Most learners had obtained their HIV and AIDS knowledge from schools, but some did so from their parents, community activities, the radio or television. No learner had commenced with sexual activities and all had heard about HIV, but not all knew what HIV was, and even fewer could define AIDS. Less than one-third of the learners could mention the three most important HIV preventive measures. Most learners were willing to undergo voluntary counselling and testing (VCT), but few had done so. As no learner had commenced sexual activities, opportunities existed to empower Grade 8 (Form 1) learners with adequate HIV and AIDS knowledge. Generally the learners’ HIV and AIDS knowledge levels were high but some misconceptions existed. Schools should engage with radio and television programmes to address misconceptions about HIV and AIDS. Learners should be enabled to access VCT services. More effective HIV prevention education in Zimbabwe’s schools, could enable more youth to remain HIV negative.

Die meeste leerders het hulle MIV and VIGS kennis by skole opgedoen terwyl ‘n paar dit van hulle ouers, gemeenskapsaktiwiteite, die radio en televisie gekry het. Geen leerders het met seksuele aktiwiteite begin nie, almal het van MIV gehoor, maar nie almal het geweet wat MIV is nie, en nog minder kon VIGS definieer. Minder as een-derde kon die drie belangrikste MIV voorkomende maatreëls noem. Die meeste leerders was gewillig om vrywillige berading en toetsing (VBT) te ondergaan, maar min het dit reeds gedoen.

Aangesien geen leerder seksueel aktief was nie, bestaan geleenthede om Graad 8 (Vorm 1) leerders te bemagtig om ingeligte besluite te neem. Oor die algemeen was die leerders se MIV en VIGS kennisvlakke hoog, maar wanopvattings het bestaan Skole behoort saam te werk met radio en televisie programme ten einde wanopvattings aan te spreek. Leerders moet in staat gestel word om VBT dienste te benut. Doeltreffender MIV en VIGS voorligting in Zimbabwe se skole, kan meer jong mense in staat stel of HIV negatief te bly.

Nearly half of the population of Zimbabwe (43%) is comprised of young people aged 15 or younger. HIV prevalence rates amongst Zimbabwe’s young people aged 15–19 years was 12% for women and 2% for men (Ministry of Health and Child Welfare (MOHCW) 2003:14). HIV prevalence for young women, attending antenatal clinics in Harare, the capital city of Zimbabwe, ranged from 28% amongst women aged 15 years to 33% amongst women aged 21 years (MOHCW 2000:26). In Zimbabwe the age group of 6 to 15 years was least infected with HIV (MOHCW 2004:14). The hope of slowing down the spread of HIV amongst young sexually active persons remains a challenge. The future of the AIDS epidemic will be shaped by the sexual behaviour of this younger age group as it has the lowest level of infection. Hence there is an urgent need to aim HIV prevention strategies at them whilst they are still likely to be HIV negative. According to Zimbabwe’s Young Adult Health Survey (MOHCW 2001–2002:70) human behaviour relating to HIV is influenced by different factors which include:

• knowledge of this infection

• risk perceptions of and attitudes towards condoms

• perceptions of persons infected with HIV

• gender roles.

However, knowledge is reported as an important influential factor on sexual behaviours. A review of social science research about HIV and AIDS (Freudenthal 2001:12) showed that many researchers consider education to be one of the most important tools for preventing the transmission of HIV. A joint press release by the United Nations International Children’s Emergency Fund (UNICEF), Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) stated that there was a strong linkage between what young people knew and how they acted (UNICEF 2002:1). Although there is no guarantee that knowledge leads to behaviour changes, at least HIV and AIDS knowledge should enable young people to make informed decisions.

A Zimbabwean survey (MOHCW 2001–2002:1) reported that many of its youth engaged in behaviour that put them at risk of HIV infection, and 71% of young persons aged 15–29 years had sexual intercourse before the age of 20. The age of sexual intercourse, the degree of sexual activity and the number of sexual partners are factors that increase the risk of HIV amongst the youth (Buseh, Glass, McElmurry, Mkhabela & Sukati 2001:526). Two studies in Zimbabwe showed that many male adolescents were sexually active by the age of 15 and, therefore, at risk of HIV infection (Boohene, Tsodzai, Hardee-Cleveland, Weir & Janowitz 1999:266). In Harare, amongst the age group 15–24, HIV prevalence reportedly remained at 20% in 2005 (MOHCW 2005:27), hence the need to provide targeted HIV information for this age group, enabling them to make informed choices.

