Challenges and obstacles in early HIV and AIDS education in South Africa, 1989-1994

Uitdagings en struikelblokke in vroeë HIV- en VIGS-opvoeding in Suid-Afrika, 1989-1994

Louis Grundlingh

Louis Grundlingh is professor in History at the University of Johannesburg and has been working extensively on aspects of the history of HIV and AIDS for the last couple of years

ABSTRACT

Very little research has been done on HIV and AIDS education in the 1980s. AIDS cases rapidly increased from less than 1 per cent in 1990 to almost 8 per cent in 1994. Both the government and non-governmental organisations started to launch HIV and AIDS education campaigns and programmes. Whilst the levels of awareness might have been relatively high, the same cannot be said for the knowledge levels. There were numerous impediments with the educational efforts. These ranged from a restrictive conservative morality, and a strictly bio-medical interpretation of the disease, to the racial context of South Africa. A variety of methods were used to convey the HIV and AIDS message. Considering the levels of illiteracy in the country, educationists made use of visual aids and dramatic performances to convey the message. Prejudice, as well as inadequate financial and human resources, impeded the educational drive. By 1994 knowledge levels rose, but no major inroads were made in the ultimate goal of behaviour change.

Key words: AIDS; behaviour; conceptualisation; context; education; government; HIV; knowledge; messages; methods; NGO; obstacles; problems, programmes

OPSOMMING

Baie min is gedoen ten opsigte van HIV- en VIGS-opvoeding in die 1980's. VIGS-gevalle het vinnig toegeneem van minder as 1 persent in 1990 tot amper 8 persent in 1994. Beide die regering en nie-regeringsorganisasies het veral in hierdie tyd HIV- en VIGS-opvoedingsveldtogte en -programme begin loods. Die vlak van bewussyn mag relatief hoog gewees het, maar dieselfde kan nie van kennisvlakke gesê word nie. Daar was heelwat beperkinge wat die opvoedingspogings in die wiele gery het. Dit het gewissel van 'n baie beperkende konserwatiewe moraliteit en 'n streng biomediese interpretasie van die siekte, tot die rasse-konteks van Suid-Afrika. Verskeie metodes is aangewend om die HIV- en VIGS-boodskap oor te dra. Opvoedkundiges het die vlak van ongeletterdheid in ag geneem en daarom het hulle van visuele middele en toneelspel gebruik gemaak om die boodskap oor te dra. Vooroordele en ontoereikende finansiële en menslike hulpbronne het baie beperkend op die opvoedkundige pogings ingewerk. Teen 1994 het kennisvlakke wel toegeneem, maar geen noemenswaardige vordering is gemaak met die uiteindelike doel om gedrag te verander nie.

Sleutelwoorde: Boodskappe; gedrag; HIV; kennis; konseptualisering; konteks; metodes; NGO; opvoeding; probleme; programme; regering; VIGS

Full text available only in PDF format.

1 M J Kelly, "HIV/AIDS and education in Eastern and Southern Africa: the leadership challenge and the way forward", Report for the African Development Forum, December 2000
2 L Gilbert and L Walker, "HIV/AIDS in South Africa - An Overview", in Cad Saúde Publica, Rio de Janeiro, 18, 3, May-June 2002, p 655.         [ Links ] In 1982 there were 2 reported AIDS cases and 2 deaths By 1994 these figures changed drastically to 3 847 and 949 respectively Source: AIDS Scan, 6, 3, September/October 1994 After that, the figures rose very sharply This was not far from the projection of 6 million HIV positive by 2005 Source: H Marais, To the Edge: AIDS Review 2000 (HSRC, Pretoria, 2000), p 5
3 R Shell, "Halfway to the Holocaust: the Economic, Demographic and Social Implications of the AIDS Pandemic to the Year 2010 in the Southern African Region", Occasional Papers: HIV/AIDS: A Threat to the African Renaissance? (Konrad Adenauer Stiftung, Johannesburg, 2000), p 11
4 UNAIDS 2008 Report on the global AIDS epidemic
5 There is a considerable literature in South Africa on HIV and AIDS and education covering the period after 1994 See for example: P Badcock-Walters, The impact of HIV/AIDS on education in KwaZulu Natal (University of Natal Press, Pietermaritzburg, 2001);         [ Links ] C Coombe, "Keeping the education system healthy: managing the impact of HIV/AIDS on education in South Africa", Current issues in comparative education, 3, 1, December 2000; C Coombe, "Rethinking some of our perceptions about HIV/AIDS and education " Unpublished paper presented at the Southern African Development Community Meeting on HIV/AIDS and Education, February 2001; M J Kelly, "Standing education on its head: aspects of schooling in a world with HIV/AIDS", Current issues in comparative education, 3, 1, December 2000         [ Links ]
