Abstract
The article reports on the aspects of a Botswana Ministry of Education and Skills Development (MoE & SD) HIV/AIDS Instructional Television (ITV) project modeled on a similar HIV/AIDS program implemented in Brazil. This Teacher Capacity Building Project (TCBP) in Botswana is in its initial years of implementation. Its overall goal is to contribute to the prevention and mitigation of the impact of HIV and AIDS by strengthening the capacity of the education and communication sectors to deliver interactive, distance HIV/AIDS education primarily to teachers so that they act as agents of behavior change among the in-school youth. One of the components of the TCBP program is a live teacher education television HIV/AIDS program called Talk Back program. Talk Back is a collaborative effort of the MoE & SD and the Botswana national television station. The Talk Back program involves development and implementation of weekly 1 hour live HIV/AIDS education interactive TV broadcasts for teachers. The development of the live programs is guided by a curriculum that provides a wide range of themes related to HIV/AIDS and education. This article reports the results of a survey of a sample of teachers and students at junior secondary schools and senior secondary schools, first, on their views and opinions regarding the Talk Back program as a TCBP. Second, how Setswana cultural beliefs, myths, and practices on sexuality affect teachers’ and adolescents’ sexual decisions, practices, and experiences as well as HIV/AIDS and sexually transmitted infection prevention. A questionnaire survey and focus group interviews were used as data collection instruments in selected secondary schools. The findings of the study suggest that the Talk Back program has not met much success as a TCBP. The findings further suggest that several myths, beliefs, misconceptions, and attitudes about HIV/AIDS exist among Botswana teachers and students and thus make it difficult for the Talk Back program to impart the HIV/AIDS message successfully. Therefore, there is a need for more stakeholders in HIV/AIDS education, where appropriate learning techniques are used, to bring about the desired behavioral change.
Introduction
The Botswana Revised National Policy on Education of 1994 stated that “Educational Broadcast serve as a valuable purpose in assisting the teacher to impact knowledge. The commission’s benchmarks from Sweden and Malaysia also showed the need for educational broadcasting as it played an important part in primary, secondary and the tertiary Education.”1(p47) The Talk Back television program is modeled on a similar instructional television (ITV) program implemented in Brazil. 2 The Ministry of Education (MoE) through the Department of Teacher Training and Development is in charge of implementing the program in Botswana. The overall goal of the program is to contribute to the prevention of the spread of HIV/AIDS and mitigate its impact. This will be achieved by strengthening the capacity of the education and communication sectors to deliver interactive, distance HIV/AIDS education primarily to teachers so that they act as agents of behavior change among the in-school youth. One component of the Teacher Capacity Building Project (TCBP) program is a live television broadcast on HIV/AIDS commonly known as the Talk Back program. The Talk Back is a collaborative effort of the MoE and the Botswana national television (BTV) station. 2 The program involves the development and implementation of weekly 1 hour live HIV/AIDS education interactive TV broadcasts for teachers. The development of the live programs is guided by a curriculum that provides a wide range of themes related to HIV/AIDS and education and are aimed at:
increasing teachers’ knowledge on HIV/AIDS and sexual and reproductive issues;
fostering the development of desirable behaviors and attitudes for curbing the spread of HIV among teachers; and
building teachers’ skills to increase their technical capacity to better manage HIV/AIDS within the school system.
The Botswana MOE and Skills Development conducted a mid-term evaluation of the Talk Back program in 2004. 3 However, the evaluation did not provide an in-depth review of the Talk Back component, as this was not specified in the scope of work. Thus, the evaluation did not provide specific and detailed recommendations on the way-forward vis-à-vis Talk Back program. The key findings from this evaluation were:
Talk Back TCBP had managed to lay a foundation for an interactive multimedia communication system for addressing HIV/AIDS and related issues in the education sector within the initial 2 years of its implementation; and
Talk Back had been effective, and there were indications that some key milestones had been achieved. Furthermore, some results that can be linked to the desired outcomes and impact, albeit not in quantitative terms, were realized. 3
This article reports the results of a survey conducted during 2005, involving a sample of teachers and students at the junior secondary schools and senior secondary schools (SSSs) on, first, how Setswana’s cultural believes, myths, superstitions, misconceptions, and practices on sexuality affect adolescents’ sexual decisions, practices, and experiences as well HIV/AIDS and sexually transmitted infection (STI) prevention. Second, the study solicited the views and opinions regarding the delivery and effectiveness of Talk Back program as a TCBP. A questionnaire survey and focus-group interviews were used as data collection instruments in selected secondary schools. The findings of the study suggest that the program has not met much success as a TCBP. The findings further suggest that several myths, beliefs, superstitions, misconceptions, and attitudes about HIV/AIDS exist among Botswana teachers and students, thus making it difficult for the Talk Back program to impart the HIV/AIDS message successfully. Therefore, there is a need for more stakeholders in HIV/AIDS education, where appropriate learning techniques are used, to bring about the desired behavioral change.
