The social construction of HIV risk and implications for HIV testing health practices amongst sexually active youth at a South African university.

Abstract

The dominant discourses related to HIV and AIDS in South Africa still construct HIV as a huge threat, and position sexually active youth between the ages of 15-24 years as at risk of, and living with, HIV. While an effort to manage HIV infection through practising safer sex is relevant to mitigate sexual transmission, it can be challenging to control the sexual practices of youth, or persuade them to condomise, if they do not prioritise this form of sexual risk. This should leave HIV testing as their primary self-protective strategy (and a priority health issue), but this is not necessarily the case. Research suggests that sexually active youth are not engaging actively in HIV testing. This study addressed this issue by investigating how sexually active university students aged 18-24 years at the University of KwaZulu-Natal on the Pietermaritzburg campus constructed HIV risk; how they constructed and positioned themselves and others in relation to HIV risk; how their constructions and positioning worked, and what they achieved by using them in this way, in relation to their own practice of HIV testing. Convenience, purposive and snowball sampling methods were used to recruit five male and 15 female student participants. In-depth interviews were conducted with all participants, and the data were analysed discursively. The findings of this study were that the majority of participants constructed HIV as an immense and overwhelming threat in terms of its prevalence in South Africa and on the Pietermaritzburg campus, and a few others constructed it as being a minimal threat. Their justifications for these constructions drew on existing discourses in advertisements, the mass media, educational awareness programmes, health research, interactions with health care providers and peers, and their experiences of health care on, and off campus. In terms of participants’ positioning in relation to HIV risk, most of them positioned themselves as being at risk but not at fault, but rather as potential victims of health policies that treat HIV using antiretroviral therapy, rendering it invisible in the ‘everyday’ life. Some of these participants referred to their experiences of a partner cheating, or the possibility of them cheating, and exposing them to risk situations, while others attributed their risk to other people’s destructive behaviours, such as at risk of a violent rapist; an unknown male figure who is positive, and at risk from non-sexual transmission routes, such as exposure to contaminated blood, or ‘touching others’. This positioning adopted by these participants positions them as unable to defend themselves against HIV, and as victims. A consequence of this positioning is that other people are made responsible for creating one’s HIV risk, and one is dependent on these people to avoid HIV transmission. In terms of participants’ engagement with HIV testing, their testing practices suggest that they do not test regularly, and that testing is not part of their management of HIV risk. Those who reported testing did it in a crisis. They were concerned about being infected with HIV after engaging in unprotected sex, or concerned about being betrayed by a partner and being exposed to HIV risk, or concerned about symptoms related to having AIDS. This study concludes that although most participants constructed and positioned themselves as being aware of how serious the threat of HIV is in their setting, they distanced themselves from this risk. This relates to the negative identity of being HIV positive, having a visible sickness, with a body severely affected, wounded, degraded, and attacked, which then also puts one at risk of stigma. In this situation, the positions which are available to them are limited, and the discourses that are available in their context limit their health actions and practices, particularly their engagement with HIV testing as a protective practice. It is as if prioritising HIV prevention through testing does not help them in the development of their desired identity. In fact, it seems to generate a negative HIV identity, and this works to undermine the value of HIV testing in their everyday life. Thus, their avoidance of HIV testing is one of their many small actions to protect themselves from the negative identity, and from knowing it, and others from associating it with them. To address this avoidance of HIV testing, this study recommends that health interventions need to focus on subtle aspects of HIV risk amongst youth, such as the cultural meanings they attach to it, their positioning in relation to it, and their ways of responding to it through testing in terms of what informs their practices, and how and why their processes around testing are maintained and sustained (and what they are), rather than simply enhancing students’ knowledge and improving coverage in the HIV testing services on, and off Pietermaritzburg campus. More discursive qualitative research on the topic of HIV risk and HIV testing amongst students across the University of KwaZulu-Natal campuses is suggested to understand how HIV testing strategies and interventions on its campuses have worked. In view of this, this study provides baseline information within which the findings of subsequent work could be compared.