How Risk and Vulnerability Become 'socially embedded': Insights into the Resilient Gap between Awareness and Safety in HIV

• Author: David Plummer
• Pages: 239-256

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HOW RISK AND VULNERABILITY BECOME ‘SOCIALLY EMBEDDED’

How risk and vulnerability

become ‘socially embedded’

David Plummer

Chapter 12

INTRODUCTION: THE ‘KAP GAP’

People engaged in HIV-related work have long been concerned about

a persistent gap between awareness, knowledge and safe practice. It

appears that being aware and knowledgeable about HIV does not have a

simple correlation with being safe. This gap –– between knowledge,

attitudes and practice –– is sometimes referred to as the ‘KAP gap’.

The existence of the ‘KAP gap’ in the Caribbean was recently confirmed

in a survey of HIV-related knowledge, attitudes and beliefs conducted in

six Eastern Caribbean states: Antigua and Barbuda, Dominica, Grenada,

St Kitts and Nevis, Saint Lucia and St Vincent and the Grenadines. The

survey was a joint initiative of the Pan American Health Organisation

(PAHO), Family Health International (FHI) and the US Agency for

International Development (USAID) (Ogunnaike-Cooke et. al. 2007).

A total of 5,897 young people between the ages of 15 and 24 was

recruited, consisting of just under 1,000 participants from each

participating country. Key results can be found in table 12.1.

The survey demonstrated that awareness of HIV and AIDS is universal:

nearly 100 per cent of the sample of young adults had heard of HIV and

AIDS in all countries. The study also documented high levels of

knowledge about HIV prevention: knowing about sexual abstinence as a

prevention strategy ranged from 86 per cent to 94 per cent; knowing

about being faithful to a single uninfected partner as a prevention strategy

ranged from 80 per cent to 92 per cent; and knowing about consistent

condom use as a prevention strategy ranged from 75 per cent to 88 per

cent.

Insights into the Resilient Gap Between Awareness and

Safety in HIV

240

SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

In contrast, the evidence relating to sexual practice revealed a substantial

gap between knowledge and safety (the ‘KAP gap’). Between 60 and 74

per cent of young people between 15 and 24 years of age reported having

been sexually active and of them, between 87 per cent and 99 per cent

had had sex with at least one non-marital, non-cohabiting partner in the

last 12 months. Only between 16 per cent and 44 per cent of the sample

used condoms with non-marital, non-cohabiting sexual partners

consistently.

The survey also found that between 22 per cent and 26 per cent of

participants experienced their first sexual intercourse before the age of 15

and that between 31 per cent and 46 per cent of the sample had multiple

non-marital, non-cohabiting partners in the last 12 months. In other

words, despite near universal awareness of HIV and high levels of

knowledge about prevention, the adoption of the ‘ABCs’ (abstinence,

being faithful and using condoms ) of HIV prevention is far from universal:

only a minority of 15 to 24 year olds have not had sex, the overwhelming

majority of those who had had sex reported at least one casual (non-

marital, non-cohabiting) partner in the past year, many had multiple

partners, and condom use was low to moderate, at best. The gap between

awareness and practice is illustrated in table 12.1.

UNPACKING THE ‘KAP GAP’ AND THE SUSTAINABILITY OF

PROTECTIVE BEHAVIOURS: METHOD

The above findings raise key questions for HIV control: (i) what factors

contribute to maintaining the gap between HIV awareness and safe

practice? (ii) how can that gap be reduced? and (iii) how do we ensure

that safe behaviours are sustainable? These complicated issues almost

certainly are multi-factorial. However, further inroads into the HIV

epidemic will depend on elucidating factors that militate against safety

and entrench risk.

To investigate these militating factors we took a dual approach: (i) we

revisited the work of other Caribbean researchers to search for clues; and

(ii) we undertook our own qualitative investigations. A qualitative