Statement of the Problem
The Long Term Vision for Botswana (Vision 2016) holds that there is a major challenge to halt or reverse the increasing incidence of the HIV virus, particularly among young people, if Botswana is to advance in the next 20 years and beyond.4(p25) The Botswana AIDS Impact Survey (BAIS II) 5 also indicates that while HIV/AIDS awareness is high among Botswana youth, comprehensive levels of knowledge are low. Consequently, safer sex practices also lag behind as attested by high teenage pregnancies that are testimonies of ongoing unprotected sex. There was, therefore, a need to investigate the possible causes of such a scenario. In view of the observations mentioned previously, the current study sought to, first, determine how Setswana’s cultural beliefs, myths, superstitions, misconceptions, and practices on sexuality affect teachers’ and adolescents’ sexual decisions, practices, and experiences as well as HIV/AIDS and STI prevention. Second, the study sought to solicit students’ and teachers’ views and opinions regarding the delivery and effectiveness of Talk Back program as a TCBP. Not much research has been carried out concerning these issues. Although TCBP provides teachers with ample opportunity to help their students on HIV/AIDS-related matters, they face challenges in schools, as most parents do not discuss sexual matters, traditional rules, and taboos freely with their children as they still attach much value to their cultural traditions that are not so open on sex matters. There was therefore the need to conduct a survey in this area.
Purpose and Limitation of the Study
The study first solicited teachers’ perceptions on what and how Setswana’s cultural beliefs, myths, and practices on sexuality affect teachers’ and adolescents’ sexual decisions, practices, and experiences as well as HIV/AIDS and STI prevention. Second, the study investigated the delivery and effectiveness of TCBP as a capacity-building program toward HIV/AIDS at the secondary school level. The study further pursued the associated stigma prevalent within the infusion of HIV/AIDS content in the secondary school curriculum. The study has the potential to provide schools and policy makers with insights into the nature of the Talk Back as a tool to enable Botswana to become a knowledge economy that will produce an HIV/AIDS-free generation by 2016 and beyond as enshrined in the national policy documents. Due to limited time and financial constraints, the study was only limited to select community junior secondary schools (CJSSs) and SSSs. Some adolescent children are found within the primary school system that this study did not include due to their lack of audiovisual equipment required for the Talk Back program.
Objectives of TCBP Program
The main objectives of the study were to investigate:
Setswana’s cultural beliefs, myths, superstitions, misconceptions and stigma, and practices on sexuality affect teachers’ and adolescents’ sexual decisions, practices, and experiences as well as HIV/AIDS and STI prevention;
the students and teachers’ views and opinion regarding the delivery and effectiveness of TCBP as a capacity-building program toward HIV/AIDS at the secondary school level.
Related Literature
The TCBP program is televised on BTV and was implemented in March 2003 by MoE with support from some organs of the United Nations such as United Nations Development Programme (UNDP), The United Nations Children's Fund, and The United Nations Educational, Scientific and Cultural Organization. African Comprehensive HIV/AIDS Partnerships (ACHAP) provided television sets, video recorders, and satellite equipment in schools in Botswana. The ACHAP also gained much support from the MoE and BTV that provided some technical equipment and recruited studio crew producers that work on weekly televised show Talk Back, a component of TCBP program. The program is specifically aimed at school teachers and student communities, as it enhances their understanding of HIV/AIDS and thus dispelling prevalent myths superstitions, misconceptions, superstitions, and stigma surrounding HIV/AIDS. The program is aimed at creating some behavioral change and breaking down the silence about HIV/AIDS. 6 The Talk Back is characterized by panel discussions on different topics and provides basic skills to students to help them with life skills such as taking personal responsibility for a brighter future and praising, criticizing, and encouraging some creative behavior (Botswana Institute for Development Policy Analysis). 7 Every week it is broadcasted for 60 minutes on BTV. It is normally telecasted live on Tuesdays and in a reverse action on Saturdays. It allows for interactions with teachers by the use of telephones, messages (short messaging service), and letters. The program is also broadcasted live on radio as audio media.
Perceptions on Myths, Misconceptions, and Superstitions about HIV/AIDS
Most people would suspect that winning Wimbledon is simply a matter of playing better than the rest. But according to the seriously superstitious Serena Williams and Ana Ivanovic, it is much more complicated than that8(p3):
The winning formula for the 25-year-old American includes tying her shoelaces in the same way, using the same shower before each match and bouncing the ball five times before the second. By contrast, the 19-year-old Serb bounces the ball only once and avoids stepping on the white lines between points. Serena, the number seven seed and twice previous champion, admits: “I have too many superstitions rituals and it’s annoying. It’s like I have to do it and if I don’t then I’ll lose.”
