.
5.4.1.2 Number of respondents who participated in the programme
The rationale for this data was to determine the number of people that have participated in the programme. By participating in a programme it may be presumed that the respondents have interacted with the programme and are familiar with the programme’s content. Table 5.3 below is a description of the number of respondents that participated in the HIV/AIDS programme.
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Table 5.3: Number of respondents per category who participated in the programme
Have you participated in the
programme? Total
Yes No
Count 12 116 128 Academics
% 9.4% 90.6% 100.0%
Group Administrative Count 33 82 115
Staff
% 28.7% 71.3% 100.0%
Count 106 371 477 Students
% 22.2% 77.8% 100.0%
Count Total 151 569 720
% 21.0% 79.0% 100.0%
Missing Item 19
(n=739)
Table 5.3 reveals that of the 739 respondents, 19 respondents did not answer the question on whether they participated in the university’s HIV/AIDS programme. A total of 116 (90.6%) academics, 82 (71.3%) administrative staff and 371 (77.8%) students established that they have not participated in the programme. Conversely, 12 (9.4%) academics, 33 (28.7%) administrative staff and 106 (22.2%) students have participated in the programme. In total, 569 (79%) of the respondents who answered this question did not participate in the programme, as compared to 151 (21%) who did participate in the programme. The availability of VCT at the university is focused on next.
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5.4.2 Respondents’ perceptions of the university’s HIV/AIDS programme
The rationale for this objective was to analyse respondents’ perceptions of the university HIV/AIDS programme. A succession of questions was asked in order to gather respondents’ perceptions of the university’s HIV/AIDS programme. The first question was to ascertain respondents’ perceptions of the availability of Voluntary Counselling and Testing at the university.
5.4.2.1 Availability of Voluntary Counselling and Testing at the university The reason for this information was to determine whether respondents were familiar with the availability of Voluntary Counselling and Testing (VCT) at the university, and the content of the programme.
Table 5.4: Availability of Voluntary Counselling and Testing at the university
Is Voluntary Counselling and Testing available at the university? Total
Yes No Don't know
Group Academics Count 85 1 44 130
% 65.4% .8% 33.8% 100.0%
Administrative Count 86 0 29 115 Staff
% 74.8% 0.0% 25.2% 100.0%
Students Count 400 8 76 484
% 82.6% 1.7% 15.7% 100%
Total Count 571 9 149 729
% 78.3% 1.2% 20.4% 100%
Missing Item 10 (n=739)
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Table 5.4 above shows that a total of 571 (78.3%) respondents indicated that VCT was available at the university, 9 (1.2%) respondents indicated that VCT was not available at the university and 149 (20.4%) respondents indicated that they did not know that VCT was available at the university. Of the total number of respondents, 85 (65.4%) academics, 86 (74.8%) administrative staff and 400 (82.6%) students indicated that VCT was available at the university. In total, 729 respondents answered this question, while 10 respondents chose not to answer this question. Academics were the only group among the stakeholders that indicated a higher percentage of “don’t know” criteria (33.8%) than any other group. Academics were also the only group with the lowest response regarding the availability of VCT at the university. The section below addresses academic, administrative staff and student attendance at the university’s VCT sessions.
5.4.2.2 Attendance of Voluntary Counselling and Testing sessions at the university
The rationale for this statement was to investigate the percentage of respondents that have attended VCT. This would reflect on the number of respondents that are aware of the VCT offering, which is supported by the programme. The response to these questions was to obtain an understanding of respondents’ familiarity with the programme’s content.
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Table 5.5: Attendance of Voluntary Counselling and Testing sessions at the University
Have you attended any Voluntary Counselling
and Testing sessions at the university? Total
Yes No
Academics Count 23 100 123
% 18.7% 81.3% 100.0%
Group
Administrative Count 46 66 112
staff
% 41.1% 58.9% 100.0%
Count 218 248 466 Students
% 46.8% 100.0% 53.2%
Count 287 414 701
Total % 40.9% 59.1% 100.0%
Missing Item 38
(n=739)
According to Table 5.5, a total of 100 (81.3%) academics, 66 (58.9%) administrative staff and 248 (53.2%) students indicated that they have not attended any Voluntary Counselling and Testing sessions at the university. A total of 23 (18.7%) academics, 46 (41.1%) administrative staff and 218 (46.8%) students indicated that they have attended Voluntary Counselling and Testing sessions at the university. From the above table it can be seen that only 287 (40.9%) of the overall sample have attended Voluntary Counselling and Testing sessions at the university while a greater number of respondents, namely 414 (59.1%), have not attended Voluntary
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Counselling Testing. Of the total 739 respondents, 38 respondents did not answer the question.
5.4.2.3 Availability of targeted programmes, practices or facilities The reason for this information was to determine respondents’ overall familiarity with the targeted programmes, practices or facilities that are available, which form part of the programme’s content. The number of responses regarding targeted programmes, practices or facilities that are available may suggest respondents’ familiarity with the programme’s content.
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Table 5.6: Availability of targeted programmes, practices or facilities
Don't Missing Yes No know Total
Group Academics Counselling facilities for HIV/AIDS Count 2 58 6 64 130
% 1.5% 45.3% 4.7% 50.0% 100.0%
HIV/AIDS testing facilities Count 2 58 7 63 130
% 1.5% 45.3% 5.5% 49.2% 100.0%
HIV educational or awareness Count 2 73 6 49 130 programmes
% 1.5% 57.0% 4.7% 38.3% 100.0%
Provision for post exposure prophylactics Count 3 15 5 107 130
% 2.3% 11.8% 3.9% 84.3% 100.0%
Needle stick policy Count 4 13 12 101 130
% 3% 10.3% 9.5% 80.2% 100.0%
Peer support for HIV/AIDS infected Count 1 25 11 93 130
% 0.7% 19.4% 8.5% 72.1% 100.0%
HIV/AIDS awareness within curriculum Count 2 31 17 80 130 modules
% 1.5% 24.2% 13.3% 62.5% 100.0%
Access to antiretroviral (ARVs) Count 2 14 5 109 130
% 1.5% 10.9% 3.9% 85.2% 100.0%
Administrative Counselling facilities for HIV/AIDS Count 16 61 5 48 116 Staff
% 12.3% 53.5% 4.4% 42.1% 100.0%
HIV/AIDS testing facilities Count 19 63 6 42 116
% 14.6% 56.8% 5.4% 37.8% 100.0%
HIV educational or awareness programmes Count 19 70 3 38 116
% 14.6% 63.1% 2.7% 34.2% 100.0%
Provision for post exposure prophylactics Count 26 18 4 82 116
% 20% 17.3% 3.8% 78.8% 100.0%
Needle stick policy Count 23 19 6 82 116
% 11.4% 17.8% 5.6% 76.6% 100.0%
Peer support for HIV/AIDS infected Count 20 41 2 67 116
% 15.3% 37.3% 1.8% 60.9% 100.0%
HIV/AIDS awareness within curriculum Count 21 26 5 78 116 modules
% 16.1% 23.9% 4.6% 71.6% 100.0%
Access to antiretroviral (ARVs) Count 23 19 6 82 116
% 11.4% 17.8% 5.6% 76.6% 100.0%
Students Counselling facilities for HIV/AIDS Count 28 350 7 108 493
% 5.7% 75.3% 1.5% 23.2% 100.0%
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HIV/AIDS testing facilities Count 32 378 12 71 493
% 6.5% 82.0% 2.6% 15.4% 100.0%
HIV educational or awareness programmes Count 39 305 19 130 493
% 7.9% 67.2% 4.2% 28.6% 100.0%
Provision for post exposure prophylactics Count 45 68 27 353 493
% 9.1% 15.2% 6.0% 78.8% 100.0%
Needle stick policy Count 47 55 27 364 493
% 9.5% 12.3% 6.1% 81.6% 100.0%
Peer support for HIV/AIDS infected Count 45 154 20 274 493
% 9.1% 34.4% 4.5% 61.2% 100.0%
HIV/AIDS awareness within curriculum Count 48 106 58 281 493 modules
% 9.7% 23.8% 13.0% 63.1% 100.0%
Access to antiretrovirals (ARVs) Count 45 41 24 383 493
% 9.1% 9.2% 5.4% 85.5% 100.0% (n=739)
Table 5.6 above reveals the results of respondents’ answers regarding the availability of some of the programmes, practices or facilities, namely counselling facilities for HIV/AIDS, HIV/AIDS testing facilities, HIV educational or awareness programmes, provision for post exposure prophylactics, needle stick policy, peer support for HIV/AIDS infected, HIV/AIDS awareness within curriculum modules and access to antiretroviral (ARVs). Their responses varied. The number of “no” and “don’t know”, responses exceeded the number of yes responses. Respondents’ answers to questions, which relate to the availability of HIV/AIDS counselling facilities, testing facilities and HIV educational or awareness programmes were higher than the number of responses that was received for the remaining five questions. The table suggests that respondents are more familiar with the more common aspects of the programme than with the provision for post exposure prophylactics. In the above table a total of 107 academics, 82 administrative staff and 353 students did not know about the availability or provision of post exposure prophylactics at the university. This computes to 73.3% (107+82+353 ÷ 739 (sample size) ×100÷1=73.3%) of respondents who did not know of the above provisions by the programme. The practices or facilities that are outlined and explained by the university’s HIV/AIDS programme are outlined below.
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5.4.2.4 Practices or facilities outlined by the universities HIV/AIDS programme
The reason for this data was to ascertain respondents’ knowledge of practices or facilities that are outlined and explained by the university’s HIV/AIDS programme. The respondents’ answers informed about respondents’ knowledge of the programme’s content.
Table 5.7: Practices or facilities outlined by the university’s HIV/AIDS programme Missing No Partially Yes Total
Group Academics Confidentiality during testing and counselling Count 34 8 8 80 130
% 26.2% 6.2% 6.2% 61.5% 100.0%
Promotion of a safe working environment Count 38 10 13 69 130
% 29.2% 7.7% 10.0% 53.1% 100.0%
Compensation for occupationally acquired HIV Count 49 19 20 42 130
% 37.7% 14.6% 15.4% 32.3% 100.0%
Employee benefits and provision and care Count 48 17 18 47 130
% 36.9% 13.1% 13.8% 36.2% 100.0%
Procedures for dispute resolution and grievances Count 46 21 17 46 130 related to HIV/AIDS and alternate employment
% 35.4% 16.2% 13.1% 35.4% 100.0%
HIV/AIDS and employment issues including Count 48 21 16 45 130 incapacity, termination of service,
% 36.9% 16.2% 12.3% 34.6% 100.0%
Education and Training available to academic staff Count 45 16 12 57 130
% 34.6% 12.3% 9.2% 43.8% 100.0%
Administrative Staff Confidentiality during testing and counselling Count 18 4 7 87 116
% 15.5% 3.4% 6.0% 75.0% 100.0%
Promotion of a safe working environment Count 21 9 10 76 116
% 18.1% 7.8% 8.6% 65.5% 100.0%
Compensation for occupationally acquired HIV Count 32 20 18 46 116
% 27.6% 17.2% 15.5% 39.7% 100.0%
Employee benefits and provision and care Count 34 8 16 58 116
% 29.3% 6.9% 13.8% 50.0% 100.0%
Procedures for dispute resolution and grievances Count 36 10 15 55 116 related to HIV/AIDS
% 31.0% 8.6% 12.9% 47.4% 100.0%
HIV/AIDS and employment issues including Count incapacity, termination of service, and alternate 34 21 16 45 116 employment
% 29.3% 18.1% 13.8% 38.8% 100.0%
Education and Training available to academic staff Count 26 9 14 67 116
% 22.4% 7.8% 12.1% 57.8% 100.0% (n=739)
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The above questions were not posed to students, as these questions pertain to respondents who are in the employ of the university. Therefore, according to Table 5.7 above, 80 (61.5%) academics and 87 (75%) administrative staff indicated that the university’s HIV/AIDS programme did explain confidentiality during testing and counselling. Promotion of a safe working environment revealed that 69 (53.1%) academics and 76 (65.5%) administrative staff indicated that the programme explained the promotion of a safe working environment. Compensation for occupationally acquired HIV showed that 42 (32.3%) academics and 46 (39.7%) administrative staff stated that the programme explained compensation for occupationally acquired HIV. Employee benefits and provision and care revealed that 47 (36.2%) academics and 58 (50%) administrative staff indicated that the programme explained employee benefits and provision and care.
Procedures for dispute resolution and grievances related to HIV/AIDS demonstrated that 46 (35.4%) academics and 55 (47.4%) administrative staff indicated that the programme explained procedures for dispute resolution and grievances related to
HIV/AIDS within the university. HIV/AIDS employment issues including incapacity, termination of service and alternative employment revealed that 45 (34.6%) academics and 45 (38.8%) administrative staff indicated that the programme explained HIV/AIDS employment issues, including incapacity, termination of service and alternative employment. Education and Training available to academic staff showed that 57 (43.8%) academics and 67 (57.8%) administrative staff indicated that education and training was available to academic staff. Practices or facilities that are effectively dealt with by the programme are examined below.
5.4.2.5 Practices or facilities effectively dealt with by the programme
The rationale for this data was to determine how many respondents indicated that the programme adequately dealt with the prevention of HIV/AIDS, treatment of HIV/AIDS and ways of mitigating HIV/AIDS within the university. These responses assisted in determining whether programme content was widely known.
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Table 5.8: Practices or facilities effectively dealt with by the programme
Don't Missing Yes No know Total
Group Academics Prevention of HIV/AIDS Count 3 47 4 76 130
% 2.3% 37.0% 3.1% 59.8% 100.0%
Treatment of HIV/AIDS Count 2 42 3 82 130
% 2.3% 33.1% 2.4% 64.6% 100.0%
Ways of mitigating HIV/AIDS Count 30 6 88 130 within the university 6
% 11.4% 24.2% 4.8% 71.0% 100.0%
Administrative Prevention of HIV/AIDS
Staff Count 7 59 1 49 116 % 6% 54.1% .9% 45.0% 100.0%
Treatment of HIV/AIDS Count 7 53 4 52 116
% 6% 48.6% 3.7% 47.7% 100.0%
Ways of mitigating HIV/AIDS Count 43 4 62 116 within the university 7
% 6% 39.4% 3.7% 56.9% 100.0%
Students Prevention of HIV/AIDS Count 22 326 9 136 493
% 4.5% 69.2% 1.9% 28.9% 100.0%
Treatment of HIV/AIDS Count 36 250 15 192 493
% 7.3% 54.7% 3.3% 42.0% 100.0%
Ways of mitigating HIV/AIDS Count 192 16 249 493 within the university 36
% 7.3% 42.0% 3.5% 54.5% 100.0%
(n=739)
Table 5.8 shows responses, which relate to practices and facilities that are dealt with by the programme. Three sub-questions were asked, namely does the programme adequately deal with the prevention of HIV/AIDS; treatment of HIV/AIDS; and ways of mitigating HIV/AIDS within the university? With regard to the first question on prevention of HIV/AIDS, 47 (37%) academics indicated that the university’s
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HIV/AIDS programme dealt with the prevention of HIV/AIDS. A total of 4 (3.1%) academics indicated that the university’s HIV/AIDS did not provide HIV/AIDS prevention and 76 (59.8%) indicated that they did not know whether the university’s HIV/AIDS programme provided HIV/AIDS prevention. Of the administrative staff, 59 (54.1%) indicated that the university’s HIV/AIDS programme dealt with HIV/AIDS prevention. A total of 1 (.9%) administrative staff member indicated that the university’s HIV/AIDS programme did not attend to HIV/AIDS prevention and 49 (45.0%) stated that they did not know that the programme dealt with HIV prevention. Amongst the students, 326 (69.2%) stated that the university’s HIV/AIDS programme did offer HIV/AIDS prevention, 9 (1.9%) disagreed and 136 (28.9%) stated that they did not know whether the programme offers HIV/AIDS prevention.
The second question on the treatment of HIV/AIDS revealed that 42 (33.1%) academics knew that the university’s HIV/AIDS programme offered treatment for HIV/AIDS, while 3 (2.4%) indicated that the university’s HIV/AIDS programme did not provide treatment for HIV/AIDS, and 82 (64.6%) mentioned that they did not know whether the university’s HIV/AIDS programme provided treatment for HIV/AIDS. Amongst the administrative staff, 53 (48.6%) indicated that the university’s HIV/AIDS programme did provide treatment for HIV/AIDS, 4 (3.7%) stated that the university’s HIV/AIDS programme did not provide treatment, and 52 (47.7%) indicated that they did not know whether the university HIV/AIDS programme provided treatment for HIV/AIDS. With regards to students, 250 (54.7%) pointed out that the university’s HIV/AIDS programme did provide treatment for HIV/AIDS, 15 (3.3%) indicated that the university’s HIV/AIDS programme did not provide treatment for HIV/AIDS, and 192 (42.0%) stated that they did not know whether the university HIV/AIDS programme provided treatment for HIV/AIDS.
The last question on whether the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS within the university revealed that found 30 (24.2%) academics stated that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS, 6 (4.8%) indicated that the university’s HIV/AIDS programme did not adequately deal with ways of mitigating HIV/AIDS, and 88 (71.0%) indicated that they did not know that the university’s HIV/AIDS
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programme adequately dealt with ways of mitigating HIV/AIDS. Administrative staff 43 (39.4%) indicated that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS, 4 (3.7%) indicated that the university’s HIV/AIDS programme did not adequately deal with ways of mitigating HIV/AIDS, and 62 (56.9%) indicated that they did not know that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS. With regard to students, 192 (42.0%) indicated that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS, 16 (3.5%) indicated that the university’s HIV/AIDS programme did not adequately deal with ways of mitigating HIV/AIDS, and 249 (54.5%) stated that they did not know that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS.
Of the total number of responses, 432 (58.5%) respondents indicated that the university’s HIV/AIDS programme provided prevention for HIV/AIDS, 14 (2.0%) respondents indicated that the university’s HIV/AIDS programme did not provide for the prevention of HIV/AIDS and 261 (36.9%) respondents stated that they did not know that the programme adequately dealt with prevention of HIV/AIDS. A total of 345 (49.8%) of respondents mentioned that the university’s HIV/AIDS programme did offer treatment for HIV/AIDS, 22 (3.2%) respondents stated that the university’s HIV/AIDS programme did not offer treatment for HIV/AIDS, and 326 (47%) respondents revealed that they did not know that the university’s HIV/AIDS programme offered treatment of HIV/AIDS. A total of 265 (38.4%) respondents showed that the university’s HIV/AIDS programme adequately dealt with ways of mitigating HIV/AIDS within the university, 26 (3.5%) respondents indicated that the university’s HIV/AIDS programme did not adequately deal with ways of mitigating HIV/AIDS at the university, and 399 (54%) respondents revealed that they did not know that the university’s HIV/AIDS programme dealt with ways of mitigating HIV/AIDS at the university. The latter two responses, when calculated to a percentage, equates to 57.5% (26+399=425÷739×100÷1= 57.5%) of respondents who indicated that the university did not adequately deal with various ways of mitigating HIV/AIDS within the university. The section below addresses the question on gender sensitivity and confidentially.
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5.4.2.6 Gender sensitivity and confidentiality
Gender sensitivity and confidentiality may be regarded as a prerequisite in the management of HIV/AIDS. Respondents’ familiarity with regard to this aspect of the programme was of particular interest, considering that stigma and gender discrimination are associated with the disease. The rationale for this question was to determine how many respondents were familiar with the programme’s content that addressed gender sensitive issues without compromising anybody’s rights and confidentiality.
Table 5.9: Gender sensitivity and confidentiality
Does the programme address gender sensitive issues without compromising anybody’s rights and confidentiality? Total
Yes No Don't know
Group Academics Count 26 3 97 126
% 20.6% 2.4% 77.0% 100.0%
Administrative Count 36 12 61 109 staff
% 33.0% 11.0% 56.0% 100.0%
Students Count 169 51 261 481
% 35.1% 10.6% 54.3% 100.0%
Total Count 231 66 419 716
% 32.3% 9.2% 58.5% 100.0%
Missing 23 Item (n=739)
Table 5.9 above revealed that 97 (77%) academics stated that they did not know that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants, 3 (2.4%) academics indicated that the programme did not address gender sensitive issues without compromising the rights and confidentiality of programme participants, and 26 (20.6%) academics indicated that the programme addressed gender sensitive issues without
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compromising the rights and confidentiality of programme participants. A total of 61 (56%) of administrative staff revealed indicated that they did not know that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants, 12 (11%) administrative staff stated that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants, and 36 (33.0%) administrative staff specified that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants.
A total of 261 (54.3%) students did not know that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants, 51 (10.6%) of students indicated that the programme did not address gender sensitive issues without compromising the rights and confidentiality of programme participants, and 169 (35.1%) of students stated that that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants. In total, 4.19 (58.5%) of the sample did not know that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants, 66 (9.2%) of respondents stated that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants indicated, and 231 (32.3%) of respondents agreed that the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants. Of the total 739 respondents, 23 (3.1%) did not answer the question on whether the programme addressed gender sensitive issues without compromising the rights and confidentiality of programme participants. Peer support for HIV/AIDS infected academic, administrative staff and students is analysed in the next section.
5.4.2.7 Peer support for HIV/AIDS infected academic, administrative staff and students
Peer support is an aspect of the university’s HIV/AIDS programme, which enables students and staff to access support and possible healthcare. The rationale for this
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question was to determine the number of respondents that were familiar with a vital aspect and initiative of the university HIV/AIDS programme.
Table 5.10: Peer support for HIV/AIDS infected academic, administrative staff and students
Is peer support available for HIV/AIDS infected academic, administrative staff and students within the university? Total
Yes No Don't know
Group Academics Count 25 11 93 129
% 100.0 19.4% 8.5% 72.1% %
Administrative Count 41 2 67 110 staff
% 100.0 37.3% 1.8% 60.9% %
Students Count 154 20 274 448
% 100.0
34.4% 4.5% 61.2% %
Total Count 220 33 434 687
% 100.0 32.0% 4.8% 63.2% %
Missing
Item 52 (n=739)
Table 5.10 above sets out responses to the question regarding peer support for HIV/AIDS infected academics, administrative staff and students. The analysis revealed the following: 93 (72.1%) academics, 67 (60.9%) administrative staff and 274 (61.2%) students did not know that the university’s HIV/AIDS programme provided peer support for HIV/AIDS infected academic, administrative staff and students, while 25 (19.4%) academics, 41 (37.3%) administrative staff and 154 (34.4%) students stated that the university’s HIV/AIDS programme provided peer support for HIV/AIDS infected academic, administrative staff and students. A total of
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11 (8.5%) academics, 2 (1.8%) administrative staff and 20 (4.5%) students revealed that the university HIV/AIDS programme did not provide peer support for HIV/AIDS infected academic, administrative staff and students. In total, 434 (63.2%) of the respondents indicated that they did not know that the university provided peer support for HIV/AIDS infected academics, administrative staff and students, while 33 (4.8%) of the respondents indicated that no peer support was available for HIV/AIDS infected academic, administrative staff and students, and 220 (32.0%) respondents agreed that peer support was available for HIV/AIDS infected academic, administrative staff and students. The frequency of Voluntary Counselling and Testing sessions is discussed next.
5.4.2.8 Frequency of Voluntary Counselling and Testing sessions The purpose of Voluntary Counselling and Testing is based on the need to encourage continuous testing. VCT is, therefore, an essential component of the university’s HIV/AIDS programme. The need for the university to comply with VCT sessions emanates from the 2012-2016 National Strategic Plan (NSP) for HIV, STIs, TB and the HEAIDS Strategic Policy Framework. The university is, therefore, expected to roll out VCT sessions as frequently as possible. The rationale for this question was that if VCT is a fundamental part of the university programme, it would be necessary to investigate respondents’ familiarity regarding how often the university conducts Voluntary Counselling and Testing sessions, which would then reflect on their knowledge of programme content.
