Student roadmap to physical, mental and social wellness by Cape Peninsula University of Technology

STUDENT GUIDE Roadmap to your social, mental AND physical wellbeing Dr Hilda Vember

Dr Rugira Marie Modeste

Ms Melanie Marais

Ms Heidi Wichman

Mr Naythan Kayser

Ms Rene Williams

STUDENT GUIDE Roadmap to Your Social, Mental and Physical Wellbeing

Dr Hilda Vember Senior Lecturer: Department of Nursing Science Dr Rugira Marie Modeste Senior Lecturer Research: Department of Nursing Science Ms Melanie Marais HIV/AIDS Coordinator: HIV/AIDS Unit Ms Heidi Wichman Student Counsellor: Student Counselling Department Mr Naythan Kayser Peer Education Officer: HIV/AIDS Unit Ms Rene Williams Administrative Assistant: HIV/AIDS Unit

Permission is granted to use the Cape Peninsula University of Technology Student Wellness Guide solely for educational purposes and not for financial gain.

Roadmap to your social, mental and physical wellbeing

Foreword My journey as a student at the Cape Peninsula University of Technology encompassed a lot of soul searching, properly and thoroughly getting to know myself. I came fresh from matric thinking that I had my life togetherâ&#x20AC;Ś not! I was never ready for the disappointments that life had in store for me, but who is? I experienced fear of failure, but realised that when fear has gone, there is nothing, and only I remain; and you must let it pass over you and through you, so that you may be liberated. I faced numerous challenges â&#x20AC;&#x201C; financial, academic and social. I grew as an individual. It was difficult, but I was determined to succeed. I had a vision and held myself responsible for taking poor and good decisions; and today I rest assured, knowing that those decisions shaped me, into the young woman that I am today. When I decided to be part of the HIV/AIDs Unit programme, not only was I ready and willing to expand myself to my fullest capacity, I was giving myself the opportunity to learn more about my surroundings. I grew up in a bubble, thinking that life was all peachy and I had limited information about HIV/AIDS, STDs, as well about common difficulties young people face in society. I immersed myself in the great pool of information that the HIV/AIDS Unit provided where I learned different perspectives of thinking, where I learned more about humanity, and about true compassion for others. Often over the years, I have listened to stories from people about their experiences in university, about their childhoods, aspirations, and relations with their family and future colleagues. Time and time again, I realized one thing: many students go through more or less the same roadmap, facing many decisions to make and challenges to overcome, and we have one common need: the need to be heard and seen in our most real and true form. Get to know who you truly are; just do what works for you, because there will always be someone who thinks differently. Learn to bring people into your world and be open-minded to experience other peopleâ&#x20AC;&#x2122;s worlds too. Love them even if you are different and know that when you truly know yourself, you become unshakable and indestructible. Nothing in life is to be feared. What is important is just to be understood, to develop resilience, tenacity, to use support systems and self-love, as these are the true keys to success. Use the opportunity to equip yourself through reading this booklet. I love its holistic approach, covering areas of importance to every student. - Thokgamo Dineo-Dintle Maretela Civil Engineering student & 2015-2016 HIV Peer Educator

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Acknowledgements Our university would like to acknowledge the Department of Higher Education and Training and the National Skills Fund for the funding made available through the Higher Education and Training HIV/AIDS Programmeâ&#x20AC;&#x2122;s (HEAIDS) HIV curriculum Integration Project. Professor Anthony Staak Deputy Vice Chancellor: Teaching and Learning, Cape Peninsula University of Technology Ms Managa Pillay Senior Programme Manager: Curriculum and Research, HEAIDS Dr Paulette Powell Technical and Capacity Support Consultant, HEAIDS CPUT Nursing Department CPUT Student Counselling CPUT HIV/Aids Unit Dr Jenny Wright Editor Ms Bridgette Hunt Graphic design

Abbreviations

AIDS

Acquired Immuno Deficiency Syndrome

MSM

Men having sex with men

ART

Antiretroviral Therapy

PEP

Post Exposure Prophylaxis

CD4

Cluster of Differentiation 4

PMTCT

Prevention-Mother-To-Child-Transmission

CPUT

Cape Peninsula University of Technology

PrEP

Pre-Exposure Prophylaxis

Curriculum Vitae

RNA

Ribonucleic Acid

DNA

Deoxyribonucleic acid

SANAC

South African National AIDS Council

DOH

Department of Health

STI

Sexually Transmitted Infection

FDA

Food and Drug Administration

TB-DOTS Tuberculosis Direct observed therapy

GBV

Gender-based violence

TSA

Testicular Self-Examination

HEAIDS Higher Education and Training HIV/AIDS Programme

TVET Technical and Vocational Education and Training

HCW

Healthcare Workers

HIV

Human Immunodeficiency Virus

UNAIDS Joint United Nations Programme on HIV/AIDS

HPV

Human Papilloma Virus

VMMC

Voluntary Medical Male Circumcision

LGBTQI Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex

WAVAW

Women against violence against women

WHO

World Health Organization

MMC

WRVH

World Report on Violence and Health

Medical male circumcision

Roadmap to your social, mental and physical wellbeing

Contents 4

1 Student Life and First Year Experience Welcome to student life Support provided at your institution

2 Good Citizenship Introduction to good citizenship Core values Overview of this chapter and expected learning outcomes Rules and policies Your country’s constitution Highlighting Chapter Two of the Constitution of South Africa, 1996 A Bill of Responsibilities for the Youth of South Africa Conclusion

3 A Student’s Road to Healthy Living Introduction to a healthy lifestyle What are the basic things I need to do to live a healthy life? Overview of this chapter and expected learning outcomes Common healthscreenings that can be offered at your campus

4 The Basics of HIV Introduction to HIV and AIDS HIV and AIDS and the immune system Important steps of HIV infection What is the role of antiretroviral treatment? Myths about HIV The link between HIV and Sexually Transmitted Infections (STIs) The link between HIV and tuberculosis (TB) Sexual violence and the risk of HIV transmission HIV and STI prevention Modes of HIV infectIon HIV prevention strategies HIV and the economy Workplace injuries Some other facts about HIV

5 Stigma and Discrimination Analysing stigma against key populations Case studies of people living with HIV New bill to criminalise hate crimes and hate speech Social media and stigma and discrimination Conclusion

6 Sexual Diversity Biological sex My friend/family member has come out as lesbian/ gay/bisexual LGBTQIQ (Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex and Questioning) Myths and facts about LGBTI People Case studies: Understanding sexual diversity Support services for young LGBTI people Conclusion

7 Men’s Health Introduction The empowerment of men Why is men’s health so important? Common Health Issues Sexually transmitted infections (STIs) Treatments of Sexually Transmitted Infections Men and testing for Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) Medical male circumcision (MMC) Gender-based violence and HIV Condom use How to use a condom 8 Women’s Health Introduction Challenges faced by women Overview of chapter and learning outcomes Interventions to improve women’s health Family planning/ Contraception 9 Gender-based Violence Introduction Signs of an abusive relationship The cycle of violence Rape and rape culture How to get help when experiencing GBV Conclusion Places to get help and more information

10 Your Journey as a Tertiary Student Boosting your career prospects Make connections Use the Internet Join a club Branding yourself Cultivate proficiencies Gain experience Preparing your curriculum vitae Big NOs when submitting CVs What must accompany a good CV When drafting a CV the following headings are important Preparing for a job interview

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Student Life and First Year Experience

Welcome to student life

‘Student life’ is the term that refers to the time when most students leave their home for the first time to go and study at an institution of higher learning. It is also the stage where a Grade 12 learner who has had no responsibility in life besides their academic work suddenly has to face the adult world with unfamiliar freedom: they need to take responsibility for their own life and sexuality. During this period of unaccustomed freedom (a critical stage of one’s life), a student needs to learn and acquire adequate knowledge to conduct themselves in an ethical and professional manner, not forgetting the core values that assisted them to get to university. A stu d new ent w ith f free oun d dom

If you are reading this, you are probably a new student and this is the beginning of a time for fulfilling your long-held dreams (‘dream the impossible dreams’) and you will no doubt begin by setting targets to reach your end goal – your degree!!!

This time is probably one of the most important parts of your life, as it is a time where you, as a student, are carefree and do not have any responsibility besides focusing on your academic studies, while your character is being built at the same time. nt justme The a d cho ol to s fro m might feel ity univers rwhelming o ve

This is also the phase when adolescents make the transition into young adulthood. You will, at times, feel that you are stranded and lonely, far away from home and no-one seems to care; and everyone just minds their own business. It is

then that you may feel like giving up, as you cannot find your feet. You may even experience a barrier with language and find it difficult to grasp new concepts in class, especially if the medium of teaching is not your mother tongue; but do know that you are not alone. Seek help and find out what support services are at your campus.

Remember with freedom comes responsibility! Don’t s is o tress, thro n the w help u g supp h stu d ay o rt s e er vic nt es

Support provided at your institution In terms of academic support, Higher Education Institutions (HEIs) have a centre which specifically focuses on additional support for students who find it challenging to cope with their first year. These departments are usually called an Academic Support Centre and form part of the academic structure of the institution. They provide support in terms of improvement of mathematics competence, assisting students with their academic literacy, and student mentorship (in terms of peer-to-peer mentoring and tutorial support).

Department of Student Affairs The Department of Student Affairs is mainly responsible for support to students outside of their academic field. It has different Departments and Units providing the following services:

Roadmap to your social, mental and physical wellbeing

Health & Wellness Cluster

Student Health Clinic

The Health & Wellness cluster refers to different departments within the Department of Student Affairs. It includes departments such as Student Counselling, Student Health Clinic, Disability Unit and the HIV & AIDS Unit. These departments help you cope with academic, physical, social, emotional and spiritual wellness needs.

This clinic provides primary health care to registered students who are attended to by professional nursing sisters and can make an appointment with the medical doctor as well. Services offered are: • Curative treatment for ill students/patients (basic medication) • Prevention / treatment of chronic illness (or referrals) • Reproductive health (family planning, cancer screening) • TB–DOTS supervision • Provider Initiated HIV Counselling & Testing (PICT) • Wound dressing and assistance with minor injuries • Treatments for sexually transmitted diseases • First aid and emergency health care • Voluntary medical male circumcision

Student Counselling This unit offers assistance, focusing on students’ mental health and wellbeing. These services offered by professional, registered psychologists and interns are the following: They offer the following services: • Individual counselling: This is confidential one-onone counselling for an hour with a psychologist or welfare officer to assist you; • Career counselling/planning: This is offered if you feel unsure of your course; if you are unhappy with the course you are studying; if you need guidance in making a choice for advanced studies; or if you want to learn more about your personal strengths and weaknesses; • Skills development workshops: Workshops are offered to assist you in coping with student life, time management, learning and studying skills, stress management, etc.

Important contact numbers Cape Town Campus Room 2.700, 2nd level Administration Building +27 21 460 3237 Bellville Campus Ground level, New Extension to the Library Building +27 21 959 6182 Mowbray Campus Ground level, Barkley Davies Building, Mowbray +27 21 680 1574 Wellington Campus Extension to Administration Building +27 21 864 5206 Athlone Campus Room 116, C Block +27 21 684 1242

Important contact numbers Bellville campus +27 21 959 6403 +27 21 959 6123 New Library Extension, Ground floor Cape Town campus +27 21 460 3405 +27 21 460 3638 Administration Building, Level 2, Room 2.900 Mowbray campus +27 21 680 1555 Administration Building, Ground floor Wellington campus +27 21 864 5522 Administration Building, Ground floor, Room A29

Disability Unit This unit provides an integrated and inclusive learning experience to students who are physically challenged. They offer services such as: • Advocacy and advice on any disability related matters; • Consultative and counselling service to students with disabilities; • Assistive technological services; screenings, training and support to students on variety of assistive devices, technologies and software available in computer labs;

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• • • • • • • •

Adaptive text arrangements: conversion of study material into accessible formats; Academic support to students with learning disabilities; Psycho-social support to students with disabilities; Test and examination concession applications (relevant medical report required); Orientation and mobility training; Referral for recommended textbooks in electronic or audio format; South African sign language interpreter service; Accessible study venues and computer lab.

Important numbers Cape Town Campus Atrium, 2nd level Administration Building +27 21 460 9071 Bellville Campus Ground floor, IT Centre Building +27 21 953 8438

HIV/AIDS Office This office focuses on awareness, advocacy and HIV prevention services, including: • Awareness Campaigns: to empower students and staff with knowledge on HIV & AIDS, STIs, TB, other women’s and men’s health-related matters; GenderBased Violence (GBV), Stigma & Discrimination; • Peer Education: This is a service whereby selected students are trained as volunteers to help with peerto-peer training on various topics to assist with the awareness programmes and interventions; • HIV Counselling & Testing (HCT): Routine HCT is provided on a voluntary basis to the student and staff population; • Mobile Wellness Unit visits all campuses to bring the services to all students; • Care & Support: Clients tested HIV positive are provided with the necessary support and referred where necessary; • Condom Promotion: The service includes the distribution of condoms and lubrication as well as education on correct usage of condoms; • Curricular Integration: Faculties are provided with support with the infusion of HIV into their curricula; • Workshops: Free workshops are offered to members of the student community on various topics.

• •

Community engagement including schools, TVET colleges and public places Internships: Students obtain invaluable work experience in the HIV/AIDS Unit

Important contact numbers Cape Town Campus Administration Building, Floor 2, Room 2.500A +27 21 460 4253/2 +27 21 959 6828 HIVunit@cput.ac.za CPUTHIVUnit National AIDS Helpline 0800 012 322 National HIV HCW Hotline 0800 212 506 Suicide Helpline 0800 708 090 (Toll free) Robbie Nurock (Cape Town) 89 Buitenkant Street, Cape Town +27 21 461 1124 Community Health Centre (Bellville) Kassesvlei Road, Bellville +27 21 951 2326

Student development Student development focuses on leadership development and capacity building of students. Besides

Roadmap to your social, mental and physical wellbeing

academic performance being the main priority of students at universities, this department also develops students by helping them obtain additional life skills to equip them to perform optimally in all spheres of life. By developing their leadership skills, students are able to excel in student structures, not only at the university, but also on a broader level both nationally and internationally.

Arts & Culture These activities range from social events to performing arts, debating, religious interaction and first year socialising programmes. Contact the departments below should you wish to find out more about the different sport codes and other extramural activities on campus.

Important numbers Important numbers Cape Town Campus Room 4.17, Student Centre, Cape +27 21 460 3499 Bellville Campus New Library Extension, Bellville +27 21 959 6010

Student Governance This division is responsible for the coordination of activities and support to the Student Representative Council (SRC) and its affiliated student societies. The SRC is the highest student governance structure at the university and it manages student matters and represents the interests of students on university and national forums.

Cape Town Campus Sports +27 21Â 460 3844 Wellington Campus Sports +27 21 864 5247 Bellville Campus Sports +27 21 959 6319/ 6377 Cape Town Campus SDO: Arts & Culture +27 21Â 460 3149

Useful RESOURCES

The SRC plays a key role in the coordination of organised student life and must ensure that the extracurricular programme contributes to the overall development of students.

Cape Peninsula University of Technology Available: http://www.cput.ac.za/ 22 March 2017

The SRC also fulfils an important communication function - on the one hand conveying student needs and interests to the university management, and on the other hand, reporting progress to the student community.

http://www.cput.ac.za/students/life/clinics

http://www.cput.ac.za/students/life/hiv http://www.cput.ac.za/students/life/counselling

http://www.cput.ac.za/students/life/development http://www.cput.ac.za/students/life/sport http://www.cput.ac.za/students/life/activities

Sports Department The Sports Department offers both competitive and recreational sporting codes and caters for all types of sports men and women. In addition to this, it also offer information and workshops on healthy lifestyle issues such as healthy eating, how to overcome addictions, weight loss programmes, etc.

http://www.cput.ac.za/services/disability

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Good Citizenship Overview of this chapter and expected learning outcomes

After going through this chapter, you should: • understand the concept of good citizenship; • know how to integrate the concept of good citizenship into your everyday life; • understand the concepts of core values and discipline; • understand the importance of good conduct as a student and in the workplace; • apply your human rights and understand your responsibility to act on your human rights; and • respect and honour the human rights of other citizens.

Introduction to good citizenship Good citizenship is important for the overall wellbeing of society. A good citizen is a person who obeys the laws of his or her country, contributes to society and uses wisdom with every decision taken. Key concepts like respect, responsibility, honesty and helpfulness are important when describing what good citizenship means. It also means to take responsibility for your own decisions. Good citizens care for their environment and assist those who cannot help themselves. They obey the laws of their country. When you are a contributing citizen, you are respectful of others’ feelings, beliefs and constitutional rights. Lastly, a responsible citizen doesn’t discriminate against another human being, regardless of race, gender, sexual orientation or socio-economic status.

Activity Tell a story about a time you had to tell the truth but found it difficult to do so. Tell a story about a time you had to take responsibility for what you had done. Tell a story about a time you had to say ‘no’ to a friend. Tell a story about someone you have a lot of respect for.

Core values A core value is something that defines you as a good citizen or a good person. It is how you brand yourself and how you want to be known as a good citizen. Examples of enacting core values are: • You deal with others in a spirit of Ubuntu; • You value excellence; and • You deal with others with respect.

Activity Now that you know what a core value is, do the following exercise to demonstrate your awareness of your personal core values: My personal core values are: My family’s core values are: My institution or school’s core values are: How do these core values differ from one another and what are the similarities between them?

Roadmap to your social, mental and physical wellbeing

Rules and policies Are you planning to start your own company one day? When you plan to start your own company, it normally starts with a vision. Along with that vision, there is a drive to bring a solution to a problem, or meet the needs of society. For that company to achieve its objectives, you will need to employ people that will represent you in the best possible way. All employers have to abide by the laws of the country. In South Africa, these laws are set out in the Basic Conditions of Employment and Labour Relations Act. The Recruitment Process: As an employer, you will draft a job description according to the needs of the company and advertise a vacant position. Once you receive all the CVs, a shortlisting is done to accommodate the most suitable candidates for the position (sometimes up to 6-8 candidates). You will have a panel that will do the interviews, after which the most suitable candidate will be selected. The next step will be to determine whether what the applicant wrote in the CV and shared in the interview, correlates with references.

Activity Now that you know more about a Code of Conduct, find out if your higher education institution / school has a code of conduct for students. Answer these questions: What is it called? Why do you think it is important for students to have a Code of Conduct? How does a Code of Conduct tie in with good citizenship? List at least 3 workplace policies. Why is an HIV Policy important in the workplace?