6 See: A du Plessis, "Managing AIDS in the Workplace: Some issues and considerations for human resource practitioners", AIDSscan, 2, December 1990, pp 6-9; A E Jordhem, "Removing the Mystery from AIDS", Management Review, February 1990, pp 20-25; L Liskin, C A Church, P T Pitrow, and J A Harris, "Population Reports: AIDS Education -a beginning", Issues in World Health, 32, 8, September 1989, pp 1-28; J Metz and J M Malan, "The Impact of AIDS on Society", South African Journal of Continuing Medical Education, 6, pp 23-29 Natalie Stockton, the first head of the AIDS Unit of the Department of National Health, confirmed this No author: "Interview with Natalie Stockton: 'Striving for a community-driven national programme'", Aids Bulletin, 1, 2, December 1992, p 7
7 C B Ijsselmuiden, "AIDS and South Africa - towards a comprehensive strategy", South African Medical Journal, 73, 16 April 1988, p 465         [ Links ]
8 One is daunted by such a question when the figures further show HIV spread from a 0,7 per cent adult infection rate in 1990 to 20 per cent in 2000 despite considerable educational efforts and awareness M Hunter, "The ambiguity of AIDS 'awareness' and the power behind forgetting: Historicizing and Spatializing Inequality in Mandeni, KwaZulu-Natal " Unpublished paper presented at the AIDS in Context Conference, 4-7 April 2001, University of the Witwatersrand, Johannesburg, p 1
9 The intention was to combine information from the different provinces
10 This period was crucial, as it was the first time that HIV and AIDS education was taken seriously enough
11 Gilbert & Walker, "HIV/AIDS in South Africa - An Overview", p 651
12 The role of these circumstances and the influence they had on health are well-known I have commented extensively on this in an earlier article, "Government Responses to HIV and AIDS in South Africa as Reported in the Media, 1983-1994", South African Historical Journal, 45, 2001, pp 124-153 Also see: L Walker and L Gilbert, "Women at risk: HIV and AIDS - A South African Case Study", African Journal of AIDS Research, 1, 2001, p 4         [ Links ]
13 See, for example: Gilbert & Walker, "HIV/AIDS in South Africa - An Overview", pp 651-654 for expanding on this for the period under discussion
14 D Everatt, Creating a Future: Youth Policy for South Africa (Ravan Press, Johannesburg, 1994) emphasised that the suggestions of the Department of Health's policies regarding HIV and AIDS under National Party rule ignored the socio-economic reality of black life in South Africa This was not the first virus to be constructed socio-politically See for example: R M Packard,         [ Links ] White plague, black labour : tuberculosis and the political economy of health and disease in South Africa (University of California Press, Berkeley, 1989)         [ Links ]
15 See my article "Government Responses to HIV and AIDS in South Africa as Reported in the Media, 1983-1994", South African Historical Journal, 45, 2001 Also see A Whiteside and J van Niftrik, "AIDS in South Africa: Government and ANC Response", AIDS Analysis Africa, 3, 4, December 1995, pp 1, 9 The Department of Education had no policy on HIV and AIDS until late 1999 C Coombe,         [ Links ] "Keeping Education Healthy: Managing the impact of HIV/AIDS on Education in South Africa", Current Issues in Comparative Eduction, 3, 1, 2002, 2000, p 14         [ Links ]
16 J Head, "Behavioural assumptions about the spread of HIV infection in South Africa", AIDS Bulletin, 1, December 1992, p 17 Head warned that an exclusive focus on "cultural traits will miss the connections between diet,         [ Links ] housing and access to health care and education which are more critical in determining most people's life chances and their vulnerability to HIV infection " Also see Walker & Gilbert, "Women at risk: HIV and AIDS - A South African Case Study", African Journal of AIDS Research, 1, 2001, p 19, where the number of factors that influenced the pattern of HIV and AIDS in South Africa were listed In 1994, 51 per cent of South Africans lived below the poverty line South African Institute of Race Relations, South Africa survey, 2007/2008, p 84
17 Head, "Behavioural assumptions about the spread of HIV infection in South Africa", p 17
