AIDS education and young people

Why is AIDS education for young people important?

AIDS education for young people plays a vital role in global efforts to end the AIDS epidemic. Despite the fact that HIV transmission can be prevented, each year millions of people become infected with the virus; in 2008 alone, there were 2.7 million new HIV infections. Almost 1-in-6 of these new infections were among people under 15 years old.¹

“In 2008 alone, there were 2.7 million new HIV infections. Almost 1-in-6 of these new infections were among people under 15 years old.”

Providing young people with basic AIDS education enables them to protect themselves from becoming infected. Young people are often particularly vulnerable to sexually transmitted HIV, and to HIV infection as a result of drug-use. Acquiring knowledge and skills encourages young people to avoid or reduce behaviours that carry a risk of HIV infection.^2 3 4 Even for young people who are not yet engaging in risky behaviours, AIDS education is important for ensuring that they are prepared for situations that will put them at risk as they grow older.⁵
AIDS education also helps to reduce stigma and discrimination, by dispelling false information that can lead to fear and blame. This is crucial for prevention, as stigma often makes people reluctant to be tested for HIV.  Somebody who is not aware of their HIV infection is more likely to pass the virus on to others. AIDS education can help to prevent this, halting stigma and discrimination before they have an opportunity to grow.⁶

Why is AIDS education for young people an issue?

Educating young people about HIV and AIDS necessitates discussions about sensitive subjects such as sex and drug use. Many people believe that it is inappropriate to talk to young people about these subjects and fear that doing so will encourage young people to indulge in risky behaviours. Such attitudes are often based on moral or religious views rather than evidence, and severely limit AIDS education around the world. Substantial evidence shows that educating young people about safer sex and the importance of using condoms does not lead to increases in sexual activity.⁷

“I did not go to school and learn about the civil war and decide to start a civil war, nor would I have had sex because of a class in school.” - Mark

The belief that young people should only be taught about sex and drugs in terms of them being ‘wrong’ also perpetuates stigmatisation of people who are living with HIV. By teaching young people that indulging in ‘immoral’ sex and drugs will lead to HIV infection, educators imply that anyone who has HIV is therefore involved in these ‘immoral’ activities.
In order to prevent becoming infected with HIV, young people need comprehensive information about how HIV is transmitted and what they can do to stop themselves from becoming infected. This information should be delivered without moral judgement.

AIDS education at school

Sex education in a school in India

Schools play a pivotal role in providing AIDS education for young people. Not only do schools have the capacity to reach a large number of young people, but school students are particularly receptive to learning new information. Therefore schools are a well-established point of contact through which young people can receive AIDS education.
At the same time, in many countries HIV and AIDS are significantly weakening the capacity of the education sector, and greater investment in education is vital for the provision of effective HIV prevention for young people.^8 9 10

Different approaches to AIDS education at school

Opinion is divided between education providers who take an abstinence-only approach to sex education and those who advocate a more comprehensive approach. Which approach is favoured significantly affects how young people are educated about HIV and AIDS.
Sex education that focuses on abstinence is based on the belief that encouraging young people not to have sex until marriage is the best way to protect against HIV infection. This approach limits AIDS education by not providing information about how young people can protect themselves from HIV infection if and when they do chose to have sex. It is vital for HIV prevention that schools provide comprehensive sex education, which educates about the importance of condom use as well as promoting delayed initiation of sex.¹¹

Teacher training

AIDS education requires detailed discussions of subjects such as sex, death, illness and drug use. Teachers are not likely to have experience dealing with these issues in class, and require specialised training so they are comfortable discussing them without letting personal values conflict with the health needs of the students.¹²
Teacher training is fundamental to the successful delivery of AIDS education in schools, and yet efforts to train teachers are often inadequate, if in place at all. For example, teachers in Malawi report not receiving any training on HIV and AIDS, and in Kenya many teachers have opted out of teaching about HIV and AIDS as a result of inadequate training.¹³

AIDS education outside of school

Although offering AIDS education at school is a principal method of reaching large numbers of young people, there are 75 million children around the world who are either unable to go to school or choose not to.¹⁴ In order to ensure that all young people are reached with basic AIDS education, programmes that target young people outside of school are essential. Young people who are in school also benefit from receiving further information about HIV and AIDS from other sources, adding to and reinforcing what they learn in school.
Families, friends, the wider community, mass media and popular culture all influence young people, and it is important that they convey accurate educational information about HIV and AIDS.

