High Risk

It was Rule 2.9 that finally sparked the revolt. On the evening news, cameras bobbed and weaved through a heaving crowd of furious, toyi-toying Technikon Witwatersrand students, as they demanded that management stop curtailing their personal freedom.

‘€œWe have a right to have sex,’€ a sweating young man yelled into the camera while fellow students set garbage alight in the background.

That was August this year shortly after management issued the offending Rule 2.9 decreeing that students were not to receive visitors (of the opposite sex) in their residence rooms.   A month later, independent mediator, attorney Tefo Raditapole, found that Rule 2.9 was unconstitutional and that students have a ‘€œright to engage in sex’€.

The fact that students engage in sex has been the focus of a series of controversies in South Africa this year. Most of the stories that have captured public attention are extreme – the Tukkies schoolgirl gang rape charges and the Rau ‘€œpeeping tom’€ sex scandal in which a former student claimed he had hidden in a cupboard and watched while older male residents had sex with a young girl.

The truth is of course that students have sex and judging from behaviour in residences, at ‘€œbashes’€ (student parties) or other traditional student hangouts, they appear to be having lots of it.

It appears as if most universities and technikons generally allow students to entertain members of the opposite sex in their rooms. Some institutions require that students obtain permission if a visitor wants to spend the night. Where there are strict curfews, the reasoning appears to be security related.

At Fort Hare for example students have unlimited access to one another.

‘€œWe don’€™t treat students as children. We think they are responsible adults’€ university spokesman Mncedi Mgwigwi said.

In his finding on Rule 2.9, Tefo Raditapole echoed this stating ‘€œafter all, students are adults who can make responsible decisions for themselves’€ but quickly added that he was shocked to find empty condom dispensers in Technikon Witwatersrand residences and urged student leaders to use their budgets to stock up.

There is no doubt that exchanging the comfort and safety of home for the freedom of university life presents many challenges for young people, most of them generally no older than 18.   For many this is their first real introduction to the freedom of the ‘€œgrown up’€ world where sex, booze and drugs are easily accessible.

Parents and guardians want to rest assured that they are entrusting their ‘€œbabies’€ to an institution that will act in the best interest of their children. They would like to believe that alcohol will be consumed responsibly, that drugs will not be easily available and that sex will not be the favourite past time on campus.

‘€œSometimes I think students are more terrified of falling pregnant,’€ says Monica du Toit, HIV/AIDS co-ordinator at the University of Stellenbosch, adding that that the ‘€œmigration’€ from a supportive home environment to the university places enormous pressure on students.

‘€œThey do not have the same tools that they may have at home,’€ she says.

University of Cape Town student Gilmore Kordom, 20, describes his arrival on campus as an overwhelming experience.

Fellow student Gomolemo Mabyane, 21, agrees: ‘€œWhen you arrive there is orientation week. There are so many parties and lots of free alcohol ‘€“ a lethal combination.’€

Parents need not be reminded that they are from a generation when their greatest fear after a night of passion on the backseat of their VW Beetle was a teenage pregnancy or being labeled ‘€œloose’€, hardly comparable to the 21st century outcome – HIV infection.

Times certainly have changed.

While rambunctious behaviour coupled with irresponsible use of alcohol and consumption of dagga has always been a feature of student life, temptations and threats to modern youth are a little scarier. Nowadays there is easy access to potent drugs such as ecstasy and cocaine and add to this the accessibility of sex and it all begins to look like a dangerous game of Russian roulette.

So, how are our tertiary institutions coping with HIV/AIDS?

Although almost every university approached was not prepared to divulge estimates of prevalence rates, statistics from other studies show that students are a high-risk group.

In 2000, research organisation Abt Associates found that the rate of HIV infection at a university undergraduate level was roughly 22%. Without intervention, this was due to rise to 33% by 2005, the researchers warned.

General statistics in South Africa reveal that people between the ages of 18 and 24 are most at risk of contracting the disease. Government statistics drawn from an ante-natal survey show that women between the ages of 25 and 29 are the most affected with an estimated 34,5% of pregnant women in this age group HIV positive in 2002.

Various tertiary institutions interpret these figures differently. Most have not conducted prevalence studies and were not prepared to estimate the numbers of students who might be infected with HIV.

