The labyrinth of HIV and AIDS education and teaching
3.4 HIV and AIDS education: a window of hope
3.4.1 The role of HIV and AIDS education and schools in addressing the pandemic
Education and schooling provide almost the only known antidote to HIV infection
(Coombe & Kelly, 2001, p. 443)
There is growing recognition, Gachuhi (1999) argues, that education and training are pivotal for development; and that quality education contributes to economic, health and social transformation. Education in general and school-based HIV-prevention programmes in particular, plays a crucial role in responding to the drastic impact of the HIV and AIDS pandemic (Gachuhi, 1999; Kelly, 2000; Shaeffer, 1994; Visser, 2004; Wood, 2008; World Bank, 2002). Notwithstanding the challenges and barriers facing such education systems, it is widely acknowledged that, globally, education is vital to convey essential HIV-related knowledge and skills to millions of school-going children. Simply put, education systems and schools are at the forefront of HIV-prevention. Along this line of argument, Kelly (2000) contends that the potential of HIV and AIDS education is threefold: to provide knowledge, attitudes and skills to those not infected with HIV affording them protection, to enhance the ability of HIV-infected individuals to manage the infection, care for those infected and address the silence, stigma and discrimination, and to cope with loss and grief due to AIDS- related deaths.
Above and beyond delivering formal HIV-prevention programmes which assist in reducing HIV and AIDS prevalence, education systems have a key role in assisting societies mitigate its impact. As many point out, HIV and AIDS impacts on health, education and social welfare systems, as well as societies and social development issues (Kelly, 2002c; Shaeffer, 1994;
Visser, 2004; World Bank, 2002). Not surprisingly, as already mentioned, a collective, multi- sectoral response is recommended (Boler et al., 2003; Coombe & Kelly, 2001; Kelly, 2002b;
Mitchell & Pithouse, 2009). Whilst some commonalities and challenges exist worldwide across countries, Shaeffer (1994) contends that the complexities of economic, social and cultural contexts demand that countries develop differential responses. HIV and AIDS education as well as learning resources, Boler et al. (2003) agree, should be locally relevant employing local statistics and case studies. It is precisely because of these complexities of
100
context and the evolving face of the HIV and AIDS pandemic that education systems have undertaken curriculum and pedagogical reform. Along this line of argument, Coombe and Kelly (2001) call for education systems to move beyond developing HIV-related knowledge, life skills and attitudes; instead, they argue that practical, personal, economic and vocational skills should be developed. Put differently, they recommend that education systems prepare learners to be flexible, resourceful and cope with HIV-related trauma, as well as learn to be entrepreneurs. Kelly (2002a) puts it this way: social dilemmas such as HIV infection and death of teachers, nonflexible content and methods of teaching, vulnerability of orphans, children, girls and women, gender inequalities and violence demand drastic reform in education.
Such reforms in curriculum and pedagogy led to the roles of schools being re-examined.
Against this realisation, Kelly (2000, p. 4) asserts that: “school in an AIDS-infected world cannot be the same as school in an AIDS-free world”. Indeed, schools “as society’s most formal teaching-learning institution” have a responsibility to respond to the HIV and AIDS epidemic (Kelly, 2002a, p. 28). However, it is critical for schools to plan responses which centre on and respond to particular demands related to HIV and AIDS. As such, Kelly (2002a) posits that the HIV and AIDS catastrophe has shifted the role of schools, which increasingly have to provide counselling and psychological support for learners and communicate HIV and AIDS information to learners, teachers and the community. Schools, Boler et al. (2003) contend, represent crucial, trusted places for young children to learn about HIV and AIDS. Wood and Hillman (2008, p. 40), likewise, maintain that: “schools are the ideal place for teaching sexuality education, developing effective life skills in learners and motivating them to make choices that will optimise their life opportunities”.
Whether schools in particular and education in general, are ideally positioned to deliver HIV- prevention messages has been an area of much debate. Of great concern, is the relationship between the level of education and prevalence of HIV. Put differently, how does the level of education influence possibilities of HIV infection?
Earlier studies in sub-Saharan African countries harshly affected by HIV and AIDS, such as Zambia, indicated that HIV-infection levels were higher among those with higher levels of education or more educated (Coombe & Kelly, 2001). Such evidence suggested that HIV
101
prevalence increases according to social or occupational class and higher levels of education (Cohen, 2002; World Bank, 2002). Teachers, Gachuhi (1999) maintains, are at greater HIV- risk due to their higher incomes and greater mobility compared to others in rural areas. As such, the recommendation was that a positive correlation exists between the probability of engaging in risky sexual behaviour as well as actual HIV-infection, and levels of education.
These earlier studies, however, were conducted in the initial stages of the epidemic when information about causal factors and precise explanations of behavioural correlates of HIV and AIDS infection were scarce and unclear. Generally, HIV-prevention messages and level of knowledge about HIV-transmission was low (Cohen, 2002; Coombe and Kelly, 2001;
World Bank, 2002).
Subsequent studies conducted in Uganda and Zambia presents a contrasting argument: school education results in a decrease in HIV prevalence rates of young people. Girls aged between 15-19 years having secondary school education, Kelly (2002b) asserts, showed a drastic decline in HIV-infection rates, while the probability of HIV-infection was three times greater in girls dropping out of school than their contemporaries who remained in school. That being the case signals a shift towards a negative correlation between levels of education and probability of HIV infection. Wood and Hillman (2008) agree that education as a ‘social vaccine’ helps prevent or reduce HIV infection, since individuals with more education seem less likely to be HIV-infected. What, precisely, is the explanation for the resulting decrease in HIV infection as the level of education increases? Gachuhi (1999) and Piot et al. (2001) concur that the skills and information of sex education programmes or family life not only encourages positive adolescent sexual behaviours, but also delays the commencement of sexual activity. That said, while some claim that increased HIV-related knowledge, life skills, attitudes and awareness about the disease contribute to declines in HIV infection rates, instead, others (Coombe & Kelly, 2001; World Bank, 2002) argue that this is due to education itself or the very process of being educated. As such, education possibly enhances the ability to utilise knowledge and develop effective life skills, make informed decisions, become economically independent and lead to brighter future prospects. Nevertheless, Cohen (2002) maintains there is still a need for behavioural research to unravel the causal factors and provide more precise explanations for such a negative correlation.
102
This crucial potential of HIV and AIDS education to decrease the probability of HIV transmission should be enhanced (Kelly, 2002b). The effectiveness of such HIV-prevention programmes, however, has increasingly been put under scrutiny (Campbell & Foulis, 2002;
Campbell et al., 2005; Clarke, 2008; Kelly, 2002c). While some countries such as Cambodia, Thailand, Brazil, Senegal and Uganda have reported success (Clarke, 2008; Kelly, 2002b;
Piot et al., 2001), the precise contribution of the education sector towards such success remains unclear. Evidence establishing the effectiveness of educational programmes presents conflicting results of success and failure (Campbell & Foulis, 2002; Clarke, 2008). This puts the role of HIV and AIDS education under the spotlight, and points to the urgent need for such research, which is currently scarce.
While this section shed light on the crucial role of education in general, and schools in particular, to address and curb the HIV and AIDS pandemic, they are nevertheless confronted with challenges which threaten effective delivery of HIV and AIDS education. Such challenges are outlined in the following discussion.
3.4.2 Challenges facing education systems and schools in delivering