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The Impact of Health Education on HIV in South Africa 

  • Writer: Sophia Yang
    Sophia Yang
  • Mar 1
  • 7 min read

Updated: Apr 10

Throughout the early 1980s, a deadly disease materialized and soon became one of thee leading causes of death in South Africa. South Africa is a hub for HIV/AIDS, accounting for more than 70% of global infection (Faust & Yaya, 2018)—as relatively low knowledge of HIV specifics continues within the area, prevalence remains at an endemic high. In 2013, South Africa accounted for 74% of the 1.5 million AIDS related deaths, and despite a decline by more than 33% in the span of several years, the epidemic persists (Kharsany & Karim, 2016). Within this mass-mortality, a common inquiry arises—the extent to which health education impacts South Africa, particularly its effect on the presence of HIV/AIDS. Teachers and students alike struggle to maintain current educational standards and create effective systems for health safety.  Over the past decade, education has become a key focus in public health. While South Africa's current efforts show some success, expanding disease-related education can enhance social awareness and further reduce HIV/AIDS rates. 



Effectiveness of Health Education 

Substantial evidence exists on the idea that increased health education results in a lowered risk of HIV/AIDS as it decreases prevalence and spreads awareness of transmission. C. Hartell, head of the early childhood education department at Pretoria University, affirms the importance of lowering high-risk scenarios in adolescents, advocating for HIV/AIDS awareness. Hartell’s research consisted of a series of interviews collecting insight on adolescent sexual behavior, including studies from governmental organizations including G. Ogunbanjo and R. Henbest, family physician professors at the Medical University of South Africa.  This study documented a significant increase in the recognition of AIDS as a major issue among 352 secondary school students in Kwaggafontein, South Africa, rising from 44% to 77% following a single educational program (as cited in Hartell, 2005). While these findings may have been adjusted since the time of data collection, the awareness of HIV/AIDS nearly doubled following an updated curriculum, providing a justifiable standard of comparison. The HIV/AIDS epidemic throughout the African continent has demanded reformation of existing knowledge of diseases, emphasizing the need for a refined health education structure. 


In agreement with the previous study, F. Okonofua, a gynecology professor at Ondo State University, affirms that health education supports the decline of cases on a review of national evaluation surveys of African countries.  Comparatively, Nigeria experienced a decline in HIV prevalence from over 5% in the 1990s to 3.4% in 2013 following improvements in its educational curriculum (Okonofua, 2015). Okonofua asserts the correlation between education and the declining cases due to the nearly halved prevalence of HIV within the country. This evaluation focused on countries in Africa rather than South Africa itself, posing difficulty in the generalization of these findings. Despite this, the author connotes potential for countries to reassess current education programs in a similar manner to Nigeria. Continuation of such programs promotes safe behaviors in the context of HIV/AIDS, stipulating the addition of supportive health education. 


Societal Limits of South Africa 

Health education is supportive towards the HIV/AIDS crisis, however the societal context of South Africa has decreased its effectiveness. C. Campbell, a social psychologist at London School of Economics and Political Science, and Y. Mzaidume, program manager of the Mothusimplio Outreach Program, assessed the extent to which peer education improved social expectations, deducing the view of HIV/AIDS as a social issue rather than medical. These social cycles are exhibited in instances where “...impoverished women sold sex in chaotic environments of hyper-masculinity, such as mines, where preventative measures were difficult to institute” (Campbell & Mzaidume, 2002). Despite high levels of knowledge pertaining to HIV/AIDS dangers, individuals engaged in high-risk activities due to social obstacles, especially in the context of poverty in areas such as South Africa. Additionally, in a social perspective from A. Gacoin, a sexuality educator in British Columbia, the use of condoms was considered a “loose moral in South Africa” (Gacoin, 2010, p. 430). Education may increase HIV/AIDS awareness. However, application of such teaching may be difficult due to conformity towards standard morals and societal norms.


Similarly, the history of apartheid affects the state of South African education systems in modern times, as identified by J. Freedman, international relations scholar at UNESCO, and N. Poku, Chair of Frontline AIDS in South Africa. Apartheid was a political system of racial segregation implemented in the late 1900s. During apartheid, education was accessible to strictly white individuals and limited to specific groups, leading to the present-day shortage of teachers, especially when compiled with the burden of HIV—Freedman and Poku monitored its lasting impacts through a statistical analysis, delving into education accessibility. This decline of educators is affirmed as there were 1300 teacher deaths within the first 10 months in 1998, more than twice the mortality in 1997 (Freedman & Poku, 2005, p. 669). This study focused on Africa as a whole, with Sub-Saharan Africa specifically detailed, however the broad area spotlights the widespread effects of societal standards. Within one year of the epidemic, the previously minimized teacher-student ratio decreased at twice the pace—despite the improvement health education posed, students were unable to gain such education due to historical social limitations, leading to the depletion of educators. 