Myths, misconceptions, and superstitions are evident in many walks of life as exemplified in the Wimbledon tennis championships. Chalkers and Weiner defined myth as “an idea or a story that many people believe but being not true at all.9(p941) Myths concerning HIV/AIDS in Botswana ascribed to the several obstacles that the program faced in achieving its intended objectives, and these need to be overcome. Several myths, superstitions, beliefs, misconceptions, and attitudes about HIV/AIDS exist among Batswana. Some examples of these are drinking a lot of water after sex is believed to decrease the chances of one becoming pregnant and free from getting infected with an STI and/or HIV/AIDS, 10 “Vaginal baths and showers after sex keep women from falling pregnant, yet sperms have the ability to swim in the cavity of womb.”11(p14) Some people in Botswana also believe that AIDS was manufactured in a laboratory, while some believe that having sex with a virgin can cure the disease. People in Botswana value their traditional religious beliefs some of which conflict with the TCBP intentions and are likely to hamper not only its effectiveness but also Botswana’s Long Term Vision 2016 aspirations. Botswana also holds misconceptions and superstitions about condoms that are distributed at clinics, hospitals, and health centers, that they carry the human immunodeficiency virus implanted by developed countries. 6 Furthermore, Botswana and other developing countries in Africa believe that most developed countries want to inherit the riches of the African continent and enjoy the favorable climate, availability of natural resources such as minerals, fauna, and flora.12(p34) Knox 13 supports this view when he stated that “Africa has all the four major climatic regions, which are tropical climate, Mediterranean, Savannah, and Desert climates.” Knox has further clarified that most commodities were found within the African continent (ie, the availability of natural resources, fauna, and flora are within the African continent). He has also alluded to the activities during the 18th century when European nations scrambled the African continent (New Imperialism), which led to the petitioning of the African continent by colonial powers.
It is also alleged that people infected with HIV have been unfaithful to their partners all their life.10(p7) Batswana also believe that HIV infection could also be through needles, knives, and razors and not only through sexual contact and that the child could also get the virus from the mother during the gestation period or lactation period. Some Batswana also believe that prostitutes are responsible for transmitting HIV, neglecting sexual networks among Batswana that can cause infection. Traditional doctors on the other hand associate HIV/AIDS with Boswagadi that is a curse from the ancestral spirits. 14 Some Batswana parents forbid their children to go for HIV testing and take them to traditional doctors. Youths die in large numbers because they are afraid of consulting modern doctors for help and prefer to stick to traditional doctors for help. The British Drug Free Powerlifting Association report clearly shows that about 55% of the teachers are using traditional doctors. Prevalent myths pose a challenge for Talk Back program with implications for its effectiveness.
Reproduction and HIV/AIDS
According to Papalia et al, “the reproductive system of a person under 18 years of age and those over the age of 35 they are risk ages. Under 18 years of age, the reproductive organs are not yet developed while over the age of 35 are too old to bear children and usually experience difficult births.”15(p67) In today’s world women comprise a larger population compared to men, and this creates some imbalance. The TCBP program in general is influencing some positive behavioral change to some extent in many individuals in Botswana. Botswana teachers have shown some attitudinal change in sexual practices and they have also started using condoms when having sex with nonregular partners.12(p133) Schapera 16 has stated a Botswana myth related to reproduction that if a man does not have sex for some time, the following could happen to him:
blood circulation will stop functioning properly and will become salty;
become stubborn and unfriendly;
become dumb (this has to do with the circulation of blood to brain);
reproductive organs will stop functioning and will later become infertile.
The TCBP and Stigmatization
The TCBP is intended to motivate students to live positively with HIV/AIDS and build an HIV/AIDS competent nation.4(p67) The question is “How are we going to achieve this when there is a lot of stigma prevailing against those who are living with the virus?” Botswana is faced with a tough challenge that is threatening one of the basic pillars of Vision 2016, having an HIV/AIDS-free society.
4
Another challenge relates to the economic boom that has led to infrastructural development across the country and involving the movement of men (mostly) to do projects. Many leave their wives behind for long periods, resulting in extramarital sexual behaviors.12(p456) There is evidence that the majority of students in secondary schools do not go for testing because they are afraid of the associated stigma if they tested positive. The BIDPA Base Line Study shows that ignorance, beliefs, myths, and superstitions about HIV/AIDS still prevail in Botswana. Botswana hold that AIDS is associated with boswagadi, a disease thought to afflict those who had sexual intercourse with someone else immediately after losing their spouse without first undergoing some ritual treatment.12(p31) The Report on a Study of Knowledge of Teachers and Students on HIV/AIDS stated that a major issue of concern was that condoms were not used consistently, and only sometimes, and that primary school teachers have more risky behavior than the rest of the teachers.7(p143) Continuing misconceptions about how the virus is transmitted contribute to the subtle fear of interacting with HIV-positive individuals, and thus stigmatization and secrecy remaining major problems in Botswana.