Activity Share personal stories about a time when you demonstrated good citizenship. For example:

An offer will be made to the most suitable candidate; and once she or he accepts the offer, they will sign an employment contract that will stipulate the employer’s responsibility and theirs, as a newly appointed employee. A newly appointed employee will also be required to sign a Code of Conduct that stipulates how they are expected to behave.

I was friendly to a new student from a different country.

Any employer has a Disciplinary Procedure that specifies the process followed when an employee has not adhered to the Code of Conduct employment contract or company policies. Employees may also follow a Grievance Procedure in cases where they are grieved by any situation within the workplace. Following a grievance procedure is important, because this is a formal and proper way of ensuring that an employee’s concerns are attended to.

I follow the rules of the road.

The employer is responsible to do induction training, introduce the employee to the company and its policies, business / work process and standard operating procedures or guidelines. The policies are rules that are put in place for the smooth running of operations and to guide employees. Guidelines or standard operating procedures outline how things should be done.

I helped clean up the class. I assisted a fellow student with food. I walked away from a fight. I said “no” when a friend asked me to steal another student’s money. I found a cell phone on campus and handed it in to my lecturer or campus security. Describe what would happen if there were no rules or laws at: Home University Traffic Discuss why rules / policies are important and define the consequences if they are broken.

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Now that you have a basic understanding of good citizenship, complete the following exercise about the responsibilities of a good citizen: being a good citizen

Your country’s constitution Good citizenship is about knowing my responsibility and exercising it. It is also important to know what factors contribute to poor citizenship so that we know how to avoid these. The South African Constitution is the most important law of the country.

not being a good citizen

Any other laws must align with this constitution. The Constitution explains what our rights and responsibilities are. Although we have many rights, those rights should not infringe on the rights of others. The next section of this chapter will deal with the South African Constitution.

Highlighting Chapter Two of the Constitution of South Africa, 1996 Chapter Two of the Constitution of South Africa contains the Bill of Rights, a human rights charter that protects the civil, political and socio-economic rights of all people in South Africa. The rights in the Bill apply to all law, including the common law, and binds all branches of the government, including the national executive, Parliament, the judiciary, provincial governments and municipal councils. Some provisions, such as those prohibiting unfair discrimination, also apply to the actions of private persons. South Africa’s first Bill of Rights was contained in Chapter 3 of the transitional Constitution of 1993, which was drawn up as part of the negotiations to end apartheid. This “interim Bill of Rights”, which came into force on 27 April 1994 (the date of the first non-racial election), was largely limited to civil and political rights (negative rights).[1] The current Bill of Rights, which replaced it on 4 February 1997 (the commencement date of the final Constitution), retained all of these rights and added a number of new positive economic, social and cultural rights. Although Section Two already provides for the supremacy of the Constitution over all laws and government actions, Section Eight explicitly states that the Bill of Rights applies to all law and binds all branches and organs of government. It further states that the provisions of the Bill also bind private parties to the extent that they are applicable, given the nature of the rights in question, and require the courts to develop the common law to this effect. Finally, Section Eight extends the benefits of the Bill of Rights to juristic persons, taking into account the nature of the rights and the juristic persons in question. Thus, for example, the right to human dignity and the right to health care clearly only apply to actual human beings, while the right to freedom of expression and the right to property apply also to corporations.

Roadmap to your social, mental and physical wellbeing

My responsibility in ensuring the right to equality Section 9 of Chapter 2 in the Constitution The Section starts with: “Everyone is equal before the law and has the right to equal protection and benefit of the law. Equality includes the full and equal enjoyment of all rights and freedoms. To promote the achievement of equality, legislative and other measures designed to protect or advance persons, or categories of persons, disadvantaged by unfair discrimination may be taken.” The Section, like the Universal Declaration of Human Rights, prohibits all discrimination but specifically lists the following grounds “race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth.” This list is more extensive than the equality provisions in most human rights instruments; and noteworthy is the distinction between “gender” and “sex”, the inclusion of “pregnancy”, the distinction between “race” and “colour”, and the inclusion of “age” and “disability”.

As South Africans, we all have rights to protect us and to see to our basic needs as humans. These rights are a privilege and, as a progressive and diverse country, we are also tasked with responsibilities to act on these rights and to practise these rights to respect and honour the rights of our fellow citizens.

A Bill of Responsibilities for the Youth of South Africa Preamble I accept the call to responsibility that comes with the many rights and freedoms that I have been privileged to inherit from the sacrifice and suffering of those who came before me. I appreciate that the rights enshrined in the Constitution of the Republic of South Africa are inseparable from my duties and responsibilities to others. Therefore I accept that with every right comes a set of responsibilities. This Bill outlines the responsibilities that flow from each of the rights enshrined in the Constitution of the Republic of South Africa.

The right to equality places on me the responsibility to: • treat every person equally and fairly; and • not discriminate unfairly against anyone on the basis of race, gender, religion, nationality, ethnic or social origin, disability, culture, language, status or appearance.

My responsibility in ensuring the right to human dignity The right to human dignity places on me the responsibility to: • treat people with reverence, respect and dignity; and • be kind, compassionate and sensitive to every human being, including greeting them warmly and speaking to them courteously.

My responsibility in ensuring the right to life The right to life places on me the responsibility to: • protect and defend the lives of others; • not endanger the lives of others by carrying dangerous weapons or by acting recklessly or disobeying our rules and laws; and • live a healthy life, by exercising, eating correctly, by not smoking, not abusing alcohol, nor taking drugs, nor indulging in irresponsible behaviour that may result in my being infected or infecting others with communicable diseases such as HIV and AIDS.

My responsibility in ensuring the right to family or parental care This right expects me to: • honour and respect my parents, and to help them; • be kind and loyal to my family, to my brothers and sisters, my grandparents and all my relatives; and • recognise that love means long-term commitment, and the responsibility to establish strong and loving families.

My responsibility in ensuring the right to education The right to education places on me the responsibility to: • attend school regularly, to learn, and to work hard; • cooperate respectfully with teachers and fellow learners; and • adhere to the rules and the Code of Conduct of the school; and concurrently places on my parents and caregivers the responsibility to: • ensure that I attend school and receive their support. and places on my teachers the responsibility to: • promote and reflect the culture of learning and teaching in giving effect to this right.

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My responsibility in ensuring the right to work This right carries with it the responsibility for all learners, parents, caregivers and teachers to: • work hard and do our best in everything we do; • recognise that living a good and successful life involves hard work, and that anything worthwhile only comes with effort; • prevent children being exposed to child labour.

My responsibility in ensuring the right to freedom and security of the person The right is upheld by my taking responsibility for: • not hurting, bullying, or intimidating others, or allowing others to do so and • solving any conflict in a peaceful manner.

My responsibility in ensuring the right to own property

My responsibility in ensuring the right to citizenship The right to citizenship expects that each of us will be good and loyal South African citizens. This means that we are responsible for: • obeying the laws of our country; • ensuring that others do so as well; and • contributing in every possible way to making South Africa a great country.

My responsibility in ensuring the right to freedom of expression The right to free expression is not unlimited, and does not allow us to: • express views which advocate hatred, or are based on prejudices with regard to race, ethnicity, gender or religion; and

The right to own property places on me the responsibility to: • respect the property of others; • take pride in and protect both private and public property, and not to take what belongs to others; and • be honest and fair (and for those who have, to give generously to charity and good causes).

We must therefore take responsibility to ensure this right is not abused by ourselves or others: we must not tell or spread lies, and must help to ensure that others are not insulted or have their feelings hurt.

My responsibility in ensuring the right to freedom of religion, belief and opinion

I accept the call of this Bill of Responsibilities, and commit to taking my rightful place as an active, responsible citizen of South Africa. By assuming these responsibilities I will contribute to building the kind of society which will make me proud to be a South African.

The right to freedom of conscience requires me to: • allow others to choose and practise the religion of their choice, and to hold their own beliefs and opinions, without fear or prejudice; and • respect the beliefs and opinions of others, and their right to express these, even when we may strongly disagree with these beliefs and opinions. (That is what it means to be a free democracy.)

My responsibility in ensuring the right to live in a safe environment This right assumes the responsibility to: • promote sustainable development, and the conservation and preservation of the natural environment; • protect animal and plant-life, as well as the responsibility to prevent pollution, to avoid littering, and to ensure that our homes, schools, streets and other public places are kept neat and tidy; and • to ensure that, in the context of climate change, we do not waste scarce resources like water and electricity.

Conclusion

Roadmap to your social, mental and physical wellbeing

Activity Please read the following case study and then answer the questions that follow. Safiq is a 24-year-old Muslim student who actively practises his faith and follows his daily prayer rituals. Recently he was placed in a double room at residence and expressed to his new roommate how he practises his faith, etc. The roommate was at first fine with the situation, but lately this roommate has been making very hurtful comments regarding Safiq’s religion. He has threatened to report Safiq for being a disturbance and also stealing from him, just to get him removed from his room. When Safiq studies, his roommate switches off the lights and tells him to go and study somewhere else as he wants to sleep. Further, his roommate has blatantly told Safiq that he hates Muslims and sees them all as terrorists. Safiq is afraid to report this, as he does not want to get his roommate in trouble or lose his room in residence. List the basic human rights of Safiq that are being violated. What would you do if you were Safiq? Which of Safiq’s human rights should he practise to get out of this situation? What disciplinary steps do you think should be taken against his roommate?

References Cockrell, A. 1997. The South African Bill of Rights and the ‘Duck/Rabbit’. Modern Law Review, 60(4):513537. Davies, l. n.d. 20 Ideas for teaching citizenship to children. http://www.kellybear.com/TeacherArticles/ TeacherTip27.html [7 March 2017]. Dickson, B. 1999. Human rights in the 21st century. Amnesty International Lecture, Queen’s University, Belfast, 11 November. Government of South Africa. Bill of Rights. 15 January 1996. No. 108 of 1996 https://www.westerncape.gov.za/legislation/bill-rights-chapter-2-constitution-republic-south-africa [7 March 2017] Hopkins, G. 2015. Teaching good citizenship’s five themes. Available at: http://www.educationworld. com/a_curr/curr008.shtml [7 March 2017]. South African Department of Education. 2009. A Bill of Responsibilities for the Youth of South Africa. http:// www.gov.za/sites/www.gov.za/files/gcis_documents/poster_2009.pdf [7 March 2017]

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A Student’s Road to Healthy Living Overview of this chapter and expected learning outcomes

After going through the chapter, you should : • understand how to look after your health; • understand how important it is to do regular health check-ups; • understand how to prevent and control obesity, high blood pressure, high cholesterol and diabetes; and understand the link between healthy living and academic performance.

Introduction to a healthy lifestyle

What are the basic things I need to do to live a healthy life?

Many conditions like strokes, heart conditions, diabetes and certain cancers could have been prevented if people took care of their health or at least went for regular check-ups.

•

In other words, high blood pressure or high cholesterol levels in your blood or diabetes can lead to a stroke. Your brain controls your thinking, emotions, movement and senses. When it gets hurt through a stroke (when a blood vessel bursts because of high blood pressure, or get blocked), certain parts of the brain stop working. The same can be said of a heart attack: when the blood vessels that supply the heart with oxygen get blocked, you can have a heart attack that could be fatal. Obesity is another condition that can lead to health complications. The good news is that when you adopt a healthy lifestyle and go for regular check-ups at least once a year, you can prevent a number of these diseases.

Watch what you eat or drink. A balanced meal consists of proteins (meat, poultry, fish, eggs, etc.), vitamins (from vegetables, fruits) and carbohydrates (maize, bread, rice, etc.) . Unhealthy food (greasy food, or food with high sugar content) is not good for your body.

Fruits Vegetables

Water

Grains Protein

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•

Blood cholesterol levels determine how much cholesterol (fat) content is in your blood. This can be done through testing a small drop of blood from a finger prick.

•

Blood pressure is the pressure of the blood inside your arteries (veins) caused by the contraction of the heart muscle. Your blood pressure is either normal, high (known as hypertensive) or low (hypotensive). Our emotions or stress levels impact our blood pressure. In other words, when we are calm, our pulse rate and blood pressure tend to be normal; when we are stressed, our pulse rate and blood pressure tend to increase.

•

Body mass index is a measure to determine if you are over- or under-weight. This will be determined through a simple calculation after measuring your height and weight.

Important to know Unhealthy food is not necessarily cheaper! For example, compare the cost of an apple versus a chocolate or fries. •

Do regular exercises (at least once a week, preferably more often). Always walk up the stairs instead of taking a lift (unless there are many floors and you are carrying heavy objects, of course!). Walk instead of taking a bus if the distance is not too great.

•

Water is freely available. Drink at least 6-8 glasses of clean water every day.

•

• •

Dental care is important. Simply brush your teeth twice a day (mornings and evenings) and visit your dentist at least once a year. Good dental care prevents bad breath and certain oral infections. It also helps you to keep your teeth into your old age. Regular health checkups. When your campus has a health awareness day, make use of the opportunity to check your body mass index (to see if you are under or overweight), blood pressure, blood sugar and cholesterol levels; and don’t forget to get to know your HIV status.

Reflection Now that you know the importance of living healthy, why do you think it is important to focus on your own health? How does a healthy lifestyle impact your academic performance?

Have a look at the chapters that focus on men’s and women’s health for more information. Last but not least, listen to your body. When it is tired, give it rest. When it is thirsty, give it plenty of water. When it is stressed, manage it. When it is not feeling well, visit your doctor or campus clinic.

Common health screenings that can be offered at your campus •

Blood sugar levels determine how much sugar content is in your blood. This can be done through testing a small drop of blood from a finger prick.

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Reflection What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to adopt a healthy lifestyle: 1. I can

2. I can

3. I can

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The Basics of HIV Overview of this chapter and expected learning outcomes

After going through the chapter, you should: • understand the basics of HIV; • understand the link between HIV, STIs and TB; • understand how high risk behaviour among students can contribute to HIV infection; and • understand the impact of HIV on the economy

Introduction to HIV and AIDS Can you explain the difference between HIV and AIDS? It is quite simple. HIV is the abbreviation for Human Immuno Virus; in other words, HIV is a virus that targets the human immune system. Once the virus enters your body and infects the CD4 cells, you are known to be infected with HIV; but that does not mean you have AIDS, so

be careful when referring to someone as ‘having AIDS’. AIDS is the abbreviation for acquired immune deficiency syndrome. In other words, once your immune system is depleted, there are no more CD4 cells to fight the virus and your body is open to all kinds of infections. The good news is that antiretroviral treatment (ART) blocks the HIV virus from further attacking your immune system. When this happens, your immune system gets a chance to repair itself. Fortunately, you no longer have to wait for your CD4 cell count to drop before you can start treatment. You can now start ART immediately after testing HIV positive.

Activity HIV prevalence exercise Research the HIV infection rate of the top five countries in the world. (Search on WHO and UNAIDS sites.) Country

HIV infection rate 2000 HIV infection rate 2012 HIV infection rate 2015 Current HIV infection rate

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Bruce Jones Design Inc. 2009

After completing the previous table on page 17, answer the following questions: • Identify the country with the highest HIV infection rate. What do you think are the contributing factors for the HIV infection rate in that country? • Identify the country where there has been an increase in the rate of HIV infection. • What is your country doing to reduce the HIV infection rate? Do you think it is working? Explain your answer.

HIV and AIDS and the immune system The human body is built to protect itself. Your skin is your first level of protection. You therefore cannot get infected with HIV by shaking hands or kissing someone living with HIV. It is not possible for an organism to enter your body when your skin is intact (in other words, unbroken skin). However when the skin is damaged through an injury, for example, your body is immediately exposed to an invasion of organisms like bacteria or viruses. This is when the next level of protection kicks in and your white blood cells act as the “army” of the body. There is one important white blood cell known as T-lymphocyte or the CD4 cell. This cell sends important messages to alert your immune system of invading viruses or bacteria. It is also the target point of the HI-virus. When HIV infects your CD4 cells the following happens: Multiplication of HIV – Here HIV uses the CD4 cell as a host to produce more viruses. A viral load test is a blood test that determines how many of the HI-viruses are in your body. Reduction in CD4 cell count – As the CD4 cells are invaded by the HI-virus, your CD4 cell count goes down. Without the CD4 cell, HIV is unable to multiply.

Important steps of HIV infection See the HIV Life cycle on the next page HIV gains access through an open wound/cut (can be very small cuts that cannot be seen with the naked eye) Binding - HIV binds to the CD4 cell wall Fusion - The virus membrane fuses with the CD4 membrane Uncoating - The contents of the virus are deposited within the CD4 cell. (There are 3 important enzymes: Reverse transcriptase, integrase and protease + viral RNA.) Reverse transcription - Viral RNA is changed to Viral DNA with the help of the enzyme Reverse transcriptase. Integration - The Viral DNA enters the nucleas (core) of the CD4 cell and attaches itself to the CD4 DNA that cannot identify the Viral DNA as an invader. Then thousands of immature viruses are produced. Translation - The Viral DNA (infected CD4 DNA) uses protease to change it to Viral RNA.

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Assembly - The Viral RNA + viral proteins assemble (including the 3 important enzymes). Budding â&#x20AC;&#x201C; The assembled parts of the newly formed HI-virus buds out from the infected CD4 cell wall.

What is the role of antiretroviral treatment? Antiretroviral treatment blocks most processes of HIV infection, preventing the virus from producing more viruses. When this happens, the virus is suppressed to a level of undetectable.

Maturation - The virus matures and looks for a CD4 cell, enters it, then starts the cycle of HIV infection.

REMEMBER

Aidsinfo (2017) Aidsinfo (2017)

Activity: Based on this information What do you think could happen if someone living with HIV stopped drinking their tablets/medicine? Explain your answer in a group. N.B.: Antiretroviral treatment can also be used to prevent HIV infection in the form of Pre-exposure prophylaxis (PreP) and post exposure prophylaxis (PEP): Prep is antiretroviral treatment used by an HIV negative sexual partner to prevent possible HIV transmission from an HIV positive sexual partner, for example, in cases of sex workers, discordant couples (one partner is HIV negative and the other partners is HIV positive). PEP is used in cases where someone has been exposed to the bodily fluids of another person, for example, in cases of rape or accidental injury like needle prick injury. It is important that antiretroviral treatment starts as soon as possible, or within a maximum of 72 hours after possible infection. It is safest to start ASAP.

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Myths about HIV There are still many myths around HIV. Many of us know family members and friends living with HIV. Myths can interfere in many people’s decisions to use treatment, to use protection or to infect others.

