Understanding gender , sexuality and HIV risk in HEIs : narratives of international post-graduate students

Thirty years into the HIV&AIDS pandemic, the world is still striving to reduce new HIV infections and halve AIDS related deaths by 2015. However, sub-Saharan Africa still faces the burden of HIV infections as governments and private institutions try out different prevention strategies (UNAIDS 2011). Several scholars have argued that multiple concurrent sexual partnerships (MCSP) pose the greatest risk for new HIV infections. Furthermore, research has also linked MCSPs to mobility and migration. This paper draws from the project ‘Sexual identities and HIV&AIDS: an exploration of international university students’ experiences” which employed memory work, photo-voice, drawings and focus group discussions with ten (5male and 5female) Post Graduate international students at a South African university. Focussing on the data produced through memory work, I present university students’ lived-experience narratives of mobility and migration in relation to how they perceive MCSPs and HIV risk. The findings show how students construct their gendered and sexual identities in a foreign context and how these constructions intersect with their choices of sexual relationships and HIV risk. I argue from the findings that Higher Education Institutions should be treated as high risk ‘spaces of vulnerability’ and hence health support services and HIV intervention programming policies should be geared towards addressing such vulnerabilities in order to create sustainable teaching and learning environments that allow for all students to explore their full capabilities.


Introduction
Sub-Saharan Africa remains the region most heavily affected by HIV.Thirty years into the HIV and AIDS pandemic, the world is still striving to reduce new HIV infections and halve AIDS related deaths by 2015.According to the UNAIDS (2010a) report, in 2010, about 68% of all people living with HIV resided in sub-Saharan Africa, a region with only 12% of the global population.The UNAIDS (2010a) report also states that nearly 80% of young people living with HIV, most of whom are still at school, live in sub-Saharan Africa.Sub-Saharan Africa was also reported to have accounted for 70% of new HIV infections in 2010, with South Africa having more people living with HIV (an estimated 5.6 million) than any other country in the world (UNAIDS, 2011: 7).This becomes cause for concern because South Africa has become an educational hub for other African countries due to the internationalisation of higher education (Altbach & Knight, 2007;Gacel-Avila, 2005), making South Africa' HIV pandemic an African problem.With HIV prevalence being very high among school-going youth, it is important to interrogate and understand the conditions that are implicated in this state of affairs.

HIV/AIDS and young people
Several studies have been conducted on school-going youth in order to establish the relationship between education and sexual behaviour.These studies highlight the ways in which gender power relations are played out in heterosexual relationships and the power dynamics that facilitate unsafe sexual practices, with most of the studies focussing on sexual harassment and coercion (see Morrell, 2003;Pattman, 2005).Other studies have looked into the social constructions of the pandemic and as such have examined the social and cultural practices that create challenges with regard to infection and prevention, especially the taboo nature of sexuality issues in communities (see Buthelezi, 2004;Simpson, 2007).
UNAIDS has thus made empowering young people to protect themselves from HIV a priority area (UNAIDS, 2010a).It has called on countries to implement comprehensive programmes that put young people's leadership at the centre of national responses, to provide rights-based sexual and reproductive health education and services, and to empower young people to prevent sexual and other transmission of HIV infection among their peers.According to the UNAIDS (2010a) report on young people, this can be achieved by ensuring access to HIV testing and prevention efforts with and for young people in the context of sexuality education and by ensuring enabling legal environments, education and employment opportunities to reduce vulnerability to HIV.
Evidence of the effectiveness of comprehensive sexuality education in HIV and AIDS prevention has emerged (Coombe, 2003;Bruess and Greenberg, 2004;Hargreaves et al, 2008;Kirby, 2008).For the first time since the AIDS virus was discovered there are indications of a slowing of HIV incidence, as more young people are adopting safe sex practices (UNAIDS 2010a).There is thus a very real possibility of getting ahead of the pandemic.This can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond.It has been argued by scholars that programmes to protect young people from HIV must use combination prevention approaches that are friendly to young people (Coombe, 2003;Kelly, 2002;Pattman, 2006).Such programmes for young people must promote comprehensive services that include knowledge about HIV, sexuality education, access to sexual and reproductive health services and discussion on harmful sexual norms and practices.So how does this state of affairs translate into young people's sexuality choices when they get to universities?Many young people today go to universities for further studies while having little or no knowledge of how to ensure their safety against HIV infections.This places universities at the forefront of the pandemic in terms of ensuring that they cater for the needs of the student body.Interestingly, when Pouris and Pouris (2011) investigated the nature and extent of HIV-related published research worldwide, they concluded that South Africa is a "scientific powerhouse" basing their findings on the number of journal articles published by South Africans in the period 2005-2009.South Africa was ranked 5th in the world, with most of the research being in the social sciences.With such research output one would have expected 539 a decline in the HIV prevalence within South Africa, especially among young people.However, the high HIV prevalence rates suggest that the research has had a very small impact.Thus, Louw, Johnson and Smit (2009), appropriately argue for "new generation universities" which should be of service to the society in relation to the immediate needs of the communities, such that they can address the "challenges faced by their constituent communities" (Louw, et al., 2009: 2).It is within this context that this paper aims to explore how international students experience their sexuality in the context of mobility and migration in the age of HIV and AIDS.