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Table 5.11: Frequency of Voluntary Counselling and Testing sessions
Group Frequency Percent Valid Percent Cumulative Percent
Academics Valid Weekly 4 3.1 3.3 3.3
Fortnightly 2 1.5 1.6 4.9
Monthly 3 2.3 2.4 7.3
Quarterly 8 6.2 6.5 13.8
Annually 6 4.6 4.9 18.7
Unsure 100 76.9 81.3 100.0
Don’t know 0 0 0 0
Total 123 94.6 100.0
Missing Item 7 5.4
Total 130 100.0
Administrative Valid Weekly 8 6.9 7.2 7.2
staff Fortnightly 0 0 0 0
Monthly 3 2.6 2.7 9.9
Quarterly 14 12.1 12.6 22.5
Annually 5 4.3 4.5 27.0
Unsure 72 62.1 64.9 91.9
Don’t know 9 7.8 8.1 100.0
Total 111 95.7 100.0
Missing Item 5 4.3
Total 116 100.0
Students Valid Weekly 44 8.9 9.7 9.7
Fortnightly 11 2.2 2.4 12.1
Monthly 83 16.8 18.2 30.3
Quarterly 59 12.0 13.0 43.3
Annually 8 1.6 1.8 45.1
Unsure 213 43.2 46.8 91.9
Don’t know 37 7.5 8.1 100.0
Total 455 92.3 100.0
Missing Item 38 7.7
Total 493 100.0 (n=739)
Table 5.11 above illustrates responses to the question: how often does the university conduct Voluntary Counselling and Testing sessions? Of a sample size of 739 respondents, 50 (6.7%) chose not to answer the question, 385 (55.9%) were unsure and 46 (6.7%) did not know how often the university conducted Voluntary
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Counselling and Testing sessions. The unsure responses, when calculated to a percentage, revealed that (100+72+213=385÷739×100÷1=52%) 52% of the respondents were unsure of the frequency of Voluntary Counselling and Testing sessions at the university. When these responses were added to don’t know responses and calculated to a percentage, they equated to 58.3% (385+46÷739×100÷1= 58.3%) of respondents’ who did not know or were “unsure” of the frequency of VCT sessions being conducted at the university. A meagre 37.5% of respondents provided an answer of weekly, fortnightly, monthly, quarterly, or annually to the question, which relates to on the frequency of Voluntary Counselling and Testing sessions. Of these options, quarterly responses were among the highest response 8 (6.5%) for academics, 14 (12.6%) of administrative staff and 59 (13%) of students who indicated that VCT was available. However, 83 (18.2%) students chose monthly sessions as an option, and 59 (13%) students selected the quarterly option as a response to the frequency of VCT sessions being conducted at the university. An analysis of respondents’ awareness of the university HIV/AIDS programme is provided below.
5.4.3 Respondents’ awareness of the university’s HIV/AIDS programme
In assessing programme awareness, the researcher posed questions, which relate to programme awareness in order to identify respondents’ awareness of the programme. The rationale for this data was to determine respondents’ awareness of the university’s HIV/AIDS programme. Respondents were asked whether they have heard of the programme. The number of respondents who have heard of the programme would indicate whether the university’s population is aware of the programme or not. Fewer respondents who have heard of the programme may suggest that fewer individuals are aware of the programme.
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Table 5.12: Awareness of the university’s HIV/AIDS programme
Have you heard of an HIV/AIDS
programme at the university? Total
Yes No
Count 96 34 130 Academics Group % 73.8% 26.2% 100.0%
Administrative Count 94 22 116 staff % 81.0% 19.0% 100.0%
Count 355 136 491 Students % 72.3% 27.7% 100.0%
Total Count 545 192 737
% 73.9% 26.1% 100.0%
2 Missing Item (n=739)
Table 5.12 above shows that amongst the three groups, namely academic, administrative staff and students, 545 respondents indicated that they have heard of the programme, 96 (73.8%) academics, 94 (81.0%) administrative staff and 355 (72.3%) students. Conversely, 34 (26.2%) academics, 22 (19.0%) administrative staff and 136 (27.7%) students indicated that they have not heard of the programme. The table further shows that a total of 737 respondents answered this question, while 2 respondents did not answer the question. The next section examines respondents’ awareness of HIV/AIDS posters at the university.
5.4.3.1 Visibility of HIV/AIDS posters at the university The rationale for this question was to determine respondents’ awareness of the programme. Respondents’ acknowledgement of the visibility of HIV/AIDS posters at the university may point to their awareness of the HIV/AIDS programme.
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Table 5.13: Visibility of HIV/AIDS posters at the university
Are HIV/AIDS posters visible at the university? Total
Yes No Don’t know
Group Academics Count 88 35 4 127
% 69.3% 27.6% 3.1% 100.0%
Administrative staff Count 87 25 2 114
% 76.3% 21.9% 1.8%
348 120 18 486 Students Count
% 71.6% 24.7% 3.7% 100.0%
Total Count 523 180 24 727
% 71.9% 24.8% 3.3% 100.0%
Missing Item 12 (n=739)
Table 5.13 above illustrates that 88 (69.3%) academics, 87 (76.3%) administrative staff and 348 (71.6%) students acknowledge that HIV/AIDS posters are visible at the university. A total of 180 (24.8%) respondents indicated that HIV/AIDS posters were not visible at the university, and this response comprised of 35 (27.6%) academics, 25 (21.9%) administrative staff and 120 (24.7%) students. Conversely, 24 (3.3%) respondents indicated that they “did not know” that posters were visible at the university and these included 4 (3.1%) academics, 2 (1.8%) administrative staff and 18 (3.7%) students. A total of 727 of 739 respondents answered the question, and 12 respondents chose not to answer the question. The next section addresses the effectiveness of the university’s HIV/AIDS programme.
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5.4.4 Effectiveness of the university’s HIV/AIDS programme
Respondents’ reasons to engage with the programme may suggest that the programme is effective in creating programme awareness. The rationale for this question was to measure the number of respondents who engaged with the programme and their response as to whether the programme improved since they first heard of the programme.
5.4.4.1 Reason to engage with the programme directly The rationale for this information was to ascertain the number of respondents who have engaged with the programme directly. The higher response rate may suggest that individuals do engage with the programme, and are hence aware of the programme and its offerings. Knowledge and awareness of the programme are possible suggestions that the programme is effective in reaching the targeted audience.
Table 5.14: Reason to engage with the programme directly
Have you had reason to engage
with the programme directly? Total
Yes No
Count 12 36 48 Academics % 25.0% 75.0% 100.0% Group
Administrative Count 18 24 42
staff % 42.9% 57.1% 100.0%
Students Count 115 111 226
% 50.9% 49.1% 100.0%
Total Count 145 171 316
% 45.9% 54.1% 100.0%
Missing Item 423 (n=739)
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Table 5.14 illustrates that from the sample population, 36 (75.0%) academics, 24 (57.1%) administrative staff and 111 (49.1%) students indicated that they have not had reason to engage with the programme directly. Conversely, 12 (25.0%) academics, 18 (42.9%) administrative staff and 115 (50.9%) students within the response group indicated that they did have reason to engage with the programme directly. A total of 316 (42.8%) respondents answered this question, while 423 (57.2%) respondents choose not to respond to this question, probably owing to its sensitivity. The next section addresses the question on improvement of the HIV/AIDS programme.
5.4.4.2 Improvement of the HIV/AIDS programme The rationale for this question was to ascertain the number of respondents who indicated whether the HIV/AIDS programme has improved since they first heard of the programme. Higher response rates regarding this question may suggest that improvement in the programme points to its effectiveness. A higher response rate may also suggest that respondents are familiar with the characteristics of the programme in order to identify the change.
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Table 5.15: Improvement of the HIV/AIDS programme
Has the HIV/AIDS programme improved since you first heard of the programme? Total
Yes No Don’t know
Group Academics Count 22 40 16 78
% 28.2% 51.3% 20.5% 100.0%
Administrative
staff Count 41 37 10 88
% 46.6% 42.0% 11.4% 100.0%
Students Count 155 181 110 446
% 34.8% 40.6% 24.7% 100.0%
Total Count 218 258 136 612
% 35.6% 42.2% 22.2% 100.0%
Missing Item 127 (n=739)
Table 5.15 above reveals that 22 (28.2%) academics, 41 (46.6%) administrative staff and 155 (34.8%) students indicated that the HIV/AIDS programme has improved since they first heard of the programme. However, 40 (51.3%) academics, 37 (42.0%) administrative staff and 181 (40.6%) students indicated that the HIV/AIDS programme has not improved since they first heard of the programme. A total of 16 (20.5%) academic, 10 (11.4%) administrative staff and 110 (24.7%) students indicated that they did not know whether the HIV/AIDS programme has improved since they first heard of the programme. Of a total of 739 respondents, 612 respondents answered the question, while 127 respondents chose not to answer the question on whether the university’s HIV/AIDS programme improved since they first heard of the programme. The no and don’t know responses, when combined, revealed a total of (258+136= 394) 53.3% of the total number of respondents. The yes responses, when calculated as a percent (218÷739×100÷1=29.5%), amounted to 29.5%, while the missing amount, when
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calculated as a percent (127÷739×100÷1=17.2%), amounted to 17.2%. The section on cross tabulation follows next.
5.4.5 Cross tabulation The rationale for the use of cross tabulation was to show a side by side comparison of two or more survey questions to determine how they are interrelated at the same time. A cross tabulation is a two (or more) dimensional table that records the number (frequency) of respondents that have the specific characteristics, which are described in the cells of the table (IBM, 2011, p.3). Cross tabulation tables were supported by chi-square analyses, which is one of the techniques that are used to test the significant relationship between two variables. The groups comprised of academic, administrative staff and students. The chi-square tests whether or not the two variables are independent. If the variables are independent, then the results of the statistical test will not be significant (Pallant, 2007, p.215; Guerrero, 2010, p.180). If the variables are related, then the results of the statistical test will be statistically significant, which means that one can state that there is a relationship between the variables. The results are regarded as statistically significant at “.05 or 5% level” of significance (Mendenhall, Beaver, & Beaver, 2013, p.333). This means that the variables have a low chance of being independent. The following cross tabulation was conducted.
5.4.5.1 Number of respondents who participated in the programme and the availability of Voluntary Counselling and Testing at the university
The rationale for this cross tabulation was to determine the relationship between the number of respondents who have participated in the programme and the number of respondents who indicated that VCT was available at the university.
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Table 5.16: Number of respondents who participated in the programme and availability of Voluntary Counselling and Testing at the university
Is Voluntary Counselling and Testing available at the university? Total
Yes No Don't know
Have you participated in the Yes Count 143 1 5 149 programme?
% 96.0% .7% 3.3% 100.0%
No Count 411 8 142 561
% 73.3% 1.4% 25.3% 100.0%
Total Count 554 9 147 710
% 78.0% 1.3% 20.7% 100.0%
Missing Item 29 (n=739)
Table 5.16 above revealed that 149 respondents participated in the university HIV/AIDS programme. Of the 149 respondents, 143 (96%) indicated that voluntary counselling testing was available at the university, 1(.7%) indicated that it was not available and 5 (3.3%) indicated that they did not know whether voluntary counselling and testing was available at the university. Of the total of 710 respondents that answered the question, 561 did not participate in the programme. Of the 561 (75.9%) respondents who did not take part in the programme, 411 (73.3%) responded that voluntary counselling and testing was available at the university, 8 (1.4%) stated that VCT was not available at the university, and 142 (25.3%) stated that they did not know whether VCT was available at the university. The chi-square table is set out below.
Table 5.16.1: Chi-Square
Value df Asymp. Sig. (2- sided)
Pearson Chi-Square 35.724a 2 .000
The Chi-Square table, Table 5.16.1 above, shows a statistical significant difference (X²= 35.72; p<.001) between those who participated in the university HIV/AIDS programme and those who did not in relation to their response to the availability of VCT at the university. The number of respondents who participated were more than
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those who did not in terms of acknowledging the availability of VCT at the university, as reflected in Figure 5.2 below.
Figure 5.2: Respondents who participated in the programme and those who stated that Voluntary Counselling and Testing was available at the university
Have you participated in the programme?
120%
100% 96%
80% 73%
60%
40% 25% 20% 1% 1% 3% 0% Yes No Don't know Is Voluntary Counselling and Testing available at the University?
Percentage of those who have participated in the programme
Percentage of those who did not participate in the programme
Figure 5.2 above illustrates the significant difference between those who participated in the university HIV/AIDS programme and those who did not, in relation to their response to the availability of VCT at the university. The above figure shows that 96% of those who participated in the programme indicated that VCT is available at the university, while 73.3% of respondents who did not participate in the programme stated that VCT is available at the university. A meagre 0.7% of those who participated in the programme indicated that VCT is not available at the university, while 1.4% of those who did not participate in the programme indicated that VCT is not available at the university. A total of 3.3% of those who participated in the programme stated that they did not know that VCT was available at the university,
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while 25.3% of those who did not participate in the programme responded that they did not know whether VCT was available at the university. The next cross tabulation addressed the number of respondents who participated in the programme and those who did not, in relation to their response to the question whether the programme does address gender sensitivity without compromising anybody’s rights and confidentiality.
5.4.5.2 Number of respondents who participated in the programme and gender sensitivity and confidentiality
The rationale for this comparison was to determine the relationship between the number of respondents who participated in the programme and the number of respondents who answered the question, which relates to whether the programme addresses gender sensitive issues without compromising anybody’s rights and confidentiality.
Table 5.17: Number of respondents who have participated in the programme and gender sensitivity and confidentiality
Does the programme address gender sensitive issues without compromising rights and confidentiality? Total
Yes No Don't know
Have you Yes Count participated in the 77 21 50 148 programme?
% 52.0% 14.2% 33.8% 100.0%
No Count 143 42 364 549
% 26.0% 7.7% 66.3% 100.0%
Total Count 220 63 414 697
% 31.6% 9.0% 59.4% 100.0% Missing Item 42 (n=739)
Table 5.17 above reveals that 148 respondents participated in the university’s HIV/AIDS programme. Of these 148 respondents, 77 (52%) indicated that the university’s HIV/AIDS programme does address gender sensitive issues without
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compromising anybody’s rights and confidentiality, 21 (14.2%) indicated that the university’s HIV/AIDS programme does not address gender sensitive issues without compromising anybody’s rights and confidentiality, and 50 (33.8%) indicated that they did not know whether the university HIV/AIDS programme addressed gender sensitive issues without compromising anybody’s rights and confidentiality. Of the total number of 697 respondents, 549 (74.2%) did not participate in the programme. Of the 549 respondents who did not take part in the programme, 143 (26%) respondents indicated that the university’s HIV/AIDS programme does address gender sensitive issues without compromising anybody’s rights and confidentiality, 42 (7.7%) said that the university’s HIV/AIDS programme did not address gender sensitive issues without compromising anybody’s rights and confidentiality, and 364 (66.3%) stated that they did not know if the university’s HIV/AIDS programme addressed gender sensitive issues without compromising anybody’s rights and confidentiality. In total, respondents who said no and those who said that they did not know whether the university’s HIV/AIDS programme does address gender sensitivity without compromising confidentiality, totalled is 474 (63+414=474). The chi-square is displayed in the next table.
Table 5.17.1: Chi-Square Value df Asymp. Sig. (2- sided)
Pearson Chi-Square 51.196a 2 .000
The Chi-Square (Table 5.17.1) analysis shows a statistical significant difference (X²= 51.19; p<.001) between those who participated in the university’s HIV/AIDS programme and those who did not, in relation to their response to the effectiveness of the university’s HIV/AIDS programme in addressing gender sensitive issues without compromising anybody’s rights and confidentiality. This is reflected in Table 5.17, and these results are graphically presented in Figure 5.3 below.
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Figure 5.3: Respondents who have participated in the programme and those who indicated that the programme addresses Gender sensitive and confidentiality issues
Have you participated in the programme?
70% 66.3%
60% 52% 50%
40% 33.8% 30% 26%
20% 14.2%
10% 7.7%
0% Yes No Don't know Does the programme address gender sensitive issues without compromising confidentiality?
Percentage of those who have participated in the programme
Percentage of those who did not participate in the programme
Figure 5.3 above presents a graphical representation of the significant difference between those who participated in the university’s HIV/AIDS programme and those who did not, in relation to their response to the effectiveness of the university’s HIV/AIDS programme in addressing gender sensitive issues without compromising anybody’s rights and confidentiality. Of the respondents who participated in the university’s HIV/AIDS programme, 52% indicated that the programme does address gender sensitivity without compromising confidentiality. A total of 26% of the respondents who did not participate in the programme indicated that the programme does address gender sensitivity without compromising confidentiality. Furthermore, 14.2% of those who participated in the programme indicated that the programme does not address gender sensitivity without compromising confidentiality, and 7.7% of those who did not participate in the programme stated that the programme does not address gender sensitivity without compromising confidentiality. Also, from the
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above figure it is seen that 33.8% of those who participated in the programme indicated that they did not know whether the programme does address gender sensitivity without compromising confidentiality, while 66.3% of respondents who did not participate in the programme indicated that they did not know whether the programme addressed gender sensitive issues without compromising confidentiality. The next cross tabulation on number of respondents who participated in the programme and those who have reason to engage with the programme directly, is presented below.
5.4.5.3 Number of respondents who participated in the programme and those who have reason to engage with the programme directly
The rationale for this comparison was to determine the relationship between the number of respondents who participated in the programme and the number of respondents who have reason to engage with the programme directly.
Table 5.18: Number of respondents who participated in the programme and had reason to engage with the programme directly
Have you had reason to engage with the programme directly? Total
Yes No
Have you Yes Count participated in the 78 22 100 programme?
% 78.0% 22.0% 100.0%
No Count 65 147 212
% 30.7% 69.3% 100.0%
Total Count 143 169 312
% 45.8% 54.2% 100.0%
Missing Item 427
(n=739)
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Table 5.18 above illustrates that 100 respondents participated in the university’s HIV/AIDS programme. Of these 100 respondents, 78 (78%) indicated that they have reason to engage with the university’s HIV/AIDS programme directly, while 22 (22%) indicated that they did not have reason to engage with the university’s HIV/AIDS programme directly. Of the total number of 312 respondents that answered the question, 212 of them did not participate in the university’s HIV/AIDS programme. Of the 169 (54%) respondents who stated that they did not have reason to engage with the programme directly, 22 (22%) of them indicated that they did participate in the HIV/AIDS programme, while 147 (69.3%) said that they did not participate in the HIV/AIDS programme. Therefore, it appears that more respondents (54.2%) had reason not to participate in the programme, as opposed to 45.8% who indicated that they had reason to engage with the programme directly. The chi- square table is presented below.
Table 5.18.1: Chi-Square Value df Asymp. Sig. (2- sided)
Pearson Chi-Square 61.336a 1 .000
The Chi-Square (Table 5.18.1) analysis shows a statistical significant difference (X² 61.36; p<.001) between those who participated in the university’s HIV/AIDS programme and those who did not, in relation to their response to the question regarding whether they had reason to engage with the university’s HIV/AIDS programme directly. This has also been represented in the bar chart in Figure 5.4 below.
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Figure 5.4: Respondents who participated in the programme and those who had reason to engage with the programme directly
Have you participated in the programme? 90% 78% 80% 69.3% 70% 60% 50% 40% 30.7% 30% 22% 20% 10% 0% Yes No Have you had reason to engage with the programme directly?
Percentage of those who have participated in the programme
Percentage of those who did not participate in the programme
Figure 5.4 above shows a significant difference between those who participated in the university’s HIV/AIDS programme and those who did not, in relation to their response to the question regarding whether they had reason to engage with the university HIV/AIDS programme directly. A total of 78% of respondents who participated in the programme indicated that they had reason to engage with the programme directly, while only 30.7% of those who did not participate in the programme indicated that they had reason to engage with the university’s HIV/AIDS programme directly. A total of 22% of those who participated in the programme stated that they have no reason to engage with the programme directly, while a larger number of 69.3% of those who did not participate in the programme indicated that they had no reason to engage with the programme directly. The final cross tabulation concerning the reason to engage with the programme directly and attendance of Voluntary Counselling and Testing sessions at the university, is explained below.
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5.4.5.4 Reason to engage with the programme directly and attendance of Voluntary Counselling and Testing sessions at the university
The rationale for this comparison was to determine the relationship between the respondents who had reason to engage with the programme directly and the number of respondents who attended Voluntary Counselling and Testing sessions at the university.
Table 5.19: Reason to engage with the programme directly and attendance of Voluntary Counselling and Testing sessions at the University
Have you attended any Voluntary Counselling and Testing sessions at the university? Total
Yes No
Have you had reason to engage No Count 58 112 170 with the programme directly?
% 34.1% 65.9% 100.0%
Yes Count 95 47 142
% 66.9% 33.1% 100.0%
Total Count 153 159 312
% 49.0% 51.0% 100.0%
Missing Item 427 (n=739)
Table 5.19 shows that 170 respondents did not have reason to engage with the university’s HIV/AIDS programme directly. Of the 170 respondents, 58 (34.1%) indicated that they attended VCT sessions at the university, and 112 (65.9%) indicated that they did not attend VCT sessions. Of the total 312 respondents, 142 had reason to engage with the university’s HIV/AIDS programme directly, 153 (49%) did attend VCT sessions at the university, and 159 (51%) did not attend VCT sessions at the university. Of a total of 739 respondents, 427 (57.8%) respondents did not answer the question. The large percentage on missing item may be attributed to several reasons, which are discussed in the subsequent chapter. The chi-square table is presented below.
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Table 5.19.1: Chi-square Value df Asymp. Sig. (2- sided)
Pearson Chi-Square 33.275a 1 .000
The Chi-Square (Table 5.19.1) analysis shows a statistical significant difference (X² 33.27; p<.001) between respondent’s who had reason to engage with the programme and those who had not, in relation to their response to whether they have attended any VCT sessions at the university. These results have been graphically represented in Figure 5.5 below.
Figure 5.5: Respondents who had reason to engage with the programme directly and those who attended Voluntary Counselling and Testing sessions at the university
Have you had reason to engage with the programme directly? 80%
70% 66.9% 65.9%
60%
50%
40% 34.1% 33.1% 30%
20%
10%
0% Yes No Have you attended any Voluntary Counselling and Testing sessions at the university?
Percentage of respondents who had reason to engage with the programme directly
Percentage of respondents who had no reason to engage with the programme directly
Figure 5.5 above shows a significant difference between respondents who had reason to engage with the programme and those who had not, in relation to their response to whether they have attended any VCT sessions at the university.
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According to the chart, 66.9% of those respondents who had reason to engage in the programme directly indicated that they have attended VCT sessions at the university, while only 34.1% of those respondents who had no reason to engage with the programme directly, stated that they have attended VCT sessions at the university. A total of 33.1% of those who have reason to engage with the programme directly stated that they have not attended VCT sessions at the university, while 65.9% of those who had no reason to engage with the programme directly, stated that they have not attended VCT session at the university. The next section addresses an analysis of the interviews.
5.5 Analysis of interviews A total of 14 participants were interviewed for this phase of the research. Participants were sampled from three groups within the university, namely academics, administrative staff and students. Each group was interviewed to obtain different information. Content analysis was employed to analyse notes that were made during the interviews. A thematic content analysis “…portrays the thematic content of interview transcripts by identifying common themes in the texts provided for analysis…” (Anderson, 2007, p.1). Content analysis is, therefore, best utilised to answer research questions, which include “what”, “why” and “how”. Babbie and Mouton (2001, p.491) define content analysis as a research method that examines phrases and words within interviews.
Content analysis examines data from different perspectives with an aim of identifying key words in the text to help to understand and interpret the raw material (Maree, 2008, p.101). Content analysis considers similarities and differences within text and makes assumptions. “The researcher groups and distils from the texts a list of common themes in order to give expression to the communality of voices across participants” (Anderson, 2007, p.1). Hence, once the interviews were completed, notes were taken and the content was used to make comparisons of the answers to the questions, whilst conclusions were then drawn. The same questions were posed to all interviewees, except for the students, whose questions were more student specific. This made the data analyses process easier. The most frequently cited
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answers from respondents were summarised (as reflected in Appendices I and J). Participants were given the following codes: Ad (administrative staff), Ac (academic), S (student), and the number that followed the Ad or Ac or S denoted the participant’s number. Appendix I shows a categorisation of thematic analysis per participant. Appendix J expands on Appendix I, which sets out themes and codes per group. The following section outlines and describes the interviews, which were conducted on academics, administrative staff and students.