According to the MOHCW survey (2001–2002:31), young people engage in high risk behaviours like alcohol and drug abuse, early sexual debuts and sex with older men who might be infected with HIV. Mataure et al. (2002:217) reported that 63% of females and 70% of males in Harare’s secondary schools drank alcohol and that they engaged in high risk sexual behaviour whilst intoxicated. Girls had sex with older men in exchange for money whilst boys had sex with casual sex workers. Fritz et al. (2002:227) found a strong association between alcohol consumption and sexual risk behaviours in Harare. A survey of experiences of young people in urban Zimbabwe reported that they engaged in sexual activity, prostitution, drug and alcohol abuse at an early age (Phiri 2000:4–9).

As from 1993, Zimbabwe’s education system included HIV and AIDS programmes in all primary and secondary schools (Grades 1–12). The purpose of this HIV and AIDS school programme is to provide knowledge about HIV and AIDS to learners, to promote healthy lifestyles, positive values and attitudes and responsible behaviour amongst learners (MOESC 2003:5). This is in line with the Zimbabwe National HIV and AIDS policy which states that children should have access to knowledge and life skills that are needed to avoid HIV infection (MOHCW 1999:22).

The curricula for primary and secondary school learners address the following:

• human growth and development

• information about HIV and AIDS (what it is and how it is acquired, transmitted and prevented)

• life skills that promote positive behaviour changes

• the impact of HIV and AIDS on individuals, families and the nation

• promoting behaviour that prevents and reduces this infection and its transmission amongst learners (MOESC 2003:6–7).

The basic HIV and AIDS knowledge of secondary school learners should at least encompass the ABC (abstain from sex, be faithful to one sexual partner, and use condoms) of HIV and AIDS prevention. The fourth aspect (D indicating diagnosis) involves voluntary counselling and testing (VCT) about which learners should also be knowledgeable (MOESC 2003:4).

Youth and young people: include the terms ‘adolescent’ and ‘teenager’, referring to young people who are undergoing the physical, mental and cultural transition from childhood to adulthood. According to the WHO (2006:1) adolescents are people aged 10–19 years and young people 10–24 years. In Zimbabwe youth and young people fall within the age group of 10–30 years. (Ministry of Youth Development, Gender and Employment Creation (MYDGEC) 2000:12). For the purpose of this study, young people will refer to people aged 10–30 years, as defined by the Zimbabwe National Youth Policy, and will be used interchangeably with youth.

The exploratory descriptive design has been chosen because it could generate new information, about the knowledge of HIV by secondary school learners, that could influence their chances of remaining HIV negative. The quantitative design was chosen because it enabled the interviewer to remain objective and to ask the learners factual questions.

Form 1 learners from the four selected schools could participate, provided their parents had granted them permission and provided the individual learners were willing to be interviewed on the days when the interviewer visited their particular school. Learners who were not in Form 1 at the four participating schools were excluded, as well as those whose parents did not give their permission, or who were unwilling to be interviewed, or who were absent from school on the days when the researcher visited their particular school.

At each participating school, all Form 1 learners were invited to participate in the study and and requested to obtain written permission from their parents. Ten girls and ten boys from each participating secondary school were expected to take part in the survey. However, the total sample size comprised 75 Form 1 learners (39 girls and 36 boys). The first 10 male and the first 10 female volunteers were interviewed from each school, but only 15 learners from the high density school participated. The school principals specified that a maximum of ten male and ten female learners could be interviewed at each school to minimise the potential disruption to the ongoing school programme.

• demographics (age, gender, religion, type of school attended)

• HIV knowledge

• HIV prevention methods

• sources of HIV knowledge

• sexual behaviours.

