Skip to main content

Advertisement

Log in

The Impact of Contextual Factors on Comprehensive Sexuality Education for Learners with Intellectual Disabilities in South Africa

  • Original Paper
  • Published:
Sexuality and Disability Aims and scope Submit manuscript

Abstract

Adolescents and youth with disabilities in South Africa still lack access to sexual and reproductive health and rights services including comprehensive sexuality education, which may increase their vulnerability to SRHR issues such as HIV and sexual violence. This is exacerbated for learners with intellectual disabilities whose educators often lack skills and tools to accommodate these learners in comprehensive sexuality education lessons. The following paper outlines the findings of a formative evaluation of an innovative sexuality training approach for educators of learners with diverse disabilities (Breaking the Silence approach). This approach was developed and piloted with educators across eight schools for learners with intellectual disabilities in KwaZulu-Natal, South Africa. The paper discusses the educators’ understanding and experiences of using this approach. The findings revealed that although educators were able to implement parts of the approach, contextual factors impacted the degree of implementation. These factors were related to perceptions of socio-cultural norms, interpersonal engagement with peers and management, the structural environment of school settings, and the wider community setting. Educators began to address cultural taboos related to talking about sexuality, but were challenged by untrained staff and the larger socio-cultural context, which includes a heighted risk of sexual violence against their learners. The paper concludes with recommendations for a further investigation of the approach within a whole school setting considering the needs of educators to not only acquire skills and knowledge but also to address their larger socio-cultural context in which they have to implement comprehensive sexuality education.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. UNFPA: UNFPA Operational Guidance for Comprehensive Sexuality Education: A Focus on Human Rights and Gender. UNFPA, New York (2014)

    Google Scholar 

  2. United Nations General Assembly: Transforming our World: The 2030 Agenda for Sustainable Development. UN, New York (2015)

    Google Scholar 

  3. South African National AIDS Council: Let Our Actions Count. South Africa’s National Strategic Plan on HIV, TB and STIs 2017-2022. SANAC, Pretoria (2017)

    Google Scholar 

  4. South African Department of Social Development: National Adolescent Sexual and Reproductive Health and Rights Framework Strategy 2014–2019. DSD, Pretoria (2015)

    Google Scholar 

  5. UNICEF: UNAIDS: All In. Towards ending the AIDS epidemic among adolescents. Paper presented at the 69 Session of the United Nations, New York (2014)

  6. UNICEF: Opportunity in Crisis: Preventing HIV from Early Adolescence to Young Adulthood. UNICEF, New York (2011)

    Google Scholar 

  7. UNAIDS: UNAIDS Strategy 2016–2021: On the Fast-Track to end AIDS. UNAIDS, Geneva (2015)

    Google Scholar 

  8. United Nation General Assembly: Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight Against HIV and to End the AIDS Epidemic by 2030. UN, New York (2016)

    Google Scholar 

  9. Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa, 2003. Art 14. (2003)

  10. UNESCO: Young People Today. Why Adolescents and Young People Need Comprehensive Sexuality Education and Sexual and Reproductive Health Services in Eastern and Southern Africa. United Nation Educational Scientific and Cultural Organization, Paris (2013)

    Google Scholar 

  11. Holness, W.: Informed consent for sterlisation of women and girls with disabilities in the light of the convention on the rights of persons with disabilities. Ageda 27(4), 35–54 (2013)

    Google Scholar 

  12. Jones, L., Bellis, M.A., Wood, S., Hughes, K., McCoy, E., Eckley, L., Bates, G., Mikton, C., Shakespeare, T., Officer, A.: Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies. Lancet 380(9845), 899–907 (2012). https://doi.org/10.1016/S0140-6736(12)60692-8

    Article  PubMed  Google Scholar 

  13. Hughes, K., Bellis, A.M., Jones, L., Wood, S., Bates, G., Eckley, L., McCoy, E., Mikton, C., Shakespeare, T., Officer, A.: Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet 380, 899–907 (2012)

    Article  PubMed  Google Scholar 

  14. United Nations Population Fund: Sexual and Reproductive Health of Persons with Disabilities. United Nations Population Fund, New York

  15. World Health Organisation: World Bank: World Disability Report. WHO, Malta (2011)

    Google Scholar 

  16. South African Department of Social Development: Elements of the Financial and Economic Costs of Disability to Households in South Africa. Results from a Pilot Study. DSD, UNICEF, Johannesburg (2016)