Activity: Reflection What does the term ‘myth’ mean to you?

Can you think of a few myths related to HIV?

Which of these myths are true and which are untrue? Explain your answers.

The link between HIV and Sexually Transmitted Infections (STIs) HIV is considered a sexually transmitted infection (STI), because it is transmitted through unsafe sex. Unsafe sex means having unprotected sex with your partner: in other words, without using a condom. There are several sexually transmitted infections like herpes simplex, genital warts, gonorrhoea, trichomoniasis, syphilis, etc. that increase your risk of contracting HIV when you have an STI and have unprotected sex with a partner who is HIV positive. Read more about STIs in Chapters 7 and 8).

The link between HIV and STIs When there is an infection in the genital area, there is swelling and redness causing the infected area to bruise and bleed easily during sex, providing direct access for the HI-virus. Symptoms of STIs: • Foul smell from the genital area • Abnormal discharge or “drop” • Pelvic pain • Burning urination • Ulcer or sores in the genital and anal area • Genital warts • Skin rash

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The link between HIV and tuberculosis (TB) Tuberculosis is known as an infectious disease caused by bacterium mycobacterium tuberculosis (TB) and generally affects the lungs. It can also affect other parts of the body. When HIV positive, your immune system is compromised, making you more susceptible to contracting TB. When you have TB, you are at risk to someone living with HIV. Remember: TB is an airborne disease and can be spread through speaking, sneezing and coughing.

Do you have at least two of these symptoms? Go and have yourself checked out.

IMPORTANT: Anyone can contract TB. Having TB does not mean you are HIV positive. TB is a treatable disease and can be cured!

REMEMBER! Wash your hands regularly. When coughing, hold the back of your hand against your mouth. Working and living in well ventilated rooms or areas is IMPORTANT!

Common symptoms of TB: • Persistent cough for longer than two weeks • Night sweats • Weight loss • Productive blood staining cough (haemoptysis) Aidsinfo (2017)

Activity Why do you think the Western Cape has the highest TB infection rate in the world? Research will assist with your answer. (Useful resources: Google Scholar, WHO, UNAIDS, SA DoH) Test your risk of contracting HIV or STIs Read through the questions below and circle the relevant risk level How often do you drink alcohol? I do not drink alcohol I occasionally drink alcohol I frequently drink alcohol

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

How often do you take recreational drugs (tik, cocaine, crack, pot, dagga, etc.)? I do not use drugs High risk Low risk I occasionally use one of these drugs High risk Low risk I frequently use two or more of these drugs High risk Low risk

No risk No risk No risk

Are you, or a person you had sex with, circumcised? Yes No I don’t know

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

Do you use a condom when having sex with your partner? I always use a condom High risk I occasionally use a condom High risk I never use a condom High risk

Low risk Low risk Low risk

No risk No risk No risk

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Do you know your partner’s HIV status? Yes No I don’t know

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

When last did you go for an HIV test? Less than a year ago More than a year ago Never been for a test

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

How old is your sex partner? Older than me My age Younger than me

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

Have you ever had sex with a “blesser” in exchange for goods or money? Yes High risk No High risk

Low risk Low risk

No risk No risk

Do you have any STI symptoms? Yes No

High risk High risk

Low risk Low risk

No risk No risk

What are your sexual practices? Abstinence Penis to vaginal sex Having sex with sex toys Penis to anal sex Finger to vaginal sex Oral sex

High risk High risk High risk High risk High risk High risk

Low risk Low risk Low risk Low risk Low risk Low risk

No risk No risk No risk No risk No risk No risk

Sexual violence and the risk of HIV transmission Research the link between intimate-partner violence and HIV transmission. Find and study an article on a recent gender-based violence incident. • Was the incident intimate-partner related? • What do you think could have been done to avoid the incident?

Have a group discussion/debate on the following topic: Why does South Africa have such a huge problem with sexual and gender-based violence; and what, in your opinion, can be done to address it? How do you think the issue of “Rape Culture” can be addressed at Higher Education Institutions? (Use your institution’s ‘Sexual Harassment Policy’ to assist you.) What role do you think graduates can play to address intimate partner violence in society?

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High risk behaviour amongst students at your campus Activity: Reflection What does the term ‘high risk behaviour’ mean to you?

What acts do you think would qualify as high risk behaviour?

What actions would you take to address high risk behaviour amongst students?

Confidentiality activity (Source unknown) The facilitator hands out a small piece of paper to you and your class. Each of you is asked to write down your deepest secret. Fold it into a small wad and hand it to the person next to you, who then needs to hold it in their hand without unfolding it. Answer the following questions: • What went through your mind when asked to do this task? • Were you comfortable to hand the folded paper to the person next to you? Why? • What did you expect the person to do with your secret? • How do you associate this activity with someone trusting you with their HIV positive status?

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HIV and STI prevention Safer sex Condom use Did you know... That a condom is the only contraceptive that can • Prevent you from impregnating your partner? • Protect you from contracting STIs or HIV? That the Choice condoms, provided by the state, undergo stringent tests by the South African Bureau of Standards to ensure that that they are safe and reliable? That a condom can only be used once and should then be disposed of by wrapping it in toilet paper, before throwing it away?

Correctly number the steps from 1-10 on how to correctly use a male condom (find the correct answer on last page in the book)

Did you know that a male condom can be used as a finger condom?

Move the condom down inside the packaging and tear the package carefully. Do not use your teeth or nails to do this.

Throw the used condom away. You can wrap it up in toilet paper and throw it in the rubbish bin. Check the expiry date on the condom; and make sure the package is sealed and that no air is escaping.

Roll the condom to the base of the penis near the testicles.

Roll down the condom about a centimetre to see which way is the right side.

Hold the tip of the condom to leave space for the semen and to keep air bubbles out.

If the penis is uncut (uncircumcised), pull the foreskin back first.

Make sure the penis is erect. When pulling out, hold the condom at the base near the testicles so that it doesn’t slip off.

Put the lube on the tip of the condom once it is on. For both vaginal and anal sex, use only water-based lubrication, such as KY Jelly.

Important to know HIV can enter the body through: • The lining of the anus or rectum • The lining of the vagina and/or cervix (mouth of the womb) • The opening to the penis • Mouth sores or bleeding gums • Cuts or sores on the body

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The female condom Female condoms can be inserted any time up to eight hours before sexual intercourse. See the instructions opposite.

outer ring add extra lubricant if wanted

Blood and body fluid spilling • • • •

Wear appropriate personal protective wear (gloves, mask); Cover the spill with paper towel; Carefully pour 1:10 bleach around the edges and onto the spill and allow to stand for 10 minutes; Use a paper towel to clean up the spill from the edges to the centre and discard into a hazardous waste container.

inner ring at the bottom

inner ring

open end

Activity Your friend accidentally got injured and is bleeding. How will you assist your friend without putting yourself at risk?

Modes of HIV infecTIon

D pubic bone

Photocredit: Avert

HIV is found in VERY LOW concentration - or is ABSENT - in saliva, sweat, tears and urine

HIV is found in MEDIUM concentration in anal secretions

HIV is found in HIGH concentration in blood, semen, vaginal secretions, menstrual fluid and breast milk

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HIV prevention strategies The ABC (Abstain, Be Faithful and Condomise) strategy is no longer regarded as an effective approach to prevent HIV infection. There are up to 10 HIV prevention methods (see the list that follows). A collective or combination approach to HIV prevention is more effective than a single approach.

1. Abstinence - This is the only guarantee that you won’t contract HIV or STIs, but there are other risks of contracting HIV and that is through needle prick injuries, being exposed to bodily fluids through assisting, for example, at accident scenes, through using drug users’ contaminated needles, etc. The use of gloves can prevent work-related injuries like cleaning up someone’s bodily fluids. Discarding contaminated materials the correct way will prevent risk of exposure to bodily fluids or needle prick injuries. 2. Being faithful – Although this is not a guarantee, it is important to know your HIV status and be faithful to the same partner. Having multiple sexual partnerships is a huge risk for HIV and STI transmission. 3. Regular condom use during sex – Condoms act as a barrier against HIV infection. When used correctly and 100% of the time, condoms will prevent exposure to the HI-virus and protect you from contracting HIV or STIs. 4. HIV counselling and testing – Getting to know your HIV status is very important, because if you are tested HIV positive, you will be referred for further care and antiretroviral treatment. If you test HIV negative and were exposed to someone’s bodily fluids less than three months ago, you will be asked to return for another HIV test within 3 months after your last exposure to that person’s bodily fluids. 5. Treatment of sexually transmitted infections and other vaginal inflammation not caused by STIs. When the vagina or penis is infected with an STI or there is vaginal inflammation, the risk of lacerations is much higher, creating an entry point for the HI-virus. When an infection is treated, the risk is lower.

6. Voluntary Medical Male Circumcision – This is the full removal of the foreskin. When an HIV negative male is fully circumcised, his risk of contracting HIV is up to 60% lower. Other health benefits include lowered risk of certain STIs; and being circumcised is more hygienic and reduces his female partner’s risk of contracting cervical cancer. 7. Post exposure prophylaxis (PEP) – This is antiretroviral treatment taken after a person was accidentally (or intentionally) exposed to another person’s bodily fluids, varying from semen to vaginal fluids or blood. NB: This treatment must start within 48 to 72 hours after exposure. 8. Prevention of Mother to child transmission – This is also known as PMTCT and is a method used to reduce the risk of HIV transmission from a mother who is infected with HIV to an infant. HIV can be transmitted from a mother to an infant before, during, and after labour. 9. Pre-exposure prophylaxis – This is also known as PrEP and is an antiretroviral treatment that involves taking a pill every day and is used by people who are at risk of contracting HIV. The pill contains two drugs, tenofovir and emtricitabine, known as truvada. 10. Microbicide ring (Dapivirine) – This is a matrix ring (silicon) that is inserted inside the vagina. The ring consists of an antiretroviral drug referred to as Dapivirine that is slowly released in the vaginal area with the objective of preventing HIV transmission. Recent study findings have proven that the ring reduces a female partner’s risk of contracting HIV by up to 30%. The ring is not available as yet and still needs approval from the USA FDA and SA Medicine Control Council before it can be made available.

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Number each from 1 to 10 Which of the 10 prevention strategies would you use for …? (You can select more than one.)

A pregnant woman Someone who, for example, was exposed to another person’s bodily fluids, injured themselves while assisting on an accident scene, or was raped? Drug users who inject themselves with drugs Sexually active individuals Female partners who have difficulty negotiating condom use with their partners

Choosing the right HIV awareness method for the right audience

Workshops can normally last for few hours (3 to 6 hours). Interactive activities, icebreakers, short educational videoclips and regular short breaks are important when conducting a workshop. Keep presentation slides to a minumum. Allow participants to present group activities and remember to let them complete an evaluation form to help you improve your sessions. Door-to-door visiting is a good way of speaking to small groups of people. Remember safety first. This method works for reaching people who do not attend events. Taking pamplets and informational leaflets is important so you can leave these behind in cases where people do not have time to listen to you. Pamplets and posters must be interesting, appealing, short and to the point. Avoid too much jargon and speak to the audience.

Talks and discussion groups at campus residences, churches, organisations, schools. These should not be longer than 20 minutes and leave time for lots of questions. Introduce an interesting topic that affects the youth, like social justice, sexual and genderbased violence, teenage pregnancy or the blesser phenomenon. If you don’t have the answer to a question, write down the question and find out. Avoid giving inaccurate answers. Plays, music and songs are effective ways of educating people who do not like to sit in a workshop or lecture room. This works well for youth groups and schools. Competitions can be used as effective way to draw people.

News articles and radio can be used for educational stories, short talks, columns and radio interviews. Addressing assemblies or community meetings. Here you can make short speeches to empower and educate larger groups of people. Make short introductory speeches covering the key issues you want to carry over. Talk facts and avoid reading speeches off a paper. Allow an opportunty for questions. Always remember that people can ‘read’ if you are honest, well informed and sincere when adressing them.

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HIV and the economy HIV has a ripple effect on the economy. Any economy requires people to drive it. When people are unable to work due to illhealth, it impacts the economy. A lot can, however, be done to reverse the impact of HIV on the economy.

Activity: Reflection Write down three examples that show the impact of HIV in a workplace. Example

What would be some signs to look out for?

What could you do to manage this situation?

e.g. Productivity

The employeeâ&#x20AC;&#x2122;s productivity decreases.

Offer assistance through and employee assistance programme

Workplace injuries A workplace injury is something that occur in relation to employment. Some workplace injuries are high risk, some are low risk and some no risk at all. Certain workplace injuries can increase your risk of contracting

HIV. A good example is that of nurse, dentist or any health care worker that is exposed to contaminated needles or bodily fluids. Remember there are infections like hepatitis B that are highly contagious through a needle prick injury.

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Complete the table below, and indicate in which category these workplace injuries fall. Workplace

Level of risk (No risk, Low risk, high risk)citizen

Type of workplace injuries

Prevention strategy

Construction Management Nursing, Dentistry Hospitality industry Radiography Business Emergency Medical Services Education Engineering

Some other facts about HIV

Photocredit: AidsInfo (2017)

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Reflection What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to make a difference at your campus community. 1. I can

2. I can

3. I can

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REFERENCES Aidsinfo. 2017 HIV Life Cycle. https://aidsinfo.nih.gov/education-materials/glossary/814/budding [22 March 2017] Jenkins J. 2001. The dynamics of Icebreakers. Available: http://www.albany.edu/cpr/gf/resources/Icebreakersand-Introductions.htm[24Mar17)

useful resources World Health Organisation website: http://www.who.int/hiv/en/ UNAIDS website: http://www.unaids.org/ HIV replication- https://www.youtube.com/watch?v=mzfnxCEsck4 HIV infection & prevention- https://www.youtube.com/watch?v=Eqxu3jjh3LE Blesser phenomena- https://youtu.be/nKA7FLYc-GM 2015 Peer Educator Conference https://www.youtube.com/watch?v=Cyv77cS7UPg 2016 Peer Educator Conference https://www.youtube.com/watch?v=RUmVDDoDBMk Avert. https://www.cabsa.org.za/book/export/html/1098

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Stigma and Discrimination THE AIM of this chapter IS: • • •

to create an awareness of stigma and discrimination; and to expose students to possible situations/scenarios of discrimination to display various platforms in which stigma and discrimination can take place

People can be stigmatized or discriminated against for various reasons. In most cases, this stigmatization or discrimination occurs when a person presents with a physical, emotional, spiritual or moral difference when, compared to the ‘norm’. The most instinctive thing for many people is then to see the other person’s difference as ‘abnormal’ and then discriminate against the person in wider circumstances beyond the situation where the original difference was noticed. Stigma and discrimination occur in different forms and can be practised on various platforms, like at work, in school and in sports teams. Stigma occurs when a person or a group of people are devalued because they are associated with a certain disease, behaviour or practice. The effects of these can be even worse for groups who are already marginalized because of their gender, sexuality, ethnicity, or their substance abuse. Often, those who stigmatize people living with HIV falsely believe that the virus is highly contagious and that they could easily become infected. When that happens, others start to view people with HIV as a threat and, as a result, those living with the virus become isolated – within their homes, in public, or in their workplaces.

Activity: Think of a situation or scenario in your own life where you felt you were unfairly treated, then answer these questions: • What was the situation? • Did you have any control over the situation? • How did you feel when it occurred?

People living with HIV are further stigmatized by others’ assumptions about their moral integrity – such as the belief that they became infected with HIV because they chose to take part in risky behaviour. Because women are held to a different moral standard than men in many countries, women are often disproportionately blamed for the spread of HIV in their communities. In the end, stigma and discrimination undermine global efforts to prevent HIV transmission and provide care and treatment services to people living with HIV. Among marginalized or ‘key populations’ most at risk of HIV – like adolescent girls, men who have sex with men, sex workers, or people who inject drugs – stigma and discrimination impede access to and uptake of HIV services.

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Stigma and discrimination also hinder people living with HIV from telling their partners about their status, for fear of being abandoned, ostracized or physically abused. Additionally, HIV-related stigma affects people’s ability to earn a living, making it even more difficult for people living with HIV to lift themselves out of poverty. Ultimately, stigma and discrimination infringe upon people’s basic human rights.

Analysing stigma against key populations MSM (Men who have Sex with Men) Stigmatized for: not getting married; not being a ‘real man’; being effeminate; using effeminate gestures; the way they speak; the way they dress; being different. Where? School; work; in the family; cafés and bars; religious spaces public ceremonies; local neighbourhood; police station; prisons. Why? Lack of understanding; fear of difference; cultural beliefs; religious beliefs; holding certain judgments about the difference; laws that punish same-sex acts. Effects: isolation; suicide; anger; unwanted or forced marriage; risk-taking; poverty; unemployment.

Where? Health facilities; family; community; workplace. Why? Fear; moral judgments; traditional beliefs. Effects: depression; loss of employment; suicide.

The different types of stigmatization External stigmatization is the way others regard People living with HIV (PLHIV). It is displayed through attitudes or actions aimed at PLHIV, including insults, rejection, avoidance, intolerance, stereotyping, discrimination, and physical violence.

Sex workers Stigmatized for: having multiple partners; earning money from sex; living a ‘reckless’ life; not conforming to societal norms. Where? Family; clinic; bars; in the streets. Why? Moral judgments; cultural beliefs. Effects: living a secret life; suffering violence; depression; children stigmatized; avoidance of attending the clinic; being ostracised from local community and society; no marriage prospects.

People who inject drugs Stigmatized for: being seen to be putting their lives in danger; being irresponsible. Where? Home; clinic; in public; school. Why? Fear that they are out of control; seen as not caring; seen as dangerous or rule-breakers. Effects: further drug use; increased vulnerability to risk-taking; isolation; avoidance of seeking treatment.

People living with HIV Stigmatized for: being ‘careless’; being ‘promiscuous’; being ‘immoral’.

Internalized stigmatization happens when PLHIV begin to believe the negative things that those around them say or think. It can also be seen as thoughts and behaviours resulting from the person’s own negative thoughts about him/herself based on his/her HIV status. Anticipated stigmatization is the anticipation or expectation that one will be treated differently or poorly because of the stigmatized identity of PLHIV as a group. Lastly, “courtesy stigmatization” is the stigmatization a person perceives or experiences due to his or her association with a stigmatized individual or group.