Stigma is highly prevalence in most remote areas of Botswana unlike in Urban and the Peri-Urban areas. This can be the result that media such as Radio, Television, and Newspapers do not reach certain places at all.17(p234)
HIV/AIDS Infusion into the Secondary Curriculum of the Batten Disease Family Association
The rationale behind the TCBP is to infuse what is learned in the program into other subjects of the school curriculum. 10 The program also encourages behavioral change in students and is intended to make them “Talk” their views, thus breaking the silence regarding HIV/AIDS-related issues. Infusion happens through discussions, questions, and interactions with each other. In some secondary schools, there are youth clubs on HIV/AIDS- and health-related issues. The TCBP targets these clubs and helps to infuse some information to students. Infusion can feature in all subjects, yet science, biology, and chemistry are quite compatible subjects. Infusion can also be done through methods such as drama, role-plays, and simulations, as they appeal to the domain of feeling that is so relevant to behavioral change. Despite the unavailability of a cure for AIDS, the TCBP is a worthwhile attempt to make the life of Botswana teachers and students longer, healthier, and normal.
Delivery and Effectiveness of TCBP
The ACHAP Report revealed that over 120 teachers died and over one-third are still living with HIV/AIDS. This has been clarified in the Report on Knowledge, Attitude and Practices of the Teacher Capacity Building (2002) stating that:
We teachers are not secure because when we teach our students about HIV/AIDS we tend to be encouraging them to be actively involved in sexual relationship, and we are criticized for this attitude by parents and Nation. (p. 78).
18
This suggests that teachers are ambivalent regarding their commitment and the competence in the delivery of HIV/AIDS information. HIV-positive teachers are inclined to refuse to open their status to the public for the reason that they will feel offended when they are asked to participate in the talk back studio. More stakeholders are needed if Talk Back has to be effective. Even “kgotla” (traditional gathering) and clinics should be supplied with cassettes so as to facilitate their active participation and involvement.
12
Some teachers and students who get admitted to hospitals and clinics should have access to the program. Infusion of Talk Back HIV/AIDS information should not end in student and teacher environment but should be “something to give and show to the people in all walks of life.”2(p60) Teachers reported that the language used in the program was highly technical and involved a lot of difficult terminology. This hindered Talk Back to be infused effectively in the students. This is true according to the report of July 2005, which stated that:
For some teachers at the secondary level, some panelists who are discussing HIV/AIDS tend to use the language that is too technical and beyond language comprehension of some teachers. This limits the use of this information by this group of teachers.2(pp60-61)
Theoretical Framework of Study
Symbolic interaction (SI) framework was used to guide the study given that ITV uses signals to communicate information. The SI refers to the peculiar and distinctive character of interaction as it takes place between human beings. The peculiarity rests in that human beings interpret each other’s actions instead of merely reacting to each other’s actions. Thus, human interaction is mediated by the use of symbols, interpretation, or ascertaining a process of interpretation between stimulus and response in the case of human behavior. 19 In this particular study, ITV is used to mediate the communication so that the intended audience could engage in the symbolic interaction so as to deduce meanings and values based on their experiences. The SI therefore focuses on the nature of the interaction and the activities that take place between among the people rather than the characteristics of the given behavior. Human actions can therefore be stimulated by both symbols and physical stimuli so that a person is capable of stimulating others and bringing about the desired outcomes. Human beings learn meanings and values through communication of symbols and learn from other’s actions. The learned symbols, meanings, and values occur in clusters and can be very large and complex. Society is seen to be composed of interacting individuals. Society and its culture precede any existing individual, and individuals are expected to learn and conform to the set of behavioral requirements. Socialization therefore occurs in a dominant culture as well as in various subcultures. The SI theory recognizes the societal and family’s influence on human development, including sexuality development at various phases. The utilization of this theoretical framework guided the study, as it was found to be appropriate, given the attitudinal change required for the problems of HIV/AIDS.
Methodology
Based on the objectives mentioned previously, the study used both qualitative and quantitative research analysis methods to complement each other. Some observations and focus group interviews were conducted with the support of discussions with both teachers and students. Interview guides and a questionnaire were developed to guide these processes.