18 C Carolus, "Addressing the challenge of AIDS", Aids Bulletin, 1, 1, August 1992, p 2 Also see: S de Villiers,         [ Links ] "Dealing with AIDS: Lessons from Antropology", Journal of Comprehensive Health, 3, pp 195-199;         [ Links ] JW Moodie, "The AIDS epidemic", South African Journal of Continuing Medical Education, 6, 3, 1988, pp 37-67;         [ Links ] M Zazayokwe, "Some barriers to education about AIDS in the Black Community", Social Work Practice, 2, 9, undated;         [ Links ] M Galloway and E Scheepers, "AIDS research in South Africa - what have we learned?", AIDS Bulletin, 2, 3, November 1993, p 4;         [ Links ] M Steinberg and Q Abdool Karim, "AIDS research in South Africa What gaps remain?", Aids Bulletin, 2, 3, November 1993, pp 18-19;         [ Links ] No author, "Documenting HIV and AIDS Good Practices in South Africa", The AREPP Education Trust, undated, pp 3-4, 15
19 Carolus, "Addressing the challenge of AIDS" p 5 Also see: De Villiers, "Dealing with AIDS: Lessons from Anthropology", pp 195-199; Moodie, "The AIDS epidemic", pp 37-67; Zazayokwe, "Some barriers to education about AIDS in the Black Community" This viewpoint coincided with progressive organisations such as Networking AIDS Community of South Africa (NACOSA) See: M Crewe, "Reflections on NACOSA", Aids Bulletin, 3, 2, July 1994, p 1 It presented alternatives to the failure of the government both to develop an effective national HIV and AIDS programme by 1990 and to take the AIDS epidemic seriously enough to ensure that effective education and prevention programmes were developed and supported timeously         [ Links ]
20 C de Beer, The South African disease: apartheid, health and health services (South African Research Service, Johannesburg, 1984);         [ Links ] M Price, "Health care as an instrument of apartheid policy in South Africa", Health Policy and Planning, 1, 1986, pp 158-170;         [ Links ] E Preston-Whyte and M Zondi, "To control their own reproduction: the agenda of black mothers in Durban", Agenda, 4, 1989, pp 47-68;         [ Links ] L Kuhn, M Steinberg and C Matthews, "Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa", HIV and AIDS Care, 6, 2, 1994, pp 161-162 and ME West,         [ Links ] and E A Boonzaaier, "Population groups, politics and medical science", South African Medical Journal, 76, September 1989, pp 185-186         [ Links ]
21 She was the Deputy Director of the HIV Division of the Centre for Disease Control in Atlanta and visited South Africa to observe the impact of the migrant labour system
22 The Daily News, 16 April 1990 and Vrye Weekblad, 20 April 1990
23 Galloway & Scheepers, "AIDS research in South Africa - what have we learned?", pp 2, 4
24 L Nicholas and K Durrheim, "Religiosity, AIDS and sexuality knowledge, attitudes, beliefs, and practices of black South African first year university students", Psychological Reports, 27, 1995, p 1328         [ Links ]
25 The process of assessing knowledge, attitudes beliefs and practices regarding AIDS and using that for the development of educational programmes is referred to as KABP D Wilson and A Mehryar, "The Role of AIDS knowledge, attitudes beliefs and practices research in sub-Saharan Africa", AIDS, 5, 1991, pp 177-180         [ Links ]
26 This was a nationally co-ordinated NGO
27 N Schaay, "The Aids programme of the National Progressive Primary Health Care Network", Aids Bulletin, 1, 2, December 1992, p 4;         [ Links ] Galloway & Scheepers, "AIDS research in South Africa - what have we learned?", p 2
28 Soul City is the popular name for the Institute for Health and Development Communication and an internationally recognised South African NGO Also see discussion below
29 Soul City Website, http//:www.soulcity.org.za and undated publication "Soul City Heartbeat of the Nation", Series 4 Impact Evaluation, p 4, accessed 29 July 2007 Another example of high awareness was findings of research done amongst university students D Elkonin, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among University students " MA thesis, University of Port Elizabeth, 1992
30 S Naidoo, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among black adolescents " MA thesis, University of Port Elizabeth, 1994, pp 60-61; L J Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region " MA thesis, University of Port Elizabeth, 1996, p 72; C G Glover-Walton, "HIV and AIDS behavioural changes in the Eastern Cape " Unpublished paper presented at the AIDS in Context Conference, 4-7 April 2001, University of the Witwatersrand, Johannesburg, p 1
31 Business Day, 10 June 1993 and Sunday Times, 13 June 1993 This confusion, of course, can be seen as another barrier to education It will receive more detailed discussion later
32 Business Day, 10 June 1993 and Sunday Times, 13 June 1993
33 South African Health Review, 2000, p 306
