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Deadly inertiaA cross-country study of educational responses to HIV/AIDS

NOVEMBER 2005

AuthorsTania Boler and Anne Jellema

Published in 2005 by The Global CampaignFor Education, 5 Bld Du Roi Albert II. 1210Brussels, Belgium

© Global Campaign for EducationFor citation purposes:

Boler, T. and A. Jellema (2005). Deadly inertia: A cross-country study ofeducational responses to HIV/AIDS.Brussels, Global Campaign for Education.

FRONT COVER PHOTOGRAPH: ACTIONAID

1

Executive summary 3

1 Introduction and methodology 9

1.1 Background and rationale for the study 91.2 AIDS: Why it must be a priority for educators 101.3 Education as the ‘social vaccine’ 111.4 Impact of HIV/AIDS on the supply of education 121.5 Special educational needs of children infected or affected by AIDS 141.6 Mapping the impact of AIDS on children’s education: challenges for policy-makers 14

2 National responses to HIV/AIDS and education 18

2.1 Overall policy and planning 182.2 HIV/AIDS-related structures within the Ministry of Education 192.3 HIV/AIDS education in the classroom 212.4 Responses to orphans and vulnerable children 272.5 Responses to HIV-infected and affected teachers 28

3 Civil society responses to HIV/AIDS and education 30

3.1 Civil society responces to OVCs 303.2 The role of NGOs in HIV/AIDS education 313.3 Civil society responses to the impact of AIDS on teachers 33

4 Partnerships for change 35

4.1 Overall relationships between civil society and Ministries of Education 354.2 Types of collaboration between Ministries of Education and civil society 374.3 Partnerships between education coalitions and HIV/AIDS coalitions 384.4 Advocacy responses to HIV/AIDS and education 38

5 Conclusions and recommendations 42

Appendix 45

The Global Readiness Report 45GCE partnership with the Canadian International Development Agency (CIDA) 45

GLOBAL CAMPAIGN FOR EDUCATION DEADLY INERTIA

CONTENTS

Deadly inertiaA cross-country study of educational responses to HIV/AIDS

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ACRONYMSAIDS Acquired immune deficiency syndrome

ART Anti-retroviral therapy

ARV Anti-retroviral

CIDA Canadian International Development Agency

CSO Civil society organisations

EFA Education for All

EI Education International

EMIS Education Management Information System

FBO Faith-based organisation

GFATM Global fund for AIDS, Tuberculosis, and Malaria

HBC Home-based care

HEARD Health Economics and AIDS Research

HIV Human immunodeficiency virus

IATT Inter-agency task team on HIV/AIDS and Education

IMF International Monetary Fund

INGO International NGO

MOEC Ministry of Education and Culture (Tanzania)

NGO Non-governmental organisation

OVC Orphans and vulnerable children

SCF-US Save the Children Fund – United States

SRH Sexual reproductive health

STI Sexually transmitted infection

UNESCO United Nations Educational, Scientific and Cultural organisation

US United States of America

VCT Voluntary counselling and testing

WHO World Health Organization

GLOBAL CAMPAIGN FOR EDUCATION

ACKNOWLEDGMENTS

GCE was funded by CIDA to carry out this work, in partnership with IIEP, UNESCO. Tania Boler(ActionAid) led the research project, with the assistance of Kate Carroll (ActionAid). Coordinating the national level work were Angelina Lunga, Jean Claude Fignole, Anne MarieHadcroft, Branimir Torrico, Tito Lopez, Mr Brian Gilligan, Emmanuelle Abruix, Ramesh Joshi, Ms Suman, Justice Egware, Joe Makano, Sileye Gorbal Sy, Matarr Baldeh, Adelaide SossehGaye, Assibi Napoe, Eulalie Nibizi, Mamadou Diallo, Lydia Aku Adajawah, Juliana Adu-Gyamfi,Kamilia Ibrahim Kuku, Nydeng Gordon, Mubark Ali Yagoub, Peter Modison Yugu, ElizabethBaroudi, Bruna Siricio, Mahjoub M., Fred Mwesigye, Salome Anyoti, Blastus Mwizarubi, Njeri M.Kinyoho, Wambua Nzioka, Vincent Mwakima, Olad Farah, Otieno Aluoka, Emily Kioko-Echessa,Light Wilson Aganwo.

Thanks also to Wouter Van der Schaaf and Elie Jouen (Education International), Diego Postigo(Ayuda en Accion), Alexandra Draxler (UNESCO), Maysa Jalbout (CIDA), Dan Wilson (HEARD),Peter Badcock Walters (HEARD) Chris Desmond (HEARD) Otieno Aluoka, Emily Kioko-Echessa,Vincent Mwakima, Wambua Nzioka, Njeri M.

Comments were gratefully received from Sheila Aikman, David Archer, Elizabeth Baroudi, Don Bundy, Kate Carroll, Christopher Castle, David Clarke, Alexandra Draxler, Harinder Janjua and Jan Wijngaarden.

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Executive summary

However, faced with these awesome challenges, theeducation sector appears to be paralysed. Fewcountries have mounted ambitious, nationwide effortsto mobilise all schools in the fight against AIDS. Ourresearch, undertaken in 2004 in coordination with thefirst-ever UN Education Sector Global HIV/AIDSReadiness Survey, found that only two of the 18countries reviewed had a coherent education-sectorAIDS strategy that was actually being implemented. Inother cases, strategic plans either did not yet exist, orthey were largely ignored because they had beendeveloped in isolation from other policy and budgetaryprocesses.

Our research revealed that no action had been takenin 17 out of 18 countries to prevent the potentialimpact of teacher shortages, and governments wereturning a blind eye to the educational needs oforphans and HIV positive children. In most cases,donor aid was not helping governments to addressthese problems more systematically. Rather, aidtended to be directed towards a series of stand-aloneinitiatives that enjoyed little ownership by government.

An effective educational vaccine demands, first, a fullyfunded plan to achieve universal primary education(UPE). A complete primary education is the thresholdat which young people’s risk of infection starts to fallsignificantly, and secondary education brings

The AIDS epidemic has become a global crisis – currently threatening the lives ofaround 38 million people and devastating entire societies. Education systems havea critical role to play in fighting this epidemic, because of their capacity to reachvery large numbers of young people with life-saving information and skills. Acomplete primary education can halve the risk of HIV infection for young people;and in fact, basic education has such a powerful preventative effect, especially foryoung women, that it has been described as the ‘social vaccine’. As the epidemicgathers pace, however, it poses increasing risks to education itself, threatening tostop children from enrolling, teachers from teaching and schools from functioning.

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additional protective benefits. However, the protectivebenefits of education are being missed when one intwo African children either fails to enrol in primaryschool at all, or drops out before finishing. In most ofthe countries studied, large numbers of the childrenmost at risk of HIV infection – girls, working children,the very poor and children affected by conflict – arenot in school at all, or drop out too early to benefit. These countries urgently need coordinated supportfrom the international community, for example throughan expanded Education for All Fast Track Initiative, to expand access to education and achieve UPE. Second, an effective AIDS response must includespecial measures to ensure that HIV/AIDS infectedand affected learners are not left out. Unfortunately,although the plight of AIDS orphans has beenhighlighted internationally, the educational responseshave been misguided, unsustainable and one-dimensional. The widespread practice of providingschool bursaries is a temporary, quick-fix solution,which does not tackle the pressing need to removeuser fees and reduce other costs of schooling.Furthermore, although school bursaries may reduce the financial barriers facing orphans andvulnerable children (OVCs), they do not address thepressing psycho-social needs of these highlyvulnerable children.

Evidence shows that in many countries, children whoare (or are suspected to be) HIV positive are beingturned away at the school gate. Although civil societyhas a role to play in combating stigmatisation, onlygovernments can guarantee and uphold the right ofHIV positive children to attend school. In thisresponsibility – a responsibility to one of the mostvulnerable and powerless groups in society – they arefailing shamefully. Rather, efforts to keep HIV positivechildren in the classroom have been largely left up toindividual teachers and school committees, who notonly have to fund these efforts themselves but alsohave to battle the prejudices of the local communitywithout any assistance or leadership from the Ministryof Education. Despite laudable initiatives by someschools, AIDS-related stigma and lack of resourcesmore often than not mean that schools to give up onthese children.

AIDS also poses a grave threat to the educationworkforce, yet policies to address workforce issuescan only be described as abysmal. Teacher shortages,already severe in much of Africa and South Asia, areexpected to worsen significantly in the wake of AIDS.However, most of the countries that we revieweddidn’t have any plans in place for coping with AIDS-related staffing crises. The UN Global ReadinessSurvey found that only about 25% of high-prevalencecountries have plans to train more teachers to copewith increased staff losses, and only about 10% havereviewed or amended their human resource policies inlight of the AIDS challenge. Only one country of the 18 we reviewed was monitoring attrition rates andusing this information to plan for the future.

Moreover, because teachers are perceived aschildren’s guardians and role models, those with HIVhave been particularly vilified; and with little prospectof confidential counselling and testing services oraffordable access to treatment, they are afraid todisclose their status. Yet no country in our study hadadequately put in place laws or procedures to protectteachers from AIDS-related discrimination.

Too much government and donor money is beingspent on poorly designed interventions that gounimplemented because the most basic foundations –resources, ownership, training, even basic data – have


GIDEON MENDEL/CORBIS/ACTIONAID

not been put in place first. In the absence ofcomprehensive, system-wide planning for HIV/AIDS,both donors and Ministries of Education haveconcentrated efforts on getting prevention messagesand materials into the classroom. This is a highlyvisible intervention that can seemingly beimplemented as a stand-alone project. In practice isimpossible to teach children about HIV in classroomsthat lack the essential ingredients for successfulteaching and learning about any subject. In most ofthe 18 countries studied, classrooms were tooovercrowded, management systems too under-resourced and teachers insufficiently trained to deliver HIV/AIDS messages effectively. Notsurprisingly, implementation of HIV/AIDS educationremains piecemeal. It fails in three key areas:materials, content and training. Insufficient quantitiesof materials are reaching schools, the realities ofsexual transmission are not covered, and training toenable teachers to handle the new topics is woefullyinadequate. In only three of the 18 countries hadMinistries of Education made systematic attempts totrain teachers about HIV and AIDS.

On all of these counts, the plans and policies of mostof the 18 countries studied are shockingly inadequate.However, the blame cannot simply be passed ontonational governments. The international donorcommunity has also failed to deliver leadership andpolitical commitment. Few donors are pledging thecoordinated, large-scale assistance that would beneeded to implement a programme of free anduniversal access to education in the face of HIV/AIDS– and few countries struggling with the economic andsocial impact of the epidemic can afford to financesuch steps themselves. Finally, education non-governmental organisations (NGOs) are surprisinglyunder-informed about the epidemic. Their contributionshave been patchy at best; at worst, some NGOs haveused AIDS as a vehicle to promote ideological andreligious messages of their own choosing.

But while the response to date is undoubtedly toolittle, it is not too late. By acting in concert now,donors, governments and civil society can give ouryoung people a fighting chance to stay safe fromAIDS. It is not too late to break the deadly inertia.

Responses by Ministries of Education

Strategic responses

There was huge variation in the degree of strategicresponse to HIV/AIDS in education, although the typeof response was remarkably similar across countries,perhaps revealing the donor-driven nature of theresponses. In the Asian and Latin American countries,there was no policy response from Ministries ofEducation, firstly because HIV/AIDS was seen as theresponsibility of Ministries of Health and secondlybecause HIV/AIDS was not deemed a seriousproblem. In Africa, Ministries of Education had madedifferent levels of progress in developing andimplementing an HIV/AIDS strategy.

Moreover, HIV/AIDS strategic plans, where they exist,are not being implemented because they have beendeveloped in isolation from other policy and budgetaryprocesses.

• HIV/AIDS units within Ministries of Education are notworking. They tend to be isolated, under-resourced,and lacking in political power. Where this is thecase they have not succeeded in getting Ministriesof Education to take AIDS more seriously.

• Ministries of Education do not have access to theevidence base they need to formulate effectivepolicies on HIV/AIDS.

• Ministries are not engaging systematically with civilsociety to design HIV/AIDS policies.

Curricular responses

Ministries of Education have made most progress inthe area of HIV/AIDS curriculum development, not,coincidentally an area that has also been popular withdonors. Nearly all countries had developed anHIV/AIDS curriculum – often with the support ofUNICEF or UNESCO. However, in almost all thesecases, implementation was very limited. HIV/AIDS

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Summary ofkey findings

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material is not integrated into the general syllabus but is left on the margins, or is ignored all together.Implementation failure can be traced to the followingproblems:

• Civil society groups and teachers have not beeninvolved in the design of HIV/AIDS curriculum, inmost cases leading to a lack of ownership and aperception that the curriculum is ‘donor-driven’.

• The majority of countries have not investedadequately in pre-service and in-service training toequip teachers to handle HIV/AIDS topics.

• Implementation of HIV/AIDS education, in mostcases, has been slow and piecemeal, andinsufficient quantities of HIV/AIDS learning materialsare being distributed.

• Lessons tend to avoid open discussions aroundsexual health, and are further undermined by thefailure to provide specific training and support toteachers so that they can handle the new subjects.

• HIV/AIDS education is often treated as a marginaland stand-alone topic instead of being reviewedand integrated through a general curriculum-development process. Since the general curriculumis already overloaded in most countries, this meansthat HIV/AIDS modules tend to be ignored orneglected.

• Many schools suffer from quality challenges andteacher shortages so severe that they make‘interactive’ and ‘participatory’ approachesimpossible.

Responses to infected and affected learners and teachers

There was overriding consensus that Ministries ofEducation are not taking sufficient steps to ensure thatHIV/AIDS infected and affected learners can stay inschool.

• In the vast majority of countries, Ministries ofEducation had little understanding of the specificeducational challenges facing OVCs.

• Although some OVCs have access to bursariesand/or free school meals, these tend to be localisedinterventions sponsored by NGOs, which can reachonly a small proportion of OVCs.

• In the few countries where there was a national-level educational response, this was also restrictedto providing bursaries to cover school fees. Existingbursary schemes were criticised for beingpiecemeal and under-resourced.

• None of the 18 countries studied had adequatelaws, policies or procedures to prevent schools fromdiscriminating against HIV positive children.

• Beyond financial needs, counselling to respond tothe psycho-social needs of OVCs is rarely available.

It appears that the issue of HIV/AIDS-affected teachershas been ignored, partly because of the controversy itcauses. In particular, because teachers have animportant role in society as guardians and role modelsfor children, the immorality associated with AIDSserves to vilify HIV positive teachers even more thanother HIV positive people. The situation is furtheraggravated as the teachers are less likely to disclosetheir status because of the lack of confidentialvoluntary counselling and testing (VCT) services, andfree or affordable access to anti-retrovirals (ARVs).

Ministries of Education are ill-prepared to deal withpotential impact of HIV/AIDS on teachers.