The defensive reaction from some tertiary institutions approached for this feature certainly reflects high levels of fear, stigma and bewilderment. Responding to a general request for information on prevalence and what programmes were in place, Marie Muller, convenor of the Rand Afrikaans University’€™s HIV/AIDS committee responded with the curt; ‘€œStatistics ‘€¦.are confidential ‘€“ you will have to apply for this type of ‘€˜sensitive’€™ info in terms of the Access to Information Act.’€

The University of the Western Cape also invoked the ‘€œconfidential’€ defence as ‘€œcampuses do not want the media to misrepresent or sensationalise figures that could result in drops in student registrations’€.

In Johannesburg, the University of the Witwatersrand ‘€œimagined’€ their prevalence to be the same as similar demographic groups in Gauteng province.

The university has proposed that a survey be conducted on prevalence but funding constraints have shifted the short-term focus to providing interventions that are service and education oriented and that will be of immediate benefit to students.

On the flipside, the University of Natal plans to conduct an HIV prevalence study on its campuses next year, but for now are operating on the assumption that around 16% of   students are HIV positive (A projection for 2003 that was done for the university by Abt Associates).

The University of Cape Town is also planning to conduct a prevalence study, but no matter what this reveals, prevention and support strategies would remain the same.

 ‘€œWe are not only engaged in addressing rates of infection among students and supporting them, but also aim to produce students who can respond appropriately to the epidemic in their future work settings,’€ says Cal Volks, UCT’€™s HIV/AIDS Unit director.

Some will argue that it is unfair to place the onus on universities to protect students, but these institutions of higher learning have a much broader significance as it is here that the future of the country is shaped as young doctors, nurses, teachers, government leaders, economists and farmers (to name only a few) are trained and sent into the world.

It is vital then that these institutions commit extra resources to inform and educate their students about HIV/HIDS and hopefully averting a catastrophe that could potentially damage South Africa’€™s professional workforce.

The World Bank has predicted that by 2005, up to half of the Malawian professional workforce could die of AIDS-related illnesses.   This could devastate the economy of that small country. At present no such prediction has been made for South Africa.

‘€œWithout planned and sustained efforts at prevention and changes in behaviour, students are particularly vulnerable to infection due to factors that make institutional environments a focal point of social and sexual interactions. We are at risk of losing the most valuable citizens in our economy,’€ confirms Barbara Michel, Programme Director of Higher Education Against HIV/AIDS, a partnership between the South African Universities Vice-Chancellors Association (SAUVCA), the Committee of Technikon Principals and the national Department of Education.

The body provides support to the 500 000 students and thousands of members of staff.

Michel identifies five key motivations to address HIV/AIDS.

Firstly, the epidemic affects not only the health status, but also the social, economic and psychological well being of individuals and communities. ‘€œHIV is more than a disease,’€ says Michel. This makes HIV a development issue and not only a health issue.

Secondly, higher education institutions in all countries are highly prized national institutions and a resource for the nation making it important to preserve them.

Thirdly, HIV and AIDS affects human resource development and higher education institutions are the educators and trainers of most skilled people in most economies.

Michel said institutions also had a critical role to play in the search for new and better ways of prevention and learning to understand and cope with a world affected by HIV and AIDS.

Finally, the universities and technikons, the professionals who staff them, their students and their associated communities were being called upon to take a stand against denial and prejudice; and to lead open debate and social action against the pandemic.

Getting the message?

It is clear that the University of Cape Town has set the pace in responding to the epidemic.

UCT’€™s Cal Volks believes that institutions should be graduating what she terms ‘€œHIV literate people who have developed a critical consciousness of the epidemic’€.

Established in 1994, the UCT unit is held up as a best practice model with several awards to its name. It has six staff members and is the first fully university-funded HIV/AIDS unit at a tertiary institution.

‘€œStaff at the university had the foresight early on to see that this epidemic was going to have a major impact. We designed our programme so that it is driven from the top by our management which comes with the critical political commitment needed, but this is all coupled with a grassroots response, ensuring we reach communities affected by the epidemic’€ explains Volks.

UCT have a range of responses to HIV and AIDS including an Mphil in HIV and AIDS and leading in research areas such as vaccine development, ARV treatment, the economic impact of AIDS and actuarial modeling of the epidemic. The university is also involved in a wide variety of HIV/AIDS outreach projects.

One of the many programmes is curriculum intervention where HIV/AIDS is weaved into the undergraduates’€™ work in a way that is relevant for them.

An example is a theme presented recently to a group of commerce students where the discussion involved their interest area – the economic impact of HIV/AIDS. Issues of stigma are thrown into the deliberations.

At the conference’€™s conclusion, 80% of the students surveyed indicated that they had learnt something new while 77% said they had thought about how the epidemic affected them personally.

