Education And HIV/AIDS: A Window of Hope

Washington, DC, May 7, 2002

PRESENTERS:
Ruth Kagia
Donald Bundy
Phil Hay

MR. HAY: Well, good morning, everyone, and thanks very much for coming along this morning to our launch of Education and HIV/AIDS: A Window of Hope. Just a quick announcement about the embargo before we get going. Of course, it's embargoed until 1:00 p.m. Eastern this afternoon. That's 17:00 G.

Without any further ado, let me introduce our panelists here with us today. On my immediate left is Ruth Kagia. She is the World Bank's Director of Education, and it's fair to say, I think, Ruth, a lifetime spent in education has made her an international authority on the subject. On her immediate left is Don Bundy. He's the lead author of today's report. And Don, similarly, is an international authority on matters of school health and nutrition.

So without any further ado, let me ask Ruth Kagia if she would start us off with a couple of minutes of introductory remarks about the big picture in which education and HIV\AIDS cohabit.

Ruth?

MS. KAGIA: Thanks, Phil, and thanks those who are here.

I think we take this discussion from a much broader international context, where we are focusing much more on education in development. And as we all know, education is the seed and the flower of development. One of the most powerful instruments for reducing poverty and for building the basis for sustained economic growth. And this is a fact that many times, we tend to forget; you know, whether it is in terms of enabling society to adapt to technological change; whether it is in terms of enabling societies to absorb new knowledge; whether it is in terms of enabling societies and economies to grow and become more productive, education remains central.

But it is not just central in terms of the macroeconomic, in terms of sort of the productivity elements that it brings. It's also a central element in terms of personal opportunities. It broadens opportunities for individuals. It empowers individuals. The Nobel Prize winner, Amatiya Sen, calls it the greatest personal freedom that a society can impart on its people.

And these are no simple approaches or simple statements that are being put on the table, too, you know, because education is receiving international attention. They are time-tested facts for every society, and as we speak, rural society has never achieved sustained economic growth until at least 40 percent of its population has achieved at least six years of broad education.

MR. PARASURAM: How many years?

MS. KAGIA: At least five years of basic education.

And yet, as we speak today, we've got countries such as Niger or Mali where the adult population has a level of education that is only 0.8 years, less than one year. Lest you think that that is an abnormality, Nepal, the average population has 2.5 years and so on and so forth. And most of the developing world, when you look at the education levels of the populations, they do not exceed about three or four years, compared to the OECD, where you are talking about 9 to 12 years.

And with that kind of a gap, we come into the education program in the Bank joining hands with the international community in a real commitment to education to support countries to close that gap, because as long as countries are that ill-equipped, there is no way they are going to become competitive in an international competitive economy. There is no way they are going to take advantage of modern technology that is certainly the defining force in today's societies.

So over the past couple of years, the international community has become much more focused on how can we support countries to accelerate their educational development? And we are using all the instruments at our disposal, whether it is financial support; whether it is support for policy and education reform, to help countries accelerate the pace of development of their education programs.

And this, in some ways, is a unique year. We've got the G-8 having as one of its themes for the summit in June as education, focusing on how do you get countries to achieve at least 5 years of education for all its population. But the challenge is great. We have 1 billion adults who are illiterate. Two-thirds of those are women. One in five children age 6 to 11 are out of school, more than 100 million of them. Over 100 million adults start school, but they drop out before they have had four years of education and so on and so forth.

So whether you are looking at the very basic levels of education; whether you are looking at access to information and technology, the gap grows wider by the day, and the challenge of the international community is to support developing countries to close this gap not just in a more systematic manner, which we should do, but to accelerate the pace, to help them leapfrog, because if we wait for it to accelerate through the years, it will be another 50 years before you even begin to approximate the minimum levels.