• Ministries have failed to put laws, policies andprocedures in place to prevent discriminationagainst HIV positive teachers.

• None of the countries in this study had adequateworkplace polices on HIV/AIDS.

• Few governments are able to monitor teacherabsenteeism and mortality, or have a plan to tackleAIDS-related teacher attrition.


Responses by civil society

Partnership

The relationship between civil society and Ministries ofEducation differs greatly across countries. In 17 of the18 countries, there were some partnerships betweenNGOs and Ministries. However, there was concernthat these partnerships were perceived as one-sided,in that the Ministries viewed NGOs with suspicion andonly favoured partnerships with the larger and verymuch more powerful, international NGOs. In mostcases, partnerships were informal and dependedmore upon individuals and ‘personalities’ rather thanformal institutional cooperation.

Within the field of HIV/AIDS and education, someNGOs had been involved in designing the HIV/AIDSstrategy paper, while others had been involved incurriculum design and data collection. Overall, civilsociety respondents complained at the lack ofpartnership and cooperation with HIV/AIDS andeducation, suggesting that they had a useful role toplay in teacher training and curriculum design.

The study also found that there were very fewpartnerships between education and HIV/AIDScoalitions – in most cases, the GCE project offered thefirst opportunity for such collaboration. There is a needto strengthen the capacity of coalitions to developtheir partnership work so that they can represent civilsociety organisations in linking to key policy-makersand also linking organisations together at the sub-regional level.

Programmatic responses

NGOs have responded to HIV/AIDS in education intwo key ways: providing HIV/AIDS education inschools, and giving direct and indirect support forchildren orphaned by AIDS. NGOs have been muchslower to respond to the issue of teachers and HIV –and the little work that is being conducted isconcentrating solely on HIV prevention.

Efforts are hindered by a number of issues.

• Many education-sector organisations still lack arudimentary understanding of HIV/AIDS issues whilemany health-sector organisations pay little or noattention to the role of the education system infighting the spread of AIDS.

• There is an overall lack of coordination, with littlenetworking or partnership between teacher unions,education NGOs and HIV/AIDS networks. FewNGOs involved in running school-basedprogrammes consult ministries when decidingwhich schools they should target, leading toextremely uneven coverage. Conflicting and multiplemessages on HIV/AIDS are delivered when NGOsdetermine the contents of HIV/AIDS educationaccording to their own ideology or religious beliefs.

• Finally, NGOs tend to tackle the immediatesymptoms without considering the underlyingcauses, which means that some of their actionsmay be self-defeating in the long run. Many NGOsare involved in providing school bursaries, forexample, but this could undermine wider populardemand for free and universal basic education. Thecreation of special schools for OVCs, anotherpopular NGO response, may stigmatise children.

Advocacy responses

GCE members have campaigned relentlessly toachieve Education For All. Three campaign areas inparticular (abolition of user fees, girls’ education andquality education) are strongly linked to theeducational response to HIV/AIDS. Campaigningaround HIV/AIDS should not create any contradictionto campaigning on Education for All, because theHIV/AIDS epidemic only serves to highlight theimportance of free and quality education.

In terms of specific campaigns around HIV/AIDS, GCEmembers have been slow to respond. However, thisproject has already led to a number of importantchanges, including proposed campaign work onHIV/AIDS in eight of the participating countries.Obviously the areas of concern differ depending onthe local context but there are common threadsemerging around protecting the human rights ofteachers and OVCs, as well as ensuring the right toinformation for all.

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1 Ministries of Education should formulate a clear andcosted strategic plan on HIV/AIDS, which is integrated intoeducation-sector plans and national poverty-reductionstrategies, and which is complemented by state anddistrict level plans.

2 Ministries of Education must clearly define the rights of HIV positive children in schools, as well as the rights ofHIV positive education workers, and establish policies,regulations and procedures to prevent AIDS-relateddiscrimination against learners and teachers. Workplacepolicies must be put in place to respond to the needs of HIV positive teachers. At the very least these should include access to confidential VCTservices and affordable access to treatment.

3 Greater effort must be made to understand the specialeducational needs of children affected by HIV/AIDS. Theeducational response must go beyond simply providingbursaries to include psycho-social support throughexisting counselling services in schools.

4 Governments must put in place adequate monitoringsystems for measuring the impact of the epidemic on education. In particular, education managementinformation systems (EMIS) need to be strengthened in order to capture data on teacher absenteeism andmortality as a result of AIDS.

5 High priority must be given to training teachers to teach about HIV/AIDS. Both in-service and pre-service teacher training should include compulsoryHIV/AIDS components that are examinable or certifiable.Teachers and their unions must be involved in the designand roll-out of such programmes.

6 HIV/AIDS should not be taught in isolation, but as part ofa wider sexual and reproductive health framework.Curriculum development should be in partnership withcivil society and, while being culturally appropriate, shouldbe based on scientifically accurate information rather thanbeing ideologically driven. Such curricula must be basedin the reality of young people’s lives and provide youngpeople with realistic choices to protect themselves fromHIV infection.

7 Civil society organisations (CSOs) need to be more proactive and systematic in seeking to influenceHIV/AIDS-related policies and plans of their government.Stronger linkages and alliances between teachers’ unions,education groups and health groups (among others)would help to ensure a more effective and better-informed civil society input to policy discussions. CSOscan make important contributions to the design andimplementation of school-based HIV education, but theirefforts should be coordinated by the Ministry of Educationto avoid duplication or contradiction. At the same time,however, CSOs have a responsibility to act asindependent monitors of HIV/AIDS policies and spending at all levels, and to campaign for theeducational rights of all vulnerable groups.

8 In order for schools to play an effective role in fighting AIDS, all children, especially the poorestand most marginalised, must be able to go to school.Completion of primary education is the threshold level to unlock the preventative power of education, yet across Africa only 1 in 2 children ever finishes primaryschool, while large class sizes and under-trained teachersundermine learning. Basic education must be made free,universal and compulsory. Governments must abolishfees, build more schools and train more teachers,establish stipends and/or school meals to help keepchildren in school, and take additional necessary steps toensure schools attract girls, orphans and other vulnerablechildren.

9 Financing these measures will require immediate and major increases in aid and debt relief for affectedcountries. In the face of the wider economic andbudgetary pressures, earlier donor estimates of countries’education-sector needs may need to be revised, and inparticular, more money made available for recurrent costssuch as payroll costs. While the potential to finance suchmeasures through HIV/AIDS designated funding channelsshould be further explored (such as The Global Fund forAIDS, Tuberculosis and Malaria), it is urgent that the FastTrack Initiative (FTI) partnership expands to include morelow-income countries and to offer coordinated andgenerous support for Ministries of Education to scale-up their response to AIDS.

Recommendations


It is clear that none of the initiatives summarised above is enough to deal with adeadly epidemic currently infecting more than 13,000 people each day. A larger,better-coordinated and more systematic response is urgently needed, and in orderto achieve this, a number of key challenges must be addressed without delay:

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1. Introduction and methodology

1.1 Background and rationale for the study

This report analyses responses to the HIV/AIDS crisis,both by Ministries of Education and civil societygroups working on education, in 18 countries acrossAsia, Latin America and Africa.

As summarised in our 2004 report Learning to Survive,there is growing evidence that a general foundation ineducation promotes safe behaviour and is highlyeffective in protecting against HIV infection. (see Box1). As AIDS continues its rapid spread across much ofthe developing world, it is imperative that educationsystems are ready to play their full role in fighting thisdevastating disease.

The action research underpinning this report wascarried out in coordination with the first-ever UNEducation Sector Global HIV/AIDS Readiness Report,a questionnaire-based exercise that collectedinformation from 71 Ministries of Education. The UNsurvey’s aims included:

• assessing each country’s education system in terms of ‘readiness’ and response capacity

• analysing vulnerability and need in order to guidedonor agency support

• establishing a benchmark for the annual updating of this information

• helping Education Ministries to assess their ownpreparedness and identify areas of concern orvulnerability.

Global Campaign for Education (GCE) discussions inlate 2003 with the UN working group backing thesurvey revealed that no plans had been made toinvolve civil society in the exercise, either at national orat global levels. Although the time remaining to make

an input to the Global Readiness Survey was by thenextremely limited, we felt that our members at thenational level could still provide valuable data to helptriangulate and assess official responses fromgovernments. We also hoped that through theirinvolvement in the survey process, our memberswould gain knowledge and make links that wouldencourage them to increase their own advocacyefforts on AIDS and education in future.

With the backing of the UN Inter-Agency Task Team onHIV/AIDS and Education, and with funding from theCanadian International Development Agency (CIDA),we launched a rapid action research exercise incooperation with our members – civil societyeducation networks and teachers’ unions – in thefollowing 18 countries: Bolivia, Burundi, El Salvador,Gambia, Ghana, Haiti, India, Kenya, Mali, Nepal,Nigeria, Senegal, Sudan, Tanzania, Togo, Uganda,Zambia and Zimbabwe.

The objectives of the project included:

1 improving the accuracy and usefulness of theGlobal Readiness Survey by feeding civil societyperspectives and experiences into the researchprocess

2 enabling national civil society to engagegovernment, media and others in serious dialogueon the policy issues raised in the report, in order toensure that the findings of the Global ReadinessSurvey are not ignored by senior policy-makers ingovernment

3 laying the foundations for ongoing civil societyinvolvement in shaping AIDS and education policiesby increasing AIDS awareness and concern amongeducation NGOs and teachers’ unions, and bylinking these groups to civil society AIDS networks,Ministries of Education and donor agencies(specifically, members of the UN’s Inter-Agency Task Team).

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All 18 coalitions received a small amount of funding tohold a consultation, bringing together diverse civilsociety groups from the education and AIDS sectorsto share and consolidate information and perspectiveson existing educational responses to the AIDS crisis.All 18 were subsequently asked to complete aquestionnaire developed by the GCE to parallel theUN questionnaire being distributed to ministries. Six ofthe participating coalitions received additional fundingto carry out more detailed studies on particular issueshighlighted in the Readiness Survey. The Appendixgives a more detailed description of the actionresearch process.

This report attempts to synthesize learning from the 18countries and in particular, to answer the followingthree questions:

1 What progress have Ministries of Education madein responding to the epidemic?

2 How have civil society organisations working oneducation responded to the epidemic?

3 How can the educational response to HIV/AIDS bestrengthened and galvanised?

Although limited funding and time meant that we werenot able to cover the role of donors as fully as wewould have liked, the national reports did yield someuseful insights on donor engagement and these havebeen mentioned where relevant.

It should be pointed out that both the UN survey and our research were carried out over a period ofapproximately three months in 2004, and thereforecannot capture how policies have changed over time.Some of the countries included in our study havetaken significant steps forward since the research was completed. We hope, however, that the baselineassessment sketched in this report will be useful notonly to policy-makers and civil society groups in thecountries covered, but will also enable stakeholders in other countries to draw some useful lessons thatmight improve their own AIDS planning.

The report is split into four chapters. This firstchapter describes why educators need to start takingHIV/AIDS seriously; the second gives an overview ofnational responses to HIV/AIDS; the third chapterdiscusses civil society responses to HIV andeducation, and the fourth covers partnershipsbetween NGOs and Ministries of Education.

1.2 AIDS: Why it must be a priority for educators

The AIDS epidemic is fast becoming one of the mostsevere societal challenges facing education systems.The lives of millions of children and teachers havebeen permanently changed by the epidemic, in waysthat constrain their ability to go to school, to stay inschool and to learn or to teach (Ainsworth and Fimer2002; Bennell, Hyde et al. 2002; Case, Paxman et al.2003, Boler, 2004). Finding ways to meet theseneeds, to keep children in school and teachersteaching, is a pressing issue for the educationcommunity, as discussed in section 1.2.1 below.However, it is also a matter of urgent concern forsociety as a whole, even in countries where theprevalence rate is still low – because education is anecessary part of any HIV/AIDS-prevention campaignand pivotal in stemming the spread of the epidemic.

A sceptical civil servant in a developing country mightpoint out that education systems are alreadystruggling at the limits of their capacity, and hardlyhave the staff, the administrative capacity or thebudgetary resources to take on yet another ‘priority’.Why does HIV/AIDS deserve special attention?

There are three major reasons why educators mustscale-up their collective response to the AIDSepidemic:

• First, without a medical vaccine, education iscritically important as the most powerful ‘socialvaccine’ against HIV infection.

• Second, without a systematic strategy for mitigatingthe impact of AIDS, the epidemic will undermine theprovision of education, thereby denying childrenaccess to the quality learning they need to stay safefrom HIV, and slowing or even reversing progresstowards universal education.

• Third, the children who most need the protectionand skills afforded by education – those affected orinfected by the disease – will not be able to attendschool unless their special needs are addressed.


1.3 Education as the ‘social vaccine’

Central to economic and social development for thenation as a whole, formal education is also often oneof the only chances that individuals and families haveof breaking the cycle of poverty. Recognising this,leaders of both developed and developing countriesput universal basic education at the heart of the UN’sMillennium Development Goals (MDGs) for halvingworld poverty. The MDGs call on rich and poorcountries to cooperate to attain gender equality inprimary and secondary school enrolments by 2005,and universal completion of primary education (usuallyabbreviated to ‘Universal Primary Education’ or UPE) by2015. Within the MDG framework, education ministersand donor agencies have made further commitmentsto a more ambitious and holistic vision of ‘Educationfor All’ that includes not only UPE and gender equality,but also a 50% reduction in adult illiteracy by 2015,measurable quality improvements and an expansionin lifelong learning opportunities.

In the early years of the AIDS crisis there was atendency to treat the epidemic as largely or entirely amedical problem. The debate on appropriate policyresponses was dominated by scientists and doctorsand focused mainly on issues surrounding treatmentand palliative care. What prevention initiatives therewere tended to be run by health departments.

However, as the epidemic continues its frighteninglyrapid spread with no vaccine in sight, there has beengrowing recognition, first, that prevention is critical;and second, that prevention requires more than justtransmitting accurate health information. The onlyeffective way to prevent HIV is by helping people tochange behaviours that put them at risk, such as ageof sexual debut, number of sexual partners and use ornon-use of condoms. These behaviours are usually

embedded in deep social, economic and culturalpatterns, so that billboard advertising or flyersdistributed in health clinics may have little effectunless accompanied by other efforts.

The new emphasis on accompanying treatmentwith prevention has generated interest in the powerof education as a complementary weapon againstAIDS. School systems have a threefold role to play infighting AIDS:

• Education protects individuals. Completion of atleast a primary education is directly correlated withdramatic reductions in HIV infection rates, even ifpupils are never exposed to any specific AIDSeducation or life skills programmes in theclassroom. The reasons for this are not adequatelyresearched, but a general foundation in educationequips individuals with cognitive skills needed tounderstand, evaluate and apply health information.Education also boosts earning power, self-confidence and social status, giving young peopleand especially young women increased control oversexual choices. Girls who are in school are morelikely to delay sex than their out-of-school peers.Finally, schooling is a sustained and powerfulsocialisation process, shaping values, identities andbeliefs through daily exposure.