Questions about HIV knowledge focussed on the learners’ ability to define HIV and AIDS and describe its modes of transmission. Learners were requested to list three behaviours that could ensure that a person would remain HIV negative, to assess their HIV prevention knowledge. Questions were also asked about the learners’ knowledge about voluntary counselling and testing (VCT) services, and their utilisation of VCT services. Questions about the learners’ sexual behaviour requested information about their sexual activities, their knowledge about the advantages of using condoms and where they may access condoms.

The structured interview schedule was specifically designed to collect data about the HIV and AIDS knowledge of secondary school learners. It was based on the literature reviewed and on Zimbabwe’s school HIV and AIDS programme’s guidelines. The interview schedule was reviewed by a statistician and two experienced nurses who were also researchers. The instrument was pre-tested by conducting interviews with Form 1 learners from two schools who did not participate in the actual study. No problems were encountered whilst pretesting the instrument.

One researcher conducted all of the interviews and asked the same questions in the same sequence from all learners. The interviewer recorded all the responses on the interview schedule. Responses to open-ended questions were recorded verbatim.

• A, representing a low density school (27%; n = 20)

• B, a private school (27%; n = 20)

• C, a high density school (20%.; n = 15)

• D, a rural school (27%; n = 20).

There were more female 52% (n = 39) than male 48% (n = 36) respondents. The learners’ ages ranged from 12 to 14 years; 69.3% (n = 52) of the respondents were 13 years old, followed by learners aged 14 years (26.7%; n = 20) whilst learners who were 12 years old were in the minority (4%; n = 3). The age range is consistent with learners who have completed seven years of primary education in Zimbabwe, given the fact that they enrolled in Grade one at six years of age and had completed at least seven years of schooling when the data were collected.

Reportedly all learners (100%; n = 75) were Christians. Of the learners 68% (n = 51) grew up in urban areas; 17.3% (n = 13) in small towns and 14.7% (n = 11) in rural areas. Stratified by gender, more males (19.4%; n = 7) than females (10.3%; n = 4) grew up in the rural areas and almost an equal number of males and females grew up in urban areas.

More female learners (97.4%; n = 38) knew about HIV than their male counterparts (94.4%; n = 34). However, fewer female learners could define AIDS (82%; n = 32), compared to the male learners (97.2%; n = 35).

As indicated in Table 1, all learners (100%; n = 75) knew that having sex with an infected partner could cause HIV infection, that a person could not become infected through mosquito bites (94.7%; n = 71), nor from eating from the same plates as infected persons (98.7%; n = 74), nor from using the same toilets as infected persons (97.3.%; n = 73), nor through coughing (97.3%; n = 73). Knowledge about infection through parent to child transmission was high (94.7%; n = 71) and infection through needle prick injuries (96%; n = 72). Fewer learners knew that HIV infections could occur through blood transfusions (74.7%; n = 56) and tattooing (48.2%; n = 36).

Of the learners, 96% (n = 72) knew that an HIV positive person could appear healthy. All learners (100%; n = 75) mentioned that boys who used the services of prostitutes could acquire HIV and AIDS and other sexually transmitted infections. Learners indicated that the risks of having sex with older men included acquiring HIV and AIDS (89.3%; n = 67), being infected with Sexually Transmitted Infections (STIs) (5.3%; n = 4) and becoming pregnant (18.7%; n = 14). The girls’ loss of virginity (1.3%; n = 1) and the possibility of being murdered (2.7%; n = 2) were also mentioned as risks.

Of the learners, 28% (n = 21) spontaneously mentioned three different ways of avoiding HIV infection, 56%. (n = 42) mentioned two ways and 14.7% (n = 11) only mentioned one way, and one learner failed to mention any method of preventing HIV infection.

Of the learners, 93.3% (n = 70) reported that they had never been tested for HIV whilst 6.7% (n = 5) had been tested. However, 70.7% (n = 53) reported that they wanted to be tested for HIV but 29.3% (n = 22) did not want to do so. Out of the 70 learners who had not been tested, 31.4% (n = 22) reported that they did not want to be tested for HIV and 68.6% (n = 48) were willing to be tested. All the learners who had been tested previously (6.7%; n = 5) wanted to be tested again for HIV.

