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Strategy sessions II.1 > HIV/AIDS
World Education Forum
Dakar, Senegal 26-28 April 2000
 Overcoming the effects of HIV/AIDS on basic education
Issues Paper
Strategy Session II.1
Original : English
 HIV/AIDS presents a critical challenge to the viability of education systems in many countries. As the spread of the HIV/AIDS epidemic continues, the potential of the education sector to respond to the root causes of vulnerability to HIV/AIDS has increasingly been highlighted. While raising the educational level of the population is a desirable goal in itself, it can help to curtail the spread of HIV/AIDS through effective prevention education linked to adequate support services provided by other sectors.
  Numerous international normative texts and global agreements have reaffirmed the basic right to education for all, and countries have invested considerable public and private resources in developing their education system. Without specific targeted responses, the AIDS epidemic will continue to threaten this investment in several ways. In countries with a high prevalence of HIV, the human resource base of education systems is decreasing. Other sectors are also affected, reducing productivity and hard-won human capacity, and thereby reversing economic and social development gains.
Education in a world with HIV/AIDS cannot be the same as education in a world without AIDS. In many countries today, children and adolescents are growing up amidst multiple challenges exacerbated by the direct or indirect threat of HIV/AIDS infection. The challenges facing sub-Saharan Africa are particularly dramatic. In this region, where 90% of all HIV infections are found, one-third of the children currently do not attend school, and an increase in the absolute number of out-of-school children is projected.

HIV/AIDS can affect every sector of society, but only the education system, through its network of schools, has the necessary reach and potential to cover all communities. While schools cannot act alone, they can provide access to young people, and through them to whole families, that can facilitate inter-sectoral and multi-strategy approaches to intensify action against HIV/AIDS.

Preventing HIV/AIDS infection and dealing with the fear and discrimination deriving from the epidemic require careful attention to a range of cultural, social, religious, health and education issues, as well as the ethical and moral ramifications of interventions. HIV/AIDS is inextricably linked to issues that are at the very heart of education, such as human rights, the status of women, discrimination, personal relationships, community development, social responsibility and health.

To achieve sustained control over HIV/AIDS, a multi-sectoral analysis of its impact is required and integrated responses must be developed. However, the focus of this Strategy Session is first to analyze the needs of the education sector, and then to identify processes and measures that can facilitate progress.

The interaction of HIV/AIDS with the education sector needs to be considered from two important perspectives: (A) the impact of HIV/AIDS on the education sector, and (B) the impact of the education sector on HIV/AIDS. Some aspects of these impacts are already evident, while others can be anticipated.
(A) The Impact of the AIDS epidemic on the education sector
AIDS affects education is several different ways.
1. Impact on the demand for education:

- Enrollment figures have declined as HIV/AIDS has spread. The overall demand for general education, for vocational education, and tertiary education has dropped.

- AIDS has reversed progress in reducing infant and child mortality, drastically affecting the actual population entering schools in the most affected areas. An estimated 3.8 million children have been infected with HIV since the start of the epidemic, and over two-thirds have died.

- The number of young people dropping out of school has increased, and school attendance has declined due to various HIV-related phenomena affecting children, such as having to cope with personal illness, caring for family members (particularly by girls), trauma related to illness and death in the family, discrimination and stigma, declining financial support from parents, and the need to work to earn some income. Such problems are exacerbated for the estimated 10 million orphans under 15 years of age in the Africa region. In countries such as Zambia, Swaziland and Zimbabwe, the number of children of primary school-age will be more than 20% less by 2010 than projected before the HIV/AIDS epidemic, and a high percentage of these children will be orphans, with very limited resources and few incentives to enter school.

- Pessimism about the value of education has spread as parents perceive the early death of their children as likely and thus are unwilling to spend their limited resources on education. A lack of public confidence in the quality of education and the strain of poverty also appears to push children into early employment to boost family income, rather than schooling, especially in families who are economically strained to provide for orphans from other families or relatives.