Sampling Procedure and Participants
The researcher used a randomized sample of teachers and students in selected secondary schools. The purpose was to find out the delivery and effectiveness of TCBP and also what and how Setswana’s cultural beliefs, myths, superstitions, misconceptions, stigma, and practices on sexuality affect adolescents’ sexual decisions, practices, and experiences as well as HIV&AIDS/STI prevention. The regions identified for the study were Ramotswa (region 1), Mochudi (region 2), and Lobatse (region 3). The basis for selecting these regions was to include both urban areas and the surrounding rural areas so that the sample could be a representative of the entire country. Some form of convenience sampling was therefore used in which random sampling within places were conducted, as the study could not cover all sections of the towns or villages. In each school, the researcher sampled a total of 10 teachers and students, making an overall number of 30 teachers and 30 students. The main units of analysis were the teachers and students in the selected secondary schools in the identified regions. Where necessary other relevant informants that could enhance understanding of the issues involved in the development and implementation of TCBP were included in the study (ie, health professionals and possibly media/communication professionals).
Data Collection Instruments
A multipronged research methodology was used that includes a survey questionnaire and focus group interviews. Both qualitative and quantitative research designs were used in the study. The instruments were developed and used for data collection. A checklist was also developed for the environment scan of the school facilities. The Statistical Package for Social Scientists (SPSS Version 20; IBM, Armonk, New York) was used for analyzing quantitative data, while content analysis was used to analyze data from the focus group interviews to generate themes. The data were then compressed and reported under the selected themes. Data from individual interviews were integrated into focus group interview reports. Some demographic data were also provided in the results.
Results of the Study
Demographic Characteristics of Respondents
The unit of analysis was composed of 60 teachers whose age ranged between 24 and 50 years. The majority (93%) of the respondents were from CJSSs, while only 7 (7%) resembled SSSs. More than half (60%) were single while 40 (40%) reported cohabiting. Furthermore, from a total of 30 student respondents, most (60%) were between the ages of 15 to 19 and 40% were between 20 and 24 years. In all, 43% were male and 57% were female. In all, 60% were from CJSS, while 40% were SSS students.
Traditional Myths, Superstitions, Misconceptions, and Stigma on HIV/AIDS
All teacher respondents (70% strongly agreed and 30% agreed) agreed that traditional myths, misconceptions, and superstitions about HIV/AIDS caused much confusion among teachers and students and posed a dilemma. The findings show that teachers encountered problems during the TCBP program with their students due to the prevalent myths (eg, that mosquitoes could transmit HIV through bites, use of knives, needles, and other utensils at homes, hospitals, and clinics, as possible ways of spreading HIV). Some teachers reported that they were themselves not reconciled with the possible explanations provided by the program. The following excerpts from focus group interviews and individuals show aspects of teacher and student’s utterances to support the findings:
Teacher excerpts
Alleged that students did not believe the fact that myths were untrue stories.
Argued that the issue of knives, needles, and other utensils used at homes, hospitals, and clinics created some problems in convincing students that HIV cannot be passed on through sharing these.
Geography and history teachers from an SSS alleged that the myth that AIDS was brought by foreigners to our continent to wipe out its people so that they can inherit African resources was true.
Agreed that the disease signifies the end of the times and gave Biblical references (Matthew 24:1, Timothy and Paul’s letter to Corinthians, 1 Corinthians 4:23).
Believed that wars, famine, hunger, earthquakes, and catastrophic disasters such as floods and diseases signify that people have turned away from God and are being punished.
Myths, misconceptions, superstitions, stigma, and traditional beliefs concerning HIV/AIDS were still prevailing among Botswana students and had significant effect on moral issues and prevalent stigmatization in the schools. Students alleged that HIV was considered an airborne disease like tuberculosis (TB). They reported that TB was one of the diseases prevalent in HIV-infected patients. Students also believed that condoms had worms because after their use, they become rotten and have a pungent smell. Most senior secondary students believed the myth that one could get HIV by sharing utensils with an HIV-infected person. They were confused by this issue, because they were taught in biology that the virus could not survive in utensils but only in the human blood. However, HIV is “a virus which causes AIDS in the human body, but immediately when it leaves the human body, the virus dies.”14(p123) Likewise, students also believed the myth that AIDS came from foreign immigrants. From a geographical point of view, students learned that Botswana was landlocked and had no accesses to the sea. The stability of the country had also led to many immigrants coming to live in Botswana. Many couples have broken up due to an influx of unmarried men; some neglected and left their families behind, thus engaging in sexual activity with new partners. Some students are orphans and are vulnerable to abuse.
Student excerpts
pointed out that a used razor blade or a knife and any other utensil after several days can still infect a person with HIV.
reported during TCBP that kissing, sharing toilets, blood stains in toilets, and hugging infected persons would transmit HIV.
a focus group from a CJSS reported that HIV could be transmitted through kissing on the mouth as it secretes liquid.
students also believed the myth that AIDS came from foreign immigrants.
