HIV/AIDS is caused by the Human Immunodeficiency Virus. The HI virus is most commonly passed from one individual to another through unprotected sexual intercourse in which bodily fluids such as semen are freely exchanged between individuals. However, the virus can be transmitted to a person through any contact of bodily fluids that are infected with the HI virus. This includes, but is not limited to, natural child birth in which the virus can be passed from mother to child and blood transfusions involving unsterile needles can cause someone to become infected as residual blood from an infected patient can remain on the needle and when this is needle used on an unaffected patient the HI virus can enter the person’s bloodstream and infect them. Once the HI virus has entered a person’s body, the virus starts to attack the CD4 cells of the immune system which are responsible for fighting off infections. With less cells to fight off infections, the infected individual’s immune system weakens making them much more susceptible to contracting infections and illnesses. Although there is no cure for HIV, antiretroviral drugs help to keep the virus under control and allow people to live a full life. Without receiving this proper treatment, the HIV could advance to the final stage of AIDS (Acquired Immunodeficiency Syndrome) in which the immune system has become so weak (a CD4 cell count of less than 200 per mm3) that an array of infections, the most common being TB (Tuberculosis) , have entered the body and caused it to become severely infected.
The HIV/AIDS Epidemic
The HI virus only came to the knowledge of medical authorities in the 1980s although the exact origins of the virus is unknown. However, the 1990s marked the start of the beginning of the HIV epidemic in South Africa and by the start of the 21st century about 20% of the South African population was infected. Though, in recent years, according to UNAIDS, in 2017, 36.9 million people worldwide were living with HIV of which 7.1 million of these were found to be in South Africa, making South Africa the country with the most number of infected individuals. Despite this, the number of new cases of HIV have dropped by 30% from 2010 to 270 000 new cases, indicating that the South African governmental programmes to combat the spread of the virus, namely better education and better access to contraception, is successful. However, many groups in South Africa are still vulnerable such as gay men, transgender women, sex workers and drug addicts. It was also found that due to South Africa having one of the highest rape rates in the world, girls between the ages of 15 and 24 were four times more likely to contract HIV than their male counterparts were. Furthermore, an estimated 280 000 children between the ages of 0 and 14 were infected in 2017. But the number of new infections in children declined from 25 000 in 2010 to 13 000 in 2017 owing to the successful implementation of the prevention of mother to child transmission system in which 95% of pregnant mothers received antiretroviral medication. South Africa has developed some of the best and most effective programmes in the world to combat the spread of HIV however the statistics are still extremely high and the country is facing an HIV epidemic.
Contraception is any mechanism or technique that prevents a sperm cell from reaching and fertilizing an egg cell thus preventing pregnancy from occurring. However, many contraceptives, specifically those that fall into the category of barrier method, serve a dual purpose as they prevent against pregnancy as well as the spread of STIs and STDs such as HIV. Thus, barrier method contraceptives play an integral part in practicing safe sex and combating the spread of STDs and STIs. In recent years, due to the rise of third wave feminism, and a shift in the general consciousness of populations from sex being a taboo topic to being something that is openly and safely discussed, there has been a large increase in the selection of contraceptives that have become available, particularly for women. Women can now choose the specific type of contraceptive that is suited to their needs and lifestyle. In addition, many governments have also become involved in the sex reform within society and some, such as the South African government, have started to make contraceptives more easily accessible by distributing condoms in public bathrooms and subsidizing the full cost of other forms of contraception such as the birth control pill in public clinics and hospitals. The production and distribution of condoms increased by 60% in 2017. This coupled with better education has allowed people to make more informed decisions regarding their sexual choices and this has lead to a decrease in the amount of unplanned pregnancies as well as the HIV epidemic in South Africa being kept under better control. This can be seen in the amount of individuals who have HIV live longer and more productive lives as it shows that quality of antiretroviral treatments in South Africa has increased. However the rates of teenage pregnancy and people living with HIV still remain high, indicating that South Africa is facing an HIV epidemic and that more measures need to be put in place to get the crisis under control.
HIV in the youth
South Africa is currently facing an HIV epidemic having about 7.1 million people living with the disease. Among the most vulnerable groups are those groups of society who have previously been marginalized such as gay men, transgender women, sex workers, drug addicts and teenage girls. This study will focus on the connection between HIV and the South African youth, most specifically females between 15 and 24 or what, according to the United Nations, is deemed as youth. Approximately 4 million people that suffer from HIV in South Africa belong to this age group. Furthermore, 2.4 million people in the age group have lost either one or both parents to AIDS.