34 People maintained their own ideas and beliefs about where the virus came from, how it is transmitted and who gets the virus Ideas that it was solely an African disease and that one can get infected by mosquitoes also lasted long Also see: Galloway & Scheepers, "AIDS research in South Africa - what have we learned?", p 2
35 Naidoo, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among black adolescents", pp 67, 88, 92; Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 74
36 D McLean, "Community report on the concerns of women in Kyelitsha", AIDSscan, 2, 9
37 Naidoo, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among black adolescents", p 104
38 C Mathews, C Kuhn, L Metcalf, G Joubert and N A Cameron, "Knowledge, attitudes and beliefs about AIDS in township school students in Cape Town", South African Medical Journal, 78, 9, 3, November 1990, pp 511-516         [ Links ]
39 Galloway & Scheepers, "AIDS research in South Africa - what have we learned?", pp 2, 4 See similar findings by Naidoo, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual activity among black adolescents", p 98
40 See my article: "HIV/AIDS in South Africa: a case of failed responses because of stigmatisation, discrimination and morality 1983-1994", New Contree, 46, November 1999, pp 55-81
41 M L Neethling, "Die houding van die adolessent teenoor VIGS met besondre verwysing na die opvoedingsverantwoordelikheid van die skool" ["The attitude of the adolescent towards AIDS with special reference to the educational responsibility of the school"] M Ed thesis, University of the Orange Free State, Bloemfontein, 1993, pp 41, 42, 55, 63, 66, 87-88, 100; Transvaal Education Department Circular Minute 70/88 This policy was reaffirmed at a workshop organised by the AIDS Unit of the Department of National Health in 1991
42 Neethling, "Die Houding van die adolessent teenoor VIGS met besondere verwysing na die opvoedingsverantwoordelikheid van die skool", pp 120-121, 162
43 E Preston-Whyte, "The influence of culture on behaviour", Aids Bulletin, 1, 1, August 1992, p 21; Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 38 and Carolus, "Addressing the challenge of AIDS", p 5
44 In a study on the knowledge of black adolescents of HIV and AIDS the former Education Department of the House of Delegates would not allow the section dealing with sexual behaviour in the questionnaire because it was regarded as being too personal Naidoo, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among black adolescents", p 29
45 See general approach of Neethling, "Die Houding van die adolessent teenoor VIGS met besondere verwysing na die opvoedingsverantwoordelikheid van die skool"
46 See, for example, the announcement by Professor Van Loggerenberg, Director of the Free State Teachers' Association, and D Schroeder, Chairperson of the Federal Teachers' Organisation, Die Volksblad, 23 Junie 1988 and Beeld, 2 Februarie 1989; Transvaal Education Department Circular Minute 70/88 Also see my article: "HIV/AIDS in South Africa: A case of failed responses because of stigmatization, discrimination and morality, 1983-1994", pp 55-81
47 J Oosthuizen, "The management of AIDS in South African schools", Koers, 59, 2, 1994, pp 149-150         [ Links ]
48 P Busse, "Response of people with HIV and AIDS to representations of themselves", Aids Bulletin, 4, 1, July 1995, p 23         [ Links ]
49 The elementary lessons dealt with health in general and barely mentioned HIV and AIDS at all, though teachers were told questions from children who fear that they could contract the disease should be addressed "honestly and simply " Half of the next level of lessons dealt with HIV and AIDS Only in the higher grade lessons, a majority directly addressed HIV and AIDS and was there discussion of the sexual transmission of HIV and the possibility of prevention through sexual abstinence On the Grade 9 to 12 level, the social and economic consequences of HIV and AIDS were addressed in a single lesson Although certain lessons were geared to elicit sympathy for people with HIV and AIDS and thus attempt to curb potential discrimination, the guides never addressed the homophobia and racism underlying much of the HIV and AIDS hysteria that the curriculum was ostensibly trying to dispel
50 C Robensteine, "HIV education at secondary level: an urgent necessity", NASSP Bulletin, 77, 557, 1993, pp 9-16; C Carolus, "Addressing the challenge of AIDS", p 4 See also my article, "HIV and AIDS in South Africa: A case of failed responses because of stigmatization, discrimination and morality, 1983-1994", pp 55-81
51 Findings at UCT:
• Sexually active students: 51 per cent
• No regular partner: 37 per cent
• Use of condom by sexually active students: 31 per cent
