University Students and HIV
Students at Chancellor College - Photograph courtesy of the author.
Today’s blog is from Devan Jaganath, a medical student from the David Geffen School of Medicine at the University of California, Los Angeles. Devan writes about his thoughts on HIV education and prevention strategies aimed at university students following his experiences in Malawi.
While there is a strong foundation in HIV education for students, there is a missing piece that bars behavioral change.
Youth between 15-24 contribute to the majority of new cases of HIV worldwide, university students fall into this range and several programs in Sub-Saharan Africa focus on this community. I am spending three weeks at Chancellor College, in Zomba, Malawi, to learn of the unique risks that students face in getting HIV and why increased focused should be placed on this group. In some ways it is difficult to imagine that students at Chancellor would be at risk of HIV.The entire University of Malawi system has around 7000 students; for a nation of about 14 million people, these individuals are considered among the best and brightest in the country. As I walk around the campus, endless posters by faith-based groups promote abstinence and deride sexual misconduct. Also, first year students attend an orientation program by Zamanawe (“Give it a Try”), a HIV peer education program organized by four universities in sub-Saharan Africa, including Chancellor. For fourth years, there is Why Wait?, a program that promotes abstinence.
So as I chat with students here, they don’t want to learn more about HIV; they’ve been barraged with every fact. And yet, a recent study at Chancellor showed that only 19% of students know their HIV status and 38.7% know how to properly use a condom. Within two days at Chancellor, I had been invited to a party, advertised to have plenty of alcohol and beautiful women. Students talk about “gorillas,” those who casually have sex with multiple partners, the same study showed that 40.4% have had multiple partners in the last year. I visited the university clinic, whose Voluntary Counselling and Testing (VCT) services require more funding, and are under used because of stigma. Antiretroviral (ARV) resources are also poorly accessed because students are afraid that peers will find out; I heard of one student who travels over four hours to Lilongwe (~330 km) to receive ARVs, resulting in irregular treatment.So while there is a strong foundation in HIV education for students, there is a missing piece that bars behavioral change.
In several ways, it is not so different than the obstacles for prevention of sexually transmitted infections (STIs) in the United States. At UCLA, I started a program where medical and public health students speak to freshman undergraduates about sexual health. While we provide facts about STIs and birth control methods, much of our discussion is meant to highlight risky behaviors and increase comfort level in talking about sexual issues and using testing services. These students, like their peers at Chancellor, understand the basic facts. However, if we can increase their willingness to talk about these issues openly, the hope is that testing and other resources on campus will be no longer stigmatized, but rather utilized to increase healthy behavior.
Here are a few goals that we must continue to pursue in HIV education and awareness programs for university students:
1) Reduce discrimination for students with HIV. While many of the students I speak to say that they treat people with HIV/AIDS equally, they would not get tested at the college clinic for fear that others would find out. Greater emphasis on the confidentiality of results and broader awareness campaigns that improve acceptance of students with HIV would increase VCT and use of ARV resources on campus.
2) Advocate asking partners of their status. While abstinence and condom use are the main ways students cite in HIV prevention, it is believed that few ask their sexual partner’s HIV status. While they may be comfortable in speaking about HIV with friends or family, if students cannot talk about it with sexual partners, we are missing a large component in our programs.
3) Focus on horizontal programs to reduce risky behaviors associated with HIV contraction.
Students at Chancellor resoundingly acknowledge that extreme alcohol and drug use places students at risk for unprotected sex and HIV. Next to each poster about a prayer group there is another flier promoting a disco the upcoming weekend. At Chancellor, they have a ‘Social Weekend’ where students from across the University of Malawi system come for parties. Increased resources for programs that reduce alcohol and drug abuse and alternative non-alcohol activities would create a safer environment for these students.
So yes, Chancellor students are intelligent. Yes, they will be the future leaders in Malawi. However, every new case of HIV at the university limits that potential. As the individuals who will lead the next era in HIV prevention and eradication, we need to continue to improve our programs to increase not only knowledge about HIV, but actual changes in behavior.
Devan Jaganath
2nd year medical student, UCLA
devan@ucla.edu