HIV/AIDS prevention knowledge among youth in cape town, South Africa.

Author:Anderson, Kermyt G.
 
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INTRODUCTION

Considerable attention has been paid in social science, medical, and public health research to the factors influencing HIV/AIDS risk behaviours. Many models of health behaviour, such as the AIDS Risk Reduction Model, the Information-Motivation-Behavioural Skills Model, and the Health Belief Model, posit that knowledge about the facts of HIV/AIDS transmission will lead to more preventive behaviours and fewer risky behaviours (1-3). HIV/AIDS knowledge among young people is of great concern in South Africa, where HIV prevalence among 15-24 year-olds is 10.3% (4). As in many other less developed countries, the primary method of HIV/AIDS transmission in South Africa is heterosexual intercourse (5). Numerous HIV/AIDS education and prevention programmes in South Africa have operated under the premise that educating youth and other high-risk groups is key to reducing the spread of the disease (6). For example, the ABC campaign, advising people to Abstain, Be faithful, and use a Condom, has received widespread dissemination in South Africa. Yet many questions remain about the level of HIV/AIDS knowledge among South African youth and their ability and willingness to make use of that knowledge to reduce HIV/AIDS risk (7-9). In a country with high HIV prevalence, understanding the level of HIV/AIDS prevention knowledge and the factors influencing this knowledge could have important and far-reaching implications on a public health phenomenon that threatens to negatively impact numerous aspects of society, ranging from health and mortality to economic productivity. This paper examines HIV/AIDS prevention knowledge and its correlates for a representative sample of youth in Cape Town, South Africa. It also examines whether the correlates of HIV/AIDS knowledge operate differently by race, an important social category in South Africa.

HIV/AIDS knowledge: Recent studies among youth in South Africa and other African countries have found at least moderate levels of knowledge about HIV/AIDS, but important gaps in HIV/AIDS knowledge remain (4),(7),(10-13). Condoms, abstinence, and monogamy or limiting the number of partners are the most frequently named methods of preventing HIV/AIDS, although condoms are mentioned far more often than the other methods (14-15).

The relationship between HIV/AIDS knowledge and behaviours has been debated. Engagement in high risk HIV/AIDS behaviours (e.g., multiple sex partners, inconsistent condom use) despite knowledge about HIV/AIDS has been found in some studies of youth in Africa, but other studies have found positive associations between HIV/AIDS knowledge and HIV/AIDS prevention behaviours (8),(9),(11),(16-18). Further, recent evidence on the sexual behaviours of young South Africans indicates that preventive behaviours (condom use and fewer sexual partners) have increased (15),(19-20). This suggests that campaigns to increase knowledge about HIV/AIDS may be having an effect on behaviours, and underscores the importance of assessing knowledge about HIV/AIDS prevention.

Besides risk behaviours, a number of other factors may be correlated with level of HIV/AIDS knowledge among young people in Africa. Young people who know someone living with HIV/AIDS or who died of the disease may be more knowledgeable about the disease than others (10). Youth who have completed more grades in school may have received more information about HIV/AIDS than others, and a positive association between educational attainment and HIV/AIDS knowledge has been found in some African studies (7),(10). School enrollment status may be important as well because youth who are in school may have more current exposure to HIV/AIDS education and prevention methods than youth who are not. Educational attainment and school enrollment status also may serve as proxies for socioeconomic status. In addition, we might expect older youth to be more knowledgeable about HIV/AIDS prevention than younger youth (11),(16),(21), but some studies have found no association between age and HIV/AIDS knowledge(7). Finally, evidence about the relationship between gender and HIV/AIDS knowledge is also mixed, with studies finding no gender effects, effects favoring males, or effects favoring females (7),(11),(16),(22).

Race and HIV/AIDS knowledge: Although race has been, and remains, a major factor in South African social life, relatively little attention has been paid to racial or ethnic differences in HIV/AIDS knowledge. Race (population group) is particularly important in South Africa, in part because of the legacy of apartheid, the former policy of strict racial segregation. Under apartheid, coloureds (mixed race) and Indians (Asians) were moderately disadvantaged relative to whites (European ancestry), while blacks (Africans) were severely disadvantaged. Although apartheid laws were repealed by the early 1990s, racial inequality and de facto segregation still exist in South Africa, contributing to continued economic and health inequalities by race (23),(24). HIV prevalence varies by race. Among South African ages 15 to 24, 12.3% of blacks, 1.7% of coloureds, 0.3% of whites, and 0.8% of Indians are HIV positive (4). Studies in South Africa that have used multi-race samples have found white and Asian youth are more knowledgeable about HIV/AIDS than black and coloured youth (22),(25). However, most studies in South Africa have used single race samples (typically black). In order to better understand and redress racial health inequalities, it is important to consider whether there is racial variation in the correlates of HIV/AIDS knowledge.

Hypotheses: We predict that current school enrollment, grade attainment, knowing somebody with HIV or who died of AIDS, and having ever had sex (i.e., being sexually experienced) will be key correlates of HIV/AIDS knowledge. We expect higher values of each of these four variables to be associated with higher levels of HIV/AIDS prevention knowledge. Background variables in our study are age, race, and gender. Age may be positively associated with HIV/AIDS knowledge, and blacks may have less HIV/AIDS knowledge than coloureds and whites. In view of the mixed findings of previous studies, we make no specific predictions about the possible association between gender and HIV/AIDS knowledge.

MATERIALS AND METHODS

Data: We used data from Wave I of the Cape Area Panel Study (CAPS), a new study of youth and their families living in Cape Town, the second largest city in South Africa(26). CAPS is a joint project of the University of Cape Town and the University of Michigan, operating under the approval of human subject review boards at both universities. Written consent was obtained from all respondents, and written parental consent was obtained for respondents under age 18. Both authors of this paper were involved in the design and implementation of the Wave I study.

CAPS used a two-stage probability sampling design. The first stage sampled 440 Census Enumeration Areas (EAs) and the second stage sampled 25 households (in both formal and informal housing areas) within each selected EA. Black and white households were oversampled with the goal of obtaining roughly equal numbers of black, coloured, and white youth. Upon recruitment into the survey, the household questionnaire was administered to the person most knowledgeable about the household. Full-length youth questionnaires were given separately to up to three young people (ages 14 to 22) in each household. (For further details about the design of CAPS, see(26).)

The 2002 baseline wave of CAPS included 5,256 households containing 22,631 residents (42.3% black, 43.7% coloured, and 14.1% white). Detailed interviews were conducted with 4,752 young people (44.7% black, 39.5% coloured, and 15.7% white). The response rates for the youth...

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