Research question
What are international university students' experiences of sexuality in the context of mobility and migration in the age of HIV and AIDS?

Methodology
This paper draws from a bigger phenomenological study which employed memory work, drawings, photo-voice and focus group discussions to explore how the university environment shapes the sexual identity constructions of selected international students in order to understand how such constructions are implicated in the HIV pandemic and how these issues can be addressed for HIV prevention.
To make meaning of participants' perceptions of MCSP in relation to mobility and migration, this paper employs a deconstructive stance which perceives reality as socially and culturally constructed and interrogates these constructed texts (Derrida, 1976;Kincheloe & McLaren, 2002).It seeks to challenge and unmask issues that are taken for granted and as given in our social life.As Atkinson (2003: 37) puts it, "The effect of a deconstructive approach is to question the assumed educational, theoretical or moral superiority of particular worldviews or dominant paradigms in educational research and practice."

Participants
Ten postgraduate international students from a South African university, ranging in age from 25 to 35 years old, were purposively selected to participate in the study (see Marshall and Rossman, 1995).Cole and Knowles (2001) argue that in the personal experience genre, we aim for depth over breadth and that the aim of participant selection is not population representativeness.They claim that it is much more important to work thoroughly, meaningfully and authentically with one participant than to end up with very partial and sketchy understandings based on work with many.Following this argument I worked with only ten post-graduate international students.The decision to adopt a qualitative approach and working with a small group to produce data in a variety of ways is supported by Lather (1991) who has shown that qualitative approaches and engagements with small groups allow a researcher to do "thick and deep" (p.10) work to gain understanding into how a few individuals perceive and experience a phenomenon.Additionally, Clandinin and Connelly (2000) maintain that narrative inquirers use a range of qualitative methods to engender and collect field texts that relate diverse aspects of researchers' and participants' experiences in the research setting.
Participants were given a prompt for recording a critical sexuality experience in their lives as university students.The memory accounts or narratives had to be descriptive and convey what happened, to whom, how, when and to what effect (Richert, 2002;Elliott, 2005).The memory accounts were discussed in single sex focus group discussions.These discussions were audio-recorded and transcribed verbatim.All transcribed data was taken back to the participants to check for correctness of meaning and to consent to the use of the data before it was analysed.The transcriptions and memory accounts were analysed using thematic analysis, whereby themes are generated from the data and coded for meaning (Patton 2002).This is supported by Nieuwenhuis (2007b: 101) who posits that content analysis is used when working with narratives such as journals or diaries, or to analyse qualitative responses to open-ended questions on surveys, interviews or focus groups.