5.5.1 Participants’ perceptions of the content of the university’s HIV/AIDS programme
The rationale for this information was to ascertain interviewee familiarity with the programme content of the university HIV/AIDS programme.
• What do you think about the university’s HIV/AIDS programme?
In order to ascertain interviewee familiarity with the university’s HIV/AIDS programme content, administrative staff, students and academics were asked what they thought of the university’s HIV/AIDS programme. Two administrative staff noted that the programme was informative, since it made people aware of the provisions of the university’s HIV/AIDS programme. They went on to comment that an attempt to create awareness was welcomed and “…every employee and student should be informed of their right to be educated and to make better choices…” (Ad7). One administrative staff member said that the programme needed improvement, while another administrative staff member stated that they did not know. The administrative staff member added that if one was not aware of an active problem, then this should be regarded as a concern. Three students said that the programme was good, as the programme created a foundation to help others. One student thought that the programme was advantageous; especially for students and that more testing was needed. One academic noted that the programme needed a revival and an improvement. Two academics agreed that the programme was poorly managed. Academics added that they did not know about the actual programme, except for the random poster.
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5.5.2 Participants’ awareness of the university’s HIV/AIDS programme
The rationale for this question was to ascertain the way that programme co- ordinators create awareness, and to establish how their views on awareness compare to that of the rest of the interviewees.
Describe various ways in which HIV/AIDS programme co-ordinators at the university create programme awareness? Three administrative staff members at the university’s Institutional Office for HIV and AIDS (IOHA) mentioned that the university’s HIV/AIDS programme co-ordinators held programme awareness sessions according to the national health calendar, whereby various months are allocated to different activities. This is combined with communication via university corporate communication, peer champions, Linked champions, the use of posters, voluntary counselling and testing and distribution of condoms.
Administrative staff was asked about various ways in which HIV/AIDS programme co-ordinators at the university create programme awareness. They agreed that co- ordinators created awareness by using notice boards, posters, circulars and testing. In their words, “Not much has been done; I have seen something at the gate and on the notice board but not something important” (Ad4). “Mostly the posters, but in my opinion they are not effective. They stay up for an hour at most until a new one comes up, some circulars, wellness bulletins and on university radio” (Ad5). “Circulars, awareness functions, visitors are often invited. I have not been to one.” (Ad6).
Three academics were asked to describe various ways in which HIV/AIDS programme co-ordinators create programme awareness. One academic said that programme co-ordinators create programme awareness through the distribution of condoms. Another academic added that programme co-ordinators create awareness through the use of posters, notice boards, flyers and circulars, and the third academic said that programme awareness did not concern her as she knew her status.
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In your view, what are the characteristics of the programme? With regard to this question, one Institutional Office for HIV and AIDS (IOHA) administrative staff member added that the programme involved monitoring and prevention and training of wellness champions. Different views have arisen regarding the above mentioned question. Administrative staff members were asked about the characteristics of the programme. Interviewees agreed that their concept of the characteristics of the university’s HIV/AIDS programme was the distribution of condoms. One of the interviewees stated that distributing condoms defied the message of abstinence, and that condoms should not be seen as a reason to have sex, and said: “We hand them condoms and tell them it is fine to go have sex and don’t get AIDS” (Ad4).
Both academic staff members revealed that they did not know what were the characteristics of the programme. They assumed that it would be awareness, testing and communication, while another academic mentioned assisting with issues relating to HIV/AIDS. Students were asked about the characteristics of the university’s HIV/AIDS programme. They responded that the programme was characterised by the distribution of condoms, voluntary counselling and testing, community service and dissemination of HIV/AIDS information.
Why do you think that the university should continue to invest in its HIV/AIDS programme?
IOHA administrative staff members were asked why they think that the university should continue to invest in its HIV/AIDS programme. All three interviewees agreed that the university should continue to invest in the programme in order to take care of staff and to change their focus to third year students before they leave the university and enter the workplace. All administrative staff agreed that the university should continue to invest in the university HIV/AIDS programme, in order to invest in the lives of students. One administrative staff stated that staff should take on the responsibility and play the role of parents. She further maintained that “it is an illness. They are children we need to take on the responsibility of their parents. Not be the parent, but educate them as a parent would” (Ad4). “It is very important to invest in the programme, a number of students across all campuses. One person
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can have HIV and transmit the disease. If this occurs with one person imagine what would happen to the rest of our students. Prevention education and social awareness is essential. We need to invest in our brand” (Ad5). “There are too many students from other parts of the country and rural areas. They might not have had the opportunity to be exposed to HIV awareness. This would help students on where to go and what to do” (Ad6).
Two academics mentioned that the university should continue to invest in the health and education of students. While another academic added that HIV/AIDS affects more people than we know, hence we should continue to invest in people. This particular academic went on to add that “the University is a community institution that does not exist in isolation from the rest of South Africa, if we don’t invest in our students we are not looking at reality. Students from different backgrounds and poor environments need a programme that accommodates these needs when addressing HIV” (Ac1).
What would you like to see changed regarding HIV/AIDS programme awareness within the university? The above question was posed to IOHA administrative staff members who remarked that they would like to see top management take responsibility, staff members to change their lifestyle regarding HIV/AIDS, and also for the programme to focus on senior students regarding awareness. Administrative staff members were asked what they would like to see changed regarding HIV/AIDS programme awareness within the university. One administrative staff member suggested that the programme should create a greater awareness of the number of facilities that the programme offers. Many students were unaware of how they could access assistance regarding HIV/AIDS. Two interviewees suggested that the programme should focus on creating awareness and visibility of the programme.
When the abovementioned question was asked to academics, all three academics gave different responses. One academic said that she would like to “see first years receive regular awareness at orientation. Programme consistency is not something that continues to happen. HIV does not stop at the university gate it happens within
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the university” (Ac1). The other academics added that academics should be equipped with ways in which they may come to the assistance of students and staff, as most academics were not familiar with the university HIV/AIDS programme. In this question students responded by saying that they would like to see more involvement and enthusiasm, encouraging students to become more involved and to show a willingness to ask questions. Students emphasised that they would like to see HIV/AIDS awareness within lectures and within modules, and greater interaction with schools and companies.
Does the programme provide adequate health management tools, for example, VCT testing, counselling and medical assistance?
According to the interviewees, the university’s HIV/AIDS programme provides for VCT testing, assistance by wellness personnel at the Centre for Psychological Services and Career Development (PsyCaD) and medical assistance to a certain extent. However, interviewees added that a fraction of staff and students do not belong to Medical Aid. These individuals may attend state hospitals, which are better equipped, however, the long queues are unhelpful. Two administrative staff members said that they did not know whether the university’s HIV/AIDS programme did provide adequate health management. One administrative staff member said that there was an entire system in place.
Two out of three academics said that the programme provided VCT, and the third academic said that they did not know whether the university HIV/AIDS programme provided adequate health management tools such as VCT, counselling and medical assistance. In their words, the academics stated that the “clinics do offer VCT as, I have seen it” (Ac1). “I think they do VCT on campus” (Ac2). “I don’t know if they are testing. If they were, I would know” (Ac3). All four students said that the university’s HIV/AIDS programme did provide adequate health management tools, and one student added that the programme provided adequate health management tools in the form of counselling and the distribution of condoms.
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From your viewpoint, are the HIV/AIDS programme co-ordinators doing enough to encourage health management within the programme?
IOHA administrative staff members who worked with the programme were asked if they did enough to encourage health management within the programme, and they responded affirmatively. They were doing a lot considering that they were under- staffed and poorly equipped. While one interviewee said that they were not doing enough considering that their overburdened workload did not permit them to do any more. Two interviewees agreed that HIV/AIDS programme co-ordinators were doing enough to encourage health management within the programme, whereas two disagreed. In their words, one of the interviews stated: “No, you don’t see them being helpful. I have helped students at PsyCaD programme co-ordinators treat them as a number” (Ad4). The second interviewee added: “You cannot say yes or no the programme is not visible enough, cannot say what they are doing.” (Ad6). Two out of three academics said that they felt that the HIV/AIDS programme co- ordinators were not doing enough to encourage health management within the programme. When four students were asked the above question; one said that HIV/AIDS programme co-ordinators were not doing enough to encourage health management within the programme (S4). Whereas two other students said that HIV/AIDS programme co-ordinators are present, and the fourth student stated that HIV/AIDS programme co-ordinators are doing their best (S3).
What did you learn from being exposed to the HIV/AIDS programme? The above question was posed to students. One student, in particular, stated that she was first introduced to the university’s HIV/AIDS programme through the IOHA, while the second student knew of HIV before arriving at the university and the third found the programme informative and the fourth student said that: “I have not learnt as much, I have gathered my own knowledge from television and newspapers” (S4).
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What can you observe about yourself that is different now from when you first encountered the programme, which you believe is directly related to what you learned in the programme?
Students found that since participating in the programme they have a change in attitude towards the disease, as they are more informed, compassionate and aware of those around them. One of the students did not experience a difference, and added: “Nothing much the university clinic and brochures at the clinic that speak about STI and HIV has remained unchanged” (S4).
If you were talking to another student about the programme, what would you tell him or her?
Students were asked if they were to engage in a conversation with another student regarding the university’s HIV/AIDS programme, what they would tell him or her regarding the programme. Students added that they will tell them to know their status, to be more involved and to show compassion. Students, in their words revealed: “Know their status. They (students) need help. They may think that they know a lot until they find out that they are HIV positive” (S1). “I would tell him or her that HIV does not just affect her but it affects all of us” (S3). “We should be involved with the programme and find out more” (S4).
5.5.3 Effectiveness of the university’s HIV/AIDS programme
The rationale for the questions within this section was to determine the effectiveness of the university’s HIV/AIDS programme.
What do you think about the effectiveness of the programme? Interviewees stated that the programme was effective; one interviewee added that it was effective with room for improvement. Two of the four administrative staff members agreed that the programme was effective; whilst other administrative staff members indicated that they could not comment or did not know whether the programme was effective, as they were not involved. Administrative staff members stated the following: “Yes, to see the effectiveness. Programme co-ordinators need to make students aware that they can get help” (Ad4). “I do not know if it is effective
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or not. I am not involved as I should be in the HIV/AIDS programme. I do not know if the programme is effective as we do not receive feedback regarding the programme” (Ad5). “I don’t want to say it is not effective but it is difficult if you did not attend” (Ad6). “Yes the programme is very effective programme co-ordinators do a lot; they put a lot of systems in place” (Ad7).
Two academics said that they found the programme to be ineffective. “The programme is not effective it is divorced from reality and the needs of the country and university” (Ac1). “The programme is not effective it is not as it should be because we are exiting more HIV positive students than we should” (Ac2). One said that it was difficult to say if the programme was effective. Two students said that the programme was effective; another said that the effectiveness of the programme varies, while another student said that the programme was effective to an extent. Students in their words added: “It is everywhere, notice boards and posters. It is effective for me” (S1). “It is effective if they are doing testing, this helps students change if they have a scare” (S2). “It varies if you make it your own it would appear effective if not then no” (S3). “To a certain extent, it is effective. Some actually give themselves time to find out. It seems effective to other people” (S4).
What is your experience with the success of the programme? Interviewees mentioned that they encounter challenges with the university’s HIV/AIDS programme. The VCT sessions are successful, but the lack of participation is discouraging. With regard to the above question, three administrative staff members agreed that they did not see the programme as being successful. One administrative staff member said that one should have empathy with those who are infected. When the above question was posed to three academics, one academic said that they had little success with the programme, whilst another said that they had not been involved in the programme and the third said that they did not know. Academics added the following: “Besides circulars and the very little on testing day” (Ac1). “I don’t read the circulars and therefore I am not involved. Why can’t we market HIV like any other product at the university?” (Ac2). Students were asked about their experience of the programme. One student said that they learnt from the programme, while another added that she had little success with the
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programme and, subsequently, two students said that the programme has taught them a lot and that they had been tested, not for participating in the programme, but for knowing their status. The students had the following to say about the programme: was “…mostly pleasant and I have had interesting time. I got to learn different things some of it has been mostly helpful” (S1). “I am a more conservative person. If I had to test it will be at a hospital” (S2). “The programme has taught me a lot it has helped me reaffirm my values” (S3). “However I went to VCT not because of the programme I wanted to know my status” (S4).
Are you satisfied with the programme? Interviewees agreed that there was room for improvement. Interviews said: “There is room for improvement I am satisfied with the outcome. However, the Linked programme needs more training” (Ad1). “I am satisfied with the programme there is a scope for improvement” (Ad2). Three administrative staff members said that they were not satisfied with the programme and one administrative staff member said that they were satisfied with the university’s HIV/AIDS programme. Academics responded by saying that more should be done. While one academic said that they did not use the programme. “More needs to be done” (Ac1). “No, the programme co- ordinators can do more” (Ac2). “I never use the programme” (Ac3). Two students said that they were not satisfied with the programme; the second said that the programme should be developed and another added that she was satisfied with the programme. Some students were not satisfied and stated: “No really, I am not satisfied there is a lot of room for improvement. Programme co-ordinators need resources that may enable them to do more” (S1). “In a way the programme needs to be developed” “I am not satisfied” (S4).
How can the programme be improved? When asked how the programme could be improved, interviewees suggested that better resources and visibility was an issue. Interviewees stated: “We need more resources, offices, provisions, visibility maybe closer to PsyCaD. Auckland Park Kingsway campus (APK) is the biggest campus with the smallest office” (Ad1). “Focus on the employees, target interventions at Soweto campus (SWC) and reach out to academics” (Ad2). One administrative staff member said that by getting the
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“Top guns” (Vice Chancellor, Deputy Vice Chancellor, Deans and Heads of Departments and Schools) involved. “Top guns getting involved not just on the field day, but understanding how the programme works” (Ad4). Another administrative staff member mentioned marketing, while two other administrative staff members added that there is a need for the university’s HIV/AIDS programme to become visible. “I cannot stress the importance of visibility when marketing awareness it should be in your face everywhere you go” (Ad5).
Academics added that the programme could be improved through visibility, communication and by doing more. “We need to see the programme before we test it; the programme needs to be everywhere. The programme is not visible” (Ac1). “The communication department or body running the programme needs should be better manned. They need more people” (Ac2). “Any programme should be improved. I answered in the negative. This shows that they are not doing enough” (Ac3). Two students said that: the university’s HIV/AIDS programme could be improved with intensive marketing. “Extend marketing to those who need to be tested HIV/AIDS could happen to anybody” (S2). “Having more participation from people who have HIV have these individuals described their experience of living with the disease” (S3). “Marketing should involve students” (S4). The other two students said that the programme needs the help and support of more people in order to be improved. “The programme needs more people” (S1).
What have you learned from the functioning of the programme? Interviewees were asked what they had learnt from the programme. Some mentioned that a change of perception and working as a team is what they (interviewees) cherished from the functioning of the programme. “Being part of the programme changed my life. I now enjoy people, I used to be uncomfortable with, gay, transgender people and HIV positive people and now I am comfortable and open to them” (Ad1). “Working together as a team is an achievement such as the HIV committee structure planning together” (Ad2). One administrative staff member said that the programme does not work; another said that they are not involved in the programme, whilst another said that not many people know about the programme. Three academics were asked: what have you learned from the
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functioning of the programme? One academic said that she was recently made aware that there are offices at the university. “Recently, I have just known of their offices after six years at this campus” (Ac1). The second said that the co-ordinators are trying, and the third said that she had not learnt anything from the functioning of the programme. Students were asked what have they learned from the functioning of the programme. One student said that they now see the disease differently; another said that HIV is real, whilst the third student said that HIV cannot be viewed negatively, and the fourth student refused to comment. “…to look at the disease differently. If I am informed about the disease I will know how to maintain my negative status” (S1). “HIV is real and not an illness” (S2). “HIV/AIDS is something that we cannot view in a negative light. Mistakes are always experiences to learn from” (S3).
5.5.4 The extent that the university’s HIV/AIDS programme conforms to the HEAIDS programme
The rationale for this information was to determine whether the university HIV/AIDS programme conforms to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education.
Does the university’s HIV/AIDS programme conform to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education?
Interviewees were asked whether the university’s programme conformed to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education. Interviewees agreed that the university’s programme was aligned to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education, as they were mandated to do so whilst reporting on a quarterly basis. The interviewees stated the following: “Yes this is our mandate together with the Department of Health, HEAIDS programme; National Strategic Plan the university conforms to the two” (Ad1). “The programme does conform with the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education as the HIV committee education framework we report to HEAIDS quarterly” (Ad2). “The programme does conform to HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education
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100% as our policy is aligned with HEAIDS” (Ad3). For the purpose of appreciating interviewee responses, frequently used words have been visually represented in the next section.
5.5.5 Qualitative data visualisation
Qualitative data visualisation is a means of appreciating and absorbing qualitative data in a visual snap shot that “processes raw data into an interactive display of itself” (Erwin, 2008, p.2). A word cloud and a data table were assembled to visually present frequently used words that were gathered during the one-on-one interviews.
Figure 5.6: Interview word cloud
Figure 5.6 above displays the most frequently used words that were gathered during the one-on-one interviews. The word cloud provides a visual presentation of word counts from one or more texts, where the more frequent word appears larger within the word cloud display (Viégas, & Watternberg, 2008; Henderson, 2013, p.57). When the larger words are combined to form a sentence, a striking statement can
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be identified as more programme needed, needs involvement, improvement, visibility and awareness.
Table 5.20: Frequently used words per category
Programme Awareness Catergory 1 2 3 4 5 6 7 8 9 10 11 posters are visible condoms are available testing is being done circulars offer visiblity need for compassion know your status more awareness needed invest in students more involvement needed health management is provided not doing enough health professionals doing their bit programme needs improvement programme needs to be more informative Programme effectiveness not effective interviewees have no experience with programme satisfied not satisfied programme lacks visibility needs more marketing programme is doing more Programme content programme content is good could do more to improve complies with HEAIDS
Table 5.20 above graphically sets out the entries per categories that were grouped after the qualitative interviews were conducted. These entries represent the recurrent statements that were made by the interviewees. It is apparent from the number of entries made in the above table that interviewees believe that the university’s HIV/AIDS programme requires greater involvement, followed by a need for awareness, need for improvement and greater visibility of the programme. The next section examines an analysis of reviewed institutional documents.
5.6 Analyses of reviewed institutional documents The rationale for reviewing the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education was to compare the university’s HIV/AIDS workplace
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programme with the HEAIDS Policy and Strategic Framework, which provides a set of overarching principles and components in order to realise its objectives. Objective 1 was compared to the university’s programme: “To ensure the comprehensive and appropriate use of the Higher Education mandate for teaching and learning, research, innovation and knowledge generation; and community engagement to effectively respond to the drivers of the pandemic” (HEAIDS,2012,p.24). “In addition, each component contains suggested programmatic elements to assist institutions in planning, developing and implementing comprehensively conceptualised HIV and AIDS policies and programmes” (HEAIDS,2012,p.24). Component 2 of objective 1 was used to compare the university’s policy. Component 2 recommends that institutions may consider the need to develop and implement appropriate, innovative and effective HIV/AIDS prevention strategies for their institution. Component 2 suggests that the institution may possibly provide access to comprehensive prevention programmes for staff and students across all campuses and residences, which include:
“HIV, AIDS, STIs, and TB awareness campaigns;
HIV Counselling and Testing (HCT) programmes;
Peer education and health promotion activities; and condom use and distribution;
Male medical circumcision;
Prevention of mother-to-child transmission (PMTCT);
STI treatment;
Infection control programmes; and
Initial and on-going training” (HEAIDS, 2012, p.25).
On analysing the HEAIDS Policy and Strategic Framework, it was apparent that the HEAIDS Policy and Strategic Framework contained individual programmatic elements that enabled individual institutions to adopt and operationalisation policy and programme, according to individual institutional needs and context (HEAIDS, 2012, p.20). The HEAIDS Policy and Strategic Framework allow individual institutions the freedom to create and develop a programme. The HEAIDS Policy and Strategic Framework was intended to enable the institutions, “…response to be
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implemented to scale more evenly and expand its reach; thereby enriching the Higher Education sector’s contribution to addressing HIV/AIDS at a national level” (2012, p.20). A comparison of the HEAIDS Policy and Strategic Framework and the university’s HIV/AIDS workplace programme was tabulated in order to illustrate the similarities and differences between the HEAIDS Policy and Strategic Framework and the university’s HIV/AIDS workplace programme.
Table 5.21: Comparison of HEAIDS Policy and Strategic Framework and the University HIV/AIDS workplace programme
HEAIDS Policy and Strategic University workplace programme Framework: Objective 1 Component 2
HIV, AIDS, STIs, and TB Prevention and treatment of STI’s awareness campaigns;
HIV Counselling and Testing Promotion of VCT (HCT) programmes;
Peer education and health Provision of treatment, care and
promotion activities; support for people with HIV and AIDS Condom use and distribution; Condom usage
Male medical circumcision; None
Prevention of mother-to-child None transmission (PMTCT);
STI treatment; Education about treatment of STI
Infection control programmes; None and
Initial and on-going training” Training of line managers, up (HEAIDS, 2012, p.25). skilling of peer educators (Ramafola, 2012)
The HEAIDS Policy and Strategic Framework formed the basis to evaluate of the university’s HIV/AIDS prevention programme, which is analysed below.
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5.6.1 University’s HIV/AIDS workplace programme
The rationale for reviewing this document was to analyse and establish the university’s HIV/AIDS workplace programme, which is an example of one of different types of programmes that are utilised within the university. The analysis of the programme indicated that the university has a functioning HIV/AIDS workplace programme, an Employee Assistance Programme (EAP), and an Employee Wellness Programme (EWP). The university has an inclusive HIV/AIDS wellness policy, which is accompanied by a disability management and occupational health policy. The university, in addition to the above mentioned policy, has an executive- level champion for HIV/AIDS in the Workplace Programme, as well as wellness coordinators. The HIV/AIDS programme has a strategy, budget and an active HIV/AIDS committee that assists to implement the HIV/AIDS strategy. The university’s HIV prevention services for staff members targets all staff (excluding contract staff), and include training and an active peer education programme. According to the HIV/AIDS programme, condoms are dispensed through the campus clinic and restrooms. This initiative is undertaken by the university’s IOHA staff.
Staff members have access to VCT services at the campus clinic. The university has a treatment and care and support service, which is available to employees who are expected to utilise their medical aid fund to access prevention-of-vertical- transmission-of-HIV services and antiretroviral (ARV) therapy. The university has a policy on post-exposure prophylaxis (PEP), which is free to all staff members who may require it. Moreover, employees with HIV infection may access free nutritional supplements from the university’s clinic. Employees who need ARVs and who are not on medical aid are referred to a state hospital. The university clinic also treats Sexually Transmitted Infections (STIs). This university HIV/AIDS programme was compared to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education. However, findings contrary to the above were found. The remaining three institutional documents are discussed below.
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5.6.2 HR Wellness report
The rationale for reviewing the HR wellness report was to determine whether deliverables mentioned in the HIV/AIDS workplace programme were being met. The report reflected the success and challenges faced by the university HR Wellness team.
5.6.3 University’s IOHA Policy Booklet
The university’s IOHA Policy booklet which concentrates on the university’s institutional policy objectives was reviewed for reasons similar to the HIV/AIDS workplace programme, namely to compare the policy with the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education, and to determine compliance with the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education objectives. IOHA, according to their policy booklet, supports the HEAIDS Policy and Strategic Framework. IOHA provides community engagement and residence programmes related to HIV/AIDS; psycho-educational support through PsyCaD for students who are affected and infected by HIV/AIDS. IOHA initiatives include collaborative HIV-related projects in partnership with relevant internal and external stakeholders; and curricula and research promotion on HIV and AIDS at faculty level. IOHA is located on all four campuses. All HIV and AIDS activities at the university are monitored by the HIV and AIDS Committee under the auspices of the Registrar to ensure service delivery (UJ, 2011, p.89). Table 5.22 below illustrates a comparison between the HEAIDS Policy and Strategic Framework and the IOHA Policy Booklet.