The media

Using the media is a powerful way of reaching large numbers of young people with HIV and AIDS information and prevention messages.

LoveLife campaign billboard in South Africa

Many countries have tried some form of AIDS education advertisements, films, or announcements. LoveLife is a prominent campaign in South Africa, which uses a variety of media to educate young people about HIV and AIDS. The LoveLife campaign has produced eye-catching posters and billboards. It has also educated through TV soaps that are popular with young people, and used rap and kwaito music to get its message across.¹⁵
However, it is difficult to measure the extent to which media-based AIDS education reaches young people, and the effect that it has. In 2005, The Global Fund withdrew its funding of LoveLife on the basis that the campaign was not reaching the majority of young South Africans, and that its contribution to HIV and AIDS prevention was unclear.^16 17

Peer education

Peer education is the process by which a group is given information by someone who is a member of the same group or community, and who has already been trained in the subject. Peer education programmes are important for HIV prevention, as they are a cost-effective means of influencing the knowledge and attitudes of young people.^18 19

Young people learning about HIV and AIDS at a youth centre in Angola

Young people are strongly influenced by the attitudes and actions of others their age, and for many young people much of their existing knowledge of sex and HIV is based on information they have received from friends. This information can often be distorted. Peer education harnesses this method of sharing knowledge to convey accurate information about HIV and AIDS to young people.
Peer education is a particularly effective way of targeting difficult to reach groups, such as young people who do not attend school, with vital AIDS education.²⁰ Many young people who do not attend school are marginalised in other ways, and may distrust or not take in information given to them by an authority figure. The same information is more likely to be effective if it is provided by someone that young people identify with and see as credible.^21 22

“Peer education works very well for students and young people. Sharing a conversation with people of the same age or social group you can be more relaxed, and, for example, you can ask questions that would be difficult to ask to an adult.” - Selma, HIV and AIDS peer educator²³

Making AIDS education effective

When should young people start to be taught about AIDS?

There is no set age at which AIDS education should start, and different countries have different regulations and recommendations. Often young people are denied life-saving AIDS education because adults consider the information to be too ‘adult’ for young people. These attitudes hinder HIV prevention, as it is crucial that young people know about HIV and how it is transmitted before they are exposed to situations that carry a risk of HIV infection.
AIDS education should begin as early as possible. Information can be adapted so that awareness of AIDS can begin from an early age whilst still ensuring that topics are age-appropriate. For example, UNESCO guidelines advise that basic education on human reproduction should begin as early as age five. This information provides the foundation on which children can build AIDS specific knowledge and skills as they develop; education about condoms and how they can protect from HIV infection can be introduced from around age nine.²⁴

Active learning

Young people doing group work as part of an AIDS education programme in Thailand

Simply providing young people with information about HIV and AIDS is not enough to ensure that they will absorb and retain that information. Effective AIDS education encourages young people to participate and engage with the information that is being presented to them by offering them the opportunity to apply it.²⁵ Group-work and role-play are particularly important methods in which students might discover the practical aspects of the information they are given. These methods also allow pupils an opportunity to practise and build skills – saying “No” to sex, for example.
Active learning approaches are widely considered to be the most effective way for young people to learn health-related and social-skills.²⁶ Furthermore, active learning offers an opportunity to make AIDS education lessons fun. AIDS education classes can be constructed to involve quizzes, games, or drama, for example – and can still be very effective learning sessions.
Avert.org has a selection of educational quizzes and an AIDS game to test young people's knowledge in a fun and interactive way.

Making it cross-curricular

Effective AIDS education encompasses both scientific and social aspects of HIV and AIDS. Knowledge of the basic science of HIV and AIDS is important for understanding how the virus is passed on and how it affects the body, for example. But AIDS education that deals only with medical and biological facts, and not with the real-life situations that young people find themselves in, does not provide young people with adequate AIDS awareness.²⁷ Developing life skills and discussing matters such as relationships, sexuality and drug use, are fundamental to AIDS education. Knowing how HIV reproduces won’t help a young person to negotiate using a condom, for example.

What needs to be considered?

