Across the world, schools play a major role in shaping the attitudes, opinions and (perhaps most importantly) the behaviour of young people. Today’s generation of school children have been born into a world where AIDS is a harsh, unavoidable reality – a situation that their time at school can help them to prepare for. As well as providing an environment in which people can be educated about AIDS, schools often act as a centre-point for community discussion and activity; as such, they can be a vital tool in monitoring the epidemic and co-ordinating a response to it. With a capacity to reach large numbers of young people with information that can save their lives, basic school education can have such a powerful preventive effect that it has been described as a ‘social vaccine’.
At the same time, efforts to educate young people in developing countries are being hampered by the epidemic itself. Pupils and teachers are falling ill, taking time off to care for family members and, in many cases, dying as a result of AIDS. This page explores these problems and the other effects that AIDS is having on schools, as well as the ways in which schools can be used to reduce the impact of the epidemic.
The effect of AIDS on schools
AIDS is one of the most serious challenges currently facing the education systems of poorer countries. As the diagram below shows, the damaging effect that AIDS is having on schools is, in turn, aggravating the epidemic itself in a vicious cycle:
“Without education, AIDS will continue its rampant spread. With AIDS out of control, education will be out of reach.” Peter Piot, head of UNAIDS
The most obvious way in which AIDS can affect a pupil is where the individual concerned is living with HIV, but a child’s education is also likely to be seriously disrupted if one or more of their family members are infected. In many of the areas that have been hit hardest by AIDS, the majority of children are likely to be ‘affected’ by the epidemic, in that they probably have close friends or relatives who are living with HIV or have died from AIDS. In such areas, it is likely that some children will take time off school to care for others living with HIV, or to take care of household duties that those people would otherwise have done.
Worldwide, 15.2 million children had been orphaned as a result of AIDS by the end of 2005. Upon the death of their parents, a child may be forced to move house and/or be affected by emotional stress and poverty, which can disrupt their education and lead them to drop out of school. If they have younger siblings, they may also be forced to leave school to look after them and act as the head of the household. Studies have shown that orphans in sub-Saharan Africa are 13% less likely to attend school than non-orphans.
The prospects of children who have been orphaned by AIDS are often further dampened by compulsory school fees, which must still be paid in the majority of poor countries. These fees are simply not affordable for most AIDS orphans or those who care for them, and often extended families that care for orphans see school fees as a major factor in deciding not to take on additional children orphaned by AIDS.
Teachers and other members of staff
It is not only pupils that are affected by the epidemic. Teachers, many of whom are part of an older generation that did not receive AIDS education in their younger years, are also highly susceptible to HIV infection in many countries. For example, in Zimbabwe one study found that 19% of male teachers and close to 29% of female teachers were HIV positive. As in many other countries, teachers are in short supply in Zimbabwe. In rural areas of the country in particular, schools often depend upon a small number of teachers; if one is ill, or taking time off to care for family members or attend to funerals as a result of AIDS, it can seriously disrupt classes.
Other adult members of staff can be affected too. Schools depend on a variety of individuals, from pupils and teachers to cleaners and support staff; if anyone involved with the school is affected by AIDS then this is likely to have repercussions for the ability of that school to function.
The role of schools in the fight against AIDS
The devastating effect that AIDS is having on schools should be one of the biggest concerns to those involved in fighting the epidemic, not least because schools provide one of the most cost-effective and efficient ways of reaching young people. While the education sector is seriously threatened by AIDS, it is also an invaluable tool in the fight to establish an environment where people living with HIV are well-supported and new infections are prevented.
Providing education to young people and others
Young people are more likely to be affected by HIV and AIDS than any other age group, but they are also more likely to change their behaviour as a result of education than any other group. At a time when, globally, more children are in school than ever before, it is therefore vitally important that countries invest in schools as a means of informing young people about how they can avoid HIV and AIDS before it is too late. Studies have shown that the HIV prevalence of an area is likely to decrease as education increases, that primary education can half the risk of infection amongst young people8 and that reduced vulnerability to HIV is observed in people with secondary or higher education.9 Schooling increases earning power, self-confidence and social status, allowing young people to take greater control over their sexual choices.
Through education, schools can also help to reduce stigma and discrimination – a major problem for people around the world who are living with HIV, which, as well as being distressing for those people themselves, has created a situation where others who may be infected are sometimes reluctant to be tested or access treatment for fear of prejudice. Education in general is likely to encourage a more respectful, open-minded attitude towards other people; in the case of HIV/AIDS education, giving pupils a greater understanding of the epidemic can help them to realise that AIDS can affect anyone, and that no-one has the right to judge an individual on the basis of their HIV status.
