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Louw has been accepted towards fulfillment of the requirements for the PhD. degree in Rehabilitation Counselor Educafion / i t .-f {1/ ”A I {6" Major Professor’s Signature fli/og/m Date MSU is an Affirmative Action/Equal Opportunity Employer LIBRARY Michigan State University PLACE IN RETURN Box to remove this checkout from your record. To AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested. DATE DUE DATE DUE DATE DUE 5/08 K:IProleoc&PreleIRC/DateDue.indd TEACHERS’ AND CHILD CARE PROVIDERS’ VIEWS OF SEXUALITY, HIV AND AIDS EDUCATION IN WORKING WITH LEARNERS WITH DISABILITIES IN SPECIAL NEEDS SCHOOLS IN SOUTH AFRICA By Julia S. Louw A DISSERTATION Submitted to Michigan State University in partial fitlfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Rehabilitation Counselor Education 2010 ABSTRACT TEACHERS’ AND CHILD CARE PROVIDERS’ VIEWS OF SEXUALITY, HIV AND AIDS EDUCATION IN WORKING WITH LEARNERS WITH DISABILITIES IN SPECIAL NEEDS SCHOOLS IN SOUTH AFRICA By Julia S. Louw Learners with disabilities are at increased risk of HIV infection. Providing sexuality education to learners with disabilities is imperative. Teachers and child care providers are often the primary individuals imparting this knowledge to learners with disabilities. The purpose of the current investigation was to explore teachers and child care providers views of teaching sexuality, HIV and AIDS programs in working with learners with disabilities at Special Needs Schools. Participants were teachers and child care providers teaching at Special Needs Schools in South Africa. A mixed-method approach was employed using a survey questionnaire and semi-structured individual interviews concurrently. Descriptive statistics on ten study variables indicate high mean scores for causation (4.5) and levels of comfort (4.4). This is expected given the educational level of the sample. Correlation matrix for the ten study variables indicates strong positive associations for teaching practices with cure (r = .37, p < .01) and serious AIDS problem (r = .35, p < .05). The four major constructs indicate high mean scores for both knowledge (4.2) and teaching practices (4.2). Strongest positive correlation between knowledge and attitudes (r =41 , p < .01) indicating a high level of knowledge relates positively to attitudes towards taking care for HIV infected persons and the importance of training programs related to HIV and AIDS. With regards to the qualitative data, participants' reported that their experiences related mostly to dealing with the cognitive abilities of their learners and their own level of comfort. The most important need expressed by participants' related to training, particularly suitable material and lessons addressing the needs of learners with disabilities. Participants also noted that the importance of imparting this knowledge related to sexuality, HIV and AIDS education to their learners. Lessons used are based on mainstream public schools, thus there seem to be no accountability for disability when teaching this topic. Teachers therefore adapt and modify lessons based on the needs of their learners. Implementing new training designs is crucial therefore providing teachers with updated and current training will allow them to teach more effectively on this topic. Relationship of findings to the theoretical framework used to guide the present investigation, implications of study findings related to practice, policy and training, and suggestions for future research are provided. ACKNOWLEDGEMENTS I am nothing without my Heavenly Father who grants me so many blessings daily. All praise to Him for seeing me through this journey. To my dissertation chair, Dr. John Kosciulek, I am so thankful that we had the opportunity to work together throughout this process. Your expertise, continuous support and guidance have been instrumental in me completing this process. Thank you for the confidence you had in me and guiding me to conduct high quality research. To my committee members, Drs. Michael Leahy, Susan Peters, and Nancy Crewe, you have been such a great source of support to me. I feel extremely fortunate to have had the unique opportunity to gain insight and knowledge from individuals who are well- versed in the areas of rehabilitation counseling, special education, and issues related to disability. I appreciate your warmth and support in pushing me to the next level. To my Dad, who is my ultimate supporter and mm, words cannot express the heartfelt gratitude I am filled with when I think about where I began and where I am now. For your unconditional love and support in every area of my life, I thank you and could not have done this without you. To my Mom, sisters and brother, I thank you for your love, support and care, I hope to continue to make the family proud. A special note of thanks to my fi'iends in South Africa and here in the United States, thanks for your words of encouragement and continuous support. Lastly to my cohort members and doctoral students at Michigan State University, for all of the conversations, laughs, tears, support, advice, and resources, I thank you. You truly added to my experience. iv TABLE OF CONTENTS LIST OF TABLES ........................................................................................................... vii LIST OF FIGURES ........................................................................................................ viii LIST OF ABBREVIATIONS ........................................................................................... ix CHAPTER 1 ...................................................................................................................... 1 Introduction ........................................................................................................................ 1 Background ..................................................................................................................... 1 Statement and Significance of Problem .......................................................................... 2 Theoretical framework .................................................................................................... 3 Purpose of the Study ....................................................................................................... 8 Research questions .......................................................................................................... 8 Definitions of terms ........................................................................................................ 9 Overview of the study ..................................................................................................... 9 CHAPTER 2 .................................................................................................................... 10 Literature Review ............................................................................................................. 10 Background ................................................................................................................... 10 Review of Relevant Literature ...................................................................................... 12 Statistics of HI V and AIDS infection ......................................................................... 12 Disability, sexuality and HIV and AIDS ................................................................... 12 Schooling and sexuality education ........................................................................... 14 Teachers ’ role in sexuality, HIV and AIDS education .............................................. 16 Sexuality, HIV and AIDS curriculum ........................................................................ 17 Exposure to HIV and AIDS information ................................................................... 21 Sexual activity and HIV and AIDS infection ............................................................. 24 Challenges to HIV/AIDS training programs ............................................................ 26 Importance and relevance of current research .............................................................. 29 CHAPTER 3 .................................................................................................................... 32 Method ............................................................................................................................. 32 Context of the study ...................................................................................................... 32 Participants .................................................................................................................... 33 Participant Demographic Characteristics ................................................................ 36 Key Informant Demographic Characteristics ........................................................... 3 8 Procedures ..................................................................................................................... 4O Variables and Instruments ............................................................................................ 42 Survey questionnaire ................................................................................................. 42 Key Informant Interview guide ................................................................................. 45 Research Design ........................................................................................................... 45 Data Analysis ................................................................................................................ 47 Survey instrument ..................................................................................................... 47 Qualitative questions ................................................................................................ 47 CHAPTER 4 .................................................................................................................... 50 Results .............................................................................................................................. 50 Quantitative data - Survey instrument .......................................................................... 52 Research Question 1 ................................................................................................. 52 Qualitative data - Survey instrument ............................................................................ 65 Research Question 2 ................................................................................................. 65 Qualitative data — Key Informants ................................................................................ 75 Research Question 3 ................................................................................................. 75 CHAPTER 5 .................................................................................................................... 85 Discussion ........................................................................................................................ 85 Narrative summary of results ........................................................................................ 86 Implications of Study Findings for Special Needs Schools .......................................... 94 Relationship of Findings to Theoretical Framework .................................................... 98 Limitations of the Study ............................................................................................. 101 Suggestions for future research and practice .............................................................. 104 APPENDIX .................................................................................................................... 107 REFERENCES ............................................................................................................... 121 vi Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: LIST OF TABLES Participant Demographic Characteristics .............................................. 37 Demographic information of Key informants ........................................ 39 Item level analysis ........................................................................ 53 Descriptive statistics of 10 variables ................................................... 59 Correlation Matrix Among 10 Study Variables ...................................... 61 Descriptive statistics of 4 major constructs ........................................... 63 Correlation Matrix Among 4 Major Study Constructs (Mean) ..................... 64 Survey question 4.1 - Level of seriousness of HIV and AIDS ..................... 