When planning an AIDS education lesson or curriculum, it is important to be aware of local guidelines, as many places have legislation that dictates what sex or AIDS education can or should be given. Local cultures also need to be taken into consideration, as views between cultures differ on issues that are a necessary part of AIDS education, for example human sexuality. Awareness of cultural and religious beliefs enables AIDS education to sensitively, yet effectively, deal with issues in a way that does not conflict with the values of young learners.
When educating a group of young people, the personal circumstances of students need to be taken into account. Some of the students may have been personally affected by HIV or, particularly in high prevalence areas, may themselves be infected with HIV.^28 29 The sexuality of students and their families is something else that needs to be considered. AIDS education needs to include information about and for people of all sexualities.
The best place to start when planning AIDS education for young people is to talk to the young people themselves. Allowing learners to ask questions and encouraging their input will enable young people to express what they want from their AIDS education. Speaking to the class also ensures that educators are aware of the current knowledge of the students, so that AIDS education can be more effectively targeted towards areas of informational need.

AIDS education for young people around the world: Case studies

There is no single model of AIDS education that is appropriate to every country; different situations call for different responses. However, the experiences of AIDS education programmes around the world can provide important insights when designing and implementing AIDS education for young people.³⁰

Kenya

Kenya has witnessed a declining HIV prevalence in recent years – in 1997/98 the prevalence was estimated at 10 percent; by 2006 this figure had almost halved to 5.1 percent.³¹ The decline has been attributed to a number of factors, including a reduction in risky behaviours.³² Kenya’s education sector has taken an active role in the country’s response to the AIDS epidemic, having a particularly positive effect on HIV and AIDS awareness and leading to a reduction of risk behaviour among young people.³³
Kenya has integrated AIDS education into all subjects at school, and introduced a weekly compulsory HIV and AIDS lesson into all primary and secondary curricula. An evaluation of 2000 schools found that AIDS education is effectively promoting healthy behaviours and reducing the risk of infection.³⁴
One particularly successful initiative has been the Primary School Action for Better Health Kenya (PSABH). PSABH began in October 2001 in Nyanza Province with the aim of creating positive behaviour change among upper primary school pupils to reduce their risk of exposure to HIV.³⁵ The programme involves training the head teacher, a senior classroom teacher and one parent/community representative from each participating school, on a week-long course. One term later, two additional teachers are trained. Topics that are covered include:

• Information on the routes of HIV transmission and prevention strategies
• Skill-building for resisting the social, cultural and interpersonal pressures to engage in sexual intercourse
• Adolescent health and sexuality
• Issues related to HIV stigma and discrimination
• The care of people living with AIDS

Teachers are then taught how to train their colleagues at school and how to integrate HIV education within classroom subjects. With the aim of a national roll-out, around 11,000 out of 19,000 Kenyan schools had implemented PSABH by June 2006.³⁶
Evaluations of the programme revealed positive results – an increase in condom use among boys was reported and girls were more likely to decrease or delay sexual activity.³⁷

India

In India, where young people represent a large proportion of the country’s population, an estimated 2.4 million people are infected with HIV.³⁸ In phase II of the country's National AIDS Control Programme, the Adolescent Education Programme (AEP) was launched. The programme aimed to train teachers and peer educators to educate the student community both in and out of school about life skills, HIV prevention and HIV related stigma and discrimination. Under the initiative 112,000 schools were covered and 288,000 teachers were trained.³⁹
However, there is a discrepancy between the large amount of effort invested in HIV/AIDS curricula and training packages on a national level, and the lack of actual education being carried out in many schools. In the states of the country where there is a relatively low HIV prevalence, officials have been reluctant to encourage AIDS education, claiming that the problem is not significant enough in these areas to warrant a widespread educational response.⁴⁰ In reality, it is crucial that young people learn about AIDS in areas with a low prevalence so that the prevalence stays low.
In 2007 it was reported that a number of states had decided not to implement the Adolescence Education Programme in its present form, rejecting the material that had been supplied.⁴¹ Many young people across India are still not receiving information about HIV/AIDS.
“We had a session on AIDS in school once, but it was sketchy. I still do not know the difference between HIV and AIDS. We could not ask any questions, because the boys in our class would tease us later... At home, my mother knows even less, and my father would not allow such a conversation”. - Chaudhury, an arts undergraduate in Alwar, India⁴²