Although 62.7% (n = 47) of the learners did not know of anyone who had tested HIV negative, 54.7% (n = 41) also did not know anyone who had tested HIV positive, but 16 (n = 12) knew one person, 10.7% (n = 8) knew two people, 6.7% n = 5) knew three people, 2.7% (n = 2) knew four people, 4% (n = 3) knew five people and 1.3% (n = 1) knew seven or more people who had tested HIV positive.

Most learners (80%; n = 60) did not consider themselves to be at risk of HIV infection, whilst only 18.7% (n = 14) considered that they were at risk. Of the learners 54.7% (n = 41) reported that they were not at risk because they had never had sex before, 8% (n = 6) reported that they did not share needles or razor blades with anyone, 2.7% (n = 2) believed that they were at no risk because there was no one in their family who was HIV positive, whilst 1.3% (n = 1) considered that they were not at risk because their parents were HIV negative, and 1.3% (n = 1) reportedly thought himself or herself not at risk because he or she knew how to prevent HIV infection. However, 2.7% (n = 2) reported that they could be at risk if they dated someone who was infected with HIV, whilst 1.3% (n = 1), felt at risk because he or she could become infected through injuries in an accident or during sexual abuse (1.3%; n = 1).

Ethical clearance to conduct the study was granted by the Research and Ethics Committee of the Department of Health Studies, University of South Africa, Zimbabwe’s Ministry of Education, Sports and Culture (MOESC) and the management of each participating school.

The principle of respect for human dignity requires that the right to self determination and full disclosure were respected (Polit & Hungler 2008:33). This was achieved by providing information about the study to enable each learner to decide whether or not to participate, without incurring any penalties. No learner was forced to participate.

The principle of justice demands fair treatment and the right to privacy (Polit & Hungler, 2008:35). No identifying information was collected from any learner and confidentiality was ensured throughout the research process. No signed consent was requested from individual learners, but the researcher asked every interviewee the following questions:

• ‘Your parent or guardian signed consent for you to participate in the study. Are you willing to be interviewed by me?

• Do you understand that you may refuse to answer specific questions and you may stop being interviewed at any stage?’

Only learners, who answered positively to both questions, were interviewed. No identification details were entered onto any interview schedule, thus safeguarding the learners’ anonymity. No names of the participating schools would be disclosed. Information shared with the interviewer was not divulged to any other person. The completed interview schedules were kept under lock and key and would be destroyed after the acceptance of the research report. Only the researchers and the statistician had access to the raw data.

To enhance validity, the instrument was developed using questions similar to those from research reports assessing HIV knowledge and sexual behaviours. The instrument was reviewed by two experienced researchers and a statistician. These persons accepted that the items on the structured interview schedule reflected the real meaning of the concept under consideration, namely the HIV and AIDS knowledge and sexual behaviour of the learners (Babbie & Mouton 2001:142).

This matches the Zimbabwe Demographic and Health Survey (ZDHS 2005–6:184) report stating that in the population aged 15–49, the knowledge levels of HIV and AIDS were 98% amongst women and 99% amongst men. According to the ZDHS (2005–6:184) report, young people aged 15–24 generally had lower levels of HIV and AIDS knowledge than those in older age groups.

Unprotected sex, as the most common method of HIV transmission (WHO 2004:5), was mentioned by almost all (96%; n = 72) the learners. However, if the school HIV and AIDS programme had been effective, every learner should have known this. The statistics in Table 1 indicate that more than 90% of the learners were knowledgeable about most transmission methods of HIV. However, learners seemed to lack knowledge about HIV transmission through blood transfusions and tattooing. This might be attributable to the extremely rare circumstances under which blood transfusions could be administered in Zimbabwe and to the learners’ potential unfamiliarity with ‘tattooing’. However, no learner requested more information about these terms.

Of the learners, 96% (n = 72) knew that a person who is HIV positive could appear healthy. The results are higher than the findings of the Zimbabwe’s Young Adult Survey (MOHCW 2001–2:71) in which 73% of young women and 77% of young men knew that a person infected with HIV could look healthy. If the school HIV and AIDS programme had been successful, 100% of the learners should have had this knowledge.

All learners knew that boys who used the services of prostitutes could become infected with HIV, and almost all of them (89.3%; n = 67) knew that girls who have sex with older men risked becoming HIV positive. It could not be ascertained why 100% of the learners were not knowledgeable about this possibility which should be stressed in the HIV and AIDS school programme.

