Norma INTE ISO 50001:2018

Sub-Saharan Africa is the most heavily HIV and AIDS infected region in Africa, accounting for 70% of all people living with HIV and 46% of all AIDS-related deaths in the world (Avert, 2017). Of the 22.5 million people living with HIV in the region, it is estimated that 60% are females and 12% are children (UNAIDS, 2016). Given the increasing numbers of HIV-infected individuals, there is an urgent need for effective HIV-prevention programming in this region. The social, health and economic consequences are far-reaching for individuals and communities on a country level.

Of the Sub-Saharan African countries, HIV and AIDS-prevalence is highest in SA, Swaziland, Zimbabwe, Botswana and Lesotho, which together account for the HIV-prevalence rates of 46% of the entire Sub-Saharan region in 2016 (Avert, 2017; UNAIDS, 2016). There was an estimated total of 960 000 new infections in Sub-Saharan Africa and, of those, 56 000 new infections were amongst children in Sub-Saharan Africa (UNAIDS, 2016). SA has the highest prevalence of HIV and AIDS compared to any other country in the world, with seven million people living with HIV. There were 380 000 new infections and 180 000 HIV-related deaths recorded in 2016 (Statistics South Africa, 2016; Avert, 2017). In addition, in 2016, HIV was recorded as the third leading cause of natural death in SA (Statistics South Africa, 2016).

Furthermore, youth aged between 15 – 24 years have the highest prevalence of HIV and AIDS, accounting for 25% of new infections in SA (Avert, 2017). Given that the estimated youth population in 2016, aged 15 – 24 years in SA was 18.5 million out of the total population of 52.9

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million, indicated that a very high proportion of the South African population (almost half the population of youth), which are constituents of this age-group, are in the highest-risk bracket for the contraction of HIV infection (Avert., 2017; Statistics South Africa, 2016). The HIV-prevalence amongst South African youth aged 15-19 years was 7.3% in 2016 and this has not shown a decline since 2010 (Avert, 2017).

KZN is the province with the highest HIV and AIDS prevalence in the age group 15-24 years at 16.9% out of all youth in SA (Avert, 2017). In addition to possessing the highest HIV and AIDS prevalence in SA, KZN possesses the highest teenage-pregnancy rate with more than 26 000 teenage pregnancies recorded. This is followed by the Eastern Cape with more than 20 000, and Limpopo with more than 13 000. This contributed to a total of 99 000 pregnancies amongst youth in SA in 2015 (Statistics South Africa, 2015). The national prevalence of ever having had an STI was 7.4% in South African youth in 2016 (Avert, 2017). Of those who have had an STI, 63.6% reported receiving treatment for an STI (Avert, 2017). KZN learners were reported as having the highest prevalence of STIs contracted in the year 2016, among youth in SA, at 16.9% (Avert, 2017). In addition to having the highest prevalence of HIV, teenage pregnancy and STI contraction, KZN also has a higher proportion of schools that are considered as poor compared to other provinces and the highest school-dropout rates in SA (DoE, 2016).

With regard to sexual behaviour, adolescents aged between 16 and 18 years are significantly more likely to have engaged in sexual activity as compared to younger adolescents between the ages of 13 and 15 years (Department of Health, 2013b; Human Science Research Council, 2014; Reddy et al., 2010). The findings of the Human Science Research Council (2014), indicate that the proportion of secondary-school learners engaging in sexual activity almost doubles between Grade 9 (24.9%) and Grade 11 (52.1%) with about one in two Grade 11 learners reporting being sexually active. The largest percentage increase in sexual activity among Grade 9 to Grade 11 learners appears to occur as learners change from Grade 9 (30.3%) to Grade 10 (42.5%) (HSRC, 2014). In addition to the prevalence of sexual activity, differences in prevalence figures between Grade 9 and Grade 11 learners for other high-risk behaviours such as alcohol usage, substance abuse and smoking suggest that future research would best be used by sampling both Grade 9 and 11 learners due to the variation in risk behaviours between these grades (HSRC, 2014).

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Therefore, youth in KZN aged 16-18 years are at high risk of contracting HIV and STIs as well as KZN producing youth with unwanted pregnancies and the related negative consequences. Furthermore, perceptions of risk-susceptibility for HIV contraction, STI infection and teenage pregnancy are lower in youth than in other age groups (DiClemente & Crosby, 2008; Shisana et al., 2009). Youth perception of risk-susceptibility for HIV, STI and teenage pregnancy is fundamental to understanding precautionary behaviour (Shisana et al., 2009). If youth are of the opinion that teenage pregnancy, HIV and STIs are less likely to affect them during their lifetime, they will be less likely to use protective methods when engaging in sexual behaviour (Scott- Sheldon, Walstrom, Harrison, Kalichman & Carey, 2013). Given that this is the highest risk group and that, in addition, there is a lowered perceived susceptibility to the contraction of HIV/STIs and teenage pregnancies, an optimum school environment is necessary to support the teachings of sexuality education via the LO curriculum, in order to promote safe sexual attitudes and behaviours.

