HIV/AIDS Blunts Progress In Getting All Children Into School By 2015

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WASHINGTON D.C., May 7, 2002 - HIV/AIDS kills teachers faster than they can be trained, makes orphans of students, and threatens to derail efforts by highly-infected countries to get all boys and girls into primary school by 2015, a new World Bank report warns. And yet a good basic education ranks among the most effective, and cost-effective means of preventing HIV.

According to the new report Education and HIV/AIDS: A Window of Hope countries need to urgently strengthen their education systems. Education offers a window of hope unlike any other for countries, communities, and families to escape the deadly grip of HIV/AIDS. Vigorous pursuit of the Education for All goals is imperative, along with education aimed at HIV prevention. Education systems that promote a nation's future are being gravely threatened by the epidemic, particularly in areas of high or rising HIV prevalence.

World Bank President, James D. Wolfensohn, writing in a foreword to the report, says that the World Bank is a committed partner along with developing countries, UN agencies, aid donors and others in the global effort to provide every child with access to a basic education, but adds that the task of achieving EFA in countries afflicted by HIV/AIDS is extremely difficult:

"With more than 113 million children not in school in the poorest countries, this already presents a major challenge. However, HIV/AIDS makes this much greater in those countries where the education system was already struggling to grow, teachers are dying, or are too sick to teach. And every year more children are losing their parents and the support that allows them to go to school. Achieving Education for All in a world of AIDS presents an unprecedented challenge to the world education community."

AIDS destroys

The scale of the AIDS epidemic is enormous. UNAIDS estimates that by the end of 2001, over 40 million people were living with HIV/AIDS, 17.6 million of them adult women, and 2.7 million children under 15 years. About 5 million people were newly infected in 2001 alone—roughly the same as in 1999. AIDS orphans and other vulnerable children now number some 15.6 million, following nearly 25 million AIDS deaths by the end of 2001.

The epidemic's grip on Africa has been by far the deadliest, but no part of the world is immune. Sub-Saharan Africa remains the epicenter: average life expectancy has now fallen to 47 years (compared with an estimated 62 without AIDS), and its prevalence rates are the world's highest—above 10 percent in 16 countries and as high as 44 percent in some groups (pregnant women in urban Botswana). Globally, the epidemic is on the upswing, spreading fastest in Eastern Europe: new infections in the Russian Federation appear to be almost doubling annually since 1998. Data from Asia too warn against complacency: national prevalence rates are low but mask localized epidemics, and infection rates in Myanmar, Cambodia, and Thailand are in the 2-4 percent range and similar to many West African countries, while India is second only to South Africa in the number of people currently infected.

The epidemic has a profound impact on growth and poverty. UNAIDS estimates a loss of more than 20 percent of GDP by 2020 in the worst-affected countries and a rapid increase in the number of destitute families, faced with lower income, more dependents, and sharply higher health care expenditures. Already weak private sectors are crumbling further, as companies face higher costs from training, insurance, benefits, and absenteeism.

AIDS and education

Most devastating and far-reaching, perhaps, is the epidemic's impact on education systems. Half of the world's 15,000 new infections every day occur among 15- to 24-year-olds (1999). The epidemic's ravages are well under way in Africa's worst-affected countries, which face high teacher prevalence rates (30 percent in Malawi), a burgeoning of the orphan and out-of-school population and a widening gender gap in education. Already more vulnerable than boys to HIV infection, girls are also more vulnerable to dropping out of school, being more often retained at home to care for sick relatives or assume other domestic duties.

The full scope of the epidemic's impact on education can be seen in the context of the formidable challenges already confronting the sector. More than 113 million children, aged 6 to 12, are out of school in developing countries, two-thirds of them girls. Of those who enter school, one out of four drops out before attaining literacy. Even without reflecting the epidemic's impact, at least 55 of the poorest countries seem unlikely to achieve universal primary enrollment by 2015; 28 of these countries are also among the 45 worst affected by HIV/AIDS. With AIDS, several of the worst-hit countries (such as South Africa and Botswana) are seeing a reversal of hard-won educational gains, while countries already struggling to achieve EFA goals are being further set back. Attaining the goals is an even dimmer prospect when EFA is defined to encompass completion of the primary cycle—essential for true learning. A total of 88 countries are estimated to be at risk of not attaining universal primary completion by 2015. The goal of eliminating gender disparities in primary and secondary education by 2005 poses an even greater challenge, given that the date is fast approaching, as well as the greater likelihood of girls dropping out of school because of HIV/AIDS in their immediate families.

"The time for business as usual is past; no country can afford not to act. Worst-affected countries need to arrest the epidemic's ravages and protect future generations—Uganda and Thailand have shown this to be possible," says Don Bundy, lead author of Education and HIV/AIDS: A Window of Hope and a World Bank specialist on school health. "Low-prevalence countries need to recognize the speed with which complacency can lead to crisis and, equally, the tremendous opportunity for saving of lives and financial resources through prevention. For all countries, two mutually reinforcing objectives are paramount: prevention of HIV and protection and sustenance of the education sector."

Curbing HIV/AIDS via the classroom: what education ministries could do differently

A broad strategic response rooted in education—and set within a national, multi-sectoral context—is essential for all countries. National responses to the HIV/AIDS epidemic have too often been piecemeal, of small scale, health-focused, and weakly integrated into related efforts. Strong political commitment is key to addressing such shortcomings. Particularly in low-prevalence countries, governments will need to recognize early that complacency can be disastrous.