Furthermore, 60% of both respondents agreed, while 40% strongly agreed that myths, stigma, superstitions, and traditional beliefs concerning HIV/AIDS were prevalent among Botswana teachers and students. The majority of both teachers and students in the selected schools were Botswana who valued and respected Setswana’s traditions. Botswana still values “Dingaka tsa setso” (traditional doctors). Some teachers reported that they felt better after visiting the traditionalists compared to when they were restricted to antiretroviral (ARV) therapy. Some of the teachers interviewed suggested that some traditional doctors be invited to participate in TCBP panel discussions as is the practice in other BTV programs (eg, The Eye and Matlho-a-Phage). They also suggested that traditional doctors be invited to visit Botswana’s modern hospitals to assist modern doctors with their rich knowledge of traditional medicine. Some teachers also reported that traditional doctors did not ignore them as is the practice in hospitals and clinics, where they queue for several hours for the doctors to come. Talk Back is faced with challenges associated with cultural practices prevalent among Botswana. However, teachers also reported that traditional doctors encourage the public to always rely on traditional healers for help and to ignore modern medicines like ARV drugs that could be dangerous to the nation and counterproductive to the fight against HIV/AIDS.
Teacher excerpts
Some teachers believe in the myth that HIV was manufactured in a laboratory by foreigners who wanted to take natural resources of the African continent from them. They reported that more people were dying in Africa in large numbers followed by Asia. Some reported that their relatives had died in large numbers and were suspicious that AIDS was a man-made problem.
Some teachers teaching Biology in Forms 4 and 5 reported that the prevention of mother-to-child transmission (PMCT) raised many arguments during the interactive learning with students. It was difficult for the teachers to convince students, given the contradictions between academic content taught in biology lessons and TCBP explanations.
Some teachers reported that they faced a lot of problems with their students concerning the issue of PMCT due to lack of authentic knowledge regarding the issue. The provided list of myths was identified to be prevalent among Botswana teachers and students:
pregnant women placing their knives under the bed so as to cut labor pains;
one could not become pregnant by having sex during menstruation period;
drinking a lot of water after sex decreases chances of one becoming pregnant and protects one from STI and HIV infection;
vaginal baths and showers after sex keep one from becoming pregnant;
using the pill would protect one from getting pregnant and contacting some STIs;
most Botswana students do not really believe that AIDS exists, given that the symptoms are like those of known diseases;
AIDS is caused by widow or widowers who are not cleansed or who do not undergo widowhood rites, and women who have committed abortion;
traditional doctors associate HIV/AIDS with boswagadi that is a curse from the ancestral spirits;
HIV is an airborne disease like TB and makes it difficult to interact with AIDS victims;
after the death of a spouse, one remaining to undergo purification by traditional doctor to avoid infecting sexual partners with incurable disease boswagadi believed to be HIV/AIDS;
AIDS is a curse and is sometimes related to witchcraft;
having sex with a virgin can cure AIDS;
persons infected with HIV have been unfaithful to their partners all their life;
HIV infection could also be through needles, knives, razors, and not only through sexual contact;
condoms cannot be used consistently but can be used sometimes;
condoms have worms because after use, they become rotten and have a pungent smell;
prostitutes are mostly responsible for HIV transmission;
mosquitoe bites can transmit HIV;
use of razor blades, knives, and other utensils after several days can still get a person infected with HIV;
Kissing, sharing toilets, blood stains in toilets, and hugging HIV-infected persons would transmit HIV;
HIV could be transmitted through kissing on the mouth as it secretes liquid.
Top 10 Misconceptions on HIV/AIDS
(View video provided for more detail)
HIV does not cause AIDS;
because of ARV medication, we no longer need to be concerned about HIV/AIDS;
if you already have HIV, and you are sexually active, you no longer need to practice safer sex;
you cannot contract HIV through oral sex;
you cannot get HIV from one sexual encounter;
a woman cannot spread HIV to another woman by having sex with her;
if you are HIV positive but your viral load is undetectable, you cannot spread HIV;
AIDS can be spread through kissing, hugging, and shaking hands;
if you have HIV, you can cure it by having sex with a virgin;
every individual with HIV will eventually develop AIDS. 20
HIV/AIDS Testing, Stigma, and Infusion Dilemma
One hundred percent of teacher respondents strongly agreed that stigma was a major factor hindering them from taking up the HIV testing. They reported that the level of stigmatization prevalent among the teachers’ work environment was a big threat. Some HIV-positive teachers were afraid to be open about their HIV status and did not transmit any knowledge to the students freely, because they feared they would be discriminated by both staff and students. The findings show that the TCBP has not impacted significantly on the issue of stigma within the secondary school system at this juncture and that more work has to be done. Stigma is therefore one of the determining factors hindering teachers from going for HIV testing, and this has had a negative effect on the TCPB program. Half of the teachers agreed that infusion of HIV/AIDS would be successful while myths, misconceptions about AIDS, and other cultural issues prevail among teachers and students. However, the other half disagreed that infusion would not work amid these myths and misconceptions. Those who agreed alleged that both teachers and students had to be optimistic in the fight against HIV/AIDS using TCBP and that some success had already been met despite many challenges ahead. Those who agreed also reported that after continuously watching TCBP, they decided to use a condom to protect themselves each time they have sex.