Trustworthiness
According to Nieuwenhuis (2007a), engaging several data production methods can lead to trustworthiness.He also argues that having several investigators or peer researchers could also enhance trustworthiness.In this study, several methods of generating data were employed and the research participants also acted as co-researchers, engaging in the analysis of the data, in order to enhance the trustworthiness of the study.Riessman (2002: 256) also argues that personal narratives are not meant to be read as an exact record of what happened, nor are they a mirror of the world.Therefore in this study, trustworthiness and not 'truth' is the key issue.Lincoln and Guba (1985) refer to the trustworthiness of findings in qualitative research as findings which can be trusted and are worth paying attention to.While he uses four constructs, i.e. credibility, transferability, dependability, and confirmability to ensure trustworthiness of the findings (De Vos 2005: 346), I draw on Merriam's constructs (as put forward in Jansen 2007: 38) of crystallization, using several sources and methods to develop the findings, and member checks with the data being verified by others than those initially involved in the study, to ensure the trustworthiness.

Ethical issues
The sensitivity of the phenomenon under study demanded that I seek ethical clearance to ensure that ethical procedures would be employed throughout the study.Ethical clearance was granted by the university's Human Research Ethics Board.The participants were informed about the aims of the study and they signed informed consent forms allowing me to use their data for research purposes.Every effort was taken to ensure that the identities of the participants remain known only to the participating group to avoid prejudice from the university community 2 .Pseudonyms have been used to tell the participants' stories.

Findings: sexuality experiences in relation to mobility and migration, in the age of HIV and AIDS
The participants' experiences of mobility in relation to their sexuality highlighted several issues which have been grouped into three main themes namely: partners left at home, lonely academic life, and multiple and concurrent sexual partnerships.The findings are presented according to these themes in relation to male and female participants' experiences.
2 University community is used to refer to both local and international students at the university.

Partners left at home-males
The male participants argued that they have 'steady'3 partners or wives in their home countries and they have been used to having female company whenever they wanted.Being in a different country has, according to them, necessitated them finding female companionship from other women.Their discussion highlights the following: For these men, there is nothing wrong with having another woman while the steady partner is away because they feel entitled to have a woman around.Participant Q argues that "I got used to having her around" while P states that "I am used to having sex…" For these participants these statements justify their engagement in extra-marital or 'cheating' relationships within the university.The interesting factor in these sexual relationships is that apart from the partners left at home, some of the men are having more than one partner at the same time within the university community.From the discussion above it is evident that the men see nothing wrong with having more than one partner because "they can't all have a headache at the same time…" By implication, these men have no concerns with the number of sexual partners they have as long as their sexual needs are met.

Partners left at home-females
Similarly, the female participants' reasons for finding new partners within the university community related to them having left their partners at home.They also argued that they got used to having a man around and therefore had to find someone to give them the kind of attention they got from their 'steady' partners when they were at home: Just like the male participants, some of the female participants also have more than one sexual partner within the university community.They interestingly also have the same sense of entitlement to male attention because they got used to having their partners back home giving them the attention they needed.All the female participants argue that they needed someone to help with their needs while at university and that is why they got other men.
From the women's discussions, another reason for engaging in sexual relationships with local men was to be able to afford some luxuries that they had gotten used to in their home countries.
However, these were not the only reasons why the participants found themselves engaging in sexual relationships with other people within the university community.All the participants, male and female, argued that academic life especially for post-graduate studies was a very lonely life.They argued that they did not attend any lectures and therefore their chances of meeting new people and making friends or having colleagues that they could talk to were reduced.For both the male and female participants, the loneliness of post-graduate studies and academic frustrations make them needy of companionship, which they get from their local partners.The need to have someone to talk to, someone who understands what they are going through, makes them vulnerable to engaging in extra-marital or 'cheating' relationships.While they argue that their partners that are left behind in their home countries understand the challenges they go through as students, they also argue that it would have been better if these partners were around.Thus the challenges of studying in a foreign context, by implication, are exacerbated by the loneliness caused by having left loved ones behind.While the participants are not aware of the sexual conduct of their partners back home, there are chances that the partners are facing similar challenges in relation to loneliness.This brings in an additional risk of a wide network of sexual intersections within the host country and in the home countries.

