Volume HIV

Educational planning and management in a world with AIDS
Volume
Setting the Scene
International Institute for Educational Planning/UNESCO 7-9 rue Eugne Delacroix, 75116 Paris, France Tel: (33 1) 45 03 77 00 Fax: (33 1 ) 40 72 83 66 IIEP web site: http://www.unesco.org/iiep EduSector AIDS Response Trust CSIR Building, 359 King George V Avenue, Durban, South Africa Tel: (27 31) 764 2617 Fax: (27 31) 261 5927
The designations employed and the presentation of material throughout the publication do not imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any country, territory, city or area or of its authorities, or concerning its frontiers or boundaries. All rights reserved. IIEP/HIV-TM/07.01 Printed in IIEPs printshop.
The modules in these volumes may, for training purposes, be reproduced and adapted in part or in whole, provided their sources are acknowledged. They may not be used for commercial purposes.
UNESCO-IIEPEduSector AIDS Response Trust (ESART) 2007
Foreword
With the unrelenting spread of HIV, the AIDS epidemic has increasingly become a significant problem for the education sector. In the worst affected countries of East and Southern Africa there is a real danger that Education for All (EFA) goals will not be attained if the current degree of impact on the sector is not addressed. Even in countries that are not facing such a serious epidemic, as in West Africa, the Caribbean or countries of South-East Asia, increased levels of HIV prevalence are already affecting the internal capacity of education systems. Ministries of education and other significant stakeholders have responded actively to the threats posed by the epidemic by developing sector-specific HIV and AIDS policies in some cases, and generally introducing prevention programmes and new courses in their curriculum. Nevertheless, education ministries in affected countries have expressed the need for additional support in addressing the management challenges that the pandemic imposes on their education systems. Increasingly, they recognize the urgent need to equip educational planners and managers with the requisite skills to address the impact of HIV and AIDS on the education sector. Existing techniques have to be adapted and new tools developed to prepare personnel to better manage and mitigate the impact of the pandemic. The present series was developed to help build the conceptual, analytical and practical capacity of key staff to develop and implement effective responses in the education sector. It aims to increase access for a wide community of practitioners to information concerning planning and management in a world with HIV and AIDS; and to develop the capacity and skills of educational planners and managers to conceptualize and analyze the interaction between the epidemic and educational planning and management, as well as to plan and develop strategies to mitigate its impact. The overall objectives of the set of modules are to: present the current epidemiological state of the HIV pandemic and its present and future impact; critically analyze the state of the pandemic in relation to its effect on the education sector and on the Education for All objectives; present selected planning and management techniques adapted to the new context of HIV and AIDS so as to ensure better quality of education and better utilization of the human and financial resources involved; identify strategies for improved institutional management, particularly in critical areas such as leadership, human resource management and information and financial management; provide a range of innovative experiences in integrating HIV and AIDS issues into educational planning and management. By building on the expertise acquired by UNESCOs International Institute for Educational Planning (IIEP) and the EduSector AIDS Response Trust network (originally the Mobile Task Team [MTT] on the impact of HIV/AIDS on education) through their work in a variety of countries, the series provides the most up-to-date information available and lessons learned on successful approaches to educational planning and management in a world with AIDS.
The modules have been designed as self-study materials but they can also be used by training institutions in different courses and workshops. Most modules address the needs of planners and managers working at central or regional levels. Some, however, can be usefully read by policy-makers and directors of primary and secondary education. Others will help inspectors and administrators at local level address the issues that the epidemic raises for them in their day-to-day work. Financial support for the development of modules and for the publication of the series at IIEP was provided by the UK Department for International Development (DFID) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The Mobile Task Team (MTT) on the impact of HIV/AIDS on education, based at HEARD at the University of KwaZulu-Natal from 2000 to 2006, was funded by the United States Agency for International Development (USAID). The EduSector AIDS Response Trust, an independent, non-profit Trust was established to continue the work of the MTT in 2006. The editing team for the series comprised Peter Badcock-Walters, and Michael Kelly for the MTT (now ESART), and Franoise Caillods, Lucy Teasdale and Barbara Tournier for the IIEP. The module authors are grateful to Miriam Jones for carefully editing each module. They are also grateful to Philippe Abbou-Avon of the IIEP Publications Unit for finalizing the layout of the series.