But even as we focus on the issues of getting children into school, keeping them there, getting more girls in school and keeping them there, dealing with sort of what I call 20th Century problems of just simple access and equity, we are confronted with new challenges. Perhaps the most severe of those that is going to have a major impact on the achievement of that goal is HIV-AIDS, and I now turn to my colleague, Don, to talk a little bit about that intersection between this very important and achievable goal that is within reach if everything else were to remain equal but is severely compromised by HIV-AIDS.

Don, over to you.

MR. BUNDY: Thanks, Ruth, and I think Ruth made the point very strongly about the importance of education and the achievability of education for all but also the point that HIV-AIDS is compromising the ability for countries to achieve universal basic education. And the thesis that the Bank ought to be able to present, the strategy that we will talk about, is to recognize that AIDS is important to achieving education for all and for preventing the achievement of education for all, but at the same time that education for all is a solution, a part of the solution, to the AIDS problem.

When we think of HIV-AIDS, we think first, perhaps, of Africa, and no doubt, that's the area that's worst affected. But we should recognize that there's no country in the world that's immune from AIDS, and if we take the example of India, the number of cases of AIDS in India, the number of cases of infection in India is second only to South Africa. The fastest rate of increase of HIV in the world is in Eastern Europe, and we can see rapid rises in West Africa, in the Caribbean, in East Asia and in South America.

AIDS is having a major impact or its most immediate major impact in Africa on education systems. As usual, we have a lack of precise data about the prevalence of infection in teachers, but we know that this is around 12 percent in South Africa, 19 percent in Zambia and greater than 30 percent in Botswana. In some of these countries, AIDS is killing teachers faster than they can be trained. Zambia, for example, has just doubled the number of teachers that are being produced by its system, and the effect of the--many countries are now projecting the impact of AIDS on their education systems, and here, we can see the projected number of teachers required by 2015 to achieve education for all and the red line showing how that shortfall will occur due to the impact of HIV-AIDS.

And the factor to note is that as the grip of AIDS tightens, as the epidemic worsens, the shortfall becomes greater. And eventually, one asks the questions, where will the new teachers come from to be trained to fill this gap?

MR. PARASURAM: Can I have some numbers?

MR. BUNDY: Numbers in terms of --

MR. PARASURAM: The gap.

MR. BUNDY: I mean, in Zambia, for example, about 1,000 teachers a year are dying, and they were training 1,000 a year. They're now training 2,000 a year.

But the major impact is not this. The major impact is actually on absenteeism, absenteeism of teachers, because the disease takes a decade to tighten its grip. And during that time, teachers are absent from school and not teaching, and they're not substituted by other teachers, so that as one visits the worst-affected countries in Africa, one finds schools which are empty or schools with one teacher and several hundred students.

Some people have suggested that as the number of teachers declines, so will the number of students and that in some bizarre sense, this becomes a balance. But the reality is, again, not in line with this. In an analysis of the worst-affected countries, only six of them will actually show an actual decline. Everywhere else, everywhere else in Africa, student numbers will continue to rise, will continue to rise, so that the enrollment rates, if one balances teachers against numbers of students, the enrollment rates will continue to fall.

Added to this, adult mortality is creating orphans. It's creating orphans at the fastest rate ever known in peacetime. Some 13 million orphans have been created by HIV-AIDS. In Africa, orphans represented around 2 percent of the child population, but by 2010, some countries will have more than 15 percent of their child population orphaned, and that would apply to Botswana, to Namibia, to South Africa and Zimbabwe.

Orphans lack emotional and financial support to go to school, so again, the achievement of education for all will be compromised. So what we see is that we have ravaged education systems and one in six children in some countries orphaned. And this is going to happen in countries which already have weak education systems. Of the 55 countries, 55 poorest countries that have been identified as already failing to achieve education for all goals, 31 of those 55 rank amongst the worst affected by HIV-AIDS. And I don't need to add to Ruth's point that failure to reach these EFA goals will ripple through the generations. These children, these children who don't go to school are most at risk of becoming infected, and if they themselves have children, the chances of those children going to school are also diminished.