It is not just pupils that are educated through schools, though – members of the wider community, including teachers, cleaners, other members of staff and parents, can also increase their knowledge about HIV and AIDS by means of the school environment. Teachers who expand their understanding of the subject while researching for a lesson can pass this information on to adults as well as pupils, and the same can be said for the children themselves; once informed about AIDS, they can go home and tell their parents or their friends what they have learnt. If there are HIV positive children at the school, the adults connected to that school are also likely to learn more about HIV and AIDS through the school’s efforts to support those children.
Schools and the wider community
As a place where friendships are formed and bonds are established between teachers, pupils and parents, schools have always been more than just places where education takes place. They are often the focal-point of local community activity, especially in rural areas. This gives them enormous potential to act as the base from which local responses to the AIDS epidemic can be co-ordinated and strengthened. Unfortunately, in many developing countries schools do not have the staff, resources, or finances to effectively harness this potential.
One school that AVERT has worked with in rural South Africa is as an example of how schools can serve as more than just educational outlets. Here, an after school club has been set up where pupils who are severely
affected by HIV are kept behind after normal classroom hours to do their homework, but in addition are offered food and support that they do not receive at home. At this particular school, around a quarter of the pupils are directly affected by HIV – that is, they are either living with HIV themselves, have lost parents to AIDS or have a family member who is affected. Still, when asked what she thought was the biggest problem facing the school the headmistress pointed to the leaking roofs, cracks in the walls of classrooms and a lack of books – evidence that schools in developing countries are suffering from numerous problems besides AIDS.
Supporting children who are living with HIV
Schools can give children who are living with HIV a better understanding of their situation. As well as supporting those children themselves, schools can also provide assistance to the families that are caring for them. This is particularly important in countries where large numbers of children are living with HIV. Through education, HIV positive children can learn to stand up for their rights and challenge discrimination. They can also be encouraged to access treatment where available.
Reducing the vulnerability of girls
More than 113 million school-age children in developing countries do not attend school, two thirds of whom are girls.10 In many countries, traditional gender roles grant men greater economic and social power than women, and for some parents the education of their daughters is not seen as a priority. This poses a huge problem, because female subordination allows a situation where young women cannot encourage the use of condoms and may be coerced into sex with older men, which can lead them into situations where HIV is more likely to be transmitted.
Schools can help to reduce the vulnerability of girls to HIV and AIDS by empowering them with knowledge. Education can contribute to female economic independence, delayed marriage, and family planning. Several studies have demonstrated the fact that education can protect women from HIV; for example, a study in Zambia showed that young women with a secondary education were less likely to be HIV-positive than those who had not received a secondary education. Another study carried out in Uganda showed that, while infection rates had fallen among all young women, the decline was greatest for women with a secondary education.
Unfortunately, gender inequalities thrive in some schools. Sexual abuse carried out by male pupils and teachers is common in poorer countries, with some teachers taking advantage of their position to coerce schoolgirls into sex, often in exchange for food or good exam results. By acting in this way, those teachers not only create a situation where HIV transmission can occur but also undermine the very messages that they are supposed to be teaching to pupils about safe sex and a woman’s right to enforce condom use. Sexual abuse of this kind is also likely to discourage girls from attending school, which will damage their education and possibly prevent them from learning how to protect themselves against HIV infection.
AIDS education in schools worldwide: some case studies
There is no single model of school-based HIV/AIDS education that is appropriate to every country. Different situations call for different responses; a typical developed country programme that emphasises the importance of individual responsibility may be thoroughly inappropriate in a developing country where social interdependence is key to survival and personal choice is limited by poverty. What is universally clear, though, is that schools are in a position to change young people’s attitudes and behaviour, and that where this potential is harnessed successfully the impact of the AIDS epidemic can be significantly reduced. The following are some interesting examples of different national responses to HIV and AIDS education and the concerns that have surrounded the subject in different countries.
Kenya has witnessed a declining HIV prevalence in recent years, partly helped by increased efforts to provide AIDS education in schools. A weekly compulsory HIV/AIDS lesson has been inserted into all primary and secondary state curricula, and on top of this AIDS education has been integrated into all subjects at school – a strategy that has been widely commended. At the same time, AIDS education in Kenya still faces numerous problems. A recent survey carried out by the Kenya National Union of Teachers (KNUT) showed that Kenyan teachers are not generally well prepared for lessons and that many are not well informed about the subject. Only 45% of the teachers surveyed understood that HIV had no cure, whereas 24.4% and 12.4% respectively thought that herbs and traditional medicines as well as witchdoctors could cure infection. More positively, the study found that Kenyan pupils were generally happy to learn about HIV and AIDS: at least 55.7% of students had a positive attitude towards the topic, with only 14.4% displaying a negative response.