- Gains in gender equity in education will be set back for many reasons, including early marriage and pregnancy as girls are pushed out of expanding households or seek to escape them, or because men look for younger women whom they assume are uninfected. Already, due to the interactions of men with younger girls, infection rates among girls as young as 13 have risen, thereby reducing their likelihood of completing and benefiting from their schooling. Some parents have withdrawn their daughters from school because of the risk of sexual exploitation and pregnancy, caused by boy students as well as male teachers.

- Disparities in access to education will grow as the impact of HIV/AIDS increases the numbers of marginalised young people -- orphans, street children, out-of-school youth, and working youth.

- Early childhood care is likely to be the only area of increased demand as households expand and the traditional care-givers (girls and grandparents) need to work to help support the family.
2. Impact on the supply of education:

- High morbidity and mortality rates of teachers and administrators, have severely affected the supply of educational services in schools and vocational training centres and universities. In Zambia, for example, the mortality rate for the 15-49 year-old age group is 23 per thousand; for school teachers in 1998 it was 70 per cent higher, at 39 per thousand. Education systems must cope with the high cost and disruption of absenteeism of teachers who are ill or caring for others, or seeking more profitable work outside the school.

- Teaching time and quality are more erratic in the most affected countries, as both teacher and student attendance is irregular due to HIV-related reasons; and stop-gap solutions such as multi-grade teaching may become a more common way of coping with this situation.

- Schools may close, as enrollments and the number of teachers fall below sustainable levels. The remaining students and teachers may then need to travel further, which could increase their vulnerability, for example, by taking them away from family support and health care services.

3. Impact on the quality of educational services
The AIDS epidemic has highlighted the enormous disparities in the quality of education both within and between countries in respect to the teaching/learning process and programme content, which together largely shape the overall learning environment.
3.1 Factors influencing the teaching-learning process:

- Social interactions may change among students, teachers, and communities due to discriminatory attitudes and behaviour towards HIV/AIDS-infected individuals.

- Young girls may face increased risk of sexual exploitation at school and in the community, especially where they are regarded as "safe" because they are perceived as free from infection.

- The irregular attendance and competence of teachers and learners coping with HIV/AIDS is bound to affect the quality of teaching and learning, which can be further compromised as schools resort to using untrained replacement teachers.

- Inadequate training and support of teachers, undermined further by HIV/AIDS, delays much needed improvements in teaching and in assessing learning outcomes.

- Teachers and other education personnel are not generally well informed nor well prepared for dealing with HIV/AIDS related issues in their own lives, let alone in the classroom.

- Urban-rural disparities may grow due to employment practices or teacher preferences that result in more and better trained teachers being assigned to urban schools, either to be close to medical facilities or nearer to families, thus leaving rural schools to make do with fewer and untrained teachers. Certainly, technology has the potential to overcome geographical distances, empower teachers and learners through information, and bring the world into the classroom by the touch of buttons or the glare of a screen. Expectations that technology would revolutionize education are not new. In 1922, Thomas Edison predicted an educational revolution through the use of motion pictures (films). "In a few years, (motion pictures) will supplant largely, if not entirely, the use of textbooks," Edison predicted. Similar claims have been made about other technologies, including the radio, television, and computers. On the other side of the issue are those who claim that technologies are too expensive to be effectively integrated in struggling educational systems, or that they cause problems rather than offer solutions. Reality may be sought somewhere in-between these two extremes.

3.2 Factors influencing education content:

The sensitivity of HIV/AIDS-related issues and the fear surrounding them makes it difficult to treat them rationally in curricula. Where HIV/AIDS appears in curricula, it tends to be inadequately addressed with an over-emphasis on information about the disease, but little attention to shaping attitudes, values and skills, particularly those related to human sexuality, gender issues and social norms. Teaching and learning materials on HIV/AIDS are often of poor quality and in short supply.

4. Impact on educational management:

- Existing legislation and policy may fail to take HIV/AIDS into account. Education management policies and practices, especially those related to the recruitment, training, and compensation of personnel, often overlook factors such as the need to be close to family or medical services.

- Mechanisms and policy for dealing with discrimination and personal safety, especially in respect to those staff and students affected by HIV/AIDS, are generally non-existant.