Findings at Wits:
• Not at risk of contracting HIV: 80 per cent
• Use of condom by sexually active students: 26 per cent
E A Robertson, "A survey of knowledge, attitudes and practices among university residence students " Honours Thesis in Psychology, University of Cape Town, cited in D Skinner, "A review of studies of knowledge, attitudes, beliefs and behaviour in relation to HIV and AIDS within the South African context " Unpublished paper presented at the 22nd conference of the Association for Sociology in South Africa, July 1992, Pretoria These findings are strikingly similar to those from studies of the sexual behaviour of young people in the advanced industrial countries See: C Boyer and S Kegeles, "AIDS risk and prevention among adolescents", Sociology of Science and Medicine, 33, 1, 1991, p 13
52 S Bell, A Feraios and T Bryan, "Adolescent males' knowledge and attitudes about AIDS in the context of their social world", Journal of Applied Social Psychology, 20, 5, 1990, pp 55-59
53 No author, "Interview with Natalie Stockton", p 6
54 Galloway & Scheepers, "AIDS research in South Africa - what have we learned?", p 2; No author, "Highlights of the prevention and education strategy", Aids Bulletin, 3, 2, 1994, p 8
55 No author, "Highlights of the prevention and education strategy", p 8 Doctor Zuma reaffirmed this in 1996 when she outlined 5 key strategies to fight HIV and AIDS Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 24
56 See similar finding in: H Homans and P Aggleton, "Health education, HIV infection and AIDS", in P Aggleton and H Homans (eds), Social aspects of AIDS (Falmer Press, London, 1988), pp 154-176
57. The Star, 2 April 1992; Rapport, 26 April 1992
58 Whiteside and Van Niftrik, "AIDS in South Africa", p 1
59 J D Forrest and J Silverman, "What public school teachers teach about preventing pregnancy, AIDS and sexually transmitted diseases", Family Planning Perspectives, 21,2, 1989, pp 65-72         [ Links ]
60 J R Kriel, "The nature of AIDS beyond the medical view," in A van Niekerk (ed), AIDS in context: a South African perspective (Lux Verbi, Cape Town, 1991)         [ Links ]
61 This trend continued Reported deaths in this age group rose by 170 per cent between 1997 and 2006 AIDS & HIV information from AVERT.org, accessed 25 February 2009
62 Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 47
63 A J Flisher, C F Ziervogel, D O Chalton, P Leger and B A Robertson, "Risk-taking behaviour of Cape Peninsula high school students", South African Medical Journal, 83, pp 495-497
64 Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 120
65 Neethling, "Die Houding van die adolessent teenoor VIGS met besondre verwysing na die opvoedingsverantwoordelikheid van die skool, p 97 Also see for the discussion on puppet shows and comics
66 M Crewe, AIDS in South Africa: the myth and the reality (Penguin, London, 1992), p 61         [ Links ]
67 The Sunday Star, 24 March 1991 Although it was announced in 1990 that educational programmes would be introduced, this was only made compulsory in all white secondary schools in 1991 and in all schools from 1992 Die Burger, 23 Maart 1990; The Cape Times, 22 March 1990, 22 March 1991; Editorial, Weekend Argus, 23 March 1991; Pretoria News, 11 October 1991 See also: Vrye Weekblad, 21 Junie 1991
68 The Star, 2 April 1992
69 New Idea, 9 May 1992
70 No author, "Attic Fighting AIDS through training, information and counselling", Aids Bulletin, 1, 1, 1992, p 8
71 No author, "Interview with Natalie Stockton", p 6; No author, "Highlights of the prevention and education strategy", p 8
72 Business Day, 15 May 1989
73 No author, "Highlights of the prevention and education strategy", p 8; M Maclachlan, M Chimombo and N Mpemba, AIDS Education for Youth through Active Learning: A School-based Approach from Malawi (University of Malawi, Lilongwe, undated)         [ Links ]
74 K Everett, "The development of an AIDS photo-comic for South African teenagers", Aids Bulletin, 1, 2, 1992, pp 8-9         [ Links ]
75 See further discussion below
76 See for example the study of M Hunter, "The ambiguity of AIDS 'awareness'", pp 7-8
77 Soul City Website, http//:www.soulcity.org.za and undated publication "Soul City Heartbeat of the Nation", accessed 29 July 2007
78 More than 45 per cent of adult blacks are completely illiterate and 25 per cent semi-literate D Ensor, "Co-ordinator of Operation Upgrade (adult literacy)", Pretoria News, 30 November 1992
79 J E Osborn and D E Rogers, "Preventing HIV and AIDS in adolescents", Journal of School Health, 64, 1, 1994 Galloway &         [ Links ] Scheepers, "AIDS research in South Africa - what have we learned?", p 2