65 vii LIST OF FIGURES Figure 1: Interaction between components of the International Classification Functioning, Disability and Health .................................................................. 4 Figure 2: Number of schools selected ............................................................. 35 Figure 3: Four Major Study Constructs and Ten Study Variable .............................. 44 Figure 4: Analytic Steps for Thematic themes ................................................... 49 viii HIV: AIDS: ICF: WCED: WHO : KABP: TR: KI: DOE: SNS: LIST OF ABBREVIATIONS Human Immunodeficiency Virus Acquired immunodeficiency syndrome International Classification of Functioning, Disability and Health Western Cape Education Department World Health Organization Knowledge, Attitudes, Beliefs, Practices Transcript Key Informant Interviewer Department of Education Special Needs Schools ix CHAPTER 1 Introduction Background Globally, the percentage of persons living with HIV has stabilized since 2000 (UNAIDS, 2008) but AIDS has caused immense human suffering worldwide. The impact of the disease has been especially huge on vulnerable populations (Chappell & Radebe, 2009; Groce, 2005), in particular on persons with disabilities. There appears to be an assumption that persons with disabilities are not at high risk of HIV infection (World Bank, 2004). Individuals with disabilities are often perceived as asexual and hence are viewed as not involved in sexual risk behaviors. On the contrary, individuals with mental, physical, sensory or intellectual disabilities are perhaps at increased risk for every known risk factor for HIV and AIDS (Groce, 2003). Further, persons with disabilities are more likely than others to be poor, most stigmatized (World Bank, 2004), poorly educated about sex and vulnerable to sexual abuse (Kaiser Family Foundation, 2007; World Bank, 2004). Behavioral risk factors for HIV related to sexual activity among persons with disabilities are the same as those for the general population (Groce, 2005). Therefore, providing learners with disabilities with sexuality, HIV and AIDS education is essential. Particularly in sub-Saharan Afi'ica, the HIV and AIDS epidemic has had its most profound impact to date (UNAIDS, 2008). It is reported that nearly 90% of all HIV positive children reside in sub-Saharan Africa where an estimated 67% of all people are living with HIV (UNAIDS, 2008). According to the Kaiser Family Foundation (2007), there are more than 5 million people living with HIV in South Afiica alone, the greatest number of any country in the world. Women comprise the majority of those living with HIV and AIDS in the region and young people are at particular risk (UNAIDS, 2008; Kaiser Family Foundation, 2007). In the South African education system, it has become mandatory for all teachers to teach on the topic of sexuality, HIV and AIDS education to all learners with disabilities. But not many studies have been conducted to investigate what the impact of these educational programs are and in particular, what teachers and child care providers views are related to teaching this topic to learners with disabilities. Statement and Significance of Problem Persons with disabilities are largely ignored in HIV prevention campaigns worldwide and this is a matter of grave concern (Groce, 2003). Various reasons have been advanced for the lack of attention to HIV prevention issues for persons with disabilities. These include the lack of appropriate educational material and insufiicient training of teachers and health professionals in dealing with person with disability (Wazakili, Mpofu & Devlieger, 2009). Exploring teachers and child care providers views of teaching this topic to learners with disabilities will equip learners with the necessary information to protect themselves from risk factors associated with HIV infection. Specifically since the risk factor related to HIV transmission for adolescents are increased by social marginalization (World Bank, 2004) that alienates them from the rest of society. Often, teens with disabilities are ‘excluded from social interaction thus limiting their opportunities to set boundaries for themselves’ when they engage with the opposite sex (Groce, 2005,p.217). As a result, teens with disabilities are most often pressured into sex because of the need for acceptance and inclusion Wazakali et a1, 2009) Studies conducted with youth with disabilities (Chappell & Radebe, 2009; Wazakili et a1, 2009; Groce, Yousafzai, Dlamini & Wirz, 2006; Mulindwa, 2003; Cheng & Udry, 2002), all concur that reaching disabled populations with AIDS messages is complicated. In Africa in particular, high illiteracy rates are a factor and when AIDS education is available, youth with disability may be often excused from such instruction because teachers may assume that they will not need the information (Chappell & Radebe, 2009). According to the Department of Education in South Africa (DOE) (2004), a large proportion of youth with disabilities are not in formal school. Further, Schneider (2000) reports that youth with disabilities under the age of 18 only reach primary level education and they are less likely to reach grade 12. Chappell and Radebe (2009) further emphasize the critical role education plays in the development of skills, knowledge and identity therefore without education it inevitably leads to youth with disabilities unable to participate in the social and economic mainstream of society. It is important to help youth with disabilities to develop insight into their relationships with members of both sexes and provide the education and understanding that will enable individuals to use their sexuality effectively and sensitively in any role. Given that teachers are the main educators in providing this information, it is imperative to gain an understanding of teachers’ and child care providers’ views, experiences and beliefs in teaching sexuality HIV and AIDS programs to learners in Special Needs Schools. Theoretical framework As shown in figure 1, the proposed study will be based on the biopsychosocial model of disability as described by the World Health Organization’s (WHO) definition of the 2001 International Classification of Functioning, Disability and Health (ICF) (WHO, 2008). ICF belongs to the WHO family of international classifications of which ICD-lO (the International Statistical Classification of Diseases and Related Health Problems) is the best known focusing mainly on classifying diseases whereas ICF classifies health (WHO, 2002). Imperative to note is that the ICF does not classify people but rather it describes the situation of the person being evaluated within an array of health-related domains. Thus, it portrays a unique interaction of the individual’s functioning and disability within a given context (Peterson, 2005). This is different fi'om its predecessor, the 1980 Impairment, Disability and Handicap (ICIDH) (Peterson & Kosciulek, 2005) in that it goes beyond providing only diagnosis and focuses on functioning and awareness of impairment. ICF Biopsychosocial model of disability Health condition (disorder or disease) T e I I I Body functions Activity Participation & Structure A T Environmental Personal Factors Factors Contextual factors Figure 1: Interaction between components of the International Classification Functioning, Disability and Health. World Health Organization (WHO, 2001). Disability is traditionally viewed in western society via a medical or individual model where disability is seen as a problem located within the individual, posing it similar to an illness and reliant on medical intervention. This has also been the case in South Africa (Watermeyer et a1, 2007). But persons with disabilities are not necessarily ill and most are not likely to be cured of their disability (Woolfson, 2004). This view has not been accurate or helpful in promoting the well being for a person with a disability. The social model of disability on the other hand, views disability as a socially created problem with an unaccommodating physical environment brought about by attitudes and other features of the social environment (WHO, 2002). This model lacks emphasis on the interaction between the impairment, functioning and environment as highlighted by the ICF (Peterson, 2005). On their own neither model is adequate, therefore a useful model synthesizing and drawing on the strength of both these two models is the biopsychosocial model on which the ICF is based upon (WHO, 2002) which is the premise of this dissertation. The ICF further challenges the medical and social perspectives in making a distinction between impairment and disability, defining disability as the social implication of being disabled in a disability society over and above the experience of the impairments (WHO, 2008). The recognition that disability is socially produced is not, however, to deny the importance of addressing the pain or chronic illness experienced by some disabled people, but instead to argue that the consequences of the impairment itself are distinct from the physical barriers of the built enviromnent and the prejudices and negative attitudes of non-disabled people (WHO, 2008). The development of the ICF Children and Youth version (ICF—CY) that was published by WHO in 2007, has been extremely instrumental given the differences between the nature and type of firnctioning between children compared to adults (Simeonsson, 2003; McAnaney, 2007). The ICF-CY is intended to facilitate continuity in documenting functioning, activity, participation and the role of the environment across the transition from childhood to adulthood. Further, it aims to facilitate communication between professionals, service providers and parents. Essentially, the ICF-CY is consistent with the structure and organization of the ICF but in addition expands to cover important aspects of functioning and environment of childhood and adolescence (McAnaney, 2007). Therefore, the current study underscores both the importance and application and ICF and ICF-CY as its foundation. Peterson and Rosenthal (2005) noted that the ICF in particular reflects important historical developments in rehabilitation that ultimately influenced the scope of practice of rehabilitation practice. According to Peterson and Rosenthal (2005), the revised and current updated ICF reflects a ‘holistic’ view of persons with disabilities as well as its practical application (Peterson & Kosciulek, 2005) that encapsulates the rehabilitation philosophy. This radical shift in the definition pertains to moving from the emphasis on the person’s disabilities to now focusing on their level of health (WHO, 2002). It is this holistic view that is the basis of this study. In reviewing the literature regarding the use of ICF as it relates to different types of disabilities, researchers frequently highlights this holistic view, but more importantly the role and impact of environmental factors as it functions and interacts with the person’s disability (Simeonsson, 2003). According to Simeonsson (2003), the addition of environmental factors exemplifies the importance of the environment as a facilitator or barrier to human functioning. This study holds that the impact of environmental factors as it relates to societal attitudes towards youth with disabilities and their sexuality is potentially harmful to developing a positive sexuality. Disapproving attitudes and narrow-mindedness related especially to sex and sexuality often limit youth with disability to gain more knowledge and confidence about their own sexuality. Discussing sex and sexuality with any child can make parents and educators uncomfortable and in particular in the case of youth with special needs, thus anxieties and concerns are frequently intensified (Groce, 2005). In addition, cultural, ethical, religious and moral issues influence sexuality and, as such, prescribed sex education is notoriously controversial (Mpofu, Jelsma, Maart, Lopez Levers, Montsi, Tlabiwe, Mupawose, Mwamwenda, Ngoma & Tsombe, 2007). Therefore children with special needs are particularly vulnerable to societal modeling, myths and misconceptions; they are taught to be obedient to authority and that may put them at higher risk of sexual abuse (Mpofu et a1, 2007). The ‘rules’ surrounding sexuality for individuals with disabilities are frequently not the same as those imposed on the rest of society (Sweeney, 2007). Societal norms of beauty, power, and productivity present a challenge to the person with an acquired disability who is attempting to develop a positive, optimistic approach to their sexuality (Di Giulio, 2003). At the community level, persistent myths and stereotypes still linger concerning the sexuality of persons with disabilities and this has a huge influence on how they receive information regarding HIV and AIDS (Wazakili et