Contradictions, tensions and dilemmas mitigating the adoption of risk reducing sexual behaviour in the rural Eastern Cape, South Africa.

Abstract

Despite considerable effort to prevent HIV and increase awareness about the HIV and AIDS epidemic, many South Africans continue to engage in risky sexual behaviours, putting themselves at a greater risk of HIV infection. This study explores this lack of sexual behaviour change. The study aims to understand sexual activity dynamics in Ematyholweni, a rural area in South Africa. It focuses on the tensions and dilemmas in the positions that men and women in Ematyholweni take in relation to safe sex practices. It also explored how these tensions and dilemmas relate to contradictions in the sexual activity system and the state of contradiction in the activity system. The study used a qualitative research design. It used existing data from a broader NRF funded project. A purposive sampling technique was used in order to meet the objectives of the study. The data was collected using semi-structured interviews and focus group discussions. Data collection was conducted from 2012 to 2013. This study sampled 47 interviews transcripts. This sample consists of 22 men and 25 women in the age range 18 to 60 years. It also sampled 6 male focus groups and 7 female focus groups also aged between 18 and 60 years old. The study used an activity theory framework to guide the development, analysis and interpretation of this study. This model helps with identification of tensions and contradictions in an activity system and therefore helps with understanding the potential for change and transformation within an activity system. It used thematic analysis and activity system analysis as complementary analytic tools. Data analysis highlighted that all participants were aware of the risk of HIV and HIV prevention measures. However, dilemmas that they experience in sexual activity, and the related tensions and contradictions do not lead to sexual behaviour change. Sexual activity was linked to a way of achieving gendered identity, making it problematic to effect behaviour change. However, the mediating artefact of the conceptual system of HIV risk is stronger for women than for men. The contradictions within women’s activity systems are at a mature stage and near crisis, while men’s activity systems are at an early stage of maturity and lack crisis. This lack of crisis in the activity system of men helps to understand lack of sexual behaviour change.