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Table 5.22: Comparison of HEAIDS Policy and Strategic Framework and the IOHA Policy Booklet HEAIDS Policy and Strategic Framework IOHA Policy Booklet Objective 1 Component 2
HIV, AIDS, STIs, and TB awareness Prevention and treatment of STI’s campaigns;
HIV Counselling and Testing (HCT) Promotion of VCT programmes;
Peer education and health Provision of treatment, care and promotion activities; support for people with HIV and AIDS
Condom use and distribution; None
Male medical circumcision; None
Prevention of mother-to-child None transmission (PMTCT);
STI treatment; Education about treatment of STI
Infection control programmes; and None
Initial and on-going training” None (UJ IOHA, 2009, p.8) (HEAIDS, 2012, p.25).
The university wellness programme is examined next.
5.6.4 University’s wellness programme for HIV infected students and staff
The university’s wellness programme for HIV infected students and staff is similar to the university’s IOHA Policy Booklet. The intention was to compare and determine whether the policy meets the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education’s objective. The purpose of this programme is to provide on-going care and support to HIV infected students and staff. As yet, the university does not offer a complete spectrum of HIV treatment on campus. This programme facilitates a wellness plan for HIV positive patients to ensure that their health is properly managed.
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5.7 Summary
This chapter analysed data that was collected by establishing academic, administrative staff members and students’ views, opinions and experiences regarding issues pertaining to the effectiveness of the university’s HIV/AIDS programme. Data was processed and analysed in a way that assisted the researcher to answer the research questions. The collected data from survey questionnaires and reviewed institutional documents was used to support the data that was collected from interviews.
The self-administered questionnaire consisted of four sections, namely section A, which covered demographic data of respondents such as type of staff member, gender, age, year of study and position within the university. Sections B, C and D consisted of closed-ended questions and statements, which used a 4 to 7 point Likert scale. Interviews were conducted with administrative staff at the IOHA offices, administrative staff at HR Wellness, academic, administrative staff and students. Themes and codes were derived from the interviews which formed the foundation of the qualitative analysis (as reflected in Appendices I and J). An analysis was presented in three sections, namely perceptions of programme content, programme awareness and programme effectiveness. Results of the analysis were illustrated by using tables and charts. The next chapter discusses the research findings.
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CHAPTER 6 Discussion of Findings
6.1 Introduction
The purpose of this chapter is to discuss the results of the findings, which emanated from the data analysis in Chapter 4. This chapter interprets, discusses and clarifies information that was obtained from the self-administered questionnaires; semi- structured interviews and institutional documents that were reviewed in order to address the research questions and achieve the research objectives. The quantitative and qualitative data was mixed or triangulated in the discussion of the findings, as Bryman (2007, p.9) notes: “…one consideration when linking the analyses is not to lose sight of the rationale for conducting mixed methods research in the first place” and therefore, “…bringing quantitative and qualitative findings together has the potential to offer insights that could not otherwise be gleaned” (Bryman, 2007, p.20). The following discussion was derived from the data analysis.
6.2 Demographic data related issues The demographic data revealed that more female respondents participated in all three stakeholder categories. Of the total respondents, 62.91% are female employees and 37.1% are male employees. Female students were far more approachable and willing to participate in the study when compared to their male counterparts. Anderson and Louw-Potgieter (2012, p.1) mentioned in his study that more women were willing to participate in the HIV/AIDS programme than their male counterparts. This phenomenon allows room for further inquiry, but the parameters of this study does not allow for it. In order to obtain a general overview, it was necessary to determine how many respondents did in fact participate in the university’s HIV/AIDS programme. The results of the findings revealed that 79% of the respondents did not participate in the programme. The somewhat high percentage of respondents that did not participate in the programme raised a concern that the programme has not been attracting individuals that it was intended to benefit. The HIV/AIDS stigma may as well be seen as an effective barrier in HIV/AIDS prevention and treatment programmes (Mahajan, et al., 2010, p.7; Gobind
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& Ukpere, 2012, p.11120; Anderson & Louw-Potgieter, 2012, p.1). The HIV/AIDS stigma, according to Mahajan et al., (2010, p.7), may be blamed for the low uptake of and poor adherence to prevention and treatment services. Therefore, poor response with regard to participation in the programme may be attributed to the effect and consequence that stigma has on participants. However, the response rate of questions pertaining to the content, awareness and overall effectiveness of the programme suggested that respondents were willing to answer other questions relating to the programme, rather than questions pertaining to their involvement in the programme. The pattern of response created the impression that knowledge and awareness of the programme seemed to have been gathered from a source other than the university’s HIV/AIDS programme. One may speculate and propose that a possible source may be “word-of-mouth”. The next section, which deals with respondents’ perceptions of the university’s HIV/AIDS programme, offers further insight into the findings.
6.3 Stakeholders’ perceptions of the university’s HIV/AIDS programme Various questions were used to elicit responses, which relate to respondents’ perceptions of the content of the university’s HIV/AIDS programme. At the outset respondents were invited to reveal if they participated in the programme. Determining respondents’ level of participation in the programme was necessary in order to determine participants’ perceptions of the programme. It may be presumed that participation in the programme inadvertently exposes one to the programme’s content. Yet, the data revealed that 78.3% of respondents knew about the availability of voluntary counselling and testing. Contradictions in respondents’ perception levels are noted at this point. Firstly, respondents stated that they have not participated in the programme and yet know that VCT is available at the university. Secondly, 78.3% stated that VCT is available, but, 59.1% have not attended VCT sessions at the university. Data suggests that a number of respondents, who knew of the availability of VCT, chose not to attend VCT sessions. Therefore, it may be inferred that many respondents do not participate in the programme yet they know of VCT, however, merely knowing about VCT does not compel respondents to attend VCT sessions. Therefore, non-attendance at VCT and
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non-participation in the programme disadvantages respondents from knowing about the programme’s content. Participation in either of these instances would have exposed respondents to aspects of the programme’s content.
It is clear that respondents’ perceptions of the content of the programme is lacking. Interestingly, these findings, when compared to the HEAIDS 2008 survey, which reported that 68% of students attended VCT sessions at the university compared to 40.9% in the current study, which amounts to a 27.4% drop in VCT attendance amongst students, suggest that the programme is not meeting expectations (HEAIDS, 2010, p.13). In simpler terms, the programme seems not to have effectively persuaded respondents to utilise VCT sessions at the university. This may also confirm that respondents’ familiarity with VCT does not suggest that respondents were familiar with the content of the programme. In 2008 it was estimated that between 19% and 28% of students could be at risk of infection (HEAIDS, 2010, p.56). This was within a period when VCT attendance was 68% (HEAIDS, 2010, p.13) and when compared to a drop in 2013 (40.6%), it may be assumed that the risk of infection has increased.
Further investigation of respondents’ perceptions of the programme’s content maintained that respondents were more familiar with VCT than any other programme, practices or facilities, which are included in the university’s HIV/AIDS programme. A possible justification, according to HEAIDS, is that VCT campaigns “as carried out at most HEIs seem particularly effective in attracting students. Thus the majority of VCT are undertaken during campaign periods” (2010, p.20). Fewer respondents knew of the programme’s practices or facilities mentioned in the programme, as portrayed in Table 5.6. Anderson and Louw-Potgieter (2012, p.1) made a similar observation at the University of Western Cape, where the VCT programme was said to have reached its intended target population, as HIV negative respondents perceived the voluntary counselling and testing as informative and rated it positively. However, the uptake of the programme remained problematic, since “women were using the programme more than men. Staff were poor users of the programme, as they may utilise other means and sites to obtain their HIV status” (Anderson & Louw-Potgieter, 2012, p.1). Respondents were
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familiar with the importance of confidentiality during VCT sessions, the promotion of a safe work environment and the availability of training and education, which is offered to staff. This is in comparison to aspects of the programme content that pertained to compensation for occupationally acquired HIV/AIDS, employee benefits and procedures for dispute resolution and grievances related to HIV/AIDS within the university. In contradiction to respondents’ answers to confidentiality during VCT sessions, promotion of a safe working environment and the availability of training and education offered to staff, 57.7% of respondents, according to Table 5.8, indicated that the university’s HIV/AIDS programme has not adequately dealt with various ways of mitigating HIV/AIDS within the university. Yet, the previously stated areas are examples of ways to mitigate HIV/AIDS within the university. It is apparent that respondents’ perception of the university’s HIV/AIDS programme is riddled with inconsistency.
The findings of the question on gender sensitivity further demonstrate the contradiction, since 67.7% of respondents, according to Table 5.9, indicated that they were not aware of the programme’s content regarding gender sensitivity and confidentiality. It is important to stress that gender sensitivity and confidentiality are facets of ways of mitigating HIV/AIDS within the university’s environment. Respondents were inconsistent in their answers. This may be attributed to HIV fatigue, although this view is inconclusive. Cloete et al., (2010, p.1) study may reveal a possible explanation, since AIDS-related stigma continues to be a barrier for women accessing free voluntary counselling and testing (VCT). However, as previously mentioned, Anderson and Louw-Potgieter (2012, p.1) gathered that more women were accessing VCT than men, which leaves room for further inquiry.
A total of 90.6% of academics according to Table 5.3, indicated that they did not participate in the programme, while 65.4% according to Table 5.4, 65.4% disclosed that voluntary counselling and testing was available. However, when questioned on whether they attended voluntary counselling and testing, 81.3% of academics, according to Table 5.5, indicated that they have not attended voluntary counselling and testing. This was further collaborated with the findings from the cross tabulation, which revealed that the number of respondents who were aware of VCT sessions
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were higher than the number of respondents who participated in the programme. One academic, in particular, when invited to respond to the question on whether the programme provides adequate health management tools, stated: “I don’t know if they are testing, if I were attending VCT session, I would know” (Ac3). Academic staff, according to HEAIDS (2010, p.41), are less likely to test for HIV on campus, as just one in ten academic staff and less than a quarter of administrative staff utilise the campus clinic for testing purposes.
The HEAIDS (2010, p.41) report revealed that students and staff are unwilling to access services at the university’s Health Centre for fear of being identified or perceived as being HIV positive. The risk of being seen as HIV positive within the university’s context has a profound and a significant impact. Being open about one’s HIV status and to be seen as seeking help on campus creates the likelihood of not being able to engage in courtship and relationships, while inviting stigma and pity (HEAIDS, 2010, p.41). The explanation presented in the HEAIDS report may be the reason why one academic stated: “I never use the programme” (Ac3). However, this raises a concern and may also imply that the programme has not resulted in behaviour change since 2008.
Results of the data revealed that academics lacked familiarity with aspects that are specific to the content of the programme. A possible explanation for the lack of familiarity with aspects that are specific to the content of the programme may be owing to the assertion made by the United Nations (UN), where a UN study found that educational managers are expected to give an increasing proportion of their time responding to HIV/AIDS, and by virtue of the time constraint attached to this contribution, academics are weary when offering their services or time (UN, n.d). Non-involvement in the programme may be a chosen option and a result of academic complacency. Table 5.6 displays a series of questions that were posed to academics. The results of their negative responses were in the upper 50% range, which reflects the fact that many academics lack knowledge of the programme’s content. This can be supported by academic responses, as presented in the said table. During the one-on-one interviews academics were invited to offer their input with regard to what they thought of the programme’s content, and one academic
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revealed that, except for the posters, she did not know much about the programme’s content (AC3). To reiterate, academics knew of voluntary counselling and testing, however, according to Table 5.5, they have not attended these sessions. Therefore, it can be said that academics’ perceptions of specific areas pertaining to the content of the programme was negligible, according to table 5.6. Table 5.9 also illustrated that a whopping 79.4% of academics lacked awareness with aspects of the programme’s content that address gender sensitivity issues and confidentiality.
When administrative staff members were requested to offer information concerning whether or not they participated in the programme, 71.3% of administrative staff stated that they did not participate in the programme. However, 74.8% of administrative staff acknowledged that voluntary counselling and testing was available at the university, and 41.1% attended voluntary counselling and testing sessions at the university. A large percentage of administrative staff claimed not to have participated in the programme, and yet an even larger percentage knew of the availability of VCT sessions. These administrative staff ironically chose not to participate in the testing. Administrative staff members who claimed to know about VCT were not as familiar with the actual programme, practices or facilities that were specific to the programme’s content. These results were displayed in Table 5.6. The analysis suggested that administrative staff were unaware of most of the programmes, practices or facilities that were available, except voluntary counselling and testing.
This was further evident when questioned about an aspect of the programme that dealt with gender sensitive issues, which did not compromise rights and confidentiality. According to Table 5.9, at least 56% of administrative staff did not know whether the programme dealt with gender sensitive issues. One administrative staff member, in particular, when invited to divulge what she knew of the programme simply added that she did not know much about the programme, and claimed that she was not aware of there being an active programme, which she declared was a problem (Ad4). Conversely, another added that the programme was good and that people were aware of the programme (Ad6). What seemed to become apparent
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during the interviews were the contradictions in participants’ statements and the quantitative results.
According to Table 5.3, a relatively high percentage of 77.8% of students revealed that they had not participated in the programme. Students appear to know that voluntary counselling and testing is available at the university. According to Table 5.4, an overwhelming 82.6% of students indicated that they are aware of the counselling and testing. However, 46.8%, according to Table 5.5, indicated that they have not attended voluntary counselling and testing. When probed about specific content in the programme, other than voluntary counselling and testing, students were unable to answer. Table 5.6 revealed students’ poor responses to questions pertaining to programme content. During the interview sessions one student commented: “It is good because others can get help if they know of students who are living with HIV. They can get help; they know that they are not the only ones. It is a good idea” (S1). Student responses in certain instances were inconsistent. Table 5.9 shows that students were invited to offer information about gender issues, which is a component of the programme: 63.3% indicated that they did not know that the programme dealt with gender sensitive issues. In 2008 HEAIDS reported that “more than two thirds of students (70%) and around half of service staff had been tested in the past year. Around one in seven students (15%) and fewer staff had ever been tested at UJ, which may indicate that there are barriers to accessing VCT at the university” (HEAIDS, 2010, p.40). It would appear that these barriers have remained unchanged.
When perceptions of programme content were compared between stakeholders, 90.6% of academics, according to Table 5.3, did not participate in the programme, compared to 71.3% of administrative staff and 77.8% of students. The number of respondents that did participate in the programme is a concern, and may point to the programme being ineffective. With regard to familiarity with voluntary counselling and testing, groups did not vary in their responses. As illustrated in Table 5.4, most stakeholders knew of the availability of VCT sessions at the university, since 65.4% of academics, 74.8% of administrative staff and 82.6% of students knew about the availability of VCT. However, according to Table 5.5, when compared to attendance
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at a voluntary counselling and testing session, 81.3% of academics, 58.9% of administrative staff and 53.2% of students did not attend voluntary counselling and testing. According to Table 5.11, about 52% of stakeholders were unsure about the frequency of VCT sessions at the university. Being familiar with VCT sessions, according to the findings, does not indicate knowledge of the content. What it appears to imply is that stakeholders seem to be accustomed to the presence of VCT sessions at the university. This statement may by supported by Table 5.8, where respondents were questioned about whether the university’s HIV/AIDS programme dealt with the treatment and mitigation of HIV/AIDS within the university, as 46.6% and 35.8% stated that the university’s HIV/AIDS programme dealt with these issues.
Table 5.9 illustrates that 77% of academics, 56% of administrative staff and 54.3% of students did not know that the programme addressed gender sensitive issues without compromising confidentiality. Table 5.10 demonstrated that 72.1% of academics, 60.9% of administrative staff, and 61.2% of students did not know about peer support for HIV/AIDS infected staff and students. Table 5.6 suggests that there are differences between group responses. The group with the most conflicting responses was the academic group. Their lack of participation and familiarity with the programme’s content was evident during the one-on-one interviews: “except for the poster, I don’t know” (Ac3), remarked one academic; “a terribly managed programme” (Ac2) added another; and “needs revival, a revamp” (Ac1); concluded another. It is clear that respondents’ perceptions of the HIV/AIDS programme’s content is restricted to VCT, an explanation of which may stem from the extensive marketing and awareness efforts attached to VCT at a national level. In a previous study, which was conducted by HEAIDS (2010a, p.20), researchers made an observation that VCT sessions seemed particularly effective in attracting students. The findings in the HEAIDS (2010a, p.20) study seems to conflict with the findings of this study, as respondents’ knowledge of VCT (see Table 5.5) failed to stimulate their attendance of VCT sessions. Respondents’ awareness of the university’s HIV/AIDS programme is discussed below.
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6.4 Awareness levels of HIV/AIDS at the university
Levels of programme awareness were examined with the intention of arriving at the objective and the purpose of the study. Respondents’ awareness of the programme was revealed in Table 5.12, which illustrated that 73.9% of respondents have heard of the programme. Respondents’ awareness level regarding the visibility of HIV/AIDS at the university was examined. A total of 71.9% of respondents, according to Table 5.13, agreed that the posters pertaining to the programme were visible. The one-on-one interviews revealed that participants were aware of the programme, posters and VCT sessions, however, they were unaware of the actual programme. A total of 69.3% of academics, according to Table 5.13, indicated that posters were visible. During the quantitative analysis, academic awareness of the programme appeared significant. For instance, in Figure 5.3, it can be seen that 66.3% of respondents who did not participate in the programme indicated that they did not know whether the programme addressed gender sensitivity without compromising confidentiality issues.
This gave room to enquire whether these findings were indeed supported by the participants during the one-on-one interviews. An academic, when probed if they were satisfied with the programme’s awareness indicated: “…not really except for the condoms, we are a small campus. Sometimes at the gates, this has no impact” (Ac1). Another added, “I know my status so I don’t bother” (Ac2). It became apparent during the one-on-one interviews that academic staff knew about the programme and yet they are unaware about the programme other than the condoms that are available at various toilets in the university. One academic stated that she had seen posters, notice boards, flyers and circulars (Ac3), while an administrative staff member added that posters are mostly visible, and in her opinion, they were ineffective as posters stay up for short periods of time and are generally replaced by new posters that may not necessarily pertain to HIV/AIDS. This particular administrative staff member also added that programme awareness was also created by circulars, the university’s wellness centre, and the university’s radio station (Ad5).
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However, a student seemed to have captured the essence of this level of awareness when she added that she was not exposed to the programme as much as she would have like, but from the little exposure she has had, she has found the programme informative and, in her opinion should be reinforced (S3). It could be inferred from the results and responses that HIV/AIDS awareness has not reached the desired level, whereby programme co-ordinators may relax their awareness initiatives. IOHA co-ordinators have confirmed that awareness levels are yet to be achieved. “We need to focus more on seniors not first years, second years we abandon them, third years do what they want what we told them not to do in first year. VCT at student centre are mostly first years not supported by third years. They are negative in their first year and positive by the third year. They are forced to attend in their first year by third year they no longer do” (Ad1).
A total of 81% of administrative staff, according to Table 5.12, have heard of the HIV/AIDS programme. Table 5.13 illustrated that 76.3% of administrative staff indicated that HIV/AIDS posters were visible at the university. In addition, 74.8%, according to Table 5.4, indicated that voluntary counselling and testing was available at the university. With respect to voluntary counselling and testing, during the one-on-one interviews, administrative staff members were requested to comment on whether the programme provided adequate health management tools, for example VCT sessions, counselling and medical assistance. One participant indicated that the programme did not provide adequate health management tools, (Ad4), whilst another added that they were not sure whether the programme provided adequate health management tools, as students who attend awareness days are often referred to by someone else and, therefore, students do not receive the assistance that they need (Ad5). A third stated that she did not know that the programme provided adequate health management tools (Ad6).
The contradictions in the findings pertaining to VCT occurred during the one-on-one interviews when respondents, when interviewed, stated that they did not know that VCT was available. During the one-on-one interviews administrative staff members were invited to comment on what they would like to see changed regarding HIV/AIDS programme awareness at the university. One participant said: “More
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awareness is important. It should not go unnoticed. One every year/6 months is not enough for a student” (Ad5). The findings suggest that awareness levels are encouraging, however, during the interviews one participant indicated that the existence of the programme was gathered from posters and not from interaction with the actual programme, hence: “…from posters it is about awareness normally, HIV tests at the student centre, getting to know your status, it is all about what they are doing and not about the educating getting to know is not enough not before becoming positive there is no information that is relevant to HIV positive person.” (Ad5). This inference may be supported by administrative staff responses in Tables 5.3, 5.8 and 5.14, where 90.6% of administrative staff stated that they did not participate in the programme, only 39.4% knew of the ways the university HIVAIDS programme works to mitigate the spread of HIV/AIDS and a reasonably high percentage (57.1%) of administrative staff stated that they did not engage with the programme directly. It can be gathered from this result that administrative staff knew about the programme and not the content, which does not amount to awareness of the programme, as intended by HEAIDS.
Table 5.13 illustrated students’ responses to the visibility of posters, and 71.6% indicated that HIV/AIDS awareness posters were visible. During the one-one interviews students were invited to disclose what they had learnt from the programme, and one of the participants indicated that she did not learn much from the programme itself, compared to the brochures that are found at the clinic, which generally spoke about STI’s and HIV (S4). Students and administrative staff make reference to posters as a source of awareness. Testing appears to be an association of awareness. Participants referred to testing when questioned about awareness: “…have random HIV testing and counselling” (S2); and “…they usually run testing” (S4). Far more administrative staff seemed to have heard of the HIV/AIDS programme than academics or students. During the one-on-one interviews, administrative staff indicated that the programme was good, as the programme made people aware that a programme was in place (Ad6). Administrative staff members indicated that HIV/AIDS posters are visible. Far more administrative staff (75%) than academic and students indicated that HIV/AIDS posters are visible.
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However, according to Table 5.4, which dealt with voluntary counselling and testing availability at the university, showed that student responses outnumbered those that were provided for by administrative staff and academics. It seems that administrative staff members knew about the programme from the posters, rather than actual interaction with the programme. Overall, these findings suggest that participants are generally aware of the programme. Participants who had heard of the programme acknowledged visibility of HIV/AIDS awareness posters and voluntary counselling and testing. However, there is a supposition that participants’ awareness levels may not be indicative of effectiveness. This, according to HEAIDS, may be a reflection of a “lack of consistent, well supported and visible HIV and AIDS response programmes, and a lack of vocal champions, including HIV positive campus leadership” (2010, p.60). The word cloud in Figure 5.6 is a graphical display of this point. Participants’ responses visually depicted a mass of key words that suggest that there is a need for an improved programme that is visible whilst creating awareness. The effectiveness of the university’s HIV/AIDS programme is discussed next.
6.5 Effectiveness of the university’s HIV/AIDS programme
Two questions were posed across academic, administrative staff and student groups in order to determine their overall perception of the effectiveness of the HIV/AIDS programme. They were invited to disclose if they had reason to engage with the programme, and according to Table 5.14, almost 54.1% of participants had not engaged with the programme. When questioned whether the programme improved since they first heard of the programme, 64.4% of participants, according to Table 5.15, indicated that they did not know that the HIV/AIDS programme improved, since they first heard of the programme. Participants were further probed during the one- on-one interviews with regard to what they had thought about the effectiveness of the programme. IOHA programme co-ordinators and members of HR Wellness stated that there is “room for improvement” (Ad2), “…not 100%...” (Ad3).
In order to investigate the effectiveness of the university’s HIV/AIDS programme, academics were questioned around whether they had reason to engage with the
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programme. A total of 75% of academics, according to Table 5.14, indicated that they did not have reason to engage with the programme, while 25% indicated that they had engaged with the programme. If one had to compute the percentage of the total number of academics who participated in the study, namely 130 (100%) with the number of academics who had reason to engage with the programme 12 (25%), then that percent would equate to 9.2%. It can be inferred that a small percentage of academics have reason to engage with the programme. According to Figure 5.4, a staggering 69.3% of respondents who did not participate in the programme indicated that they had no reason to engage in the programme directly. Figure 5.5 revealed a similar picture, where 65.9% of respondents who did not have reason to engage with the programme stated that they have not attended VCT sessions at the university. During the one-on-one interviews academics added that the programme was not effective and was divorced from reality, the country and, most importantly, the university (Ac1). Another added that the programme was not as it should be, as the university is not expected to be exiting more HIV positive students. The programme should try to avoid exiting many HIV positive students. A total of 51.3% of academics, according to Table 5.15, indicated that the programme did not improve.