• Education informs individuals. Schools have thepotential to be efficient and inexpensive vehicles forpassing on HIV/AIDS information and promotingsafe behaviour, because they reach the right targetgroup (children and youth) at the right time (whentheir values, beliefs and sexual behaviours are stillopen to change), and reach them daily over aperiod of months and years (Kelly 2000).

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Additionally, while young people do not necessarilylearn about sex from their teachers, schools areviewed by young people as important and trustedplaces to learn about AIDS (Boler, Adoss et al. 2003).

• Education protects societies. Over the medium to long term, keeping education systems functioning iscritically important to mitigate the loss of humancapital as increasing numbers of adults die, takingtheir skills and knowledge with them. Many high-prevalence countries are already starting toexperience shortages of nurses, teachers and otherkey workers.

There is therefore both a social and a moral imperativefor schools to take some responsibility in teaching allchildren and young people about sexual reproductivehealth –both to encourage behaviour shifts that are inthe interests of the whole society, and so that youngpeople can have a chance to protect themselves frominfection.

There is also a strong pedagogical rationale forincluding HIV/AIDS and sexual reproductive health in the curriculum. Educational theory dictates thateducation systems should be flexible enough torespond to the changing needs of their learners,including when necessary, a change in what is actuallytaught. Schools have a purpose and responsibility toprepare children and young people for adult life. Schools often teach technology, home economics, and sewing – the argument for teaching aboutHIV/AIDS surpasses them all.

1.4 Impact of HIV/AIDS on the supply of education

In order for schools to deliver the ‘education vaccine’effectively and make the necessary impact on HIV’sspread, governments first have to be able to get allchildren, girls as well as boys, into the classroom andkeep them there long enough to acquire basic analyticaland literacy skills – usually said to require five to sixyears of education, or a full cycle of primary schooling.This would be accomplished if all countriesimplemented the promise they made in 2000 to achieveuniversal completion of primary education (UPE) by2015, which requires steps to expand supply (buildingmore schools and training more teachers) as well as tounlock demand (abolishing school fees, enforcing lawsagainst child labour, ending early marriage).

Unfortunately, progress towards UPE – already tooslow to achieve the 2015 goal – is further threatenedby the spread of AIDS, and especially by its impact onthe teaching force. Sub-Saharan Africa is alreadyfacing a serious teacher shortage and AIDS-relatedsickness and mortality is exacerbating this problem. Infact, early during the epidemic it was reported thatteachers were actually more at risk of HIV than the


Box 1 Learning to survive

Recent studies indicate that young people with littleor no education may be 2.2 times more likely tocontract HIV as those who have completed primaryeducation. This implies that, while those without acomplete primary education represent around 36per cent of young adults in low-income countries,they are likely to experience around 55 per cent ofnew HIV cases for that age group.

Without universal primary education (UPE), we canexpect 1.3 million young adults who lack primaryeducation to become infected every year – asubstantial proportion of the predicted five millionnew infections annually. However, if everyonereceived a full primary education, we would expectover 700,000 of these cases (about 30 per cent ofall new infections in this age group) to beprevented each year. Keeping these 700,000 youngpeople safe from HIV would in turn prevent themfrom infecting others, and educated young peoplealso play an important role in spreading safe sexmessages and practices among their peers; so theultimate effect on prevalence rates would be evengreater than these estimates suggest.

Source: GCE 2004

ICIAR DE LA PÈNA/AYUDA EN ACCIÓN

general population because of their relatively highsocio-economic status and a general lack ofunderstanding about how the virus was spreading.(Kelly 2000). This trend appears to have changed,especially where mature epidemics exist, withincreasing evidence that the more educated peopleare, the better able they are to change their behaviour.Indeed, some evidence suggests that teachers maynow be changing their behaviour faster than thegeneral population making them relatively low risk toHIV (Bennell, Hyde et al. 2002; Boler 2004).

Nevertheless, even if teachers, administrators andother education workers face infection rates no greater than those affecting the rest of the population,in medium- and high-prevalence countries this isenough to cause serious problems in the supply andquality of education.

Long before an HIV positive teacher dies, she is likely to be ill, and therefore absent from school, forsubstantial periods, leading to teacher shortages orclasses being taught jointly. A lack of HIV-related

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A significant number of methodological limitationsexist in current approaches to quantifying the impactof HIV/AIDS on teachers and teaching. Not only isthe data, in most cases, unreliable, but it is alsolimited unless placed in context. It is clear that theimpact will be felt differently in different contexts:depending on how mature the epidemic is and what wider educational reforms and policies exist tomediate impact.

The clearest quantifiable impact of HIV/AIDS onteachers is the level of in-service mortality. Actualand past impacts have been measured mostlythrough school-based surveys, and educationalpersonnel records. The second key area ofquantitative research has been around HIVprevalence for teachers; the data in this case reliesmostly on projections and some limited population-based studies.

Personnel systems and EMIS (EducationManagement Information Systems)

Well-functioning personnel systems and EMIS offerconsistent, sustainable and simple ways to examineteacher mortality. These systems need to bestrengthened in a number of resource-poor countries– not merely to further our understanding of theimpact of HIV/AIDS, but more crucially, to better thecapacity to monitor and respond to changes in theeducation sector. From a wider managementperspective, EMIS human-resource related datacould be integrated with personnel, e.g. payrollsystems, to allow for a more rigorous assessment ofquality and completeness of data.

Seroprevalence studies

Large-scale and representative seroprevalencestudies are an important way to quantify the actualand likely impact of HIV/AIDS on teachers. This typeof study should be encouraged in the school-placeand testing should ideally also include a CD4 countso that progression of the virus can be monitored.Although testing is anonymous, it is vital that VCTservices are available for teachers and that testingshould, more broadly, be part of an initiative torespond to the needs of infected staff.

Modelling

Projections are our main tool to understand, and plan for, the future impact of HIV/AIDS on teachers.However, given the paucity of robust input data,projections must be contextualised as much aspossible and should offer scenarios which reflect thesubtleties described earlier. This level ofsophistication requires the work of experiencedmodellers.

Finally, projections must be frequently validated, andrevisited with epidemiological, demographic and riskbehaviour data.

In attempting to quantify the impact of HIV/AIDS onteacher mortality, it is paramount to bear in mind thatimpact will differ between districts, and evenbetween schools and years. Teachers are not ahomogenous group and data should therefore bedisaggregated as much as possible. It follows thatimpact management must – at the very least – becountry specific, and target different sub-groups ofteachers in different ways.

Box 2 Quantifying impact of AIDS on teachers (extract from Boler, 2004)

14

workplace polices compounds the problem as thereoften is no sick pay, no access to treatment andinadequate teacher replacement policies (Coombe2000; Badcock-Walters, Desmond et al. 2003). AIDSmortality also substantially increases the educationwage bill, as attrition costs are high and deathbenefits soar.

1.5 Special educational needs of children infected or affected by AIDS

There are an estimated six million people indeveloping countries in urgent need of, but unable toaccess, anti-retroviral drugs (WHO 2004). Hence, forthe majority of HIV positive people, the virus inevitablyleads to death, preceded by chronic illness (Coombe2000; Kelly 2000; Cohen 2002). In sub-SaharanAfrica, the main mode of transmission of HIV isthrough sexual intercourse (UNAIDS 2002).Consequently, those who are dying are adults duringthe most productive part of the human life cycle (bothin terms of procreation and economically).

‘Impact of HIV/AIDS’ refers to the consequences ofthis pattern of increased chronic illness and death(Barnett and Whiteside 2002). Each person – as anindividual in society – is embedded in a network offamily, peers, communities and society. As a personbecomes ill and dies, there are importantconsequences (impact) for their family – particularlyfor any dependents such as children or grandparents.When enough individuals become infected with HIV,the consequences begin to affect whole communities.

Some researchers argue that the impact of HIV/AIDSis first felt as an immediate and severe shock (short-term impact); and later by more complex, gradual andlong-term changes (long-term impact) (Whiteside1998; Barnett and Whiteside 2002). For instance,when a parent dies, a child might have to move house– a sharp and perceptible consequence. A few yearslater, that child might drop out of school because ofemotional stress and poverty – both of which wereindirectly triggered by their parent dying.

In most cases, children are first affected directly by theconsequences of HIV/AIDS when an adult member oftheir family becomes ill through a weakened immunesystem, yet very little is known about the impact ofparental illness on the well-being of children. Thelimited research which does exist suggests thatparental illness triggers a role reversal in whichchildren – particularly girls – begin to care for sickadults and take on income-generating activities(Morgan 2000; Patel 2000; Ainsworth, Beegle et al. 2002).

Upon the death of a parent, the extended familytraditionally takes responsibility for the welfare of theorphans (Foster 1997). Given the rise in the number oforphans, it appears that these coping systems areoverstretched and are no longer coping (Nyambedha,Wandibba et al. 2003). In many cases, orphans arebeing cared for by grandparents (Foster 1997; Ntoziand Nakamany 1999; Bicego, Rutstein et al. 2003), orlooking after themselves – evidenced by the increasein the number of child-headed households (Sengendoand Nambi 1997; Gregson, Waddell et al. 2001).

1.6 Mapping the impact of AIDSon children’s education:challenges for policy-makers

When enough people have been affected byHIV/AIDS, whole societies begin to feel theconsequences (Whiteside 2000). Governments arebecoming increasingly aware that the very institutionsholding society together, such as health andeducation systems and industry, are under threat.

However, it has been difficult for policy-makers toanticipate or head off these threats, as empiricalunderstanding of the wider societal impacts ofHIV/AIDS is still weak (Barnett and Whiteside 2002;Bennell, Hyde et al. 2002). This is as true in theeducation sector as anywhere else.

One possible reason is that in developing countries,many institutions are already under considerablestress, making it hard to disentangle the specificimpacts of AIDS from other deep-seated structuralproblems (Badcock-Walters, Desmond et al. 2003).Moreover, as the chain of causation moves from the


individual and household to higher-level institutions, itbecomes more complex – with many more interveningfactors coming into play – and less well understood.

In the education sector, understanding has beenfurther limited by the fact that most research on AIDSimpacts has focussed on only one specific sub-groupof affected children (orphans), and one specific sub-category of education indicators (enrolment) (Bank2002). Unfortunately, this does not provide a verystrong basis for policy formulation. It tends toencourage an overly simplistic approach that identifiesdrop out as the main impact and orphanhood (thedeath of one or both parents) as the main cause. Inreality, AIDS-related educational disadvantage is farmore complex.

While the evidence does confirm that educationaldisadvantage is faced by children whose parents havedied, it is not known how much of this disadvantagetook place before the parent died (Boler and Carroll2004). Current knowledge certainly does suggest thatwhen parents die, the amount of resources availablefor education decreases, and hence, orphans aremore likely to drop out of school than non-orphans, as school fees and other education costs becomeunaffordable. There is a dearth of data, however, onthe educational problems faced by children whoseparents are ill with AIDS. It is also obvious thatparental death is not the only factor affecting how well a child does at school. Anecdotal evidence alsosuggests that AIDS-affected households often have to call on children to work, and that AIDS-relatedstigma in the classroom also causes children to drop out of school.

Furthermore, research and monitoring of AIDS impactsis often restricted to enrolment indicators. Althoughenrolment is important, it is obvious that it does notcapture all dimensions of educational disadvantage. Achild may be enrolled at school but not learningbecause she is hungry; or else not able to concentratebecause of anxiety at home, or missing classes tolook after her family. Beyond increasing enrolments,policies should aim to improve retention andcompletion rates and learning achievement amongorphans and vulnerable children (OVCs)1. Again, thisrequires tools to monitor, and measures to address,the ways in which the impact of HIV/AIDS on learning outcomes is mediated by factors such asgender, race, socio-economic status, physical ability or ethnicity.

The educational needs of children born with HIV havealso been widely ignored, possibly because they areseen as children without a future – and education isan investment for the future. This notion, alwaysdubious from an ethical standpoint, also looksincreasingly short-sighted with the increasingavailability of ARVs and the consequently risingnumber of HIV positive children who are now reaching adulthood.

In short, current research is not providing policy-makers with enough data to identify with any degreeof precision which children are at risk of becomingeducationally disadvantaged, when, why and how toreach them. Policy-makers also need more informationabout how intervening factors (such as gender,

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1 The term Orphans and Vulnerable Children, (OVC) has been coined inlight of the high number of children affected by the AIDS epidemic,and refers to the wide spectrum of children and young people whoare have been affected in one way or another by the AIDS epidemic.

KATE HOLT/EYEVINE/ACTIONAID


Consquences for Education OVCs Issues Education Response

• Low educational expectations of orphans

• Lower prioritisation of orphans’education over other children within the household

• Lack of homework support orhousehold encouragement of education

• Increase school-home liaison to work with familieson increasing support to education

• Create after-school homework clubs to provideadditional support to those without families

• Create mentor schemes in which vulnerable childrenhave a mentor to provide emotional and intellectualsupport to their studies

LACK OFFAMILY SUPPORT

• Low attention

• Absenteeism

• Difficulty in participating in certain school activities (e.g. sports)

• Take special consideration with respect ofeach school activity to ensure that less physicallyable children are included

• Train all staff in first aid

• Resource person within the school withknowledge of local healthcare providers

CHRONICILLNESS

• Drop out of education due to unaffordable schools fees

• Stigmatised because of inadequateuniform and learning materials

• Low attention span due to hunger

• Abolish school fees or provide bursaries for poorchildren

• School feeding schemes

• Change polices around uniforms and learningmaterials

POVERTY

• Social exclusion: marginalisation ofchildren affected by HIV/AIDS

• Negative learning environment

• Barriers to participation

• Create inclusive school policies and practices

• Eliminate discrimination in education and careservices

• Pressurise authorities to recognise rights and allocate funds

• Encourage all learners and educators to adoptinclusivity and zero tolerance towards discrimination

• Education of community and parents to combat AIDS-related stigma

• Low expectations of children

• Fear of infection by learners and educators

• Difficulties in adhering to ARVtreatments due to lack of understanding

• Train teachers and learners around infection, to reduce stigmatisation and ensure that necessarysafety precautions are available

• Foster policies, practices and cultures on inclusive education

HIV POSITIVE

Extract from ‘Addressing the Educational needs of Orphans and Vulnerable Children’, Boler and Carol, 2004)

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STIGMA

Spectrum of educational needs faced by orphans and vulnerable children

poverty, family size and family educationalbackground) influence the ways in which AIDS affects children.

It is clear that OVCs face multiple disadvantages intheir lives, which are reflected in their educationalneeds. One useful way to think about these needshas been developed by a group of academics anddevelopment workers in the UK, who identify themajor problems facing OVCs and the correspondingpolicy measures that could be considered (Boler andCarroll 2004).

