Print Version Why the education sector has a key role in the HIV and AIDS response in South Asia Prevention requires new knowledge and skills: HIV is already present in all countries in South Asia, and infection rates are increasing. It has been argued that the traditional cultures of South Asian societies will be protective and that the epidemic will be less severe than elsewhere. Whatever the truth to this argument, it is weak grounds for complacency in the face of AIDS. Traditional values are not immutable – witness the increasing rates of obesity and STIs in South Asian youth – and the new generation growing up in a world of HIV and AIDS needs knowledge and stronger skills to address this challenge. The education sector is ideally placed to offer that protection. School children are a window of hope: Even in the worst affected countries, children of school age have the lowest rates of infection of any age group. In the epicenter of infection in Southern Africa where adult infection rates often exceed 30%, infection in schoolchildren is less than 4%. In South Asia almost all school children are uninfected. With the right help, these children could grow up uninfected and remain uninfected for the rest of their lives. They are a window of hope into the future. In countries already affected by the epidemic, this gives hope that the face of the epidemic could be changed in a generation. In South Asia, taking advantage of the window of hope now could halt the epidemic. Education can break the silence: There are well documented examples throughout South Asia of children being ostracized or expelled from schools because they or their relatives are suspected of being infected or affected. This stigmatization and discrimination is harmful in itself but also indicates a profound lack of understanding of the causes of infection and of the actions needed for prevention. Education can help dispel this fear and ignorance and create a society that is able to make a more realistic response. Program and Project Examples Nepal: A life-skills based education program for grades 1-10 is being developed as part the national five year education plan, and piloted in 10 districts. Three key preparatory activities have helped guide the development of the program: (i) a 2002 survey of teenagers in Nepal as a basis for life-skills development and HIV and AIDS prevention; (ii) in 2003, an assessment of the impact of HIV and AIDS on the education sector in Nepal; and (iii) also in 2003, a review of the grades 1-10 Health and Social Studies textbooks and teacher's training manuals for substance/drug abuse and HIV and AIDS prevention education. Sri Lanka: A life-skills based education program was introduced into the school curriculum for grades 7-9 in 1997. The key focus areas are values, reproductive health, preventing HIV and AIDS, preventing substance abuse, gender issues, and related topics of violence prevention and conflict resolution. More recent discussions have emphasized the need also to address HIV and AIDS prevention within the context of overall school health and well being, including improved nutrition. Stronger synergy between the work undertaken by the Health and Education sectors is being developed. India: The Ministry of Human Resource Development and the National AIDS Control Organization (NACO), in collaboration with development partners, are scaling up programs for educating adolescents about HIV and AIDS. The plans call for training teachers and peer educators in conducting courses and leading study groups on HIV and AIDS awareness and prevention. The programs aim to reach at least 33 million students in secondary schools over the next three years. Pakistan: A project run by a UNICEF partner, AMAL Human Development Network Pakistan, is working with Pakistan’s top pop group "Strings" to reach the most vulnerable and isolated children. The project uses music to provide children and young people who are out of school, and often working or living on the street, with access to life-skills, non-formal education, basic health information and hygiene training. |
What the education sector can do to respond to HIV and AIDS Deliver the social vaccine of an education: There is no biological vaccine against HIV but education can serve as a social vaccine to protect children as they grow up. When the epidemic was new and the causes and means of protection unknown, it was often the more educated members of society that became infected. But today this pattern has reversed. An eleven year study in Uganda, for example, has shown that a child who drops out of primary school, or who never enrolls, is almost three times as likely to be infected in her twenties as a child who completes a basic education. The Global Campaign for Education estimates that 7 million cases of infection could be avoided by ensuring that all children complete a basic education. In South Asia, achieving universal basic education could deliver the social vaccine to 42 million children who are out of school and at risk. Promote girls' education: An estimated 1/3 of people infected with HIV in South Asia are women and the proportion is growing. The feminization of the AIDS epidemic is a result not only of the physiological vulnerability of women but also because girls are often more socially and economically vulnerable due to their status in society. In India, for example, only 43% of women aged 15-49 years have ever heard of HIV and AIDS. In rural areas, this proportion drops to 33%. Knowledge of HIV and AIDS varies across states ranging from 30% in Gujarat, Madhya Pradesh, and Rajasthan to more than 70% in Andhra Pradesh, Delhi, and Goa. The level of knowledge is likely to be much lower still amongst schedule caste/tribe women. The considerable societal and economic benefits of educating girls are well documented and this is now known to translate into reduced risk of HIV infection. Girls’ education programs