To recap about academics’ views about the programme, it was previously mentioned that 90.6% of academics did not participate in the programme, 9.2% did not engage with the in the programme, and 51.3% of academics did not know whether the programme has improved since first hearing of the programme. From this it can be deduced that academics are indifferent to the programme. At the interviews academic staff indicated: “we need to see the programme before we test it. The programme needs to be visible. HIV has taken lives, effecting people around the programme” (Ac1); “Effective communication needs to be established. The department or body responsible for providing communication needs to be better manned. This department should utilise government allocated budgets and spend more money implementing ideas. Why is the money not coming to the university, there is no support” (Ac2); and “Any programme should be improved. I believe that they are not doing enough” (Ac3).
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A total of 57.1% of administrative staff members, according to Table 5.14, indicated that they did not have reason to engage with the programme. During their one-on- one interviews administrative staff added: “To see the effectiveness they need to make students aware that they can get help” (Ad4). Another added that she did not know if the programme was effective, as she was not involved in the programme. The administrative staff further added that the programme does not provide feedback about its progress (Ad5), while a third administrative staff pointed out that it was difficult to determine if the programme was effective if one did not attend the programme (Ad6). A total of 42% of administrative staff members, according to Table 5.15, disclosed that the programme did not improve since they first heard of it.
Administrative staff suggested that the programme could be improved by “…top guns getting involved not just on the field day but by understanding work circumstance and students” (Ad4); and “Visibility is important, we can’t stop with the marketing awareness it should be in your face everywhere you go. At APK it is easy to make students aware of what the programme constitutes.” (Ad5). One of the questions that was posed during the one-on-one interviews dealt with what they have learned from the functioning of the programme, to which administrative staff added: “It does not work largely it is organic we need to speak to older people discuss it with them this is a cultural thing.” (Ad4); “HIV awareness equates to how to treat and prevent HIV and not many students know about it” (Ad5); and “I have not been involved” (Ad6).
According to Table 5.14, 49.1% did not engage in the programme, whilst 50.9% indicated that they did engage with the programme. One student added that she had no reason to engage with the programme, as her experience was “…very minimal, I am a more conservative person If I had to test, it will be at a hospital” (S2), while another added: “I went to VCT not because of the programme, I wanted to know my status” (S4). In response to the question regarding the improvement in the HIV/AIDS programme, 65.3% of students, according to Table 5.15, indicated no and don’t know in terms of whether the programme has improved since they first heard of it. Students suggested that the programme could be improved, as according to one student, the programme needed more volunteers (S1); another stated that testing should extend to everybody as the disease could happen to anybody, and so by
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including participation from people who are HIV positive, it would be helpful for “them to describe how they are living with the disease” (S3); and “programme needs more marketing and the involvement of students” (S4).
The interview word cloud which provides a visual presentation of word counts shows more frequent words that are used and are displayed larger within the word cloud. Viégas and Watternberg (2008) and Henderson and Segal (2013, p.57) revealed that the word involvement stood out larger and, therefore, suggests that the word was more frequently mentioned. Participants mentioned during the one-on-one interviews that the programme needs more active involvement and programme awareness.
When participants’ responses regarding the same questions were compared between groups, it was evident that 75% of academics, according to Table 5.14, have not engaged with the programme, compared to 57.1% of administrative staff and 49.1% of students. An academic, during the one-on-one interviews, was requested to comment on their engagement with the programme. The academic was clear to point out that, “I don’t have much knowledge about it or to be in a position to know” (Ac3). Students, conversely added: “I have tried to get involved they were helpful at the IOHA programme. I have had pleasant experience they thought me a few things and showed me around” (S1). An administrative staff member stated: “I don’t know much. If you are not aware of an active programme, it is a big problem” (Ad4).
The second question regarding improvement of the programme was compared and, according to Table 5.15, a whopping 71.8% of academics indicated no and did not know in terms of whether the programme has improved since they first heard about the programme, while 53.4% of administrative staff and 65.2% of students agreed that they did not notice an improvement in the programme. Administrative staff members were probed during one-on-one interviews about their experience with the success of the programme. Administrative staff added that they could not comment on the programme as they were not involved. One administrative staff member mentioned that she found it inconvenient to take time out to attend the programme,
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but she did, however, state that she received e-mails on testing sessions and appreciates the need to get tested and to lead by example. Another academic added that she did not know much about the programme besides the circulars and a little information about testing day. A student added that the programme “…needs to be developed” (S2).
It can be noted that participants predominately indicated a negative response. With regard to certain aspects participants indicated that familiarity with the programme’s content and effectiveness are lacking. Dell (2010, p.1) made similar observations in his study and noted that “the study found students' lack of knowledge of some aspects of HIV prevention. ‘Inadequate’ answers were given to questions relating to transmission of HIV through breastfeeding, availability of drugs for post-exposure prophylaxis in the case of rape and the legality of sex with partners younger than 16”. The university’s HIV/AIDS programme was evaluated, and these results are outlined below.
6.6 The university’s HIV/AIDS programme evaluated/compared
Institutional documents were analysed, and the rationale to review the institutional documents was to arrive at the research objectives as set out in section 1.1.4.
6.6.1 Compliance with the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education
The Policy and Strategy Framework was based on the “Policy Framework on HIV and AIDS for Higher Education in South Africa” (HEAIDS, 2010) that was adopted in November 2008. The provisions of the 2008 Policy Framework have remained valid, but have been revised to dovetail with the 2012-2016 National Strategic Plan for HIV (NSP), Sexually Transmitted Infections (STIs) and Tuberculosis (TB) (HEAIDS, 2012, p.8). The NSP, which was launched by the South African National Aids Council in 2011 positions a clear role for the Higher Education sector. The Higher Education sector has been engaged in responding to these goals, which include: adoption and implementation of the Policy Framework, a Sero-prevalence and
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Related Factors Report, First Things First HIV Counselling and Testing (HCT) campaign and among these, A Sector Framework for Workplace Programmes.
The institutional document, when compared with the Policy and Strategic Framework, “provides a set of overarching principles and components in order to realise its objectives” (HEAIDS, 2012, p.24). Objective 1 was compared to the university’s programme which reads as follows: “To ensure the comprehensive and appropriate use of the Higher Education mandate of teaching and learning, research, innovation and knowledge generation; and community engagement to effectively respond to the epidemic” (HEAIDS, 2012, p.24). In addition, each component within the Policy and Strategic Framework objective contains suggested programmatic elements to assist institutions in planning, developing and implementing comprehensively conceptualised HIV and AIDS policies and programmes. Component 2 of objective 1 was used to compare the university’s policy. Component 2 intends to: “Develop and implement appropriate, innovative and effective HIV and AIDS combination prevention strategies for the Higher Education sector. This component provides access to comprehensive prevention programmes for staff and students across all campuses and residences” (HEAIDS, 2012, p.25). Elements of component 2 may include:
“HIV, AIDS, STIs, and TB awareness campaigns;
HIV Counselling and Testing (HCT) programmes;
Peer education and health promotion activities; condom use and distribution;
Male medical circumcision;
Prevention of mother-to-child transmission (PMTCT);
STI treatment;
Infection control programmes; and
Initial and on-going training.” (HEAIDS, 2012, p.25).
The university’s HIV/AIDS programme may vary according to HEAIDS. “Individual programmatic elements will inevitably differ, as institutions ensure that operationalisation of the framework is properly contextualised within the institution itself. Finally, the Framework forms the basis for measuring progress in the sector”
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(2012, p.20). The research objective entailed the examination, evaluation and comparison of the extent that the university’s HIV/AIDS programme conformed to the HEAIDS programme. The findings emanating from the examination and comparisons of the university’s programme are discussed in the subsequent sections.
6.6.2 University’s HIV/AIDS workplace programme The university’s HIV/AIDS workplace programme sets out two major goals or pillars of the programme; Goal 1: To prevent the spread of new HIV infection; and Goal 2: To provide treatment, care and support for people with HIV and AIDS. Goal 1 emphasises prevention and treatment of STI’s, condom usage, accessibility of HCT/VCT services to contract staff, Education, Training and Testing, campus media structures, informing staff regarding university policy in relation to HIV/AIDS, and fully functional Staff Peer Educators (SPE’s). Goal 2 emphasises the provision of treatment, care and support for people with HIV and AIDS, and entailed the following: to avail (TB/STI/ARV) resources and services to all staff, support groups for staff, to have own treatment accredited site, absenteeism management, HIV and AIDS disease management, provision of nutritional support, psychosocial support and counselling (Ramafola,2012).
According to the 2012 HIV workplace programme, key activities include the following: peer education program, Staff HIV and AIDS awareness programs, promotion of VCT, distribution of condoms, education about the treatment of STIs, treatment focus on higher-risk groups, World AIDS Day, supporting people with HIV and AIDS, nutritional assistance, grief and bereavement counselling, absenteeism management, reduction of stigma, treatment of STI, access to comprehensive services related to HIV and AIDS for medically insured employees, equitable access to treatment for non-medical aid staff, referral of HIV infected employees to health facilities, training of line managers, up skilling of peer educators and, community development and up-liftment (Ramafola,2012).
The university’s HIV/AIDS workplace programme contains various aspects of the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education,
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hence objective 1, component 2 was satisfied in the following way. The university’s HIV/AIDS programme has most of the HEAIDS Policy and Strategic Framework aspects in place, with for the exception of male medical circumcision; prevention of mother-to-child transmission (PMTCT); and infection control programmes (see Table 5.5 below). There appears to be a strong compliance with the HEAIDS Policy and Strategic Framework. This was substantiated when IOHA co-ordinators and HR wellness members were questioned regarding the programme conforming to the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education. Their responses were as follows: “Yes, this is our mandate together with the Department of Health, HEAIDS National Strategic programme, the university conforms to the two” (Ad1); “It does, the HIV committee education framework we report to HEAIDS quarterly” (Ad2); and “It does 100%, because our policy is aligned with HEAIDS, national strategic plan, co-ordinated regular workshops and conferences and events that are initiated by HEAIDS” (Ad3). Discussion pertaining to the HR wellness report is set out below.
6.6.3 HR Wellness report
The HR wellness report was examined to determine whether deliverables that are mentioned in the HIV/AIDS workplace programme, complied with objectives that are mentioned in the HEAIDS Policy and Strategic Framework. According to the report, these activities were undertaken during the month of March, 2013: Staff HIV/AIDS; TB and STI Awareness; Education and Training Programmes; Reabua talk sessions for Service staff, Line Managers Training; Staff Peer Education Recruitment and Training; HIV Counselling and Testing (HCT) offered as part of Wellness Campaigns Collaborate with Communications to assist with all marketing initiatives; communicating relevant University HIV and Wellness-related policies to staff; referral of staff (insured and uninsured) to internal and/or external services with reference to TB, STIs, and ARVs; nutritional support; clinical management of HIV; and psychosocial support and counselling in accordance with the university’s Wellness Programme for infected staff.
According to the report, most of these activities were met with no challenges (Ramafola, 2013). However, during the one-on-one interviews, the IOHA co-
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ordinator indicated: “For me, we encounter challenges the programme is doing what we wanted it to do customer and counsellor surveys show that” (Ad1). Some of these challenges were identified by participants who, for instance, added that the programme should invest time and effort in their marketing and communication strategy, “Communication, department or body doing this should be better manned they need more people” (A2). “Visibility they can’t stop with the marketing awareness it should be in your face everywhere you go” (Ad5). According to the report, collaboration with communication to assist with marketing was still in progress. Comparisons between the HEAIDS Policy and Strategic framework, the university’s HIV/AIDS workplace programme, and the HR wellness report found that results from the analysis were contradictory to activities and reports in the programme. This statement is supported by the results in Tables 5.5 and 5.11, which revealed that fewer participants attended voluntary counselling and testing, and, that a large percentage of participants indicated that they did not know how often voluntary counselling and testing occurred, while Tables 5.6 and 5.7 revealed that participants were unaware of aspects in the programme’s content. The university’s IOHA policy booklet was examined in order to gain further insight.
6.6.4 University’s IOHA Policy Booklet
The university’s IOHA policy booklet, which concentrates on the university’s institutional policy objectives, was reviewed to supplement findings on previous institutional documents, and to compare the IOHA policy with the university’s HIV/AIDS workplace programme and the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education, to determine compliance with the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education objectives.
The purpose of the IOHA policy was to establish a clear set of guidelines that ensures that all members of the university’s community have a broad understanding of, the impact and consequences of HIV/AIDS. This includes having a better understanding of the physiology of HIV/AIDS and transmission of the virus. The IOHA policy gives careful consideration to behavioural activities related to the transmission and prevention of the disease and associated opportunistic infections and illnesses such as Tuberculosis. Workplace and student issues such as labour
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and equity legislation, human rights and productivity, including that of student success are essential components of the policy. Further to sustained programmes and services, the policy includes mechanisms that address curriculum response in terms of teaching and learning, research and community engagement. The IOHA policy has included an integrated approach to curriculum within departments and faculties. The institution of HIV/AIDS Prevention, Prophylactic and Control Programme are in place to ensure that occupational risks of transmitting or contracting the disease are controlled (UJ IOHA, 2009, p.8).
When comparing the IOHA policy with the HEAIDS Policy and Strategic Framework’s Objective 1, Component 2, one would notice that a few sections are omitted in the IOHA policy. The IOHA policy may not fit the HEAIDS Policy and Strategic Framework as much as the university’s HIV/AIDS workplace programme did, however, there are sections that the IOHA policy contains that the HEAIDS Policy and Strategic Framework do not include. For instance, the IOHA policy (2009,p.8) states that the purpose of the policy is to: “Institute a HIV/AIDS Prevention, Prophylactic and Control Programme to ensure the occupational risks of transmitting or contracting the disease are held in check”. However, the findings of the analysis indicate otherwise. The purpose of the policy (UJ IOHA, 2009, p.8) speaks of “curriculum response in terms of teaching and learning, research and community engagement, as well as an integrated approach to curriculum within and among departments and/or faculties, and institute a HIV/AIDS Prevention, Prophylactic and Control Programme to ensure that occupational risks of transmitting or contracting the disease are held in check”.
A question on targeted programmes, practices or facilities that are available was posed to academics, administrative staff and students alike. A total of 78.8% students, according to Table 5.6, did not know about provision for post exposure prophylactics, while 63.1% did not know about HIV/AIDS awareness within curriculum modules, and 81.6% did not know about needle stick policy. A question around human rights issues relating to gender was posed to stakeholders, hence 54.3% students, 56% of administrative staff and 77% of academics, according to Table 5.9, revealed that they did not know whether the programme addressed
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gender sensitive issues without compromising confidentiality. Policy and the programme may provide purposes and objectives, and yet the impact of such a policy and programme are far from being realised. The results of the HEAIDS research, which was conducted in 2008-2009 revealed that “knowledge levels about HIV and AIDS are generally high but not on all key issues. For instance, HIV transmission risks associated with breastfeeding and drugs for post exposure prophylaxis were less known among students and administration staff” (2010, p.59). It would appear that these results have remained unchanged. The university’s wellness programme for HIV infected students and staff was reviewed in the discussion that follows below.
6.6.5 University’s wellness programme for HIV infected students and staff As stated in the previous chapter, the university’s wellness programme for HIV infected students and staff members is similar to the university’s IOHA Policy Booklet. The purpose of this programme is to provide on-going care and support to HIV infected students and staff. As yet, the university does not offer a complete spectrum of HIV treatment on campus. This programme facilitates a wellness plan for HIV positive patients to ensure that their health is properly managed. The intention for reviewing this programme against the HEAIDS Policy and Strategic Framework on HIV and AIDS for Higher Education was to compare and determine whether the policy meets the Policy and Strategic Framework’s objective 1 and component 2. The intention behind this programme, according to IOHA (n.d), is to ensure the ideal health management of patients who are HIV positive. This includes regular clinical examinations and provision of psycho-social and psycho-educational wellbeing support. Although the programme does not offer anti-retroviral therapy (ART) at the university, various university support structures have been established to offer ART at recommended sites close to the university. Upon their exit from the university, Campus Health offers these patients a referral to a treatment site of the patient’s choice, and continuous psycho-social support is offered by the Positive Conventions group to students who leave the university.
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During the one-on-one interviews participants, in general, were questioned about the referral system that was mentioned in the policy, and an IOHA co-ordinator stated that the referral system, with external stakeholders, was doing well (Ad1). However, none of the participants during the one-on-one interviews revealed that they knew of the referral system. In support of this discussion, participants’ lack of knowledge in this regard can be substantiated by data that was gathered regarding access to ARVs. The referral system allows patients’ access to ARVs. It can be assumed that if students are aware of the referral system, they would also be aware of the availability of ARVs. This assumption may be supported by the quantitative data, which revealed that 85.2% of academics, 76.6% of administrative staff and 85.5% of students according to Table 5.6, did not know about the availability of ARVs at the university.
The university’s wellness programme for HIV infected students and staff members speaks of post exposure prophylaxis (PEP) and Isoniazid Prophylaxis Therapy (IPT). When questioned about the availability of programmes, practices or facilities at the university, 84.3% of academics, 78.8% of administrative staff and 78.8% of students, according to Table 5.6, did not know whether post exposure prophylactics were available. The university’s wellness programme for HIV infected students and staff states that the purpose of this programme is to provide on-going care and support to HIV infected students and staff. However, when students and staff were requested to respond to offer information on the referral system, access to ARVs and the availability of prophylactics, they claimed to be unaware of the availability of such programmes, practices or facilities at the university. Therefore, this implies that the programmes’, practices or facilities that are made available by this programme have not impacted stakeholders, which suggests the ineffectiveness of the programme. The limitations of the study are outlined below.
6.7 Limitations of the study
The findings of this study are subject to at least two limitations. One of the main limitations of the study that arguably may have caused a limitation in the study was participants’ reluctance to participate in the study. The missing items, which represent the nonresponse rate were not helpful in answering specific questions, for
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example, there were 423 missing items in Table 5.14, as respondents did not want to indicate whether they had reason to engage with the programme directly. This is a case where some of the respondents chose not to respond to the question, although they were willing to respond to other questions. Similarly, during the one-on-one interviews, interviewees in some instances responded with a clear “I don’t know”. After much probing, “I don’t know” was all that the participants were willing to offer. The expression on the participants’ faces could easily be interpreted as indifference. This was disturbing. However, conversely, some participants used the opportunity to complain about the programme diverting from the original question. However, under careful direction, interviews were redirected to the avoided questions. This helped to strengthen the outcome of the research.
The diverted responses forced the researcher to spend a longer time with the interviewees, however, the additional time spent with the interviewees allowed for a richer response. Having experienced challenges with some stakeholders, it was disappointing to receive an indifferent response at the university’s Human Resource (HR) Department. The supposed “custodians” of university personnel refused to participate in the study. Access to their inputs would have been invaluable. One out of fifteen questionnaires was answered by the HR Department, with the one respondent being a former student of the researcher. In addition to the Human Resource Department, campus security was unable to participate in the study, and yet during the pilot interview phase it was revealed that a significant number amongst campus security personnel were challenged by the disease, hence their feedback would have been crucial to the study. These individuals would have been able to offer insight into the awareness and perception levels of the university’s HIV/AIDS programme.
In addition to the many challenges faced when interacting with various stakeholders, academics proved to be the most limiting. It was disturbing to find that many academics refused to participate in the study, an almost mirrored response to the university’s HIV/AIDS programme. Academics were unwilling to co-operate with the study, which is quite ironic, considering that academics are familiar with the effort that is required when conducting a study. The next limitation involves asking
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participants to indicate on which campus they were based. This question was not asked, and would have allowed for the reporting of findings per campus. The findings of this question would have alerted programme co-ordinators to the campus with the most needs. However, this allows room for future studies, using the same questionnaire with one additional question.
Figure 6.1: Limitations of study
Limitations of Current study study
Figure 6.1 diagrammatically demonstrates how minor limitations may tip the scale of research. However, the strength in the value-added contribution allows for a positive imbalance. Significance of the study follows below.
6.8 Significance of the findings
Overall, the empirical study assessed the effectiveness of the HIV/AIDS programme and highlighted areas that are lacking in the HIV/AIDS programme. Participants’ lack of tangible awareness with regard to the programme’s purpose, facilities, practices and content was identified as a major area that affected the effectiveness of the HIV/AIDS programme. The programme appeared to have concentrated to a large extent on voluntary counselling and testing, with little attention given to attracting participants towards programme awareness, visibility and exposure to the purpose and objectives of the programme. Respondents know about the programme and not about the programme’s content. Knowing about the programme does not suggest
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that respondents are aware of the guidance provided in the programme. The programme seemed to have lacked ease of access and user-friendliness. If either of these factors were in place, far more respondents would have been aware of the programme’s accessed facilities, and would have been aware of the practices within the programme. According to respondents, posters do create visibility of the existence of the programme, but not of its accessibility to the content of the programme, which is vital when in search of assistance. As the interview word cloud in Figure 5.6 depicted, more involvement, improvement, visibility and awareness is needed. Once again, this points to little effort that has been placed on attracting stakeholders and other interested parties to the programme.
The study established that the quarterly reports requested by HEAIDS provide for regular upkeep of the programme. In the absence of these reports, the programme runs the risk of disuse. If the HIV/AIDS programme is not reviewed, academic, administrative staff and students will not be informed of the improvements and objectives of the university’s HIV/AIDS programme. Final year students will continue to exit the university as HIV positive, and will be clueless about the programmes, practices and facilities that they could have accessed as students, while at the university. Academics, whilst being absorbed in their daily activities, would not be able to access vital information that could easily be passed on in the lecture room. Administrative staff, with their vast awareness of the disease and the programme, show promise as having potential to be utilised as peer buddies and ambassadors of the programme. Students have the potential to be recognised as a catalyst of change and inspiration can be attained from those who take the initiative to address the disease without lassitude.
6.9 Summary
This chapter discussed the research findings. Findings from the questionnaires and interviews were combined, in order to address similar issues whilst being true to mixed method methodology. The university’s HIV/AIDS programme is guided by the HEAIDS Policy and Strategic Framework. The HEAIDS Policy and Strategic Framework is a document that standardises and guides all issues pertaining to HIV/AIDS programme and policy. In the absence of the HEAIDS Policy and
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Strategic Framework, universities would be ill-equipped to develop and implement HIV/AIDS programmes and policy. The university’s HIV/AIDS programme, together with other institutional documents, was compared to the HEAIDS Policy and Strategic Framework. The HEAIDS Policy and Strategic Framework allows for variations in the HIV/AIDS programme. The university’s programme, when compared to the HEAIDS Policy and Strategic Framework, was lacking in certain areas. However, this allowed for variation in the programme. The programme paid more attention to voluntary counselling and testing rather than to the promotion of programme awareness. Respondents were unaware that the programme’s purpose was to mitigate HIV/AIDS within the university, or that gender sensitive issues is a criteria in the IOHA Policy Booklet, or that the university has a referral system for HIV positive staff and students. The programme displays the inner workings of an effective programme and yet, like a disappointing ending, the programme fails to impress. In the final chapter the researcher concludes and makes recommendations concerning the research study, allowing for future evaluation of the university’s HIV/AIDS programme.
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CHAPTER 7 Recommendations and Conclusion
7.1 Introduction
The purpose of the study was to evaluate an HIV/AIDS programme at a South African university. The research problem encapsulated the view that among the abundance of HIV/AIDS policies and programmes, the need for a comprehensive HIV/AIDS policy and programme had to be developed. HEAIDS, in conjunction with HEIs and the government, developed the HEAIDS Policy and Strategic Framework. The framework, designed by HEAIDS, sets out objectives and instructions that are directed towards HEIs in South Africa. These directives are costumed to guide HEIs on HIV/AIDS programme design and implementation. One of the key directives of the framework is the evaluation of the programme upon completion of the implementation process. Several HEIs around South Africa have successfully implemented this mandate. However, of the various HEIs that have implemented HIV/AIDS policy and programmes, many have yet to undertake an evaluation of their policy and programme. Research questions stemmed from this problem statement that resulted in research objectives that guided development of the study. The problem statement led to various research questions, which motivated the research objectives that guided the development of the study.