Lonely academic life-males
When asked how they felt about their sexual relationships, the participants had mixed views.Some of the participants started questioning their sexual practices while others felt it was safer to have multiple sexual partnerships as a safety net against being cheated upon: Multiple and concurrent sexual partnerships-males P I think things work better for me this way.The ladies know about my wife and they know that we are just having fun.They also know about each other.
I also know about their steady partners too.So using protection is very easy S In my culture it is allowed for a man to have many wives.My religion also allows it.As long as they all know about each other then it is not risky.

R The question is P, does your wife know about your ladies and do you know about your wife's other men? P My wife with another man…never!
Many African communities still practice polygamy either because of the dictates of culture or religion.This makes it acceptable for a man to have many sexual partners, while it is forbidden for a woman to have many sexual partners.Some of the male participants in this study seemed to resort to culture and religion as excuses for their multiple sexual partnerships, while some of them believe that as men they are entitled to have any number of women they want.Despite women being forbidden in many communities to have multiple sexual partners, the female participants in this study have a different view to the status quo: Multiple and concurrent sexual partnerships-females L This is more transparent than the so-called monogamous relationships in which there are so many unknown sexual connections.It is interesting to note that only the female participants brought in the notion of love into the discussion, even though they were questioning its validity.The implication of this discussion is that the female participants in this study have reconstructed their perceptions of what it means to be a good woman differently from what society dictates.They argue that for women to survive in today's world they also need to have multiple sexual partners.According to them, women should start having relationships in which they are in control of when, how, where and with whom to have sex.

Discussion
While the findings present some challenging issues regarding the incidence of MCSPs and HIV vulnerability in the lives of international university students, they also highlight a context in which young people are challenging hegemonic constructions of sexuality.While women and girls are mostly painted as victims in sexual relationships within the existing literature, this study shows that women and girls have the potential to be active agents of their sexuality (Hunter, 2002).This is evidenced by the female participants going out in search for their own sexual fulfilment irrespective of society's dictates.
In many societies, girls and women are raised to believe that to be sexually active is to transgress the rules of femininity, and the pursuit of sex transforms good girls into bad girls.Thus most women accept the cultural standard of minimalism defined as "fewer partners, fewer positions, less pleasure and less sex" as observed by Kimmel (2004: 240).These rules of femininity are enforced not just by men, but also by other women, and institutionalised in churches, the state and schools.However, as evidenced in the comments raised by the female participants in this study the women are challenging this assumption and are pursuing their sexual satisfaction irrespective of the dangers involved.Ericsson (2005: 141) argues that the idea of "problematic sexuality" still resides in girls and that the sexual behaviour of boys is seldom made an issue.In agreement, Kimmel (2004: 239) argues that men still stand to gain status and women to lose it from sexual experience: "he is a stud who scores; she is a slut who 'gives it up'".This is because women are pictured as basically having a problematic and unruly body whose sexuality and reproduction is in need of constant surveillance and regulation, argues Ericsson (2005:135).
The male participants in this study felt a sense of entitlement to many sexual partners.This is in line with what has been observed by Jewkes (2002Jewkes ( :1092) ) and Bergen (2007) who have argued that in many societies, men have a sense of entitlement to the bodies of the women in their lives.Thus, for these participants, if one woman cannot give them sex then they should get it from another one.This creates a context in which women are emotionally coerced to have sex with their partners through a sense of obligation, or to avoid being cheated on (Basile, 2002).
Despite these arguments, both the male and female participants are vulnerable to HIV infections due to the multiplicity and concurrency of their sexual encounters within the university community.While some of the participants alluded to safer sex practices, many of them were very silent on the issue.This could be attributed to the fact that people are still uncomfortable to talk about sex and condoms because of the taboo nature of sex in African societies.However, Morrell (2003) warns that silence regarding sexuality issues creates a fertile ground for new HIV infections as lack of knowledge increases vulnerability.
The International Organisation for Migration (IOM) defines mobile populations as People who move from one place to another temporarily, seasonally or permanently for a host of voluntary and/or involuntary reasons (IOM 2002).Human mobility in southern Africa impacts on the individual health of migrants, as well as the public health of host communities.This, coupled with the highest prevalence of HIV globally, means that migrants and those affected by the migration process in southern Africa are particularly vulnerable to HIV (UNAIDS, 2010).In 2009, 34 per cent of people living with HIV and AIDS resided in 10 countries in southern Africa: Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe.These numbers become problematic considering that the mobile student groups coming into South Africa's institutions of higher learning are from some of these vulnerable communities.Considering the challenges described by the participants in this study, it is evident that mobility and migration create networks beyond each country's borders in terms of HIV infections.This means that both host communities as well as home communities become more vulnerable to being infected with HIV in the context of unsafe sexual practices.
Additionally, locations where people's health is at high risk are described as spaces of vulnerability by the IOM (2002).The organisation argues that spaces of vulnerability are those areas where migrants and mobile populations live, work, pass through or originate from.Because international university students are a mobile population as well, then universities and higher education institutions (HEIs) should be regarded as high risk spaces of vulnerability.South African HEIs and universities are a kaleidoscope of diversity in terms of languages, different cultures and other social signifiers.Students from other countries constitute a big percentage of students within South African universities (HESA, 2010).This diversity perpetuates the discourse of the "exotic other", in which difference is constructed as erotic (Farahani, 2007) thus encouraging sexual experimentation within international student groups and also with local students.This situation of wanting to try out something different exacerbates students' vulnerability to HIV infections by creating a fertile ground for multiple and concurrent sexual partnerships.
Treating South African HEIs as spaces of vulnerability means we should acknowledge the challenges that international as well as local students face in such spaces and create teaching and learning environments that address the vulnerabilities that students bring into the universities.It means that health support services and HIV intervention programming policies should be geared towards addressing the highly sexualised environments which characterise HEIs in order to ensure that the sexual and reproductive health rights of students are protected such that we create sustainable teaching and learning environments that allow for all students to explore their full capabilities.