Stigma on top of stigma HIV-related stigmatization often happens together with other forms of social stigmatization as a result of race, gender and class-based inequalities, engaging in sex work, having non-normative gender identities or sexualities, religious persecution, xenophobia, drug use, mental and/or physical disability, disease, and so forth. This increases both the exclusion and devaluation of PLHIV leading to double or multiple stigma (i.e., “super-stigmatization”).

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Case studies of people living with HIV Vuyo Vuyo is 22 years old and has been with his boyfriend for the last two years. He has recently tested HIV positive and has decided not to tell his boyfriend yet. He has been given information about re-infection, and he also wants to protect his boyfriend, so he needs to start using condoms. However, he doesn’t know how to start talking to him about it.

Melissa Melissa is 19 years old and is the youngest member of a new support group for people living with HIV. She is keen to represent young people who are HIV positive, but feels that sometimes she is not taken seriously by older group members. She finds it difficult to speak in meetings when everyone talks loudly. Although she is thinking of leaving the group for this reason, she would rather stay involved in it because she cannot talk about HIV to her friends.

Ibrahim Ibrahim is 20 years old and is living with HIV. He was rejected by his family and has been selling sex to men in the capital city for the last nine months to make ends meet. He often attends group meetings for MSM led by peer educators from a local NGO, but he has not told anyone there that he is HIV positive. He wishes he could be more open and talk to someone about his situation, but does not know where to start.

Zahara Zahara is a 23-year-old sex worker who is HIV positive. She is taking antiretroviral drugs and is very healthy. She always uses condoms with her clients but not with her boyfriend, who refuses to use them. Zahara is now worrying that she may be pregnant. She does not know whether to tell her boyfriend, and wonders how she will survive if she needs to

Shaun Shaun is 20 years old and has recently found out that he is HIV positive. He has been seeing his new partner for just one month. He would like to tell his partner about the HIV result but is worried about what might happen. He is falling in love, and the thought of his partner leaving him has given him sleepless nights. He doesn’t know what to do.

• • •

• • • •

How can Vuyo start talking about condoms? Do you think Vuyo should tell his boyfriend about being positive? If so, how? If not, why not? If Vuyo lived in your area/campus, what types of services could Vuyo go to for support?

Why do you think the rest of the group do not take Melissa seriously? What tips could you give Melissa to help her be heard in the group? What particular issues do young people face when they are living with HIV that older people may not recognise? Are there any services available specifically for young people in your area?

He fears they may reject him from the group because he is HIV positive. • What do you think are some of the reasons that Ibrahim has not told anyone in his peer education group about being HIV positive? • What can NGOs do to help people in Ibrahim’s situation to be open about their status? • Are there any services in your area that could support someone like Ibrahim?

stop working as a sex worker. She doesn’t trust her boyfriend as he is unreliable. • Why do you think Zahara does not use condoms with her boyfriend? • What tips would you give Zahara to tell her boyfriend about being pregnant?

• • •

Do you think Shaun should tell his new partner about being HIV positive? If so, why? If not, why not? Do you know anyone who has been in this situation? If so, discuss. What role do you think NGOs or other service providers can play in supporting someone in Shaun’s situation?

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New bill to criminalise hate crimes and hate speech

Photo: Flickr.com/Alisdare Hickson

PARLIAMENT - Cabinet on Thursday announced it had given the green light for a new bill which would make hate crimes and hate speech criminal offences to be published for public comment. “The bill seeks to create the offences of hate crimes and hate speech and to put in place measures to prevent and combat these offences,” said Minister in the Presidency Jeff Radebe while briefing journalists on Wednesday’s fortnightly cabinet meeting. “The aim is to address the increasing number of racial incidents and to further address other types of criminal conduct motivated by bias, prejudice or intolerance in the form of hate crimes and hate speech, which have occurred in the recent past.” The bill, which was first drafted to only make provision for hate crimes, was later amended after several instances of hate speech via social media which caused an outcry among South Africans. This included KwaZulu-Natal real estate agent Penny Sparrow calling black people monkeys in a Facebook post which made headlines and saw dozens of complaints being lodged with the South African Human Rights Commission. The Prevention and Combating of Hate Crimes and Hate Speech Bill will create offences for several forms of discrimination, including on the basis of race, gender, sexual orientation, religion and nationality. Africa News Agency

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Social media and stigma and discrimination These days, social media and the Internet have taken over our daily lives. We display our thoughts and feelings about various issues on various platforms and put ourselves at risk of being labelled as sexist, homophobic, racist and generally insensitive towards other people. How you depict yourself on social media regarding various issues can be viewed as stigmatising of and discrimination against other people. Consider this example:

if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite.” Our way of life has become always to look at others and what they are doing wrong or to think, ‘That’s not normal’. It has become natural to seek the difference and abnormality in others for us which helps us to feel more ‘normal’. The question is, who decides what is normal and who determines who is normal? The solution and answer is very simple: it lies in the inclusion and acceptance of all in the human race. We should condition ourselves to thinking that it is actually abnormal to hate and discriminate against others based on the colour of their skin or any other personal trait. Indeed, it should be become more normal to love than to hate.

REFERENCES Brown , L., Trujillo,L., Macintyrye, K. (2001). Interventions to reduce HIV/Aids stigma : What have we learned?. Brown, L., Trujillo, L., Macintyre, K. 2001. Interventions to reduce HIV/Aids stigma: What have we learned? Louisiana: The Population Council Inc. Chiya, C., Chonta, M., Clay, S. & Hernandez, J. 2013. ‘Understanding and challenging HIV stigma: toolkit for action’. International HIV/AIDS Alliance. Goldbach, J., Amaro, H., Vega, W., Walter, W. 2015. The grand challenge of promoting equality by addressing social stigma. Grand Challenge for Social work initiative, working paper no. 18. Baltimore, MD: American Academy of Social Work and Social Welfare. Most recently, the news has been buzzing with cases where people expressed hate speech on various social media platforms. Most of these cases were racially inclined, but in so many cases, people utter hate speech towards LGBTI people and even people that are HIV positive. The consequence of these hateful acts can be legal prosecution and in most cases being suspended from one’s university, work or school. No form of hate speech can or must be tolerated and we should all come to terms with the reality that we live in a diverse and multicultural country.

Conclusion Nelson Mandela once said: “No one is born hating another person because of the colour of his skin, or his background, or his religion. People must learn to hate, and

Smita, P., Brady, M., Carter, M., Fernandez, R., Lamore, L., Meulbroek, M., Ohayon, M., Platteau, T., Rehberg, P., Rockstroh, J. & Thompson, M. 2012. HIV-related stigma within communities of gay men: a literature review. Aids Care, 24(3-4): 405-412. https://www.ncbi. nlm.nih.gov/pubmed/22117138 [5 April 2017]. doi: 10.1080/09540121.2011.613910

Useful RESOURCES http://www.enca.com/south-africa/new-bill-to-criminalisehate-crimes-and-hate-speech http://www.dispatchlive.co.za/news/2017/03/12/yusufambramjee-lays-criminal-charges-man-hate-speechsocial-media/ http://www.theguardian.com/world/2013/dec/22/pr-execfired-racist-tweet-aods-africa-apology

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Sexual Diversity THE AIM of this chapter IS: • • •

To create a sense of inclusivity amongst the student population To create an understanding of all aspects of sexual diversity To establish sensitivity amongst students in regards to the LGBTIQA community

‘Sexual diversity’ is an inclusive term that encapsulates various sexual orientations, identities and sexual relationships. It is an umbrella term that gives understanding and meaning to your gender, sexual preferences and how you engage sexually with others. Every person has their own sexual identity that is made up of a combination of three inter-related factors – biological sex, sexual orientation and gender. These factors combined determine the sexual identity of a person.

Biological sex Male (InterseX) Female Most people are born biologically either male or female. However, even biologically, there are exceptions when people are born intersex. This means they are born either of indeterminate sex (with male and female genitals or undeveloped genitals) or are affected by hormonal conditions due to internal ovarian tissue (in boys) or testicular tissue (in girls). Most often, surgical intervention gives intersex individuals a female genital identity, as this is often easier than constructing male genitalia. Intersex does not indicate a specific sexual orientation – it reflects biological features. An intersex person may be heterosexual, homosexual or bisexual.

women. Gender concerns men and women, including conceptions of both femininity and masculinity. The difference between ‘gender’ and ‘sex’ is that the latter refers only to biological differences. Gender does not mean focusing solely on women or females, but rather on the inequalities between males and females, and should not be confused with feminism or women’s studies. Analyses of gender differences often show a disadvantaged and weaker position of women and girls in social, political, economic, legal, educational and physical issues. This is why there is a tendency for gender discussions and interventions to focus on correcting these imbalances by specifically targeting women and girls.

Gender identity FEMININE (TRANSGENDER) MASCULINE Gender identity relates to cultural customs and social roles. Gender roles are socially defined and will determine acceptable behaviours and roles for women and men. In patriarchal societies, a masculine gender identity usually assumes relative power over a feminine gender identity.

Gender ‘Gender’ refers to the socially-constructed roles of and relationships between men and

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Activity: Act like a man … Act like a woman! List all the characteristics and behaviours society expects from men and women: MEN

WOMEN

After doing the above activity please discuss the following questions: • Could it be difficult for a woman to be expected to behave in this manner? Why? • What emotions are women not allowed to express? • How can social norms and expectations to “at like a woman” have a negative impact on a woman’s sexual reproductive health? Can women actually live outside the box? Is it possible for women to challenge and change existing gender roles?

Sexuality Sexuality is an expression of who we are as human beings. It includes all our thoughts, behaviours and feelings of being male or female, of being in love and attracted to particular people. This includes being in a relationship, being intimate and having sexual contact with another person. The concept of sexuality begins before birth and is determined by various influencing factors within your life. A person’s upbringing, including their morals, values, religion and culture, has a huge impact on the way somebody expresses themselves sexually.

Sexual orientation The basic model of sexual orientation is that people are heterosexual or homosexual – heterosexual means sexually and emotionally attracted to people of the opposite sex and homosexual to the same sex. HETEROSEXUAL (BISEXUAL) HOMOSEXUAL

Over time, everyone knows whether they are mainly sexually attracted to people of the same or the opposite sex. This usually happens by adulthood, but it may shift over time and some individuals may never be certain. A significant number of people, irrespective of culture or social norms, may be sexually attracted to people of both sexes. This is often referred to as being bisexual. Such people may form long-lasting, intimate and loving relationships with people of either sex.

Roadmap to your social, mental and physical wellbeing

Sexual identity and orientation Transgender people challenge traditional cultural concepts of gender and experience a conflict between their biological sex (usually assigned at birth) and their

gender identity. For example, a man who is transgender may choose to dress as a woman or to assume a lifestyle generally associated with being female. Being transgender does not define the person’s sexual orientation and a transgender person may be attracted to either men or women, or both.

Things to remember: • People may or may not express their sexual orientation/ identity in their behaviours, sexually or otherwise. YOU CAN NEVER ASSUME ANOTHER PERSON’S SEXUAL ORIENTATION; • Some people may regularly have sex with others of the same sex, without seeing themselves as lesbian or gay or bisexual (whether due to cultural, religious or personal reasons); • Gender identity/ presentation has got nothing to do with being lesbian or gay. Most lesbian women consider themselves as women and, similarly, most gay men consider themselves to be men; • Do not assume that when a man is feminine and subscribes to certain female gender roles that he is gay, or when a woman is masculine and subscribes to certain male gender roles that she is lesbian. GENDER ROLES DO NOT DEFINE SEXUAL ORIENTATION; • Being transsexual has got nothing to do with being lesbian or gay. Transsexual people can be heterosexual, lesbian, gay or bisexual; • Intersex is a biological variant and NOT a sexual orientation, nor does it refer to sexual behaviour.

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My friend/family member has come out as lesbian/gay/bisexual Think about how you felt about them before they told you - ask yourself why this would change just because they are attracted to people of the same gender or both genders. Who they are attracted to doesn’t change who they are as a person.It’s okay to let the person know that it might take you time to get used to the idea, but that you will do your best to support them. It’s also okay to ask questions, as this shows that you are taking them seriously. At the same time, try and be sensitive about how they are feeling – it’s not easy coming out to someone close to you. Sometimes it can be easy to dismiss a young friend or family member who comes out as ‘just going through a phase’ – but most people who come out have put a lot of thought into it before telling someone, so it is important to take it seriously. Try and let the person explore their sexuality without trying to change or pressure them. Understanding gender and sexuality can become a complicated and overwhelming endeavour. We form opinions and decisions based on our learned experiences and the norms to which we have been exposed. Gender, as well as sexual expression, in most cases is a taboo subject that gets overlooked, hence not many of us have a point of reference or understanding when it comes to these aspects of human nature. The best way to try and understand these concepts is to break them down into simple categories, see illustrations opposite.

Roadmap to your social, mental and physical wellbeing

LGBTQIQ ( Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex and Questioning) Terms and definitions Please note that the following terms and their definitions are not necessarily universally accepted. Variations exist both within and outside LGBTQIQ communities in the usage and interpretation of these terms. The following list of terms and definitions is taken from the Georgia State University and University of Georgia Safe Zone Facilitator Manual Term

Definition

Sexual Identity

This is how we identify ourselves. Such labels include lesbian, gay, bisexual, pansexual, straight, heterosexual, etc. This term refers to a person’s emotional, physical, romantic and sexual attraction.

Gay

Generally, this term refers to a male who is physically, emotionally, and/or spiritually attracted to other males. It may also refer to females who are attracted to other females. It is also sometimes considered an umbrella term.

Lesbian

A female who is physically, emotionally, and/or spiritually attracted to other females.

Bisexual

A person who is physically, emotionally and/or spiritually attracted to persons of the same or opposite sex.

Heterosexual

A person who is sexually, emotionally and/or spiritually attracted to member(s) of the opposite sex.

Questioning

A term used to describe an individual who is not yet certain of their sexual identity.

Asexual

A person who does not desire intimate emotional and/or sexual relationships with other people.

Pansexual (Omnisexual)

An individual who is sexually, emotionally and/or spiritually attracted to people, regardless of their gender identity or biological sex. This individual could be open to someone who is male, female, transgender, intersex, or GenderQueer.

Down Low

A label adopted by some African Americans to describe men who seek same sex relations but do not necessarily identify themselves as gay or bisexual.

Closeted

The opposite of being “out,” meaning that one’s sexual identity is concealed, or one is presumed to be heterosexual.

Coming Out

Generally, this denotes the act of telling someone that one is lesbian, gay, bisexual, transgender or another sexual identity.

Outing Someone

To declare someone’s sexual identity publicly without their permission.

Gender

A complicated set of sociocultural practices whereby human bodies are transformed into “men” and “women.” This refers to that which society deems “masculine” or “feminine.”

Gender Expression

This refers to an individual’s characteristics and behaviours, such as appearance, dress, mannerisms, speech patterns and social interactions that are perceived as masculine or feminine.

Drag Queen

A term usually reserved for individuals who identify themselves as gay men and who cross-dress for entertainment purposes.

Drag King

A term usually reserved for individuals who identify themselves as lesbians and who cross-dress for entertainment purposes.

Cross Dresser

An individual who dresses in clothing that is culturally associated with members of the “other” sex. Most of these individuals are heterosexual and participate in this activity on a part-time basis.

Gender Identity

This is the individual’s internal, deeply felt sense of being male, female, or something other, or in-between.

Transgender

A range of behaviours, expressions, and identifications that challenge the pervasive binary gender system. This is an umbrella term that can be used to describe people whose gender expression is non-conforming and/or whose gender identity is different from their birth assigned gender.

Cisgender

This refers to the situation when an individual’s biological sex and gender identity match. For example, this term describes a woman who is born biologically female and identifies as a woman. It is used as the opposite of the term transgender.

Gender Confirming Efforts

This term is replacing ‘sex reassignment surgery’ (SRS) and covers the full range of measures individuals may select to confirm their gender identity. This term takes into account the number of procedures associated with transitioning, including genital surgery, breast augmentation or reduction, hysterectomy and hormone therapy.

Sex

This is our “packaging” and is determined by our chromosomes (XX for females and XY for males) and our external and internal genitalia. About 1.7% of the population can be defined as born with both biological aspects of both sexes.

Intersex

Formerly addressed as ‘hermaphrodites’, individuals to whom this term is ascribed are born with some combination of ambiguous genitalia. About 1.7% of the population can be defined as born with both biological aspects of each sex. Some individuals participate in a movement that seeks to halt paediatric surgery and hormone treatments that attempt to normalise infants into the traditional “male” and “female” roles.

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Term

Definition

Transsexual

This describes individuals who do not identify with their birth-assigned genders and sometimes alter or align their bodies surgically and/or hormonally.

Homophobia

This is an irrational fear and hatred of all those individuals who transgress, violate, or blur the dominant gender categories in a given society. These attitudes lead to massive discrimination and oppression against the trans, drag, and intersex communities.

Heterosexism

There is a discriminatory assumption that people are, or should be, attracted to the people of the other sex. This assumption circulates anti-gay attitudes by promoting a value system and stereotypes that appear to justify prejudice and discrimination.

Hate Crime

This is any criminal act in which the targeted individual is chosen simply because of his or her affiliation to a minority group. In some states, hate crimesarry an additional penalty beyond the standard penalty for assault, murder, etc…

Myths and facts about LGBTI People

pressure to be heterosexual. This is often at great cost to self, because basic feelings haven’t changed.

Being gay is contagious

Sexual orientation emerges for most people in early adolescence without any prior sexual experience; and some people report trying over many years to change their sexual orientation from homosexual to heterosexual with no success. For these reasons, psychologists don’t consider sexual orientation for most people to be a conscious choice that can be changed voluntarily. The American Psychological Association has made several official statements that conversion therapy is unethical.

Most LGB individuals were raised by straight parents. Sexual orientation is most likely determined by genetics.

Gay people recruit others to be gay Sexual orientation can’t be changed. Gay people are attracted to other gays. This myth may come from the fact that many gay people don’t come out until they older, when they meet someone to whom they are attracted. This doesn’t mean that they weren’t gay before, just that they hadn’t come out yet. Gay people do not sexually stalk straight individuals for casual sex. There are specific gender roles in gay relationships There are a variety of forms of gay relationships, just as heterosexual relationships. Sometimes there may be specific roles for each person, sometimes these roles are very flexible. Original butch/femme roles may have come from imitating heterosexual roles.

Gay men want to look like women and lesbians want to look like men Some gay men do enjoy wearing women’s clothes, but most don’t. Most conform to cultural expectations for men’s dress. Lesbians usually do not want to look like men. Their choice of dress is more often determined by comfort and, possibly, by rebelling against stereotyped ideas of what women should look like. Some lesbians enjoy dressing in very feminine clothing.

