8.3 Findings
8.3.1 A narrow focused policy framework
Participants highlighted that policies that guide the Ministry of Primary and Secondary Education (MoPSE) in relation to broader issues of ASRH, HIV/AIDS and adolescents’
sexuality, are narrow focused and restrictive. These issues were explored to locate the position of VMMC and condoms within the prevention matrix and the larger implications of the current policy framework. The MoPSE was criticised for promoting a single approach; abstinence:
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Policies seek to regulate learners’ behaviour within a normative framework. The normative legal, cultural and religious framework prescribes that youth sexuality must be suppressed. Suppressing sexuality paves way for sexual abstinence, which must be promoted as the sole and viable option. However, some youths choose to be sexually active, thus abstinence messages may not be helpful to them. Helping such youths is difficult because policy prescribes a universal solution (KII participant: WeGanda – a male teacher, Mberengwa).
The current policy framework is problematic. Learners have the right to relevant knowledge and means to make informed decisions about their sexuality, but policies limit us; they’re largely moralistic and judgmental. E.g., you can’t advise a learner to use a condom even if you know he/she engages in risky sexual behaviour. Condom discussion is prohibited; one must avoid being misconstrued as a condom promoter (condoms are regarded as immoral objects), hence the normative discourse is abstinence (KII participant: Rosemary – a female teacher, Zvishavane).
In other interviews, it emerged that public policy’s emphasis on abstinence wastes the golden opportunities that could be provided by biomedical approaches such as school-based sex education for mitigating HIV incidence among adolescents. E.g., prohibiting condoms may compromise the protective efficacy of VMMC. Participants argued that condom discussion can improve knowledge, attitudes, and safe sexual behaviours in general but also particularly on the importance of correct and consistent condom use:
VMMC offers approximately 60% protection and the other 40% comes from condom use; interpreting this can be a complex task, yet, school-based sex education could be a feasible option, but the problem is our ministry. Condoms are merely mentioned as an HIV preventative measure and pupils aren’t explicitly instructed to use them, although need may arise. We don’t recommend condoms because we must emphasize abstinence, although we know they’re sexually active. Factual and normative knowledge could assist them because adolescent sexual encounters have become lethal in this era of HIV/AIDS, given that most infections occur among adolescents (particularly females) (KII participant: Hoto – a male teacher, Mberengwa).
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Learners may not know how to use a condom, but as educators, we aren’t allowed to go practical, i.e. to demonstrate correct condom use. They think that if you equip learners with such knowledge, they’ll in turn indulge in sex, yet they’re already indulging. Policy makers are ignorant of facts on the ground that learners aren’t sexually chaste. I don’t think they know, or they think it’s just a small number, but now I think it’s increasing (KII participant: De Beauvoir – a female teacher, Zvishavane).
Discussions with most educator participants indicated that theoretically, school-based sex education plays a critical role in mitigating HIV incidence among adolescents. However, it emerged that the subject is a conflict arena and poses a moral dilemma to policymakers, parents and other stakeholders. They suggested that perhaps it is this moral dilemma that makes the policy to be so parochial that it does not consider alternative ways of dealing with the reality of HIV among school adolescents. A case in point was the way ASRH education was provided:
ASRH education must be innovative and relevant, but as teachers, we’re constrained;
we walk a tight rope. We’re torn between limiting ourselves to the confines of the normative framework and deliver irrelevant messages or become “deviant” and provide relevant skills and knowledge, and importantly challenge adolescents to explore alternative norms. Critical discussions on norms, gender roles and communication skills needed to negotiate condom use (perhaps more important to girls as recipients of penetrative sex) can’t be fully explored; we’re liable to being charged for being too explicit and deviating from the normative discourse of abstinence (KII participant: Muromwe – a male teacher, Zvishavane).
According to health worker participants, school-based ASRH can be a vehicle for delievering age specific health messages e.g., expanding the VMMC knowledge base, there are also challenges with this approach, e.g., the complexity of handing mixed classes in discussing sensitive issues. The challenges are further exacerbated by policy restrictions. They expressed concern that while regular teachers may be the best transmitters of health messages due to established rapport with learners, some teachers in charge of sex education are either not
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knowledgeable enough about the content they teach or shy to teach it. One health worker had the following to say:
It is common to discover that some teachers are ignorant about the issues that form the core of their duty. If knowledgeable, they may be shy to effectively deliver the content.
In that case, several feasible options could remedy the situation e.g., offering in-service training to improve teachers’ grasp of the content and stimulate innovative ways to impart ASRH knowledge. Unfortunately, the MoPSE doesn’t have a provision for such in any of its policy documents. Doing so would increase the effectiveness of current health interventions including VMMC (KII participant: Philip – a male health worker, Zvishavane).
In another interview, the same challenge of shortage of competent sex education teachers and the absence of relevant policy provisions featured prominently. This scenario was blamed for limiting the diffusion of important expert knowledge that could catapult such interventions as VMMC to fruition. The following was said:
Teaching ASRH isn’t limited to basic biology facts; it must be reflective of the real social contexts through which microbes such as HIV are transmitted. Lay information must be displaced and replaced by scientific facts. E.g.; in VMMC, expert knowledge is required to clarify critical concerns such as why circumcision, condemned yesterday for promoting the spread of HIV suddenly becomes a solution. However, some teachers may not adequately explain such, and this may negatively affect VMMC uptake.
Forming alliances with competent health workers (e.g. health educators) may be a viable strategy. Unfortunately, there is no policy provision for such inter-ministerial collaboration. There’s potential for VMMC to be isolated as a ministry of health initiative that has nothing to do with the MoPSE (KII participant: Dhadza – a male health worker, Mberengwa).
The above challenge was also reiterated by teachers themselves who attributed the problem to current policy, as largely a result of omission rather than commission. They stated that their teacher training curricula does not feature ASRH as a module. As a result, when they are
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assigned to offer sex education, they often struggle because the content is outside their subject speciality.
Sexual health education is a diverse area. It can be explored from a wide range of perspectives such that with my own examinable subject content to master, it’s difficult to divert attention to a subject like sex education. The ministry doesn’t demonstrate its commitment to the teaching of this subject (KII participant: MaMoyo – a female teacher, Mberengwa).
Ministry position on sex education is vague. There is no syllabus or specific teachers to offer this subject. As a G & C teacher, I recognise the critical role of sex education but lack of clear guidelines threatens its future. It’s a policy issue; the ministry must formulate proper guidelines and invest in manpower development starting from tertiary level, and perhaps make it a compulsory and examinable subject. Collaboration with the ministry of health will be inevitable, and this will positively impact on current HIV prevention interventions e.g., VMMC and those girl child empowerment initiatives (KII participant: De Beauvoir – a female teacher, Zvishavane).
Participants demonstrated that school-based sex education has the potential to contribute to averting several negative health outcomes associated with adolescent sexuality, including HIV and AIDS. Further deliberations indicated that the current policy framework is too narrow focused and not accommodative of alternative norms. This may negatively impact HIV preventative interventions such as the use of condoms and VMMC, especially among school adolescents.