The Nelson Mandela Foundation (NMF) and the Nelson Mandela Children's Fund (NMCF) collaborated with the Human Sciences Research Council (HSRC) to undertake a community-based study of behavioural and sociocultural factors contributing to HIV/AIDS vulnerability - and the prevalence of HIV testing - in South Africa. The national survey also focussed on the impact of the mass media on knowledge, attitudes, and prevention strategies. Its purpose was to gather data to inform efforts to contain the spread of HIV/AIDS, to care for those afflicted with HIV/AIDS, and to ameliorate the impact of HIV/AIDS.

Over the past decade, HIV prevalence estimates in South Africa have been largely derived from an annual Department of Health survey of pregnant women attending antenatal clinics, supplemented by estimates from workplace and other studies. The present study builds on those studies by gathering information on the social, cultural, political, and economic context that contributes to vulnerability to AIDS infection in South Africa. It used a population-based sample of South Africans including men, women, and children of all races and ethnic groups, and included those living in urban and rural areas and hostels. The study, which involved interviews with 9,963 persons (8,840 of whom agreed to give a specimen for an HIV test), sought to:

• determine HIV prevalence in the general population
• identify risk factors that increase vulnerability of South Africans to HIV infection
• identify the context in which sexual behaviour occurs and the obstacles to risk reduction
• determine the level of exposure of all sectors of society to prevention, education, and awareness programmes and campaigns

establish whether, and by whom, media messages are understood and accepted.

The study's findings support the conclusion that South Africa has a serious and widespread HIV/AIDS epidemic. Here is a summary of selected findings:

• HIV/AIDS affects all races in South Africa. Any differences in prevalence are due to social, economic, and behavioural factors (such as living in settlements or having no access to the information and education necessary for prevention). HIV prevalence among those aged 2 to 14 was much higher than expected. Organisers recommend that a detailed study be undertaken to explore the role of sexual abuse and health-service-acquired infections.
• Women have higher HIV prevalence than men. Organisers urge consideration of the interaction between gender and biological factors. They suggest a short-term strategy of gender mainstreaming (i.e., current counselling programmes should be made more gender-sensitive through encouraging partner involvement) and a medium- and long-term strategy involving emphasing the economic and social empowerment of women so that they might exercise their sexual rights.
• Overall levels of HIV/AIDS knowledge are high in South Africa. However, organisers urge that information be monitored to ensure that it is delivered correctly and directly. Telephone hotlines are particularly helpful to this population. Organisers point to the lower levels of access to mass media channels in rural and poor areas; addressing these limitations might necessitate investment in either community-level communications approaches that build on the resources of local health services or in partnerships with faith-based and sectoral organisations. Further, the study highlighted the importance of communicating in the home language of intended audiences (African languages and Afrikaans are relatively marginalised). The red ribbon is a powerful symbol that should continue to be integrated into campaigns.
• In light of trends (detailed in the study results section), organisers recommend that:
  
  • Prevention campaigns include a drive to encourage voluntary counselling and testing (VCT)
  • Counsellors receive additional training
  • Nutritional education and supplementation be provided, in addition to treatment of opportunistic infections
  • VCT services be dramatically increased (especially in provinces like the Eastern Cape)
  • VCT training programmes be accredited, both for lay counsellors and health professionals
  • VCT services be improved to focus also on those who are living with HIV/AIDS
  • Campaigns focussing on reducing stigma and encouraging care for those with AIDS be directed at community leaders
  • Current Department of Health and Treasury efforts to estimate the cost of providing antiretroviral therapy be fast-tracked, and additional funds allocated
  • The government use the gains it made in winning the case against pharmaceutical companies to produce generic versions of antiretroviral drugs
  • The government and NOGs galvanise support for orphaned and vulnerable children
  • Studies like these be carried out at least every two years for both policy and planning purposes, and in order to track the course of the epidemic.