- The high turn-over and unreliability of administrative staff erodes management capacity and may also undermine the quality of classroom teaching when teachers are recruited to fill management vacancies.

- Long-term planning is compromised due to the lack of accurate information on the availability and condition of the education system's human, financial, and material resources as they are impacted by HIV/AIDS. This is particularly evident in the serious inability to plan and meet the heavy demand for teaching personnel.

- The long-term sustainability and funding of the education sector may be acutely threatened due to declining support at various levels as parents, communities, associations, and governments reallocate their spending to health and social services in response to the epidemic, while international donors may withdraw support due to doubts about the potential returns on investments in education when the system is functioning so poorly.

B The impact of the Education Sector on HIV/AIDS
1. The impact of general education on HIV prevalence

- Recent studies with young people (e.g. 15 to 24 years old) in HIV/AIDS-affected countries suggest that countries with a higher level of general education may have less incidence of HIV. The inclusion of intensive programmes specifically focused on HIV/AIDS prevention and related issues seem to enhance the effectiveness of general education. Furthermore, multi-strategy and multi-sector programmes appear to be even more effective in HIV prevention, than education programmes alone.

- However, some studies in African countries, most with a high prevalence of HIV, seemed to suggest that general education is unlikely to reduce the incidence of HIV infection. These studies focused on adults who were unlikely to have been exposed to specific education components dealing with HIV/AIDS. Most of these studies used crude analyses only, and a recent re-analysis has shown the original findings were over-stated or inaccurate when important factors such as socio-economic status and age were taken into account through appropriate statistical adjustment.

- In countries where concerted efforts over time have been made, such as Thailand, Uganda, Zambia, and Senegal, education appears to have helped reduce the incidence of HIV, especially among younger age groups. It is important to note that these countries also have a longer history of specific HIV/AIDS components included in their general education. The inclusion of specific HIV/AIDS issues in education in recent years seems to have made a difference, but more research is needed.

2. The impact of HIV/AIDS-specific education on HIV prevalence

- HIV/AIDS prevention programmes work with young people. Evaluations have found that school- and community-based programmes can reduce risks and are effective in making a positive impact on knowledge, attitudes and risk behaviour (UNAIDS, 1997). The evaluations also suggest that school and community leaders need to convince parents and concerned members of the community that well planned and implemented programmes reduce risks without encouraging involvement in sexual relations.

- Nevertheless, although exceptions exist, specific HIV/AIDS education components have been generally disappointing in developing countries, due to the over-emphasis on information and lack of skills training to link knowledge, attitudes and values. Often, too, they have been conducted without an adequate policy framework, structures and support services (e.g. training and materials) to ensure consistent and high quality coverage.

- Comprehensive HIV/AIDS education as an integral component of national education programmes has become imperative, whether in Sub-Saharan Africa or in the emerging countries of Central and Eastern Europe and the Commonwealth of Independent States, where the epidemic exacts its heaviest toll on young people and women. Evidence from some developing countries (e.g. Senegal, Zambia, Uganda and Thailand) suggests that comprehensive and relevant HIV prevention content and delivery within the education system can contribute to reduced HIV infection levels. Social and behavioral influences on HIV/AIDS risk are critical to prevention, care and support, and education programmes can address these. However the emphasis of programmes needs to differ according to the context and the nature of the epidemic. (M.J.Kelly, 1999)

 3. Increasing the impact of education on HIV/AIDS and reducing its impact on education
In many of the most affected countries, HIV/AIDS prevalence among teachers and other education staff is substantial or even higher than among the general population, resulting in considerable disruption in the provision of education. Add to this the many other problems cited above that are crippling education systems, and we clearly have a dramatic situation that calls for dramatic and concerted actions. A key objective of an international strategy should be to realize the great potential the education system has to serve as a vehicle to help reduce the incidence of HIV/AIDS and alleviate its impact on society - thereby also reducing the very constraints that the epidemic is imposing on education today.
This Strategy Session will seek to identify the key steps that are needed to salvage and protect education systems in countries heavily impacted by HIV/AIDS and then to determine what the various constituents of the international community can and must do to encourage and assist countries to overcome the effects of the epidemic on basic education.
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