ARTICLES

 

The use of drawings to explore LGBT youths' access to HIV education in life orientation

 

 

Chishamiso Rita Mandizadza^I; Anthony Brown^II

^IDepartment of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa. mandizadzachish@gmail.com
^IISchool of Interdisciplinary Research and Graduate Studies, College of Graduate Studies, University of South Africa, Pretoria, South Africa

 

 

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ABSTRACT

In this article we examine how a minority sexual identity group of learners considered being LGBT acquire HIV education information in life orientation. We further explore how this group navigate within the discussions that follow. South Africa is a democratic country and all learners are equal and should benefit from education irrespective of their sexual orientation. However, research has indicated that, since schools are heteronormative in nature, such a minority group is being marginalised due to biases in schools - especially when it comes to the teaching and learning of HIV/AIDS and sexuality education in life orientation. These biases lead to these learners with diverse sexual orientations leaving schools ill-equipped on issues of sexual health and human rights. We collected data using purposive sampling from 7 participants - 3 lesbian and 4 gay students who shared their narratives through draw-and-tell and focus-group interviews. Four themes emerged from the draw-and-tell and focus-group interviews: telecommunication and television, church as an agent of societal plight, the school as a socialisation agent and common experiences and tastes and trust (friendship). The study was grounded in empowerment theory as it encourages participants to question and challenge existing beliefs and take action to address social, economic and political inequalities. The findings reveal that sexuality education is not taught in schools due to a lack of adequate knowledge on the part of teachers, and ignorance and stereotyping of gender and sexuality. We learnt that gender sexual diversity is silenced in schools and silence perpetuates compulsory heteronormativity in schools. We recommend that LGBT issues should be incorporated in the curricula for educator training (Msibi, 2011).

Keywords: bisexual; gay; heteronormativity; heterosexual; lesbian; transgender

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Introduction

Human immuno-deficiency virus (HIV) infection and acquired immuno-deficiency syndrome (AIDS) remain a global challenge and a major setback for the health sector. HIV/AIDS has had a devastating effect on the education system as the youth are the most affected and it is in schools that they have the biggest challenge of trying to fight the disease. South African HIV statistics is the highest in the world. In 2023 it was reported that 7.8 million people had HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2023). UNAIDS (2018) reveals that 50,000 young people in South Africa between the ages of about 10 to 16 got infected with HIV which led to AIDS. Sadly, these youths, among which are infected lesbian, gay, bisexual, and transgender (LGBT) learners, are under the guidance of life orientation teachers who are not responsive to the needs of the learners.

The government responded by introducing the teaching of life skills in the subject, life orientation. Life skills are taught to learners in high schools between the ages of 13 and 19 years (Smith, KA & Harrison, 2013). The programme was designed with the goal of providing learners with information about, among others, the transmission and prevention of HIV and other sexually transmitted infections (STIs). South African schools are perceived to be the vehicle for sex education that advocates for the prevention of unhealthy sexual behaviour as they reach large numbers of learners (Department of Basic Education [DBE], Republic of South Africa [RSA], 2013; Kirby, 2002; World Health Organisation, 2006). Schools have a responsibility to educate all learners about sexuality and relationships, regardless of their background and orientation. It is critical for young people to know how to protect themselves from harmful and risky sexual behaviour and how to access treatment should they be exposed to any form of sexually related illnesses. For this reason, schools are to be proactive in conveying this knowledge to school learners.

Life orientation was introduced to mitigate the scourge of HIV infection among young people in schools. Life orientation focuses on medical knowledge of HIV (Brown, 2016) and creates the perception that schools are innocent places (Bhana, 2014a). If ever aspects of sexuality are addressed it is done through a heterosexual lens (Mayeza & Vincent, 2019). The challenge is that teachers are uncomfortable with the topics of HIV, sex and sexuality as many deem it against their values and do not want to address such in class (Bhana, 2014b; DePalma & Francis, 2014; Rothman & Simmonds, 2015). More concerning is that these teachers express a heightened dissonance towards queer identities and their sexual practices (Mayeza & Vincent, 2019) and, if pressured, will only address the topic of heterosexual practices with a focus on abstinence (Ngabaza & Shefer, 2019). This void has the potential to leave LGBT school youths vulnerable to gain their own sexual reproductive health education which is relevant to their identity and lifestyle.