80 In the United States the most common approach in videos dealing with AIDS was to have an expert discussing gay sexuality, rates of infection, and routes of transmission, intercut with shots of clubs and bars, hospitals and laboratories with test tubes, all to a background of sombre music These videos were generally dull and pedantic, quite often prejudiced, judgmental and contained misleading information See: J W Jones, "The Sick Homosexual: AIDS and Gays on the American Stage and Screen," in J L Pastore (ed), Confronting AIDS Through Literature: The Responsibilities of Representation (University of Illinois, Illinois, 1993), p 109         [ Links ]
81 B Rich, as cited in: B Horrigan, "Notes on AIDS and Its Combatants: An Appreciation", in M Renov (ed), Theorizing Documentary (Routledge, London, 1993), p 168;         [ Links ] J Greyson, as cited in Horrigan, "Notes on AIDS and Its Combatants: An Appreciation", in M Renov (ed), Theorizing Documentary (Routledge, London, 1993), p 169;         [ Links ] M Vaughan, "Syphilis in Colonial East and Central Africa: The Social Construction of an Epidemic", in T Ranger and P Slack (eds), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge University Press, Cambridge,1992), p 273         [ Links ]
82 Television was harnessed as a lucrative propaganda tool by the apartheid state Thus by the early 1980s, when the state suffered a growing crisis of legitimacy, the SABC-TV producers were instructed to make programmes in order to reinvigorate public support for the 'total strategy' and concomitant increased militarisation Strict censorship of public broadcasting operated throughout the 1970s and 1980s
83 R Hodes, "HIV/AIDS in South African Documentary Film, c 1990-2000", Journal of Southern African Studies, 33, 1, March 2007, p 157         [ Links ]
84 These films did not only have an educational message They also captured the blatant inefficiency of successive South African governments to curb the HIV and AIDS pandemic While the earlier films highlighted the failure of the Nationalist government to mount education campaigns to curb transmission, those that postdate the first democratic election in March 1994, focused on the worsening of these circumstances In the time between 1994 and 2000, government policy regarding the treatment of HIV-positive South Africans amounted to genocide through negligence - what Zachie Achmat has referred to as "a holocaust of the poor" E Cameron, Witness to AIDS (Tafelberg, Cape Town, 2005), p 137
85 C Rifkin and A Croucamp, "Approaches to the comic story medium as an AIDS education resource", Aids Bulletin, 4, 1, 1995, pp 12-13 Also see: S S A Karim, "Traditional Healers and AIDS prevention", South African Medical Journal, 83, January 1993, pp 423-424
86 R Coleman, "The Hlabisa HIV video: an attempt to bridge the gap between knowledge and behaviour", Aids Bulletin, 4, 1, July 1995, p 25 See also: E Green, Aids and STD's in Africa. Binding the Gap between Traditional Healing and Modern Medicine (Natal University Press, Pietermaritzburg, 1994), pp 1-5, 7-16, 177-205         [ Links ]
87 Coleman, "The Hlabisa HIV video", pp 24-25
88 Oosterlig, 1 Desember 1988; Eastern Province Herald, 13 January 1989; The Natal Witness, 29 March 1990; Daily Dispatch, 3 August 1990
89 No author, "Attic Fighting AIDS through training", pp 6-8
90 Historically, the NPPHCN AIDS Programme emerged out of voluntary working groups within NPPHCN The major impetus for the establishment of the programme came from the Maputo conference, hosted jointly by the Centre for Health in Southern Africa and the ANC Health Secretariat in April 1990 Schaay, "The Aids programme of the National Progressive Primary Health Care Network", p 1
91 Schaay, "The Aids programme of the National Progressive Primary Health Care Network", p 1
92 Pretoria News, 9 April 1992
93 See, for example: R Kidd and N Colleta (eds), Tradition and Development: Indigenous Structures and Folk Media in Non-Formal Education (German Foundation for International Development and International Council for Adult Education, Bonn, 1981)
94 It was already acknowledged that dramatic formats are extremely suitable to risk recognition and to change risk behaviour Multiple issues could be dealt with in an emotionally involving and entertaining way Aids Bulletin, 4, 1, July 1995, p 11
95 L Dalrymple and E Preston-Whyte, "A drama approach to AIDS education - an experiment in 'action' research", Aids Bulletin, 1, 1, August 1992, pp 9-10         [ Links ]