Franoise Caillods Deputy-Director IIEP
Peter Badcock-Walters Director EduSector AIDS Response Trust
Volume 1: Setting the Scene

Educational planning and management is an essential part of any education system, and in many countries, the planning needs are changing due to HIV and AIDS. In Volume 1, you are given the backdrop of how HIV and AIDS are unfolding in your schools and within the larger society. First you must understand the environments that HIV and AIDS are creating before your actions can be effective.
Learners guide List of abbreviations HIV and AIDS knowledge test 7 11 15
MODULE 1.1: THE IMPACTS OF HIV/AIDS ON DEVELOPMENT Aims Objectives Questions for reflection Introductory remarks The challenges posed by HIV and AIDS HIV, gender and culture HIV/AIDS and poverty AIDS, development and economic growth Implications for the education sector Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
21 22 22 23 24 26 31 35 38 42 45 46 47 50
1. 2. 3. 4. 5.
MODULE 1.2: THE HIV/AIDS CHALLENGE TO EDUCATION Aims Objectives Questions for reflection Introductory remarks The impacts of HIV and AIDS on the context for education HIV and AIDS constitute a systemic problem for education The impacts of HIV and AIDS on an education system HIV and AIDS affect what society expects from its education systems Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 1.3: EDUCATION FOR ALL IN THE CONTEXT OF HIV/AIDS Aims Objectives Questions for reflection Introductory remarks EFA timeline EFA and the Millennium Development Goals HIV and AIDS as an obstacle to attaining EFA EFA and HIV prevention Using EFA to overcome the impact of AIDS Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
53 54 54 55 56 58 60 62 71 73 75 77 78 81 82 82 83 84 86 88 97 99 103 110 111 112 113
1. 2. 3. 4.
1. 2. 3. 4. 5.
MODULE 1.4: HIV/AIDS RELATED STIGMA AND DISCRIMINATION Aims Objectives Questions for reflection Introductory remarks Definitions of stigma and discrimination Causes and types of stigma and the language used Consequences of stigma and discrimination for programmes Policies and laws: human rights and education Confronting stigma and discrimination in the education sector Education as a tool to counter stigma and discrimination in the classroom Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 1.5: LEADERSHIP AGAINST HIV/AIDS IN EDUCATION Aims Objectives Questions for reflection Introductory remarks Leadership Advocacy Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
117 118 118 119 120 122 124 129 131 133 138 141 142 143 145 149 150 150 151 152 153 168 173 174 175 184
1. 2. 3. 4. 5. 6.
1. 2.
Useful links HIV and AIDS fact sheets HIV and AIDS glossary HIV and AIDS knowledge test answers The series
185 189 195 200 204
Learners guide
by B. Tournier
This set of training modules for educational planning and management in a world with AIDS is addressed primarily to staff of ministries of education and training institutions, including national, provincial and district level planners and managers. It is also intended for staff of United Nations organizations, donor agencies, and non-governmental organizations (NGOs) working to support ministries, associations and trade unions. The series is available to all and can be downloaded at the following web address: www.unesco.org/iiep. The modules have been designed for use in training courses and workshops but they can also be used as self-study materials.
Background
HIV and AIDS are having a profound impact on the education sector in many regions of the world: widespread teacher and pupil absenteeism, decreasing enrolment rates and a growing number of orphans are increasingly threatening the attainment of Educational for All by 2015. It is within this context, that the series aims to heighten awareness of the educational management issues that the epidemic raises for the education sector and to impart practical planning techniques. Its objective is to build staff capacity to develop core competencies in policy analysis and design, as well as programme implementation and management that will effectively prevent further spread of HIV and mitigate the impact of AIDS in the education sector. The project started in 2005 when IIEP and MTT (the Mobile Task Team on the Impact of HIV and AIDS on Education), now replaced by ESART, the Education Sector AIDS Response Trust, brought together the expertise of some 20 international experts to develop training modules that provide detailed guidance on educational planning and management specifically from the perspective of the AIDS epidemic. The modules were developed between 2005 and 2007; they were then reviewed, edited and enriched to produce the five volumes that now constitute the series.