The Bank has estimated that the financing gap for 33 of the worst-affected countries in Africa is of the order of half a billion dollars a year as a result of HIV-AIDS. That's the financing gap in achieving education for all. This is a conservative estimate and will only get worse as the epidemic spreads to other parts of the world.

And yet, the paradox in all of this is that education is, itself, one of the best preventative responses to HIV-AIDS. And I'm talking here about a general education, not specifically about an education targeting prevention of AIDS. There has been a real change in the nature of the epidemic. In the early epidemic, the educated and better-off people were the ones who contracted the infection. They were the ones with more money, more mobility, and perhaps, therefore, higher rates of partner change.

But now, many analyses are showing, including analyses in Africa, that more-educated children, more-educated youth are better protected. In Zambia and in Zimbabwe, there are lower HIV infections in children who have higher levels of education, but it's already been well-documented for girls' education generally, and we can talk here about surveys of 17 countries in Africa and four in Latin America which show that educated girls delay sex and become pregnant at a later age and therefore reduce their risks of infection.

So it's clear that education itself and particularly if linked with preventative education will protect children and allow them to grow up into uninfected adults. And what we are working towards is a response that has three components to it, a response that ensures that countries are able to achieve EFA, that supports countries in their efforts to achieve EFA despite the impacts of HIV-AIDS, a response which will help girls, orphans and other vulnerable children to gain access to education.

And these two responses are the responses that the Education for All goals would drive for in any event, but one wants to add to that a third element, which is specific prevention, using the education system to reach students and, of course, their teachers to reduce risk of infection.

The strategy note from the Bank is called the Window of Hope. The Window of Hope is the school children. School-aged children, even in the worst affected countries, are uninfected in general. And school-aged children need never become infected. There is no cure; there is no biological vaccine, but this is a condition which is entirely preventable. There is no reason why these children, uninfected today, should not grow up to be uninfected adults. Father Michael Kelly in Zambia uses the phrase the education vaccine, and it's probably true that education is the best vaccine that we have available at this time.

So the education systems of the world have a choice: they can become amongst the worst victims of AIDS, and some are succumbing, or they can become part of the most effective and cost-effective responses to AIDS, and to achieve that, we need action now for the uninfected children of the world.

MR. HAY: Don and Ruth, thanks very much indeed. Let's throw it open to questions.

Don, let me just get back and ask you just to--you mentioned in Africa empty schools, schools with, you know, one teacher. I want just for the benefit of some of our latecomers, you could just leave us with that image again, and we'll throw it up to questions.

MR. BUNDY: The implication, the point there was that the prevalence of infection in teachers is high. The estimate is that it's around 12 percent in South Africa, 19 percent in Zambia and greater than 30 percent in Botswana and that in some countries, the infection is killing teachers faster than they can be trained, faster than they can be replaced. Countries are responding to this. Zambia has just doubled the number of teachers that they are training to try and deal with this issue.

But nevertheless, as the epidemic tightens, as the epidemic proceeds, the number of teachers available is declining, and finding new teachers, finding people with the basic education background to train as teachers is becoming increasingly more difficult. So one faces the reality of a loss of teachers with a high rate of mortality in teachers, but actually probably more important is absenteeism of teachers, and this is often not appreciated. AIDS is a disease that takes 10 or more years to kill. But during that time, people are frequently sick, frequently sick for long periods of time. And teachers in that situation simply don't go to school, simply don't teach.

So one sees a picture in Africa increasingly, in the worst-affected countries, of empty schools or schools with very few teachers.

MR. HAY: Thank you, Don.

Let's throw it open to questions.

MR. PARASURAM: One thing--we can agree that education is a good antidote. At the same time, how is it that the first victims of AIDS included the best-educated, the best-off, very well-off people and very prominent socially in developed countries, well-educated, but still, they get AIDS. How is that?

