NationalNational StudentStudent SexualSexual HealthHealth HIVHIV Knowledge,Knowledge, AttitudeAttitude andand BehaviourBehaviour Survey:Survey: Focusing on Student Men who have Sex with Men at 14 Higher Education Institutions in South Africa NOVEMBER 2014 Supported by: Published by HEAIDS and NACOSA This research was made possible by the support of the Global Fund to Fight HIV, TB and Malaria for the Networking HIV/ AIDS Community of South Africa (NACOSA) MSM/LGBTI Higher Education Programme, conducted in partnership with Higher Education and Training HIV/AIDS Programme (HEAIDS). HEAIDS, an initiative of the Department of Higher Education and Training, is a dedicated national facility designed to develop and support the higher education sector through the oversight and implementation of HIV and related healthcare support interventions. Its key focus is to ensure that young people passing through the higher education sector, at more than 400 campuses countrywide, are healthy and competent. HEAIDS is implemented by Higher Education South Africa (HESA), the representative body of all public higher education institutions in South Africa, in partnership with the South African College Principals’ Association (SACPO), which represents all technical and vocational education and training colleges. The views expressed herein are the views of the research and publishing institutions and do not represent the views or opinions of the Global Fund to Fight AIDS, Tuberculosis and Malaria nor is there any approval or authorisation of the material, express or implied, by the Global Fund to Fight AIDS, Tuberculosis and Malaria. National Student Sexual Health HIV Knowledge, Attitude and Behaviour Survey: Focusing on Student Men who have Sex with Men at 14 Higher Education Institutions in South Africa NOVEMBER 2014 Foreword by the Deputy Minister of Higher Education and Training, the Honourable Mduduzi Manana The rich tapestry of South Africa is woven between our oceans, across mountains and plains, urban settlements and rural expanses. It incorporates traditional beliefs that originated hundreds of years ago and these beliefs live alongside the internet generation. Human and natural diversity are the essence of South Africa. Scattered across this landscape are 25 universities and 50 technical and vocational education and training colleges (TVETs) with close to 427 campuses. These institutions are critical to national progress in the fields of research, engineering, agriculture, teaching, the arts, sporting endeavour, artisan and building trades, mining and telecommunications. They are also the operational sites of the Higher Education and Training HIV/AIDS Programme (HEAIDS). We appreciate that the youth population is diverse. In the context of the HIV, TB and STI epidemics, it is important to recognise and pay attention to the multiplicity of sexual orientations among students and the behaviours associated with various sexual orientations. This report provides a glimpse of the diverse ways in which young people experience sex, relationships and intimacy – and it explores the implications of this diversity for sexual health. The report contains the findings of the first South African higher education sector survey on knowledge, attitudes, perceptions and behaviours relating to sex, HIV, and alcohol and substance use among men who have sex with men (MSM) and young people who are lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI). This study is the first of its kind to address issues related to LGBTQI youth, who are identified as a “key population” in the South African National Strategic Plan for HIV, STIs and TB, 2012–2016. Its findings provide a foundation for further research and the development and implementation of programmes to protect our students and youth from HIV infection in an inclusive way that caters for all sexual orientations. Essentially the findings tell us that young MSM are marginalised in the South African higher education environment. They are well informed about HIV/AIDS. Many have been tested for HIV and intend to do so in future. Yet they frequently engage in intimate relationships that increase their risk of acquiring STIs, including HIV. Many MSM have sex only with men, but some also have sex with women. These relationships are often regarded as clandestine and this makes it all the more important to provide health services to this population. A substantial percentage of MSM have multiple partners while the use of condoms and lubricants to reduce the risk of HIV transmission and STIs is often inconsistent. On a daily basis, MSM are faced with homophobia and stigma which inhibit access to sexual health services, and also leave them with little confidence that the higher education sector can constructively deal with their marginalisation and experiences of violence. This picture stands in contrast to the inclusive, non-sexist, non-racist human rights enshrined in the South African Constitution and in many other laws, policies and programmes that have helped transform South Africa during the last 20 years. It demands a bold and integrated