7.2 Addressing the research objectives The main research objective was aimed at evaluating the effectiveness of the HIV/AIDS programme. This was followed by four subsidiary objectives. The first objective of the study was aimed at examining current HEAIDS HIV/AIDS programmes within a university, hence the researcher was able to understand and appreciate the university’s HIV/AIDS programme. This process enabled the formulation of the self-administered questionnaires, which in turn formed the basis of the semi-structured questionnaires. The second objective was aimed at comparing the extent to which the university’s programme conformed to the HEAIDS 2012 Policy and Strategic Framework. This process permitted the researcher to compare and evaluate the HEAIDS Policy and Strategic Framework with the university’s HIV/AIDS programme. The outcome of the comparison provided the researcher with
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evidentiary support regarding the university’s compliance with the HEAIDS Policy and Strategic Framework. The third objective was aimed at understanding stakeholders’ perceptions of the HIV/AIDS programme’s content within the university. The purpose of this objective was to determine stakeholder knowledge of the programme’s content. It is presumed that knowledge of the programme’s content may determine the effectiveness of the programme, as the programme continues to inform stakeholders within the university. The fourth objective was aimed at critically examining stakeholders’ (academic, administrative staff and students) awareness of the HIV/AIDS programme. The purpose of this objective was to determine stakeholder awareness regarding the programme. It was presumed that higher levels of awareness may suggest a degree of effectiveness. However, this was not the case. An overview of the findings is set out below.
7.3 Overview of findings
An overview of the findings indicate that participants appeared to be aware of the HIV/AIDS programme based on their familiarity with the voluntary testing and counselling sessions that occur in and around the university. Actual participant awareness of the HIV/AIDS programme became apparent after further investigation, when quantitative and qualitative data was compared and assembled, which resulted in the in a coherent compilation of evidence. The demographic data offered a breakdown of the gender and sample size of each stakeholder group. The findings did indicate that more women than men participated in the survey. However, these statistics do not rationalise why more females participated in the survey. A possible explanation, one could postulate, is that women are possibly more approachable than men.
Stakeholders’ perceptions of the university’s HIV/AIDS programme were evident at the outset, where 79% of the participants indicated that they did not participate in the programme. When questioned about the programme’s content, voluntary counselling and testing was mentioned. Participants attribute knowledge of programme content to voluntary counselling and testing. Participants were asked of the ways in which HIV/AIDS is mitigated at the university, and yet again participants were unable to answer. Specific areas within the programme were unknown to most
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participants. Fewer academics participated or knew of the programme compared to administrative staff and students. The findings of the research are clear: participants at the university do not know the content of their HIV/AIDS programme. Academics, in particular, are oblivious of the programme, other than the voluntary counselling and testing sessions that are occasionally visible at the university. This is by default, as the testing sessions are generally done on a large scale, without noticing that a session would be unlikely. Administrative staff members were equally unaware of the programme’s content. However, administrative staff’s level of non-participation in the programme was far lower than that of the academic staff. Comparatively, students’ knowledge of the programme’s content did not fare as well when compared to administrative staff. Students’ lack of knowledge of the programme content ranked between academic and administrative staff. Being unaware of the programme’s content reflects negatively on the effectiveness of the programme. A programme cannot be classified as effective if the individuals that the programme was designed to serve are unaware of the programme’s content.
Awareness levels of the university’s HIV/AIDS programme were further investigated, as participants were questioned on aspects relating to their awareness of the university’s HIV/AIDS programme, and in this regard all three groups of participants were consistent in their answers. The data suggested that participants are aware of the programme. However, these findings were contradicted during the one-on-one interviews. Participants were aware of the existence of the programme through posters, word-of-mouth and voluntary counselling and testing. In simpler terms, participants’ awareness may be compared to being familiar with the name of an individual, and yet not knowing the individual. This type of awareness may be classified as superficial awareness, which means having the perception of something’s existence, unlike non-superficial awareness, which involves understanding (Ossimitz, n.d, p.4). One can conclude that participants have heard of the programme, but are unaware of the contribution that the programme affords. This is supported by participants’ statements during the qualitative interviews. These statements when compared with data from the previous section, support the inference that the extent of participants’ awareness of the programme is minimal.
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The effectiveness of the university’s HIV/AIDS programme was examined when participants were asked if they engaged with the programme and whether the programme has improved since they first heard of the programme. Table 5.3 clearly illustrated that academics did not respond positively to both questions, while administrative staff and students had a slight improvement in their response. Academics were the least responsive compared to the other groups. However, the improved response of the administrative staff and students did not suggest that the programme was effective. The responses suggested that administrative staff and students responded more positively to the questions than academics.
Holistically, fewer participants had reason to engage with the programme and fewer participants agreed that the programme had improved. This implies that the programme is ineffective as the purpose of the programme is to engage participants and inform them of the facilities and options that are available to them. If a participant does not know whether a programme has improved, it suggests that the participant is not utilising the programme to know the difference. Participants’ lack of engagement and knowledge of the improvement of the programme may prove that the programme lacks effectiveness. These findings have contributed to the value- add of the study. Programme co-ordinators would now have a clearer picture of the effectiveness of the HIV/AIDS programme. The systematic review of literature, the gathering and analysis of data have allowed for theoretical, methodological and practical contributions towards understanding the effectiveness of the university’s HIV/AIDS programme.
7.4 Recommendations
As a result of the research findings, the study has revealed various recommendations that the university may consider in order to further improve the current state of the university’s HIV/AIDS programme. Taking direction from the striking statement identified within the word cloud, which clustered data to reveal the following dominant words, namely “more programme needed’, ‘needs involvement’, ‘improvement’, ‘visibility’ and ‘awareness’, the recommendations are proposed below.
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1. There is a need for a comprehensive programme
The first sets of words, namely “more programme(s) needed” may appear confusing at first, however, on completion of the study it is clear that the existing HIV/AIDS programme is ineffective. This programme should be reconsidered. It is recommended that programme co-ordinators should consider revising the programme. The programme should expand on its existing structure and should consider including an additional group of stakeholders, for example, contract staff and other contracting parties to be covered and involved in the programme. This group of stakeholders, although not currently included in the university’s HIV/AIDS programme, should continue to interact with other stakeholders mentioned in the current HIV/AIDS programme. Human nature compels individuals to interact; this interaction may lead to friendships, associations and sexual interactions. In order to avoid individuals from interacting, unaware of the benefits that may be derived from the programme, it is best to include them and make them aware of these benefits. This would include the involvement of many stakeholders at the university, as the decision to include contract staff and other contracting parties should come from the university’s executive leadership.
2. Increase stakeholders’ involvement
The university’s HIV/AIDS programme requires more involvement. The study revealed that academic staff members are reluctant to participate in the programme. However, academics have not taken the initiative to include HIV/AIDS in the curriculum, and this integration does not compel an academic to disclose his or her status. Curriculum integration entails the inclusion of HIV/AIDS material within existing modules. The reasons mentioned by academics for not participating in the programme will not apply in this instance. Academics may use their lecture periods to interact with their students and the programme, as this will help to create awareness of the programme. Yet academics have not considered in doing their share of including HIV/AIDS in the curriculum. Citizenship and diversity are issues that are given priority at the university. Academics are compelled to complete annual reports that set out and explain how citizenship and diversity would be included in the curriculum, and yet HIV/AIDS remains on the planning table. Heads of Departments, professors and Deans have not involved themselves in the
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programme. Curriculum integration should be a directive that comes from the top down, and this responsibility lies with Vice Chancellors who are equally accountable. Administrative staff members know about the programme, but are nonetheless unenthusiastic about working with the programme. Students are not adequately attracted to involve themselves with the programme. Involvement in the programme is non-credit bearing and, therefore, the need to participate is of little value to a student.
Creative measures should be devised to involve stakeholders and executive leadership in the programme. A possible suggestion would be to include participation in the programme as an aspect within performance contracts. Academics and administrative staff should be compelled to participate in the programme in order to satisfy performance criteria, which are necessary for bonus and promotional purposes. Students should receive credit for participation in the programme, and may be exempt from participation on passing a module based on the HIV/AIDS programme. This module should be included across all qualifications within the university. Hence, departments would be forced to develop curricula that address and access HIV/AIDS issues within the university and community. By implementing these recommendations, the programme would reap the benefits of improvement.
3. Improvement of the programme
The university’s HIV/AIDS programme is in need of improvement and the study has shown that many participants have not heard of aspects of the programme. Improvement in the programme would revive and stimulate areas in the existing programme that have been dormant. HIV/AIDS programme administrators should reconsider the programme and compare it with that of other universities, which have a reputation for operating efficient programmes. Consultation with HEAIDS administrators may be beneficial in this process. The need for additional help, as requested by HIV/AIDS administrators, may be resolved by utilising the skills of student assistants, HR interns and volunteers. The university’s HR Department should come to the aid of these administrators. They are not doing their part in fighting the epidemic, hence they should be held accountable. HIV/AIDS visibility
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and awareness should begin at HR and flow into student enrolment and orientation programmes.
4. Improved visibility and awareness of the programme
Visibility and awareness is a serious concern, because merely knowing about VCT does not suggest that stakeholders are aware of the programme. This was apparent in the findings of the study. HIV/AIDS posters are symbols of awareness and yet levels of awareness are minimal. The popularity of VCT sessions at the university can be utilised as a platform to inform stakeholders of the programme. Visibility and awareness may take many shapes and forms, and posters are one such example. The university’s HIV/AIDS officers have not explored drama as a platform to create awareness; this is widely done at other universities in South Africa. Social media is also an avenue that is often used at the university when students need to be informed of their application status, supplementary exams, or poor performance, and this should be considered as well.
Edulink, the university’s Blackboard system, is another avenue that HIV/AIDS officers should consider. Edulink may be utilised by including “pop-ups” that remind students about using a condom or considering VCT. HIV/AIDS awareness messages may be included in timetable booklets that are distributed at registration. HIV/AIDS messages may be included in learning guides, Department notice boards, and university entrances, while posters can be placed in bathrooms, the student centre, library, lecture rooms and billboards around the university. These are a few suggestions that HIV/AIDS officers may consider as means to create awareness and visibility within and around the university. Another suggestion may include the need for continuous research.
5. The need for ongoing research
The need for further research has been briefly hinted at under the proceeding section; namely contributions of the study. This could possibly be a replication of this study with the permission and possible funding of HEAIDS at other HEIs within South Africa. An appreciation evaluation may be an alternate suggestion for further research at the university. The appreciation evaluation would allow for further
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research and involvement in the programme whilst creating programme awareness. An unexplored area and a possible suggestion would include investigation around possible funding and an opportunity to replicate the study through the Association of African Universities (AAU) into other parts of Africa. It should be noted that HIV/AIDS has affected most parts of Africa and in the process has not excluded HEIs within these countries. The possibility of replicating this study would be a contribution in itself. A practical recommendation would include the need for ongoing research, utilising a team of researchers or post graduate assistants that would allow for extensive field work, and accessing a larger sample size. Improvement in the dissemination of the programme, combined with extensive research and marketing of the programme, would enable greater coverage and awareness of the programme at the university. This would allow for ongoing research within the area of HIV/AIDS. Ongoing research would allow for the university’s HIV/AIDS programme to remain active. The need to research would encourage stakeholder involvement, which would improve the programme, create visibility, awareness and, in turn, increase the scope for further research, resulting in a new journey of improvement and development.
7.5 Conclusion of the study
As with every journey there is a destination, and often the journey inevitably makes memories where taking pictures is a norm and a reflection of the distance covered. Figure 7.1 below is a snap shot of this journey of the HIV/AIDS programme’s evaluation at the university. Seven pictures were taken, each a stopover of discovery and a step closer to arriving at the final destination, namely the completion of this PhD thesis. Figure 7.1 is a glimpse of the journey, which covers a visual representation of the seven chapters that comprise the thesis.
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Figure 7.1: A glimpse of the journey covered
Chapter 7 Recommendation Chapter 6 and conclusion Discussion of Chapter 5 findings Data analysis Chapter 4 Chapter3 Research HIV/AIDS design and Chapter 2 within a methodology Chapter1 Conceptualising higher HIV/AIDS education Introduction environmen to the study
This journey began with Chapter 1, the introductory chapter, which provided a road map of the journey and the chapters ahead. This introductory chapter set out the problem statement, research objectives whilst highlighting the effect of HIV/AIDS within South African HEIs. A concern then arose about the need for the Department of Higher Education to consider ways of mitigating the impact of the disease within HEIs. With the establishment of HEAIDS, the Department of Higher Education and various HEIs were able to establish the HEAIDS policy framework on HIV/AIDS for Higher Education in South Africa. The 2008 HEAIDS policy frame work was revitalised to align with the 2012-2016 National Strategic Plan, which was to be renamed the 2012 Policy and Strategic Framework on HIV and AIDS for Higher Education. This document formed the guiding document in addressing the second research objective. Chapter 1 continued to discuss the HIV/AIDS workplace programme and the purpose of the programme within the workplace. Research design, approach and methodology were briefly discussed. The data collection process, sampling, ethical considerations, data collection procedure, limitations and quality assurance criteria were also unpacked.
Chapter 2 and 3 dealt with conceptualising and an understanding of HIV/AIDS within a higher education environment. At the outset this clarified the distinction between the use of the terms HIV/AIDS or HIV and AIDS. Clarification of these terms was followed by the literature review, which commenced with a historical overview of the
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progression of the disease through the African continent. The symptoms related to HIV were discussed as a means of establishing the nature of the disease, transmission of the disease, and the reason for concern. The need to deliberate on the myth that shrouds the disease was essential, as myth and stigma are contributing factors that encourage transmission of the disease. Stemming from this rationale, HIV/AIDS in South Africa was explored by focusing on individuals who live with HIV and AIDS, and the significance of the HIV/AIDS stigma on the lives of individuals who are infected and affected by HIV/AIDS. In light of the level of HIV/AIDS prevalence in South Africa, the research included the role of HIV/AIDS, the health care systems and the strain placed on this system, which inadvertently applies undue pressure on business.
With the business sector sustaining the pressure of the disease, no sector was excluded from the path of the disease, and one of these sectors is education. The literature addressed the education sector as a workplace, which faces the impact of HIV/AIDS similar to any other sector. Chapter 3 went on to discuss current levels of HIV/AIDS awareness at the focussed university; HEAIDS submissions in relation to averting the impact of HIV/AIDS within the university; interventions undertaken by the university; and the HIV/AIDS programme. The chapter unpacked the HEAIDS policy framework, the objectives of HEAIDS Framework for HIV and AIDS Workplace Programmes, the effectiveness of HIV/AIDS programme in HEI and the challenges, which face HIV/AIDS programmes in HEI.
Chapter 4 focused on research design and methodology and informed the reader about the process that was followed by the researcher to attain the necessary data to answer the research questions. The chapter discussed research design and methodology. The research approach in this chapter introduced the research design which in turn introduced the research methodology. The differences between the research design, and research methodology were presented in a table for easy comparison. The research process was described by using a horizontal organisation chart. The theoretical framework unpacked the choice of paradigm, which suggested the type of methodology. Three types of methodology were discussed. The advantages and disadvantages of each methodology were debated. Evaluation
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research was deliberated and a nine step evaluation plan was identified as a practical route by which to approach the study. Within evaluation research, the pragmatic paradigm was identified as the most appropriate paradigm that was suited for the study. Literature directed the choice of methodology based on the paradigm chosen. The mixed method research design was selected as the methodological inquiry. As a method, it focused on collecting, analysing and mixing quantitative and qualitative analysis in one single study. The research methods within mixed method were discussed, and the explanatory sequential design was chosen. The rationale for choosing the design was elaborated upon. An alternating flow chart was used to diagrammatically describe the research process, which was used. The purpose, role, advantages and disadvantages of triangulation were unpacked. This was followed by the data collection procedure, analysis, questionnaires, pilot study, interview process, document review, sample, and ethical and quality assurance concluded the chapter with a prelude to Chapter 5, which dealt with the data analysis.
Chapter 5 analysed the quantitative and qualitative results that were drawn from self-administered questionnaires and semi-structured interviews. Statistical analysis and content analysis were used in the analysis of the data. The explanatory mixed method was relied upon during data analysis. This method suggests that quantitative results should guide the qualitative process. The quantitative data preceded the qualitative data. The data chapter was, therefore, set out to present the sequence of the study. The chapter commenced with quantitative research data processing, followed by a recap of the research questions. The intention was to direct the reader to the purpose and origin of the study. The research questions directed the sequence to which the analysis was set out within the quantitative and qualitative sections of the chapter. An explanation of the data followed. Descriptive statistics, cross-tabulation, chi-square test and frequency distribution were used in the analysis of the results. Subsequent sections dealt with statistical analysis, and demographic data was presented at the outset. The first section on perceptions of the HIV/AIDS programme’s content was analysed according to stakeholders’ overall perceptions. This process was followed through to the remaining two sections, namely programme awareness and programme effectiveness. These sections were
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followed by the qualitative phase of the study, namely analysis of the interviews by using content analysis (see Appendix I and Appendix J).
Chapter 6 recounted a discussion of the findings. This chapter discussed perception of the HIV/AIDS programme’s content, programme awareness and programme effectiveness. A discussion of the findings was merged, as both quantitative and qualitative data was integrated, allowing for a discussion that mixed statistical data with narrations. Institutional documents were not excluded from this process. Where possible, discussions regarding institutional documents were supported either with statistical data or narrative accounts. The purpose for the mixture was to explicate the essence of the mixed method. Chapter 6 culminated in the limitations of the study and a brief overview of the significance of the findings. As the journey reaches an end and as the researcher recollects moments in the journey, contributions that were made during this journey come to the fore. Contributions derived from this journey should not go unnoticed, as within these contributions are lessons for future travellers that wish to investigate the university’s HIV/AIDS programme.
The findings of the study have substantially contributed to our understanding of the HIV/AIDS programme’s evaluation at a South African university. Whetten (1989,p.494) explicates the essence of a value added contribution as clearly demonstrating the newness of its contribution, provided that compelling logical or empirical evidence for the new explanations given, and argue the impact that the contribution would have on research practice. The type of evaluation used in this study was a process or formative evaluation, as stated in section 3.4.3.5 of Chapter 3. The purpose of process or formative evaluation is to examine the process of implementing the programme, and determines whether the programme operates as planned. The programme theory or theory of change identifies programme activities, intended programme outcomes and specifies a chain of underlying assumptions, which link programme activities, intermediate outcomes, and ultimate goals (Wholey, 1987, p.78). The study contributed to the theory of change in various ways. Theoretical discussion on the theory of change was set out in Chapter 3, Figure 3.3.
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The study established that the university’s HIV/AIDS programme’s existing theory of change is archaic and in need of comprehensive transformation. Contributions to the theory of change are suggested in the following ways: the programme should be re- launched, while staff and students should be informed of the programme through an interactive marketing campaign that involves academic staff as much as students, and awareness of the programme should shift from voluntary counselling and testing to distribution of the programme content through interactive marketing. The programme should provide access to HIV awareness and gender issues. Staff and students should participate in activities other than and including voluntary counselling and testing, while accessing the programme through programme content non-superficially.
Awareness campaigns should be implemented at all campuses and among all stakeholders. Staff and students must internalise the programme. This process should be accessed through competitions and give-aways as programme co- ordinators develop and evaluate new activities. Staff and students are encouraged to participate through Edulink and the Intranet. Programme co-ordinators should assist staff and students with department campaigns and presentations and students with department campaigns, presentations and elections of HIV/AIDS champions within the academic fraternity. Finally, staff and students should acquire awareness, which is validated through a survey questionnaire and focus group interviews in preparation for a new evaluation cycle. Figure 7.2 below illustrates a theory of change post-evaluation, and unlike Figure 4.3, Figure 7.2 projects the adjustment made to Figure 3.3, portraying a revived Theory of Change, which is guided by the findings of the study.
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Figure 7.2: Theory of Change HIV/AIDS workplace programme post-evaluation
Awareness campaigns Programme provides Re-launch HIV/AIDS implemented at all access to HIV awareness programme campuses with all and gender issues stakeholders
Staff and students Staff and students to Staff and students begin internalise programme . hear of programme to participate in activities Staff and students through interactive other than and including awareness of marketing with possible voluntary counselling programme accessed incentives and testing through competitions and give-aways
Awareness of HIV/AIDS Staff and students Programme to shift from Staff and students begin Programme develops acquire awareness this is voluntary counselling to access programme and evaluates new validated through survey and testing to through the programme activities questionnaire, focus distribution of content group interviews programme content
Programme co- Staff and students needs ordinators assist staff Staff and students are Increased awareness are targeted by exposure and students with encourage to participate through interactive to HIV/AIDS referal department campaigns, through Edulink and marketing systems, access to ARV presentations and intranet and other facilities elections of HIV/AIDS champions
Source: Author’s fieldwork adapted from Weisse, 1998, p.59
The methodological contributions of the study can be summarised as ease and efficacy in which mixed methods can be combined into a fluid discussion. The ease in which this method can be blended is a contribution to mixed methodology. The mixed methodologist fraternity continues to debate the challenges that they face when mixing quantitative and qualitative results (Bryman, 2007, p.9). The discussion of findings in Chapter 6 is indicative of this contribution. The blending of both quantitative and qualitative results was effortless, providing a seamless discussion of the findings. The second methodological contribution is the use of qualitative data visualisation. This is a relatively new way of appreciating and exhibiting qualitative data through the representation of raw data into a visual display (Erwin, 2008, p.2). A word cloud, as it is known, is a creative way of displaying frequently used words that are gathered during qualitative data collection. The use of a word cloud is an unusual and alternative way of depicting data unlike graphs, and this method complements the expressiveness and depth of qualitative methodology.
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The practical contribution of the study is clear. The findings of the study are ample reason that programme co-ordinators cannot delay programme evaluation. The validity and reliability are contributing factors, which proclaim that this study has the ability to be replicated, and hence encompass a larger sample size. Furthermore, this study’s practical contribution allows for replication of a similar study at the remaining HEIs in South Africa and abroad if necessary. The second practical contribution is data that is acquired during the survey phase. This data allows for a rich source of information that can be mined. Individuals who are interested in areas of the university’s HIV/AIDS programme may re-examine the data and extract an area of interest, for example looking at HIV/AIDS posters as a means of communication. The third contribution is that the study offers an alternative method to the evaluation of the HIV/AIDS programme at the university.
The current study evaluated the university’s HIV/AIDS programme through an explanatory mixed method lenses. This research may be revisited by using an exploratory mixed method whereby researchers may reconsider the study and investigate why aspects in the explanatory worked or did not work. The fourth contribution would include the next phase of this study, which would entail an impact evaluation, which investigates the impact of the HIV/AIDS programme in support of the implementation evaluation. A logic model may be utilised in place of a theory of change. This would complement the recently developed HEAIDS Logic model. The Logic model may be used as an evaluation tool in future studies on HIV/AIDS programme evaluation. The last contribution is that the study allows room for a qualitative study as an option, as semi-structured interviews (see Appendices F, G and H) may be expanded to assess participants’ feelings and sense of the programme, whilst evaluating the effectiveness of the programme. As the journey closes with an almost nostalgic end, the need to caution or say a few meaningful words is almost always necessary. The researcher looks back at the road travelled and recollects the tasks completed, the heartache felt when the slowness of the journey became unbearable and yet the purpose of the journey was unmistakeably important. The distance travelled to carry a message was well worth the journey when on delivery, lives are changed.
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The former President of the United States of America, Bill Clinton, succinctly summarised the journey, which was the purpose of this study: “we live in a completely interdependent world, which simply means we cannot escape each other. How we respond to HIV/AIDS depends, in part, on whether we understand this interdependence. It is not someone else’s problem. This is everybody’s problem.” This thesis has investigated the university’s HIV/AIDS programme. It compared the extent to which the university’s HIV/AIDS programme conformed to the HEAIDS Policy and Framework, whilst critically examining stakeholder awareness and understanding of the perceptions of the content of HIV/AIDS programme within the university, and evaluating the effectiveness and awareness of the university’s HIV/AIDS programme.
