Breaking the Silence Through Delivering Comprehensive Sexuality Education to Learners with Disabilities in South Africa: Educators Experiences

  • Jill Hanass-Hancock
  • Paul Chappell
  • Rebecca Johns
  • Siphumelele Nene
Original Paper

Abstract

Comprehensive sexuality education is seen as a key intervention to address the high HIV-incidence rate and low knowledge among young people in South Africa, yet this lacks inclusion of learners with disabilities. At the same time, educators of learners with disabilities experience cultural barriers and lack skills and knowledge on how to deliver sexuality education in accessible formats. In response, the Breaking the Silence approach, a curriculum implementation and disability-accommodating approach, was developed and tested. This paper presents findings from a formative evaluation using in-depth interviews with educators from eight “schools for learners with special educational needs”. The paper focuses on their experience with implementing the approach. The analysis used conventional content analysis and NVIVO software. Educators conceptualized sexuality education within a risk-protection discourse. They revealed that the training and tools enabled them to provide sexuality education in accessible formats, tackle difficult topics such as sexual orientation and masturbation, and improved awareness and assertiveness within their learners. Educators identified the need for further development including a whole school approach, adjustments to differentiating developmental stages and addressing gender-specific topics. Through its application within the South African mainstream Life Orientation curriculum, this approach lends itself for further development and testing through implementing the approach within a whole school setting and ongoing support that will not only drive change in educators’ skills and knowledge but also drive the needed shift in cultural norms and values.

Keywords

Sexuality education Disability HIV Sexual and reproductive health South Africa Young people Adolescents Learners 

Notes

Acknowledgements

We would like to thank WCFID for providing some of the picture material for the manual development. We would also like to thank HEARD for providing the funds for the needs assessment, intervention development and part of the evaluation through its SIDA grant. In addition, we would like to thank all participating educators and KZN representatives of the Department of Basic Education for their participation in this project and courage to try out something new and daring. In addition, thanks go to the developmental team who assisted during the needs assessment namely Leandri Pretorious, Sophie Henken and Liset de Reus, who provided their time to the project on a voluntary basis.

Author's Contribution

JHH conceptualized this project and led the needs assessment, intervention and manual development, pilot of the intervention, the formative evaluation and development of this paper. RJ co-led the manual development, co-facilitated the pilot intervention, and has been part of the writing team. PC co-designed the manual, took part in the data analysis and has been part of the writing team. SN conducted the fieldwork, data analysis and has been part of the writing team.