Conclusions
This paper has discussed international university students' experiences of sexuality in the context of mobility and migration in the age of HIV and AIDS.It has brought to the fore issues regarding studying in a foreign context and the vulnerabilities thereof.The participants' negotiations of their sexual lives highlight the challenges faced by mobile populations in relation to HIV infections.Thus, a better understanding of the link between HIV and population movement in southern Africa is essential in order to develop effective HIV and AIDS interventions and strategies.Gender is an important dimension when discussing the linkages between migration and migrants' health due to the increase in migration by women, who had traditionally remained at home while men moved in search of paid work (UNFPA, 2005).Moreover, the social construction of gender and sexuality underlies HIV vulnerability of migrant and mobile populations.Gender norms which support the tendency to have many sexual partners and endorse multiple and concurrent sexual partnerships are often found to exist among migrant populations, including university students, thus exacerbating HIV vulnerability.
IOM (2010) has observed that health vulnerability stems not only from individual but also a range of environmental factors specific to the unique conditions of a location, including the relationship dynamics among mobile and sedentary populations.These factors must be taken into consideration when addressing migration health concerns, including sexual health and reproductive rights for international university students.Interventions, including comprehensive sexuality education and access to reproductive health resources, must consider and target both mobile populations as well as the communities with which they interact.The current trend in the internationalisation of higher education demands that universities and other HEIs be conscious of the challenges international students face such that the incidence of new HIV infections is reduced.We can only get to zero HIV infections if we all take concerted effort to create ecologies that are free from the virus.
married to an old man and he does not care much to come visit me here.It does not bother him if I do not go home to visit.So, I needed someone here to help with my needs… M My boyfriend and I stayed together before I came for my studies.We were almost like married.So my sister I got used to having a man around to give me some TLC, hahahaa…and I got myself a nice man on campus… L I just needed to be spoiled while I am here.I am used to having whatever I want at home 'coz my boyfriend can afford it, but these people can't afford a lot.So you need more than one man … hahahaaaa … I say 'if you can't be with the one you love, love the one you are with' It is safer for me as a woman and it gives me the power to decide on having sex and protection…I call the shots.
KWhat has love got to do with it?There is love and then there is sex.In the context in which we are you should rule love out and just have sex…men have been doing for ages and surviving very well.This way a woman can keep sane for longer...