Couple-empowerment strategies to decrease the HIV risk in a male-dominant mileu

Thesis (M.Cur. (Community Health Nursing))--North-West University, Potchefstroom Campus, 2008.Statistics have shown that there is a global escalation of HIV infection world-wide, with almost 70% of these people living in sub-Saharan Africa. South Africa, which is part of sub-Saharan Africa, has one of the worst statistics of people living with HIV/AIDS in the world, with HIV/AIDS being the fastest growing epidemic. Subsequently 60% of all adults currently infected are women and girls. The number of women becoming infected with HIV continues to rise at an alarming rate. HIV infection in South Africa is very high with women being worst affected. Heterosexual transmission remains the most common mode of HIV transmission globally by far, and women are more likely to be infected with HIV than men due to different contributing factors. A major aspect regarding the contribution to the increased risk of HIV infection is male dominance and inequality. It is apparent from this research that, in most traditional African cultures, men have always been considered superior and women are expected to be more subservient to their husbands who are seen as the heads of the family. There is a belief that males have urgent sex drives; therefore thy need sex with more than one woman. As a result, men believe that they have a right to seek new pastures constantly by having different sexual partners. Even though polygamy no longer is a norm, men tend to have many sexual partners using it as an excuse for their promiscuity and unfaithfulness. Due to women's inferior status, refusing a man sex or insisting on condom use usually results in rejection or violence or even being raped, increasing the woman's vulnerability to HIV infection. In the light of this escalation of HIV infection among women, the need to address male dominance and inequality is urgent in order to ensure that women are able to participate in sexual decision making and negotiate for safe sex. The purpose of this research was to explore and describe the experiences of female farm workers concerning male dominance and the HIV risk linked to it, to explore and describe the roles played by male farm workers concerning male dominance and the HIV risk linked to it, and to formulate recommended strategies for health education that will facilitate couple empowerment to enable couples to protect themselves from running the risk of becoming HIV infected. The research was conducted in the Potchefstroom sub-district in the North West Province of South Africa. A phenomenological research design using a qualitative approach was used to explore and describe experiences of female farm workers concerning male dominance and the HIV risk linked to it, as well as to explore and describe the roles played by male farm workers concerning male dominance and the HIV risk linked to it. The purposive sampling method was used to select participants from various homes on the farm who met the specific set criteria for this research. One population was used, namely the farm workers who are couples and work on the designated farm and live in those homes in the Potchefstroom sub-district, North West Province. The population was then divided into two subgroups of male and female groups to prevent partner fear and intimidation and to encourage free participation, and the two subgroups were interviewed separately. Vignettes, running approximately five minutes, from existing material on male dominance and the risk of HIV infection pre-recorded on a DVD were used, and an unstructured interview schedule using open-ended questions derived from the vignette stories told by participants were put forward to the participants for further probing. Data was captured on an audio-tape and transcribed verbatim. Field notes were taken immediately after each interview. The two sets of data from both male and female subgroups were analysed separately and the results pulled in as one. From the findings of this research it appeared that there were perceptions that a major aspect regarding the male farm workers' contribution to the increased risk of HIV infection is male dominance and inequality. Negative behaviours such as unfaithful and promiscuous behaviour, men using women for sexual satisfaction, dishonest and deceitful behaviour, exploitation, oppression and coercion of women were reported by female farm workers. In turn, men acknowledged being unfaithful and selfish, untrustworthy and deceiving, abusing their male status to dominate and oppress women, and admitted to risky sexual behaviour. They also acknowledged that they use coercive behaviour to get their own way. The majority of men indicated the belief that their behaviour is a result of external locus of control that they cannot account for, such as being under the influence of alcohol and women's behaviour of leading men on. In spite of the afore-mentioned, a number of women perceive men to be supportive and caring. The majority of female farm workers possess quite an extensive knowledge of HIV, despite their low educational level. It is apparent that women consider condoms the safest method for HIV prevention among couples. However, women are unable or reluctant to negotiate condom use due to feelings of powerlessness and hopelessness and fear of violence and being abandoned for someone else who cannot resist unprotected sex. It was also clear that myths, misconceptions and knowledge gaps prevailed among the farm workers which may be deemed dangerous in the quest for preventing the spreading of HIV. Despite the fact that most male farm workers indicated acceptable levels of HIV knowledge, some displayed lack of insight and knowledge in this regard. The researcher concluded that the relationships between male farm workers and female farm workers were characterised by male dominance and inequality. Female farm workers perceive male farm workers as using their superiority to spread the HIV infection. Female farm workers also perceived male farm workers to be dominating and oppressing and that they exploit women, leading to men and women being unable to participate in mutual decision making or to negotiate safe sex as couples. Recommendations were made for the field of nursing education, community health nursing practice and nursing research with the formulation of recommended strategies for health care workers to facilitate couple empowerment to enable couples to protect themselves from running the risk of becoming HIV infected. The strategies were discussed under two main categories, namely recommended strategies for health care workers, and recommended strategies for health education that can be put in place to facilitate couple empowerment with a view to enable couples to protect themselves from running the risk of becoming HIV infected.Master