References

  1. 1.
    UNAIDS: UNAIDS Strategy for Integrating Disability into AIDS Programmes. UNAIDS, Geneva (2012)Google Scholar
  2. 2.
    UNAIDS (2013) Global Report. UNAIDS Report on the Global AIDS Epidemic 2013. UNAIDS, New YorkGoogle Scholar
  3. 3.
    UNICEF: Opportunity in Crisis: Preventing HIV from Early Adolescence to Young Adulthood. UNICEF, New York (2011)Google Scholar
  4. 4.
    Statistics South Africa: Census 2011. Statistical release—P0301.4. Statistics South Africa, Pretoria (2012)Google Scholar
  5. 5.
    Statistics South Africa: Mid-Year Population Estimates. STATSA (2013)Google Scholar
  6. 6.
    Chappell, P., Rule, P., Dlamini, M., Nkala, N.: Troubling power dynamics: youth with disabilities as co-researchers in sexuality research in South Africa. J. Child. 21(3), 385–399 (2014)CrossRefGoogle Scholar
  7. 7.
    United Nations: Convention on the Rights of Persons with Disabilities. UN (2008)Google Scholar
  8. 8.
    Lansdown, G.: Disabled Children in South Africa. Progress in Implementing the Convention on the Rights of the Child. The International Disability and Human Rights Network (2002)Google Scholar
  9. 9.
    Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa, Art 14 (2003)Google Scholar
  10. 10.
    Parliament of the Republic of South Africa: Children’s Act 38. Parliament of the Republic of South Africa. Parliament of the Republic of South Africa (ed.). Parliament of the Republic of South Africa, Preotria (2005)Google Scholar
  11. 11.
    Constitutional Assembly: Constitution of the Republic of South Africa (1996)Google Scholar
  12. 12.
    Education, D.O.: Education White Paper 6, Special Needs Education, Building an Inclusive Education and Training System. Department of Education, Pretoria (2001)Google Scholar
  13. 13.
    Kirby, D.B., Laris, B.A., Lori, A., Rolleri, M.S.W.: Sex and HIV education programs: their impact on sexual behaviours of young people throughout the world. J. Adolesc. Health 40, 206–207 (2007)CrossRefPubMedGoogle Scholar
  14. 14.
    UNFPA: UNFPA Operational Guidance for Comprehenisve Sexuality Education: A Focus on Human Rights and Gender. UNFPA, New York (2014)Google Scholar
  15. 15.
    UNESCO: International Technical Guidance on Sexuality Education: An Evidence-Informed Approach for Schools Teachers and Health Educators, Vol 1. The Rationale for Sexuality Education. UNESCO, Paris (2009)Google Scholar
  16. 16.
    South African Department of Basic Education: Dept of Basic Education National Policy on HIV, STI’s and TB. Department of Basic Education, Pretoria (2017)Google Scholar
  17. 17.
    South African Department of Education: Basic Education on Development of Vocational Learning. http://www.gov.za/basic-education-development-vocational-learning-programme (2014). Accessed 20 May 2016
  18. 18.
    Jansen, L.: Teachers to be Told How to Teach About Sex. http://www.iol.co.za/news/south-africa/kwazulu-natal/teachers-to-be-told-how-to-teach-about-sex-1869387 (2015). Accessed 20 May 2016
  19. 19.
    UNAIDS: The Gap Report. UNAIDS, Geneva (2014)Google Scholar
  20. 20.
    Hanass-Hancock, J., Ann, S., Grant, C.: Inclusion of disability within the National Strategic Response to HIV and AIDS in eastern and southern Africa. Disabil. Rehabil. 33(23–24), 2389–2396 (2011)CrossRefPubMedGoogle Scholar
  21. 21.
    de Reuters, L., Hanass-Hancock, J., Henken, A.S., van Brakel, W.: The voice of educators: challenges in providing HIV and sexuality education to learners with disabilities in South Africa. Sex Educ. 15(4), 333–347 (2015)CrossRefGoogle Scholar
  22. 22.
    Rohleder, P., Swartz, L., Schneider, M., Henning Eide, A.: Challenges to providing HIV prevention education to youth with disabilities in South Africa. Disabil. Rehabil. 34(8), 619–624 (2012)CrossRefPubMedGoogle Scholar
  23. 23.
    UNICEF: Towards an AIDS free Generation: Promoting Community Based Strategies for and with Children and Adolescents with Disabilities. UNICEF, New York (2012)Google Scholar
  24. 24.
    De Beaudrap, P., Mac-Seing, M., Pasquier, E.: Disability and HIV: a systematic review and a meta-analysis of the risk of HIV infection among adults with disabilities in Sub-Saharan Africa. AIDS Care 26(12), 1467–1476 (2014)CrossRefPubMedGoogle Scholar
  25. 25.
