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The Role of Culture and Gender in the Spread of Hiv and Aids and Strategies for the Reduction of Hiv and Aids Among Farm Workers in South Africa

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The Role of Culture and Gender in the Spread of Hiv and Aids and Strategies for the Reduction of Hiv and Aids Among Farm Workers in South Africa THE ROLE OF CULTURE AND GENDER IN THE SPREAD OF HIV AND AIDS AND STRATEGIES FOR THE REDUCTION OF HIV AND AIDS AMONG FARM WORKERS IN SOUTH AFRICA by NTOMBIFIKILE ELIZABETH KLAAS submitted in accordance with the requirements for the degree of DOCTOR OF LITERATURE AND PHILOSOPHY in the subject HEALTH STUDIES at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF G THUPAYAGALE-TSHWENEAGAE CO-SUPERVISOR: DR TP MAKUA FEBRUARY 2017 Student Number: 576-703-15 DECLARATION I declare that THE ROLE OF CULTURE AND GENDER IN THE SPREAD OF HIV AND AIDS AND STRATEGIES FOR THE REDUCTION OF HIV AND AIDS AMONG FARM WORKERS IN SOUTH AFRICA is my own original work, and that all the sources that I have used or quoted have been duly acknowledged and referenced as per university requirements, and that this work has not been submitted before for any other degree at any other institution before. February 2017 SIGNATURE DATE Ntombifikile Elizabeth Klaas THE ROLE OF CULTURE AND GENDER IN THE SPREAD OF HIV AND AIDS AND STRATEGIES FOR THE REDUCTION OF HIV AND AIDS AMONG FARM WORKERS IN SOUTH AFRICA STUDENT NUMBER: 576-703-15 STUDENT: NTOMBIFIKILE ELIZABETH KLAAS DEGREE: DOCTOR OF LITERATURE AND PHILOSOPY DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GLORIA THUPAYAGALE-TSHWENEAGAE CO-SUPERVISOR: DR TP MAKUA ABSTRACT Background: Worldwide, the Human Immunodeficiency Virus (HIV) pandemic has proven to be a health care challenge from the perspective of testing and treatment, including how to create sustainable positive prevention, prevention after becoming HIV positive, that is culturally relevant and gender sensitive. South Africa has been severely affected by the HIV and AIDS epidemic and the agricultural sector is no exception. This statement is supported by the findings of the International Organisation for Migration (IOM) study. According to an IOM study, the HIV prevalence rate among farm workers in the country is about 40%, the highest ever recorded in Southern Africa. A study conducted in Limpopo and Mpumalanga farms revealed that the prevalence of the twenty-three farms was 39, 5% which is twice the UNAIDS (Joint United Nations Programme on HIV and AIDS) national prevalence percentage of 18, 1% in South Africa. The researchers of this study could not pin-point a single factor causing this high rate of HIV infection on these farms. A multitude of factors, such as multiple and concurrent partnerships, transactional sex, irregular condom use, presence of sexually transmitted infections and sexual violence. The research also showed that almost half of the women working on farms around these provinces are HIV positive, compared to only a third of the male workforce. Purpose: The purpose of this study was to explore and describe the role of culture and gender in the spread of HIV and AIDS among farm workers in South Africa; with the view of developing culture and gender sensitive HIV and AIDS prevention strategies. Methods: A descriptive and explorative qualitative approach was adopted. In depth individual semi-structured interviews were used to explore and describe the role of culture and gender in the spread of HIV and AIDS among farm workers. Purposive and convenient sampling methods were used to select participants who met the inclusion criteria in the Tshitwani and Barota farming community in the Vhembe District, Limpopo Province, South Africa. Findings: Religious and cultural beliefs were believed to be fuelling the spread of HIV among farm workers. Multiple sexual partners and inconsistent condom usage was common among participants. It was evident that stigma and social isolation leading to non- disclosure had adverse repercussions as some participants stated that they would spread HIV intentionally. Powerlessness and lack of decision-making by female farm workers was common as they were dependent on their male partners to make decisions regarding sexual matters in their relationship. Conclusion: More HIV prevention programmes tailored to dispel fears about stigma and correct myths about HIV-transmission should reach ordinary men and women in order to curb the spread of HIV among farm workers. The researcher believes that the strategies that emanate from this study would be applied in other settings other than the farming community. Keywords: AIDS; Culture; Farms; Farming community; Gender; Gender based violence; Guidelines; HIV; HIV Prevention Programme; Land reform; Liberal Feminism; Social Constructionist; Stigma. ACKNOWLEDGEMENTS Professor BG, Thupayagale-Tshweneagae, my supervisor, for your support, guidance and words of encouragement throughout the study. Doctor