SummaryThis section argued the case for why formal educationsystems must start thinking and acting upon AIDS.

HIV/AIDS has changed the demands on all educationsystems. There is an urgent need for policy-makers,administrators and head teachers to identify andunderstand the needs of infected and affectedlearners and educators, and to meet as many ofthese needs as they can with the resources that theycan mobilise. In addition, schools face an additionaland vital responsibility to teach all pupils about HIV.

However, it is far from clear that education systems are taking the epidemic seriously. The next chapterassesses the formal education sector response in the 18 countries studied, and attempts to draw somelessons for future policy-making and planning.

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ACTIONAID

18


2. National responses toHIV/AIDS and education

Programmatic responses by NGOs can broadly be splitinto two main categories. The first is providing HIV/AIDSeducation in schools and the second is providing adhoc care (including bursaries) for OVCs. Both theseapproaches have been problematic and their limitationsare discussed in this chapter.

2.1 Overall policy and planningMinistries of Education are responsible for theformulation, implementation and monitoring ofeducational policies. Any systematic response to theAIDS epidemic should be manifested in policy changes,with such changes guided by an overarching strategy.This section gives an overview of policies andstructures that have been created in response toHIV/AIDS.

Whether or not a Ministry of Education has an HIV/AIDSstrategic plan is a clear indicator of the response to theepidemic, and is one of the key indicators used in theGlobal Readiness Report. Civil society perspectivessuggest that in a number of Asian and Latin Americancountries, there has been no strategic response.

Of the African countries, many policies are still in draftform or have not resulted in significant policy change.However, in at least two African countries, strategicplans are clearly formulated and being implemented.

Generalising across regions, the policy response canbe categorized as a) zero policy response or b) a planbut no policy.

2.1.1 Zero policy response

Of the participating countries, the four countriesoutside of sub-Saharan Africa (India, Nepal, Boliviaand El Salvador) show many commonalities in theirlack of educational response, as demonstrated by theabsence of a strategic plan.

In trying to understand why there has been no officialstrategic or policy response in these countries, civilsociety representatives pointed to two key factors. Thefirst was that HIV/AIDS was perceived as theresponsibility of the Ministry of Health, and notpertaining to educators:

“Policies on HIV in mainstream education are still managed by theMinistry of Health from a specific health sector point of view.”Bolivian respondent

The second common thread, in these Asian and LatinAmerican countries, was the general perception thatHIV/AIDS was not a problem:

In only two of the 18 countries included in this action research did the Ministry ofEducation have a clearly formulated strategic plan on HIV/AIDS that was actuallybeing implemented, either as part of a wider sector plan, or as an add-on to such asector framework. In the remaining 16 countries, the MoE’s policy response can becharacterised as a) having no systematic planning at all, b) having plans thatexisted in draft form only, or c) plans that have been finalised but not yet translatedinto budgets and implementation. Section 2.1 of this chapter gives a more detailedassessment of country policies, and reviews some of the reasons for weak andineffective MoE responses to the epidemic.

“There is no policy or focal person for HIV/AIDS. This is because thegovernment doesn’t want to thinkabout AIDS, claiming it is not a problem.”Asian respondent

“There are no policies on HIV in theeducation sector because the populationat large still believes that thetransmission of HIV is restricted to “highrisk” groups”Bolivian respondent

Although these countries are facing a much smallerHIV/AIDS problem than their African counterparts, thisis also the time to act pre-emptively. Paramount topreventing an advanced AIDS epidemic is education –and thus, the lack of any guidance or polices onHIV/AIDS from the Ministries of Education is cause forconcern.

2.1.2 A plan but no policy change

In four of the African countries2, a strategic plan hasbeen drafted but not yet finalised. The process ofdrafting and adopting a strategic plan is arduous – inGhana the draft is still being revised after two years,and in Kenya the process has stalled while theCabinet considers the plan. Of the participatingcountries, Tanzania was the only country to havefinalised and started implementing its HIV/AIDSstrategic plan.

However, having a strategic plan in place does notnecessarily lead to policy changes:

“There is a strategy but in fact thegovernment is lagging behind and thepolicies are not yet in place.”Southern African respondent

Indeed, one of the criticisms from the majority ofcountries was that HIV/AIDS is treated as a stand-alone issue within the Ministry of Education. Therefore,the existence of a strategic plan was limited becauseHIV/AIDS was not mainstreamed into the overarchingeducational plans, such as Education for All or thepoverty reduction strategy processes. Without feeding

into mainstream educational policy changes, anHIV/AIDS strategic plan becomes redundant, andimpossible to implement.

This is not the case in all countries, for example, in Mali there are two national educational plans(PRODEC and EPT), and both of them addressHIV/AIDS.

2.1.3 Data collection

It is almost impossible to design effective policies andplans without adequate data. However, Ministries ofEducation have struggled to collect good qualityeducational data (Carr-Hill, Hopkins et al. 1999). Often,there is close to no capacity or resources at the districtor provincial level even to begin to collect the dataneeded for education indicators. Progress is worsewith respect to HIV/AIDS indicators: very few countriesreported any ministry-led research into HIV/AIDS andeducation. A couple of countries, Zimbabwe andKenya, reported collection of some data for HIV/AIDS-sensitive indicators (e.g. number of orphaned learnersor teacher mortality); but even in these cases, therewas concern that data for many possible indicatorswas not being collected.

In some countries, HIV/AIDS-related research hadbeen conducted by Ministries of Health, with littlefeedback to Ministries of Education (e.g. Mali andBolivia). In other countries, research had beenconducted by universities with little synthesis with – orimpact on – Ministries of Education. At the worst endof the scale, some countries (particularly the non-African countries) reported absolutely no data oneducation and HIV/AIDS.

2.2 HIV/AIDS-related structureswithin the Ministry of Education

2.2.1 HIV/AIDS units

As a way to encourage Ministries of Education to takemore responsibility for HIV/AIDS, the donor communityhas supported the creation of HIV/AIDS-relatedstructures within the ministry, and the employment ofa designated person to coordinate work on HIV/AIDS.

In most of the African countries, an HIV/AIDScoordinator is operating within the Ministry ofEducation. Their role is remarkably consistent acrossthe countries – perhaps reflecting the influence ofdonor models.

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2 Kenya, Zambia, Sudan and Ghana

20

The role of the HIV/AIDS coordinator includes the following:

• coordinating HIV/AIDS work between Ministries of Education and Health

• policy formulation and implementation ofschool-based HIV/AIDS education

• coordinating district-level responses

• facilitating funding.

In some of the countries, there was concern that theHIV/AIDS unit (or coordinator) was initiated and whollyfunded by donors, thus leading to sustainabilityproblems. The following quotation clearly demonstratesthis point:

“Funding of the focal person in many casesrelies on donors and this means thatwhen restructuring occurs again, the focalperson is left out of the planning processand unsure of what role they should play.”West African respondent

Civil society organisations also felt one reason thatHIV/AIDS units tended to be ineffective was that theywere perceived as ‘donor-driven, leading to a lack ofownership and political clout within the Ministry.However, the HIV/AIDS-unit model seems to suffer fromother structural weaknesses as well (see Box 3). In several countries, there is more than one HIV/AIDSunit within the Ministry (e.g. Mali and Zambia). In ElSalvador, HIV/AIDS has been subsumed by the‘Education for Life’ unit. However, in the majority ofcases, the HIV/AIDS unit consists of one individual,taking responsibility for all HIV/AIDS work. Having onedesignated individual taking responsibility for HIV/AIDSmay hinder effective mainstreaming of HIV/AIDS byrelieving other senior leaders and other departments oftheir responsibility to respond to the epidemic:

“The primary phase was not reviewed andno further action has evolved whilst theAIDS coordinating unit within the Ministryof Education tended to operate more andmore in isolation and ended up becominga stand-alone project within the Ministry”.East African respondent

2.2.2 Lack of effective decentralisation

Another problem faced by national HIV/AIDScoordinators is that, in most cases, the response hasnot been adequately decentralised. For instance inKenya, civil society representatives were concernedthat there was only one person working on HIV/AIDSat the national level, with no structures or support atprovisional or district levels. In contrast, both Ghanaand Zambia have made impressive progress inproviding provincial, district and school level HIV/AIDSfocal persons, although sustainability and resource


Box 3 Common problems faced byHIV/AIDS unit/coordinater

• Understaffed

• Not in control of their own budget

• No specific infrastructure

• No provincial, district or school structures

• Not integrated within the Ministry of Education

• HIV perceived as responsibility of coordinator, andnot of all Ministry employees

• HIV strategic plans and activities are isolatedactivities rather than mainstreamed

• Difficulties in working with other Ministries (e.g. logistical or ownership)

• Dependent on personality and motivation ofspecific individuals

LIBA TAYLOR/ACTIONAID

problems in Zambia have led the government toconsider HIV/AIDS committees rather than focalpersons at the district level.

Decentralisation is not, however, a magic bulletsolution, and can create structural problems of its own,as the India case illustrates. Responsibility foreducation is shared between India’s many states andits central government, so it is essential to establishstate and district level structures to implementHIV/AIDS programmes in schools. However, centralgovernment has limited power to ensure that itsguidelines and programmes are actually implemented.The challenges are even greater when responsibilityfor implementation is shared between more than oneministry or department.

2.3 HIV/AIDS education in the classroom

Creating HIV/AIDS curriculum is the intervention thathas received the most universal support fromMinistries of Education and from donors. Of the 18

participating countries, 16 reported having developedan HIV/AIDS curriculum (Sudan and Zimbabwe beingthe exceptions). However, the level of implementationwas far lower, with only two of the countries reportingthat an AIDS curriculum was being fully implementedin the majority of schools country-wide.

In a further three countries, according to interviewswith stakeholders, HIV/AIDS modules had beenimplemented into the curriculum in certain districts,with plans to scale-up to all districts in due course(e.g. Mali, Tanzania). The rationale for introducing thecurriculum incrementally is to ensure that teachers aretrained adequately before expecting them to teachnew curriculum. By contrast, in Kenya the approachhas been to get HIV/AIDS education out to as manyschools as possible, with training to follow.

In countries such as Bolivia and El Salvador, wherethere is no nationally endorsed HIV/AIDS curriculum,some district education authorities and schools havetaken the initiative to teach HIV/AIDS (see section 3.1).

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Box 4 India, decentralisation and HIV/AIDS education

The National Coalition for Education (NCE)interviewed a number of national and state leveleducation officials to find out how state and national level politics interact. NCE found that atthe national level, a huge amount of effort has beeninvested in HIV/AIDS curriculum and trainingpackages. Admirably, these efforts have involvedclose partnership between the health and education bodies.

While responsibility for implementing the HIV/AIDScurriculum rested with state level AIDS structures,situated within the health department, it was thestate level education departments that ultimatelydecided whether or not to use the materials in theirschools. The result was that only the minority ofstates that already have well-developed epidemics(Maharashtra, Tamil Nadu, Karnataka and AndhraPradesh) decided to use the materials.

In the remaining states, officials did not cite anyspecific objections to the HIV/AIDS curriculum;

rather, they evidently assumed that HIV/AIDSeducation is an unnecessary bother as long as theprevalence rate is low. In fact, of course, the oppositeis true: prevention and education efforts are cruciallyimportant in the earliest stages of an AIDS epidemic,when it is still possible to “nip it in the bud”. Lack ofunderstanding of this vital fact suggests that state-level education officials have not received muchinformation or training about HIV/AIDS.

A decentralised system also presents challenges forcivil society advocacy. The NCE wants every child,regardless of where in India she or he lives, to havethe right to learn about HIV/AIDS. One option thatNCE has explored is to take the government to courtin order to make HIV/AIDS legally required learning inall schools in India. However, the NCE hopes that byworking more closely with state departments ofeducation, sensitising them to the importance ofearly prevention, civil society will be able to increasethe implementation rate more quickly and effectivelythan through a court case.

22

Although many schools are still not implementingHIV/AIDS education, the government’s attempts atproviding HIV/AIDS education for all arecommendable.

In exploring the reasons for this large-scaleimplementation failure, we found five common factors:

• poor design and failure to include key stakeholders(including teachers themselves) in the designprocess

• failure to integrate HIV/AIDS curriculum into thecompulsory and examinable general curriculum

• inadequate training of teachers

• lack of appropriate, local-language learningmaterials, especially in rural areas.

2.3.1 HIV/AIDS curriculum design

HIV/AIDS curriculum can be categorised as takingeither a scientific approach or a life-skills approach.Within the scientific approach (e.g. India), students aretaught about HIV in science lessons such as biology,and are taught about the structure of the virus –usually without any discussion of sexual relations orsexual attitudes (Smith, Kippax et al. 2000; Bennell,Hyde et al. 2002; Boler, Adoss et al. 2003). On theone hand, this can be seen as an advantage, giventhat in many societies formidable cultural and religious

barriers make it next to impossible for teachers todiscuss sex in the classroom unless they receive extratraining and support. However, since sexualtransmission of HIV is the main cause of infectionaround the world, prevention education that ignoressex is certainly of limited use. Moreover, many expertsfeel that the scientific approach serves to‘dehumanise’ HIV, making it difficult for students toconnect with HIV as a real human issue that couldaffect them (Boler, Adoss et al. 2003).

The life-skills approach (typified by Kenya and Zambia,among the countries in our study) is based on theassumption that young people are somehow ‘lacking’certain skills to prevent HIV, which they can be taught.However, such skills-based lessons are difficult toimplement in the classroom because teachers aresuddenly expected to teach in an “interactive” and“participatory” ways without adequate training andsupport (Boler and Aggleton, 2005).

In addition, if life-skills programmes are designedwithout first-hand involvement of teachers, childrenand community members, they tend to be heavilyinfluenced by the middle-class and the somewhat‘westernised’ values of NGO workers, educationconsultants and ministry bureaucrats. For example, the notion that individuals can take control andchange their lives, often central to life-skills


Box 5 Tanzania’s attempts to introduce school-based HIV/AIDS education

In 2002, the Ministry of Education and Culture(MOEC) developed the school-based HIV/AIDSeducation programme. A holistic approach has been taken with four components:

1 life skills

2 school guardians – counselling to pupils on growing up, sexual reproductive health etc

3 peer education – peer educators trained in each class

4 school counselling and educationcommittee – a sub-committee of school board

In terms of implementation, the MOEC is still tryingto incorporate this program into carrier subjects.Some components are taken as curriculum subjectsand others as extra-curricular.

Preliminary analysis suggests that in 2004, thisprogramme was being implemented in 45 districts,reaching 7% of primary school pupils, 30%secondary and 50% of teacher training colleges. Inaddition, 12% of primary school teachers, 20%secondary school teachers and 25% of tutors inteachers colleges3 had been trained.