are a crucial element in HIV prevention in South Asia for the more than 23 million (56%) out of school children who are girls. Improve knowledge and understanding: Completing school is of itself protective, but the benefits can be increased by ensuring that the content of the education provides children with specific knowledge about developing healthy lifestyles, including the need to protect themselves from HIV. Surveys in South Asia show that even simple knowledge of HIV and AIDS is often lacking. For example, in Bangladesh and Nepal only 22% and 42% respectively of young women aged 15-24 years knew that it is not possible to identify HIV infection by external signs, a potentially fatal ignorance even among married partners. An appropriate curriculum is a key element in the response. Develop Life Skills: Knowledge is necessary but not sufficient, and needs to be linked with the development of appropriate skills, attitudes and behaviors to apply the knowledge. Experience world-wide shows the effectiveness of this Life-Skills approach in promoting positive behaviors that reduce substance abuse and unwanted pregnancy, for example. This approach has to be society-specific to be effective and, where appropriate, can reinforce societal values that promote healthy lifestyles that protect against HIV and AIDS and against other diseases. Use a life-long learning approach: Current HIV and AIDS education efforts in South Asia have largely targeted secondary school students. But with a Gross Enrolment Rate of 48% this misses a majority of children, and may present the difficult task of changing established behaviors. It is more effective to promote positive behaviors from the primary level and then reinforce these at all levels of education, including the non-formal education sector. Build on existing school health programs: Most education systems in South Asia already have national curricula that address health, hygiene and nutrition, often using the Focusing Resources on Education and School Health (FRESH) framework. Including HIV and AIDS education in these programs offers the cost-effectiveness of using an existing infrastructure, and also enhances acceptance by children and parents because it addresses current problems of children, such as worms, malnutrition and malaria, rather than the more distant threat of HIV and AIDS, and helps situate HIV and AIDS education in a health, rather than sexual, context. Recognize the central role of teachers: Teachers are role models and their individual knowledge and skills determines the quality of education. HIV and AIDS is a topic which teachers themselves need to understand and be willing to discuss before they can teach the learners. In traditional societies, teaching about the sexual dimension of HIV and AIDS presents special problems, and teachers may need to acquire specific skills to address this role effectively. Overall, teachers will require institutional support to respond to this challenge and this may include access to care and treatment. What the World Bank Group is doing to support the education sector response to HIV and AIDS The South Asia Region is focusing on developing stronger links between education and other sectors, especially health, to mainstream HIV and AIDS in new programs, and on making resources for HIV and AIDS available to the education sector. The Region has established a Multi-Sectoral Task Force on HIV and AIDS to strengthen coordination of World Bank assistance. The World Bank is also a partner in regional efforts to harmonize and align technical assistance and external financing for the education sector, through the UNAIDS Inter-Agency Task Team on Education and HIV and AIDS working group to “Accelerate the education sector response to HIV and AIDS”. What can be done to mainstream HIV/AIDS in Education? Methods | Interpretation | Policy and Strategy work | National HIV/AIDS Strategy includes education in a multi-sectoral approach. National Education Sector HIV/AIDS Strategy: sector-wide (addresses all sub-sectors); incorporated in the national education sector plan; budgeted plans of action; and addresses gender specifically. Education sector policy for HIV/AIDS: sector-wide (addresses all the sub-sectors); addresses gender, curriculum content, planning issues, and education needs of orphans and vulnerable children; and includes workplace policy using the ILO code of practice (www.ilo.org/aids). | Demonstrates the government’s commitment to responding to HIV/AIDS. The inclusion of the education sector shows recognition of the role of the sector in the response. Shows how the sector plans to contribute to the response to HIV/AIDS nationally. Costing its plan of action and inclusion in the education plan (and EFA) indicates how this strategy will be implemented. Gender is a crucial element of the strategy because girls are more vulnerable to infection and are more likely to be excluded from education. Addresses sector specific HIV/AIDS issues. Establishing policy is the essential first step in an effective sectoral response. The policy will only be effective if it is owned by the relevant stakeholders, especially the teacher unions, and if it is widely known and understood. Addressing curriculum at this stage can facilitate dialogue and agreement with the community on sensitive issues that can otherwise slow progress in implementation. | Institutional Management | Management of the sector response requires: an interdepartmental or sub-sectoral committee; department focal points who have HIV/AIDS activities as a specific part of their job description; a secretariat or unit that supports the mainstreaming of the response, and has clear political support; financial support and effective dialogue with the National AIDS Authority; and monitoring and evaluation of the response built into the EMIS. | Mainstreaming the HIV/AIDS response requires, at least initially, mechanisms for involving