The first survey of Swazis' sexual behaviour and attitudes toward HIV/AIDS has found that high awareness of the pandemic has not translated into less risk-taking behaviour, and that HIV-positive people remain unwilling to admit their status.
The study was conducted at a time when Swaziland is in need of data, said Health Minster Dr Phetsile Dlamini in her introduction to the first HIV/AIDS/STDS Behavioural Surveillance Survey.
Two years in the making, the report was carried out by the health ministry, Family Health International and the Family Life Association of Swaziland. It comes at a time when health workers have complained that insufficient data on Swazis' sex lives inhibited strategies to cut HIV transmissions in a country where 38.6 percent of the adult population is
Specific sub-groups considered most at risk from AIDS were targeted by surveyors who canvassed the country with standardised questionnaires, a technique relatively rare in Swaziland. Perceived at-risk groups included the military, police officers, local and long-distance bus drivers, and watchmen. Seasonal workers, such as sugar cane cutters on agricultural plantations, commercial sex workers, and factory workers were also targeted.
The common denominator of all these groups is they consist of people who are away from homes and spouses, or who are on the move, Zodwa Mtetfwa, communications officer for the Family Life Association told PlusNews.
Policemen and soldiers stationed around the country, itinerate bus drivers and migrant workers, even country people relocating to urban centres for factory and watchmen jobs rely on out-of-wedlock sex, putting them at risk of HIV infection, the report found.
One of the first findings of the survey was that extramarital and premarital sex is the norm for Swazis. Some 3,000 students, also considered an at-risk group, reported sexual activity began on average when they turned 16 years of age.
Across all surveyed populations, respondents reported multiple sexual partners. Sex with non-regular partners ('casual sex') was highly prevalent, as was premarital sex among youth, the report noted.
Early sex and multiple partners are a trend rooted in Swazis' history as a polygamous society, where girls married young and men had multiple wives during days of high infant mortality and low life expectancies, a sociologist at the University of Swaziland told PlusNews. Although more children are surviving infancy and Swazis are living decades longer than a century ago, cultural habits persist, contributing to the spread of HIV.
The good news was that condom usage was widespread among Swazis surveyed. However, condom use was not consistent. Seventy-four percent of young people attending school said they used condoms during their first sexual encounter, compared to only 37 percent from the same age group who were not in school.
Among tertiary students, 87 percent used condoms during sex, and those who did not explained they trusted their partner not to be HIV-positive.
People still forget to use condoms, or they feel temporarily 'safe', but it's a game of Russian roulette in a country where more than one out of three adults is HIV-positive, Agnes Kunene, a nurse in the commercial city Manzini, explained.
University of Swaziland student Cynthia Dube told PlusNews: By the time young people have reached tertiary level, they've seen what AIDS can do. They've lost friends, and probably lots of adult relatives, to AIDS. They are more cautious.
The most discouraging data from the report showed continuing widespread ignorance of AIDS among youth, a fear among all age groups of being tested for HIV, and negative attitudes that stigmatise HIV-positive people.
Knowledge questions from the survey asked: Can a person get the HIV from mosquito bites? Can people protect themselves from the HI virus by having one uninfected faithful sex partner? Can a person get the HIV by sharing a meal with someone who is infected?
The answer to all the above is no. But while virtually all young students (99.9 percent) had heard about HIV/AIDS, four out of five still held incorrect beliefs about the disease. Similarly, 98.1 percent of students were aware of sexually transmitted diseases, but only a few students could identify symptoms corresponding with such infections.
About the same number of young people who were not in school knew about HIV/AIDS, 98.7 percent, but about nine out of 10 of them held erroneous beliefs about AIDS.
Knowledge of HIV prevention methods was generally high among the adult groups, but this knowledge has not translated into desirable behavioural change, the report said.
The knowledge of AIDS is high, and we've successfully gotten the word out. But nothing we've tried has made people change their ways, noted Dr Derrick von Wissel, director of the National Emergency Response Committee on HIV/AIDS.
Most troubling in the report was that stigma toward people with AIDS or who are HIV positive persists through all social groups. Most respondents said they would be willing to take care of a family member with AIDS, but otherwise chose to shun others who are living with the virus.
Health workers trying to overcome Swazis' AIDS-phobic attitudes will not be encouraged by the study's findings. AIDS and attitude go hand in hand. AIDS will only be conquered when people accept with realism that the disease exists, and offer compassion and assistance to HIV-positive people, said Hannie Dlamini, director of the Swaziland AIDS Support
The stigma surrounding AIDS could explain the survey's finding that only a small proportion of respondents reported ever taking an HIV test.
A significant number of those who did find the courage to take the test said they received no pre or post-test counselling of any kind, leaving them to flounder in fear about their condition in a society that shuns the growing population of people living with HIV and AIDS, but who by the decade's end could comprise the majority of adults.
The report concluded with the recommendation that the government set up a national Behaviour Change Communications strategy, utilising the media, particularly radio, to encourage Swazis to practice safe
sex. (Source: IRIN Africa reports, 2/4/2003)