3 These figures were given by government officials as part of theGCE project.

programmes, may seem at best irrelevant to a youngperson growing up in an impoverished communitywhere the ties of tradition, kinship and socialinterdependence are crucial to survival. At worst, thestrong emphasis placed on individual responsibilityand self-reliance may worsen children’s feelings offailure and inadequacy.

With the exception of India, all countries with anHIV/AIDS curriculum had curriculum designed for bothprimary and secondary schools. In many cases,Ministries of Education appear to have receivedsubstantial technical support from UNICEF andUNESCO in developing such curriculum. Mali offers agood example of a multisectoral response: theHIV/AIDS curriculum was designed jointly by theMinistry of Education and Ministry of Health. In somecountries, civil society input was also sought incurriculum design (see 3.2).

2.3.2 Integration of HIV/AIDS curriculumwithin the general curriculum

Only two of the countries with an HIV/AIDS curriculumhad made these lessons a compulsory part of thegeneral school syllabus. For example, the KenyanInstitute of Education had inserted a weeklycompulsory HIV/AIDS lesson into all primary andsecondary state curricula. In the two Latin Americancountries, curriculum was designed and piloted, butno further action has been taken by the Ministry ofEducation to integrate the HIV/AIDS curriculum intothe general curriculum.

Some civil society representatives expressed concernthat ministries had produced very comprehensive (andglossy) guidelines for HIV/AIDS curriculum, but nofurther progress was evident. In other words, theHIV/AIDS curriculum was not integrated into thecompulsory general curriculum, either through carriersubjects or as an examinable subject in its own right.The result is that it was being left up to schools todecide whether or not follow the HIV/AIDS curriculum,leaving HIV/AIDS at the margins of the curriculum or

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Box 6 Building upon existing population education initiatives

In reviewing Ministry of Education policies, the IndianNational Coalition for Education found that there wasmost success in inserting HIV/AIDS into thecurriculum when it was not viewed as a stand-aloneissue, but complemented other issues. For instance,before the AIDS epidemic existed, there was alreadya push in India for stabilizing population growth,through the ‘National Population Education Project’.

HIV and AIDS are linked to population control – bothare the consequences of sexual and reproductivebehaviour. Many of the messages used for familyplanning are also relevant for HIV/AIDS education.The complementarity of these two issues has oftenbeen under-utilised because they frequently aretreated as separate spheres of responsibility.

In India, the body responsible for producingcurriculum guidelines (NCERT) used the packagethey had devised for the population health project,and included HIV/AIDS components. In this way,HIV/AIDS was treated in a holistic manner, in the

context of adolescence education. Because theHIV/AIDS curriculum built upon existing momentumfor adolescence education, it facilitated the insertionof HIV/AIDS into curricula: about 10,000 schools arecurrently implementing the program in over 350districts. In comparison, only 2,700 schools areimplementing the stand-alone HIV/AIDS curriculumin four states.

Adapting existing curriculum and programmes toinclude HIV/AIDS also counteracts the criticism thatmost school curricula are already over-burdened. As one Indian government official poetically stated:

“If you have a full glass of water, youcannot add any more water to it. But youcan add more salt, sugar and colour intothe glass. In the same way, no moreextra curriculum should be added toschool education, but existing subjectscan be modified to add in HIV/AIDS.”

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restricted to extra-curricular subjects. One respondentsuggested that the cause of the problem was thatHIV/AIDS curriculum was not part of the generalcurriculum review processes.

School curricula are already over-burdened in mostof the countries in this study (Smith, Kippax et al.2000, Kinsman 1999). With increasing pressure onteachers to meet certain learning targets, it isunderstandable why a subject such as HIV/AIDS,when neither examinable nor compulsory, is left atthe margins of curriculum.

One response to counteract this problem is to insertHIV/AIDS into carrier subjects such as economics or mathematics. In addition, there is great potential to build on existing and related initiatives such aspopulation education initiatives – something whichGhana, Mali and India have attempted to do. Thepotential advantages of building upon existingpopulation initiatives are detailed in the case study on page 23.

2.3.3 Teacher training

Teachers are the fulcrum upon which the success ofschool-based HIV/AIDS education depends. Theirimportance cannot be over-emphasised. Yet it is clear

that not enough priority has been given to investing inteachers as AIDS educators. In only three of the 18countries had Ministries of Education made systematicattempts to train teachers on HIV/AIDS. This figure isabysmal. Common sense suggests, and researchconfirms, that talking to young people about sensitivesubjects such as sex, death and disease is verydifficult, and teachers face myriad cultural andreligious challenges (Kinsman 1999; Malambo 2000).

The WHO has stipulated that teachers “should bewilling and interested in teaching about HIV/AIDS/STIs;have sufficient and appropriate knowledge aboutHIV/AIDS/STIs; be accepted by the school staff, thecommunity, and the pupils; be able to maintainconfidentiality and objectivity; be familiar with and atease when using sexual terminology and discussingsexual issues; be respectful of students’ and familyvalues; be an effective communicator and facilitator ofclassroom learning; and be accessible to pupils andparents for discussion.” To the Zambian NationalEducation Campaign (ZANEC), these expectations areunrealistic: “The desired characteristics of theeducators are very challenging and demanding forany context or country, but especially for countriesthat are poor and struggling to survive – like Zambia.”


4 References 1 and 2, Siamwiza and Chiwela, 19995 References 3 and 4, Ndutai (1997)


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Box 7 Zambia: A paradigm shift in HIV/AIDS education needed

Concerned about the role of teachers and how ill-prepared they are to take on HIV/AIDS, ZANECcarried out a review to synthesise findings fromavailable research on this topic. Some interestinginsights included:

• 30% of Zambian teachers thought that teachingabout HIV/AIDS would lead to promiscuity

• Zambian teachers who had received some training on HIV/AIDS education did not feel moreconfident to teach about this issue than thosewithout any training4

• of 13 organisations working on HIV/AIDSprevention, only one explicitly aimed to influencesexual behaviour, highlighting the resistance todiscussing the sexual transmission of HIV

• only about 30% of HIV/AIDS educationprogrammes were regularly monitored.5

Following the literature review, ZANEC conductedfocus group discussions with teachers and students in four schools and one teacher training college to find out their perspectives on the role of teachers inthe epidemic.

The discussions suggested that the followingproblems exist:

• HIV/AIDS is the individual teacher’sresponsibility Although many schools have been teaching about HIV/AIDS since the early1990s, there is not much of a formal structure,and it is often left up to the teachers to developtheir own initiatives. Given that the literaturesuggests many teachers are uncomfortable withintroducing discussion of HIV/AIDS in theclassroom, leaving HIV/AIDS education to theresponsibility of individual teachers cannot work.

• HIV/AIDS is treated as a scientific issueTeachers said they preferred to teach aboutHIV/AIDS during science lessons as it was easierto focus on the aspects of transmission of thevirus rather than on the activities or contextleading to that transmission. It is understandablewhy discussing HIV within a scientific frameworkis a less awkward option, but with evidence thatover half of 15-19 year olds in Zambia are sexuallyactive, avoiding discussion of sex, sexuality oremotions is seriously misguided.

• Selective teaching about HIV/AIDSTeachers said that with younger children theytalked about infection in terms of razor blades andsharing needles: this is problematic as itdisguises the reality of HIV – how many peopleactually get HIV from sharing razor blades? Why isthis message the most relevant message to giveto a seven-year-old? Rather than being helpful,messages such as these may confuse youngchildren who think they can get HIV from sharingobjects with other people – which in turn, is likelyto increase stigmatisation of people living with thevirus.

• Content of the curriculum The current,fashionable approach of training students in‘communication skills’ and ‘assertiveness’ isoverly general. Instead, specific skills to managethe situation of risk of HIV infection must be built.This will include frank discussion of issues suchas condoms, oral sex, heterosexual andhomosexual (i.e. vaginal, oral and anal)intercourse.

“Given the current reality for teachers,this is unrealistic – many teachersthemselves do not possess these skillsor knowledge,” ZANEC acknowledged.“However, if sufficient resources were tobe allocated towards educating oureducators, it becomes a possibility.”

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As mentioned earlier, three of the participatingcountries, Zimbabwe, Ghana and Zambia, have madeadmirable attempts at nationwide teacher training. InZimbabwe, HIV/AIDS education has been madecompulsory in the Teacher Training Colleges. However,one respondent commented:

“The programme is not examined likeother teaching courses so the studentstend to take it causally. There also isn’tany material for the trainee teachers to use.”Zimbabwean respondent

There were also complaints about the lack of trainingmaterials for teachers in Mali and Sudan.

In Ghana, the focus within HIV/AIDS education is verymuch on teacher training, with a large amount offunding secured through World Bank partnership.Unlike Zimbabwe, pre-service teacher training includesHIV/AIDS as a core and examinable course.

In Zambia, the focus has been more on in-serviceteacher training, although certain individual teachingcolleges do offer HIV as part of pre-service training.The government has set aside $120, 000 towardsteacher training and estimate that the followingnumbers of teachers have already been trained:

• 10,000 in HIV/AIDS

• 2,600 in interactive methodologies (for HIV prevention)

• 3,000 in life skills6

In-service training in Zambia has led to teachers beingsent back to colleges during their holidays and termtime – sometimes to their, and the children’sresentment:

“Teachers are actively campaigning about training because there is so much of it and it is taking teachers away from schools.”Zambian respondent

Apart from these three ‘success stories’, the othercountries appear to have only taken on teachertraining on HIV/AIDS in a piecemeal fashion. As onerespondent commented:

“Teacher training has been minimal. Veryfew teachers have been trained in just acouple of districts, with limited fundingfrom government.”East African respondent

Moreover, what little training does exist is sometimesperceived as being inadequate. For example, in Sudanthere were complaints that the training did not includeany discussion of the sexual transmission of HIV.If school-based HIV/AIDS education continues to beimplemented in the same under-resourced, under-staffed and under-trained way, then not only will it notwork, it may even serve to confuse young peopleabout the reality of HIV and AIDS. Good qualityHIV/AIDS education is intrinsically reliant on aneducation system which delivers good qualityeducation. The linkages are apparent: the samechallenges and recommendations apply to successfulHIV/AIDS education as to quality education in general.

2.3.4 Learning materials

Across all countries there was consensus that therewas an urgent need for more learning materials onHIV/AIDS. In Bolivia and El Salvador, there are noofficially endorsed or distributed learning materials atall. On the positive side, learning materials do exist inthe vast majority of countries. Perceptions of thequality of these materials vary: in Ghana and Zambia,these materials are viewed as being very good andcountry-specific. Whereas in Mali, there was concernthat the materials had not been adapted sufficiently tolocal cultures.

Apart from the overriding conclusion that there werenot enough learning materials, the following issueswere also of concern:

• language of instruction – for example, in Zambiathere are 72 local dialects but learning materials are exclusively in English

• focus on urban areas – it was noted that ruralareas are particularly lacking in learning materials


6 these numbers were given by MoE representatives

• materials are too ‘glossy’ – because mostHIV/AIDS learning materials have been funded byinternational donors, the resulting materials are oftenof a much higher standard of quality than normallearning materials. Some respondents suggestedthat schools were hiding the ‘glossy’ HIV/AIDSlearning materials away because they did not wantstudents to ruin them.

2.4 Response to orphans andvulnerable children

There was overwhelming consensus from civil societyrepresentatives that Ministries of Education were notdoing enough to respond to the needs of orphans andvulnerable children (OVCs). In 17 of the studycountries, there were no national policies orprogrammes aimed at this group of children.

In several of the participating countries, OVCs wereseen as the responsibility of other governmentdepartments (such as social welfare) rather thanMinistries of Education.

“The Ministry of Education should betaking more responsibility and not relyingon the Ministry of Health to look after theorphans. A the moment, the Ministry ofEducation doesn’t know anything aboutthe children who are suffering and whythey are suffering.”West African respondent

In the Latin American countries, there was the feelingthat government believed the OVC issue had norelevance to their country, either now or in future. Thiswas of concern to civil society representatives whourged the government to act more pre-emptively.

Obviously, the needs of OVCs go beyond formalschooling, and it is positive that other Ministries areresponding. However, that does not relieve Ministriesof Education of their responsibility to ensure that OVCsenrol in and complete at least a basic education.Ideally, Ministries of Education should be working withother Ministries to provide an integrated and holisticresponse to the OVC crisis. Unfortunately, there is nocurrent evidence of such collaboration.

2.4.1 Bursaries and school fees

Poverty is the main reason that AIDS orphans aredropping out of school (Ainsworth and Fimer 2002;Badcock-Walters 2002; Bicego, Rutstein et al. 2003;Booysen Fle and Arntz 2003; Case, Paxman et al.2003). School fees and associated school costsexacerbate the problem – not just for orphans but formillions of children. Some countries respond to thisproblem by setting up targeted waiver programmessuch as school bursaries. However, where infrastructureis poor, setting up such schemes is often prohibitivelyexpensive and most importantly, will never realiseEducation for All goals.

Two of the 18 countries – Zambia and Zimbabwe –have government programmes that allocate bursaries to cover the school fees of OVCs. Both Tanzania andKenya have recently abolished tuition fees outright,although parents and carers are still expected to coverother costs such as uniforms, books and meals.

In Zimbabwe, the bursary programme is called the Basiceducation assistance module (BEAM) and the money is allocated directly to schools. However, BEAM is aninitiative of the Ministry of Public Services, Labour andsocial Welfare. In the countries where the governmentis giving out bursaries for OVCs, respondents criticisedthe schemes for being under-resourced, and forexcluding school uniforms – a cause for schoolexclusion in Zambia.

In the remaining countries there were no systematicattempts to make school more affordable for OVCs. Insome countries, district level departments had taken the initiative to respond: for example, in the Far Westernprovince of Nepal, where HIV prevalence is relativelyhigh, local education offices are providing scholarships,food and uniforms to HIV-affected children. However,such approaches are piecemeal and measures need to be taken to scale-up the response.

2.4.2 Counselling services

If they are to complete an education, OVCs havepsycho-social as well as financial needs that mustbe addressed. In Ghana and Sudan, schools alreadyprovide counselling services for vulnerable children.Respondents highlighted the untapped potential inadapting these existing counselling services to meetthe needs of OVCs. For example, in Sudan each schoolhas a parent teacher committee, whose role it is toidentify poor children for counselling services – thesecommittees could be trained or encouraged to identify the needs of OVCs.

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Counsellors may need specialised training to deal with the AIDS crisis (e.g. bereavement/ stigma etc.).However, respondents also warned of the potentiallystigmatising effect of having specific HIV/AIDScounsellors. Indeed, some questioned whether or notthe needs of an OVC are any different to those of anypoor and vulnerable child.

Piecemeal attempts have also been made byincluding counselling services to OVCs in anti-AIDSclubs (for example, in Mali). However, these clubswere criticised as being limited, unprofessional andunder-funded.