96 Some actors and disc jockeys likewise joined hands with government departments and schools to reach the young Other examples are "Dramaide Project" of the Drama Department of University of Zululand which performed in some 770 junior and high schools in KwaZulu and a six part TV drama series - 52 Regent Street, both were government funded Indaba, 12 March 1992; Zululand Observer, 20 August 1993
97 Dalrymple & Preston-Whyte, "A drama approach to AIDS education", p 11
98 Dalrymple & Preston-Whyte, "A drama approach to AIDS education", pp 10-11 Also see: Mati, "Acquired immune deficiency syndrome: knowledge, attitudes and sexual practices among rural matriculants in Algoa region", p 118
99 No author: "AIDS drama network established" and "'Puppets against AIDS'", Aids Bulletin, 1, 1, August 1992, p 26
100 No author: "Documenting HIV and AIDS Good Practices in South Africa", The AREPP Education Trust, undated, pp 2, 9-12, 18
101 B Oskowitz, Z Hlatshwayo, C Evian, Qualitative Evaluation of the African Research and Educational Puppetry Programme (AREPP) Unpublished evaluation; Cape Town: AREPP, 1995; J Reekie, An evaluation of the efficacy of an AIDS prevention play for high-school students, Unpublished MA dissertation, Johannesburg: University of the Witwatersrand, 1996
102 No author: "Interview with Stockton", p 6
103 Vrye Weekblad, 11 September 1992
104 The Star, 24 August 1993; Citizen, 24 August 1993
105 No author: "Highlights of the prevention and education strategy", p 8; Mati, "Acquired immune deficiency syndrome", p 122
106 Mati, "Acquired immune deficiency syndrome", p 56
107 Other similar efforts were the dramatized televised educational health programmes of Safritel R Bryden, "Golden threat to a healthy nation", Health and Hygiene, December 1994, p 34
108 Television (13 episode prime time television), radio (26 part magazine-cum-drama series), print material (life skills material and a parenting booklet), a public relations and advertising strategy (promotion to popularise the broadcast media) and an education packages for children and adults (includes comics, workbooks, facilitator guides, posters, audio and video tapes)
109 M Galloway, "Soul City - harnessing the media to promote health", Aids Bulletin, 4, 1, July 1995, p 2         [ Links ]
110 It was estimated that the combined message reached 8,1 million people This was 68 per cent of the target audience A total of 46,8 per cent black South Africans over the age of 15; 31 per cent of rural and 71 per cent of informal settlement dwellers had accessed one of more of the materials, 58 per cent of this audience discussed issues raised in the materials, 95 per cent claimed to have learned something and 78 per cent of these used the information It was estimated that the fourth series reached 16,2 million people, representing 79 per cent of the target audience M Galloway, "Soul City - harnessing the media to promote health", p 5; "Soul City Series 4 Evaluation Fact Sheet, 1, 1, 1998; T Samuels, J Mollentz, R Olusanya, M Claassens, S Braehmenr and Z Kimmie, "An evaluation of Soul City", October 2000 and Soul City Website, http//:www.soulcity.org.za, accessed 29 July 2007 Based on this success, it was followed by Soul City II and III, addressing other HIV and AIDS-related issues
111 No author: "Interview with Stockton", p 6
112 N Lightfoot, "The aborted 'Yellow Hand' campaign", Aids Bulletin, 1, 2, December 1992, p 6; Aids Bulletin, 4, 1, July, 1994, p 20
113 CASE research established that approximately 92 per cent South Africans had access to radio, 76 per cent to television and 55 per cent to newspapers Galloway, "Soul City - harnessing the media to promote health", p 1
114 Mati, "Acquired immune deficiency syndrome", pp 51, 76, 110
115 Naidoo, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among black adolescents", p 64 Also see similar findings by: Elkonin, "Acquired Immune Deficiency Syndrome: Knowledge, attitudes and sexual activity among University students", 1992 and Mati, "Acquired immune deficiency syndrome", p 85
116 One of the first educational comic strips was published in the highly successful "People's College" supplement to the Weekend Post which was banned by the State in the 1970s for political reasons Everett, "The development of an AIDS photo-comic for South African teenagers", p 7
117 For example, in 1981, Andy Mason and Dick Cloete's ground-breaking alternative history comic, "Vusi Goes Back" was published by the Environmental and Development Agency The most pioneering work in educational comics was carried out by the South African Council of Higher Education (SACHED) A series of comics was published based on popular novels and autobiographies in an attempt to provide teachers with an alternative, accessible and attractive teaching tool for teaching English as a second language