Socio-economic factors such as poverty, violence, food scarcity and poor living conditions all increase an individual’s HIV risk factors. Furthermore, gender also plays a role in developing the youth’s HIV risk factor as young females are four times more likely to contract the disease than males are. These high risk levels are perpetuated by biological susceptibility, unequal economic opportunities for women, unequal status of women in society and in relationships and sexual violence and rape experienced by women.
Although in recent years the South African government has bettered education and provided campaigns to better inform the youth about HIV, in a recent study that was conducted it was found that less than half of the youth knew that condoms prevent against the spread of STDs like HIV and general knowledge surrounding the disease was poor. Furthermore, even though there has been a 60% increase in production and distribution of condoms in South Africa, the use of condoms has decreased by 15% from 2008 to 2012 in males between the ages of 15 and 24.
In addition, this view of contraception not being a worthwhile investment is being perpetuated by certain religious beliefs, ethnicities and cultures, where people are looked down upon for using contraception , and influenced by whether or not people have access to contraception. And even though, first trimester abortion is legal in South Africa for people above 12 years old without parental consent, it was found that, in 2018, 58% of all abortions were back door and illegal. This due to the fact that many cultures and religions shame woman who choose to obtain an abortion thus to not be disregarded by their communities, women choose to keep their abortions a secret and have it performed illegally at places that are often unsafe and unsterile. Furthermore, abortions are not accessible to all South African citizens. An Amnesty International report in 2017 found that less than 7% of the country’s public health facilities were performing abortions. And the cost of an abortion in private facilities is not easily affordable. The reason for discussing abortion in a debate about contraception is to illustrate that even though many are not using contraception to prevent unplanned pregnancy, abortions, theoretically, could be obtained to terminate these pregnancies. However, realistically due to the above mentioned factors, this is not necessarily true.
As can be seen above, many factors play a role in shaping the youth’s views,beliefs and actions regarding sex and contraception thus it is imperative that sexual education is healthy, adequate and unbiased. However, according to a study conducted with Sowetan youth in the Southern African Journal of HIV Medicine, it can be seen that there is dire need for youth-friendly reproductive and sexual health services and support that provide the youth with the necessary skills to make informed decisions regarding their sexual health and choices, in our modern world, especially considering the fact that this age group has one of the highest risk factors when it comes to contracting HIV. These services could include, but are not limited to, better access to contraception, family planning clinics, access to pre exposure HIV drugs for victims of rape and accessible testing for and treatment of STDs.
Furthermore, there is a notable gap between sexual education presented in the classroom and what sex has evolved into in our modern society. Many topics such as sexuality, sex between members of the LGBTQI+ community and consent are overlooked in the syllabus and mainly the traditional mechanics of male-female intercourse is taught and not enough emphasis is put on the severity of STDs and the important role that contraception can play in preventing the spread of them. This survey aims to highlight what these gaps in the system are and learn from the youth and their experiences about what they think should be better taught during sexual education as these skills are necessary to having healthy sexual practices in our modern society. The survey also aims to test the participants’ knowledge about various areas relating to sex and contraception in an initiative to further evaluate the adequacy of their previous sexual education. The testing of these two skills will help to give an indication about which topics need to be introduced or taught more effectively in the classroom and this, in turn, will help the government to pinpoint the areas where reform of the curriculum is needed.
In addition, the survey aims to investigate which form(s) of contraception the youth is most likely to use when they become sexually active by evaluating to what extent their religious and cultural beliefs influence their decisions regarding sex and contraception use. Also, whether or not the youth, specifically those belonging to the LGBTQI+ community, are seriously considering the spread of STDs and HIV when deciding on which forms of contraception to use. The above results will enable the government to set up youth friendly sexual and reproductive health and support services that encompass a large range of topics pertaining to sex and sexual health. Furthermore, it could provide a springboard for governments to set up educational programs in communities to ensure that young people are not solely basing their sexual choices off of biased and inadequate religious and cultural beliefs but rather receive all information necessary and are then in a position to make more informed decisions and choices. In a world that is so fast paced and ever changing, young people need to be given the tools to use to help them thrive in this society and, currently, these tools are unavailable to them due to lack of service delivery, heavy influences of cultural and religious beliefs and inadequate sexual education in the classroom. The survey aims to show governments the problem areas and to help them put in place policies and social structure that will empower the youth in their sexual choices while still practicing safe sex.