2.4.3 HIV positive children

HIV/AIDS strategic plans in Ministries of Education dostate the rights to education of HIV positive children,yet none of the Ministries of Education has progressedbeyond writing strategies – as demonstrated by thelack of programmatic response for HIV positivechildren. Indeed, some Ministries of Education appearto shy away from the issue:

“The Ministry of Education is doingnothing. OVCs are stigmatised anddiscriminated against. Early in 2004, HIVpositive children from Nymbain homewere denied access to primary school.The case was taken to court and thecourt ordered them to be enrolled. TheMinistry of Education did little tointervene”.Kenyan respondent

It is worrying that, in so many cases, Ministries ofEducation have remained silent on the issue of HIVpositive students. Perhaps, these children were easyto ignore because they were seen as children withouta future – and education is an investment in thefuture. But with the increasing availability of ARVs, thisargument is redundant and governments must fulfiltheir obligations of Education for All.

As part of the GCE project, Bolivian civil society groupsdebated the issue of HIV positive children. Somerespondents felt that children with HIV should betreated the same as other students, while other

participants felt they deserved special attention – suchas counselling services. In the end they agreed tocampaign to “support children and adolescents livingwith HIV, not because they are sick but because theirsituation requires more attention”. A second polemicrested around the conflicting rights of HIV positivechildren to confidentiality, and the right of parents andteachers to know.

Fundamentally, these issues are ethical ones, andneed to be resolved by Ministries of Education, whoseresponsibility it is to offer guidance to schools on suchmatters. In addition to clearly defining the rights of HIVpositive children, a holistic approach should alsoinclude education aimed at breaking stigma anddiscrimination.

2.5 Responses to HIV-infected and affected teachers

As discussed above, Ministries of Education shouldalso be responding to the impact of the AIDSepidemic on their teaching staff. Possible interventionsinclude workplace policies, voluntary counselling andtesting services (VCT), access to treatment, andsetting up early-warning signals for monitoringpurposes (Badcock-Walters, Heard et al. 2002)

Of the 18 participating countries, only one – Zambia –has launched a significant response to a potential oractual problem. In low-prevalence countries –including African ones – the sentiment was thatHIV/AIDS was not going to be a big enough problemto warrant action for teachers.

In Zambia, the Ministry of Education had identified thelooming problem of AIDS-related teacher shortages,and had taken a number of steps. First, there is apolicy of non-discrimination – the Ministry has justappointed an HIV/AIDS in the workplace technicaladviser. In addition, the HIV component of in-servicetraining includes VCT services, and teachers areencouraged to be tested and seek help. Unfortunately,not many teachers have disclosed their HIV status –partly through fear of a lack of confidentiality, andpartly because a previous lack of treatment meantthere were few benefits even if they did test ordisclose. This situation is likely to change in the nearfuture with a new government roll out of anti-retrovirals, which, while not targeting teachersspecifically, should soon be available to an increasingnumber of HIV positive people.


Finally, in an attempt to train more teachers to replacethose lost to AIDS, the MoE reduced the time it took totrain teachers from three years to two years.Unfortunately, however, this step was based on asignificant over-estimate of AIDS-related attrition.Together with IMF-advised limitations on teacher wagebills and donor reluctance to fund salary costs, thiscontributed to the creation in 2002-2004 a pool ofseveral thousand training college graduates whocould not be employed. This predicament highlights a)the importance of striving towards accurate data andb) some of the difficulties in making projections aboutthe future. Nevertheless, the Zambian Ministry ofEducation should be congratulated for moving quicklyto guarantee teacher supply.

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3.1 Civil society responses to OVCs

Children who have been infected or affected byHIV/AIDS face a number of different problems (seesection 1.3). A well-designed response should also bemulti-faceted and not just be educationally driven. NGOsfocusing on OVCs often work in both the communityand in the school. Linking the two is positive as itrecognises that a student is, first and foremost, a personin a family and community. However, it makes definingthe ‘educational response’ problematic because manyNGO programmatic responses to OVCs may not beeducational yet may indirectly affect education.

For example, one of the most common responses tofamilies affected by AIDS is for NGOs to provide home-based care (HBC). Although it hasn’t been shownempirically, it seems a logical conclusion that effectiveHBC will relieve the burden of care on the household,and children who were out of school caring for theirparents should be able to return to formal education.

Similarly HIV/AIDS awareness raising efforts in thecommunity could (if they were effective in reducingstigma and discrimination) improve the psychologicalwellbeing of OVCs, which in turn, should improve theireducational outcomes.

There are many other community-based HIV/AIDSinterventions that will indirectly benefit the education ofOVCs. For example, provision of ARVs should,theoretically, improve the health of parents, allowingthem to return to work and relieve the economic andcaring burden on children, thus improving theireducational outcomes.

Similarly, education interventions that are not specificallyaimed at OVCs are also likely to benefit OVCs. Itbecomes an issue of targeting – for example, manyNGOs target ‘poor’ children for educational support. Asorphans are, on the whole, poorer than non-orphans,socio-economic targeting will also encompass themajority of OVCs (Ainsworth and Filmer 2002). Indeed,some researchers argue that targeting for OVCs shouldnot be based on orphan status but simply on poverty, toavoid unintended stigmatisation of beneficiaries.

3.1.1 School bursaries

In the GCE project, we asked respondents to limitthemselves to discussing educational responsesrather than the broader spectrum of HIV/AIDSinterventions. Across the 18 countries many NGOsseemed to be involved in providing material supportintended to help OVCs stay in school, in the form ofschool bursaries and occasionally food aid.

These programmes were started in response toconcern that orphans were dropping out of school.However, although this type of relief does helpstudents in the short term, there are a number ofshortfalls that inherently limit its scope. First andforemost, it is not an approach that can ever reach allthe children in need, and therefore, large groups ofchildren will continue to be denied their right toeducation. So how do – or should – NGOs choosewhich orphans to help?

Second, it is worth remembering that free anduniversal primary education in Tanzania, Kenya andother countries was introduced in response tooverwhelming popular demand and systematicadvocacy by civil society, the combination of whichmade abolition of fees a political issue. When NGOspay school fees for individual children, they mayinadvertently attenuate such popular pressure. Theymay even undermine wider civil society efforts tolobby and campaign for the abolition of fees. Althoughthe motivations underlying bursary programmes arebenevolent, bursaries should only be seen as anemergency temporary response, as they cannotaddress the root of the problem: unaffordable schoolfees and the lack of a firmly entrenched legal right tofree education.

Nevertheless, the paying of school fees remainsNGOs’ main educational response to OVCs. Apartfrom the problems of coverage and sustainability,respondents also complained that paying school feesperhaps alleviated the material needs of OVCs butfailed to respond to their psycho-social needs.

3. Civil society responses to HIV/AIDS and education

3.1.2 Specialist schools

Apart from bursaries, respondents reported a numberof other interventions aimed specifically at OVCs. Insome African countries, NGOs had set up specialcommunity schools for OVCs. Some of the best ofthese programmes offered a holistic response to theeducational needs of OVCs by providing counselling,ARVs, food schemes, vocational training, parentalliaison, accelerated programmes and most importantly,eventual entry back into the mainstream educationsystem. It is difficult to imagine a governmentresponse which is so multifaceted because it wouldinvolve the coordination of many different ministries.This is clearly one comparative advantage of civilsociety participation as it is better situated to respondmultisectorally.

The three key criticisms leveraged at this response are that first, NGOs are relieving government of theirresponsibility to deliver free, basic education, andsetting up parallel systems. Second, removing OVCs –and as a result, isolating them – from mainstreameducation can, in itself, be stigmatising and theireducation could be seen as inferior to mainstreameducation. Third, specialist schools will neveraccommodate all children and are unsustainable inthe long term. The advantage of such approaches isthat they can respond to specific needs of OVCs,which most mainstream schools do not. However,rather than the creation of more specialist schools,Ministries of Education should instead replicate and scale-up innovative approaches to OVCs fromspecialist schools, feeding them into mainstreameducation.

3.1.3 Other educational responses

Across countries, NGOs had responded to theeducational needs of OVCs in a variety of otherinnovative ways. Some of these included:

• mobilising teachers – in Sudan, teacher unions haveset up a ‘therapeutic solidarity fund’, into whichunion members donate money to support theorphans. In addition, they are encouraged to identifyaffected children, and offer additional psychologicalsupport. Similar programmes are also in place in ElSalvador.

• educational rights of HIV positive children – in Indiaand Kenya, NGOs have been involved in fighting forthe rights of HIV positive students who have beendenied access to schools.

• treatment for HIV positive children – in Mali, NGOshave started ‘listening centres’ outside schools,where they offer counselling and treatment to HIVpositive children. Similarly, in Sudan and El Salvador,NGOs are offering treatment to infected students.

• institutional homes for orphans – in many of theAfrican countries, NGOs had set up orphanages tolook after abandoned orphans. As well as offering ahome to the children, these institutions often includea school. However, the specialist schools suffer fromthe same problems mentioned above.

3.2 The role of NGOs in HIVAIDS education

“Teachers do not have the necessarybasic knowledge to conduct HIV/AIDSeducation. Consequently, civil societyorganisations are called upon to teachHIV/AIDS classes.”El Salvadorian respondent

Without a doubt, civil society organisations were the first to respond to the AIDS epidemic. Much effort has gone into prevention campaigns – withschools viewed as being at the forefront of anyintervention. Frustrated at the slowness in thegovernment response, thousands of NGOs havepersuaded schools in their communities to introduceHIV/AIDS education.

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The motivations behind such interventions arecertainly benevolent. However, such a programmaticresponse has inadvertently created unfortunateconsequences. Respondents across the countriesbemoaned the lack of coordination – with the resultthat some schools received no HIV/AIDS education,while others were the target of too many interventions.In the latter case, multiple messages from differentNGOs can only serve to confuse young people (Boler,Adoss et al. 2003).

In addition to the lack of coordination, two other majorcriticisms were directed at such responses. The firstwas that even in the schools that are reached, not allstudents will be reached. In many of the countries, itwas reported that NGOs mostly visit schools aboutonce a month, reaching only a minority of students.Although these organisations are well placed toprovide alternative and creative forms of HIV/AIDSeducation (drama groups and debates were verypopular), the approach is undermined by the sheerlack of sustainability.

The second area of criticism was that many of theNGOs working in the community were faith-based,and hence, the discourse around HIV/AIDS became areligious one. The result is that many programmes areabstinence-only, either ignoring the issue of condomsor condemning them.

“AIDS is a religious problem. We need topreach the message of abstinence aswidely as possible.”West African respondent

“Civil society, particularly faith-basedorganisations, has been opposed to theHIV/AIDS curriculum. They fear that thecurriculum is yet another sex educationprogramme and they associate it withincreasing immorality.”East African respondent


Box 8 Obstacles to school-based HIV/AIDS education

There are a number of factors which need to betaken into consideration when introducing school-based HIV/AIDS education. The following listdemonstrates a range of issues. Certain issues are only relevant to particular countries.

• Parental resistance (Sudan)

• Taboos, lack of interest, embarrassment, and lackof funds (India, El Salvador)

• School policies on pregnancy (Mali)

• Religion – “the Catholic and Evangelical churches strongly opposeany discussion on HIV/AIDS and havea strong influence over the Ministry of Education”. Latin American respondent

• Lack of options for young people – “theMinistry’s policy is abstinence andteachers are not allowed to talk aboutcondoms to students”.Southern African respondent

• myths, prejudices, opposition from conservativegroups, abstinence and fidelity-only programmes(El Salvador)

• in Nepal, the following perceptions were seen as hindering efforts in the classroom:

• young people should not be taught about sex

• girls who know about HIV/AIDS are ‘fast’

• girls should not know about sex

• nepal is so different to other countries thatAIDS will not be a problem

• our culture will protect us from HIV.

There is increasing scientific evidence thatabstinence-only programmes do not work, and that giving young people choices, does not increasesexual activity (Waxman, 2004, Human RIghts Watch,2005). Coupled with the evidence that many youngpeople are sexually active, precluding discussionabout condoms is inherently limited. In fact,abstinence-only programmes only serve to makethose young people already sexually active feelashamed about their ‘immorality’ and less likely toseek advice and help when needed, whereas itseffect on not-yet sexually active young people remains doubtful.

In addition to directly providing school-based HIV/AIDSeducation, respondents reported key programmes inthe following areas:

• production of learning materials especially for privateand community schools (e.g. Zambia, Bolivia andMali)

• HIV/AIDS training for teachers (Bolivia)

• HIV/AIDS training in Teacher Training Colleges(Ghana)

• training of peer educators (El Salvador)

• education campaigns (not school-based)

• work with teachers as positive role models (Mali)

This list offers a glimpse of the type of interventionsbeing conducted, but it is far from exhaustive.

These programmes are mostly based at thecommunity level – more systematic and nationwideresponses are mostly carried out in partnership withthe Ministry of Education and are described in 4.2

3.3 Civil society responses to theimpact of AIDS on teachers

Compared to the abundance of projects focussing on OVCs or school-based HIV/AIDS education, NGOshave been much slower to target infected and affectedteachers. Of course, as with OVCs, there are manyHIV/AIDS interventions that benefit teachers but do nottarget teachers specifically. This paper will only focuson those interventions targeting teachers directly.

With the important exception of the teachers’ unions,NGOs are doing very little to respond to the impact ofAIDS on teachers. The programmes which are runningsuffer from being small and piecemeal. Moreover, inlow-prevalence countries, there was the overridingsentiment that this issue was only relevant to high-prevalence countries.

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Box 9 The role of Teacher Unions (extract fromEl document “Partnership in Health Education”)

In 1989 Jonathan Mann, the first head of WHO'sGlobal Programme on AIDS, addressed the WorldCongress of the IFFTU, one of the predecessors ofEducation International (EI). Before hundreds ofteacher leaders from all over the world, Mr Mannspoke on the impact of HIV/AIDS and mapped outwhat was to be expected in the coming decade.Despite their interest, many teacher trade unionistswondered whether the words of warning spoken byMr Mann really should be directed to them. Shouldhe not be giving his presentation at a congress ofmedical doctors?

Fifteen years later, not one EI-affiliated teachers’organisation doubts that teachers should beinvolved in the fight against the HIV/AIDSpandemic. All are fully aware that teachers can andmust play a crucial role in the prevention of HIV.This can be accomplished by sharing informationwith colleagues and students, by raising awarenessin the community, and by making skills-basedhealth education an integral part of the curriculum.

Teachers unions around the globe have adoptedresolutions and policies on HIV. Unions havestarted disseminating information and have madetraining programs on HIV part and parcel of theirday-to-day work. In Tanzania, the Teachers Union(TTU) decided that in all its meetings, specificattention would be given to HIV and AIDS. Everyissue of the monthly magazine of the South AfricanDemocratic Teachers Union (SADTU) featuresarticles on HIV/AIDS and contributes to raise theawareness of SADTU’s 210,000 members about thedisease.