TP, Makua, my co-supervisor, for your support, words of wisdom and encouragement and patiently guided me through this research endeavor. I sincerely acknowledge the contribution made by my supervisor and co- supervisor for sharing with me their valuable knowledge and for offering me critical reviews. Doctor TR Netangaheni, for assisting with data collection and translation. This study would not have been possible without the management and staff of Tshitwani and Barota farms. Thank you for taking part in this study. Special thanks to Andile Klaas, for his undivided attention and support through difficult times. Dedication I would like to dedicate this thesis to my loving husband Andile who supported me through difficult times and my beloved daughters Sinothando and Siphelele Klaas who understood that I needed to spend time away from home collecting data. i TABLE OF CONTENTS CHAPTER 1 ............................................................................................................................... 1 OVERVIEW OF THE STUDY ..................................................................................................... 1 1.1 INTRODUCTION AND BACKGROUND ................................................................... 1 1.2 STATEMENT OF THE PROBLEM ........................................................................... 4 1.3 SIGNIFICANCE OF THE PROBLEM ....................................................................... 5 1.4 PURPOSE OF THE STUDY ..................................................................................... 6 1.5 OBJECTIVES OF THE STUDY ................................................................................ 6 1.6 RESEARCH QUESTIONS ....................................................................................... 7 1.7 DEFINITION OF KEY CONCEPTS .......................................................................... 7 1.7.1 AIDS ........................................................................................................................ 7 1.7.2 Culture ..................................................................................................................... 8 1.7.3 Farming community .................................................................................................. 8 1.7.4 Gender ..................................................................................................................... 8 1.7.5 Human Immunodeficiency Virus ............................................................................... 8 1.8 THEORETICAL FOUNDATION OF THE STUDY ..................................................... 9 1.8.1 Paradigmatic and philosophical perspectives ........................................................... 9 1.8.2 Paradigmatic assumptions ..................................................................................... 10 1.8.2.1 Ontological assumption (the nature of the reality) ................................................... 10 1.8.2.2 Epistemological assumption ................................................................................... 11 1.8.2.3 Methodological assumption .................................................................................... 11 1.8.2.4 Assumptions underlying this study ......................................................................... 12 1.8.3 Theoretical framework ............................................................................................ 13 1.9 THEORETICAL FOUNDATION OF THE RESEARCH STUDY .............................. 15 1.9.1 The social construction theory ................................................................................ 15 1.9.2 Liberal feminism ..................................................................................................... 17 1.10 OVERVIEW OF RESEARCH METHODOLOGY .................................................... 18 1.11 ORGANISATION AND STRUCTURE OF THE STUDY .......................................... 20 1.12 CONCLUSION ....................................................................................................... 21 CHAPTER 2 ............................................................................................................................. 22 LITERATURE REVIEW ............................................................................................................ 22 2.1 INTRODUCTION .................................................................................................... 22 2.2 THE HISTORICAL CONTEXT OF HIV AND AIDS IN SOUTH AFRICA.................. 23 2.3 THE ROLE OF CULTURE IN THE SPREAD OF HIV ............................................. 26 2.4 THE ROLE OF GENDER IN THE SPREAD OF HIV .............................................. 33 2.5 CHALLENGES FACED BY SOUTH AFRICAN FARM WORKERS ........................ 39 2.6 CONCLUSION ......................................................................................................
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