Government Response

Conversely, there may be no need for further addition of health education as current South African prevention methods sufficiently combat the HIV/AIDS crisis. U. Schuklenk, Ontario research chair in bioethics, maintained that the South African government approach is adequate in its efforts to control HIV/AIDS.  In a letter to the editor of the British Medical Journal, Schuklenk highlights the rationale behind the South African government's refusal to fund zidovudine, an HIV medication, for HIV-positive pregnant women. He argues that doing so would '...cripple other…health education efforts, and zidovudine at the price that the manufacturer demands is not a cost-effective means of preventing HIV infection in South Africa' (Schuklenk, 1999).. These points justify the rationalization the government utilized in their current approach—moreover, these inclusions validate the notion that the current response to the HIV/AIDS epidemic is maximized for economic efficiency. Certain programs, such as viral drugs or educational interventions, would not be advantageous to present goals of the government due to the economic burdens introduced as a result. 


As of 2023, there is no widespread health educational program for HIV/AIDS in South Africa—members of the Human Sciences Research Council (HSRC) in Pretoria and representatives from the Centers for Disease Control and Prevention (CDC) including K. Zuma and E. Igumbor reinstated Schuklenk’s conception that the current South African HIV/AIDS approach is adequate. HSRC members and CDC epidemiologists compared findings from the 2012 national population-based survey to the recent 2017 collection to identify trends in disease occurrence. The incidence of HIV has declined from 1.07% in 2012 to 0.48% per year in 2017 (Zuma et al., 2022). This significant decline of over 50% cannot be attributed to HIV/AIDS educational programs, as none were prominent in this duration. The standing prevention method in South Africa has demonstrated a steady decrease of cases, construing the idea that health education would be superfluous and, ultimately, unnecessary in this context. 


Conclusion

The endemic quality of HIV/AIDS cases poses a large indicator of lacking proper prevention—it is apparent that health education is effective in the realm of the South African HIV/AIDS epidemic as it increases general knowledge. Health education has a significant impact on reducing prevalence, yet this result is overshadowed by the societal norms of South Africa. Despite this, the current government response is justified through the notion of its efficiency and effectiveness in a steady decline of cases. While this response to the epidemic is adequate in multiple views, consideration for social indicators are needed to create a successful health education program As HIV/AIDS spreads in South Africa, standardized health education will play a key role in disease control and prevention. 

 

Written by Ava Y. Liao


References:

C. Campbell and Y. Mzaidume (2002). "How can HIV be prevented in South Africa? A social perspective. (Education and Debate)." British Medical Journal, vol. 324, no. 7331, 26 Jan. 2002, pp. 229+. Gale In Context: High School, 

Coombe, C. (2002). (rep.). Keeping the Education System Healthy: Managing the Impact of HIV/AIDS on Education in South Africa (pp. 14–21). Columbia University. https://www.tc.columbia.edu/cice/pdf/25669_3_1_Coombe.pdf 

Faust, L., & Yaya, S. (2018). The effect of HIV educational interventions on HIV-related knowledge, condom use, and HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis. BMC public health, 18(1), 1254. 

Freedman, J., & Poku, N. (2005). The Socioeconomic Context of Africa’s Vulnerability to HIV/AIDS (p. 669). Review of International Studies, 31(4), 665–686. 

Gacoin, A. (2010). Sexuality, gendered identities and exclusion: the deployment of proper (hetero)sexuality within an HIV-prevention text from South Africa (p. 430). Culture, Health & Sexuality, 12(4), 429–444. 

Hartell, C. G. (2005). HIV/AIDS in South Africa: a review of sexual behavior among adolescents. Adolescence, 40(157), 171+. 

Kharsany, A. B., & Karim, Q. A. (2016). HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. The open AIDS journal, 10, 34–48. https://doi.org/10.2174/1874613601610010034 

Okonofua, F. (2015). Assessing the Impact of Sexuality and HIV/AIDS Education in Africa / Évaluer l’impact de l’éducation sexuelle et du VIH/SIDA en Afrique. African Journal of Reproductive Health / La Revue Africaine de La Santé Reproductive, 19(2), 9–12. http://www.jstor.org/stable/24877765

HIV/AIDS IN SOUTH AFRICA: HEALTH EDUCATION 7 

Schuklenk, U. (1999). South African government's response to AIDS crisis is sound. British Medical Journal, 318(7191), 1143. 

Taylor, M., Dlamini, S. B., Kagoro, H., Jinabhai, C. C., & de Vries, H. (2003). Understanding high school students' risk behaviors to help reduce the HIV/AIDS epidemic in KwaZulu-Natal, South Africa. Journal of School Health, 73(3), 97+. 

Zuma, K., Simbayi, L., Zungu, N., Moyo, S., Marinda, E., Jooste, S., North, A., Nadol, P., Aynalem, G., Igumbor, E., Dietrich, C., Sigida, S., Chibi, B., Makola, L., Kondlo, L., Porter, S., & Ramlagan, S. (2022, July 1). The HIV epidemic in South Africa: Key findings from 2017 National Population-Based Survey. International Journal of Environmental Research and Public Health. 


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