MR. BUNDY: That's a very interesting question, and it reflects the fact that AIDS is a disease that we've never known before. It's probably the worst disease the world has ever faced. When it started, people had no knowledge of how infection occurred, and those who were most vulnerable were those who had the most access to numbers of partners, which tended to be people who had more money and more mobility.

Remembering, of course, that the disease takes 10 years to develop, so from infection to people recognizing that they have the disease, there's this very long time lag. So at the beginning of the epidemic, it was precisely the people you describe who were most likely to be infected and who, indeed, were infected. As the world has begun to understand how HIV is transmitted and what are the primary risk factors and what are the preventative responses to it, the people with that knowledge and that understanding are the ones that have become least likely to be infected, and it's those who don't have access to that knowledge who are the ones that are most at risk.

I mean, it's the same paradox with the teachers: the teacher death rate is high, despite the fact that the teachers are people who are aware now or should be aware now of the consequences but were not aware 10 years ago.

MS. SCHEMS: Does that mean that the rate of new infections in teachers is declining relative to less-educated parts of the population?

MR. BUNDY: We would like to think that that's a possibility, but the reality is that programs focusing on teachers to prevent infection in teachers are still very rare and that efforts to change the behavior of teachers, to support teachers, are part of what we are certainly advocating as a strong response. But I can't say that at this time, there is very clear evidence of a falling infection rate for teachers.

MR. PARASURAM: What is the progress in trying to get a cure for AIDS?

MR. BUNDY: I think this is not a good group for that discussion, but we're certainly not hearing very hopeful messages.

MR. HAY: The research continues, you know.

MR. PARASURAM: So much money is being spent.

MR. HAY: Yes, yes.

MS. SCHEMS: In the report, you note that in--I think it was Tanzania and a number of countries, you have very high rates of infection, specifically of girls who are going to school who are getting abused by their teachers.

MR. BUNDY: Yes.

MS. SCHEMS: Which to me undermines somewhat the argument that education is the best way--I mean, as a parent, you might say I'll keep my kid home and keep them safe. I mean, is there any sort of an--how do you make the argument --

MR. BUNDY: Okay.

MS. SCHEMS: --that education is the way out when we're getting --

MR. BUNDY: First of all, it's not all teachers.

MS. SCHEMS: No, clearly not.

MR. BUNDY: But it's certainly part of a picture, and one of the consequences of people addressing the issue of HIV-AIDS is the realization of how common a part of the picture this is. And I think it's important now to recognize that this isn't just a phenomenon of some countries; it's a very common picture. And the issue here is how one addresses that as a problem. It's not simply that one--now that one has identified that as an issue, it's an issue that has major moral concerns in any event. Schools are meant to be safe, nurturing environments for children. So it's not simply a question to do with HIV-AIDS; it's a problem in the way in which education systems are being managed.

So that needs to be addressed head-on as an issue. I don't think that it detracts from the value of the use of existing education systems to reach the majority of children in the world.

MS. SCHEMS: But is there a strategy to address specifically that problem?

MR. HAY: Let me bring in Ruth.

MS. KAGIA: I think that is an important question. And this is why--I think this is the first time that the challenge of HIV-AIDS and education is being addressed as an integrated package, because, you know, we went through--in the first five years, we went through a very sort of interesting phase. The governments were in total denial, even when the statistics were showing that there was a crisis. It took a long time for governments to actually internalize the fact that they were going to be open about the issue. That has happened by and large.

Then, there is a stage where the reaction was to condone sex education. It's too narrow. You need to broaden those points in the absence of a vaccine or a permanent cure. So what we are doing here is to look at the totality of actions that need to be taken if this is to become effective. One is simple information: just drumming it to teachers, to students, to communities about how this is transmitted and how it can be prevented. The second one is making sure that we highlight the issue of risks, particularly to girls, and turning schools into safe havens. And already, that is beginning to happen in certain countries, where if a teacher is caught having had sexual relations with girls, it is turned into a public issue, partly because of HIV's risk but also, you know, raising awareness that schools are meant to be safe havens.