‘€œIt think the important thing is to make the discussions relevant in terms of their professional training,’€ says Volks.

She explains that peer educators – in this case students – are the main drivers when it comes to delivering messages.

‘€œThe thinking behind peer education is that if the messenger is similar in many ways to people receiving the message, there is more chance of the message being adopted.’€

Under the banner of   ‘€œMen make a difference’€ the university has employed a novel approach to grappling with the ‘€œconstructions of masculinity harmful to men and women’€ and are training ‘€œconversation leaders’€ who find themselves in social settings (for example parties, movies, get togethers, etc).

These conversation leaders initiate discussions and topics could include substance abuse, condom use, HIV testing or communication in a relationship.

‘€œBy generating these conversations we are hoping to create a shift or change in the culture or context in which HIV occurs,’€ says Volks.

The approach is a pilot study at this stage and Volks warns that it is crucial to conduct it in such a way that it does not alienate men.

Outreach work sees students presenting workshops and conducting research in resource poor settings where a range of issues that can be traced back to HIV/AIDS are addressed.

Another UCT student and peer educator, Thandi Gilder, 22, views the university as a ‘€œperfect place to express my passion’€ – educating fellow students on HIV and AIDS.

‘€œIt is very scary to see how young people are messing about and I realized that we are their age and that we can talk to them,’€ says Gilder.

Treatment for Students

While many institutions are still grappling with prevention, the University of Natal’€™s Senate recently approved an HIV/AIDS prevention, treatment and care policy which commits the university to providing HIV positive students with access to ‘€œspecialized treatment’€ as long as they are registered with the university.

This effectively means that the university will cover the bulk of the cost of anti-retroviral drugs for those students who need them.

While campus clinics will treat opportunistic infections, provide post-exposure prophylaxis and counselling for HIV positive students, once their CD4 count drops below 250 they are referred to a “preferred provider” with expertise in HIV/AIDS treatment. Michelle Mitchell, a clinical psychologist, has been the University of Natal’€™s AIDS programme co-ordinator since April 2002. She was appointed shortly after the university adopted a two-year HIV/AIDS plan and needed someone to implement it.   The AIDS plan is based on the assumption that the university is responsible for HIV/AIDS prevention, care and support programmes for staff and students and to alleviate the impact of HIV/AIDS on campus.

The plan has four main components. The first is to encourage campus leadership on HIV/AIDS. This has resulted in the formation of a high-powered and widely representation AIDS Task Force chaired by Deputy Vice-Chancellor and world-renowned AIDS expert Prof Salim Abdool Karim.

The second component is prevention, care and support for students and staff. This encompasses education programmes, voluntary counselling and HIV testing and support for those with HIV as well as the treatment component. Some 170 student peer educators have also been trained and take safe sex messages to fellow students.

The third component deals with research on HIV/AIDS and, as Mitchell says, “we don’€™t have to use any consultants as we have all the HIV/AIDS expertise right here”.

The fourth component deals with “mitigating the impact of HIV/AIDS on the university”. This includes getting HIV/AIDS into the curriculum of the university wherever possible, training more HIV/AIDS researchers and monitoring the sustainability of the student loan fund, pension plan and medical benefits. It also tries to soften the impact of loss of staff and productivity as a result of AIDS.

Appointed in February this year, Stellenbosch’€™s Monica du Toit feels it will take time before most students confront the reality of HIV and AIDS. Most students at Stellenbosch are from fairly well off homes and Du Toit believes this could play a role in the level of ‘€œaffectedness’€.

‘€œUnless people are personally affected they will be able to argue for themselves why they need not worry about becoming infected,’€ she says.

“Spreading scary messages is not going to work, we need to make it easy for the students to relate to HIV/AIDS.’€

Du Toit has on occasions used ambush street theatre on campus in the hope of ‘€œforcing people to engage with the issue’€.

‘€œBut I think we still have some way to go. There is an Afrikaans saying ‘€“ ‘€˜n Vinger wat druk op ou sere (A finger pressing on old sores). I believe HIV is the finger and for every person that sore is different. For some it is relationship issues, for another it’€™s cultural issues and for another it could be race issues.’€

Despite the fairly gloomy picture the current reality is that the vast majority of students will graduate successfully and go on to be productive citizens of this country and look back at the varsity years with fond and happy memories.

This story appears in the December 2003 issue of Fair Lady magazine and may not be used in other publications without permission from the editor of that magazine. It may be used for reference purposes only.

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