al, 2007). Purpose of the Study This study focus specifically on teachers and child care providers employed at Special Needs Schools in the Western Cape Province of South Africa. The purpose of the study is to explore teachers’ and child care providers’ views of sexuality and HIV and AIDS education working with youth with disabilities at Special Needs Schools (SNS). Even though parents are held to be the principal source of this information, professionals (i.e. teachers, social workers, child care providers, occupational therapists) are seen as valuable collaborators providing complementary resources (Guest, 2000). According to Guest (2000), too many authors adopt the view that professionals are the source of all knowledge and enlightenment, but they also struggle with their own inhibitions and may be reluctant to discuss sex with their students. This may be due to embarrassment and or lack of knowledge. Schools, social service agencies and health care delivery systems must develop policies and procedures to address sexuality related issues. It is important to note that this process involves a consultant or staff member with specific knowledge about disabilities. This clearly points to the need for teachers and health care providers to have training to understand and support student needs for information, skills and related . health care (Kreinin, 2001). Research questions The study will examine the following three questions: (1) What are teachers’ and child care providers’ knowledge, attitudes, beliefs and teaching practices of sexuality, HIV and AIDS programs? (2) How do teachers and child care providers describe teaching experiences, challenges and needs of teaching sexuality, HIV and AIDS programs? (3) How do key informants describe experiences related to teaching sexuality, HIV and AIDS programs? Definitions of terms Sexuality education. Sexuality education is defined by the Sexuality Information and Education Council of the United States (SIECUS), as a “lifelong process of acquiring information and forming attitudes, beliefs and values. It encompasses sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles” (SIECUS, 2009, p.1). Disability. Disability refers to any impairment, activity limitations, or participation restrictions of the external factors that represent the circumstances in which the individual lives (WHO, 2001, p.17). Impairment. Impairment does not necessarily imply the presence of a disorder but are manifestations of dysfunction in the body structure or firnctions (WHO, 2001, p.12) Health refers to components of health (e. g., seeing, remembering, learning) and health-related components of wellbeing (e.g., labor, education, transportation). Functioning is an inclusive term covering all body functions, activities, and participation in society. Overview of the study The present study explored teachers and child care providers views in teaching sexuality, HIV and AIDS education to learners with disabilities in Special Needs Schools. A mixed- method approach had been employed to collect data on this topic. A survey instrument had been administered and individual interviews conducted with study participants. CHAPTER 2 Literature Review Background The literature on adolescent health-risk behaviors and negative health outcomes is extensive. However, relatively little research has been devoted in this area to youth with disabilities (Blum, 2001). This is based on common misconceptions including ideas that people with disabilities are asexual or conversely, that they are sexually impulsive (Sweeney, 2007). Murphy and Callaghan (2004) describe this a denial of sexuality and argue that people with physical, cognitive or emotional disabilities have a right to sexuality education and reproductive health care. They have the same emotional and physical needs and desires as people who are not disabled. It is often true that people with disabilities are first identified by their disability rather than by their talents, intelligence, and attractiveness or by the fact that they are sexual. For people with disabilities, obstacles to healthy sexuality are often heightened. For young people with special needs there is particular tension between healthy sexuality and personal safety and frequently the desire to keep our children safe also unintentionally keep them dangerously in the dark (Sweeney, 2007). The fact remains that during adolescence, sexuality is important and sex during this time is the subject of sometimes painful ‘conjecture, decision-making, hypothetical thinking and self-conscious concern’ (Magaya, 2004, p4). In addition, children with special needs are also vulnerable to societal myths and misconceptions; they are taught to be compliant to authority putting them at higher risk of sexual abuse. The ‘rules’ surrounding sexuality for individuals with disabilities are often not the same as those 10 imposed on the rest of society (Sweeney, 2007). Thus, a growing body of research noted that youth with disabilities are in danger for every known risk factor for HIV and AIDS (Groce, 2003; UNAIDS, 2009) because they have equal or greater exposure to all factors of HIV and AIDS infection (World Bank, 2004). This makes sexuality and HIV and AIDS education all the more important (Kreinin, 2001), thus this present study focus on teachers and child care providers teaching this topic to learners with disabilities. A small but growing literature has identified significant gaps in knowledge, attitudes, beliefs and practices (KABP) around topics of HIV/AIDS among youth with disabilities in the United States and Europe (Nation Information Center for Children and Youth with disabilities (N ICHCY, 1992; Mpofu et al, 2007; Wazakili et al, 2009). Little attention has been paid however to the KABP towards HIV and AIDS among teachers and caregivers at Special Needs Schools in South Africa. The next section will review relevant literature on the topic of sexuality and HIV and AIDS education. The following sub-sections includes: Statistics of HIV and AIDS infection; Disability, sexuality and HIV and AIDS; Schooling and sexuality education; School Attendance and Youth with Disabilities; Teacher’s Role in Sexuality, HIV and AIDS Education; Sexuality, HIV and AIDS Curriculum; Teacher’s Knowledge and Attitudes Towards Sexuality and HIV/AIDS Education; Exposure to HIV and AIDS information; Sexual activity and HIV infection and Challenges to HIV and AIDS training programs. In conclusion, the Importance and relevance of current research will be discussed. ll Review of Relevant Literature Statistics of HI V and AIDS infection There are significant HIV and AIDS risk factors affecting all populations and in particular disabled populations around the globe. The HIV and AIDS pandemic is without doubt a serious global health threat of which the burden is being most felt in sub- Saharan Africa (Chappell & Radebe, 2009). According to UNAIDS (2008), of the estimated 33 million adults and children who are infected with HIV worldwide, 22 million of those are living in sub-Saharan Africa. Sub-Saharan Africa remains most heavily affected by HIV accounting for 72% deaths in 2007 (UNAIDS, 2008). The impact on young people is exacerbated by the fact that the population of sub- Saharan Afiica is quite young relative to other regions in the world, with 43% of the population below the age of 15, compared to 28% globally (Kaiser Family Foundation, 2007). The peak of the global pandemic can be found in South Africa, where an estimated 5.7 million people are living with HIV and AIDS (UNAIDS, 2009). Disability, sexuality and HIV and AIDS The lack of involvement of disability in particular HIV and AIDS education campaigns, is a result of the widespread belief that people with disabilities are perceived to be ‘asexual’ (Groce, 2005). Given the notion of asexuality and considering that sexual contact is the most prevalent cause of HIV infection in South Africa, people with disabilities are presumed to be at very low risk of contracting the virus (Swartz, Schneider, & Rohleder, 2006). As a result, sex education programs for youth with disabilities are rare and very few HIV and AIDS educational campaigns target or include the disabled population (Chappell & Radebe, 2009). 12 Unfortunately, many health professionals still fail to address the issues of sexuality and disability (Swartz et al, 2006) suggesting that this could be related to the fact that health professionals receive insufficient training in dealing with issues of sexuality in relation to disability and are therefore anxious about raising the issue. This lack of knowledge and anxiety could be seen as a barrier by which people with disabilities are prevented fi'om receiving adequate information relating to sex and HIV (Gallant & Maticka—Tyndale, 2004) This notion was highlighted in a study conducted in Zambia, whereby women with disabilities reported having attracted a lot of negative attention from nurses whilst attending reproductive health services, which inevitably discouraged them from using such services (Smith, Murray, Yousafzai, & Kasonka, 2004). In addition to providing this information, parents and professionals need to allow children and youth opportunities for discussion and observation, as well as to practice important skills such as decision-making, assertiveness, and socializing. Thus, sexuality education is not achieved in a series of lectures that take place when children are approaching or experiencing puberty. Sexuality education is a life-long process and should begin as early in a child’s life as possible (Tepper, 2001; SIECUS, 2009). Providing comprehensive sexuality education to children and youth with disabilities is particularly important and challenging due to their unique needs. These individuals often have fewer opportunities to acquire information from their peers, have fewer chances to observe, develop, and practice appropriate social and sexual behavior, may have a reading level that limits their access to information, may require special materials that explain sexuality in ways they can understand, and may need more time 13 and repetition in order to understand the concepts presented to them (N ICHCY, 1992) Yet, with opportunities to learn about and discuss the many dimensions of human sexuality, young people with disabilities can gain an understanding of the role that sexuality plays in all our lives, the social aspects to human sexuality, and values and attitudes about sexuality and social and sexual behavior. Schooling and sexuality education Education affects many aspects of one’s life as well as health behavior. Educational level is strongly associated with one’s knowledge and perceptions about reproductive health aspects like contraception, fertility and reproductive health service utilization (Mulindwa, 2003). In addition, formal schooling enhances one’s ability to manipulate and explore opportunities available for improved welfare. Murphy and Callaghan (2004) found that there was clear evidence in their study that sex education was associated with higher levels of knowledge and lower levels of vulnerability amongst people with intellectual disabilities. Participants in their study with intellectual disabilities showed limited understanding of consenting and non-consenting situations as wrong while non-consenting situations were sometimes not recognize as abusive. This suggested that they were more vulnerable to abuse perhaps partly because they do not recognize abusive situations. This apparent increase level of vulnerability may be partly accounted for by the limited sexual knowledge of adults with intellectual disabilities because without sufficient knowledge and education, it is difficult to decide what is and in not acceptable socio-sexual behavior (Murphy & Callaghan, 2004). In addition, given the current political climate, sexuality education is often reduced to 14 biological and or values-based approaches, neglecting essential relational and collective aspects of sexuality (Romeo & Kelley, 2009). School attendance and youth with disabilities Sexuality education, a subject of discussion in many schools, is often a controversial topic and when issues of disabilities are added to the conversations a variety of opinions exist (Blanchett & Wolfe, 2002). Sexuality education can provide youth with disabilities with the opportunity to learn appropriate socio-sexual skills, protect themselves from sexual abuse, sexually transmitted diseases, and unwanted pregnancies. Participants in Mulindwa’s (2003) study done in Uganda noted that youth with disabilities and particularly women with disabilities generally miss-out on opportunities of attaining formal schooling. Some groups attributed this to parental attitudes against children with disabilities while other participants felt that the un-friendliness