The World Bank suggests three areas: policy, supply and quality, and demand and access, where national governments and their education ministries can make a decisive impact in using education to prevent the further spread of HIV/AIDS, which in turn could protect children and teachers from infection, and ensure that developing countries reach the EFA target of securing a primary education for every boy and girl by 2015. Some priorities in these three areas could comprise:

Policy

· Argue the case for education as an urgent national priority and as a high return-on-investment sector that should be adequately funded, highlighting its crucial role in HIV/AIDS prevention and the grave dangers of inaction (including setbacks on EFA)
· Ensure—and enforce—policies that make schools safe havens for children, including zero tolerance of sexual harassment and other inappropriate or criminal behavior, particularly on the part of teachers and school officials
· Ensure close collaboration with other sectors (especially ministries dealing with health, communications, and youth affairs), recognizing that the fight against HIV/AIDS can only be won with multi-sectoral efforts

Supply and Quality

· Ensure adequate supply of teachers, compensating for higher teacher mortality and absenteeism by increasing teacher training rates, including through greater reliance on distance education; reducing length of training courses and lowering qualification requirements while expanding in-service training to maintain quality; and recruiting teachers from non-traditional sources
· Strengthen delivery of prevention education, by expanding in-service training in this area, emphasizing participatory and other innovative teaching methods that promote teaching of life skills aimed at behavioral change, training young people (including those out of school) to be peer educators and counselors, and linking programs with health services
· Adapt curriculum and learning materials, introducing health education messages early on and sustaining them throughout the education system, and focusing health education on life skills
Demand and access

· Redouble efforts to ensure access to and completion of girls' schooling, with attention to water and sanitation needs and particular emphasis on orphans and other vulnerable children, through bursaries, and other established approaches
· Expand reliance on innovative approaches to reach out-of-school children, exploring distance education as well as community school and other non-formal alternatives to provide education to rural or other inaccessible areas, for counteracting the flight of teachers to urban areas (partly to get better health treatment).
"The tremendous potential of education and the crippling impact on it of the HIV/AIDS epidemic present both an enormous opportunity for countries that act and, a grave danger for those that do not," says Ruth Kagia, the World Bank's Director of Education and herself a former teacher from Kenya. "The divergent paths will be most evident in Africa, whose predominantly young populations promise rich rewards for an education-focused strategy, but dire consequences for a passive strategy that succumbs to the vicious cycle engendered by HIV/AIDS."

Going forward

Global efforts to speed up the pace of universal primary education along the lines of the World Bank's new 'development compact for education' could also help developing countries with HIV/AIDS infection rates, prevent the spread of the disease and also protect their education systems.

Development and finance ministers attending the recent meeting of the Development Committee of the World Bank and the IMF formally approved the new education compact which maps out how developing country governments can demonstrate their commitment to education by transforming their education systemssometimes with substantial changeswhile external partners, such as wealthy donor countries and the international financial institutions, will provide financial and technical support in a transparent and flexible manner.

The compact assumes that while developing countries bear the responsibility of providing quality primary education, some countries, especially the poorest, would be unable to raise enough of their own domestic finance to accelerate their Education For All (EFA) progress and therefore they would need external assistance in the short term. Click on the following link to see the World Bank's new education compact: Education for Dynamic Economies: Action Plan to Accelerate Progress Towards Education for All

"The Bank's recognition that education should be at the center of the agenda in preventing the disease and overcoming its impacts will strengthen the resolve of its country and education partners to make better use of the 'education vaccine' in overcoming HIV/AIDS," says Father Michael Kelly, professor of education, University of Zambia, Lusaka, one of the first development voices to call for the use of education systems to contain the spread of HIV/AIDS.

UNAIDS and the World Bank

As one of eight co-sponsors of UNAIDS, the Bank is playing a role in shaping the global response to the HIV/AIDS epidemic. On January 1, 1996, UNAIDS began its expanded, multi-sectoral United Nations response to HIV/AIDS, which has since expanded to a partnership including governments, NGOs, and the private sector.

The World Bank has recently committed US$1 billion for a Multi-Country HIV/AIDS Program (MAP 1 and MAP 2) for Africa, to dramatically increase access to HIV/AIDS prevention, treatment, care and support programs in Sub-Saharan African countries, and for the first time will also support sub-regional and cross-border HIV/AIDS initiatives such as targeting transport routes the Abidjan-Lagos Corridor which passes through Cote D'Ivoire, Ghana, Togo, Benin and Nigeria. Studies show that some of the highest-risk behaviors for transmitting HIV occur along transport corridors and border stops.

Another key feature of the MAP process is its support for a pilot program to use anti-retroviral therapy (ART) in Senegal. The Bank expects other countries will also begin using MAP support for ART pilots as conditions permit. At least a dozen more countries are likely to benefit from MAP 2 in addition to the dozen that have already received financial and technical support for their national HIV/AIDS strategies from the first stage of the program, MAP1, which was approved by the Bank in September 2001 ( Benin, Burkina Faso, Cameroon, Central Africa Republic, Eritrea, Ethiopia, Gambia, Ghana, Kenya, Madagascar, Nigeria, Uganda). Similarly, the Bank has also committed $155 million MAP program for the Caribbean.