Christianity and Cultural Influences on Homosexuality

Christianity is the dominant religion in South Africa with almost 80% of the population professing to be Christians (Statistics South Africa, 2013). Religion provides norms that inform humans about how to live by creating moral rules that determine what is good and what is wrong; in this way, religion has a substantial effect on a person's attitudes (Van den Akker, Van der Ploeg & Scheepers, 2013). Religious beliefs play an important role in the denial of homosexuality as religious dogma considers homosexuality as being immoral (Ellison, 1993). Bhana (2012) concludes that teachers are silencing homosexuality and that diverse sexual orientation sexualities are heavily restricted in schools due to the toxic mix of cultural and religious norms that advance compulsory heterosexuality (Bhana, 2014a). Studies reveal that teachers have their own opinions about homosexuality and that teachers are negative towards sexually diverse learners. This was evident in their teaching resulting in sexually diverse learners feeling unaccepted and unsafe.

HIV Education in Schools

School years are the most critical considering that learners are exploring with alcohol, drugs and sexual intercourse. Promoting safe sex practices among learners is important considering the burden of HIV and other STIs in South Africa. HIV education is taught in schools as it is considered to be a safe place for all learners. The school-based HIV education programme is a very important and effective way to teach knowledge, attitudes and behaviour about sex-related health issues to all learners. Maree and Ebersöhn (2002) assert that after medical professionals, teachers are the first line of defence for learners in the fight against HIV/AIDS. This leaves teachers with the daunting task to educate learners on HIV and sexuality irrespective of learners' sexual orientation and gender expression. A chief element in HIV education is the need to support and protect young people, empower them with skills and values to ensure sexual safety, fulfilling relationships, enjoyment and well-being (United Nations Educational, Scientific and Cultural Organization [UNESCO], 2017). Since the inception of life orientation in the school curriculum, heteronormativity has been endorsed and reproduced while learners of sexual and gender diverse identities have been excluded (DePalma & Francis, 2014). Rooth (2005) contends that teachers may not be able to play their role of using the subject, life orientation, to drive HIV/AIDS programmes because of their personal biases.

Research Questions

Creswell (2002) says that formulating research question/s in the research process is a significant step as it narrows down the purpose and objective of the research. The main question for this study is: With regard to instruction and learning in life orientation, which skills, experiences, and reflections may LGBT after-school youths connect with sexuality and HIV/AIDS education?

The following sub-question articulates the problem clearly: What alternative sources did after-school LGBT youths consider when learning about HIV?

Theoretical Framework

Empowerment theory

We draw on the empowerment theory which is associated with the social scientist, Rappaport (1984) suggests that empowerment theory is about enabling individual groups to gain access to power and resources, thereby allowing them to control their own lives. In most cases social workers fight to empower individuals so that they may be in a position to overcome challenges that they face. These challenges may be in the form of substance abuse, emotional trauma, and homophobia. It is a process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights, or developing the capacity to make effective choices and convert these choices into actions and outcomes (Alsop & Heinsolm, 2005). The purpose with the life orientation curriculum is to teach learners to make meaningful decisions, solve problems and succeed in a rapidly changing society (Department of Education [DoE], 2003:10). As South Africa is a democratic country, all learners are equal before the law (DoE, 2003:10). In the field of education the empowerment theory is often associated with Pedagogy of the Oppressed by Freire (1970) who asserts that a need exists to empower individuals who are disenfranchised by taking control over their own learning and developing a deeper understanding of their own position through active participation and engagement. This theory has particular significance for this study as schools are active agents in nurturing gender and sexual identities. The Constitution of the Republic of South Africa, 1996 (RSA, 1996b) and the South African Schools Act ([SASA] RSA, 1996a) call for a community and school environment that protects and affirms those with diverse sexual orientation and gender identities. Empowerment theory empowers learners to develop skills in order to become independent problem solvers. When learners do not have power, they become voiceless and it is very hard for them to earn respect or status in society. The process becomes empowering if it helps learners to develop skills in order to become independent.

 

Methodology

We selected a qualitative research design for this study to capture a true understanding of the youths' experiences and the social context in which this takes place. In support of diverse sexual orientation learners, participants' narratives were presented through draw-and-tell and focus-group interviews. After having received ethical approval from the relevant ethics committee, data were collected. Informed consent was also obtained from all participants.

