Key Beliefs Underlying Students’ Behaviour and Decisions towards HIV/AIDS: Implications for Educational Interventions

Research Article

Austin J HIV/AIDS Res. 2016; 3(3): 1028.

Key Beliefs Underlying Students’ Behaviour and Decisions towards HIV/AIDS: Implications for Educational Interventions

Amoako-Agyeman KN*

Department of Communication Design, Kwame Nkrumah University of Science and Technology, Ghana

*Corresponding author: Amoako-Agyeman KN, Department of Communication Design, Kwame Nkrumah University of Science and Technology, Ghana

Received: August 05, 2016; Accepted: September 06, 2016; Published: September 08, 2016

Abstract

Education programmes towards HIV/AIDS prevention are still considered important in response to the epidemic. The study sought to determine key beliefs underlying students’ decisions and behavior towards HIV/AIDS. Beliefs are so pervasive that it merits consideration in behavioral interventions, especially among audiences who are exposed daily to its socializing influences in Ghana. This paper reports on the qualitative approach of a mixed method study involving Junior High School students in Obuasi, Ghana. Data was collected from three sets each of boys, girls and mixed groups’ focus groups and teachers’ interviews and analysed using thematic technique. The value-expectancy theory served as theoretical framework explaining individual‘s strength of motivation to strive for a certain goal to the expectations to attain the desired goal and the incentive value of that particular goal. The conclusions posit a preference for the promotion of abstinence and a dislike for condom promotion to curb the HIV incidence despite perceived prevailing sexual activities among students. The motivations towards abstinence was generally explained within value-based and futuristic expectation framework: pleasing God for blessings, pleasing family to gain respect and social approval, keeping virginity, avoiding negative consequence, and pursuing education for better future and marriage. The findings suggest, values may represent important protective factor: adolescents who strongly identify with such position may less likely engage in HIV risk-related behaviors. A threat to comprehensive HIV education was however, observed due to lack of self-efficacy and apathy towards sex and condoms education influenced significantly by respondent’ beliefs and sensitivity to cultural issues.

Keywords: Beliefs; Values; HIV/AIDS; Condoms; Abstinence

Abbreviations

HIV: Human Immune-Deficiency Virus; AIDS: Acquired Immune-Deficiency Syndrome; WHO: World Health Organization; FGD: Focus Group Discussion

Introduction

Major advances have been made in almost every area of the HIV epidemic response. However, progress for adolescents is falling behind becoming the leading cause of their death in Africa. Deaths are declining in all age groups, except among 10–19 year olds where new HIV infections are not declining as quickly as among others. Adolescent girls, particularly in sub-Saharan Africa, are most affected. In 2013, more than 860 girls in South Africa became infected every week, compared to 170 boys [1].

Ghana’s epidemic, described as generalised according to WHO classification, has been on a downward trend with national HIV prevalence from 3.6% in 2003, 2.7% in 2005 to 1.9% in 2007 [2] and 1.47% in 2014 [3]. Despite low national incidence, many “hotspots” record high prevalence of infection. Six out of the ten regions exceed 2.1% (Eastern: 3.7%; Greater Accra: 3.1%; Ashanti: 2.8%). In the 15-24 age groups, the rural areas recorded 1.1% whilst the urban areas recorded 2.4% among pregnant women. A total of 1,889 new child infections (17% of all new infections) were estimated to have occurred among children 0-14 years. The 15-24 year group accounted for 2,901 of the new infections (26% of new infections), of whom 64% were female. An estimated 250,232 persons with 21,223 children (8%) are living with HIV; 11,356 new infections and 9,248 AIDS-related deaths recorded in 2014 [3]. Annual AIDS death among children between 0-14 years is estimated at 1,295 [3].

AIDS is first and foremost a consequence of behavior [4] but Ajzen [5] suggests focussing on changing attitudes since we cannot sometimes directly influence behavior but an indirect agent. Among the key guides and determinants of social attitudes and behavior are values, which have with the potential to energise attitudes and underpin behavior. A person’s value system may represent a set of rules for making choices and for resolving conflicts [6].