all sub-sectors (the committee) and for implementation (the unit). Keys to success are: the focal points have space in their work program to allocate time to HIV/AIDS; the unit reports to the highest level; the unit is led at the department director level. Through National AIDS Authorities the sector now has access to new financial resources (e.g. MAP, Global Fund). | Planning | For short to medium term planning, use Education Management Information System (EMIS) and/or school survey data to assess the following at both national and district level: HIV/AIDS specific indicators; teacher mortality and attrition data; teacher attendance data; children’s attendance by ovc/non-ovc status; and proportion of children receiving prevention education. For long term planning: computer model projection of the impact of HIV/AIDS on education supply and demand; assessment of the implications of changes in supply for teacher recruitment and training; assessment of the implications for demand of changes in the size of the school age population and the proportion of orphans and vulnerable children; and completion rates by ovc/non-ovc. | Even where an effective EMIS is unavailable, school and institutional survey data can be used to assess the impact of HIV/AIDS on the education system. This should relate district level education data to the geographical pattern of the epidemic, using epidemiological data from the health service. The effects of the epidemic have a time scale of decades, and impacts only slowly become apparent. Long term planning similarly requires projection of impact over decades. This can be achieved using computer projection models which combine epidemiological and education data. Projection allows for the planning of future teacher supply needs and, where necessary, the reform of teacher training schedules. | Prevention | Achieve Education for All and implement Girls’ Education programs. The national curriculum uses a life skills approach, including: formal and non-formal components; grade- and age-specific content, beginning before the onset of sexual activity; participatory teaching methods; based in a carrier subject; delivered in the context of school health (e.g. FRESH); and with the ownership and support of the community. Complementary approaches: peer education; MinEd has input to community Behavior Change and Communication (BCC) strategies; MinEd coordinates with NGO, FBO and CBO prevention and mitigation programs; and MinEd assists MoH in promoting youth-friendly clinics for VCT, treatment of sexually transmitted infections (STIs) and condom distribution. | Completing a quality basic education is a social vaccine against HIV/AIDS. Key issues: Teaching needs to start before risky behaviors have become established, and the content needs to be matched to the development stage of the child. Teaching methods which establish knowledge, values and skills that support positive behaviors should be used. A single carrier subject (e.g. social studies) is simpler and avoids spreading messages thinly across subjects. Failure to involve the community in this sensitive area is one of the major causes of delay in implementation. An holistic approach is essential for effective prevention. Peer education can reinforce active learning by youth. BCC strategies should ensure consistent messages in the school, home and community. Building on existing programs speeds up the response. Early and effective treatment of STIs is effective in reducing HIV transmission, youth need access to VCT and condoms to translate learned behaviors into practice. | Teacher Training | HIV/AIDS prevention requires that teachers develop skills in participatory methods through: pre-service training and materials; in-service training and materials; and messages and approaches that help teachers to protect themselves. | Preventive education is more frequently taught as part of in-service training than pre-service. While both are necessary, new teachers may be more readily trained in the participatory methods that are required to teach the subject. Teacher training institutions frequently overlook the benefits of helping teachers to protect themselves. | Orphans and Vulnerable Children | Financial barriers to education are eliminated: achieve Education for All; abolish school fees and develop alternative financing mechanisms that do not act as a barrier to access; develop a mitigation strategy to avoid informal and illegal levies; and subsidize payment of informal levies. The education system helps maintain attendance: offer conditional cash (or food) transfers; and provide school health programs to support children (e.g. FRESH), including psychosocial counseling. | Achieving EFA enhances access for all children including orphans and vulnerable children (OVC). School fees in particular may prevent OVC from accessing education. Abolition provides partial relief, but fees are often substituted by levies (e.g. for textbooks, PTA, uniforms) which must be addressed in financing plans for fee abolition. Social funds offering subsidies through schools, PTAs or the community can help overcome these barriers. Ensuring that OVC are able to attend school is only the beginning: they also require support to remain in school. One effective method is to offer caregivers cash (or food) transfers that are conditional upon attendance. OVC may require special care because of their experiences, and benefit from school health programs based on the FRESH framework, including psychosocial counseling. |
This brief is a work in progress. It is updated as new information becomes available. We welcome your comments and feedback. Send them to Mariam Claeson, South Asia HIV/AIDS Program Coordinator, mclaeson@worldbank.org, Helen Craig, World Bank Senior Education Specialist hcraig@worldbank.org, or Don Bundy, Lead Education Specialist dbundy@worldbank.org
May 2006
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