And then, thirdly, ensuring that the education system does not collapse because of teachers' absenteeism and so on, and therefore, again, raising awareness to education planners and to education administrators about how they need to prepare for the large losses and then how do we look at orphans and children who have been affected directly at the personal level, how do you support them and make sure that their education does not suffer?

So the bottom line is how do you ensure that there is a sort of accelerated pace of expanding education and making sure that no child is left behind remains true even in the worst scenario of HIV-AIDS, and you need that package of results.

In some ways, this is the most important activity we are undertaking in the Bank, because it provides the promise of sustaining the gains countries have made and accelerating them, but also, it is a real and complete risk which we have to address. Now I have to run I’m afraid.

MR. HAY: Ruth was saying before, just to backtrack for a minute, that education was both the seed and the flower of development, so there's, you know, all the way along, these two sectors interact with each other in a very, very integral way, and you can't really tackle HIV-AIDS without also looking at the education system. You can't protect and safeguard the gains in the education system over previous decades without looking at the degree to which HIV-AIDS impinges on that. So it's a real sense over the last decade that we've moved away from HIV-AIDS being purely just a health problem; it really is an international development problem in all its complexity.

So let's just say thank you, Ruth.

MR. HAY: And Don and I will carry on.

TV, any other --

MR. PARASURAM: For a long time, education was thought of not merely in terms of reading and writing but also in oral tradition, for thousands of years. And in this tradition, even in small villages, somebody gives a lecture. Ten years later, they can repeat word-for-word what he has said. So is any effort being made now to reach the masses, those who are uneducated but who can be reached by storytelling or by audio filmings and cinemas and that sort of thing?

MR. BUNDY: I think the point that Ruth was making about this package of approaches, this broad-based response, has to take in not simply the formal education sector but all these informal structures that support that. And indeed, in many of the worst-affected countries, it is the informal education system that reaches most effectively into the rural areas. So certainly, that should be part of the overall response.

I think that Phil was pointing out a page in here where there is a listing of the actions in a broad-based way indicating that --

MR. PARASURAM: What's the page number?

MR. BUNDY: What's the page?

MR. PARASURAM: Fifty-two.

MR. HAY: And that's a triptych there, TV, that basically runs you through the different policy responses.

MR. PARASURAM: Yes.

MR. BUNDY: But there's no suggestion that this is exhaustive or, indeed, the final word on this issue.

MR. PARASURAM: Okay.

MR. BUNDY: Because one of the big problems that one faces in addressing this is a lack of clearly evaluated responses. It's hard to say very specifically what at this time is best practice in all areas, which is why we've used the term promising approaches to try to identify ways of moving forward.

MR. PARASURAM: Thank you.

MR. HAY: Let me follow up, TV. In Africa, the Bank, since 1990, has, under its Multi-Country AIDS program, which has committed about US$1 billion over the last 18 months to 2 years, one of the big innovative approaches of that is actually to work with community groups at the village level, because they're the groups that, you know, know the local people better than anyone.

They're also the groups, interestingly enough, that where they work with local governments very well, those countries that have the lowest prevalence rates of HIV-AIDS--let's take Africa for a case--tend to have been those that have actually drawn together a really national coalition of groups, trade unions, the local churches, you know, community groups all the way down to, you know, the small hamlet and village level.

And we find that if you can mobilize money and support that filters all the way to the grassroots, and we see that these groups are actually be in the vanguard of offering prevention and basic care to people infected with HIV-AIDS but also putting a great deal of effort into prevention activities, we have certainly seen empirically that this has been very, very effective as opposed to, you know, not using a community approach.

If you empower the local villages and communities. That's where you get really effective lower incidence of HIV-AIDS.

MR. BUNDY: Yes, and it's abundantly clear that if the messages that children are receiving at school are different from the messages they're receiving at home or in the community, then, the messages just don't work.