Each situation is different

Examples are used throughout the modules to make them more interactive and relevant to the learner or trainer. A majority of these examples refer to highly impacted countries of southern Africa, but others are drawn from the Caribbean, where high HIV prevalence levels have frequently been documented. Each epidemiological situation is different: the epidemic affects a particular country differently depending on its traditions and culture, and on the specific educational and socio-economic problems it faces. Understanding this, the strategies and responses you adopt will need to be context-specific. The suggestions offered in this set of modules constitute a checklist of points for you to consider in any response to HIV and AIDS.
In some countries, different ministries are in charge of education in addition to the ministry of education. For example there may be a separate ministry of higher education, or a ministry for technical education. For clarity, we shall use the terms ministry of education when referring to all education ministries dealing with HIV and education matters.
Structure of the series

This series contains 22 modules, organized in five volumes. There are frequent cross-references between modules to allow trainers and learners to benefit from linkages between topics. HIV and AIDS fact sheets and an HIV and AIDS knowledge test can be found in Volume 1 to allow you to review the basic facts of HIV transmission and progression. At the end of all the volumes is a section of reference tools including a list of all the web sites and downloadable resources referred to in the modules, as well as an HIV and AIDS glossary.
The volumes
Not all modules will be of relevance or interest to each learner or trainer. Five core modules have been identified in Volume 1. It is recommended that you read and complete these before choosing the individual study route that best serves your professional and personal needs.
Volume 1, Setting the Scene, gives the background to how HIV and AIDS are unfolding in the larger society and within schools. HIV and AIDS influence the demand for education, the resources available, as well as the quality of the education provided. The different modules should allow you to assess better the impact of HIV and AIDS on education and on development, and will allow you to understand the environment in which you are working before articulating a response.
Volume 2, Facilitating Policy, helps you to understand how policies and structures within the ministry promote and sustain actions to reduce HIVrelated problems in the workplace and in the education sector. Supporting policy development and implementation requires a detailed understanding the issues influencing people and organizations with regards to HIV and AIDS.
In Volume 3, Understanding Impact, you will assess the need to gather new data to understand the impact of HIV and AIDS on the education system in order to inform policy-making. You will then learn different approaches to collecting and analyzing such data.
Volume 4, Responding to the Epidemic, will provide you with concrete tools to help you plan and implement specific actions to address the challenges you face responding to HIV and AIDS. It will prepare you prioritize your actions in key areas of the education sector.
The last volume in the series, Volume 5, Costing, Monitoring and Managing, focuses on costing and funding your planned response, monitoring its evolution and staying on target. The management checklist at the end provides you with a comprehensive framework to advocate, guide and inform the planning and management of your HIV and AIDS response.
The modules
Each module has the same internal structure, comprising the following sections: Introductory remarks: Each author begins the module by stating the aims and objectives of the module and making general introductory remarks. These are designed to give you an idea of the content of the module and how you might use it for training. Questions for reflection: This section is to get you thinking about what you know on the topic before launching into the module. As you read, the answers to these questions will become apparent. Some space is provided for you to write your answers, but use as much additional paper as necessary. We recommend that you take time to reflect on these questions before you begin. Activities and Answers to activities: The activities are an integral part of the modules and have been designed to test what you know as well as the new knowledge you have acquired. It is important that you actually do the exercises. Each activity is there for a specific reason and is an important part of the learning process. In each activity, space has been provided for you to write your answers and ideas, although you may prefer to make a note of your answers in another notebook. You will find the answers to the activities at the end of the module you are working on. However, in some cases, the activities and questions may require country-specific information and do not have a right or wrong answer (e.g. Explain how your ministry advocates for the prevention of HIV). As much as possible, sources are suggested where you could find this information. Summary remarks/Lessons learned: This section brings together the main ideas of the module and then summarizes the most important aspects that were presented and discussed.
Bibliographical references and resources: Each author has listed the cited references and any additional resources appropriate to the module. In addition to the cited documents, some modules provide a list of web sites and useful resources.
Teaching the series: using the modules in training courses

As stated above, these modules are designed for use in training courses or for individual use. Trainers are encouraged to adapt the materials to their specific context using examples from their own country. These examples can be usefully inserted in a presentation or lecture to illustrate points made in the module and to facilitate an active discussion with the learners. The objective is to assist learners to reflect on the situation in their own country and to engage them with the issue. A number of activities can also be carried out in groups. The trainer can use answers provided at the back of the modules to add on to the group reports at the end of the exercise. In all cases, the trainer should prepare the answers in advance as they may require country-specific knowledge. The bibliographic references can also provide useful reading lists for a particular course.