of the Ugandan school system together with negative attitudes contributes to the youth with disabilities failure to attain formal education (Mulindwa, 2003). It is firrther reported in this study that only 64% of the female respondents had ever attended school compared to 86% of their male counterparts. Most of the respondents had attained only primary school education (56% men and 48% women). Noteworthy is that 36% of women had never attended school (Mulindwa, 2003). According to the DOE of South Africa (2004), a large proportion of youth with disabilities are not in formal education. Of the 2.5 million people who have a permanent physical, mental, sensory, intellectual or communication disability in South Afiica an estimated 4-5% of them are between the ages of 14-35 years of age (StatsSA, 2001). Schneider (2000) also reports that youth with disabilities under the age of 18 are more 15 likely to only reach primary level education and even less likely to reach Grade 12. Education plays a crucial role in the development of skills, knowledge and identity. Without education it inevitably leads to youth with disabilities being unable to participate in the social and economic mainstream of society. Kelly (2002) puts forward that education in particular school education has a significant role in reducing the high prevalence rates of HIV amongst the youth. Teachers ’ role in sexuality, HIV and AIDS education Teachers form an integral role in formal programs of sexuality education; at times they are the main and or the only people explicitly discussing sexuality with young people. The sexuality education literature has long noted the importance of educators being well prepared for teaching sexuality education in public schools (Schultz & Boyd, 1984; Greenberg, 1989). McCary (1982) states, ‘of all the arguments against school sex education, perhaps the most valid concerns is the qualifications of those who teach it’ (p.17). Thomas, Long, Whitten, Hamilton, Fraser & Askins (1985) found that sexuality education could result in long-term knowledge gain if taught by well-trained and experienced sexuality educators. The danger exists, that sexuality educators who are still struggling to accept images of themselves as sexual beings, may have those negative attitudes interfere with their abilities to teach sexuality education (Yarber & McCabe, 1984) Teachers are often left with the difficult decision of understanding the material, different viewpoints and sometimes having to select information or follow curriculum that will meet the needs of all students. Even if a teacher is not directly asked to focus in areas of sexuality education, it may not be uncommon for teachers to be exposed to 16 questions their students may have about the topic, making many teachers feel unsure and uncomfortable about how to handle specific questions. Yet, little is known about teachers’ attitudes about sexuality education or the factors that shape how and how they teach specifically in Special schools in South Africa. Many teachers report feeling ill prepared during teacher education programs and thus they do not feel comfortable to teach sexuality programs to their students (Louw, 2001). Providing teachers with the opportunity to receive knowledge as well as work through their own anxieties is important (Donovan, 1998) and teachers “should be required to have a good command of the subject matter, and adequate level of comfort with the content, and should engage in active value clarification” (Blanchett & Wolfe, 2002, p.55). In US. public schools, physical education teachers are most likely to provide sexuality education in middle and high schools, followed by health educators, biology teachers, home economics teachers, and school nurses, making it a necessary training topic for all in the education field (Gonzalez-Acquaro, 2009). In South Afiican schools, on secondary level or high school teachers are selected either based on their area of specialization related to subjects such as biology and physical science. On primary level or middle or elementary school, all teachers receive some form of training in order to teach topics related to sexuality and HIV and AIDS to their students. Sexuality, HIV and AIDS curriculum Over the years there have been repeated attempts to address sexuality in schools. Decisions on the type of sexuality education programs, curriculum and standards that should or should not be provided in schools are often left to the local level and typically include comprehensive, abstinence based, abstinence only, abstinence only until 17 marriage, and fear based programs (Gonzalez-Acquaro (2009). The goals of these efforts have varied and ranging from reducing teenage pregnancy rates, to increase safer sex practices, to protection against sexually transmitted infections including HIV and AIDS (James, Reddy, Ruiter, McCauley & Van den Borne, 2006). In the Van Oost, Csinsak, De Bourdeaudhuij (1994) study, both principals’ and teachers’ views of sexuality education were examined with the focus on the major goals in school-based sexuality education. A representative sample of 400 schools was drawn from 1,050 secondary schools in Flanders. Some of the major questions included: What are the goals for sexuality education?; Is it the task of a school to teach sexuality education?; Who should be responsible to taught sexuality education?; What topics should be taught?; and How confident are teachers with sexuality education?. All goals were deemed important but both principals and teachers agreed that developing a responsible attitude toward sexuality is the most important goal for sexuality education. Teachers used instructional strategies for sexuality education and less common were group work, demonstration and role-play. Principals preferred teachers instead of external experts to present most topics in sexuality education (Van Oost, Csinsak & De Bourdeaudhuij, 1994). Teachers themselves also have their preferences regarding certain topics. In the study done by Darroch, Landry & Singh (2000), teachers indicated that the most important topics of information they wanted to communicate to their students were related to abstinence and responsibility. Further, STDs including HIV and AIDS, reproductive facts and self-esteem were also cited as some of the most important topics or messages to be taught. 18 With regards to different styles of teaching, teachers prefer to use a didactic style of teaching sexuality more and they reported comfort with teaching more fact based rather than skill based topics (James, et al, 2006). This explained students high impact on knowledge in this particular study compared with the lack of impact on the psychosocial determinants or sexual behavior. Issues such as condom-using behavior requires more than just knowledge, positive attitudes and beliefs about its use, it requires skills that address the more proximal determinants of safe sexual behavior, such as self-efficacy beliefs and skills related to actual condom use. It is therefore of great concern that Firestone (1994) further found in his study that most teachers choose to address ‘easier’ topics. The fact remains that teachers communicate their feelings and beliefs about sexuality continuously. As in the case of parents with their children, teachers too send messages to their students about sexuality both verbally and nonverbally, through praise and punishment, in the interactions they have with them, in the tasks they give them to do, and in the expectations they hold for them. The school setting is probably one of the most important learning environments because it is there that children and youth encounter the most extensive opportunities to socialize and mix with their peers (N ICHCY, 1992). Therefore, both parents and the school system should take on responsibility for teaching children and youth about appropriate behavior, social skills, and the development of sexuality (N ICHCY, 1992). In particular, youth with disabilities do need special attention and guidance because they first learn that they are disabled before learning to see themselves as sexual people. Therefore, sexuality educators need to affirm that people of all abilities, l9 including those with early and late-onset disabilities, physical and mental disabilities are sexual people (Tepper, 2001). Also, teachers and child care providers must consider the point in life at which their students’ disabilities occurred and the subsequent effect the disabilities may have had on their psychosocial development. Sexuality education for youth with disabilities should promote maturation as a sexual person providing them with opportunities to develop healthy social skills. Being overprotected by parents and family can lead to restriction of these appropriate skills (NICHCY, 1992). Teacher ’s knowledge and attitudes towards sexuality and HIV/AIDS education Of the few studies conducted, Schultz and Boyd (1984) examined sexuality attitudes of home economic secondary teachers and human sexuality. The study also investigated the relationships among these attitudes, selected demographic variables and the degree to what 25 sexuality topics were taught by teachers. Sexuality attitudes were assessed by an inventory with a 9-point Likert response format. According to Gonzalez-Acquaro (2009), in their study implementing a pretest- post-test design, teachers in the training groups, information and information/ reflection, scored significantly higher compared to teachers in the control group on the knowledge questionnaire, the attitudes survey, and the self-efficacy survey. Teachers in the information/reflection group scored the highest on the attitudes survey compared to the control and information only group. Results of this study indicated that providing training for teachers in topics related to sexuality education and intellectual disabilities can increase not only their knowledge toward the topic but also their attitudes and their feelings of self-efficacy (Gonzalez-Acquaro, 2009). Having opportunities to reflect can 20 assist teachers in understanding and improving their teaching practice while helping teachers understand different viewpoints and needs. Teachers perceive themselves to having a great deal of competence to teaching sexuality education, high item score of 7.7. A low item score of 3.8 was found on school and community influences, thus teachers perceive getting limited support from the community. In this study, the high average item score of 8.1 for personal sexuality feelings factor suggests that teachers have very positive feelings about their own sexuality (Gonzalez-Acquaro, 2009). This the authors conclude needs to be given further attention when planning in- service training for teachers to allow them to have more opportunities to explore their own personal feelings toward sexuality. This will result in sexuality educators who feel positive and comfortable with their own sexuality and go beyond teaching only the physiological aspects of human reproductions and issues relating to sexuality. Exposure to HIV and AIDS information Blanchett (2000) noted that young people with disabilities are less likely included in samples when conducting studies, which focus on specifically HIV and AIDS knowledge and risk behaviors. Thus, little is known about the HIV and AIDS knowledge and risk behaviors of youth with disabilities. Those studies that have been done indicate the gaps in knowledge acquisition of populations with disabilities. The Disabled Women’s Network and Resource Organization’s (DWNRO) commissioned a study with purposively selecting Kampala, Katakwi and Rakai districts in Uganda. The study adopted a three-stage selection criterion together with random procedures to select eligible respondents within the three study districts (Mulindwa, 21 2003). The general objective of the study was to establish the reproductive health needs of disabled persons in a bid to facilitate the design and implementation of reproductive health programs, including HIV and AIDS programs. Both quantitative and qualitative survey methods were adopted and the results indicated that more females than males with disabilities reported awareness of abstinence as a major HIV prevention strategy (Mulindwa, 2003). Further studies conducted (Chappell & Radebe, 2009) indicate youth with disabilities learn and get information from various other sources. Overall it would appear that youth with disabilities living within the seven sub-districts of uMgungundlovu district in KwaZulu—Natal, South Africa are indeed exposed to information on HIV and AIDS from a variety of different sources. Interestingly, many of the participants indicated school and the media as being the main places in which they learnt about HIV. Media access is essential in increasing people’s