Data Collection Methods

Draw-and-tell, like any other forms of visual imagery, is about how people see the world in its simplicities and complexities (Franz, 2010). Drawing is a visual record of how the drawer understands his/her condition. Learners who are normally not reached, are reached through draw-and-tell. This method allowed LGBTs who are voiceless to reflect and tell their stories in a unique way. It also helps to draw out personal intuitive and subconscious thoughts from the participants (Hartel, 2014). After they had completed their drawings, participants were asked to write and tell to elaborate on their drawings to clarify the content and meaning of the drawings (Mitchell, Theron, Smith & Stuart, 2011). We used drawings as they proved to be easily obtained and encouraged participants to share attitudes, understandings, and inner emotional states about their experiences in life orientation.

Sampling Strategies

According to Mayeza and Vincent (2019), pedagogical approaches in life orientation are predominantly heteronormative, while Ngabaza and Shefer (2019) found that HIV education in life orientation upholds knowledge in which only cisgender and heterosexual orientation are considered. We used purposive sampling and considered students from non-heterosexual identities to explore their experiences on HIV education in life orientation. Participants belonging to the same societal and cultural background would ensure free flowing, open, and sincere discussion among participants. There is an LGBT organisation at the campus where the research was conducted. We contacted the chairperson of the LGBT organisation telephonically. A list of students who identified as lesbian, gay and bisexual was emailed to us. Unfortunately, no transgender participants contributed to the study. We contacted the potential participants using WhatsApp, text messages, and phone calls. We employed random sampling to select 10 participants from the larger population of volunteers, but only three participants participated in the research in the end. The ethics committee of the university granted approval for the study and the participants signed consent forms prior to data collection. The participants were assured of confidentiality and anonymity.

Data Analysis Process

Data obtained from drawings were analysed and interpreted for emerging themes. Thematic analysis (Smith, JA 2015) was used to identify broad themes that emerged from the participants' experiences. Data analysis required of us to do multiple readings to familiarise ourselves with the data before coding it (Braun & Clarke, 2006). Main ideas were grouped into clusters by organising and categorising the written statements and quotes into themes. A number of themes were generated and were reviewed. Pseudonyms were used to refer to the participants to maintain their privacy and dignity.

 

Findings and Discussion of Themes

Sources of Information on HIV and AIDS

We drew upon individual pictures to highlight emerging themes in the participants' experiences of HIV education in life orientation. Four themes were identified: 1) school, university and Institutional Office for HIV and AIDS (IOHA) as an agent of socialisation, 2) telecommunication and television, 3) friendship, common experiences, tastes and trust and 4) church as an agent of societal plight.

The statements below represent participants' comments on their drawings that confirm invisibility and silences on HIV and AIDS education that would be responsive to the needs of LGBT learners.

Shakes (lesbian identity) explained that she never learned about HIV and AIDS regarding people with non-heterosexual identities at school. Shakes explained that the only information she got about HIV and AIDS was that infection took place between a man and a woman should one of them be infected with HIV or AIDS.

The first information she got about HIV and AIDS pertaining to lesbian, gay, bisexual, transgender, queer and intersex people was from the university student society called International Office HIV and AIDS and older lesbian friends.

Shakes stated the following:

I was in my first year at university and gone with friends to the IOHA where they were having a health workshop. The staff members at IOHA explained to us their role in the community, especially the LGBT community. They gave a brief introduction about sex and they asked us if we saw the need for finger condoms and dental dams. That's when I realised, I don't know what dental dams and finger condoms are. That is how I got the information that HIV and AIDS can be contracted through same sex.

Most of the participants echoed the same sentiments:

Fikile (lesbian): IOHA introduced us to all the contraceptives and pre-exposure 'prophylaxis' means to prevent or control the spread of an infection or disease but I have never used them. I don't use them; I'm not getting used to them. Kamano: ... it's only when I got to varsity that's when everything opened up. I used to dry hump. I got to learn about HIV and AIDS for diverse sexual orientations at IOHA when they were having a health promotion at campus.

Kamano (gay) got his information on HIV and AIDS from the school and university. As with all participants, the HIV and AIDS information obtained from school was heterosexually biased and it was only at university that diverse sexual orientations were included in HIV and AIDS knowledge.

Fikile (lesbian) learnt about HIV and AIDS in school but this information was focussed on sexual transmission of HIV through binary sexual activities. She gained information on HIV and AIDS among lesbians from other lesbians and friends, fiction books and novels, and the internet.

Friends also contributed to knowledge about HIV and AIDS. Studies reveal that, through a common goal, friends tend to trust friends to establish social norms and behaviour in line with these norms. Friends often support each other's behaviour if they approve thereof and reward the behaviour. However, if the behaviour deviates from their behaviour they will disapprove or reject such behaviour (Theron, Liebenberg & Malindi, 2014).