Gay people could change if they want to Research has repeatedly shown this is not true - that sexual orientation is something we are born with. Examples of people who claim to have changed their orientation usually indicate someone who has changed their behaviour in response to internal or external

Therapy could cure homosexuality Treatments that claim to cure homosexuality are just successful in coercing heterosexual behaviour - you cannot change a person’s inner feelings about their basic orientation.

People are gay because they were sexually abused Most people who were sexually abused do not take on a gay identity. Gay and lesbian people, just as heterosexuals, may have been abused, but this has no relation to their sexual orientation. Straight women who have been sexually abused by men may have difficulty relating to men, but this does not mean they are lesbians.

Gay people do not have stable or long relationships Even though gay and lesbian relationships do not have the social supports which heterosexual relationships have, many gays and lesbians form long-term, monogamous, stable relationships and consider themselves to have a lifetime commitment to each other. Many heterosexual people have trouble forming stable relationships; so do some gay, lesbian and bisexual people.

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Case studies: Understanding GENDER and sexual diversity

Caster Simenya

Caster Simenya is a well-known South African athlete who came under the public eye in 2009 for the questioning of her gender. According to media reports, Caster was subjected to a gender testing to determine whether she was male or female. The test that was ordered by the International Association of Athletes,

Rupaul Charles

Rupaul Charles is a famous drag superstar and is the face and founder of the television sensation, Rupaul’s

Caitlyn Jenner

Caitlyn Jenner was born as Bruce Jenner. Bruce Jenner was a typical male who identified as a heterosexual male who was attracted to females and subscribed to many dominant male activities and characteristics. Bruce Jenner was a well-known

determined that she was intersex, in other words considered as both male and female, a condition known as a sexual development disorder. This was a very difficult time that she said she prefer to forget and focus on the future. Caster grew up as a woman and married her female partner in 2017. In an interview with BBC Sport’s Smith, Caster says about the publics view of her: ‘I think they understand me as I am. I am not a fake. I am natural. I am just being Caster. I don’t want to be someone I don’t want to be. I don’t want to be someone people want me to be. I just want to be me. I was born like this. I don’t want any changes.”. Her gender identity did not determine her sexual orientation and Caster’s sexual attraction was not probed by her gender nor sex. This example gives us a clear understanding that sex and gender are two concepts that have a closer relation to one another and sexuality, while sexual orientation is a concept that strictly has to do with your attraction and sexual attraction towards another.

Drag Race. Rupaul was born a male and, as a child, subscribed to most activities and characteristics of the male gender identity. Rupaul also shows a different dimension of gender expression when he embraces his alter ego and drags into a female persona. This persona is not a permanent expression, but is seen as an artistic expression of gender. Rupaul identifies as a gay man when in and out of drag, as his gender is always male and his sexual attraction is towards the same sex. Rupaul’s gender expression teaches us that there are born males that at times express themselves as female but have no desire to make this a permanent arrangement and still embrace their masculinity and male sex.

athlete and enjoyed fast cars and sports in general. According to Bruce in a TV interview that, as a male, he overcompensated with his macho masculine activities owing to the internal conflict he had, longing to express himself as a female. He would secretly cross-dress but never openly exposed himself. In 2015, Brace decided to undergo gender re-affirming surgery to start his process to transition to become a female. He is now known as Caitlyn Jenner. Caitlyn Jenner is a female who is sexually attracted to females, the exact same sexual orientation as Bruce Jenner. From the case of Caitlyn Jenner, we can learn that heterosexual males can also have the desire to express themselves as females and, in some cases, they want to make this a permanent arrangement, so transition to become a female. Further, we also learn that your gender expression does not determine your sexual attraction and orientation, and these two concepts are totally independent from each other.

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Support services for young LGBTI people Students seeking support can contact the following organisations and community services Cape Town Triangle Project www.triangle.org.za (021) 686 1475

Northern Cape LEGBO Northern Cape (Kimberly) www.legbo.org (073) 626 3346

LGBTI religious groups Islam The Inner Circle (Cape Town) www.theinnercircle.org.za (021) 761 0037

Christianity Metropolitan Community Churches (Johannesburg, Cape Town, Pretoria) www.mccchurch.org.za

Judaism Jewish Outlook www.jewishoutlook.org.za (076) 215 8600

Forum for the Empowerment of Women www.few.org.za (011) 403 1907/(011) 403 1907

The Durban Lesbian and Gay Community and Health Centre www.gaycentre.org.za (031) 312 7402

Transgender information and support Gender DynamiX (Athlone) www.genderdynamix.org.za (021) 633 5287 Lesbian and Gay Equality Project info@equality.org.za (011) 487 3810/1 Gauteng

OUT Well-Being Pretoria www.out.org.za (012) 430 3272

The Gay and Lesbian Archives in Memory (GALA) www.gala.co.za (011) 717 4239

Coalition of African Lesbians www.cal.org.za (011) 4030 004 KwaZulu-Natal

The Gay and Lesbian Network (Pietermaritzburg) www.gaylesbiankzn.org (033) 342 6165/(033) 342 6500

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Conclusion Gender sex and sexuality has never been an easy topic to understand or comprehend. The best way to understand this is by focusing on the person as their sexuality or sexual orientation is just one aspect of the person. If all else fails, as South Africans, we should

always be mindful that we are governed by a constitution that stipulates all people living within the country will be treated equal and not discriminated against based on their race or sexual orientation etc. The diversity of our country includes all sexualities and sexual orientations and these individuals should feel safe and secure citizens of our progressive and inclusive country.

REFERENCES Adam, M., Bell, LA. & Griffin, P. 2000. Teaching for diversity and social justice. London: Routledge. Engender Health. 2001. Men as partners: a program for supplementing the training of life skills educators. Second ed. Johannesburg, South Africa. https://www.engenderhealth.org/pubs/gender/ppasa-manual.php [5 April 2017]. HEAIDS. 2010. HIV/AIDS prevention good practice: strategies for Public Higher Education Institutions (HEIs) in South Africa. Pretoria: Higher Education South Africa. Potgieter, C. & Reygan, F. 2014. Representations of LGBTI identities in textbooks and the Development of antihomophobia materials and a training module. In Francis, D. (ed.), Sexuality, Society & Pedagogy, 97-107. Bloemfontein: SUN MeDIA. Boseley, S. 20 August 2009. What determines Caster Semenya’s sex? The Guardian. https://www. theguardian.com/world/2009/aug/20/what-sex-is-caster-semenya [10 April 2017] Layng, K. 11 January 2016. RuPaul Andre Charles. Prezi. https://prezi.com/vheoqoq0qocc/rupaul-andrecharles/ [10 April 2017] Smith, B. 20 May 2015. Caster Semenya: ‘What I dream of is to become Olympic champion.’ BBC Sport. Athletics. http://www.bbc.com/sport/athletics/32805695 [10 April 2017] Yaniv, O, 10 September 2009. Caster Semenya, forced to take a gender test, is a woman...and a man. Daily News. http://www.nydailynews.com/news/world/caster-semenya-forced-gender-test-woman-manarticle-1.176427. [10 April 2017] Weisman, A. 25 April 2015. Bruce Jenner: ‘I’m not gay, I’m heterosexual.’ Business Insider. http://www. businessinsider.com/bruce-jenner-im-not-gay-im-heterosexual-2015-4 [10 April 2017]

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Men’s Health The aim of this chapter is to encourage men to utilise various health services, including reproductive health services. It also will allow males to empower themselves to protect themselves against infections.

Introduction According to Kariem and Kariem (2008), the main driver of the HIV/AIDS epidemic in South Africa is sexual behaviour. Amongst men who are sexually active between the ages of 15 and 24 years, 23 % reported multiple partners. A growing body of evidence also suggests that men are far less likely than women to access HIV services. Men’s reluctance to use these HIV services significantly undermines prevention and treatment efforts (Peacock, et al., 2008). Sexual behaviour is shaped by personal, interpersonal, environmental, cultural and structural forces. During a survey by Kariem and Kariem in 2008, they found that 43% - 80 % of females and males had not used a condom during their last sexual activity. The HIV/AIDS pandemic demands that both males and females should take responsibility to stem the tide of the spread of HIV/AIDS.

The empowerment of men The Higher Education HIV/AIDS Programme (HEAIDS), in collaboration with other stakeholders like the South African National AIDS Council (SANAC), the Department of Health, the Department of Higher Education and Training, USAID/PEPFAR, CDC, Johns Hopkins Health and Education in South Africa (JHHESA), Sonke Gender Justice, UNICEF, IDMT, the United Nations

System in South Africa and more than forty other civil society partners working in the field of HIV prevention and Health, has embarked on a national programme across all universities and TVET colleges to reach out to all male students.

The goal is to: • Empower males to take responsibility regarding high risk sexual behaviour associated with multiple and concurrent sexual partners, and alcohol and drug abuse; and • Promote HIV testing • Other important issues that would be addressed through these empowerment campaigns, are gender-based violence, male involvement in Prevention Mother to Child Transmission (PMTCT), and healthseeking behaviours in general.

The campaign used Interpersonal communication, Mass Media and Advocacy to reach its audiences. Television and the medium of radio and print media were also utilised. Other activities included advocacy initiatives targeting all levels of government, traditional leaders, civil society, faith-based and opinion leaders within communities around social constructions of men and male responsibilities (HEAIDS, 2013).

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Why is men’s health so important? The following factors contribute to men’s health, besides the biological factors that constitute who men are: • • • • • • • •

•

The health of men and boys cannot be separated from the ideas of what it means to be a man; Men’s health and wellness does not receive enough attention; Men take the decision regarding their sexual partners; Men decide on multiple sexual partners; Men as well as women report men’s resistance to the use of condoms; Men as well as women report men’s resistance to HIV testing; Cultural and traditional ideas impact on behaviour modification and lifestyle management; Alcohol and substance abuse influence men’s attitude regarding sexual behaviour, particularly intimate partner violence; and Men do not always show interest in family health issues.

•

The normal permeability and function of the membranes that surround cells.

A diet high in saturated fats tends to increase blood cholesterol levels, whereas a diet high in unsaturated fats tends to lower blood cholesterol levels. Although some cholesterol is obtained from the diet, most cholesterol is made in the liver and other tissues. The treatment of elevated cholesterol in the blood involves: • Diet • Weight loss • Regular exercise • Medication Important to know: • Check your cholesterol regularly, beginning at age 18 years and thereafter every 5 years; • Control your blood pressure. Regular exercise, at least 30 minutes daily, plus a reasonable diet intake containing low fat and enough fibre, will control your cholesterol and high blood pressure. Also, consume more vegetables and fruit; • Do not smoke! Both cigarettes and other smoked substances are harmful.

Common Health Issues The following are common physical and mental health ailments that are prevalent in men. It is however important to know that these conditions are not only limited to men.

Physical ailments High cholesterol “Cholesterol is a compound of the sterol type found in most body tissues. Cholesterol and its derivatives are important elements of cell membranes, but high concentrations in the blood are thought to promote certain health related conditions. Cholesterol is associated with an increased risk for heart and blood vessel disease. Cholesterol is essential to: • The formation of bile acids, vitamin D, progesterone, estrogens (estradiol, estrone, estriol), androgens (androsterone, testosterone), mineralocorticoid hormones (aldosterone, corticosterone), and glucocorticoid hormones (cortisol).

Diabetes This is one of the silent killers in men (WHO, 2016) because diabetes does not present with symptoms immediately, but can take a long period to manifest. Eventually blood sugar levels increase and finally spill over into the urine. The following are the most common symptoms to look out for: • Extensive thirst • Erectile dysfunction • Frequent or increased urination • Staying hungry, even after having had a meal • Feeling tired all the time • Blurry vision • Sores or cuts that takes very long to heal • Unintended weight loss • Irritability and mood swings Consult your doctor or campus health clinic immediately, if you have some of these symptoms continuously.

Roadmap to your social, mental and physical wellbeing

Lung cancer This remains a threat to men’s health. It is a terrible disease. It grows and spreads early, even before it grows large enough to cause symptoms or even before it can be seen on an X-ray. Lung cancer is generally more common in men. Tobacco is the single biggest cause of cancer. A high intake of alcohol has also been known to contribute to throat, liver, mouth and breast cancer. Lung and testicular cancers are most common in men.

Risks factors are as follows: • Tobacco use • Alcohol use • Unhealthy diets • Lack of physical activity • Infections from Hepatitis B and C and the Human Papilloma Virus

Testicular cancer This cancer is more common in younger men aged 18 to 35. All men should do a self-check once a month after a bath or shower. This type of cancer is curable when detected early. Here’s what to do: Step 1: It’s best to do a TSE during or right after a hot shower or bath. The scrotum (skin that covers the testicles) is most relaxed then, which makes it easier to examine the testicles. Step 2: Examine one testicle at a time. Use both hands to gently roll each testicle (with slight pressure) between your fingers. Place your thumbs over the top of your testicle, with the index and middle fingers of each

Lumps or swelling may not be cancer, but they should be checked by your doctor as soon as possible. Testicular cancer is almost always curable if it is caught and treated earl (Figueroa, 2016). Prostate cancer is one of the leading cancers in men. Early diagnosis can assist in the successful treatment and beating of the disease.

hand behind the testicle, and then roll it between your fingers. Step 3: You should be able to feel the epididymis (the sperm-carrying tube), which feels soft, rope-like, and slightly tender to pressure, and is located at the top of the back part of each testicle. This is a normal lump. Step 4: Remember that one testicle (usually the right one) is slightly larger than the other for most guys — this is also normal. Step 5: When examining each testicle, feel for any lumps or bumps along the front or sides. Lumps may be as small as a piece of rice or a pea. Step 6: If you notice any swelling, lumps, or changes in the size or colour of a testicle, or if you have any pain or achy areas in your groin, let your doctor know right away.

Visit your nearest clinic or student health service should you experience the following symptoms: • Blood in the urine • Needing to urinate more often than usual • Weak or interrupted urine flow • Pain or burning feeling while urinating • Unable to urinate • Constant pain in the lower back, pelvis and upper thighs

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Mental ailments Depression and suicide Clinical depression is the more severe form of depression, also known as major depression or major depressive disorder. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. This low feeling and lack of self-worth can cause a disturbance in your entire body and mind. Common complaints include: • Depressed mood; • Loss of interest or pleasure in activities you used to enjoy; • Lack of energy and fatigue; • Feelings of guilt, hopelessness and worthlessness. Suicide prevention Suicide doesn’t just happen without symptoms: a person may talk to a friend about taking his/her life. If you think you might be depressed, reach out to any friend, your doctor, student health or counselling on your campus. If you think someone is at immediate risk of selfharm or hurting another person, do the following: • Call 911 or your local emergency number; • Stay with the person until help arrives; • Remove any guns, knives, medications, or other things that may cause harm; • Listen, but don’t judge, argue, threaten or yell. If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255. Referral Sources: National Suicide Prevention Lifeline Substance Abuse and Mental Health Services Administration Alcohol and substance abuse Although this is a problem that is common among men, it is important to note that this is not limited to men only. In the Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008) “substances” means chemicals, psychoactive substances that are prone to be abused, including tobacco, alcohol, over the counter drugs, prescription drugs and substances listed in the Drug and Trafficking Act, 1992 (Act No. 140 of 1992).

Substance dependency When it becomes difficult or impossible for someone to stop taking a substance without help after having taken it regularly for a period of time, the person is known to be substance dependent. Dependency may be psychological, physical or both. According to the South African Department of Social Development: • Approximately 270 991 South African citizens are problem drug users exclusive of alcohol and a further 1.97 million citizens are problem alcohol users. A higher number of citizens who use substances have serious health and socioeconomic problems. • Alcohol abuse is one of the biggest killers of South Africans and it costs the country R38 billion a year. South Africans (15 years and older) consumed an average of 8.2 litres of pure alcohol per annum which is well above the African continental average of 6.0 litres. • The problem of substance abuse can be attributed to a combination of factors such as experimentation, boredom, peer pressure, lack of recreational facilities, being surrounded by people who abuse substances, poverty and unemployment. • Offenders sentenced for drug-related crimes represented 2% of the total sentenced offender population of 115 753 in 2009. There was a gradual increase in drug-related crimes in all provinces for 2012 -2013 whereas statistics for 2012-2013 show a 13% increase in drug related crimes across South Africa .

Roadmap to your social, mental and physical wellbeing

Activity What are the most common substances used by youth in South Africa? What are the signs of substance abuse? What is the impact of alcohol and substance abuse?

See the interventions recommended by the Department of Social Development and give your opinion: • Not all students will be willing or able to benefit from programmes aimed at the prevention of substance abuse • The majority of students either do not use substances or are using moderately and we should build on that to influence others. • Social functions arranged for students should be carefully planned to reduce the abuse of substances. • Student leaders should set the example to other students in terms of their own use of substances. • Information sessions should be held to inform students on the dangers of substance abuse and to recognise illegal substances offered to them (pamphlets/ hand-outs could add value)

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• •

Skills development workshops should be held to teach students on how they should deal with stress and peer pressure on the campuses. Students should realise that their substance abuse patterns may influence their futures in a negative way. Enhance healthy lifestyles including sport and recreational activities On-going monitoring either by the hostel management or tutors could assist in cases whether treatment interventions are required Referral of students for professional assistance to those requiring treatment interventions Establishing of support groups for those who require support in maintaining sobriety.

For help contact your campus student counselling or call this 24 hour toll free number 0800 and SMS number 121314.

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Sexually transmitted infections (STIs) Besides HIV/AIDS, there are many other infectious diseases which all young men and women should be informed and educated about. These include all the following:

Syphilis (also known as “vuil siek”)

If you are sexually active and have any of these symptoms, visit your healthcare provider: Vaginal or penal discharge Foul smell Ulcer or sores in or around the vagina, penis or anus Difficulty in urinating Itching in the genital area (penis, vagina, anus)

have any symptoms! Both gonorrhoea and chlamydia are spread by coming into contact with the discharge. Both gonorrhoea and chlamydia can be transmitted from genitals to mouth and from mouth to genitals during oral sex that is unprotected. If a woman is not treated for either of these diseases, it could lead to a severe infection in her reproductive organs which could cause infertility.

Images: MedicineNet (2017)

Symptoms: • Losing patches of hair • Losing eyebrows • A rash on the body (anywhere on the body)

Other symptoms are: • Men and women often complain of a vaginal or penal discharge; • Frequent urination, or burning when they urinate; • In gonorrhoea, the discharge is often white; • In chlamydia, the discharge is usually clear.