    De Beaudrap, P., Pasquier, E., Tchoumkeu, A., Touko, A., Essomba, F., Brus, A., du Loû, A.D., Aderemi, T.J., Hanass-Hancock, J., Eide, A.H., Mont, D., Mac-Seing, M., Beninguisse, G.: HandiVIH—a population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations. BMJ Open 6(2), e008934 (2016)CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Shisana, O., Rehle, T., Simbayi, L.C., Zuma, K., Jooste, S., Pillay-van-Wyk, V., Mbelle, N., Van Zyl, J., Parker, W., Zungu, N.P., Pezi, S.: SABSSM III Implementation Team: South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008: A Turning Tide Among Teenagers?. HSRC Press, Cape Town (2009)Google Scholar
  27. 27.
    Groce, N.E.: Global Survey on HIV/AIDS and Disability. http://cira.med.yale.edu/globalsurvey (2004). Accessed 01 Sept 2004
  28. 28.
    Aderemi, T., Pillay, B.J., Esterhuizen, T.M.: Differences in HIV knowledge and sexual practices of learners with intellectual disabilities and non-disabled learners in Nigeria. JIAS 16(1), 17331 (2013)CrossRefGoogle Scholar
  29. 29.
    Aderemi, T.: Sexual abstinence and HIV knowledge in school-going adolescents with intellectual disabilities and nondisabled adolescents in Nigeria. J. Child Adolesc. Ment. Health 25(1), 161–174 (2013)CrossRefPubMedGoogle Scholar
  30. 30.
    Rohleder, P., Leslie Swartz, L.: Providing sex education to persons with learning disabilities in the era of HIV/AIDS: tensions between discourses of human rights and restriction. J. Health Psychol. 14, 601 (2009)CrossRefPubMedGoogle Scholar
  31. 31.
    Hanass-Hancock, J.: Interweaving conceptualizations of gender and disability in the context of vulnerability to HIV/AIDS in KwaZulu-Natal, South Africa. Sex. Disabil. 27(1), 35–47 (2009)CrossRefGoogle Scholar
  32. 32.
    Hanass-Hancock, J.: Disability and HIV/AIDS: a systematic review of literature in Africa. J. Int. AIDS Soc. 12(1), 34 (2009). http://www.jiasociety.org/series/hiv_aids_and_disability
  33. 33.
    Chappell, P.: How Zulu-speaking youth with physical and visual disabilities understand love and relationships in constructing their sexual identities. Culture Health Sex. 16(9), 1156–1168 (2014)CrossRefGoogle Scholar
  34. 34.
    Dawood, N., Bhagwanjee, A., Govender, K., Chohan, E.: Knowledge, attitudes and sexual practices of adolescents with mild mental retardation, in relation to HIV/AIDS. Afr. J. AIDS Res. 5(1), 1–10 (2006)CrossRefPubMedGoogle Scholar
  35. 35.
    Yousafzai, A., Aisha, K., Dlamini, P.J., Groce, N., Wirz, S.: Knowledge, personal risk and experiences of HIV/AIDS among people with disabilities in Swaziland. Int. J. Rehabil. Res. 27(3), 247–251 (2005)CrossRefGoogle Scholar
  36. 36.
    Jones, L., Bellis, M.A., Wood, S., Hughes, K., McCoy, E., Eckley, L., Bates, G., Mikton, C., Shakespeare, T., Officer, A.: Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies. Lancet 380(9845), 899–907 (2012).  https://doi.org/10.1016/S0140-6736(12)60692-8 CrossRefPubMedGoogle Scholar
  37. 37.
    Hughes, K., Bellis, A.M., Jones, L., Wood, S., Bates, G., Eckley, L., McCoy, E., Mikton, C., Shakespeare, T., Officer, A.: Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet 380, 899–907 (2012)CrossRefPubMedGoogle Scholar
  38. 38.
    Save the Children: Out from the Shadows, Sexual Violence Against Children with Disabilities. Save the Children, London (2011)Google Scholar
  39. 39.
    South African Department of Social Development: Elements of the Financial and Economic Costs of Disability to Households in South Africa. Results from a Pilot Study. DSD, UNICEF, Johannesburg (2016)Google Scholar
  40. 40.
    Banks, L.M., Polack, S.: The Economic Costs of Exclusion and Gains of Inclusion of People with Disabilities. London School of Hygiene and Tropical Medicine, London (2013)Google Scholar
  41. 41.
    Dickman, B., Roux, A.: Complainants with learning disabilities in sexual abuse cases: a 10-year review of a psycho-legal project in Cape Town, South Africa. Br. J. Learn. Disabil. 33(3), 138–144 (2005)CrossRefGoogle Scholar
  42. 42.
    Aderemi, T.: Teachers’ perspectives on sexuality and sexuality education of learners with intellectual disabilities in Nigeria. Sex. Disabil. 31(2), 1–12 (2014)Google Scholar
  43. 43.
    Rohleder, P.: Educators’ ambivalence and managing anxiety in providing sex education for people with learning disabilities. Psychodyn. Pract. 16(2), 165–182 (2010).  https://doi.org/10.1080/14753631003688100 CrossRefGoogle Scholar
  44. 44.
    Chirawu, P., Hanass-Hancock, J., Aderemi, T.J., de Reus, L., Henken, A.S.: Protect or enable? Teachers’ beliefs and practices regarding provision of sexuality education to learners with disability in KwaZulu-Natal, South Africa. Sex. Disabil. 32(3), 259–277 (2014).  https://doi.org/10.1007/s11195-014-9355-7 CrossRefGoogle Scholar