• A third set of activities helps teachers gainconfidence and experience in using participatorylearning methods to enable their students to acquireprevention skills.

At a global level, Education International’s work instrengthening teachers’ responses to HIV/AIDSincludes:

• holding regional seminars to support union leadersto gain knowledge and understanding in how toimplement HIV-related policies for their unions, andhow to work with their respective governments indeveloping workplace policies, curriculum andtraining

• working in partnerships with World HealthOrganization, Centre for Disease Prevention andEducation Development Centre, in creating a ‘schoolhealth/HIV prevention training and resource manual’to be used by national teacher unions in trainingteachers

• working with governments in advocating forteachers to be actively involved in HIV/AIDScurriculum design and training.

3.3.2 Treatment and care for HIV positiveteachers

In none of the participating countries had NGOs madeany attempts to target treatment and care at teachers.In fact, in Zambia, respondents were loath to targetteachers for treatment because it served to stigmatiseteachers. They felt that HIV positive teachers hadreceived a disproportionate amount of bad mediacoverage, partly because of their role within thecommunity. In order to mitigate the negativestereotyping that ensued, the decision was made toaim to treat HIV positive teachers no differently to anyother people living with HIV.

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Of the work that NGOs are conducting with teachers,the majority appears to be in HIV prevention forteachers. Groups in some of the countries (Sudan,Mali, and Burundi) were holding workshops forteachers in order to raise awareness about their ownHIV risk. In Tanzania, GCE member coalition TENMET,has been involved in a novel project which has takena two-pronged approach by raising awareness thatteachers, like anybody else, are infected and affectedby HIV. Second, they have been working withHIV/AIDS organisations to persuade them to takeresponsibility for teachers as a vulnerable group within society.

3.3.1 Teachers’ Unions

The teachers’ unions are the obvious example of asector that should be, and is, responding to the AIDScrisis. Education International – the international bodyrepresenting 315 national affiliates and some 26million workers from the education sector – has beenincreasingly active in galvanising teachers around theepidemic. Their work is based on the underlyingprinciple that teachers can significantly reduce HIVinfection by avoiding infection themselves, and byhelping young people to prevent infection. Box 4highlights some examples of the work that nationalteacher unions are carrying out.

Education International’s approach to teacher training

In partnership with the World Health Organization,Education International (EI) has developed a trainingprogramme, currently being used in 17 countries, thatcovers three related dimensions of AIDS education.

• A first set of activities is designed to help teachersexamine their own vulnerability to infection, theirown knowledge of the disease and its spread, andtheir own attitudes toward helping others, especiallystudents, avoid infection.

• A second set of activities gives teachers tools forconvincing administrators, teachers, parents andmembers of their community that HIV preventionthrough schools is appropriate and essential to thewelfare of their children, their families and theirnations.


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One of the fundamental principles underlying GCE’smission is the belief that civil society has aresponsibility to develop a coherent and unified voicein dialogue with education ministries, donors andother EFA stakeholders. Hence, the GCE hassupported the creation of national coalitions ornetworks that bring together local NGOs, internationalNGOs, child rights groups, women’s groups, faith-based organisations and teachers’ unions. Thesenational level coalitions are linked internationallythrough GCE and through regional networks belongingto the GCE such as ANCEFA and ASPBAE. Most are inregular contact with Ministries of Education, althoughtheir level of access and influence varies according tothe government’s attitudes towards civil society andthe strength and maturity of the coalition itself. Prior totheir participation in this action research project, onlyone of the education coalitions had links to HIV/AIDScoalitions.

4.1 Overall relationships betweencivil society and Ministries ofEducation

Relationships between civil society and Ministries ofEducation differ greatly depending on the country andthe specific civil society organisation. In twoexceptional cases, there appeared to be either norelationship, or a bad relationship, between the two;but in the others, the MoE did acknowledge thelegitimacy of the coalition and made some effort toconsult its members on policy matters.

In some countries, this relationship was viewed asone-sided:

“There is some collaboration – it is moreof a one-sided relationship with thegovernment getting involved when itwants to.”West African respondent

In other countries, MoEs were initially resistant to theidea of involving civil society in policy matters, buttheir suspicions had been overcome with time and, insome cases, the influence of donor agencies whichstipulated the need to involve civil society.

“Civil society presence was initially seenas a threat, and the process took time to get started, but after a while thegovernment admitted, ‘We cannot do this alone’.”Southern African respondent

Relationships between civil society and Ministries ofEducation were, in most cases, quite informal, oftendepending on relationships between individuals ratherthan between institutions:

“There are so many people in the Ministryof Education that there are not so manyofficial relationships, but more unofficialrelationships between individuals thatwork well [together].”Southern African respondent

DEADLY INERTIA

4. Partnerships for change

This chapter describes existing partnerships in the 18 countries studied betweencivil society groups working in education, HIV/AIDS networks and Ministries ofEducation. In each of the participating countries, there are many – often hundreds –of civil society organisations (CSOs) working on one or more of the interfacesbetween HIV/AIDS and education. It is far beyond the scope of this paper to detailthose responses – instead, this chapter will highlight the strengths and weaknessesof existing partnerships between MoEs and CSOs to tackle HIV/AIDS and presentrecommendations on how to build more effective collaboration.

36


CSOs identified excessive reliance on informalrelationships as a weakness, as it meant they had tostart from scratch every time a key individual left theministry. In Zambia, the Ministry of Education hasattempted to systematise its relationship with CSOsthrough organisational Memorandum ofUnderstandings. However, the extent to which CSOscan hold ministries accountable to such memorandais uncertain.

Collaboration was also undermined when the ministryand/or certain individuals within the ministry formedrelationships only with certain CSOs. Coalitionscomplained that Ministries of Education favoured thelarger international NGOs. Their privileged access tothe MoE helped, in turn, to reinforce their control overthe information, contacts and experience needed toinfluence policy.

In some countries, civil society had strongerrelationships with state or district level educationdepartments than national level officials.

“Within the Ministry of Education, it is onlyat the regional level, is the departmentopen to non-governmental cooperation,and in turn, they receive economic andtechnical support.”Bolivian respondent

Although it is difficult to generalise about therelationship between Ministries of Education and civilsociety, there was – in all cases – the potential tostrengthen partnership (see recommendations). Thefollowing issues were seen as obstacles to formingpartnerships:

• lack of consultation

• no coordination between Ministries of Educationand civil society

• HIV/AIDS unit within the Ministry lacks autonomy

Box 10 Strengthening partnerships with Ministries of Education through the GCE project

Part of the GCE project involved civil societyrepresentatives from each country to be present at ameeting at the Ministry of Education (see part 1.5.3).This meeting provided an opportunity for GCEmembers to share information with Ministries ofEducation about work on HIV/AIDS and Education, tonetwork and discuss areas of possible collaboration.The following extracts highlight some of the positiveconsequences of the meetings.

“It was an opportunity to build upmeetings and a relationship with theMinistry of Education. It was an eye-opener – the Permanent Secretary was there.”

“The presence of UNESCO was usefulbecause it meant that there was agreater likelihood of the governmentsticking to the promises of involvement.”

“The meeting was useful because itsparked the realisation that there wereno data on infected and affected, andthat the policies had inadequate supportstructures. It was good to get the UNperson involved as they are not verymotivated.”

“The meeting was really good and nowthe Ministry of Education wants to learnand gain help from the coalition. Theywant another meeting and have askedus to be in continuous contact – theyhave work which they cannot do alone.”

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• funding expectations – “NGOs think Ministriesshould give them money but often they are under-resourced. Instead, in Ghana, GCE gave the Ministrymoney to publish HIV/AIDS materials.”

• only health-related NGOs are consulted onHIV/AIDS

• inability of Ministry of Education to recognise therole of civil society

• risks of duplication, confusion over responsibilities,and ‘ownership’ issues

• negative perception of government by donors(Zimbabwe)

• different international funders fund different things –leading to a lack of coordination

• within the Ministry:

• limited capacity and structures

• lack of transparency

• slow to change

• lack of will

4.2 Types of collaboration betweenMinistries of Education andcivil society

Civil society respondents were asked to describe theways in which they had worked with Ministries ofEducation around HIV/AIDS. Again, there were greatdifferences between countries, making it hard togeneralise. In most, involvement was limited, withrespondents desiring more collaboration on policy andcurriculum design.

In three of the countries – Mali, Zimbabwe, andZambia – civil society had been a key partner informulating the HIV/AIDS strategy paper.

“Civil society has been involved to a largeextent. There was consultation at eachand every stage of the development ofthe strategic plan.”Zimbabwean respondent

In another African country, civil society was notinvolved in the initial stages of formulating theHIV/AIDS strategy, but was invited to comment on adraft. In the remaining countries (where strategy planshad been formulated) civil society was not acollaborator.

In Zambia and Mali, the MoE also invited civil societyto make an input to the design of the HIV/AIDScurriculum. In Mali, this was partly due to pressurefrom the World Bank, which was funding thecurriculum development. The role of civil society inHIV/AIDS curriculum development was one whichmany respondents saw as relevant and important(see box 10).

In many countries, teacher unions are working withgovernment to roll out HIV training to teachers, andrepresentatives of the ministries of health andeducation are part of the unions’ HIV SteeringCommittee. They provide their input, share informationand seek ways and means to strengthen their workingrelationship at national and local levels. In Rwanda,the Ministry of Education provided study leave for allteachers to attend HIV-training seminars organised bythe unions. In Senegal, the Ministry of Educationdecided to finance the printing of a large number oftraining manuals to be used by the union. In Zambia,the Ministry of Health provided the medical experts tothe union-led training programme on HIV/AIDS.

Other forms of collaboration between ministries andcivil society, in some cases, revolved around datacollection (Sudan); pre-testing learning materials(Ghana, Sudan). NGOs are also implementers ofpolicy (Ghana, Sudan, and Zambia); and fundraising(Zambia).

For example:

• El Salvador: NGOs were involved in revisingmaterials produced by the Ministry of Education,and in holding information and sensitisationworkshops with Ministry officials.

• Bolivia: at the district level, NGOs have partneredone Department of Education to jointly producelocal intervention strategies, prepare educationmaterials and train teachers and students.

• Ghana: the Ministry of Education has registered122 NGOs to work on HIV/AIDS education inschools. NGOs were also involved in pre-testing the curriculum.

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• Mali: there is strong partnership between theMinistry of Education, UNICEF, Plan International andSCF-US around a number of projects. In 2002-2003these included

• developing school health policy

• appointing technical advisers

• analysing basic education curriculum forHIV/AIDS mainstreaming

• structured partnership agreements betweenMinistries and NGOs on health education

• design of new data collection and analysis tools on HIV.

4.3 Partnerships betweenEducation coalitions and HIV/AIDS coalitions

With so many interfaces between HIV/AIDS andeducation it is surprising that only one of theeducation coalitions (GCE South Africa) had ongoinglinks with the HIV/AIDS coalitions. Part of the problemwas that the two were seen as having separatespheres of responsibility, with HIV networks workingwith Ministries of Health, and education coalitions withMinistries of Education.

Moreover, people within each type of coalition tend tocome from very different professional backgroundsand disciplines – making partnership challenging. Thesituation is lamentable, especially given the increasingrecognition of the need for a multisectoral response tothe epidemic.

Much could be gained through strengtheningpartnerships between the two types of coalitions,mainly through sharing knowledge – it cannot beassumed that education coalitions have the expertiseto deal with HIV, and conversely, it cannot beassumed that HIV/AIDS coalitions have the pedagogicexpertise to design educational interventions.

The GCE project created an opportunity for the twotypes of coalitions to come together. In about seven ofthe countries, this was actually the first time the twocoalitions had met. The results were positive, withmany coalitions making promises of futurecollaboration. However, coalitions were also quick topoint out that the capacity of education coalitions wasalready stretched and thus, sustaining alliances withHIV/AIDS coalitions would be difficult.

4.4 Advocacy responses toHIV/AIDS and education

Alongside its ability to deliver services at a local level,civil society can also make an important contributionby holding governments publicly accountable forfulfilling their responsibilities, using the media andother channels to create debate over policies andspending priorities, and developing alternative policyproposals. Although the advocacy dimension of‘partnership’ is usually much less popular withgovernments, it can be a key ingredient in movingissues up the political agenda, and framing new policies.

To date, neither GCE members nor HIV/AIDS groups in the 18 countries studied have done systematicadvocacy work on the issues raised in this report.GCE members have been very involved in advocatingfor Education for All, with many of these campaignscertainly benefiting children and teachers infected andaffected by HIV/AIDS. Although the positive effects ofcampaigning for EFA should not be under-estimated,this report has also argued that the AIDS epidemichas created new and specific challenges to educators– which should also be specifically addressedthrough advocacy.


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The AIDS epidemic in Bolivia is relatively nascentand confined. In an ideal world, a low prevalencesetting should be the perfect situation to focus onprevention.

Unfortunately, HIV/AIDS education has not beengiven its due attention. As national coordinator ofthe GCE initiative, Ayuda en Accion had theopportunity to bring together the different agenciesworking in HIV/AIDS and education during threeregional workshops in Cruz de la sierra,Cochabamba and La Paz. This was the first timethat such a diverse group of agencies had cometogether, including representatives from

• 10 government departments

• 22 international and national NGOS working inHIV/AIDS and education

• 10 networks of people living with HIV

• 8 Universities and international donors.

The aim of these workshops was to discuss, andbuild upon, Ayuda en Accion’s research, which hadhighlighted the low level of HIV awareness amongteenagers, and their demand for schools to teachabout HIV/AIDS.7

The workshops consisted of two parts – the firstwas an information-sharing stage in whichparticipating organisations presented their work inHIV/AIDS and education. The second stage involvedeach workshop splitting into three working groups,each tackling an issue of concern with regard to theeducational response to HIV/AIDS. Although mostthe issues in the readiness survey were covered, itbecame clear early on that there was one issuewhich was of utmost concern to all the participants:the lack of an HIV/AIDS curriculum.

HIV is taught in a couple of subjects – but thesedecisions were made by the specific curriculardepartments, not through any coordinated effortfrom the National Ministry of Education. The lack ofa comprehensive strategy to deal with HIV/AIDSeducation is puzzling. The Ministry of Health clearly

endorsed the inclusion of HIV/AIDS into thecurriculum8. And discussions at the workshopssuggest that the Ministry of Education did actuallyprepare a new health component to the curricula,with a strong focus on HIV/AIDS. However, thismodule never materialised into policy or official statepolicy.

One of the strengths of the workshops was that itshowed the importance of the regional context inBolivia. Without national support for HIV/AIDSeducation, some of the regional educationdepartments have partnered NGOs to startproducing their own curriculum and training. Thesedepartments (SEDUCA) encourage NGOs to accessschools in their area and undertake HIV/AIDSeducation. In exchange, the NGOs also providetechnical support to the department. This allowsNGOs such as CEMSE to coordinate their effortthrough the regional education department, andshows the strong potential of NGOs to becomeinvolved in school-based HIV/AIDS education in asystematic way.