Genital warts Gonorrhoea (Also known as “drop”)

Images: MedicineNet (2017) Images: MedicineNet (2017)

Symptoms: Gonorrhoea and chlamydia are both caused by bacteria and are easily treated. The symptoms of gonorrhoea and chlamydia are very similar. Very often, people infected with gonorrhoea or chlamydia may not

Some people only have one or two warts. When these growths are located directly in the genital area, they are usually soft-to-the-touch and can either be raised or flat. Most of the time, genital warts appear in moist areas (e.g., in or around the vagina, anus or groin or on the penis) and do not cause discomfort or pain.

Roadmap to your social, mental and physical wellbeing

Anal warts Anal warts (also called “condyloma acuminata”) are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area (Lowne, 2016). • They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area; They usually appear as a flesh or brownish colour; • Usually, they do not cause pain or discomfort and you may be unaware that the warts are present. Can I protect myself from getting sexually transmitted infections (STI’s)? The safest way to protect yourself from getting exposed to Human Papilloma Virus (HPV) or any other STD, is to use safe sex techniques: • Abstain from sexual contact with individuals who have anal (or genital) warts; • Since many individuals may be unaware that they suffer from this condition, sexual abstinence is safest; • Use condom protection; • Limit sexual contact to a single partner (this will reduce the contagious virus that causes warts); • Using condoms whenever having any kind of intercourse may reduce, but not completely eliminate, the risk of HPV infection, as HPV is spread by skin-to-skin contact and can live in areas not covered by a condom; • Be aware of a discharge and/or a feeling of a lump or mass in the anal area.

Pubic lice

other coarse body hair, such as hair on the legs, armpits, moustache, beard, eyebrows, or eyelashes. Lice found on the head are generally head lice, not pubic lice. Signs and symptoms of pubic lice: • Signs and symptoms of pubic lice include itching in the genital area and visible nits (lice eggs) or crawling lice; • Pubic lice usually spread through sexual contact and are most common in adults (WebMD Partners in Health, 2016). Pubic lice found on children may be a sign of sexual exposure or abuse. Pubic lice may be spread by close personal contact or contact with articles such as clothing, bed linens, or towels that have been used by an infected person.

Treatments of Sexually Transmitted Infections Do not try to treat an STI yourself. These diseases are contagious and serious. You must seek medical advice. Bacterial STIs can be cured with antibiotics. Viral STIs cannot be cured, but you can manage symptoms with medication. There is a vaccine against hepatitis B, but it will not help if you already have the disease. If you are given antibiotics to treat an STI, it is important that you take all of the medication prescribed to you, even if the symptoms go away. Also, do not take someone else’s medication to treat your infection as it may make it more difficult to treat.

Here are some specific treatments: HIV/AIDS: Since HIV is not curable, treatment focuses on keeping HIV levels in check. Antiretroviral drugs are the standard therapy for HIV infection, and usually you will be given several drugs to take, a so-called drug “cocktail.” Talk to your doctor about when you should begin antiretroviral therapy.

Images: MedicineNet (2017)

Pubic lice (also called crab lice or “crabs”) are parasitic insects found primarily in the pubic or genital area of humans. Pubic lice may occasionally be found on

Chlamydia and gonorrhoea: These STIs are treated with antibiotics. You should begin taking them if tests show you have the infection or if you have been exposed to it, even though you may not have symptoms. Your sexual partners will also have to be treated, regardless of whether they have symptoms. Certain strains of

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gonorrhoea have become resistant to some antibiotics, so you may have to take more than one drug to fight gonorrhoea. Failure to treat these infections can result in permanent damage to your reproductive organs and a woman’s inability to get pregnant. Syphilis: Antibiotics are used to treat syphilis. Early treatment is crucial to prevent the bacteria from spreading to and damaging other organs. Genital herpes: Once you are infected with genital herpes, the virus remains in your body for life. After the first outbreak, herpes may flare up several times per year, but these flare ups may lessen over time. Antiviral medication such as Acyclovir can help reduce the length and severity of both the initial and subsequent outbreaks. If you have outbreaks often, you may want to use suppressive therapy. In suppressive therapy, your doctor prescribes medication for you to take every day, to prevent you from getting an outbreak (WebMD Partners in Health, 2016).

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strong - HIV cannot touch me!” Their belief that their partner/s (females) test regularly and they rely on this testing on which to base their standing; Men prefer to go to traditional healers for help; Men do not want to discuss their private lives with female health workers at the community clinics; They will not allow HIV to take away their status and power as a man.

Medical male circumcision (MMC) Traditionally, boys are circumcised without painkillers, while medical facilities use analgesics as well as certain hygienic protocols when conducting a circumcision. Nowadays, medical circumcisions are done throughout South Africa at health facilities such as clinics and hospitals giving more males the option to undergo medical male circumcision.

It is of utmost importance that you prevent these STIs, as they are also predisposing factors for HIV/AIDS.

Men and testing for Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) Images: TB/HIV Care Association (2017)

The fact that men are reluctant to participate in HIV, counselling and testing (HCT) means that men are over 30% more likely to die of HIV/AIDS-related infections than women. The following factors are known regarding why men are reluctant to test: • Fear that a positive diagnosis would compel them to change their lifestyle, which may include the consumption of alcohol, substance abuse and engaging in sexual activity with multiple partners; • Refusal or reluctance to consult with health care workers at health clinics; • Fear that health care workers will gossip about them; • Fear that the community might see them entering a health facility; • Fear that if they are tested positive, they would lose respect from other men in the same community; • The belief that “real men” do not use a condom and therefore do not get sick: “I am a man, I am

NATURAL PENIS

CIRCUMCISED PENIS

Images: Healthwise Staff (2016)

•

The MMC campaign is an important element of an increasingly comprehensive HIV/AIDS programme in the higher education and training sector

Roadmap to your social, mental and physical wellbeing

•

that is being driven by the Higher Education HIV/ AIDS Programme (HEAIDS), which also champions HIV counselling and testing and other prevention, treatment and support services. Medical male circumcision is now firmly considered an effective HIV prevention measure, which reduces the risk of acquiring HIV by about 60%. Evidence shows that the inner skin of the foreskin is more likely to absorb HIV than any other skin, as it is more prone to small tears during sex. There are also cells within the foreskin that attract the HI virus (HEAIDS, 2013).

Benefits • Keeps the penis clean and maintains hygiene; • Reduces risks of infection by 60%; • Reduces risks from some STIs, particularly those that form wounds; • Prevents unretractable foreskin; • Prevents the problem of the foreskin being pulled back; • Prevents urinary tract infections; • Reduce the risks of penile and cervical cancer. Currently, the campus health clinic on the Bellville campus, offers this service and all men are encouraged to consult the nurse practitioner or the medical practitioner. For more information, contact your campus health clinic.

Gender-based violence and HIV The following are contributing factors to genderbased violence:

Alcohol and drug abuse • •

• • •

The abuse of alcohol and drugs often leads to violent behaviour; Violent behaviour can cause tremendous stress and conflict in families, particularly when money is spent on alcohol and substances instead of necessities; Arguments may finally lead to violence; and men in particular resort to violence in order to get their quick fix; Where men assume they have authority over women, women are made to feel inferior to men; When boys are reared as if they are superior to women, they can become abusive when this power is challenged by women;

•

Men/boys are therefore more likely to believe that it is okay to beat women and that they have the right to force them to have sex against their will.

Low self-esteem • • •

This develops when a person thinks that they are not valued or are less important than others; When people are at this level, they normally become very unhappy with themselves; This unhappiness may also lead to such people feeling insecure and they may resort to violent behaviour to gain power over others (to make them feel more powerful).

Poor anger management • • • •

Anger could be the cause of violent behaviour; Extreme anger is a learnt behaviour; It is important to learn how to manage anger and to deal with conflict appropriately; and Not to resort to violence to resolve conflict.

Jealousy • •

•

This is known to be a frequent cause of violence; If a man feels threatened by his partner’s achievements or her /his attraction to other partners, this may result in violent behaviour; Jealousy can be self-destructive and lead to murder or suicide.

Condom use Do you know the following facts? • That a condom is the only contraceptive that can prevent you from impregnating your partner? • That condom use if the only way to protect you from contracting STIs or HIV? • That the Choice condoms, provided by the state, undergo stringent tests by the South African Bureau of Standards to ensure that that they are safe and reliable; • That a condom can only be used once and then should be disposed of by wrapping it in toilet paper, before throwing it away.

It is important that condoms are being used correctly. The following illustrations will provide the steps for the correct usage/application of a condom.

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How to use a condom Activity A young male final year university student, Dan, lived ‘the good life’ as a student during his first three years. He indulged in excessive drinking of alcohol and smoking cigarettes. He also had multiple partners and was previously during his first and second year of studies, treated for STIs. For the last six months, Dan has been in a monogamous relationship with Tandi. He is now quite serious about looking after his health and sexuality, as he claims that he very much loves Tandi, a second year student. Both Dan and Tandi have visited the student health centre for Tandi’s contraception. Please answer the following questions: • What did Dan do to put himself at risk? • What should he and his partner do together to live a healthy and risk-free life? • What advice would you give Dan in order for him to look after his mental health as well?

Men, look after your health and keep your sexuality healthy!!!! Job Aids/Tools

REFERENCES Healthwise Staff. 2016. Circumcision. https://myhealth.alberta.ca/Health/pages/conditions. aspx?hwid=hw142449 [7 April 2017]. Kariem, S.S. & Kariem, Q. (eds). 2008. HIV/AIDS in South Africa. Cape Town: Creda Communications. Ghadgepatil, S.S., Gupta, S. Sharma, Y.K. 2015. Clinicoepidemiological study of different types of warts. Dermatology Research and Practice, Vol. 2016, Article ID 7989817, 4 pages. http://dx.doi. org/10.1155/2016/7989817 [7 April 2017]. Sharma, Y.K. 2015. Clinicoepidemiological study of different types of warts. Dermatology Research and Practice, Vol. 2016, Article ID 7989817, 4 pages. http://dx.doi.org/10.1155/2016/7989817 [7 April 2017]. WebMD. 2017. High cholesterol in men. HYPERLINK “http://www.webmd.com/men/guide/high-cholesterol” \l “1-1” http://www.webmd.com/men/guide/high-cholesterol#1-1 [7 December 2016]. World Health Organisation (WHO). 2016. Global report on diabetes. Geneva: World Health Organisation. http:// apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf [7 April 2017].

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Women’s Health Overview of chapter and learning outcomes

This chapter will present issues related to women’s health, allowing you to explore and reflect on challenges that women face, and how women’s health can be improved, allowing you to achieve the following outcomes: • You will be able to identify the various challenges faced by women and their relevance in your own community and personal life; • You will be able to discuss relevant and appropriate interventions that can be applied to facilitate improvement of women’s health; and • You will be able to discuss the value of family planning for women’s health.

Introduction In many societies, including South Africa, girls and women are faced with many challenges that have a negative impact on their health. As a society, we have a responsibility to mitigate such challenges to enhance and improve the health of women and girls.

Challenges faced by women Activity What are the challenges particular to women in your community? Form a group of 5 members. Think of the community where you grew up, where you live/d, where you attended school (and attend university), and discuss the challenges that are particular to women and how these challenges can be addressed.

Challenge

How to address the challenge

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As you may have found in your discussion, women face a number of challenges, and many health needs for women are not addressed. In that regard, the World Health Organization (WHO) has noted ten top issues that are challenges for women, namely: cancer, reproductive health, maternal health, HIV, STIs, violence against women, mental health, noncommunicable diseases, being young, and getting old.

In your groups, relook at the activity on the previous page and the table below, and identify any issue that was not discussed. In addition, discuss further how each of the top issues identified as challenges for women affects women differently from men, and discuss more suggestions on how to mitigate such challenges.

Challenges

HOW THESE affect women

Suggestions to mitigate the challenge: Provision of:

Cancer

On an annual basis, about a million women are dying of breast and cervical cancers

Screening programmes: breast selfexamination & PAP smear; human papilloma vaccine.

Challenges related to womenâ&#x20AC;&#x2122;s reproductive and maternal health (Limited access to contraception due to restricted availability or lack of awareness)

High risk of unsafe sex, unplanned pregnancy, disruption in studies, financial stress following unplanned and teenage pregnancy, etc.

Health education related to safe sexual behaviour; options for contraception, youth-friendly health services, provision of health care services, empowerment and mentoring of young girls, social support, etc.

Human Immunodeficiency Virus (HIV)

More women are infected with HIV; they carry the greater burden of HIV, higher risk of infection for young women, sexual violence against women, inability to negotiate for safe sex, delayed access to treatment, limited availability of female condoms

Health education related to safe sexual behaviour; empowerment and mentoring of young girls.

Sexually Transmitted Infections (STIs)

High rate of STIs among women, increase in stillbirth and neonatal death, emotional effects following stillbirth or neonatal death, increased risk of HIV infection, possible consequences on reproductive system

Health education related to safe sexual behaviour; empowerment and mentoring of young girls, youth friendly health services, provision of health care services

Violence against women

Physical and sexual violence, long-term consequences of the violence (physical, social, mental), increased risk of HIV and STIs, poverty if one decides to leave partner.

Empowerment and mentoring of young girls, youth-friendly health services, provision of health care services, social support, and community involvement in the fight against violence.

Roadmap to your social, mental and physical wellbeing

Challenges

HOW THESE affect women

Suggestions to mitigate the challenge: Provision of:

Disturbances in mental health (postnatal depression, suicide, substance abuse)

More women suffer mental health problems Increased vulnerability to abuse and engagement in unsafe behaviour, lack of selfesteem and self-confidence, difficulty coping with life, relationships, responsibilities; lack of motivation to better own life

Provision of screening service, including screening for post-natal depression, provision of support services, health education.

Non-communicable diseases

Mortality and morbidity related to malnutrition (obesity, anorexia, bulimia), lack of activity, smoking and substance abuse

Health education for healthy living, empowerment and mentoring of young girls, social support

Challenges associated with being young (bullying; peer pressure)

Possibility to being bullied with no resources to protect oneself, and resulting mental health problems, peer pressure to engage in unsafe sexual behaviour and resulting teenage pregnancy (annually, 13 million teenagers give birth) high risk of HIV and STI infections and violence, unsafe abortion, complications related to teenage pregnancy

Health education for healthy living, empowerment and mentoring of young girls, sexual and reproductive health, social support, career advice.

Challenges associated with getting old

Limited ability to look after themselves, their children and grandchildren, violence and abuse by younger family members, illnesses, and poverty.

Social support, community involvement, provision of health care services.

It is important to be able to identify potential and actual health problems for women, as well as the various challenges that can exacerbate their health problems. Furthermore, it is important to identify and minimise the impact of societal structures that can contribute to the worsening of women’s health. In addition to the identification of such health problems and contributing factors, one needs to implement interventions that will facilitate the improvement of women’s health.

Interventions to improve women’s health Recommended screening programmes for women Screening programmes are beneficial for the health of the population, as early diagnosis provides opportunity for early treatment which can result in the prevention of severe negative health outcomes for many of the health problems experienced. Breast cancer and cervical cancer are the

main cancers affecting women in South Africa, with an age-standardised incidence rate being documented at 41.5 and 31.7 per 100 000 women in 2012 for breast and cervical cancer respectively. Screening programmes for women include breast self- and clinical examination, PAP smear test, pregnancy test and HIV test. Breast cancer It is documented that, worldwide, about 1.67 million women developed breast cancer in 2012. Breast cancer is the most common type of cancer affecting women, and the burden is increasing. Early diagnosis of breast cancer increases survival chances. Monthly breast selfexamination facilitates early breast cancer diagnosis. For women who have no symptom or high risk of breast cancer, clinical breast examination (mammogram) should be done on an annual basis from the age of 40. Knowing the risk factors for breast cancer will facilitate awareness and breast self-examination practices. There are numerous risk factors for breast cancer, and each individual needs to assess her own risk.

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Activity Form a group of 5 and discuss each risk factor listed in the table below. Is there any risk that may be applicable to you or someone you know? Tick the risk that you can identify for yourself and for someone you know. Breast cancer risk

Explanation of the risk

Sex

Being a female. More women develop breast cancer than men, and it may be related to the oestrogen and progesterone hormones.

Age

As one grows older, the risk for breast cancer increases, e.g., about 75% of breast cancers occur after 50 years of age.

Family history

If a family member has had breast cancer, a womenâ&#x20AC;&#x2122;s breast cancer risk is doubled. The closer the relationship (mother, sister), the higher the risk. About 5% to 10% cases of breast cancer cases are hereditary

Breast density

Dense breasts (having less fatty tissues and more glandular and fibrous tissues) have an increased risk of breast cancer.

Benign breast conditions

Any medical illness related to the breast: conditions such as cysts and infection of the breast, have an increase risk, due to related cell abnormalities

Being overweight

Being overweight or obese is related to increased risk of breast cancer.

Pregnancy history

Not having had a child, or having a child after 30 years, is slightly related to increase in breast cancer risk.

Breastfeeding

Breastfeeding for about 2 years lowers the risk of breast cancer, and this may be due to reduced number of menstrual cycles. Many women are not able to breastfeed for very long time.

Lack of exercise

Lack of physical activity is related to increased risk of breast cancer.

Drinking alcohol

Increased alcohol consumption is linked to increased risk of breast cancer.

Hormone therapy

Use of oestrogen and progesterone therapy after menopause increases the risk of breast cancer.

Early menstruation Prolonged exposure to oestrogen and (before 12yrs) and progesterone hormones contribute to an /or late menopause increase in breast cancer risk (after 55yrs) Oral contraceptives

Use of oral contraceptives is associated with a slight increase in breast cancer.

Is it a risk for Is it a risk myself? for someone I know?