2.2.1. Demographics for HIV and AIDS, STIs and teenage pregnancy in South Africa

The section below documents the current statistics and prior literature of the relevant demographic characteristics regarding HIV and AIDS, STIs and teenage pregnancy amongst South African youth. The demographics covered are race, gender and age.

2.2.1.1. HIV and AIDS, STIs and teenage pregnancy-prevalence by race

Studies indicate that South Africans of African descent have the highest HIV and AIDS- prevalence compared to other South African race groups (Beksinska, 2014; Department of Health, 2013b; HSRC, 2014). While South Africans of White descent have been reported to have the lowest HIV and AIDS prevalence in the age groups 15- 24 years (Beksinska, 2014; Department of Health, 2013b; HSRC, 2014). Coloured and Black South African youth aged 15 – 19 years have a higher reported teenage pregnancy rate than White and Indian South Africans (Francis, 2013; HSRC, 2014; Medical Research Council, 2008; Reddy et al., 2010). Reported STI’s amongst South African youth aged 15 – 24 years in 2016 have been highest in Black youth, followed by Coloured youth, with ratings based on STIs reported in one year (HSRC, 2014). According to the Human Sciences Research Council (2014), there is a continued high HIV-prevalence and incidence in the Black African population within the youth and young adult-age groups in KZN.

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2.2.1.2. HIV and AIDS, STIs and teenage pregnancy prevalence by gender

According to Statistics South Africa (2016), HIV prevalence remains disproportionately high for females in comparison to males. HIV prevalence among South African females was nearly twice as high as that of males in 2016 (Statistics South Africa, 2016). This proportion has remained unchanged since 2002 and has remained a consistent result in prior surveys (HSRC, 2014; MRC, 2008; Reddy et al., 2010). The HSRC (2014) validates the disproportionate HIV prevalence in females, indicating that the increase in HIV prevalence was predominantly observed among females aged 30 years and above, whereas 9.9% of males were HIV positive and 14.4% of females were HIV positive. According to Avert (2017), the highest risk-group is females aged 25–29 years, where one in three women (32.7%) were found to be HIV positive in 2016. Rates of new infections among females aged 15-24 years were more than four times greater than that of males of the same age (Statistics South Africa, 2016). Statistics indicate that, in SA, females already have a higher HIV prevalence than males at ages 15 – 19 years with 5.9% of females being HIV positive compared to less than one percent of males (Avert, 2017). There is, therefore, a need for interventions to be targeted and tailored especially toward girls who are in their teenage years. The sustained high levels of HIV infection among young females is one of the most concerning findings of a South African 2016 survey and requires urgent attention for effective HIV prevention among females who are at their prime child-bearing age (Avert, 2017). A survey conducted in 2013 in four of the nine SA provinces indicated that 19.2% of females aged 12 - 19 years had had at least one pregnancy which was unwanted), while only 5.8% of males in the same age group had impregnated a female (Department of Health, 2013b). In addition, condom-use by 15 - 24-year- olds, in their most recent sexual encounter, declined from 85.2% to 67.5% for males and from 66.5% to 49.8% for females, according to two nationally-representative surveys conducted in 2008 and 2012, respectively (HSRC, 2014; Reddy et al., 2010). Regarding proportions of STI- prevalence by gender, the National HIV Survey South African National HIV, Behaviour and Health

Survey 2012 (HSRC, 2014), indicated that there were equal numbers of female and male youth in

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2.2.1.3. HIV and AIDS, STIs and teenage pregnancy-rates of the secondary-school learner age group

HIV-prevalence levels in the age group 15–49 years increased slightly from 15.6% in 2002 to 16.2% in 2005 and 16.9% in 2008 and in 2016 it was at its highest at 18% (Avert, 2017; Jooste et al., 2009; Shisana, Rehle, Simbayi, Zuma). South African youth continue to be vulnerable, with an HIV prevalence of 7.3% reported for youth aged 15 – 19 years in 2016 (Avert, 2017). As noted by various studies, the interpretation of HIV-prevalence trends in this age group is difficult without an in-depth analysis of HIV incidence and the impact of increasing access to Anti-retroviral Therapy (ART) (MRC, 2008; Panday, Makiwane, Ranchod & Letsoalo, 2009; Shisana et al., 2014). However, numerous South African studies do provide evidence for HIV prevalence as being high in the age groups 15-24 years (Avert, 2017; HSRC, 2014).