Those who disagreed reported that TCBP proved ineffective even though the instruction on HIV/AIDS is still ongoing in Botswana. They noted that some students were still confused and that the rate of pregnancies among students in secondary schools compared to other institutions was alarming and that this showed that their sexual behavior had not changed and has gone to alarming rates. Furthermore, some teachers reported that their colleagues with multiple partners often obtained negative results at Tebelo-Pele testing centers while those sticking to one partner tended to gain positive results. The teachers displayed some ambivalence regarding the use of condoms, and this was an indication of underlying misconceptions as some believed that the amount of wax in the condoms could transmit HIV.
Teacher excerpts
Some reported that when they had sex with their partners, they were infected immediately after using condoms. Teachers believed that the amount of wax in the condoms could transmit HIV.
Basing on the observations from their colleagues in school, teachers reported that those who had multiple partners did not contract HIV as frequently as those who had multiple partners.
Observed that teachers who had multiple partners did not use condoms, yet they were not infected, and these observations cause some confusion.
The results shown in the excerpts could have been influenced by the fact that a significant number of teacher respondents were cohabiting and projected some of these views with an intention to justify the practice that is increasingly becoming a normative pattern among young people, especially in the urban areas.
Abstinence and Safe Sex
More than half (60%) of the teacher respondents disagreed that safe sex and abstinence until marriage were critical in reducing the rate of HIV/AIDS, while 40% strongly disagreed with the statement. Some teachers reported that abstaining posed some disadvantage on the side of women, particularly those who were older than 30 years of age. They believed that abstaining for a long time resulted in early menopause, difficult births (breach birth), and also resulted in giving birth to disabled babies (eg, Down syndrome). Some female teachers alleged that abstinence was not helpful because not every women gets married nowadays, unlike in the past when polygamy was not restricted. Teachers also reported that some women were unable to conceive due to prolonged abstinence. Concerning reproduction, female teachers reported that good men were difficult to find nowadays; either the man is married or cohabiting and that safe sex was problematic if one has made a choice to have a child.
Delivery and Effectiveness of Talk Back at Secondary Level
A major objective of Talk Back is to empower teachers with knowledge, skills, and attitudes that enable them to behave in a responsible way and deal with HIV pandemic. Most (67%) teachers disagreed that the program was effective. This finding shows that Talk Back has not achieved its intended objectives and goals since its establishment in 2003. Stigma, denial, fear, and discrimination are still prevalent among teachers. Teachers are afraid to go for testing because of the associated stigma. They reported that sometimes knowing about ones status as a teacher may affect their minds, and that this may end up affecting their teaching and the entirety of their job. However, 33% agreed with the statement and reported that they have been able to conduct a survey around schools and found that some teachers had established HIV corners with artwork, poetry, and messages about HIV/AIDS. All teacher respondents alleged that the program was too long and suggested that Talk Back should be broadcasted in the evenings and should involve not only the teachers and students but also the general public. They also reported that the provision of adequate equipment and training of teacher facilitators to enhance their technical capabilities to better manage HIV/AIDS within the schools was a necessary essential requirement. The respondents preferred the broadcasts to be in Setswana, because the English language used in the studio is highly technical and not appropriate to the rest of the students.
Development of Life Skills and Behavioral Changes
Some teachers (7) agreed that they had identified life skills that were consistent with the development of attitudes and behavioral change regarding the spread of HIV, while 3 disagreed. According to the TCB Report, 2 most teachers believe that AIDS was a reality. Only 30% of the teacher’s strongly believed in myths and misconceptions about the disease. Some teachers, especially those who teach literature and history, reported that they have always believed in their ancestors throughout history. Most of them reported that they honored their ancestors even if they did not believe in them, and this has been their attitude toward HIV/AIDS and felt that their beliefs affected their rate of behavioral change as the transformation was a slow process.
Distribution of Condoms at SSSs
Of the 10 teachers interviewed, 5 agreed, 4 strongly disagreed, and 2 abstained. The teachers considered the following:
Teacher excerpts
Teachers reported that children engaged in sex at a tender age, and it was important that they are informed about sex and its consequences and should be properly equipped to protect themselves.