118 Rifkin & Croucamp, "Approaches to the comic story medium as an AIDS education resource", pp 12-13
119 SAMRC
120 No Author, "Roxy - life, love and sex in the nineties", Aids Bulletin, 2, 2, July 1993, p 23
121 Busse, "Response of people with HIV and AIDS to representations of themselves", p 23 and Coleman, "The Hlabisa HIV video: an attempt to bridge the gap between knowledge and behaviour", p 24
122 No author: "Interview with Stockton", p 6; A R Lifson, "Do alternate modes for transmission of Human Immunodeficiency Virus Exist?", Journal of Applied Social Psychology, 20, 1, July 2006, pp 424-448
123 Mati, "Acquired immune deficiency syndrome", pp 6, 11, 47
124 Preston-Whyte, "The influence of culture on behaviour", p 20
125 Carolus, "Addressing the challenge of AIDS", p 4
126 Preston-Whyte, "The influence of culture on behaviour", p 22
127 Carolus, "Addressing the challenge of AIDS", p 5
128 D Mokhobo, "AIDS in Africa", Nursing RSA, 4, 3, March 1989, pp 20-22
129 It was only in 1996 that the government increased the HIV and AIDS budget from R21-million to R85,5-million Mati, "Acquired immune deficiency syndrome", p 24
130 R Hodes pointed that that the newly constituted Department of Health - headed in 1994 by Doctor Nkosazana Zuma still - faced a number of daunting problems Decades of apartheid health policy, which saw the concentration of resources in the privileged white sector, while services for the majority of the population remained grossly underfunded R Hodes, "HIV/AIDS in South African Documentary Film, c 1990-2000", Journal of Southern African Studies, 33, 1, March 2007, p 164         [ Links ]
131 No author, "Attic Fighting AIDS through training, information and counselling", pp 7-8
132 No author: "NACOSA - update on the regions", Aids Bulletin, 3, 2, July 1994, pp 10-12
133 No author, "NACOSA - update on the regions", pp 10-12
134 The Citizen, 24 October 1992
135 Whiteside and Van Niftrik, "AIDS in South Africa: Government and ANC Response", pp 1, 9; Zazayokwe, "Some barriers to education about AIDS in the Black Community" Also see my article "Early responses, attitudes and behaviour regarding HIV and AIDS in South Africa, 1983-1988", Journal for Contemporary History, 26, 1, June 2001, pp 86-103
136 Kuhn, Steinberg, and Mathews, "Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa", pp 161-171; B M Magwentshu, "Critical analysis of sex education knowledge and behaviour of teenagers in Soweto high schools: A nursing perspective" MA thesis, University of South Africa, Pretoria, 1990; N P Page, "Effectiveness of a sex education programme in changing sexual knowledge, attitudes and behaviour of black adolescents " Unpublished MA thesis, University of South Africa, Pretoria, 1990; AK Perkel, The Mindscape of AIDS. Dynamics of Transmission (Percept Publishers, Cape Town, 1992); Robinson, "An investigation into pupils' knowledge of and attitudes towards AIDS: a survey of four private schools", 1991; Z Stein, "Important evidence about HIV prevention: lessons from researchers", Aids Bulletin, 2, 3, November 1993, p 14
137 Naidoo, "Acquired Immune Deficiency Syndrome", pp 107-108
138 P M Bowen, "AIDS 101", in T F Murphy and S Poirier (eds), Writing AIDS; Gay literature, language and analysis (Columbia University Press, New York, 1993), pp 140-160         [ Links ]
139 C J van Dam, "AIDS: Is Health education the answer?", Health Policy and Planning, 4, June 1989, pp 141-147         [ Links ]
140 A Butchart, "Qualitative research in public health Complementing epidemiological information with the individual perspective on risk and risk factors", AIDS Bulletin, 2, 3, November 1993, p 13
141 Naidoo, "Acquired Immune Deficiency Syndrome", p 102
142 R Young, A critical theory of education (Teachers College Press, New York, 1990)         [ Links ]
143 M J Kelly, Planning for education in the context of HIV/AIDS (International Institute for Educational Planning, Paris, 2000)         [ Links ]
144 The figures confirm this By the middle of 1995, there were 1,2-million South Africans already infected with HIV The rate of increase during the first part of the 1990s, was as follows: 1991 1,35 per cent;
1992 2,42 per cent;
1993 4,25 per cent;
1994 7,6 per cent;
1997 16 per cent
Moreover, the figures doubled every 15 months and a striking feature was the racial difference of infection: 10 times more "blacks" than "whites" were infected Eastern Province Herald, 20 June 1995; A Baleta, "South African faces an AIDS crisis as government health campaigns fail", The Lancet, 653, 1, 20 February 1999        [ Links ]