awareness and knowledge of what is taking place around them, which may eventually affect their perceptions and behavior (Chappell & Radebe, 2009). Mulindwa’s (2003) study established access to media by asking whether respondents listen to radio and read newspapers. The results showed that 70% of the female respondents in Kampala District listen to the radio daily compared to 86% of the male respondents. In Rakai District, the proportion that listens to radio is 58% of females compared to 67% of males. Daily radio listenership is only 16% among females in Katakwi compared to 41% of the male respondents. Noteworthy is that 35% of females in Katakwi District never listen to the radio. Over a half of the respondents in Katakwi and Rakai Districts never read newspapers. The percentages for women are higher than those 22 of males in both districts. Of the respondents that read newspapers, a good number of them in all the three districts do it occasionally. This is very different to Collins et al (2001) study whereby youth with disabilities were often excluded fiom health education classes in school. In a study done by Groce, Yousafzai, Dlamini & Wirz (2006), focusing on deaf and hearing populations, knowledge of HIV and AIDS is directly related to accessible sources of information. Therefore, the survey sought information on where respondents were regularly receiving messages about AIDS. In their study, the sources of information were distinctly different between the deaf and hearing populations. According to Groce et a1 (2006), the top 3 sources of HIV/AIDS information listed by the deaf population were posters (70%), Disabled People’s Organizations (DPOs) (69%) and television (66%). By contrast, the hearing population listed Radio (95%), Relatives (89%) and Newspapers (79%) (Groce et al, 2006). There is ome concern related to the sources from which the deaf population is getting their information. Posters and bill boards do not contain in depth information and tend to be in English, posing difficulties in properly understanding the information. Despite this exposure, many of the participants still lacked clear understanding of what HIV and AIDS were and some even doubted the authenticity of the information they had received. Therefore, training teachers periodically and providing them with the necessary support is imperative to achieve positive outcomes for youth disabilities as they develop their own sexuality that they which they are currently deprived from. 23 Sexual activity and HIV and AIDS infection Blum et al (2001) identified the risk involvement of three groups of young people with disabilities; mobility impairment, learning disabilities and emotional disabilities relative to a comparison group. Their analysis was based on the National Longitudinal Study of Adolescent Health (ADD Health), a nationally representative sample of 20,780 7th through 12th grade youth in the United States. They found that for most negative health outcomes studies, youth with disabilities were found to be significantly more involved than their peers. Compared to their peers they were significantly more likely to report suicide attempts, regular smoking, regular alcohol abuse, use of marijuana and having had their first sexual intercourse at the age of 12 which was highly significant compared to the comparison group (Blum et a1 2001). Indeed, the Global Survey on Disability and HIV and AIDS conducted by Yale University and the World Bank has proven the assumption wrong that people with disabilities are not sexually active (World Bank, 2008). A project funded by Peral S Buck International Vietnam, that focused on adolescence with Down syndrome showed that a quarter of the respondents 14 years and younger, show interests for the opposite sex and that after age 14 this number is doubled. It is interesting in this study that the increased interest for the opposite sex of female respondents is equally present in both age groups (USAID, 2003). Mulindwa (2003) found incidence and management of STIs present in their study, confirming reports of fi'equent sexual activity for people with disabilities. The proportion ever contracted STIs is 38% of women and 35 % of men. Further, incidence of 24 STIs was reported to be higher among females in urban areas of the three districts that relates to exposure of sexual activity (Mulindwa, 2003). Further, in the Disabled Women’s Network and Resource Organization (DWNRO), the data show that 85% of women and 82% of men in the sample have engaged in sex. Women with disabilities have sex earlier (16 years) than their male counterparts (18 years). This finding is different to a study conducted with youth with disabilities in Zimbabwe, reporting that sexual intercourse for males earlier than females and for some starting as early as at age nine, but females who reported having sex engage in sex more frequently than males (Magaya, 2004). This study employed self-reporting measures to determine the interplay between sexual risk behavior, family structure and family environment. Results also show that the incidence of sexually transmitted infections is higher among women in urban areas (41%) and those with primary education (42%). Awareness about HIV/AIDS is almost universal. However, only 6% of either sex reported testing for HIV as a means of knowing one’s HIV status. Most persons with disabilities are aware that HIV is transmitted through sexual intercourse with an infected party (Magaya, 2004). Blumberg and Dickey (1999) in analyzing findings from the 1999 US National Health Interview Survey, results show that adults with mental health disorders are more likely to report a medium or high chance of becoming infected with HIV. In addition, they are more likely to be tested for HIV infection, and are more likely to expect to be tested within the next 12 months than are members of the general population (Dickey and Blumberg, 1999). Such findings should not be unexpected for individuals with disability. 25 Of most concern was the findings from the study on STI/HIV Prevention for Deaf and Hearing impaired Young Persons of Ho Chi Minh Deaf club targeting 30 deaf youths to participate and several of them were selected and trained to become peer educators. It was found that sexual practice of most deaf youth of the club seems to remain far from being safe of STI/HIV infection indicating that they had no idea of condoms, nor do they know much of contraceptive methods or transmission of HIV/AIDS. Most were employed as low skilled workers and 30% earn less than one dollar per day (USAID, 2003) It is important though to remember that a disability that may have less significant implications in a life lived in a developed country may make a huge difference for a disabled individual in a developing country, especially if supporting equipment i.e. hearing aids, wheelchairs are unavailable or unaffordable (World Bank, 2004). Even so, men and women with disabilities are even more likely to be victims of violence or rape although they are less likely to obtain police intervention or legal protection (Groce & Trasi, 2004). Challenges to HIV/AIDS training programs Reaching disabled individuals with HIV and AIDS messages presents unique challenges. According to Ambrose (2004) this is especially the case in many rural areas in Afiica where most people with disabilities live, there is a general misconception that HIV/AIDS is caused by witchcraft. This is a big constraint to efforts that are meant to sensitise people with disabilities on the nature and threat of HIV and AIDS. Instead of seeking medical care, a person having HIV and AIDS or disability would prefer to visit a witchdoctor or traditional healer. There are many chances of 26 people with disabilities acquiring HIV and AIDS through practices of witchcraft either through sexual abuse by the witchdoctors or sharing of sharp instruments/equipment and performance of cultural rituals. This increases the likelihood of infection by HIV and AIDS (Ambrose, 2004). Groce (2003) noted that factors such as increased physical vulnerability, the need for attendant care, life in institutions, and the almost universal belief that disabled people cannot be a reliable witness on their own behalf make them targets for predators. Also, in cultures in which it is believed that HIV-positive individuals can rid themselves of the virus by having sex with virgins, has bring about a significant rise in rape of disabled children and adults. Assumed to be virgins, they are specifically targeted (Groce, 2003). In some countries, parents of intellectually disabled children now report rape as their leading concern for their children's current and firture well-being (Groce & Trasi, 2004). Disability disproportionately affects the poor (Swartz et al, 2006). Those who are poor are likely to live and work in more physically dangerous environments, have less to eat, and receive poorer quality medical care or none at all. This feedback loop between disability and poverty places people with disabilities at a marked disadvantage at every stage of their lives (Groce et al, 2006). Therefore, children with disabilities, particularly those with more visible disabilities are frequently assumed to be in frail health and unlikely to survive into adulthood. Indeed, in many countries, a significantly disabled child is referred to as ‘an innocent’ or a ‘little angel’ (Groce et al, 2006). From this perspective, sending such children to school, including them in social interactions, or preparing them for participation in the adult world seems unnecessary. Educating disabled populations about AIDS is also difficult. Lack of access to 27 education has resulted in extremely low literacy rates, which makes communication of messages about HIVIAIDS even more difficult. This lack of access is reflected in significantly lower rates of knowledge about HIV prevention in several studies among deaf people and adolescents with intellectual impairment. Sex education programs for those with disabilities are rare. Indeed, where HIVIAIDS educational campaigns are on radio or television, groups such as the deaf and the blind are at a distinct disadvantage (Groce et al, 2006). When teachers do perceive themselves as having a great deal of competence related to teaching sexuality education in public schools (Schultz & Boyd, 1984), but they perceive a limited level of support from the community for the inclusion and teaching of sexuality education in schools. Firestone (1994) noted in his study that teachers report that members of the local community were typically seen as the greatest barrier to full exploration of difficult issues. Even if AIDS messages do reach disabled populations, low literacy rates and limited education levels complicate comprehension of these messages. Therefore, well trained teachers are best suited to convey comprehensive sexuality and HIV/AIDS programs because literacy is vital to understanding HIV messages and translating them into individual behavior change (World Bank, 2008). This study is therefore based on the conceptual framework that well trained and educated teachers and child care providers’ lead to better outcomes for their students. Therefore, the level and quality of teachers’ and children providers’ knowledge, attitudes, beliefs and teaching practices of HIV/AIDS is imperative to positive aspects of students’ development of a healthy sexuality. 