Donald (gay) explained that he got the information from the Catholic school that he attended. Most of the priests were trained as teachers but also served the communities who were infected and affected by HIV and AIDS. They disseminated information on how to protect one from HIV infections. This information was always heterosexual, based on monogamy and celibacy if one was not married.

Donald stated as follows:

I was depressed as people were judging me and was having so many things going through my mind. So, I remembered they say before you die you either go to hell or heaven if you want to go to heaven you have to repent. I decided to go to church to confess and while confessing it happened that the father was also gay. The confession stopped the father came to me we talked and later on went on a date.

His first sexual experience was with a priest who nevertheless coached him to always use a condom and lubrication to avoid tearing during sexual penetration.

Religion is used as gatekeeper of sexual diversity. Brown (2018) asserts that religious dogma is used to police sexuality. Msibi (2012) contends that religion makes demands of its followers that ensure that they do not deviate from the norm. It is through religion that homosexuality is rejected (Francis & DePalma, 2014). The church as institution emphasises heterosexual marriages and discourages homosexuality.

Cookie (lesbian) got her information on HIV and AIDS from Twitter posts about HIV and AIDS awareness for people with LGBT sexual orientations. Cookie also indicated that the HIV and AIDS information she learned at secondary school was heteronormative and cisgender in nature.

Fikile (gay) said that he got his information from television and friends at school. The information that he received from university was more comprehensive and inclusive of diverse sexual orientations and gender identities compared to the compulsory heteronormative HIV and AIDS education which mainly focussed on information about sexually transmitted disease and teenage pregnancy.

Mpho (gay) got his information from a drama series, Intercession, on one of the local television channels. The series shows how inter-relationships between sexual partners contributed to the spread of HIV in society. This programme presented the various HIV infection risks based on heterosexual orientations. Mpho started to research HIV risks for non-heterosexual identities by accessing the internet through his smart phone which provided him with privacy. He later got more information about HIV and AIDS relevant to individuals of diverse sexual orientations at university and friends.

Television

At the time of publication, a number of television programmes were broadcast in an effort to educate the society about same-sex feelings and parenting. Examples are comedy shows on National Broadcasting Corporation (NBC) like The New Normal and Marry Me. The South African Broadcasting Corporation 1 (SABC) or channel 194 presented uZalo and Generations. According to Adrian (2013), soap operas depict real-life situations such as friendship, romance and family life.

 

Discussion: Sexuality and HIV Education

Sexuality and HIV education is problematic for sexual minorities due to its heteronormative nature which results in the marginalisation of learners with diverse sexual needs. Non-heterosexuality is silenced - particularly in terms of the classroom curriculum and textbooks (Kjaran, 2017). Leaving safe-sex instruction for diverse sexual orientation learners out of the curriculum will increase the likelihood of health problems for them, making them vulnerable to the risk of contracting HIV/AIDS as they do not know how to engage in safe sex. Sexuality and HIV education should close the gap between heterosexual learners and learners with diverse sexual orientations as it is the only way in which they may access reliable information on sexuality and sexual health.

Recommendations for Comprehensive Sexuality and HIV Education for Teachers

Teachers should be aware of the diverse backgrounds and experiences of their learners. This will help teachers to recognise and manage their own biases to create an inclusive learning environment, deal with their own discomfort, and acknowledge that proper comprehensive sexuality education has important benefits not negative consequences. This will impact the teaching of sexuality education in a more positive way. It is important that the curriculum should change to implement education for the other and education about the other.

 

Conclusion

In this study we investigated the experiences of after-school youth on accessing information on HIV/AIDS from a compulsory heteronormative perspective in life orientation. We used drawings as data collection tool. This was creative, empowering, and engaging for the participants as it allowed them to air their views without being judged. The participants represented diverse sexual orientations among the youth. We conclude that learners are eager to learn about HIV/AIDS and sexual diversity. It is now the responsibility of teachers to teach these learners. People with diverse sexual orientations share with the rest of the society a full range of risks including HIV and AIDS, as they face a profound and poorly understood set of additional health risks due to stigmatisation.

 

Acknowledgements

We acknowledge and thank the participants who participated in the research and willingly shared their experiences without fear.

 

Authors' Contributions

CRM wrote the manuscript and AB conducted the interviews. Both authors analysed the data and reviewed the final manuscript.

 

Notes

i. Published under a Creative Commons Attribution Licence.

 

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Received: 11 June 2023
Revised: 14 October 2024
Accepted: 8 February 2025
Published: 31 May 2025