AIDS education in Kenya is based around a ‘life skills’ approach – that is, an approach that focuses on relationship issues and the social side of HIV, as well as simply the scientific facts about infection. But since Kenyan teachers are more used to teaching subjects in a factual, academic fashion, many find it difficult to address the topic in a way that is relevant to the social realities of student’s lives. With school education in Kenya very much focused on examinations, teachers are used to inundating students with facts and figures, whereas AIDS education requires that they engage pupils in active learning sessions.
HIV positive teachers in Kenya have also reported that school administrators and other members of staff have failed to support them, and that they have often faced discrimination. HIV positive teachers are less likely to get promoted than those who are not infected, and many claim that they do not feel secure in their job.
As with Kenya, the government of Uganda has put a lot of effort into AIDS education and this seems to have paid off in the form of a falling national HIV prevalence. In 2001, The Presidential Initiative on AIDS Strategy for Communicating to Young People (PIASCY) was launched – the country’s first national AIDS curriculum for primary schools. Under this programme, primary schools are required to hold weekly assemblies about HIV and AIDS and a set of teachers manuals have been distributed to give guidance on teaching the subject. Similar initiatives have been carried out in colleges and universities, although it has been reported that AIDS education in secondary schools is virtually non-existent. A lack of knowledge among teachers is also a problem, as teacher training initiatives have not been included in the government’s strategy. Difas Munywa, a member of the Uganda National Teachers’ Union, argues that even in primary schools, AIDS education is still not visible enough:
“PIASCY requires only that we hold a weekly assembly to pass on information about HIV/AIDS to pupils. That is what we do… we now need a more comprehensive strategy. We would feel more comfortable if we had more HIV/AIDS training. Except in large assemblies, teachers fear to talk about HIV/AIDS because pupils may ask difficult questions.”
In India, there is a discrepancy between the large amount of effort invested in HIV/AIDS curriculums and training packages on a national level and the lack of actual education being carried out in many schools. In the states of the country where there is a relatively low prevalence of HIV, officials have been reluctant to encourage AIDS education, claiming that the problem is not significant enough in these areas to warrant a widespread educational response.17 In reality, it is crucially important that young people le
arn about AIDS in areas with a low prevalence so that the prevalence stays low.
Where AIDS education is carried out in India it is incorporated into science lessons, with students being taught purely about the biological aspects of the subject.18 This approach has advantages, in that it is more adaptable to teachers who have not received any training to teach about AIDS and avoids the cultural and religious barriers that make it difficult for teachers to talk about sex in the classroom. At the same time, most experts agree that programmes that address the social side of HIV and AIDS are more effective than purely scientific approaches, which can make it difficult for students to appreciate the ‘human’ side of the topic.
In many districts of India, the topics of HIV and AIDS have been integrated into existing adolescence education curriculums, rather than being treated as stand-alone subjects. This approach has generally been successful; as one government official stated, even when school curriculums are overburdened it is always possible to adapt existing subjects to include information about AIDS:
“If you have a glass of water, you cannot add any more water to it. But you can add more salt, sugar and colour to the glass. In the same way, no more extra curriculum should be added to school education, but existing subjects can be modified to add in HIV/AIDS.”
India’s examination board has proposed to introduce HIV/AIDS education into nurseries and schools, teaching children as young as five about HIV and AIDS, drugs, hygiene and nutrition in an appropriate manner.20 NACO and the Ministry of Education have also designed a sex education programme to be taught to 15 to 17 year olds in Indian secondary schools, which could potentially be an invaluable tool in India’s fight against AIDS. However, this plan has been met with loud opposition, with politicians, teachers and parents protesting that such education is not appropriate and goes against Indian cultural values. This has led a number of state governments, including some of India’s most progressive states, to refuse to implement the plans, something that Sujata Rao (head of NACO) is dismayed by, along with other sexual health campaigners:
“We are talking about saving lives… that should be at the back of it, and not talk about ideological considerations. It is saving lives.”
In the U.S., AIDS education in schools is carried out within the wider framework of sex education. Debate has raged over whether AIDS education should take the form of abstinence education (where pupils are encouraged purely to avoid sex until marriage) or comprehensive AIDS education, which promotes other options such as condom use – alongside abstinence – as ways of preventing infection. Ultimately, comprehensive education has been shown to be more effective since it is more realistic about the lifestyles of young people, and because abstinence only protects an individual from AIDS if the person that they marry has also abstained from sex. Still, given the strong influences of religious groups and the political right in the US, many objections have been raised to comprehensive education.