    Google Scholar 

  17. United Nations: Convention on the Rights of Persons with Disabilities. UN, New York City (2008)

    Google Scholar 

  18. UNICEF: Towards an AIDS Free Generation: Promoting Community Based Strategies for and with Children and Adolescents with Disabilities. UNICEF, New York (2012)

    Google Scholar 

  19. Trani, J.F., Browne, J., Kett, M., Bah, O., Morla, T., Bailey, N., Groce, N.: Access to health care, reproductive health and disability: a large scale survey in Sierra Leone. Soc. Sci. Med. 73, 1477–1489 (2011). https://doi.org/10.1016/j.socscimed.2011.08.040

    Article  PubMed  Google Scholar 

  20. Bremer, K., Cockburn, L., Ruth, A.: Reproductive health experiences among women with physical disabilities in the north west region of Cameroon. Int. J. Gynecol. Obstet. 108, 211–213 (2009)

    Article  Google Scholar 

  21. Johns, R., Adnams, C.: My Right to Know: Developing Sexuality Education Resrouces for Learners with Intellectual Disabilities in the Western Cape South Africa. Pretoria University Law Press, Pretoria (2016)

    Google Scholar 

  22. Gooey, S.L., Chappell, P.: HIV and sexuality: why are people with disabilities left behind? HIV Aust. 12(2), 45–47 (2014)

    Google Scholar 

  23. Rohleder, P.: Educators’ ambivalence and managing anxiety in providing sex education for people with learning disabilities. Psychodyn. Pract. 16(2), 165–182 (2010). https://doi.org/10.1080/14753631003688100

    Article  Google Scholar 

  24. Rohleder, P., Swartz, L., Schneider, M., Henning Eide, A.: Challenges to providing HIV prevention education to youth with disabilities in South Africa. Disabil. Rehabil. 34(8), 619–624 (2012)

    Article  PubMed  Google Scholar 

  25. de Reuters, L., Hanass-Hancock, J., Henken, A.S., van Brakel, W.: The voice of educators: challenges in providing HIV and sexuality education to learners with disabilities in South Africa. Sex Educ. 15(4), 333–347 (2015)

    Article  Google Scholar 

  26. Chirawu, P., Hanass-Hancock, J., Aderemi, T.J., de Reus, L., Henken, A.S.: Protect or enable? Teachers’ beliefs and practices regarding provision of sexuality education to learners with disability in KwaZulu-Natal, South Africa. Sex. Disabil. 32(3), 259–277 (2014). https://doi.org/10.1007/s11195-014-9355-7

    Article  Google Scholar 

  27. Aderemi, T.: Sexual abstinence and HIV knowledge in school-going adolescents with intellectual disabilities and nondisabled adolescents in Nigeria. J. Child Adolesc. Ment. Health 25(1), 161–174 (2013)

    Article  PubMed  Google Scholar 

  28. Aderemi, T.: Teachers’ perspectives on sexuality and sexuality education of learners with intellectual disabilities in Nigeria. Sex. Disabil. 31(2), 1–12 (2014)

    Google Scholar 

  29. Kvam, M.H., Braathen, S.H.: Violence and abuse against women with disabilities in Malawi. SINTEF health report, pp. 1–65. SINTEF, Norway (2006)

  30. Save the Children: Out from the Shadows, Sexual Violence Against Children with Disabilities. Save the Children, London (2011)

    Google Scholar 

  31. Sicking, L.: The Challenges of Reporting, Investigating, and Prosecuting of Sexual Violence Among People with Disabilities in South Africa. Vu University, Amsterdam & University of KwaZulu-Natal, Amsterdam (2013)

    Google Scholar 

  32. Hanass-Hancock, J.: Disability and HIV/AIDS—a systematic review of literature in Africa. J. Int. AIDS Soc. 12(34). http://www.jiasociety.org/series/hiv_aids_and_disability (2009)

  33. Kvam, M.H., Braathen, S.H.: “I thought…maybe this is my chance”: sexual abuse against girls and women with disabilities in Malawi. Sex. Abuse-J. Res. Tr. 20(1), 5–24 (2008)

    Article  Google Scholar 

  34. Francis, D.: Sexuality education in South Africa: whose values are we teaching? Can. J. Hum. Sex. 22(2), 69–76 (2013)

    Article  Google Scholar 

  35. Francis, D.: Sexuality education in South Africa: Wedged within a triad of contradictory values. J. Psychol. Afr. 21(3), 317–322 (2011)

    Article  Google Scholar 

  36. Chappell, P., Rule, P., Dlamini, M., Nkala, N.: Troubling power dynamics: youth with disabilities as co-researchers in sexuality research in South Africa. J. Child. 21(3), 385–399 (2014)