The NGOs hope that the national government takesthe lead from some of its regional departments.Lessons can be learnt and fed into the nationallevel – both in terms of training and learningmaterials.

Impatient with waiting, the agencies gathered at theGCE workshops and decided to take decisiveaction. The first was an inter-agency commitment towork towards the immediate inclusion of HIV/AIDSeducation into the general state curriculum.

This commitment involves:

• creation of working groups to prepare for meetingwith Ministry of Education

• systematising experiences from civil society tofeed best practices into the HIV/AIDS curriculum

• immediate inter-agency cooperation andcoordination around HIV/AIDS education

• submitting a proposal for the immediate inclusionof HIV/AIDS education into the curriculum.

Box 11 Bolivia: Building partnerships

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On the positive side, the Global Readiness Reportprocess and civil society meetings provided CSOswith opportunities to discuss policy-influencingpriorities and opportunities. Moreover, the researchhelped to provide a stronger evidence base fromwhich to plan future advocacy. At the end of the actionresearch project underpinning this report, eachnational education coalition reported back plans andideas for future advocacy around HIV/AIDS andeducation, some of which are summarised below.GCE hopes to take these ideas further in a proposedsecond phase of the action research project.

In Bolivia, impressive civil society momentum hasbeen generated through the project, resulting in amulti-organisation campaign to include HIV/AIDSeducation in the general curriculum (see box opposite).

Following the regional workshops and inter-agencycommitment, the group put together a proposal to besubmitted to the Ministry of Education. The proposalincludes the following items:

• insertion of an integrated HIV/AIDS curriculum

• the provision of HIV/AIDS training in both pre-service and in-service training

• the involvement of the Communication Unit of theMinistry of Education in work on HIV/AIDS

• creating a coordinating mechanism between theMinistry of Education and the Ministry of Health towork jointly on HIV/AIDS

• inclusion of an article on the law on children andteenagers living with HIVAIDS.

This proposal is to be submitted to the Ministry ofEducation in 2005. The inter-agency group, which was formed through the GCE initiative, is currentlypetitioning the government to include HIV/AIDSeducation into the national curriculum, as laid outtheir proposal.

The other participating countries are also makingprogress in developing advocacy strategies aroundHIV/AIDS and education. The table oppositesummarises proposed activities:

7 392 interviews were conducted in 10 schools in Santa Cruz de la Sierra. 16% of the teenagers had never heard of AIDS. 19% of teenagers thought there was a cure for AIDS. 98% of the teenagers thought that HIV/AIDS education and sexual reproductive health topics should be taught in schools.

8 The Key Ministry of Health AIDS documents, “Bases for 2000-2004 strategic planning on the prevention and control of sexually transmitted infections/HIV/AIDS”, clearly describes the need for the Ministry of Education to include HIV/AIDS into its wider educational reform


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Bolivia

Tanzania

Sudan

Zimbabwe

Kenya

Mali

Burundi

Zambia

• Education and HIV/AIDS NGOs are petitioning the Ministry of Education to include HIV/AIDS in the generalcurriculum. Future activities include:

• encouraging the setting up of a communications unit within MoE to work on HIV and sex/health as cross-cuttingthemes

• HIV/AIDS sensitisation in all spheres of community life

• pushing for mass media to discuss HIV

• encouraging the creation of structures for coordinated work between MoH and MoE

• inserting HIV/AIDS subjects into the curriculum as an integrated and crosscutting theme

• strengthening training on HIV in TTC, and developing a strategy for on-going in-service training on HIV

• inclusion of an article in the law on children and adolescents living with HIV

• Plans to hold a roundtable meeting at MOEC to share campaign issues

• Proposed conference on HIV/AIDS and education

• Lobbying religious leaders who are a standing block to effective HIV prevention

• Lobbying to support comprehensive sex education in schools

• Pushing for more funding from the Ministry of Finance for the MoE to deal with HIV

• Advocating HIV/AIDS education at all levels and in vocational training centres

• Offering psycho-social support to teachers

• Lobbying government to provide ARVs to teachers

• Lobbying government/ Ministry of Education to provide syllabuses and training materials to train teachers

• Participating in forthcoming legislation on HIV/AIDS

• Working to reduce HIV related discrimination in education

• Informing people that HIV and malaria are avoidable and to prioritise preventive education

• Raising awareness to promote VCT

• Pressing for schools to recognise their responsibility to teachHIV

• Creating efficient and reliable relationships to fight HIV

Box 12 plans for future campaigning work on education and HIV/AIDS

Few effective steps have been taken to mitigate theepidemic’s growing impact on pupils, teachers andschools. Orphans and HIV positive children are beingforced out of school because governments are doinglittle or nothing to support and protect them.Stigmatisation and discrimination against both childrenand teachers with HIV have been allowed to flourish.Dangerously little is being done to avert loomingteacher shortages due to AIDS-related attrition.Although much donor money and government efforthas gone into producing lesson plans and learningmaterials on HIV/AIDS, few schools are actuallydelivering quality AIDS education to pupils.

AIDS has drastically changed the demands oneducators, schools and students, posing formidablechallenges to education systems that are already over-stretched and under-resourced. These new challenges– like the epidemic – are complex and require newways of thinking and responding within the education

sector. Successful responses tothe crisis require a coherentsystem-wide strategy and plan,exactly what most of thecountries reviewed in this studywere lacking. Stand-aloneprojects targeting a singledimension of the AIDS challenge(such as developing anHIV/AIDS curriculum withoutaddressing teacher trainingneeds, or offering bursaries toorphans without a sustainablelong-term plan to make basiceducation free for all) have failedmiserably.

The stark reality is that thesefailures of policy and leadershiphave already condemnedmillions of young people toneedless infection and evendeath. However, it is not too lateto overcome the policy inertia on

AIDS in education if government, donors and civilsociety work together more systematically andtransparently.

Educators have a powerful role in forming society'svalues and attitudes. They have a unique platform thatcan be used to combat stigma, fear and apathy, andin particular to break moral taboos on open discussionof sex and the realities of sexual transmission. At alllevels from the Minister of Education down to thevillage headmaster or NGO fieldworker, therefore, theyhave a responsibility to demonstrate leadership andcourage in the fight against the epidemic. Bychanging the way that the education system dealswith AIDS – replacing inertia with vigorous action,silence with frank discussion, and discrimination witha strong affirmation of the rights of the infected andaffected – we can begin to change the way thatindividuals and communities respond to the epidemic.

The following recommendations should be on the to-do list of all ministries:


5. Conclusions and recommendationsThe classroom represents a vital opportunity to reach youth with life-savinginformation and skills, but this opportunity is being squandered by the deadlyinertia surrounding AIDS policy in the education sector.

HOWARD LEWIS-BAKER/ACTIONAID

42

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1 Ministries of Education should formulate a clear andcosted strategic plan on HIV/AIDS, which isintegrated into education sector plans and nationalpoverty reduction strategies and which iscomplemented by state and district level plans.

• More effort needs to be made to translatestrategic plans into policy and practice.

• National level responses must be complementedby state, provincial and district level responses.

• More resources need to be allocated to HIV/AIDSwithin Ministries of Education. In particular, thepotential to gain funding from HIV/AIDSdesignated funding sources should be furtherexplored (e.g. GFATM).

2 Ministries of Education must clearly define the rightsof HIV positive children in schools, as well as therights of HIV positive education workers, andestablish policies, regulations and procedures toprevent AIDS-related discrimination against learnersand teachers. Workplace policies must be put inplace to respond to the needs of HIV positiveteachers. At the very least these should includeaccess to confidential VCT services and affordableaccess to treatment.

• Ministries of Education must create workplacepolicies around HIV infected teachers, showingzero tolerance to HIV-related discrimination.

• Confidential VCT services should be offered toteachers and school counselling programmesmust be expanded.

• Ministries of Health must strive towards providingaffordable treatment for AIDS.

• The underlying problem of unaffordable schoolfees must be addressed and governments mustprovide free basic education to all children, notjust orphans.

• It is important to study existing ‘social and cultural safety nets’ that could be mobilised orstrengthened to ensure access to education for OVCs.

3 Greater effort must be made to understand thespecial educational needs of children affected bythe HIV/AIDS. The educational response must gobeyond simply providing bursaries to includepsycho-social support through existing counsellingservices in schools.

4 Governments must put in place adequatemonitoring systems for measuring the impact of theepidemic on education. In particular, educationmanagement information systems (EMIS) need tobe strengthened in order to capture data on teacherabsenteeism and mortality due to AIDS.

5 High priority must be given to training teachers toteach about HIV/AIDS. Both in-service and pre-service teacher training should include compulsoryHIV/AIDS components that are examinable orcertifiable. Teachers and their unions must beinvolved in the design and roll-out of suchprogrammes.

6 HIV/AIDS should not be taught in isolation, but aspart of a wider sexual and reproductive healthframework. Curriculum development should be inpartnership with civil society and while beingculturally appropriate, should be based onscientifically accurate information rather than beingideologically driven. Such curricula must be basedin the reality of young people’s lives and provideyoung people with realistic choices to protectthemselves from HIV infection.

7 Civil society organisations (CSOs) need to be moreproactive and systematic in seeking to influenceHIV/AIDS related policies and plans of theirgovernment. Stronger linkages and alliancesbetween teachers’ unions, education groups andhealth groups (among others) would help to ensurea more effective and better-informed civil societyinput to policy discussions. CSOs can makeimportant contributions to the design and

Recommendations

44

implementation of school-based HIV education, buttheir efforts should be coordinated by the Ministry ofEducation to avoid duplication or contradiction. Atthe same time, however, CSOs have a responsibilityto act as independent monitors of HIV/AIDS policiesand spending at all levels, and to campaign for theeducational rights of all vulnerable groups.

• Ministries of Education and CSOs should draw upMemorandums of Understanding to clarify andsystematise the nature and limits of theircollaboration on specific activities.

• Individual CSOs should form a common platform,such as the national education coalitions involvedin this study, in order to take a coherent andconsistent set of policy messages to government.Education coalitions should partner HIV/AIDSnetworks for combined advocacy efforts.

• Future advocacy should build upon existing EFAcampaigns and education groups must includecampaigning on HIV/AIDS as an important part oftheir campaigns on quality and free education.

8 In order for schools to play an effective role infighting AIDS, all children, especially the poorestand most marginalised, must be able to go toschool. Completion of primary education is thethreshold level to unlock the preventative power ofeducation, yet across Africa only one in twochildren ever finishes primary school, while largeclass sizes and under-trained teachers underminelearning. Basic education must be made free,universal and compulsory. Governments mustabolish fees, build more schools and train moreteachers, establish stipends and/or school meals tohelp keep children in school, and take additionalnecessary steps to ensure schools attract girls,orphans and other vulnerable children.

9 Financing these measures will require immediateand major increases in aid and debt relief foraffected countries. In the face of the widereconomic and budgetary pressures, earlier donorestimates of countries’ education-sector needs mayneed to be revised, and in particular, more moneymade available for recurrent costs such as payrollcosts. While the potential to finance such measuresthrough HIV/AIDS-designated funding channelsshould be further explored (such as The GlobalFund for AIDS, Tuberculosis and Malaria), it is urgentfor the Fast Track Initiative (FTI) partnership toexpand to more low-income countries and to offercoordinated and generous support for Ministries ofEducation to scale-up their response to AIDS.


DAVID SAN MILLÁN/ACTIONAID

AppendixThe Global Readiness Report

In 2000, a number of the UN agencies wereconcerned about the lack of coordination within theUN around HIV/AIDS and education, and consequentlyset up the UN Inter-agency task team on HIV/AIDSand Education (IATT).

As part of its remit, the IATT recognised the need toassess how ready Ministries of Educations were torespond to the AIDS epidemic. Partnering withresearchers at HEARD (University of KwaZulu-Natal),they designed a survey to be conducted by Ministriesof Education.

The survey consisted of a series of questionsregarding the absence/presence of key indicators.Most of these questions elicited a yes/no or true/falseresponse but some required priorities to be ranked

GCE partnership with the CanadianInternational Development Agency (CIDA)

In the original proposal for the Global ReadinessReport, there was no mention of civil societyinvolvement. However, it was soon recognised thatcivil society could have an important role incontributing to the survey, and ensuring that thesurvey was used as benchmark for advocacy. CIDAand IATT therefore partnered with GCE as a way tosystematically mobilise national education coalitionsaround HIV/AIDS. Moreover, the Readiness survey wasseen an important opportunity for GCE members tostart engaging around HIV/AIDS – both with Ministriesof Education and with HIV networks.

With CIDA’s support, GCE embarked on an ambitiousHIV/AIDS project that included capacity building,research and advocacy. The complex process follows:

Pre-meeting: Each of the 18 participating countrieswas encouraged to hold an initial meeting to bringtogether civil society perspectives and buildpartnerships between HIV and education coalitions.This informal forum – known as a pre-meeting –allowed GCE members to discuss their key concernsregarding the Ministry of Education, and to debate therole of civil society.

Although guidelines were provided, it was up toindividual countries to decide how best to hold themeetings. A wide cross-section of stakeholders was

invited, including students, teacher unions,government officials, parents, church and youthgroups, and UN agencies. There were countryvariations in the strategy. For example, in Bolivia, aseries of meetings was held across the country,leading to the formation of an inter-agency proposalwhich the group presented to the Ministry ofEducation (see 3.3). For many countries, the meetingprovided a seminal opportunity for education coalitionsto meet HIV coalitions and plan joint work together. Forsome countries, the level of awareness of HIV amongGCE members was very low, and the forum was usedfor increasing knowledge. For example in Nepal anextra day was added to the pre-meeting, whereeducation coalitions were briefed on critical aspects in HIV/AIDS.

Meeting at Ministry of Education: In eachparticipating country, a meeting was set up at theMinistry of Education in order to complete the GlobalReadiness Report. This meeting was coordinated byone GCE representative and one IATT representative,although others were often present at the meetings,and offered the opportunity to strengthen partnershipsbetween civil society and UN agencies.

Although the Global Readiness Report was completedby three or four key ministry officials, the GCErepresentative took the meeting as an opportunity toshare information and learn more about the nationaleducational response to the epidemic.

Feedback to wider civil society: An important partof the process was to feed information from theMinistry of Education meeting back to national andinternational GCE partners, in order to frame any futurecampaigning work on HIV/AIDS.

This was done in three ways. First, the 19 GCErepresentatives completed GCE questionnaires thatwere designed to elicit civil society perspectives onthe key issues raised during the ministry meeting.Second, a workshop was held in Ottawa for the sixcountries involved in the research stage. The aim ofthis workshop was to pull together conclusions fromthe project, which could in turn, feed into advocacystrategies. Finally, each of the participating countriesheld dissemination workshops in which the findings of the project (both at national and international levels)were discussed.

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