  45. 45.
    Schaafsma, D., Kok, G., Stoffelen, J.M.T., Curfs, L.M.G.: Identifying effective methods for teaching sex education to individuals with intellectual disabilities: a systematic review. J. Sex Res. 39(2), 157–166 (2014).  https://doi.org/10.1080/00224499.2014.919373 Google Scholar
  46. 46.
    Aderemi, T., Pillay, B.J.: ‘Sexual or not?’: HIV/AIDS knowledge, attitudes and sexual practices among intellectually impaired and mainstream learners in Oyo State, Nigeria. Afr. J. Rhetor. 3, 197–218 (2011)Google Scholar
  47. 47.
    Healy, E., McGuire, B.E., Evans, D.S., Carley, S.N.: Sexuality and personal relationships for people with an intellectual disability. Part 1: service-user perspectives. J. Intellect. Disabil. Res. 53(11), 905–912 (2009)CrossRefPubMedGoogle Scholar
  48. 48.
    Swango-Wilson, A.: Caregiver perceptions and implications for sex education for individuals with intellectual and developmental disabilities. Sex. Disabil. 26, 167–174 (2008)CrossRefGoogle Scholar
  49. 49.
    United Nations: Thematic Study on the Issue of Violence Against Women and Girls with Disability. Report of the office of the United Nations High Commissioner for Human Rights, vol. A/HRC/20/5. United Nations, New York (2012)Google Scholar
  50. 50.
    Bryen, D.N., Bornam, J.: Stop Violence Against People with Disabilties! An International Resource. Pretoria University Law Press. http://www.pulp.up.ac.za/pdf/2014_12/2014_12.pd (2014). Accessed 20 May 2016
  51. 51.
    Johns, R., Chappell, P., Hanass-Hancock, J.: Breaking the Silence: Accommodating Young People with Disabilities in Sexuality Education. Reader for Educators. HEARD, Durban (2014)Google Scholar
  52. 52.
    Hanass-Hancock, J., Henken, S., Pretorius, L., de Reus, L., van Brakel, W.: The cross-cultural validation to measure the needs and practices of educators who teach sexuality education to learners with a disability in South Africa. Sex. Disabil. 32, 279–298 (2014)CrossRefGoogle Scholar
  53. 53.
    Nixon, S.A., Cameron, C., Hanass-Hancock, J., Simwaba, P., Solomon, P.E., Bond, V.A., Menon, A., Richardson, E., Stevens, M., Zack, E.: Perceptions of HIV-related health services in Zambia for people with disabilities who are HIV-positive. J. Int. AIDS Soc. 17(18806), 18806 (2014).  https://doi.org/10.7448/IAS.17.1.18806 CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Hanass-Hancock, J., Myezwa, H., Nixon, S.A., Gibbs, A.: “When I was no longer able to see and walk, that is when I was affected most”: experiences of disability in people living with HIV in South Africa. Disabil. Rehabil. 37(22), 2051–2060 (2015).  https://doi.org/10.3109/09638288.2014.993432 CrossRefPubMedGoogle Scholar
  55. 55.
    Jackson, S.F.: A participatory group process to analyze qualitative data. Prog. Community Health Partnersh. 2(2), 161–170 (2008).  https://doi.org/10.1353/cpr.0.0010 CrossRefPubMedGoogle Scholar
  56. 56.
    Pretorious, L., Hanass-Hancock, J.: Breaking the Silence: Strengthening Sexuality Education Within the Life Orientation Curriculum for Learners with Disabilities. Workshop Report. HEARD, Durban (2014)Google Scholar
  57. 57.
    Rohlander, P., Swartz, L., Schneider, M., Henning Eide, A.: Challanges to providing HIV prevention education to youth with disabiliteis in South Africa. Disabil. Rehabil. 34(8), 619–624 (2012)CrossRefGoogle Scholar
  58. 58.
    Hanass-Hancock, J., Casale, M.: Out of the box onto the catwalk: creative approaches for sex, relationship and HIV education in southern Africa. In: Stanovic, J., Lalic, M. (eds.) Sexuality Education and Attitudes, pp. 68–98. Nova Science Publishers Inc., Hauppauge (2010)Google Scholar
  59. 59.
    Raising Voices: what will it take to prevent violence against women and children? Raising Voices 2012–1016 Strategy. Raising Voices (2012)Google Scholar
  60. 60.
    Department of Education KwaZulu-Natal: Letter of support for breaking the silence project. In: Hanass-Hancock, J. (ed.) (2012)Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.South African Medical Research CouncilCape TownSouth Africa
  2. 2.School of Health ScienceUniversity of KwaZulu-NatalDurbanSouth Africa
  3. 3.WITs UniversityJohannesburgSouth Africa
  4. 4.Cape TownSouth Africa
  5. 5.HEARDUniversity of KwaZulu-NatalDurbanSouth Africa

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