    Article  Google Scholar 

  37. Chappell, P.: How Zulu-speaking youth with physical and visual disabilities understand love and relationships in constructing their sexual identities. Cult. Health Sex. 16(9), 1156–1168 (2014)

    Article  PubMed  Google Scholar 

  38. McKenzie, J.A., Swartz, L.: The Shapting of sexuality in children with disabilities: a Q methodological study. Sex. Disabil. 29, 363–376 (2011)

    Article  Google Scholar 

  39. Wilson, N.J., Mckensie, J., Kahonde, C.: Commentary on “The experience and needs of mothers supporting young adolescents with intellectual disabilities through puberty and emerging sexuality” (O’Neill, Lima, Thomson Bowe, & Newall, 2015) Research and practice in Intellectual and Developmental Disabilities. Res. Pract. Intell. Dev. Disabil. 3(1), 48–53 (2016). https://doi.org/10.1080/23297018.2016.1157515

    Google Scholar 

  40. Kahonde, C.: A grounded theory study of family caregivers’ responses to the sexuality of young adults with intellectual disabilities. UCT (2016)

  41. Johns, R., Chappell, P., Hanass-Hancock, J.: Breaking the Silence: Accommodating Young People with Disabilities in Sexuality Education. Reader for Educators. HEARD, Durban (2014)

    Google Scholar 

  42. Hanass-Hancock, J., Henken, S., Pretorius, L., de Reus, L., van Brakel, W.: The cross-cultural validation to measure the needs and practices of educators who teach sexuality education to learners with a disability in South Africa. Sex. Disabil. 32, 279–298 (2014)

    Article  Google Scholar 

  43. Hanass-Hancock, J., Chappel, P., Johns, R., Nene, S.: Breaking the Silence through delivering comprehensive sexuality education to learners with disabilities in South Africa: Educators experiences. Sex. Disabil. (2018). https://doi.org/10.1007/s11195-018-9525-0

  44. Pretorious, L., Hanass-Hancock, J.: Breaking the silence: strengthening sexuality education within the life orientation curriculum for learners with disabilities. Workshop report. HEARD, Durban (2014)

  45. de Reuters, L.: The Voice of Educators: Perspectives of Educators Providing Sexuality and HIV Education to Learners with Disabilities. Vreje Universitiat Amsterdam & HEARD, Amsterdam (2013)

    Google Scholar 

  46. Chappell, P.: Secret languages of sex: disabled youth’s experiences of sexual and HIV communication with their parents/caregivers in KwaZulu-Natal, South Africa. Sex Educ. 16(4), 405–417 (2016)

    Article  Google Scholar 

  47. Hanass-Hancock, J.: Interweaving conceptualizations of gender and disability in the context of vulnerability to HIV/AIDS in KwaZulu-Natal, South Africa. Sex. Disabil. 27(1), 35–47 (2009)

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank WCFID for providing some of the picture material for the manual development. We would also like to thank HEARD for providing the funds for the needs assessment, intervention development and part of the evaluation through its SIDA grant. In addition, we would like to thank all participating educators and KZN representatives of the Department of Basic Education for their participation in this project and courage to try out something new and daring. In addition, thanks go to the developmental team who assisted during the needs assessment namely Leandri Pretorious, Sophie Henken and Liset de Reus, who provided their time to the project on a voluntary basis.

Author information

Authors and Affiliations

Authors

Contributions

JHH conceptualised this project and led the needs assessment, intervention and manual development, pilot of the intervention, the formative evaluation and development of this paper. RJ co-led the manual development, co-facilitated the pilot intervention, and has been part of the writing team. PC co-designed the manual, took part in the data analysis and has been part of the writing team. SN conducted the fieldwork, supported the data analysis and has been part of the writing team.

Corresponding author

Correspondence to Jill Hanass-Hancock.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study received ethical clearance from the University of KwaZulu-Natal Biomedical Research Ethics Committee (HSS/0959/013PD) and the Kwazulu-Natal Department of Basic Education. Participation was voluntary and participants were fully informed about the study and signed informed consent forms.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hanass-Hancock, J., Nene, S., Johns, R. et al. The Impact of Contextual Factors on Comprehensive Sexuality Education for Learners with Intellectual Disabilities in South Africa. Sex Disabil 36, 123–140 (2018). https://doi.org/10.1007/s11195-018-9526-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11195-018-9526-z

Keywords

Navigation