28 Importance and relevance of current research People with disabilities very often feelunease, shame and fear, even guilt in relation to their sexual organs, sexual reaction and feelings (Zdravka & Mihokovic, 2007) which are a part of the normal process of maturation, it is important to provide sufficient support in the form of sexuality and HIV and AIDS education fi'om well trained teachers and care providers. Especially during their youth and adult age, interest in their own sexuality, as well as a desire to experience sexuality increases. But very often people with disabilities describe sexual behavior as bad, indecent, dangerous and forbidden and they speak of it with unease. Further, their experience of their own sexuality in terms of fear and insecurity results in the suppression of their own sexual needs and wishes that further leads to a negative attitude towards sexuality or an unhealthy sexuality experience. In addition, extreme poverty and social sanctions against marrying a disabled person mean that they are likely to become involved in a series of unstable relationships (Groce, 2003). On the other hand, people with disabilities who do have a positive attitude towards their sexuality do not have a sufficiently developed sense of responsibility and the need for the protection of dignity (Zdravka & Mihokovic, 2007) thus they need proper guidance. Given the context they often live in, it is not surprising that research on the sexual knowledge, sexual experience and sexuality education of people with disability confirms the disadvantages they face (Di Giulio, 2003). This is connected to social skill about suitable behavior. For some of the young people, their disability may be visible and evident, for others the disability may be hidden but whatever the situation, it is therefore incumbent 29 upon teachers to understand the associated risks so as to help youth with disabilities avoid additional behaviors that will adversely affect their health and the quality of their lives (Blum et al, 2001). Ballan (2001) noted that the biggest myth though is that sexuality education will cause people with disabilities to become overly stimulated and to engage in sexual activity when normally they would not. This myth is based on the belief that sharing information will unleash desires and conflicts that would otherwise have remained dormant and that knowledge will trigger uncomfortable and insatiable urges (Ballan, 2001) Although human sexuality is varied and complex, in the education realm this broad subject often becomes focused upon the narrow concept of sexual intercourse, the realities of which provoke understandable concern by adults on behalf of the youngsters in their care (Sweeney, 2007). The truth is that sexuality is an integral part of every person’s life from infancy and no matter what cognitive abilities a person might have, growth into adulthood combines a physically maturing body and a range of sexual and social needs and feelings (Ballan (2001). With non-disabled youth gaining information from variety of sources, youth with disabilities on the other hand, are far more dependent on adults for what information they receive. Sometimes even parents think that their children are too young to be told about HIV/ and AIDS. Instead of making them understand the dangers of the epidemic, they only give open-ended instructions: ‘don’t do this’, ‘don’t do that’ As a result of this, adolescents do not get correct, appropriate and reliable information (N ICHCY, 1992). 30 In some other instances, some parents are not able to communicate and/or talk to their children because of lack of modes of communication because they do not know sign language, for example. These young people need to be informed that they are not condemned to a life of celibacy. It should be remembered that these young people are human. Disabled they may be, but this will not distract from their natural desires for healthy interpersonal relationships and sensual experiences (N ICHCY, 1992). According to Kreinin (2001), it is heartening though to see teachers acknowledging the needs of disabled youth but it is sad that much is based on preventing negative aspects of sexuality, sexual abuse, teenage pregnancy and disease. This is crucial but it is important to provide all children, including those with disabilities, with accurate information and skills to lead them to view sexuality as a natural and healthy part of life (Kreinin, 2001). It is important to help people with disabilities, in particular youth to develop insight into their relationships with members of both sexes and provide the education and understanding that will enable individuals to use their sexuality effectively and sensitively in any role (Guest, 2000). Since parents shy away from this responsibility teaching their children on the topic of sexuality and HIV/AIDS education, teachers are the adults next in line taken up this task. The ultimate value of getting information from teachers regarding their perceptions on HIV and AIDS and knowing what teachers are thinking and feeling can help improve HIV and AIDS education programs. The ultimate outcomes for students with disabilities will be better relative to their personal adjustment, sexual health, academic achievement and adult functioning. 31 CHAPTER 3 Method Context of the study The education system in South Africa underwent a huge transformation after the country's democracy in 1994 with the introduction of a new curriculum for all schools. The new curriculum reflects updated subjects and topics including a Life Skills program that is mandatory in all schools. As part of this Life Skills program, all teachers are compelled to teach sexuality, HIV and AIDS programs to all learners including learners at Special Needs Schools. SNS in the Western Cape Province, rank second highest in number of all SNS in South Afiica. The people in the Western Cape Province in particular, comes from many diverse cultural backgrounds and gives the province 3 very cosmopolitan essence, creating a demographic profile quite different from the remaining eight provinces in South Africa. As a result, race issues in this province have been unique in how the previous system of oppression, Apartheid], affected fundamental services including educational opportunities for the different race groups. Evidence still exits of disparities in Special Needs Schools that directly relates as a result of the previous policies of apartheid. The SNS in this present study include specialization services to learners across all types of disabilities as well as specific specialization services on a particular disability type. Thus, some SNS only accept enrollment of learners with a specific disability type and other SNS enroll learners with irrespective of the disability type. All SNS schools 1 ‘Apartheid’ is the system of oppression that previously divided South Africans based on race into four categories ‘White’, ‘Afiican’, ‘Coloured’ and ‘Indian' 32 have four major educational phases including the foundation, intermediate, senior and school leaver phases. Participants The population of interest in this study was teachers and child care providers at Special Needs Schools in South Afiica. Participants in this study were all employed by the national Department of Education of that particular school where data were collected. All participants were in a teaching position providing lessons and/ or special care services (i.e. counseling, evaluation) to students with disabilities between the ages of six and twenty years old. Students at Special Needs Schools are grouped in academic phases given their intellectual abilities and need for care given their specific impairment. The phases include the foundation, intermediate, senior, occupational and the school leaver phase. Both male and female teachers and child care providers were included in the study as participants, however females make up the majority of staff members at Special Needs Schools in the education system of South Afiica. The educational qualification of teaching staff at the Special Needs Schools include a three or four year training diploma or degree in teaching at college level or/ and at university level. These training diplomas or degrees does not necessarily include specialization in working with youth with disabilities, instead teachers choose to do an additional short courses to be skilled in working with youth with disabilities. Only those participants who take on a position of child care provider received training specializing in working with youth with disabilities. The child care provider position is similar to paraprofessionals in United States schools and includes a psychologist, occupational therapist, and nurse positions. 33 The participants were teachers and child care providers from all racial backgrounds. The majority of schools in this study were located in previously ‘white’ areas with the majority of staff members also coming from a predominantly ‘white’ racial background. This is due to the historical background of South Africa during the system of ‘Apartheid’ where the majority of Special Needs Schools were located in white areas and open to only ‘white’ learners for enrollment as well as enrollment for only some of the ‘coloured’ students. In addition to teachers and child care providers, participants further included key informants who were teachers in the position of either specifically coordinating the HIV and AIDS program or in charge of the sexuality, HIV and AIDS curriculum at that particular school. The sample for this study was drawn from the provincial government website that provide information and services available to all citizens within the Western Cape province. This sample from the Western Cape province was selected, based on several variables including meeting the selection criteria of the population of interest, familiarity with prior participation in empirical research, and overall willingness to participate. All 50 Special Needs Schools listed on the provincial government website were selected to participate in this study. These 50 schools were divided into four regions within the Western Cape province that include the Metropole East, South, North and Central. Each region had listed between nine to fourteen schools (see Figure 3 below) with contact details as well as the school’s specialization information provided. (see profile of schools in Appendix F). 34 Figure 2 Number of schools selected and number of schools who participated in study Western Cape Province Department of Education (W CED) Special Needs Schools Metropole Central Metropole M t l 14 schools East Metropole grog: e 9 schools North 0‘“ 14 schools 13 “boats _ 50 schools selected and invited from the provincial government website in the Western Cape Province 11 (22%) schools participated in the study East (4), North (5), South (1), Central (1) All 50 schools received an invitation to participate in the study via email notification. A total of 15 schools responded and a total of 11 (22%) schools participated in the study. Generally, the number of staff members including both teachers and child care providers at each Special Needs Schools varies between ten and forty teachers in number, depending on the number of learners at each school. A total of 78 surveys were collected. Initially only 6 schools responded with a total of 57 questionnaires completed. It was anticipated that the 5 0 principals would notify their teachers and child care 35 providers with principals motivating a higher level of teacher response. A second reminder mailing yielded a total 21 completed questionnaires from 5 more schools. Participant Demographic Characteristics Demographic data, including age, race/ethnicity, gender, educational level, language, marital status, job title, years teaching experience, grade level and training was collected. The demographic data questionnaire was part of the survey questionnaire, the ‘ Teachers Views on HIV and AIDS Education Survey ’ is attached as Appendix A. The total sample (n=78) was comprised of 68 teachers and 10 child care providers. The data presented is the combined responses collected from both teachers and child providers at SNS. The majority of the sample participants comprised of females (84.6%, n = 66) with only 12.8% (n = 10) males in the sample. The average age of participants was 45.6 with the highest percentage of participants comprising the age categories of 41-50 (28.2%) and 51-60 (32.1%). Nearly 72% (n = 56) of participants were married and more than half of the sample (61.5%, n = 48) was Afrikaans speaking. In relation to race/ethnicity, the participant breakdown was as follows: 10.3% (n = 8) of participants were African; 33.3% (n = 26) were Coloured; 55.1% (n = 43) were White; None of the participants identified as being Indian or belonging to more than one racial/ ethnic group (i.e. Other). Except for one participant, all other participants in the sample had an educational qualification of at least three years or more. This educational qualification include either a diploma or certificate (55.1%, n = 43), a BA degree (19.2%, n = 15) or a post degree (i.e. Honors, B Ed, etc.) (21.8%, n = 17). The average number of years teaching for the sample was 13.1 years ranging from (2 months to 38 years). All participants indicated a form of training that they have had related to teaching this topic 36 to learners with disabilities, with the majority of the sample (69.3%, n = 54) having had a general type of training. Table 1 Participant Demographic Characteristics (N = 78) Variables Freq % M SD Rm Gender Female 66 84.6 Male 10 12.8 Age 45.6 10.9 21-68 20 — 30 years 9 11.5 31 — 40 years 13 16.7 41 - 50 years 22 28.2 51 — 60 years 25 32.1 61 years and older 5 6.4 Race Afiican 8 10.3 Coloured 26 33.3 White 43 55.1 Indian 0 0.0 Other 0 0.0 Marital Status Divorced 6 7.7 Married 56 71.8 Single 15 19.2 Widowed 1 1.3 Educational Qualification BA degree 15 19.2 Diploma/ Certificate 43 55.1 Matric 1 1.3 Post degree 17 21.8 Language Afiikaans & English 12 15.4 Afrikaans 48 61.5 English 10 12.8 IsiXhosa 6 7.7 XiTsonga 2 2.6 Grade Level Teaching Gr R (pre-school) 2 2.6 Gr 1-3 8 10.3 Gr 1-7 32 41.0 Gr 1-12 2 2.6 Gr 4-7 4 5.1 Gr 4-12 10 12.8 Gr 8-12 15 19.2 continued 37 Table 1 continued Years teaching 13.1 9.7 .2-38 1 month — 10 years 34 43.6 10 years — 20 years 26 33.3 20 years —— 30 years 13 16.7 30 years — 40 years 5 6.4 Type of training General (pre-service) 54 69.3 Regular (in-service) 1 1 14.1 Intensive 8 10.3 None 1 1.3 Note: Sample size (n = 78) for demographic characteristics may not equal 78 due to missing data. Key Informant Demographic Characteristics Five key informants participated in this study. The key informants were selected from the schools that participated in the paper and pencil survey. Key informants were asked to provide demographic information including age, gender, race, marital status, educational qualification, language, grade level, years teaching and job title. Criteria for key informant inclusion in this study included: a) qualified teaching certificate, diploma or degree, b) being employed at a public Special Needs School in the Western Cape and c) be an HIV and AIDS curriculum or program coordinator. Key informants were all females with the mean age of 47.4 ranging from 38 to 57 years of age. Regarding race, only one key informant was ‘African’ and one ‘White’ with the remaining three being ‘Coloured’. The average years teaching for key informants were 20 years ranging from 16 to 31 years and two key informants had post degree educational qualifications. All five key informants’ job title included the role of HIV Coordinator and the grade level range from grade 1 to 12. 