Among psychological models that explain health related behavior, this study draws on value-expectancy behavior theory. The Integrated theory [4] and Value-Expectancy theory, also known as a cognitivemotivational framework [7] has become the source of many different social and behavioral theories [8]. It relates an individual‘s level or strength of motivation to strive for a certain goal to the (product of) expectations to attain the desired goal and the incentive value or valence of that particular goal. People‘s motivation to choose and strive for a particular goal is primarily conceptualized in terms of the intensity of motivation to attain that goal [7].

A growing up child in Ghana is confronted with what Ahlberg [9] considers four overall value systems of socialization with their associative normative behavior. The first is the traditional, where virginity is cherished and young people expected to have sex only in marriage. Next is the religious, mostly, Islam and Christianity, which also stress virginity, importance of family values, moral and behavioral standards. The third, is the legal, defined by the 1992 Constitution and Children‘s Act, and finally, the romantic love, characterized by romantic ideas of friendship and love.

Religion is considered a major social institution by Ryan et al. [10] with pervasive effects on various aspects of adherents’ lives, attitudes and behaviors. Several scholars have indicated that religion has emerged as a potent social force in both private and public life in Ghana [11,12], a key influence that exerts force on young people. Ghanaians are rated highly religious: 97% indicate God is central and very important in their lives; more than 90% belong to religious denominations [13].

Literature argue that religion may discourage risky behavior and therefore serve as a barrier to HIV infection [14,15]. Church participation in Africa may create an environment for social exposure and interaction resulting in new ideas [16], which could enhance HIV/AIDS prevention. However, opposition by religious leaders to the use of condoms to prevent HIV infection is a noted barrier to prevention in Ghana [17]. Also, Awusabo-Asare et al. [18] cite Christian fundamentalism in the school system, as an obstacle to the discussion of HIV prevention strategies due to the tendency to defer to God for solutions and attitudes of “predestined to happen” or “punishment or act of God” responses to problems.

The study focus was on key influences regarding students’ decisions and actions on HIV/AIDS interventions in Ghana. Among the research questions were the scope and pattern of influence of students’ beliefs on decisions and future actions towards HIV/AIDS towards informing prevention strategies.

Methodology

Study design and setting

This paper reports on the qualitative approach of a mixed method study involving 448 Junior High School (JHS) students at Obuasi, a mining town in Ashanti Region and a major HIV ‘hotspot’, with a higher prevalence [3]. The selection of both town and schools was purposive though the results may not necessarily be generalizable [19].

Data collection methods were Focus Group Discussion (FGD) and interview. Three sets each of boys, girls and mixed groups’ focus groups and teachers’ interviews were conducted and analysed using thematic analysis. The groups chosen included a consideration of gender and religion to take advantage of what both homogeneous and heterogeneous groups offer. The study participants’ age ranged from 13 to 16 years.

Focus groups offer an effective method for in-depth exploration of knowledge, attitudes, and beliefs of various audiences [20]. Ethical consideration was based on emphasis that HIV/AIDS is a potentially sensitive subject and working with young people therefore, demands the awareness of the legal and cultural context in which they operate [21]. Official and parental permission was sought and respondents were assured of confidentiality, anonymity and the right to withdraw. Respondents eagerly contributed in the discussions conducted in English, based on the protocol, [22] but had the option to express themselves in the local language, Akan, in the absence of teachers.

Results and Analysis

The data was transcribed and analysed following Miles and Huberman [23] framework and involved three processes: data reduction, data display, and drawing and verifying conclusions. These components, according to Punch [24] involve three main operations: coding, memoing and developing propositions. Through thematic analysis, a method for identifying, analysing and reporting patterns within data, common and new themes were identified.

The results from the FGDs and the in-depth-interviews, analysed into two major themes, each did not show much difference among the groupings. In place of a concept map (able to display linkages among labels and themes), a Table is presented for each of the methods below.

Table 1 Analysis of students’ focus group discussions.

Citation: Amoako-Agyeman KN. Key Beliefs Underlying Students’ Behaviour and Decisions towards HIV/AIDS: Implications for Educational Interventions. Austin J HIV/AIDS Res. 2016; 3(3): 1028. ISSN : 2380-0755