CHAPTER TWO
2.7 Disability and HIV/AIDS
2.7.2 Intellectual disability and HIV/AIDS – a review of the literature
2.7.2.9 Sexuality and HIV/AIDS prevention education
Birch, Angermeier, and Gentsch (2002), utilising structured telephone interviews with 19 directors of education cooperatives in rural Indiana, report a mean ranking of 7.4 for the importance of HIV/AIDS education for learners with intellectual disability. It is not surprising then that little collaboration between the administrators and the school district AIDS resource
140 persons was reported. The poor administrative collaboration may be responsible for the variations in collaboration between health and special educators at classroom level. The study also reveals that provision of HIV transmission and prevention varies according to the severity of intellectual disability. Students with mild intellectual disability are more exposed to HIV education by their inclusion in general health education classes than those functioning at moderate and severe levels. Although inclusion is good, the extent to which learners with mild intellectual disability will benefit from such an approach is questionable. According to Di Giulio (2003), they require more disability-specific education and may not understand concepts at the same rate as mainstream learners.
Birch et al. (2002) identify other barriers to HIV education in the rural setting, including: low perceived severity of HIV by parents and the community; conservatism of parents and the community regarding the appropriateness of HIV education; low collaboration between health educators and special educators; the reluctance of special educators to teach HIV education; and lack of a tailored HIV education curriculum.
Training of special educators in HIV prevention and development of a tailored HIV curriculum are therefore crucial to the provision of HIV education to this group of learners (Birch et al., 2002). They also recommend individualised instruction for each student. Moreover, the issue of culture must not be overlooked when developing an HIV education curriculum and, thus, parents have to be involved from the beginning of such efforts. The community also has to be involved to make the education successful.
Furthermore, Newens and McEwan (1995) evaluate two approaches of teaching HIV/AIDS education to learners with severe intellectual disability through non-participatory observation.
Their analysis yields the following effective ways of presenting sexuality and HIV education to IIL of up to 18 years:
Learning materials should be explicit in nature, but reinforcement of the private nature of sex should be done on a one-to-one basis to avoid confusion
The social aspects of personal and sexual relationships should not be separated from the more explicit anatomical/physical aspects
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There is always heterogeneity in learning ability, even within a group. To overcome the problem of differing needs for information against the need to involve all members of a group, questions should be directed to individual group members in turn
A teacher-pupil relationship ensures better integration and interaction than using an outsider
To account for the heterogeneity of group members‘ experiences of sexual relationships, group work should always be complemented by individual one-to-one sessions
The subjects of sexual intercourse and disease transmission should not be closely linked so as to avoid greater perceived risk than is realistic
Practising using condoms increases self-efficacy
Using materials from a limited range of previously validated programmes is better than using newly acquired resources
Sexuality and HIV education should be culturally sensitive, reflecting the parental cultural values
Information should be delivered within the context of health, personal relationships and body awareness education
The study again draws attention to the key role of teachers in providing sexuality and HIV/AIDS education to learners with intellectual disability. However, health workers and HIV programme developers may also play a role in establishing training collaborations with teachers, thereby adequately equipping them to teach these learners. Parents should be included, as mentioned earlier, so that their input and values can be integrated into such education and they will be able to follow up with their wards at home.
Despite the high vulnerability of PWID to HIV infection, they are often denied sexuality and HIV education based on the assumption that it will make them more promiscuous (Hanass- Hancock, 2008). In addition, they are less likely to be reached by HIV education than other PWD (Olaleye et al., 2007; Steadman Group, 2008). Comprehensive sexuality and HIV education, apart from providing the standard education, is beneficial in equipping this vulnerable group with social and interpersonal skills for forming and maintaining relationships, as well as skills necessary for recognising and avoiding sexual abuse (Di Giulio, 2003). However, Rohleder and
142 Leslie (2009) report a tension between the human rights of PWID to sexuality and HIV information and the assumed need to restrict their sexual expressions by people who are saddled with the responsibility of caring for them. Although acknowledging their need for sexuality and HIV education, the authorities would rather offer them education that discourages sexuality by painting sex as dangerous and associated with abuse and diseases.
The time is ripe for Africa to rise up to the challenge of curbing the spread of HIV among PWID, as with other citizens. Against this background it is necessary to know more about this group in relation to their sexuality and vulnerability to HIV infection, and to come up with informed and tailored interventions.
Currently, there are no such studies in Nigeria despite her teeming population, and the likelihood of a higher number of PWID than in other African countries. This group is being denied its human rights to factual information and access to skills that will assist with leading healthy sexual lives.
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