38 835380 >5 mm m; Sacco—ED 805m BEE caoE< 038$ 5‘ m GOSH—Gog £5- aaaesoo 2 823 Beam 2 «Bean m§x£< BEE 2.5» case S a 8:25:80 092.3 82%: >5 2 323 E a: Saga. 820% 8528 case S m 3985 mesa. : oi as: 8m ammaam Bees 8528 case S N 885980 829 >5 2 @8380 80m Em m§§< 8E8 8528 uses mm _ ”5:33 douse—.555 mafia «Ea—ESE 2:» non. 33> 596— 2:20 SEES—Em— owazunaq 15.32 35— wow ow< mov— fiaeatoRS Evie toNNeELcKS .oSREMQEeQ N 033. 39 Procedures Following notice of Human Subjects Approval from the Michigan State University Institutional Review Board (IRB), written permission to conduct the study at the schools where participants’ work was requested from the Department of Education in the Western Cape. Included in the email notification sent to all 50 schools was the notice of Human Subjects Approval from the Michigan State University Institutional Review Board (IRB) (Appendix A), the letter of permission from the Western Cape Department _zs-_"‘“""."'“"! of Education (Appendix B), a formal letter of invitation and the IRB approved consent form (Appendix C). Any ethical requirements the institution requested had been followed in addition to the Michigan State University Institutional Review Board requirements. The participants were treated in a professional, honest and ethical manner. Participants were provided written explanation, and in most cases verbal explanation via telephone and in person of the nature of the research prior to obtaining their verbal consent to participate. In addition, participants each received a copy of the informed consent document before data collection. The written explanation included a clear statement regarding the extent, nature and implications of their participation. Also, included was a clear indication that their participation is voluntary and that they may withdraw at any time or decline to answer any specific questions with no effect on their academic status or employment. Researcher information was included in the event of questions and concerns. A follow-up phone call was made to the principal after the schools showed interest in participating to introduce the researcher and provide more details regarding the study. A suitable day and time was arranged with schools that agreed to participate in the 40 study. All schools chose to have the survey questionnaires dropped off at their schools and picked up two days thereafter, giving them more time to complete the survey outside of their official teaching time. Some schools requested a briefing session to all staff members that was done by the researcher on a specific agreed upon day and time. Data collection was done using a mixed-method approach (Creswell, 2009). A quantitative survey questionnaire and semi-structured individual interviews were conducted concurrently. The semi- structured individual interviews were done with the specific teacher in charge for overseeing the sexuality, HIV and AIDS program or coordinating the curriculum at the school that participated in the study. This interview was done to gain further insight and an in-depth understanding regarding this important topic. This process allowed the researcher to elaborate on or expand on the findings of one method with another method and further examine the constructs related the topic (Creswell, 2009) The survey instrument, based on the WHO KABP questionnaire, was administered to participants and the survey questionnaire took approximatelyl 5-20 minutes to complete and the individual interview with the key informants was between 15 -30 minutes in duration. The survey questionnaire and the key informant interviews were both completed in English. All data collected had been treated as confidential and participants were not identified by name in reporting the data. The tapes, electronic copies, printed documents, memos and field notes will be retained for a minimum period of 7 years to be used for future research. All of this data will be stored in a secured and locked location in the office of the investigator. Any information entered onto a computer will be secured 41 through password identification, Norton Anti Virus, SpyBot, and Windows firewall protection. Variables and Instruments Survey questionnaire The World Health Organization’s (WHO) interview schedule that relates to AIDS-related knowledge, attitudes, beliefs and practices (KABP) (WHO, 1994), has been the premise of the present study’s survey instrument, ‘Teachers Views on HIV and AIDS Education Survey’. Organized into four parts, this WHO measurement has been prepared to permit researchers to follow a standardized approach to this type of research and to generate information that will be adapted comparable and between countries (WHO, 1994). This original WHO measurement was developed in 1988 by research teams from 17 different countries to assess how to develop a broad, adaptable knowledge, attitudes, beliefs and practices survey and interview schedule for AIDS research. Therefore, survey constructs and variables have been directly adapted from the WHO manual and guidelines, to inform the ‘Teachers Views on HIV and AIDS Education Survey ’ designed by the Principle Investigator specifically for the purpose of this study. This instrument is attached as Appendix A. In addition, for the purpose of this study, individually selected items for the survey questionnaire had been selected from the South African National HIV Prevalence, Behaviour and Communication Survey (SABSSM II), also developed based on the WHO interview schedule. The Human Science Research Council (HSRC), a renowned research company in South Africa had been conducting this SABBSSM survey every alternative year since 2001 to investigate the overall HIV prevalence and incidence of the South 42 African population. The ‘Teachers Views on HIV and AIDS Education Survey’ items have further been adapted and modified to address specifically this study’s topic of interest. The survey instrument was pre-tested for validity and consistency before being used for data collection. The pre—testing exercise was conducted by a team of 6 doctoral students in the Rehabilitation Counseling and Measurement and Quantitative Methods programs at Michigan State University. The pre-testing procedure provided information that was used in the finalization of the survey instrument. Comments from the six doctoral students were incorporated related to language, sentence construction and clarity. The ‘Teachers Views on HIV and AIDS Education Survey’ comprised of five sections, the first section is on demographic characteristics and includes information on variables such as age, sex, language, race, marital status, academic qualification, grade level teaching and number of years of teaching experience. The additional four sections included the following sections: Knowledge of HIV and AIDS, Attitudes towards HIV and AIDS, Beliefs about HIV and AIDS and Teaching practices of HIV and AIDS programs. The four major constructs related to the four sections were defined as follows: the term knowledge in this study refers to a cognitive understanding of a fact or commonly expected research or clinical finding. Attitudes refer to a notion to respond in favor or not in favor to an object, person, institution or an event. Beliefs are viewed as intentions or behaviors related attitudes therefore beliefs are primarily determinants of attitudes (WHO, 1994). Teaching practices are viewed as those methods and techniques used to impart information related to sexuality, HIV and AIDS. 43 Ten variables were identified under the major constructs including Knowledge, Attitudes and Beliefs. (see Figure 3 below) Figure 3 Four Major Study Constructs and Ten Study Variable Four Constructs Eleven Variables l I 1. Causation 1. Knowledge 2 CHIC l 3. Treatment . 4. Care 2' Attitudes 5. Training Programs I 6. Seriousness of AIDS problem . 7. Teachers’ comfort level 3- Beliefs 8. Responsibility for HIV infection 9. Responsibility for teaching HIV and 1 AIDS 4. Teaching 10. Teaching Practices Practice Except for the demographic section and question 4.1 under major construct Beliefs of HIV and AIDS, ten variables consist of Likert-scale responses ranging in values from to 5, with 1 meaning strongly disagree and 5 strongly agreed. Question 4.1 had a multiple response scale. In addition, the survey questionnaire included open-ended qualitative response questions related to teachers’ or child-care providers’ experiences, challenges and needs related to teaching sexuality, HIV and AIDS programs. The survey questionnaire was completed by teachers and child care providers at Special Needs Schools. Key Informant Interview guide The individual interviews comprised of open-ended qualitative questions that reflected the same qualitative questions of the survey questionnaire. The purpose of the key informant interviews questions were to further explore important constructs specifically related to teaching practices of HIV and AIDS programs in Special Needs Schools. The key informant interview guide provided an opportunity for key informants to address and expand on issues that may not have been taken up in the survey qualitative questions. The key informant interviews were conducted at the same schools that participated in the survey questionnaire. The necessary ethical steps in protecting both participants’ confidentiality and anonymity had been taken. The key informant interviews were done with senior staff members at the schools who have the responsibility of coordinating or overseeing the sexuality, HIV and AIDS programs and curriculum at school. Research Design The research design took the form of a mixed-method approach. Mixed-method approaches use both quantitative and qualitative techniques within the same research project (Creswell, 2009; Patton, 1985). According to Creswell (2009), since all methods have limitations, the biases embedded in a single method could be neutralized or canceled by the other method. Research in social sciences largely depends on measurements and analysis and interpretation of numerical as well as non-numerical data. Quantitative research methods therefore focus on statistical approaches and qualitative methods are based on content analysis, comparative analysis, grounded theory, and interpretation (Creswell, 2009). Quantitative methods emphasize objective 45 measurements and numerical analysis of data collected through polls, questionnaires or surveys and qualitative research focuses on understanding social phenomena through interviews and personal comments (Patton, 1985). It has also been argued that an integrated approach, or mix-method approach to social analysis, could close the gap between quantitative and qualitative methods and both these methods could be used together for social research studies (Creswell, 2009). For the purpose of this study, the strategy of inquiry was concurrent mixed- method procedure (Creswell, 2009; Lincoln & Guba, 1985). Thus, the study began with a quantitative method in which theories or concepts were tested. At the same time a qualitative method involving key informant interviews was conducted with key informant participants to further explore issues related to the topic. Given that the study aimed to understand teachers’ and child-care providers’ understanding of knowledge, attitudes, beliefs and teaching practices of HIV and AIDS at Special schools, it was determined that qualitative inquiry in addition to quantitative inquiry could best address the research questions. In order to understand and interpret the perceptions of teachers and child care providers with regards to teaching sexuality, HIV and AIDS to youth with disabilities, it is believed that qualitative research best provided a view of youth with disabilities as they interact with their social worlds and thus construct reality (Lincoln & Guba, 1985; Patton, 1985). It was believed that qualitative research involving teachers and child care providers teaching this topic to youth with disabilities would provide a revealing lens through which the social interactions of these youth with disabilities could be viewed. 