response from our political, academic and student leadership. It also requires stakeholder engagement in order to achieve social change that brings MSM and LGBTQI populations into the fold of protection and risk-reduction in relation to their sexual health and psychological and overall wellness. I commit to working with colleagues and friends from across the higher education and training sector to embrace and use the findings from this report so that we can continue to build a caring, healthy and prosperous South Africa. The Department of Higher Education and Training is grateful to NACOSA and to the Global Fund for providing financial support that enabled the department, through HEAIDS, to undertake this research. I trust that interventions that will be built to address the related issues will yield positive results in mitigating the impact of HIV, TB and STIs and facilitate the protection of human rights in the higher education sector in South Africa. Mduduzi Manana Deputy Minister of Higher Education and Training ii Statement by HEAIDS Programme Director Dr Ramneek Ahluwalia The key focus of the HEAIDS Programme is to ensure that young people passing through our sector on all 400 campuses countrywide are healthy and competent to take their rightful places in contributing to the development of our country. The HEAIDS Programme, with the support of its partners, has assisted in increasing life expectancy for many thousands of vulnerable young people, who are now accessing proper care in terms of treatment, psychological support and social wellbeing. It has been proven that early detection and treatment can now prolong life expectancy for people living with HIV by more than 30 years. This eventually provides a return on our investment in health care, allowing young people to contribute to the welfare of their own families, to our sector and to the economy of the nation as a whole. The HEAIDS Programme has extended its services in the areas of health promotion, prevention of diseases of lifestyle, cancer screening and contraception through our award-winning First Things First initiative. HEAIDS focuses on men’s health through its partnership with Brother’s for Life and on women’s health through the Zazi intervention. It has a dedicated LGBTQI programme and addresses alcohol and drug abuse through Balance Your Life. Previous studies have shown that higher education institutions (HEIs) are enabling and empowering spaces for young South Africans, and benefit their health and wellness. The current HEAIDS model, which facilitates the implantation of healthcare programmes in the sector, is designed to promote student attendance and retention, boost throughput rates, and increase graduate competencies. The National Student Sexual Health HIV Knowledge, Attitude and Behaviour Survey: Focusing on Student Men who have Sex with Men at 14 Higher Education Institutions in South Africa is first the first of its kind in South Africa and it helps build evidence for effective intervention. The study confirms that gender and sexual orientation and associated risk factors put certain student populations – namely, MSM and LGBTQI individuals – at increased risk of becoming infected with HIV and other STIs. This finding has implications for managing the HEAIDS programme as targeted, evidence-based interventions are needed to reduce risk factors and address associated issues of stigma and discrimination that impact on MSM and LGBTQI. We will only be able to achieve the national HIV, TB and STI goals, as set out in the National Strategic Plan 2012- 2016, if we address the totality of risk factors that contribute to these epidemics. We also need to maximise the window of opportunity afforded to us by the research so that we can protect all students and ensure that no one is left behind. Narrow-minded views which fuel homophobia and obstruct holistic and equitable provision of health information, education and services need to be tackled head-on. For this we need bold leadership from students, staff and management and key stakeholders from across the higher education and training sector to act decisively to strengthen the response to stigma and discrimination challenges. We also need to heed the researchers’ recommendations that we should expand research and promote interventions which improve self-esteem, encourage responsible use of alcohol and other substances, tackle harmful sexual behaviour trends and nurture the principles of social justice, equality and non-discrimination within the higher education and training sector. Dr Ramneek Ahluwalia Programme Director iii Statement by Dr Maureen van Wyk, Executive Director, NACOSA Over the past 12 years, NACOSA has learned that when people come together to tackle community challenges they have a stronger voice and are more effective at finding solutions. Our role as a network of over 1 400 civil society organisations is not just to take services to people but to bring people and their ideas into the development of health and social services. Only if we work together, can we start to turn the tide of HIV, AIDS and TB in South Africa.