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Breast self-examination One of the screening activities is breast selfexamination, and can be done by women themselves in the comfort of their homes. This can be done standing in front of a mirror first. The picture below shows the steps to follow when doing a breast self-examination:

Figure 8.1

SexInfo Online, 2013. Breast cancer

Warning signs for breast cancer When doing breast self-examination, the woman needs to know the abnormalities to check for. This will provide opportunity for early consultation with a health care provider who will continue with the required care. If you notice any of these symptoms depicted in the following pictures, you should consult a health care provider for further assessment:

Figure 8.2: Warning signs of breast cancer (Cancer Association of South Africa, 2016a)

Cervical cancer In South Africa, cervical cancer (cancer of the cervix) affects about 2% of women. Worldwide, in 2012 it was documented that cervical cancer was the 4th most common cancer and the 4th most common cause of cancer death in women. Considering that cervical cancer may progress to invasive cancer over a period of 10 to 20 years, having regular screening allows detection of abnormalities early enough to be able to prevent the cervical cancer from spreading. The screening is called a Pap smear, and should be done at least every three years for all women who are 25 years and older. The government services offer Pap smear screening for women aged 30 years at 10-year intervals, provided there are no additional risks. Cervical cancer is caused by the Human Papilloma Virus (HPV) and can be prevented through HPV vaccination for primary prevention for girls aged 9 years and can be given to women up to the age of 45 years. HPV is a group of more than 150 viruses that are related. HPV is sexually transmitted, and can be passed even when the infected person does not display any of the signs and symptoms. HPV has been documented as the most common STI around the world, for most sexually active people. The prevalence is higher in women under the age of 25 year, and the proportion is higher in women living with HIV. In South Africa, the National Department of Health has started school wide vaccination campaigns, and the HPV vaccine is offered free of charge to girls from Grade 4 to create immunity before they are exposed to the virus.

Warning signs for gynaecologic cancer • Abdominal vaginal discharge or bleeding • Pelvic pain or pressure • Abdominal and back pain • Passing urine frequently • Itching and burning of vulva • Changes in vulva colour or skin such as a rash, sores or warts

Risk factors for cervical cancer There are several factors that increase the women’s risk of getting cervical cancer. The table below highlights the risks, and you are required to reflect on whether the risk may apply to you or someone you know.

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Activity Looking at the following risk factors for cervical cancer, is there any risk that may be applicable to you or someone you know? Tick the risk that you can identify for yourself and for a person that you may know. Cervical cancer risk Having a Human Papilloma Virus (HPV) infection: some types of HPV are linked to cancers, and 2/3 of cervical cancers are reported to be caused by HPV 16 and HPV18 Having first full term pregnancy for women under 17 years, and first sexual encounter before age of 18 years Having many sexual partners Smoking tobacco products increases oneâ&#x20AC;&#x2122;s risk: women who smoke are more susceptible to cervical cancer than women who do not smoke. Using oral contraceptives for longer than 5 years. It is documented that the risk goes back to normal after stopping for about 10 years Having a weakened immune system Poor economic status: some women may not be able to afford regular Pap smears or have limited access to screening and early treatment Sexual partners who have multiple partners or who participate in high-risk sexual activity Having three or more children. This is linked to continued unprotected sex, with increase in possible exposure to HPV Failure always to use barrier methods during sexual intercourse Ineffective management and treatment of sexually transmitted infections (STIs)

Is it a risk for myself? Is it a risk for someone I know?

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Family planning/ Contraception Having a child is considered a blessing for many people. That blessing comes with a lot of responsibilities and adjustments for the parents, especially for the mother who will carry the baby for 9 months. It is important that women can make plans related to the timing of having a child, to ensure physical, psychological, emotional and financial readiness. A woman needs to be physically mature to be able to deal with the physical stress that goes with being pregnant and childbirth. Many young girls who fall pregnant when they are still young and unprepared risk not being able to continue with their schooling, which keeps them in the cycle of poverty. Being able to provide for the needs of a child requires sufficient financial means and, when these are not available, the new motherâ&#x20AC;&#x2122;s well-being is compromised, in addition to the well-being of the baby. It is advised that women receive family planning services, so that they may plan their pregnancy in a situation that will promote good health. The provision of family planning services includes the provision of

Western Cape Government, 2016. Contraception

contraception. There are various contraception options: as a pill (tablet) that must be taken every day; as an injection that can be given every two or three months; as an implant that can provide protection for a period of three years; or as an intrauterine device. These methods basically work by changing the levels of oestrogen and progesterone in the body, thus preventing fertilisation and pregnancy, either by stopping the egg from fusing with the sperm, or making the uterine wall an unfavourable environment for implantation. All women should know that these types of contraception are available and provided for free in all public health care services.

Key concepts in this chapter Having completed this section, how will you explain the following concepts to your fellow student? CONCEPT

YOUR EXPLANATION

Breast clinical examination

Breast self-examination

Cervical cancer

Contraception

Pap smear test

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Reflection Having completed this section on Womenâ&#x20AC;&#x2122;s Health, reflect on the most important aspects that you have learnt in this chapter and your action plan to improve women health. What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to promote womenâ&#x20AC;&#x2122;s health 1. I can

2. I can

3. I can

Roadmap to your social, mental and physical wellbeing

REFERENCES American Cancer Society, 2016a. Breast cancer. [Online] Available at: http://www.cancer.org/cancer/ breastcancer/detailedguide/breast-cancer-risk-factors. American Cancer Society, 2016b. What Are the Risk Factors for Cervical Cancer? [Online] Available at: https:// www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html [Accessed 16 March 2017]. Breastcancer.org, 2016. Breast Self-Exam (BSE): The Five Steps of a Breast Self-Exam. [Online]. Available at: http://www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps [Accessed 5 December 2016]. Bustreo, F., 2015. Ten top issues for women’s health. [Online]. Available at: http://www.who.int/life-course/news/ commentaries/2015-intl-womens-day/en/ [Accessed 5 December 2016]. Bustreo, F., Knaul, F.M., Bhadelia, A., Beard, J. and Carvalho, I.A.D., 2012. Women’s health beyond reproduction: meeting the challenges. Bulletin of the World Health Organization, 90(7), pp.478-478A. Cancer Association of South Africa (CANSA), 2015. Fact Sheet on Breast Cancer in Women. [Online]. Available at: http://www.cansa.org.za/files/2016/09/Fact-Sheet-Breast-Cancer-Women-NCR-2011-web-Sept-2016.pdf [Accessed 15 March 2017]. Cancer Association of South Africa (CANSA), 2016b. Women’s health - Women and Cancer. [Online] Available at: http://www.cansa.org.za/womens-health/ [Accessed 6 December 2016]. Cancer Association of South Africa, 2016a. Women’s health - Breast cancer. [Online] Available at: http://www. cansa.org.za/files/2016/09/Womens-Health-Info-graphic-BREAST-ENG.pdf [Accessed 6 December 2016]. Centers for Disease Control and Prevention, 2014. Gynecologic Cancers. [Online] Available at: https://www.cdc. gov/cancer/cervical/basic_info/risk_factors.htm [Accessed 16 March 2017]. Centers for Disease Control and Prevention, 2016. Human Papillomavirus (HPV) - What is HPV. [Online] Available at: https://www.cdc.gov/hpv/parents/whatishpv.html [Accessed 29 January 2017]. Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D.M., Forman, D. and Bray, F., 2014. GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. 2013, Lyon, France: International Agency for Research on Cancer. Marie Stopes South Africa, 2016. Types Of Contraception & How They Work. [Online] Available at: http://www. mariestopes.org.za/types-contraception-work/ [Accessed 6 December 2016]. Mohamed, H.A.E.A., Ibrahim, Y.M., Lamadah, S.M., Hassan, M. and El-Magd, A., 2016. Application of the Health Belief Model for Breast Cancer Screening and Implementation of Breast Self-Examination Educational Program for Female Students of Selected Medical and Non-Medical Faculties at Umm al Qura University. Life Science Journal, 13(5), pp. 21-33. Ritcher, K., 2015. Implementation of HPV vaccination in South Africa. Pretoria: Public Health Association of South Africa, pp. 1-4.Available at: https://www.phasa.org.za/wp-content/uploads/2015/02/Richter_ Implementation-of-HPV_article-4.pdf [Accessed 22 January 2017] SexInfo Online, 2013. Breast cancer. [Online] Available at: http://www.soc.ucsb.edu/sexinfo/article/breast-cancer [Accessed 16 March2017]. Stewart, B. & Wild, C. P., 2014. World cancer report 2014, Lyon: World Health Organization. Western Cape Government, 2016. Contraception (family planning). [Online] Available at: https://www. westerncape.gov.za/service/contraception-family-planning [Accessed 22 January 2017].

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Gender-based Violence The aim of the chapter is to help you understand what gender-based violence (GBV) is, to introduce you to the various types of gender-based violence, to give you information which would help you to recognise when you are in a violent relationship, and to provide some guidance in terms of how to manage this type of situation.

Introduction

on Violence and Health (WRWV,2002:5), describes violence as follows: “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development or deprivation”

Alexas Fotos/ Pixabay Burundian Anglicans establish safe house for victims of gender based violence (2016)

The negative impact of violence on lives is indisputable. Violence is considered by most people to be limited to physical acts. This, however, is a misperception which can lead to many acts of violence being normalised or discounted. The World Report

The WRVH further divides violence into: • self-directed violence – Here the perpetrator and victim are the same, e.g., suicide, self-abuse. • interpersonal violence – This relates to violence between individuals e.g., child maltreatment, intimate partner violence, assault by strangers, etc. These individuals can be known to each other or they can be unknown. • collective violence –This relates to violence perpetrated by large groups of individuals.

Answer the following questions pertaining to GBV. What is gender-based violence? What does the term gender-based violence mean to you? What acts do you think would qualify as GBV violence?

Roadmap to your social, mental and physical wellbeing

Gender-based violence is the physical, sexual or psychological suffering of mostly a female partner, whether occurring in public or in private. This can include threats, coercion and/or deprivation of freedom.

Gender-based violence therefore forms part of the category of interpersonal violence. Some of the myths associated with gender-based violence (GBV) include: • Victims of GBV provoke the abuse through their inappropriate behaviour. • Most women are abused by strangers. Women are safe when they are home.

• • •

GBV happens only to poor and marginalised women. GBV is not common in industrialised countries. Men cannot control themselves. Violence is simply a part of their nature.

Regarding each of the above: 1: The tendency to blame the victim is precisely the kind of attitude that has the potential to cause harm to a survivor of violence. 2: Studies consistently show that most women who experience GBV are abused by people they know; often the perpetrators are those they trust and love. 3 GBV happens among people of all socioeconomic backgrounds.

Have you heard any of these myths? Which one/two have you heard most often?

Signs of an abusive relationship It is important to understand the difference between a healthy relationship and an abusive one. Here is a table which might help you to evaluate whether you are in an abusive relationship.

Do you…

Does your partner…

Feel afraid of your partner much of the time?

Humiliate or yell at you?

Avoid certain topics out of fear of angering your partner

Criticise you and put you down?

Feel that you can’t do anything right for your partner?

Treat you so badly that you’re embarrassed for your friends or family?

Believe that you deserve to be hurt or mistreated?

Ignore or put down your opinions or accomplishments/

Wonder if you’re the one who is crazy?

Blame you for their abusive behaviour?

Feel emotionally numb or helpless?

See you as property or a sex object rather than as a person?

Your partner’s violent behaviour or threats: does he/she …

Your partner’s controlling behaviour: does he/she …

Have a bad and unpredictable temper?

Act excessively jealous and possessive?

Hurt you, or threaten to hurt or kill you?

Control where you go or what you do?

Threaten to take your children away or harm them?

Keep you from seeing your friends or family?

Threaten to commit suicide if you leave?

Limit your access to money, the phone or the car?

Force you to have sex?

Constantly check up on you?

Destroy your belongings?

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The cycle of violence Research indicates that perpetrators of gender-based violence follow a similar pattern in the manner in which they perpetrate the violence within a relationship. The following diagram explains this cycle.

Various authors have categorised and described such violence. The United Nations General Assembly (1993), for example, divides this violence into physical, sexual, psychological and economic forms, with examples: Such behavior includes: • Physical: acts of physical aggression, such as slapping, hitting, strangling, kicking and beating • Psychological: isolation, verbal aggression, verbal abuse, intimidation, constant belittling and humiliating • Sexual: forced intercourse and other forms of sexual coercion, using threats, etc. • Economic: withholding funds, controlling victim’s access to health care, employment, etc. Examples: • Physical: slapping, kicking, burning, strangling; • Sexual: coerced sex through force, threats, etc.; • Psychological: isolation, verbal aggression, humiliation, stalking; • Economic: withholding funds, controlling victim’s access to health care, employment, etc.

Gals (2012)

Types of gender-based violence There are various types of gender-based violence. These will be discussed separately. Types of gender-based violence include: • Intimate partner violence (physical, sexual, psychological, economic) • Sexual coercion • Childhood sexual abuse • Rape • Trafficking • Female Genital Mutilation • Honour killings • Dowry deaths

(The United Nations General Assembly 1993)

Sexual coercion Heise, Moore and Toubia (1995:6) explain this:

… the act of forcing (or attempting to force) another individual, through violence, threats, verbal insistence, deception, cultural expectations, or economic circumstance to engage in sexual behavior against his or her will. As such it includes a wide range of behaviors from violent forcible rape to more contested areas that require young women to marry and sexually service men not of their choosing. Sexual abuse

(The United Nations General Assembly 1993)

Intimate partner violence According to Bott et al, (2005, 9) intimate partner violence can be defined as “Any behavior within an intimate relationship that causes physical, psychological or sexual harm.”

This is unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear or disbelief. Longterm symptoms include anxiety, fear, or post-traumatic stress disorder.

Roadmap to your social, mental and physical wellbeing

Rape and rape culture

Photography: Chase Carter Everyday Feminism (2014)

Rape is a violent crime in which a person uses sexual acts to intentionally harm and hurt another. The Criminal Law (Sexual Offences and Related Matters Amendment Act, Act 32 of 2007) has been in effect in South Africa since 16 December 2007. This law states that it is a crime to intentionally commit a sexual act with another person without that person’s consent. The formal definition of rape that is presently used by our legal system is:

Any person who unlawfully and intentionally commits an act of sexual penetration with a complainant, without the consent of the complainant, is guilty of the offence of rape.

It is very important to understand what the word “consent” means. According to the law, even if you indicated consent to the rapist in some way, for example by saying ‘yes’ or by not resisting, there is no consent or permission granted to a sexual act under these circumstances: • • • •

if you are forced into a sexual act by violence; if you are drunk, drugged, asleep or unconscious; if you are younger than 12 or mentally challenged; if you are forced into consent by your boss, teacher or lecturer.

Rape culture Universities around the world have become instrumental in highlighting the issue of rape culture. ‘Rape culture’ is a term that was coined by feminists in the USA in the 1970s (WAVAW, 2017). The WAVAW website defines rape culture as: … a complex set of beliefs that encourages male sexual aggression and supports violence against women. It is a society where violence is seen as sexy and sexuality as violent. In a rape culture, women perceive a continuum of threatened violence that ranges from sexual remarks to sexual touching to rape itself. A rape culture condones physical and emotional terrorism against women as the norm … in a rape culture both men and women assume that sexual violence is a fact of life, inevitable – however, much of what we accept as inevitable is in fact the expression of various attitudes that can change. Rape culture is a setting in which rape is pervasive and normalised due to societal attitudes about gender and sexuality. The following behaviours are considered to be a part of rape culture: • Victim blaming, • Sexual objectification, • Trivialising rape, • Denial of widespread rape, • Refusing to acknowledge the harm caused by some forms of sexual violence • Or a combination of these. (WAVAW, 2017)

Rape culture is prevalent on South African university campuses.

How is a rape culture perpetuated in society and on university campuses? Read the following quote: ‘Rape culture includes jokes, TV, music, advertising, legal jargon, laws, words and imagery that make violence against women and sexual coercion seem so normal that people believe that rape is inevitable. Rather than viewing the culture of rape as a problem to change people in rape culture, think about the persistence of rape as ‘just the way things are’.

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Activity In your own words explain what consent means:

Some everyday examples: • Ridiculously lenient sentences for sexual assault; • People who believe that girls ‘allow themselves to be raped’; • Substituting the word ‘sex’ for ‘rape’ as if they are the same thing; • Sexual assault prevention education programmes that focus on women being told to take measures to prevent rape, instead of men being told not to rape; • Publicly defending celebrities accused of rape just because they are celebrities and ignoring or denouncing what the victim has to say. It is vital that we all work towards eliminating a rape culture in our environments and especially on our campuses. In the event that either you or someone you know is raped it is important to know what steps to take. The following is a guideline (Rape Crisis, 2017):

Steps to take after rape: 1. Go to a safe place as soon as possible; 2. Tell the first person you see and trust - take their name and number; 3. If you are badly hurt, go straight to the doctor or hospital - the police can be called to the hospital if you want to report the rape; 4. If you fear that you could have been exposed to HIV, it is important to receive medical attention within 72 hours; 5. Decide whether you want to report the rape to the police. You may not feel like making the decision so soon after the rape. However, the sooner a doctor examines you, the more likely she/he is to find evidence, like blood, bruising, hair, semen and saliva.

When reporting a rape: A few things to remember: • You have the right to speak to a female police officer; • There are officers from the Family Violence, Child Abuse and Sexual Offences unit (FCSU) who are specially trained to deal with rape incidents; • At some police stations, there is a Victim Support Room where volunteers from the community will take you. This is a private and safe space to make your statement; • It is advisable to bring a friend or family member along with you; • It is possible to report a rape, but not lay a charge. It is still very important for you to seek medical attention as soon as possible; • The police are not allowed to tell you to come back the next day - the police should take any survivor directly to a public health facility. If this is not done, call Rape Crisis immediately. When laying a charge, this is very important: • You need to preserve evidence of the rape, so • do not throw away your clothes, • do not wash yourself, • do not eat or drink anything; • Keep clothes and other evidence in a PAPER bag - plastic may destroy evidence; • If you need to use the bathroom, keep any toilet paper and other sanitary material; • If you were drugged, you need to have a blood and urine test within 24 hours; • No police officer can tell you that you cannot lay a charge, or that you do not hav enough proof you can lay a charge at any time as there is no restriction period for rape;

Roadmap to your social, mental and physical wellbeing

Female genital mutilation • • •

An officer will investigate your case - he/she will be your investigating officer; Your case will be assigned a police case number, also called a CAS number; Make sure you get the name and contact details of the investigating officer.

This is the cutting, partial or total removal, of the external female genitalia for cultural, religious or other non-medical reasons. It is usually performed on girls between the ages of 4 and 10 and is also known as female circumcision (Unicef, 2016). Girls and women are subjected to health risks, which have life-threatening consequences, based on false beliefs that have nothing whatever to do with religious or medical teachings.

Recovery from rape It is recommended that you seek support from a counsellor, therapist, psychologist or services such as the Rape Crisis Centre and other support services.

“Blesser” relationships

It is important to realise that the feelings you experience after being raped are a completely natural response to a terrible event. You are not going mad, nor are you over-reacting - no matter who tells you so.