When comparing President Bill Clinton’s statement and the purpose of this study, which was to evaluate the effectiveness of the university’s HIV/AIDS programme, how we respond to HIV/AIDS depends, in part, on whether we understand our interdependence with our communities and their people. This research was undertaken to evaluate the university’s HIV/AIDS programme in order to access the programme’s effectiveness, and hence make recommendations that will benefit and improve the programme, thereby making the outcome of this study not someone else’s problem, but everybody’s problem. By embracing the recommendations suggested in the study, the university and the communities that partner with the university would be positively impacted, as there will be substantial improvement as the programme attempts to change the face of HIV/AIDS at the university. The journey has ended only to pass the road map to others who will embrace the contributions and implement the recommendations.
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Weyers, M. L., Strydom, H., & Huisamen, A. (2011). 'Triangulation in social work research: the theory and examples of its practical application’, Social Work/Maatskaplike Werk, 44: 2, 207-222
Whetten, D.A. (1989). What constitutes a theoretical contribution? Academy of Management Review, 14(4), p.490–495. Retrieved from http://chitu.okoli.org/bios/pro/research/research-summaries/whetten-1989
Wholey, J. S. (2004). Handbook of Practical Program Evaluation. San Francisco: Jossey-Bass.
Wholey, J. S. (Ed). (1987) Organizational excellence: Stimulating quality and communicating value. Lexington, MA: Lexington Books.
Wholey, J., (1987) Evaluability assessment: developing program theory, New directions for evaluation, vol. 33, pp. 77-92.
World Health Organisation (WHO) (2013) Male circumcision for HIV prevention Retrieved from available http://www.who.int/hiv/topics/malecircumcision/en/
Yale school of Management and Change Observer (2013). Treating HIV/AIDS in South Africa Retrieved from http://nexus.som.yale.edu/design-project- m/?q=node/97
Yeasmin, S., &. Rahman, K. F. (2012). Triangulation Research Method as the Tool of Social. Science Research BUP JOURNAL, Volume 1, Issue 1, September 2012, ISSN: 2219-4851 Retrieved from. http://www.bup.edu.bd/journal/154-163.pdf
Yin, R.K. (1989). Case Study Research: Design and Methods (Applied Social Research Methods). Thousand Oaks. Sage Publications
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Young, S.D, Hlavka, Z, Modiba, P, Gray, G, Van Rooyen, H, Richter, L, Szekeres, G., & Coates, T. (2010). HIV-Related Stigma, Social Norms, and HIV Testing in Soweto and Vulindlela. South Africa: National Institutes of Mental Health Project Accept (HPTN 043), J Acquir Immune Defic Syndr. 2010 December 15; 55(5): 620–624. Retrieved from http://pubmedcentralcanada.ca/pmcc/articles/PMC3136617/pdf/nihms253003.pdf
Zinovieff, M.A. (2008). Review and Analysis of Training Impact Evaluation Methods, and Proposed Measures to Support a United Nations System Fellowships Evaluation Framework. World Health Organisation (WHO) Department of Human Resources for Health. UN Task Force on Impact Assessment of Fellowships Geneva Retrieved fromhttp://esa.un.org/techcoop/fellowships/SFOMeeting/ParticipantArea/Backgro undDocuments/6_REVIEW%20report%20FINAL%20.pdf
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Appendix A: Ethics approval
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Appendix B: Request to assist with survey
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Appendix C: Questionnaire academic staff
Evaluation of HIV/AIDS programme at a South African university
The aim of this research is to examine academic staff perceptions of the current HIV/AIDS programme at the university.
You are invited to participate in this survey. The purpose of the survey is to enable the researcher to obtain data for completion of a doctoral study. Participation is voluntary and anonymous. All responses will be treated as strictly confidential, while no respondent will be identified in this survey.
The survey consists of four sections: Section A includes demographic-related questions; Section B includes HIV/AIDS programme-related questions; Section C includes detailed questions, which relate to your perceptions and experience of the HIV/AIDS programme at the university; and Section D includes questions on the HIV/AIDS programme’s content. The survey is expected to take you approximately 15 minutes to complete. Please read each question statement carefully, and select answers that are most applicable to you.
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Section A: Demographic Questions
1. What is your gender?
Male Female
2. What is your age?
Under 21 years 21 to 30 years 31 to 40 years 41 to 50 years 51 to 60 years 61 years and older
3. What is your position within the university?
Contract Lecturer Junior Lecturer Senior Lecturer Associate Professor Professor Head of Department Dean of Department Other, please specify
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Section B: Programme Awareness
4. Have you heard of an HIV/AIDS programme at the university?
Yes No
5. If yes, where have you heard about the programme?
Campus Clinic Lecture room Edulink Posters Other, please specify
6. Do you feel that the HIV/AIDS Programme is relevant to you?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
7. Do you feel that the HIV/AIDS Programme is relevant to the university?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
8. Have you had reason to engage with the programme directly? Please give a reason for your answer.
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______
9. Are HIV/AIDS posters visible at the university?
Yes No Do not know
10. Has the poster had any impact on you?
Not at Low Slightly Neutral Moderately Very Extremely all
11. How often are these posters changed?
Monthly Quarterly Annually World HIV/AIDS awareness week Seldom Do not know
12. How often do you receive HIV/AIDS awareness brochures/leaflets?
Weekly Fortnightly Monthly
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Quarterly Annually Never
Section C: Health Management
13. How are condoms distributed at the university?
How are condoms distributed: Yes No Do not know Condom dispensing machines By collection In the university toilets Other forms of distribution. Please specify:______
14. How do academics obtain information about HIV/AIDS services, which are provided at the university? ______
15. Is Voluntary Counselling and Testing available at the university?
Yes No Do not know
16. If yes, how did you find out about Voluntary Counselling and Testing at the university? If no, or do not know proceed to Question 20. ______
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______
17. How often does the university conduct Voluntary Counselling and Testing sessions?
Weekly Fortnightly Monthly Quarterly Annually Unsure Do not know
18. Have you attended any Voluntary Counselling and Testing sessions at the university? If yes, please proceed to Question 20. Yes No
19. If you have not, please explain why not. ______
Section D: HIV/AIDS Programme content
20. Are the following targeted programmes, practices or services available? In the table below, please indicate whether the following programmes, practices or facilities are available at the university.
Programmes, practices, services Yes No Do not know Academic staff counselling services for HIV/AIDS
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Academic staff HIV/AIDS testing service HIV educational or awareness programmes Provision for post exposure prophylactics Needle stick policy Peer support for HIV/AIDS infected academic staff Peer support for HIV/AIDS infected staff HIV/AIDS awareness within curriculum modules Academic staff access to anti-retro virals (ARV’s)
21. Does the university’s HIV/AIDS programme explain the following and which do you think are important?
Yes No Important Not important Confidentiality during testing and counselling Promotion of a safe working environment Compensation for occupationally acquired HIV Employee benefits and provision and care Procedures for dispute resolution and grievances related to HIV/AIDS HIV/AIDS and employment issues, including incapacity, termination of service, alternative employment Education and training available to academic staff
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22. Does the programme address gender sensitive issues without compromising academic staff rights and confidentiality?
Yes No Do not know
23. Does the programme adequately deal with the following?
Yes No Do not know Prevention of HIV/AIDS Treatment of HIV/AIDS Ways of mitigating HIV/AIDS within the university
24. Has the HIV/AIDS programme improved since you first heard of the programme? Yes No Do not know
25. If yes, please explain. ______
Thank you for your contribution.
Please forward the completed questionnaire to Jenni Gobind at [email protected]
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Appendix D: Questionnaire administrative staff
Evaluation of HIV/AIDS Programme at a South African university
The aim of this research is to examine administrative staff perceptions of the current HIV/AIDS programme at the university. You are invited to participate in this survey. The purpose of the survey is to enable the researcher to obtain data for completion of a doctoral study. Participation is voluntary and anonymous. All responses will be treated as strictly confidential, and no respondent will be identified in this survey. The survey consists of four sections: Section A includes demographic related questions; Section B includes HIV/AIDS programme related questions; Section C includes detailed questions, which relate to your perceptions and experience of the HIV/AIDS programme at the university; and Section D includes questions on the HIV/AIDS programme’s content. The survey is expected to take you approximately 15 minutes to complete. Please read each question statement carefully, and select answers that are most applicable to you.
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Section A: Demographic Questions
1. What is your gender?
Male Female
2. What is your age?
Under 21 years 21 to 30 years 31 to 40 years 41 to 50 years 51 to 60 years 61 years and older
3. What type of administrative position do you hold within the University?
Faculty officer Departmental secretary
Administrative officer
Administrative assistant
Coordinator academic support General assistant Other, please specify ______
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Section B: Programme Awareness
4. Have you heard of an HIV/AIDS programme at the university?
Yes No
5. If yes, where have you heard about the programme?
Campus Clinic Lecture room Edulink Posters Other, please specify
6. Do you feel that the HIV/AIDS Programme is relevant to you?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
7. Do you feel that the HIV/AIDS Programme is relevant to the university?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
8. Have you had reason to engage with the programme directly? Please give a reason for your answer. ______
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______
9. Are HIV/AIDS posters visible at the university?
Yes No
10. Has the poster had any impact on you?
Not at Low Slightly Neutral Moderately Very Extremely all
11. How often are these posters changed?
Monthly Quarterly Annually World HIV/AIDS awareness week Seldom Do not know
12. How often do you receive HIV/AIDS awareness brochures/leaflets?
Weekly Fortnightly Monthly Quarterly Annually Never
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Section C: Health Management
13. How are condoms distributed at the University?
How are condoms distributed: Yes No Do not know Condom dispensing machines By collection In the university toilets Other forms of distribution. Please specify:______
14. How do administrators obtain information about HIV/AIDS services, which are provided at the university? ______
15. Is Voluntary Counselling and Testing available at the University?
Yes No Do not know
16. If yes, how did you find out about Voluntary Counselling and Testing at the university? If no or do not know, proceed to Question 20. ______
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17. How often does the university conduct Voluntary Counselling and Testing sessions?
Weekly Fortnightly Monthly Quarterly Annually Unsure
18. Have you attended any Voluntary Counselling and Testing sessions at the university? If yes, please proceed to Question 20. Yes No
19. If you have not, please explain why not. ______
Section D: HIV/AIDS Programme content
20. Are the following targeted programmes, practices or facilities available? In the table below, please indicate whether the following programmes, practices or facilities are available at the university.
Programmes, practices, facilities Yes No Do not know Administrative staff counselling facilities for HIV/AIDS Administrative staff HIV/AIDS testing facilities
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HIV educational or awareness programmes Provision for post exposure prophylactics Needle stick policy Peer support for HIV/AIDS infected administrative staff Peer support for HIV/AIDS infected administrative staff HIV/AIDS awareness within curriculum modules Administrative staff access to anti-retro virals (ARV’s)
21. Does the University’s HIV/AIDS programme explain the following and which do you think are important?
Yes No Important Not important Confidentiality during testing and counselling Promotion of a safe working environment Compensation for occupationally acquired HIV Employee benefits and provision and care Procedures for dispute resolution and grievances related to HIV/AIDS HIV/AIDS and employment issues, which include incapacity, termination of service, alternative employment Education and training available to administrative staff
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22. Does the programme address gender sensitive issues without compromising administrative staff rights and confidentiality?
Yes No Do not know
23. Does the programme adequately deal with the following?
Yes No Do not know Prevention of HIV/AIDS Treatment of HIV/AIDS Ways of mitigating HIV/AIDS within the University
24. Has the HIV/AIDS programme improved since you first heard of the programme? Yes No
25. If yes, please explain. ______
Thank you for your contribution.
Please forward the completed questionnaire to Jenni Gobind at [email protected]
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Appendix E: Questionnaire students
Evaluation of HIV/AIDS Programme at a South African university
The aim of this research is to examine student perceptions on the current HIV/AIDS programme at the university. You are invited to participate in this survey. The purpose of survey is to enable the researcher to obtain data for completion of a doctoral study. Participation is voluntary and anonymous. All responses will be treated as strictly confidential and no respondent will be identified in this survey.
The survey consists of four sections: Section A includes demographic related questions; Section B includes HIV/AIDS programme related questions; Section C includes detailed questions, which relate to your perceptions and experience of the HIV/AIDS programme at the university; and Section D includes questions on HIV/AIDS programme content. The survey is expected to take you approximately 15 minutes to complete. Please read each question statement carefully, and select answers that are most applicable to you.
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Section A: Demographic Questions
1. What is your gender?
Male Female
2. What is your age?
Under 20 years 21 to 30 years 31 to 40 years 41 to 50 years 50 years and older
3. What is your current year of study at the university?
1st year student 2nd year student 3rd year student 4th year student Honours student Masters student Doctoral student Other, please specify
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Section B: Programme Awareness
4. Have you heard of an HIV/AIDS programme at the university?
Yes No
5. If yes, where have you heard about the programme?
Campus Clinic Lecture room Edulink Posters Other, please specify
6. Do you feel that the HIV/AIDS Programme is relevant to you?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
7. Do you feel that the HIV/AIDS Programme is relevant to the university?
Not at Low Slightly Neutral Moderately Very Extremely all relevance relevant relevant relevant relevant
8. Have you had reason to engage with the programme directly? Please give a reason for your answer. ______
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______
9. Are HIV/AIDS posters visible at the university? If no proceed to Question 14.
Yes No Do not know
10. Have the posters had any impact on you?
Not at Low Slightly Neutral Moderately Very Extremely all
11. How often are these posters changed?
Monthly Quarterly Annually World HIV/AIDS awareness week Seldom Do not know
12. How often do you receive HIV/AIDS awareness brochures/leaflets?
Weekly Fortnightly Monthly Quarterly Annually
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Never
Section C: Health Management
13. How are condoms distributed at the university?
How are condoms distributed: Yes No Do not know Condom dispensing machines By collection In the university toilets Other forms of distribution. Please specify:______
14. How are condoms distributed at the University residences?
How are condoms distributed: Yes No Do not know In the residences Male residences Female residences In the university toilets Male toilets Female toilets Other forms of distribution. Please specify:______
15. How do students obtain information about HIV/AIDS services, which are provided at the university?
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______
16. Is Voluntary Counselling and Testing available at the university?
Yes No Do not know
17. If yes, how did you find out about Voluntary Counselling and Testing at the university? If no or do not know, proceed to Question 21. ______
18. How often does the university conduct Voluntary Counselling and Testing sessions?
Weekly Fortnightly Monthly Quarterly Annually Unsure Do not know
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19. Have you attended any Voluntary Counselling and Testing sessions at the university? If yes, proceed to Question 21. Yes No
20. If you have not, please explain. ______
Section D: HIV/AIDS Programme content
21. Are the following targeted programmes, practices or services available? In the table below, please indicate whether the following programmes, practices or services are available at the university.
Programmes, practices, services Yes No Do not know Student counselling service for HIV/AIDS Student HIV/AIDS testing service HIV educational or awareness programmes Provision for post exposure prophylactics Needle stick policy Peer support for HIV/AIDS infected students HIV/AIDS awareness within Curriculum modules Student access to anti-retro virals (ARV’s)
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22. Does the programme address gender sensitive issues without compromising student rights and confidentiality?
Yes No Do not know
23. Does the programme adequately deal with the following?
Yes No Do not know Prevention of HIV/AIDS Treatment of HIV/AIDS Ways of mitigating HIV/AIDS within the University
24. Has the HIV/AIDS programme improved since you first heard of the programme? Yes No Do not know
25. If yes, please explain. ______
Thank you for your contribution.
Please forward the completed questionnaire to Jenni Gobind at [email protected] Appendix F:
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Appendix F: Interview schedule for Academic and Administrative (Admin) staff
Interview Schedule Academic and Administrative Staff
The purpose of the study is to assess the effectiveness of the University of Johannesburg’s (UJ’s) HIV/AIDS programme. The effectiveness of UJ’s HIV/AIDS programme plays a key role in determining the awareness levels of the disease and the programme. The programme also plays a vital role in determining the future of the institution when applied and monitored well, as it can bear positive results for the institution. I would like you to answer the following questions; your responses are extremely valuable for the success of this research. You are at liberty to refer me to someone that will be in a better position to answer questions, which you cannot. I would like to reassure you that your name, title or position will not be disclosed during this process. The interview will not take longer than 20 minutes. Thank you.
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Programme Awareness
1. Describe how HIV/AIDS programme co-ordinators at UJ create programme awareness. ______2. In your view, what are the key characteristics of the programme? ______3. Discuss a few events that are undertaken by the programme of which you are aware. ______4. With which areas or sections in the UJ HIV/AIDS programme are you familiar? ______5. Why do you think that the university should continue to invest in its HIV/AIDS programme? ______
6. What would you like to see changed regarding HIV/AIDS programme awareness at the university?
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______Health Management 7. From your experience, does the programme provide adequate health management tools, for example, VCT testing, counselling and medical assistance? ______8. Do you feel that the programme adequately provides for the distribution of condoms? ______9. Do you believe that the HIV/AIDS programme co-ordinators are doing enough to encourage health management within the programme? ______10. Would better HIV/AIDS health management improve the programme? ______
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HIV/AIDS programme content
11. What are the goals and outcomes of the programme? ______12. What changes would you like to see in the programme? ______13. What do you think about the programme? ______14. What is your experience of the programme? ______15. What have you learned from the programme? ______16. Are you satisfied with the programme? ______
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17. What did you like most about the programme? ______18. What do you think about the effectiveness of the programme? Please explain. ______19. How can the programme be improved? ______20. Is there anything else that you would like to say about the programme that was not covered in this interview? ______Thank you
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Appendix G:
Interview schedule for Programme Co-ordinators
Interview Schedule Programme Co-ordinators
The purpose of the study is to assess the effectiveness of the University of Johannesburg’s (UJ’s) HIV/AIDS programme. The effectiveness of UJ’s HIV/AIDS programme plays a key role in determining the awareness levels of the disease and the programme. The programme plays a vital role in determining the future of the institution when applied and monitored well, as it can bear positive results for the institution. I would like you to answer the following questions; your responses are extremely valuable for the success of this research. You are at liberty to refer me to someone that will be in a better position to answer questions, which you cannot. I would like to reassure you that your name, title or position will not be disclosed during this process. The interview will not take longer than 20 minutes. Thank you.
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Programme Awareness
1. Describe how HIV/AIDS programme co-ordinators at UJ create programme awareness. ______2. In your view, what are the key characteristics of the programme? ______3. Discuss a few events that are undertaken by the programme of which you are aware. ______4. With which areas or sections in the UJ HIV/AIDS programme are you familiar? ______5. Why do you think that the university should continue to invest in its HIV/AIDS programme? ______6. What would you like to see changed regarding HIV/AIDS programme awareness at the university?
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______
Health Management
7. From your experience, does the programme provide adequate health management tools, for example, VCT testing, counselling and medical assistance? ______8. Do you feel that the programme adequately provides for the distribution of condoms? ______9. Do you believe that are the HIV/AIDS programme co-ordinators are doing enough to encourage health management within the programme? ______10. Would better HIV/AIDS health management improve the programme? ______
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HIV/AIDS programme content
11. What are the goals of the programme? ______12. What are the outcomes of the programme? ______13. Does the programme conform to the HEAIDS framework? Please explain. ______14. What do you think about the effectiveness of the programme? ______15. What is your experience regarding the programme’s success? ______16. What have you learned from the functioning of the programme? ______
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17. Are you satisfied with the programme? ______18. What did you like most about the programme? ______19. How can the programme be improved? ______20. Is there anything else that you would like to say about the programme that was not covered in this interview? ______Thank you
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Appendix H: Interview schedule Students
Interview Schedule
Students The purpose of the study is to assess the effectiveness of the University of Johannesburg’s (UJ’s) HIV/AIDS programme. The effectiveness of UJ’s HIV/AIDS programme plays a key role in determining awareness levels of the disease and the programme. The programme plays a vital role in determining the future of the institution when applied and monitored well, as it can bear positive results for the institution. I would like you to answer the following questions; your responses are extremely valuable for the success of this research. You are at liberty to refer me to someone that will be in a better position to answer questions, which you cannot. I would like to reassure you that your name, title or position will not be disclosed during this process. The interview will not take longer than 20 minutes. Thank you.
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Programme Awareness
1. What have you learned from being exposed to the HIV/AIDS programme? ______2. What key characteristics of the programme are you aware of? ______3. Discuss a few of the programme’s events that you have observed. ______4. What about yourself has changed since you first started the programme, which can be attributed to what you learned in the programme? ______5. If you were talking to another student about the programme, what would you tell him or her? ______
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Health Management
6. In your opinion, does the programme provide adequate health management tools, for example, VCT testing, counselling and medical assistance? ______7. Do you believe that the programme adequately provides for the distribution of condoms? ______8. Do you believe that the HIV/AIDS programme co-ordinators are doing enough to encourage health management within the programme? ______9. How does the programme compare to other types of counselling or programmes that you have experienced in the past? ______HIV/AIDS programme content
10. What do you think of the content of the programme? ______
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11. What is your experience of the programme? ______12. What changes would you like to see in the programme? ______13. What do you think about the programme? ______14. Tell me about your experience with the programme? ______15. What have you learned from the programme? ______16. Are you satisfied with the programme? ______17. What did you like most about the programme? ______
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______18. What do you think about the effectiveness of the programme? Please explain. ______19. How can the programme be improved? ______20. Is there anything else that you would like to say about the programme that was not covered in this interview? ______Thank you
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Appendix I:
Analysis of interviews
IOHA admin staff and HR wellness
Question Participant Quote Themes
Programme “This is guided by national health calendar beginning Awareness Poster the year with condom STI Testing Describe how HIV/AIDS week campaign, May care Ad1 Use condoms programme co-ordinators at month, HEAIDS candle UJ create programme lighting ceremony. Poster awareness. VCT takes place accompanied with testing. How to use condoms
focused on first years they
are informed where to find condoms together with STI screening held at gazebos around the student centre” (Ad1).
“Student, staff HIV
committee plan together
with peer champions Ad2 wellness champions and Linked champions. Wellness champions are Peer champions
main drivers example at a Linked champions meeting invite someone to
do awareness and explain
to team to do it by them self they often say send info we will read it” (Ad2).
“Circulars, communication
via UJ corporate communication at DFC,
wellness day during July – Circulars, August service provider’s communication via UJ Ad3 deskdrop word of mouth
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wellness campaigns and peer educators” (Ad3).
In your opinion, what are the Ad1 ‘I would say monitoring and Monitoring and characteristics of the prevention” Ad1. prevention programme?
Ad2 “We run training with line Train wellness Managers HIV and National champions
Health strategic plan Train
wellness champions, up skill wellness champions” (Ad2).
”Knowing your status Ad3 training of peer educators” (Ad3).
Why do you think that the Ad3 “Staff members are core Investment, take care university should continue to people if sick productivity of our staff invest in its HIV/AIDS will stop we need to invest programme? in them return on
investment, take care of our staff” Ad3. Ad2 Can’t afford to have “We don’t have care educators sick prevention work, care for relatives, absenteeism results in lower productivity we can’t afford to have educators sick government states zero infection, zero deaths, zero stigma and zero mother to child infection. We need to address this” (Ad2). Ad1 We need to focus on “Students at risk exposed third year’s senior at first year they are ok students and when however, by third year there they leave us is a higher concentration at
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UJ. We need to focus on third year’s senior students and when they leave us. We need to change our focus from first year to seniors” (Ad1).
What would you like to see Ad2 “Top management taking Top management changed regarding HIV/AIDS responsibility give us access taking responsibility programme awareness at the to the people at the top Prof university? Muller is visible we need to put HIV on Department agendas and during performance contracts” (Ad2).
Ad3 “Staff members need to Staff members need change their lifestyle by to change their participating in HCT lifestyle phobia/stigma, reduction less discrimination on positive people” (Ad3)
“Focus more on seniors not Ad1 first years, second years we Focus more on abandon them third years seniors not first years do what they want what we told them not to do in first year. VCT at student centre are mostly first years not supported by third years. They are negative in their first year and positive by the third year. They are forced to attend in their first year by third year they no longer do” (Ad1).
Health management Ad1 “We do the best we can. UJ rolling out ARV’s Love to see UJ rolling out From your experience, does ARV’s referral system with the programme provide external stakeholders we adequate health management
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tools for example VCT testing, are doing well’ (Ad1). counselling and medical assistance? Ad2 “It does, clinic VCT testing It does, clinic VCT
and assistance by wellness testing officers PsyCaD we have
enough” (Ad2).