MR. BUNDY: You have to work across the whole system. And so, when one talks about an institutional response to HIV-AIDS, it isn't just the education system in the formal sense, but it would also include--and very specifically include--parent-teacher associations, a very powerful ally and a very powerful part of this, and the teachers' unions. Teachers are very distressed and concerned about the situation of HIV-AIDS in Africa. These figures of teachers' deaths are not simply numbers.

MR. PARASURAM: Do they have in Africa the equivalent of what we have in India, the Panchayat system, which is greatly prosperous; in each village, 30 percent of them have to be women, and they decide all the local matters. Do they have something like that in Africa?

MR. BUNDY: Yes; it varies clearly from country to country, but the idea of institutional structures at the village level do exist, in most countries less formally than the Panchayat system, which the Bank, in part, supports with other partners through the ECDS programs in India, of course.

But there are some parallels.

MS. SCHEMS: A question. I'm not really clear on--is the heart of what you're saying that the ravages of AIDS threaten the goals of EFA and education systems in developing countries, or is really the heart education really represents the chance out? Because that second part, just reading through this last night, and I didn't find that argument borne out by what's cited here unless there's other material.

This chart is talking about the rates of AIDS in Botswana, which is one of the most advanced countries in Africa, has the highest rates, and Equatorial Guinea, which was, like --

MR. BUNDY: Those aren't rates of AIDS. Those are rates of --

MS. SCHEMS: HIV-AIDS prevalence rates, no?

MR. HAY: Here, Don.

MR. PARASURAM: Market access. Each one

is --

MR. BUNDY: Sorry, sorry, I misunderstood.

The pattern of HIV in the world reflects some historical origin, not well-understood by epidemiologists, but indicating that the disease, that the epicenter of the disease was somewhere in Southern Africa and that the disease is progressing from that epicenter globally and that if one looks at--if one talks about established epidemics, mature epidemics and contrasts that with early epidemics, then, the early epidemics in Africa are further to the west and the north.

But yes, and one has to be careful here, because my intention isn't to suggest that all countries inevitably have to have significant epidemics of HIV-AIDS, although that does seem to be the pattern that we observe. What's clearly happening is that from that epicenter in the southern area, the infection of the disease is moving out and is beginning to take its grip on other parts of the world.

So if one sees a low rate in a particular area, it doesn't necessarily imply that they've had some effective response or some cultural protection against the infection but rather --

MS. SCHEMS: It just didn't get there yet?

MR. HAY: Although there are countries like Senegal, for example, where, through very vigorous national prevention campaigns, their incidence is less than 1 percent, which is fairly significant in terms of the African setting. But that's, once again, because of what we were describing before: very strong national HIV-AIDS strategy by the government, by the churches, by the clergy, by community groups throughout.

So it can be done, but it also rather tragically coexists along with the examples Don was suggesting as well.

MS. SCHEMS: Right; but then, what you're looking at when you're looking at the more advanced countries like Botswana and a very high rate there, are you looking at essentially the early--the kind of after-effects of the early pattern that is no longer borne out by more recent infections?

MR. BUNDY: It's very--I mean, yes is the short answer. That's precisely how we interpret that position. These are the countries that never saw AIDS coming. AIDS suddenly was a major problem in those countries. And again, it's worth emphasizing how different this disease is from most that we're used to. The infection occurred 10 years ago for people who are dying now.

So what we see in many countries is denial of the presence of AIDS, because there is nobody dying of AIDS. And then, suddenly, in 10 years' time, the epidemic emerges. Nowadays, we know to look for the epidemic. We know to look for HIV infection and to know that in the future, that will result in disease, but in Botswana and South Africa and Swaziland and Namibia and Zaire and the traditional epicenter of the disease, they did not know that.

So what we're seeing is the fallout from the disease getting its grip on the population as a whole.

MR. PARASURAM: Which are the countries? Botswana?

MR. BUNDY: The whole of the southern cone of Africa.