Although 86.7% (n = 65) of the learners knew that there was no cure for AIDS and 97.3% (n = 73) believed that having sex with a virgin could not cure AIDS, all learners did not know these basic facts. These aspects could indicate shortcomings in the HIV and AIDS school programme.

Although 93.3% (n = 70) of the respondents had never been tested for HIV, 70.7% (n = 53) wanted to be tested. All the learners who had been tested previously (6.7%; n = 5) wanted to be tested again for HIV. This finding indicates that many learners who were willing to access VCT services, had not yet done so, and should be assisted to access VCT services. School HIV and AIDS programmes should address ways to access VCT services. The fact that all previously tested learners were willing to be re-tested could indicate that they did not experience VCT negatively.

Only 75 learners were interviewed because the interviews were conducted at a time when there were few teachers and learners at schools, resulting from teachers striking for better salaries. Only learners who were willing to be interviewed could participate in this study. There can be no guarantee that learners unwilling to be interviewed had similar levels of HIV and AIDS knowledge. The relatively small sample size of 75 learners was a limitation in itself. As a convenience sample was used, only descriptive statistical analyses could be applied to the results.

Reportedly none of the interviewed learners had been sexually active, which made questions about sexual practices irrelevant, and the study was, thus, incapable of reporting on these issues. The responses of the learners might have been influenced by the presence of the interviewer. The researchers were advised by teachers and healthcare professionals, to select structured interviews, and not self-completion questionnaires, to obtain information about the knowledge of HIV and AIDS of secondary school learners. Form 1 learners in Harare, might have been unable to complete questionnaires on their own, resulting in vast numbers of unanswered questions, rendering the raw data relatively useless.

The school curriculum needs to be revised to emphasise improving the learners’ knowledge about HIV and AIDS and to address misconceptions (even if only held by a minority of learners). These misconceptions include HIV and AIDS transmission through being scratched by the nails of a person who is HIV positive, the fact that there is no cure for HIV and AIDS and the fact that HIV and AIDS cannot be cured by having sex with a virgin. The school-based HIV and AIDS programme should also stress that, provided that one takes precautionary measures to protect oneself against contamination with the HIV positive person’s body fluids, one is unlikely to become HIV infected whilst caring for such a person. The school curriculum should also emphasise the difference between HIV and AIDS and should ensure that every learner knows the ABC of HIV and AIDS prevention.

The finding, that 80% (n = 60) of the learners did not consider themselves to be at risk of contracting HIV and AIDS, should be addressed by HIV and AIDS programmes, which should emphasise that every person can be at risk. Radio and television programmes, targeting young people with HIV and AIDS information, should be sustained, monitored and expanded.

Future studies should involve learners from Forms 1 to 5 (Grades 8–12), to identify the average ages at which secondary school learners commence sexual activities. Ideally a randomly selected sample of all secondary school learners throughout Zimbabwe should participate in a study to evaluate the HIV and AIDS knowledge level of all Zimbabwe’s learners, and to redesign the HIV and AIDS school curriculum accordingly.

As most learners were willing to undergo VCT, these services should be made accessible to secondary school learners in Zimbabwe.

All learners had heard about HIV and AIDS and the school was the most frequently mentioned source of information, followed by television, radio, parents, newspapers and community activities. Although the school HIV and AIDS programme had achieved some successes, its impact could be enhanced, as well as HIV and AIDS messages, through television, radio and parents and, furthermore, community activities should be encouraged. Every learner should be able to define HIV, AIDS and the ABC of preventing HIV infections.

More than half of the learners were reportedly willing to undergo VCT, but most had not done so. Making VCT services available to secondary school learners should be prioritised to enable this age group to make informed decisions, that affect themselves and their future children. School HIV and AIDS programmes should enable learners to access VCT services.

The HIV and AIDS school programme in Zimbabwe should be assessed regularly, to measure its impact on the knowledge levels of secondary school learners about HIV and AIDS. Based on the research findings, the HIV and AIDS curriculum should be adapted at regular intervals to address identified shortcomings.

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