To a certain extent fraction Ad3 To a certain extent do not belong to Medical Aid. They attend state hospitals which are better equipped however; long queues make the medical aid better” (Ad3)
In your opinion, are the Ad1 “Yes it makes you feel Yes it makes you feel HIV/AIDS programme co- happy when a student happy when a student ordinators doing enough to comes to you comes to you devastated, encourage health devastated, after 4 after 4 sessions they regain management within the sessions they regain hope they go out they tell programme? hope they go out they others she became an tell others she became activist when she came in it an activist when she was the end of the world” came in it was the end (Ad1). of the world”
“Can’t say enough other Can’t say enough than we deal with other Ad2 issues not just HIV we need
dedicated HIV coordinators.
Wellness champions can’t
be loaded we can’t do as
much as we like” (Ad2).
We are under staffed “From the part of staff we Ad3 IOHA are doing a lot. are under staffed IOHA are
doing a lot. We are not well equipped” (Ad3).
Programme content
Does the programme conform “Yes this is our mandate Yes this is our Ad1 to the HEAIDS Policy and mandate
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Strategic Framework on HIV together with the and AIDS for Higher Department of Health, Education? Please explain. HEAIDS programme National Strategic programme UJ conforms to the two” (Ad1).
It does HIV committee Ad2 “It does HIV committee education framework education framework we we report to HEAIDS report to HEAIDS quarterly” quarterly (Ad2). Ad3 “It does 100% because our It does 100% because policy is aligned with our policy is aligned HEAIDS, national strategic with HEAIDS plan, co-ordinated regular workshops and conferences and events that are initiated by HEAIDS” (Ad3).
Programme Ad1 “Yes it is effective imagine if Yes it is effective we did not have it mandate effectiveness from MEC and HIV What do you think about Committee is that we must the effectiveness of the test 20% of the UJ programme? population we exceeded that” (Ad1).
“Room for improvement Room for Ad2 encouraging we need improvement resources manager balance scorecard” (Ad2).
Ad3 “Not 100% we could do We could do with with more man power if we more man power had man power” (Ad3).
What is your experience with Ad1 “For me we encounter We encounter the success of the challenges the programme challenges programme? is doing what we wanted it
to do customer and
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counsellor surveys show that” (Ad1).
“Testing, screening, we are Success testing Ad2 seeing people are no longer shy, to stand in queues. People come they respond non-academic 100% academic no.” (Ad2).
Ad3 “Individuals not numbers Lack of participation one would envisage lack of participation with HOD and line manager” (Ad3).
Are you satisfied with the Ad1 “There is room for room for improvement programme? improvement I am satisfied with outcome. However the Linked programme needs more training” (Ad1).
Ad3 “No because of the factors Need apathy just mentioned, we also need apathy from mangers passion we need to put it in their KPI to make it happen” (Ad3).
Ad2 “I am there is a scope for Room for improvement journey ahead improvement people need to play their part often have not taken responsibility” (Ad2).
How can the programme be Ad1 “More resources, offices, Resources, visibility improved? provisions, visibility maybe closer to PsyCaD APK is the biggest with the smallest office” (Ad1).
“Focus on the employee, Reach out to Ad2 target interventions at SWC academics
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and reach out to academics” (Ad2).
Ad3 “This is one of the ways Hire contractors who tenders should be accepted have their own HIV we should hire contractors programme that have their own HIV programme in place” (Ad3
What have you learned from Ad1 “Changed my life from I Changed my life the functioning of the enjoy people I used to be programme? uncomfortable with
transgender people, gay
and HIV positive people and
now I am comfortable open
to them” (Ad1).
“Working together as a team Ad2 Working as a team is a success example the
HIV committee structure
planning together” (Ad2).
Ad3 Need a dedicated unit “Need full participation
budget , man power,
someone to run this on a full time basis we need a dedicated HIV/AIDS co- ordinator a Unit if possible” (Ad3).
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Admin staff
Question Participant Quote Themes
Programme Ad4 “Not much have seen Notice board at gate something at the gate notice Awareness board not something major’
How do HIV/AIDS programme (Ad4). co-ordinators at UJ create programme awareness? Ad5 “Mostly the posters but, in my opinion they are not Posters, circulars, UJ effective they stay up for an FM hour most until a new one comes up, some circulars,
UJ wellness and UJ FM”
(Ad5).
Ad6 “Circulars, awareness functions, call people from outside; I have not been to Circulars , functions one” (Ad6).
Ad7 “Advertise testing, distribute condoms, and educate people” (Ad7). Testing
In your opinion, what are the Ad4 “We hand them condoms Handing out condoms characteristics of the and tell them it is fine to go programme? have sex and don’t get
AIDS” (Ad4).
Ad5 “form posters it is about awareness normally, HIV Awareness tests at the student centre, getting to know your status,
it is all about what they are
doing and not about the educating getting to know is not enough not before becoming positive there is no info that is relevant to
HIV positive person” (Ad5).
Ad6 “AIDS awareness to be
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aware tells people, learn
more” (Ad6).
Awareness Ad7 “Education, not to be shy,
not to victimization” (Ad7).
Education/awareness
Why do you think that the Ad4 “It is an illness education Take responsibility university should continue to they are children we need to invest in its HIV/AIDS take the responsibility of the programme? parent not be the parent but
educate them as a parent would” (Ad4).
Ad5 “Very important to invest Invest in students because number of students across all campuses one person can have it and transmit it if this occurs with one person imagine the rest prevention and education social awareness is essential we need to invest in our brand” (Ad5). Ad6 Invest in students “There are too many
students from other parts of
the country and rural areas
they might not have had the
opportunity to be exposed
to HIV awareness this
would help students where
to go what to do” (Ad6). Ad7 Invest in people
“Disaster they will be no people health is an issue” (Ad7).
What would you like to see Ad4 “Make them aware of the Where to go
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changed regarding HIV/AIDS programme what to do programme awareness at the where to go” (Ad4). university? “More awareness is More awareness Ad5 important it should not go unnoticed one every year/6months is not enough for a UJ student” (Ad5).
Ad6 “Make it more visible” Visibility (Ad6).
Ad7 “Can’t think of anything well done managed and displayed” (Ad7).
Health management Ad4 “No actually don’t” (Ad4). Not done
From your experience, does Ad5 “Not sure once you have the programme provide Not sure been to awareness day do adequate health management they refer them to someone, tools for example, VCT testing, there is no assistance” counselling and medical (Ad5). assistance?
“I would not know” (Ad6).
Ad6 Do not know
“Yes definitely have a whole system in place test Ad7 counsel you very nice” Health management in (Ad7). place
In your opinion, are the Ad4 “No you don’t see them Not involved HIV/AIDS programme co- actually involved don’t hear ordinators doing enough to them. I have helped encourage health PsyCaD treats them as a management within the number” (Ad4). programme? Ad5 “Programme co-ordinators They are doing their are doing their bit but UJ no, bit.
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we need to support what is happening the number of students if UJ does not support them they can’t spread the word” (Ad5).
Ad6 “Can’t say yes or no Not sure programme is not visible enough, can’t say what they are doing” (Ad6).
Ad7 “Definitely definitely Definitely doing their definitely” (Ad7). bit
Programme content Ad4 “I don’t know much if you I don’t know are not aware of an active What do you think about the programme it is a big programme? problem” (Ad4). Participants were asked Ad5 “Good programme any A lot of room for attempt to create improvement awareness is good, a lot of room for improvement constantly need to work at it find ways to better it customer satisfaction, replace condoms with UJ support” (Ad5).
Ad6 “It is good, makes people Makes people aware aware of its existence” (Ad6). Informs every Ad7 “Very good for every employee and student employee and student to be informed know their rights to be educated with good choices” (Ad7).
Programme Ad4 “Yes to see the Need to make effectiveness they need to students aware effectiveness make students aware that
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What do you think about the they can get help’ (Ad4). effectiveness of the programme? Ad5 “Not know if it is effective or Do not know not I am not involved as I should be we don’t get feedback” (Ad5).
Ad6 “I don’t want to say it is not It is not effective but it is difficult if you did not attend” (Ad6).
Ad7 “Yes very effective do a lot, they put a lot of systems” (Ad7).
What is your experience with Ad4 “Nothing” (Ad4). No experience with the programme’s success? the programme
“I have not been involved Ad5 just inconvenient to take the Nothing experience time out e-mail need to go
out to get tested as an
example there is no
representation” (Ad5).
“None” (Ad6). Ad6
None experience “Just look and read have Ad7 empathy with the people” Just have empathy (Ad7).
Are you satisfied with the Ad4 No” (Ad4). Not satisfied with the programme? programme Ad5 “No I don’t think we should be satisfied if we do we will Not satisfied with the stagnate” (Ad5). programme
Ad6 “Not me I have not been involved in any way” (Ad6). Not involved Ad7 “Yes, yes, yes” (Ad7).
I am satisfied with the programme
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How can the programme be Ad4 “Top guns getting involved Top guns getting improved? not just on the field day but involved understand work circumstance and students who pay their salaries” (Ad4).
Ad5 “Visibility can’t stop with the Visibility, marketing marketing awareness it should be in your face everywhere you go APK is easy make students aware of what it constitutes” (Ad5).
Ad6 “Let everyone in visibility” Visibility (Ad6).
Ad7 “Don’t know nothing is Nothing missing missing” (Ad7).
What have you learned from Ad4 “It does not work largely it is It does not work the functioning of the organic we need to speak to programme? older people discuss it with them this is a cultural thing” (Ad4).
Ad5 “HIV awareness how to Not many people treat and prevent not many know about it students know about it” (Ad5).
Ad6 “I have not been involved” Not involved (Ad6).
Ad7 “Anytime any place Anytime any place assistance for HIV info, care assistance for HIV and testing” (Ad7). info, care and testing”
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Academic
Question Participant Quote Themes
Programme AC1 “Not really except for the Condoms condoms, we are a small Awareness campus no, sometimes at
How do HIV/AIDS programme the gates this has no impact” co-ordinators at UJ create (Ac1). programme awareness? Ac2 “I know my status so I don’t bother” (Ac2). Don’t bother
“I have seen posters, notice
Ac3 boards, flyers and circulars” (Ac3). Posters, flyers, circulars
In your opinion, what are the Ac1 “Don’t know and that is sad” Don’t know characteristics of the (Ac1). programme?
Ac2 “Don’t know really maybe Don’t know maybe awareness, testing and awareness communication with people who do need help” (Ac2).
Ac3 “Assist with HIV and how to deal with it” (Ac3). Assist with HIV
Why do you think that the Ac1 “Because the university it is Invest in our university should continue to a community institution that students invest in its HIV/AIDS does not exist in isolation programme? from the South African
problem, if we don’t invest in
our clients we are not
looking at reality. Students from different backgrounds poor environments they need a programme that accommodates these needs when addressing HIV” (Ac1). Ac2 “Students have an issue Students
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multiple partners very frivolous in sexual interaction we need to invest in the country’s future” (Ac2).
Ac3 “HIV affects more people HIV affects more than we know, we need to develop counselling support people than we for academics this will come know. in handy this can help you to be safe, good to know the precautions” (Ac3).
What would you like to see Ac1 “See first years receive Assist first years changed regarding HIV/AIDS regular awareness at programme awareness at the orientation programme university? consistency is not something that happens. HIV does not stop at the University gate it happens within the University. You can get HIV here” (Ac1).
Ac2 “Can’t think visibility through Visibility us academics I would not know how to handle it” (Ac2). Ac3 Don’t know what “Don’t have much should be changed knowledge about it or to be in a position to know” (Ac3).
Health management Ac1 “Clinics do, I have seen Have seen VCT VCT” (Ac1). From your experience, does the programme provide Ac2 “I think they do have them adequate health management They do have them on campus, student may not tools for example, VCT want to test unless forced to” testing, counselling and (Ac2). medical assistance?
Ac3 “I don’t know if they are
testing if I were I would Don’t know if they are know” (Ac3).
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testing
Do you believe that the Ac1 “We don’t see them where Yes they are doing HIV/AIDS programme co- are they” (Ac1). enough ordinators are doing enough to encourage health Ac2 “I don’t think so, more can management within the be done” (Ac2). Don’t think so that programme? they are doing enough Ac3 “I would not know that either” (Ac3). Do not know that they are doing enough
Programme content Ac1 “Needs revival a revamp” Needs improvement (Ac1).
What do you think about the Ac2 “A terribly managed Poorly managed programme? programme can’t be a small
office needs to be manned
better authorised funds, we deal with younger people we need to create the right attitude” (Ac2).
Ac3 “Except for the poster I don’t
know” (Ac3). Don’t know much
about the programme Programme Ac1 “No not effective divorced Not effective from reality from the country effectiveness and the university” (Ac1). What do you think about the effectiveness of the Ac2 “No not as it should be Not as it should be programme? because we are exiting more HIV positive students than we should” (Ac2).
Ac3 “It will be hard to say” (Ac3). Hard to say
What is your experience with Ac1 “Besides circulars and the Very little the programme’s success? very little on testing day”
(Ac1).
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Ac2 “Because I don’t read it I am I am not involved not involved why we can’t market HIV like any other product at UJ” (Ac2). Ac3 “Have none” (Ac3). Don’t know
Are you satisfied with the Ac1 More needs to be done” More needs to be programme? (Ac1). done
Ac2 “No, they can do more” Need to do more (Ac2).
Ac3 “Never use it” (Ac3). Don’t use it
How can the programme be Ac1 Let’s see the programme Visibility improved? before we test it, needs to be everywhere it no longer does HIV has taken lives effecting people around the programme” (Ac1).
Ac2 “Communication, Communication department or body doing this better manned they need more people, departments should take over, budget and spend more money implement ideas, why is the money not coming to UJ not powerful or skilled there is no support” (Ac2).
Ac3 “Any programme should be Doing more improved. I answer in the negative this shows that they are not doing enough” (Ac3).
What have you learned from Ac1 “Recently I have just known That they have offices
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the functioning of the of their offices after six years programme? at this campus” (Ac1).
Ac2 “Nothing UJ colour is I have not learnt orange I have learnt about anything HIV from the poster” (Ac2). Ac3 “No they are trying” (Ac3). They are trying
Students
Questions Participants Quote Themes
Programme S1 “I have tried to get involved Showed me around they were helpful at the Awareness IOHA programme. “I have
What have you learned from had pleasant experience being exposed to the they thought me a few HIV/AIDS programme? things and showed me around” (S1).
S2 “I have been exposed at a
very young age. I have Knew about HIV realised how many people before are affected” (S2).
S3 “I have not been exposed to it as much as I would like. From the little
exposure it has been Informative informative but it needs to
be reinforced” (S3).
S4 “I have not learnt much, my own knowledge from
TV and newspapers” (S4).
Not learnt much
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In your opinion, what are the S1 “They are involved more Community, help characteristics of the on community level, helpful students and condoms programme? to students who want to get to know about HIV,
condoms and how they
work” (S1). S2 “Have random HIV testing at UJ and counselling” Testing and (S2). counselling
S3 “Informative, interactive
and engaging the Informative programme has been very informative and has given me a broader outlook holistically” (S3).
S4 “They usually run testing
and tests” (S4).
Testing
What about yourself has S1 “We are all affected for me More compassion, changed since, you first to be more cautious helpful more cautious started the programme, which and show more can attribute to what you compassion try and help learned in the programme? where I can” (S1).
S2 “Before I would say I was Before I was ignorant ignorant” (S2).
S3 “Before HIV is an Was detached epidemic it seemed detached and out there after the programme it is happening everyday” (S3).
S4 “Nothing much UJ clinic Not much brochures at the clinic that speak about STI and HIV” (S4).
If you were talking to another S1 “Know their status take it Know your status student about the programme, from there they are willing
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what would you tell him or they need help they may her? think that they know a lot until they find out that they are positive” (S1).
S2 “I would say it is a step in Know your status the right direction good exposure to real issues it is life changing” (S2). S3 “Tell him or her it is not just Compassion affect her but it effects all of us” (S3).
S4 “We should be involved Get involved with the programme and find out more” (S4).
What would you like to see S1 “More energetic more More involved changed regarding HIV/AIDS enthusiasm people to get programme awareness at the students more involved university? and show interest willing to help and answer question” (S1).
S2 “I would like to see it put Interaction at schools forward and made interactive in schools and implemented at lectures in modules” (S2).
S3 “Programme has taught me a lot it has helped me reaffirm values I have makes me feel ok in believing in what I believe and that is to wait” (S3).
S4 “Companies this is an Companies to join in important aspect and they should take part in this concern as well” (S4).
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Health management S1 “With condoms with Condoms counselling it is a job they From your experience, does are not in the spirit of the programme provide counselling you it is brief” adequate health management (S1). tools for example, VCT testing, counselling and medical S2 “Yes” (S2). assistance? Yes does provide S3 “Yes it does” (S3).
Yes does provide S4 “Yes they do the counselling follow up after 3 months they do a good Yes does provide job” (S4).
Do you believe that the S1 “No, sometimes if they are They are present HIV/AIDS programme co- out here by their red and ordinators are doing enough to white tents” (S1). encourage health management within the S2 “The fact that they have They are present programme? physical presence they are here it is our own initiative” (S2).
S3 “Co-ordinators are doing Doing their best their best it is up to the individual” (S3).
S4 “Not doing enough some Not doing enough people are sceptical to involve themselves not availing themselves because they are not clear. All I know is when I see tents” (S4).
Programme content S1 “it is good because others It is good can go to get help they What do you think about the know that who are living
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programme? with it they can go to get help they know that they are not the only ones it is a good idea” (S1).
S2 “Very good it has a good Good foundation needs more built into it” (S2).
S3 “I think that the Is advantageous programme is advantageous more testing is needed” (S3).
S4 “It is a good idea Good idea especially for students” (S4).
Programme S1 “It is everywhere notice It is effective boards posters it is effectiveness effective for me” (S1). What do you think about the effectiveness of the S2 “It is effective if they are It is effective programme? doing testing helps them change if they have a scare” (S2).
S3 “It varies if you make it It varies your own it would appear effective if not then no” (S3).
S4 “To a certain extent it is To an extent effective some actually give themselves time to find out seems effective to other people” (S4).
What is your experience with S1 “Mostly pleasant and I I have learnt from it the programme’s success? have had interesting time
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get to learn different things some help some don’t but mostly helpful” (S1).
S2 “Very minimal I am a more Very minimal conservative person If I had to test it will be at a hospital” (S2).
S3 “Programme has taught Has taught me a lot me a lot it has helped me reaffirm values I have makes me feel ok in believing in what I believe and that is to wait” (S3).
S4 “When I went to VCT not I went to test because of the programme I wanted to know my status” (S4).
Are you satisfied with the S1 “No really I am not No I am not satisfied programme? satisfied a lot of improvement people the people working there need resources” (S1).
S2 “In a way it needs to be Needs to be developed” (S2). developed
S3 “Yes” (S3). Yes I am satisfied
S4 “No, not satisfied” (S4). No not satisfied
How can the programme be S1 “Need more people” (S1). Need more people improved? S2 “Extend market of who is Marketing testing it could happen to anybody” (S2).
S3 “Having more participation More participation from people who have HIV from people living with
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for them to describe and HIV say how they are living with the disease” (S3).
S4 “Marketing and involving Marketing students” (S4).
What have you learned from S1 “To look at the disease See the disease the functioning of the differently if I happen to differently programme? know I will know how to maintain it” (S1).
S2 “HIV is real and not an HIV is real illness” (S2).
S3 “HIV/AIDS is something HIV can’t be viewed that we cannot view in negatively negative light mistakes are experiences to learn from” (S3).
S4 “Nothing” (S4). I have not learnt anything
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Appendix J:
Analysis of interviews across participants
Analysis of interviews across participants Between group
Question IOHA/HR Admin Staff Academic Student Discussion of wellness analysis
Programme Posters Notice board at gate Condoms Showed me Posters, condoms, around testing, circulars, Awareness Testing Posters, circulars, UJ notice boards, Peer FM Don’t bother Describe how functions champions Circulars , functions Knew about HIV/AIDS Posters, flyers,
Linked testing circulars HIV before programme co- ordinators at UJ champions Informative create programme Use condoms Not learnt awareness. Circulars, much Communication
via UJ
In your opinion, Monitoring and Handing out Don’t know Community, Awareness, don’t what are the prevention condoms Don’t know help students know, testing characteristics of Train wellness Awareness maybe and condoms the programme? champions Awareness awareness Testing and counselling Education/awareness Assist with HIV Informative testing
What about More yourself is different compassion, since you first more cautious started the programme, which Before I was you can attribute ignorant to what you learned in the Was programme? detached
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Not much If you were talking Know your to another student status about the programme, what Know your would you tell him status or her? Compassion Get involved Why do you think Investment, Take responsibility Invest in our Students, that the university take care of our students staff/people should continue to staff, invest in its can’t afford to Students HIV/AIDS have educators Invest in students programme? sick, HIV affects We need to Invest in students more people focus on third than we know. year’s senior Invest in people students and when they leave us
What would you Top Where to go Assist first More involved Visibility, more like to see management years involved changed regarding taking More awareness HIV/AIDS responsibility Interaction at programme Visibility Visibility schools awareness at the Staff members university? need to change Don’t know Companies to their lifestyle join in Focus more on seniors not first years Health UJ rolling out Not done Have seen Condoms Yes, not sure/don’t ARV’s VCT know management Not sure Yes Does Not know They do have provide From your It does, clinic them Yes Does experience, does Health management VCT testing in place provide the programme provide adequate Don’t know health To a certain yes Does management extent provide tools, for example VCT testing,
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counselling and medical assistance?
Do you believe Yes it makes No involved Yes they are Not doing Yes, no, not sure that the HIV/AIDS you feel happy doing enough enough programme co- when a student They are doing their ordinators are comes to you bit. They are doing enough to devastated, Don’t think so present encourage health after 4 that they are management sessions they Not sure doing enough within the regain hope Doing their programme? they go out best
they tell others
she became an Definitely doing their Do not know activist when bit Not doing that they are she came in it enough doing enough was the end of the world”
Can’t say enough We are under staffed IOHA are doing a lot.
Programme content Yes this is our Does the mandate programme conform to the It does HIV HEAIDS Policy committee and Strategic education Framework on HIV framework we and AIDS for report to Higher Education? HEAIDS Please explain. quarterly
It does 100% because our policy is aligned with
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HEAIDS
What do you think Yes it is I don’t know Needs It is good Good, need about the effective improvement improvement, programme? A lot of room for effective (1) Room for improvement Good improvement Poorly Makes people aware managed Is
We could do advantageous Informs every with more man Don’t know power employee and Good idea student
Programme Yes it is Need to make Not effective It is effective Room for effective students aware improvement , effectiveness It is effective effective, don’t What do you Room for Do not know know think about improvement Not as it should the It is not effective be It varies effectiveness We could do of the with more man To an extent programme? power Hard to say
What is your We encounter No experience with Very little I have learnt Nothing, learnt, experience with challenges the programme from it testing the programme’s I am not success? Success No experience involved testing No experience with Very minimal the programme Don’t know empathy Lack of Has taught participation Just have empathy me a lot
I went to test
Are you satisfied Room for Not satisfied with More needs to No I am not Room for with the improvement programme be done satisfied improvement , no programme? (6) Need apathy Not satisfied with Need to do programme more Needs to be Room for developed Not involved with
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improvement programme Don’t use it Yes I am satisfied Yes I am satisfied with programme No I am not satisfied How can the Resources, Top guns getting Visibility Need more Visibility, programme be visibility involved people marketing, improved? Reach out to participation academics Visibility, marketing Communication Marketing Hire contractors Visibility Doing more More who have their participation own HIV from people programme living with HIV
Marketing
What have you Changed my It does not work That they have See the Does not work, see learned from the life offices disease disease differently, functioning of the Need a Not many people differently I have not learnt programme? dedicated unit know about it anything, they are Working as a HIV is real trying team Not involved I have not learnt anything HIV can’t be Anytime any place viewed assistance for HIV negatively info, care and They are trying testing” Nothing
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