References

1. UNAIDS (2009, November), 'AIDS epidemic update'
2. UNESCO (2009, May), 'A strategic approach: HIV & AIDS and education'.
3. Paul-Ebhohimhen V.A. et al (2008), 'A Systematic Review of School-based Sexual Health Interventions to Prevent STI/HIV in sub-Saharan Africa' BMC Public Health 8(4).
4. Bankole A. et al (2007), 'Knowledge of Correct Condom Use among Adolescents in sub-Saharan Africa' African Journal of Reproductive Health 11(3).
5. UNESCO, Director-general (2008), 'Why are we still failing our young people?'.
6. UNDP Iran (2008) ‘The Stigma Factor by Ban Ki-Moon'.
7. UNESCO (2009, June) ‘International Guidelines on Sexuality Education: An evidence informed approach to effective sex, relationships and HIV/STI education’.
8. The World Bank (2002), ‘A window of hope’.
9. UNESCO (2009) ‘Overcoming inequality: why governance matters’.
10. UNESCO (2006), ‘Good policy and practice in HIV and AIDS education: overview’.
11. UNAIDS (2008), ‘Report on the global AIDS epidemic’.
12. UNESCO (2009, May), ‘Teachers and HIV & AIDS: Reviewing achievements, identifying challenges’.
13. UNESCO (2008), ‘Good policy and practice in HIV & AIDS and education: effective learning’.
14. UNESCO (2009) ‘Overcoming inequality: why governance matters’.
15. LoveLife, 'LoveLife: about us'.
16. IRIN Plus News (2005), 'Global Fund withdraws support for LoveLife'.
17. Pettifor A.E. et al (2007, August), ‘Challenge of evaluating a national HIV prevention programme: the case of LoveLife, South Africa’ Sexually Transmitted Infections 83(suppl 1).
18. UNAIDS (1999), ‘Peer education and HIV/AIDS: Concepts, uses and challenges’.
19. Youth Peer Education Network (2005), ‘Youth peer education tool kit: Standards for peer education programmes’.
20. UNAIDS, 'Education: in and out of school settings'.
21. UNESCO & UNAIDS (2001, 1st January), ‘HIV/AIDS and human rights: young people in action’.
22. United Nations ESCAP (2003), ‘Young people: partners in HIV/AIDS prevention’.
23. UNESCO & UNAIDS (2001, 1st January), ‘HIV/AIDS and human rights: young people in action’.
24. UNESCO (2008), ‘International Guidelines on Sexuality Education: An evidence informed approach to effective sex, relationships and HIV/STI education’.
25. UNESCO (2008), ‘Good policy and practice in HIV & AIDS and education: effective learning’.
26. UNICEF (2009, May), 'Child-friendly schools manual', chapter 2: Dynamics of theory in practice.
27. Campbell C. & MacPhail C. (2002), 'Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth' Social Science and Medicine 55(2).
28. UNESCO (2008, December), 'Supporting the educational needs of HIV-positive learners: lessons from Namibia and Tanzania'.
29. UNESCO (2008, February), 'School-centred HIV and AIDS care and support in Southern Africa: consultation report'.
30. The World Bank (2008), ‘A sourcebook of HIV/AIDS prevention programs: vol. 2’.
31. UNGASS (2008, January) 'Country progress report – Kenya'.
32. UNGASS (2008, January) 'Country progress report – Kenya'.
33. Actionaid (2003), 'Sound of Silence: Difficulties in communicating on HIV/AIDS in schools'.
34. Kenya National AIDS Control Council (2009, March), ‘HIV prevention response and modes of transmission analysis’.
35. PSABH 'A snapshot of PSABH as delivered across Kenya'.
36. Maticka-Tyndale, E, Wildish, J & Gichuru, M (2007) 'Quasi-experimental evaluation of a national primary school HIV intervention in Kenya', Evaluation and Program Planning 30, 172-186.
37. Maticka-Tyndale, E, Wildish, J & Gichuru, M (2007) 'Quasi-experimental evaluation of a national primary school HIV intervention in Kenya', Evaluation and Program Planning 30, 172-186.
38. UNAIDS (2008), ‘Report on the global AIDS epidemic’.}{!ref: UNGASS (2008, February) ‘Country Progress Report 2008: India’.
39. National AIDS Control Organisation (2007) 'Adolescence Education Programme (AEP)'.
40. Global Campaign for Education (2005, November) 'Deadly Inertia: A cross-country study of educational responses to HIV/AIDS'.
41. National AIDS Control Organisation (2007, 13th August) 'Sex education in curriculum'.
42. The Washington Post (2007, 7th December) 'Getting AIDS education on track in India'.