MR. HAY: To addjust a personal note to what Don is saying, I mean, I've lost two brothers in my family to HIV-AIDS over the last 8 years myself, you know, from New Zealand and Australia, you know, two of the most highly advanced educational systems in the world, you know, which just bears testament to what Don is saying that it's no respecter of socioeconomic impact on life.

And, you know, 10 years ago, 15 years ago, 18 years ago, nobody knew this was here.

MR. BUNDY: See, I'd like us to focus much more on the more recent evidence that's looking at what's happening to girls who are now leaving school.

MR. HAY: That's right.

MR. BUNDY: And that, I think is --

MS. SCHEMS: And what is that showing?

MR. BUNDY: And that's showing very clearly that the more educated girls are, particularly if you can get them into secondary school --

MR. HAY: Yes.

MR. BUNDY: --and keep them in secondary school that that really protects them from early sex, from early pregnancy, from early marriage, all of which are high-risk issues in thse countries, in the affected countries, so that education very clearly has a big impact on the sexual exposure of girls. And that, frankly, isn't a new finding. That's one of the reasons why girls' education has always been so strongly on the agenda of education development groups and governments.

MS. SCHEMS: Here in this country, there has been this whole controversy over abstinence education, you know, comprehensive sex education, et cetera. Do you see any difference in terms of, you know, outcomes, HIV rates and so forth depending on what kind of sex education a girl gets in school?

MR. BUNDY: The major focus on reproductive health education is in the area of skills-based approaches, approaches that are based on understanding how to behave rather than understanding biological facts. Those seem to be at the core.

But realistically, one has to have a broad-based understanding, a broad-based knowledge as well as--as well as a comprehension of behavioral consequences and values. Therefore, certainly, a strategy based on abstinence and fidelity is at the root of an approach, but there also has to be an element of prudence in how these are delivered.

MS. SCHEMS: But is there any study of that?

MR. BUNDY: Yes?

MS. SCHEMS: I'm sorry; I didn't mean to interrupt. I was just wondering, is there any study that has looked at--because I know that was something that a lot of people, in fact, in most surveys, people say exactly what you're saying; logically, parents say exactly the same thing. I was just wondering if there was any evidence around the world that since it's such a charged issue here --

MS. SCHEMS: --if there is any evidence in other countries --

MR. BUNDY: Yes.

MS. SCHEMS: --that's a little bit more neutral.

MR. BUNDY: There's very clear evidence that sex education and reproductive health education does not increase sexual behaviors. It reduces--it is very clear--and concluding from this country.

But I would like us, rather than address the issue from a domestic focus, to focus on the fact that we're addressing here a problem which is not philosophical or theoretical. It's a major challenge to --

MR. BUNDY: --to the development of communities and to the health of children throughout the world.

MR. HAY: Let me just point out this quote here on the back, where Professor Kelly, who is probably one of the first voices in the world, Don, to talk about the need to address HIV-AIDS in terms of education systems. He talks here about an education vaccine, which I thought was a very poignant point to make. You were talking about that before, TV --

MR. PARASURAM: Yes.

MR. HAY: --in terms of, like, drug cures. And, you know, in the absence of that, it seems fairly clear that Father Kelly's point there is quite striking.

Any other--

MR. PARASURAM: Thank you.

MS. SCHEMS: Thank you.

Are there any numbers that I would be able to cite to kind of prove this contention that the rates are changing, the rates of infection are showing a slowing down among more educated classes? If there are any specific numbers that I could put on that, I think that --

MS. SCHEMS: Stronger, yes.

MR. HAY: You do mention some, Don, don't you?

MR. BUNDY: Page 5 has got some of that, and in Box 1-3 and on page 7. So, for example, in Zambia, during the 1990s, the HIV infection rate fell by half or almost half in educated women with little decline for women without formal skills.

MS. SCHEMS: Great; thank you. I haven't seen that.

[Whereupon, at 10:52 a.m., the press briefing was concluded.]