It is important to distribute condoms at schools, given that sex cannot remain as a taboo forever. Other teachers suggested that condoms be made available only to students aged 18 years and older, because teenagers do not exercise self-control.
Those who agreed reported that:
HIV infection statistics showed higher rate of infection in the students of age 15 to 24 years so that the roll out of condoms was a necessity and that this should be done with or without parental consent. This did not necessarily make sex at a young stage right or desirable.
They further reported that:
The majority of students engaged in sex at any time, and parents and teachers would be foolish to think they could control their children’s sex life by refusing them access to condoms.
Condoms from chemists such as Lovers Plus condoms was felt to be different from those distributed at clinics; condoms at clinics were waxy, greasy, and tended to burst when used.
Those who disagreed reported that:
Parents sent their children to schools to learn and not to practice sex. Instead, they suggested that we should tell our youth to abstain. They further reported that:
Most students come from poor families but they continue to add their parent’s burdens by having babies when they get pregnant.
Discussion, Conclusion, and Recommendations
Symbolic interaction theory holds that societal and family influence on human development includes sexuality development at various phases. The TCBP communicates HIV/AIDS information using television, and learning from this medium is intended to bring about the desired behavioral change among teachers and students, yet learning through ITV takes time, given its iconic nature. Affective domain values also occur in clusters that can be very large and complex, especially given the double-bind situations caused by cultural beliefs, myths, superstitions, misconceptions, stigma, and practices on sexuality about HIV/AIDS. As society and its culture precede any existing individual, teachers and students are expected to internalize and conform to the set normative behavioral patterns within their culture, and it is quite difficult to unlearn these practices quickly as is expected of them due to the HIV pandemic. Socialization into the dominant cultures of the respondents as well as in various subcultures has had a significant influence that needs time to be overcome and more stakeholders (boundary crossing) are required to bring about the required transformation and retooling of respondents. More stakeholders are therefore required to develop the required models that would bring about the required behavioral change. The TCBP technological tools (ITV and cell phone messages) are not the end of all but require human-centered (sociotechnical) approaches that are capable of bringing about the desired outcomes.
The TCBP has provided a platform for individuals to be open and express themselves in order to grasp issues of HIV/AIDS and related issues. However, both the respondents reported that they encountered some problems during the interactive program learning, which relate to Setswana’s cultural beliefs, myths, superstitions, misconceptions, stigma, and practices on sexuality and these conflict with the information communicated by the program. Increasing teachers’ and students’ knowledge on HIV/AIDS, sexuality, and reproductive issues amid a wide range of contradictions caused by these prevalent practices and associated stigma posed more challenges. Therefore, there is the need to be innovative in the approach to confront these challenges, and a collaborative approach where more stakeholders (parents, hospitals, traditional healers, and many more) are brought into the program seems a viable option. The findings also suggest that the delivery and effectiveness of the capacity-building program toward HIV/AIDS at the secondary school level were not significant and needed some improvement. The provision of adequate equipment and training of teacher facilitators to enhance their technical capabilities to better manage HIV/AIDS within the schools will be an added advantage. The respondents also preferred that the program be broadcast in both English and Setswana, because the English language used in the studio is highly technical and not appropriate for most students and teachers at the secondary and primary levels.
Recommendation 1
There is need to distribute condoms at secondary schools, given that students are sexually active. It could be sad but is a reality that AIDS exists among student community and it kills.
Recommendation 2
An effective way of providing condoms would be to provide sex education and make condoms available in vending machines. In the olden days, young girls were not permitted to discuss sex issues with their parents and the situation has not changed much, and more education in schools in collaboration with parents is essential.
Recommendation 3
The need to communicate beyond the classroom by adopting a collaborative approach (boundary crossing), where more stakeholders (parents, hospitals, kgotla, churches, traditional healers, village committees, family welfare educators, community home–based care teams) are brought into the program to support teachers in order to achieve the desired behavioral change.
Recommendation 4
The TCBP should also take place through both English and Setswana languages, given that the English language used in the studio is highly technical and not appropriate to the rest of the teachers and students.
Recommendation 5
There is a need to provide the required audiovisual equipment and materials in all schools, (eg, video cassette recorder and television cassettes, etc) and trained technical personnel to monitor these facilities so as to enhance the program.
Recommendation 6
The TCBP to engage traditional organizations such as Botswana Dingaka Association (BNA) and other relevant traditional stakeholders in the transformation process to deal with prevalent Setswana’s myths, misconceptions, and practices related to HIV/AIDS.
Recommendation 7
There is a need for supportive instructional materials that teachers can use in their lesson planning.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.