46 Data Analysis Survey instrument The survey questionnaire data was analyzed using the statistical software package SPSS. Descriptive and inferential statistics provided background of participants with regards to their age, sex, race and years teaching at the school. Descriptive statistics on the ten study variables and the four major study constructs are provided. In addition, a correlation matrix among ten study variables as well as the four major study constructs was conducted. The correlation is one of the most common and most useful statistics, a single number that describes the degree of relationship between two variables. The findings are presented in the form of graphs and tables to gain understanding of the data. In addition, a short summary has been written for each of the tables and graphs presented. Qualitative questions The analysis of interview transcripts and survey qualitative responses were based on an inductive approach geared to identifying patterns in the data by means of thematic quotes. Patterns, themes, and categories of analysis came from the data and they emerge out of the data rather than being imposed on them prior to data collection and analysis (Patton, 1985). Analysis began with an open-coding process, which included a line-by- line review of each transcript to identify words or phrases attributable to participant implications throughout the interviews and survey responses. An inductive analysis was used to group the emerging quotes into themes. The process of coding and conceptualizing the data is one of the most difficult and yet compelling aspects of the qualitative research process. The challenge is to stay true to the story that is being told ; (Lincoln & Guba, 1985) 47 A process of comparative analysis by two additional readers was used to establish triangulation and to confirm the reliability and the validity of the researcher’s findings. This process included each reader to carefully review, examine and evaluate the initial coding and thematic analysis. Denzin (1978) suggested that triangulation could involve multiple data sources and researchers/evaluators to promote a better understanding of the data. In this study, triangulation was used to offset researcher bias and to establish reliability through consistency in the researcher’s interpretations of the findings. After a E thoughtful discussion amongst the researcher and two additional readers, an agreement 1. was established regarding thematic quotes and themes that emerged from the data. Revisions made based on the triangulation data analysis process included the addition of several new themes and editorial changes to the wording of original themes (see Figure 5). 48 Figure 4 Analytic Steps for Thematic themes Gavey responses: \ flewiew responses: \ Phase I — (3 broad categories) 1. Experiences — 6 themes 2. Needs — 6 themes 3. Challenges — 4 themes Phase II — (sub-themes Phase I — (transcript 1- 5) Transcript l- 6 themes Transcript 2- 4 themes Transcript 3- 7 themes Transcript 4- 8 themes Transcript 5- 6 themes for each of the 3 broad Qteeories) / Phase III TRIANGULA TION A.Survey responses- editorial changes made B.Interview responses-4 new themes added ”base IV \ Write up and synthesis of all / 49 Phase II Combined themes = 15 j i I.“ '" 3‘8, CHAPTER 4 Results The purpose of the current study was to examine teachers’ and child care providers’ views, experiences and beliefs in teaching sexuality, HIV and AIDS programs to learners in Special Needs Schools in South Africa. The high rate of HIV infection among youth in Afiica has accorded both national and international attention (Gallant & Maticka- Tyndale, 2004). The critical role education plays is essential to the development of skills, knowledge and identity. Undoubtedly, without education it will lead to youth with disabilities being unable to participate in the social and economic mainstream of society (Chappell & Radebe, 2009). According to Magnani, Maclntyre, Mehyrar Karim, Brown, & Hutchinson (2004), school-based life skills education that include sexuality, HIV and AIDS programs, appear capable of communicating key information and helping youth develop skills relevant to reducing HIV risk. Given that youth with disabilities are at increased risk of HIV infection (Ballan, 2001; Ambrose, 2004; Groce, 2005; Chappell & Radebe, 2009), it is imperative that they receive and are exposed to education related to sexuality, HIV and AIDS education. This responsibility is often left to teachers and child care providers, therefore it becomes key to investigate their views about teaching sexuality, HIV and AIDS to learners with disabilities. The present study is guided by the following three research questions: Quantitative data — Survey instrument Research question I: What are teachers’ and child care providers’ knowledge, attitudes, beliefs and teaching practices of sexuality, HIV and AIDS programs? 50 Qualitative data — Survey instrument Research question 2: How do teachers and child care providers describe teaching experiences, challenges and needs of teaching sexuality, HIV and AIDS programs? a. Describe in 2-4 sentences teachers’ experiences in teaching sexuality, HIV and AIDS programs to their learners in Special Needs Schools? b. What are the challenges and/or barriers teachers face when teaching sexuality, HIV and AIDS programs? c. What are teachers’ needs to improve on their teaching related. to sexuality, HIV and AIDS programs? Qualitative data — Key Informants Research question 3 .' How do key informants describe experiences related to teaching sexuality, HIV and AIDS programs? Interview guide: a. Describe teachers’ experiences in teaching sexuality and HIV and AIDS programs to their students in Special needs schools? - What issues make teaching to be less comfortable for teachers or make them feel more at ease to teach sexuality, HIV and AIDS programs? b. Describe the methods, techniques and approaches teachers are using in teaching sexuality, HIV and AIDS programs to their students? -Describe the effectiveness of these techniques in imparting a positive view of sexuality and knowledge of HIV and AIDS to their students? c. What are the challenges and/or barriers teachers face when teaching sexuality, HIV and AIDS programs? 51 -Describe how teachers and child care~ providers respond to cases where children engage in sexual activities such as kissing, fondling their private parts, etc.? (I. What are teachers’ needs to improve on their teaching programs related to topics such as sexuality, HIV and AIDS? -What guidance and additional assistance do teachers need to be effective in them teaching sexuality, HIV and AIDS education? Below are the combined study data presented of responses from both teachers and child care providers at SNS. Quantitative data - Survey instrument Research Question I What are teachers’ and child care providers’ knowledge, attitudes, beliefs and teaching practices of sexuality, HIV and AIDS? Research question 1 was addressed by collecting data with the survey instrument based on the WHO KABP guidelines (see Appendix D for Survey instrument). Responses on individual items for each of the ten variables were computed into a mean. Thereafter, the ten individual variables were computed to get a mean for each of the four major constructs. Item level data including mean, standard deviation and range for items that comprise the ten study variables is provided in Table 3. 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VA 75 8888m08 mQH< H80 >HH.H 5:00me £008 00 0000 8 0H .58» 833:0 -808 82: mQH< H80 >HH.H 80% mouHHBmmHv 53» :80» £008 00 wcHwEHHflHo 0.88 0H 0H 030600 BI 03 0:3 figwfim quomou 80308 a 26: 008 2:03 00> .320 805080 00 0088.808 00 8008m 05 005 “£08 2003 :0» .3280 >HHH 8 $30 .80» 8 80003 a 80 08m 00% .HH 0030005 80800: wanmoHdH maflomoh 835:8 m 038 57 Descriptive statistics 0f10 Study Variables Table 4 depicts descriptive statistics for each study variable, including means, standard deviations, ranges, and alpha levels. The Cronbach’s alphas for the study variables were all less than .70. Thus, all of the internal consistency reliability coeflicients for the measures used in the study seem to be generally low, indicating that the measurement of study variables may not be stable. Researchers recommend internal consistency reliability coefficients for the measures used in a study to be above the .70 for reliability (Leedy & Ormrod, 2005 ). The variable causation as per Table 3 indicates the highest overall mean score of 4.5. The range of scores for causation in the present investigation was 2.60 to 5.00 (e.g., higher scores indicating a higher level of knowledge on causes of HIV and AIDS), indicative of a high level of knowledge on causes of HIV and AIDS. The second highest mean score is 4.4 for the variable teacher’s comfort level. This is an indication of teachers who strongly agree being comfortable in talking about this topic of HIV and AIDS. The variables cure, seriousness of HIV and AIDS and teaching practices all have a mean of 4.2 indicating a high score on each of these items. This indicates a higher level of knowledge of cure for HIV and AIDS amongst participants, a high level of agreement of participants taking the problem HIV and AIDS serious and lastly, a high level of agreement of participants regarding teaching practices related to sexuality, HIV and AIDS as essential. The lowest mean scores were found for the variables responsibility for teaching HIV and AIDS (3.4), Care (3.5) and responsibility for HIV infection (3.6). These lower mean scores indicate participants’ level of neutrality related to who should be responsible for teaching HIV and AIDS 58 programs, who should be responsible for taking care of the infected and lastly, who should be held responsible HIV infection. Table 4 Descriptive statistics of 1 0 variables Major Variables Mean SD Range or Constructs Knowledge 1. Causation 4.5 .43 2.60 — 5.00 .568 2. Cure 4.2 .56 2.40 — 5.00 .541 3. Treatment 3.8 .46 2.50 — 4.60 .554 Attitudes 4. Care 3.5 .71 1.67 — 5.00 .593 5. Training 3.8 .62 2.00 — 5.00 .575 Beliefs 6. Serious AIDS 4.2 .80 2.00 - 5.00 .603 problem 7.Teachers’ comfort 4.4 .66 2.00 — 5.00 .576 level 8. Responsibility for 3.6 .50 3.00 — 5.00 .632 HIV infection 9. Responsibility for 3.4 .49 1.00 — 5.00 .590 Teaching HIV/AIDS Teaching 10.Teaching 4.2 .61 , 2.25 — 5.00 .536 Practice Practices Correlation Matrix Among 10 Study Variables The correlation matrix, as shown in Table 5 depicts statistically significant correlations between the variables of causation, cure, treatment, care, training, teachers’ comfort level, responsibility for teaching HIV and AIDS and teaching practices. Teaching practices shared statistically significant relationships with a number of other variables of interest, but the strongest statistically significant correlations were with cure (r = .37, p < 59 .01) and seriousness about HIV and AIDS (r = .35, p < .05). This finding indicates an understanding of the cure for HIV and AIDS and taking HIV/AIDS seriously relates positively to a willingness to teach programs to learners with disabilities. The strongest statistically significant correlation was found amongst causation and cure (r = .48, p < .01), indicating knowledge on HIV and AIDS relates strongly to understanding the cure for HIV and AIDS. A few weaker positive relationships were found for responsibility of HIV infection with seriousness of AIDS (r = .01), causation (r = .04), treatment (r = .05), and training (r = .05), but these relationships were not statistical significant. It is important to note that a few negative relationships between variables were found but none of these relationships showed any statistical significance. 6O H0>0H no. v H 05 80 8005.86 8 80880800... H0>0H S. v 8 05 80 880E880 8 88880800: mooflowum ooflomum -- 8. 3.- ton 1.2.. *8. 2. mo. :3. .1. 8808.8 .8 88888 wees/8 w88000H. 80H -- 2. ram. 8. mo; 80.. 2. *3. 2. 88588838 .0 808088 >HH.H 80H -- 2.- 5. mo. 8.- mo. :. 3. 88388888 .8 Hoe/280.8800 -- :. S. :. om. *8. 2. 865888 803088 -- 2. 2. :. No. 8.- m8