Human Trafficking

Photo: eNCA / Lenyaro Sello (2016)

The term “blesser” in South Africa has become synonymous with someone who blesses a partner with money and gifts. The Blesser is perhaps similar in many ways to the traditional ‘sugar daddy’ (Adams, 2016). This relationship essentially involves the exchange of sex and sexual favours for money/ gifts etc.

Getty images/Stockphoto (2015)

Human trafficking is a type of gender-based violence which is often not seen by the public as such. It refers to the recruitment, transportation, transfer, harbouring or receipt of persons by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability, or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour (UNODC 2017)

How to get help when experiencing GBV The following guidelines have been suggested (CPUT Student Counselling Guideline, unpublished) For yourself: • Realise that help is available. Ask for it! Remember you are not alone! • Educate yourself regarding your rights. • If you think your life is in danger, don’t hesitate or question your sanity etc. ACT! • Develop a safety plan. • Get a protection order

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For a friend: • Don’t ignore ask if something is wrong. • Express concern • Listen and validate • Offer help • Support his/her decisions

Don’t … • Wait for him/her to come to you • Judge or blame • Pressure him/her • Give advice • Place conditions on your support

If a friend approached you and asked for help with a boyfriend who was physically and sexually violent with her, what would you do to help this friend?

Conclusion The topic of GBV is a complex one with many aspects which are never spoken about due to various reasons. It is hoped that by completing this chapter you, the student, will have a better understanding

of GBV, what constitutes GBV and what actions to take when you or a fellow student is confronted with this type of violence. Contact details for various organisations are provided below.

Places to get help and more information Rape Crisis Cape Town Trust Other resources related to Rape Crisis Observatory Counselling line

+27 (0)21 447 1467 +27 (0)21 447 9762

Athlone Counselling line

+27 (0)21 684 1180 +27 (0)21 633 9229

Khayelitsha Counselling line

+27 (0)21 361 9228 +27 (0)21 361 9085

Student Counselling Centres on the respective university campuses

www.rapecrisis.org.za rapecrisis.mobi info@rapecrisis.org.za @RapeCrisis on Twitter http://www.facebook.com/rapecrisiscapetown

Lifeline Counselling line

021 4611111

Student Health Clinics on the respective university campuses

Roadmap to your social, mental and physical wellbeing

REFERENCES Adams, S. 2016. Blessers: a new generation of South African sugar daddies. The South African. http://www. thesouthafrican.com/blessers-a-new-generation-of-south-african-sugar-daddies/ [17 March 2017]. Sello L. 2016. Blesser Industry should be regulated. 17 July. Africa News Agency. http://www.enca.com/southafrica/blesser-industry-should-be-regulated [7 April 2017]. Bott, S, Morrison, A. & Ellsberg, M. 2005. Preventing and responding to gender-based violence in middle and low-income countries: a global review and analysis. The World Bank Policy Research Working Paper 3618. http://www.worldbank.org/en/search?q=Bott%2C+S%2C+Morrison%2C+A.+%26+Ellsberg.+2005&currentT ab=1 [7 April 2017]. Clowes, L., Shefer, T., Fouten, E., Vergnani, T. & Jacobs, J. 2009. Coercive sexual practices and gender-based violence on a university campus. Agenda: Empowering Women for Gender Equity, 80: 22-32. Department of Justice, South Africa. 2007. Criminal law (sexual offences and related matters), Amendment Act 32 of 2007. http://www.justice.gov.za/legislation/acts/2007-032.pdf [17 March 2017]. Gals. 2012. The cycle of abuse. www.galsusa.org/cycle-of-abuse.php [22 March 2017] Heise, L., Moore, K. & Toubia, N. 1995. Sexual coercion and reproductive health: a focus on research. New York: The Population Council. Pelser, A. & De Kock, C. 2000. Violence in South Africa: a note on some trends in the 1990s. Acta Criminologica, 13(1): 80-94. Saltzman, L.E., Fanslow, J.L., McMahon, P.M. & Shelley, G.A. 1999. Intimate partner violence surveillance: uniform definitions and recommended data elements. Version 1.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Rape Crisis: Cape Town Trust. 2017. The Road to Recovery: You and Rape. http://rapecrisis.org.za/wp-content/ uploads/2015/10/English.pdf [17 March 2017]. Krug, E.G., Dahlberg, L.L., Mercy, J.A., Zwi, A.B. & Lozano, R. (eds). 2002. The world report on violence and health. Geneva: World Health Organisation. http://www.who.int/violence_injury_prevention/violence/world_report/ en/ [22 March 2017] Ridgway, S. 2014. Everyday Feminism. 10 March. http://everydayfeminism.com/2014/03/examples-of-rapeculture/ [22 March 2017] Schneider, D. 2015. Human trafficking spreads through Wisconsin. http://www.greenbaypressgazette.com/story/ news/local/2015/06/06/human-trafficking-spreading-wisconsin/28573869/ [22 March 2017] United Nations: General Assembly. 1993. Declaration on the Elimination of Violence against Women, Article 1: 48/104 http://www.un.org/documents/ga/res/48/a48r104.htm [17 March 2017]. UNICEF. 2016. Current status and progress. September. //data.unicef.org/topic/child-protection/female-genitalmutilation-and-cutting/# Updated UNODC. 2017. https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html [22 March 2017] Alexas Fotos/ Pixabay. 2016. Burundian Anglicans establish safe house for victims of gender based violence. 2016. https://www.google.co.za/search?q=gender-based+violence+south+african+government+images

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Your Journey as a Tertiary Student After going through this chapter, you should:

• • • •

be able to create clear goals for yourself understand the concept and importance of branding yourself understand the importance of gaining experience prepare your own curriculum vitae (CV)

Your chances of success at university will be greatly improved by having clear academic and personal goals. A successful senior student shared her story:

If you don’t know where you are going, you will probably end up somewhere else. Lawrence J. Peter

“By identifying and investing in my goals from day one, I achieved my degree in the three-year period. My marks for first year were in the 50s but this increased to 60s in the second year and included a few 70s in the final year. I am pleased that my plan worked for me.” The “YES YOU CAN” slogan will also help you to achieve this level of success if you put your mind to it. Identifying your goals is important, but certainly not enough. A goal without a clear plan of action is wishful thinking. Let us explore simple ways to make your dreams come true.

tip

Define your goals Think about exactly what you want to achieve and decide on a deadline for achieving these specific goals. It is important to be clear on which of your goals are short-term, medium-term and long-term. The next step is to write down all your goals to keep track of your progress. The SMART principle is a useful tool to ensure your goals are clear and realistic.

Roadmap to your social, mental and physical wellbeing

tip

Believe in your goals

tip

Plan the steps

Be clear on why these goals are important to you and how achieving them will improve your life. Identify the internal and external motivators for achieving your goals. Reflect on how much time and energy you are prepared to invest in achieving your goals.

Write down the steps to reach each goal: - the actions needed, with smaller manageable tasks; - resources and support systems you have in place; and - possible obstacles along the way and what you will do to address each. For example, a senior student would plan a balanced weekly timetable to allow for adequate time for working on assignments, preparing for tests, pre-reading for lectures, compiling lecture notes, relaxation and sleep. Clearly identify the number of hours per day you will invest in the various tasks. Then you can give it a test-run for a week to check if it is a realistic plan or not. If not, revise your plan to make it more manageable.

tip

Review your progress regularly You can have strikingly written goals laminated and pasted on your wall, but it will be of little value if you never read them. Regularly read your goals and the action plans to measure your progress. By reviewing your progress, you will determine whether you are on track or stagnating. If you meet your target results, acknowledge your accomplishments. If you are not making progress, reflect on why your targeted goals are not being met and what you can do to achieve them.

Consider joining a peer education programme or any other extramural programme at your institution where you get recognition for your contribution through obtaining a certificate that you can use to boost your CV.

Boosting your career prospects There was a time when having a degree guaranteed you a worthwhile job. Today, and for better or worse, that is no longer the case. We live in a time where previously obscure terms like Emotional Intelligence (EQ) and soft skills have become workplace needs; where job applicants need to display resourcefulness and ingenuity from the interview room onwards. Todayâ&#x20AC;&#x2122;s young graduates and job seekers are having to provide more than just a certificate as an

Without goals and plans to reach them, you are like a ship that has set sail with no destination. Fitzhugh Dodson indication of their job worthiness. Todayâ&#x20AC;&#x2122;s employers are looking for more. Of course, becoming a hot property in the job market requires a long-term investment in yourself and careful planning. Ideally, you should start working at it sooner rather than later.

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The first question is, where does one start? Once you have a good idea of what industry or field you wish to enter, you need to take three important steps: •

•

Create a network of contacts and mentors who will help you position yourself within the industry or field that you are entering; Cultivate proficiencies that will make you stand out among the many graduates who will be applying for jobs at the same time as you; Gain experience that will enhance the knowledge that you are gaining in your chosen academic field.

Make connections One of the most important rules for any job seeker is to make connections. You are more likely to land a job through networking (it’s who you know) than by your credentials alone. Getting to know other students in your field, getting to know lecturers and professors, joining professional organisations, working part-time or volunteering in your field — these are all excellent ways to create opportunities for future jobs. Network with everybody.

strong, well-managed online presence not only allows you to connect with people of interest to you, but also tells prospective employers that you are an energetic, well-adjusted individual with good social skills. However, remember that what you publish on social media cannot be undone. It’s very important that you guard your personal reputation to ensure that no unwanted pictures or entries are attached to your sites or your name. Blogs are a great way of practising your writing skills and sharing your insights and thoughts about interesting subjects. Discuss your targeted industry frequently and, where possible, add helpful information. Understand the ethos of the new media environment: it‘s about adding value, sharing knowledge, skills and insights, and connecting with others responsibly. If you do this well, future employers will see you as somebody who has a passion for life-long learning and keeping up with trends, while also having the desire to share your knowledge.

Don’t make the mistake of thinking your peers can‘t contribute to your future success. Make sure your fellow students and friends are aware of your job plans. You might connect with a few that are interested in getting a similar job and can assist you in the process. This may lead to some competition, but you are more likely to gain than lose through sharing ideas and information. Impress your lecturers and get to know them through campus activities. Lecturers and professors are experts in their field, and are sources of great advice and sought-after references. Find a mentor. There are many people who wish to make a contribution to South Africa‘s young people. Connect with these kinds of people, ask them to mentor you and then spend a couple of hours a month with them. They will be able to give you advice about life, your studies and the direction in which you want to take your career.

Use the Internet Create a presence online by making use of social media like Twitter, Facebook and LinkedIn. A

While you are developing your writing skills, consider getting yourself published. You may have written a really good academic paper, so why not rewrite it for publication online or in a magazine? You may not be paid for it, but the value lies in building your profile and being noticed. Consider building yourself a simple website using one of the many freeware programmes available on the Internet. If you manage this carefully and keep it updated, it could be highly beneficial. Be careful, though, not to take any of this to the point where you come across as egocentric. Add the occasional podcast to your blog or website. Interviews with others in your industry provide great content for a podcast.

Roadmap to your social, mental and physical wellbeing

Reflection Having completed this section on Women’s Health, reflect on the most important aspects that you have learnt in this chapter and your action plan to improve women health. Can you think of a recent Facebook/ Twitter post/ video that went viral?

What was the key issue of this post?

What is your opinion of it?

Join a club One of the most powerful ways of connecting with other people is through hobbies, sports and cultural activities. The best way of doing this is to join an organisation, association or club. Find one that you can enjoy being a part of and use these events to find common ground with people. In almost every job application, you will be required to demonstrate your ability to work with others. A good way of doing this is to display your sportsmanship. This doesn‘t mean that you have to be an exceptional athlete. It simply means being part of a team that meets to play sport regularly. The same goes for the arts. There are numerous opportunities for artists and musicians to showcase their talents locally. Take part in community art exhibitions or play in a local shopping mall. Better still, join community organisations that help disadvantaged youth access their creativity.

Branding yourself Define your brand Think about how you want to brand yourself. Use words such as ‘flexible’, ‘visionary’, ‘collaborative’, ‘resourceful’, ‘forward-thinking’, ‘visionary’, ‘diplomatic’, ‘intuitive’, ‘ethical’, and ‘genuine’ to describe YOU.

Create brand awareness through networking Connect with other young professionals in your industry by using social networks and commenting on their pages and blogs. Networking is a great way to become known in your industry.

The 3 Cs of branding Clarity, Consistency, Constancy. Be clear about who you are and who you are not and remain visible to your target audience.

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Get feedback from family, friends, fellow students, anywhere. Ask them what your main brand attributes and key strengths are. If they can easily tell you, then you’ve succeeded in branding YOU. Good luck!

• •

Reflection Branding yourself If you were competing for a job, why would you want the interviewer to appoint you for the job?

•

really eye-catching photographs for publications, websites and your own social media sites. Also get to know how to use tools like Flickr, which is great for anyone who wants to create a visual portfolio of his or her work. A first aid course, which will ensure that you take a leadership role during crisis situations. A course involving your creativity — art, poetry, needlework, woodwork, etc. Read widely: online, books, journals, magazines, newspapers. Being knowledgeable about your subject matter and having a good level of general knowledge is a necessity.

Gain experience

Graduates with a good range of skills — both job-related and social — are more likely to get the nod than those with a limited repertoire of proficiencies.

It is important to gain at least some work experience — whether as a volunteer, intern or parttime employee — as it gives employers an indication that you understand the world of work and company culture. It also suggests that you are willing to invest in yourself and your community. What you learn in the course of doing some kind of work while at university will help you develop the professional and social talents you’ll need throughout your life. But, remember, it is important to do relevant work. Think about getting a job that will teach you skills you can use in the future. Don’t take on a position as a plumber’s assistant doing physical labour if you intend to become an accountant. Know what basic skills you will need in your chosen career and find a job to help strengthen them. Internships give you an impressive addition to your resume. If a job recruiter sees that you have successfully completed an internship and that you have received a job reference from an important person in that company, you will likely be given greater consideration. Don’t wait for an internship.

To boost your personal value, consider doing one or more of the following: • An advanced computer course which, for example, makes you an Excel or PowerPoint expert. • A business writing-skills course, which teaches you how to take minutes, write good reports, letters and e-mails, write speeches, etc. • Joining a public speaking organisation such as Toastmasters, which will help you to become an inspiring and powerful public speaker. • A photographic course, which will help you take

Volunteer particularly for non-profit organisations (NGOs) in your field and for causes that really matter to you. Volunteer work can and should be included in a resume as it demonstrates your skills, how you use them successfully in productive work, your work ethic, and your willingness to help. Although there is no doubt that the job market has become incredibly competitive, it is also true that graduates have never had as many tools at their disposal to boost their prospects. Establishing one‘s reputation as a solid figure in a chosen career path has never been easier. All you have to do is take the initiative!

What can you contribute towards the growth of the company?

Cultivate proficiencies

Roadmap to your social, mental and physical wellbeing

Preparing your curriculum vitae A CV is the first impression you create about yourself to a potential employer.

Big NOs when submitting CVs • • • • • • •

Spelling errors Using incorrect tenses Using somebody else’s email addresses and other contact information Dishonesty Lack of cleanliness (creases, food or coffee marks etc.) Outdated information Employment gaps (state why you were unemployed and what you did- don’t leave gaps)

What must accompany a good CV

Cover letter

Recently certified copies of you identity document and certificates of all your qualifications

When drafting a CV the following headings are important

Personal information

date of birth

identity number

physical address

email address

contact number

drivers’ licence code

A personal statement- how you sell yourself

Highlights and qualifications- start with your highest qualification first

Work experience-start with the most recent work experience

Employer name

Your job title

Period worked there

Key responsibilities

Achievements (notable contributions)

Work

Personal

Skills

Hobbies and interests

Contactable references

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Activity Draft your own CV Personal Information

Personal Statement

Highlights AND Qualifications University or College

School

Work Experience Company

Key responsibilities

Job title

Reasons for leaving

Year (period from and to)

Achievements

Work

Personal

Skills

Hobbies AND Interests

References

Roadmap to your social, mental and physical wellbeing

Preparing for a job interview Do’s

DoNT’s

Understand the job requirements

Don’t answer questions with a “yes” or “no”. Elaborate briefly on your answer

Do research about the potential employer and consider possible interview questions

Do not lie in your interview

Be well prepared

Do not make derogatory remarks about your current or previous employer or colleagues

Dress smart

Do not ask about salary or employment benefits unless the interviewer bring it up

Be on time

Do not over-answer questions

Make eye contact

Do not let your discouragement show if you get the impression that the interview is not going well

Smile Greet the interviewer by shaking hands Wait until you are offered a chair before seating Sit up straight and comfortable Make them realise why they need you Be confident Prepare examples which demonstrate your uniqueness and work etiquette Convey factual and sincere points Prepare one or two questions- it shows your interest in the employer Follow up

Your end goal

Every beginning has an end. You are in the best time of your life. Make wise choices. Use support systems to help you achieve your end goal, your graduation day. Good luck!

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What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to adopt a healthy lifestyle: 1. To achieve my goals I need to do the following:

2. List the factors that could interfere with your plans to complete your studies in the required time:

3. List your action items to ensure you achieve your goals and objectives:

Roadmap to your social, mental and physical wellbeing

REFERENCES How to brand yourself. https://brandyourself.com/info/seo/how_to_brand_yourself [2April 2017] Johnson E. 2014. Business marketing. How to brand yourself. http://www.success.com/article/how-to-brandyourself [27 March 2017] South African Government. 2017. Compiling a curriculum vitae. http://www.gov.za/issues/compiling-curriculumvitae-0 [27 March 2017] South Africa News. 2017. Top five ways to boost your career in 2017. http://southafricanews.org/top-5-ways-toboost-your-career-in-2017/ [27 March 2017] Hofmeyer, A. 2015. Take caution before posting: social media and defamation. Dispute resolution matters. Cliff Dekker Hofmeyer. https://www.cliffedekkerhofmeyr.com/en/news/publications/2015/dispute-resolution/disputeresolution-matters-13-august-take-caution-before-posting-social-media-and-defamation.html [27 March 2017].

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NOTES

Roadmap to your social, mental and physical wellbeing

Answers How to use a male condom correctly: Move the condom down inside the packaging and tear the package carefully. Do not use your teeth or nails to do this 2 Throw the used condom away. You can wrap it up in toilet paper and throw it in the rubbish bin 10 Check the expiry date on the condom, make sure the package is sealed and that no air is escaping 1 Roll the condom to the base of the penis near the testicles

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