Your feedback
We hope that you will appreciate the modules and find them useful. Your feedback is important to us. Please send your feedback on any aspect of the series to: hiv-aids-clearinghouse@iiep.unesco.org it will be taken into account in future revisions of the series. We look forward to receiving your comments and suggestions for the future.
Enjoy your work!
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List of abbreviations
ABC ACU ADEA AIDS ART ARV BCC BRAC CA CAER CBO CCM CDC CRC CRS DAC DEMMIS DEO DFID DHS EAP ECCE EDI EdSida EFA EMIS ESART FAO FBO FHI FRESH FTI Abstain, be faithful, use condoms AIDS control unit Association for the Development of Education in Africa Acquired Immune Deficiency Syndrome Antiretroviral therapy Antiretroviral Behaviour change communication Bangladesh Rural Advancement Committee Cooperating Agency Consulting Assistance on Economic Reform Community-based organization Country Coordination Mechanisms (Global Fund) Centers for Disease Control and Prevention Convention on the Rights of the Child Catholic Relief Services Development Assistance Committee (OECD) District education management and monitoring information systems District education office Department for International Development Department of Human Services Employee assistance programmes Early childhood care and education EFA Development Index Education et VIH/Sida Education for All Education management information system Education Sector AIDS Response Trust Food and Agricultural Organization Faith-based organization Family Health International Focusing Resources on Effective School Health Fast Track Initiative
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GFATM GIPA HAART HAMU HBC HDN HFLE HIPC HIV HR IBE ICASA ICASO IDU IEC IFC IIEP ILO INSET IPPF KAPB M&E MAP MDG MIS MLP MoBESC MoE MoES MoHETEC MSM MTEF MTCT MTT
Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People living with or Affected by HIV and AIDS Highly active antiretroviral therapy HIV and AIDS Management Unit Home-based care Health and development networks Health and family life education Highly indebted poor countries Human Immunodeficiency Virus Human resources International Bureau of Education International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa International Council of AIDS Service Organizations Injecting drug user Information, Education, and Communication International Finance Corporation International Institute for Educational Planning International Labour Organization In-service education and training International Planned Parenthood Federation Knowledge, attitudes, practices and behaviour Monitoring and evaluation Multi-Country AIDS Program (World Bank) Millennium Development Goals Management information system Medium-to-large-scale project Ministry of Basic Education, Sport and Culture Ministry of education Ministry of Education and Sports Ministry of Higher Education, Training and Employment Creation Men who have sex with men Medium-term expenditure framework Mother-to-child transmission Mobile Task Team (MTT) on the Impact of HIV and AIDS on Education
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NAC NACA NDP NFE NGO NTFO OOSY OVC PAF PEAP PEP PEPFAR PMTCT PREP PRSP PSI PTA SACC SAfAIDS SGB SIDA SMT SP SRF SRH STI TB TOR UN UNAIDS UNDG UNDP UNESCO UNFPA UNGASS
National AIDS Council National AIDS Co-ordinating Agency National Development Plan Non-formal education Non-government organizations National Task Force on Orphans Out-of-school youth Orphans and vulnerable children Programme Acceleration Funds (UNAIDS) Poverty Eradication Action Plan Post-Exposure Prophylaxis (US) President's Emergency Plan for AIDS Relief Prevention of mother-to-child transmission Pre-exposure prophylaxis Poverty reduction strategy paper Population Services International Parent-teacher association South African Church Council Southern Africa HIV and AIDS Information Dissemination Service School governing body Swedish International Development Cooperation Agency School management team Smaller project Strategic response framework Sexual and reproductive health Sexually transmitted infection Tuberculosis Terms of reference United Nations Joint United Nations Programme on HIV/AIDS United Nations Development Group United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations Population Fund United Nations General Assembly Special Session on HIV/AIDS
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UNICEF UP UPE USAID VCCT VCT VIPP WCSDG WHO WV
United Nations Children's Fund Universal precautions Universal primary education United States Agency for International Development Voluntary (and confidential) counselling and testing Voluntary (HIV) counselling and testing Visualization in participatory programmes World Commission on the Social Dimensions of Globalization World Health Organization World Vision
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HIV and AIDS knowledge test

Adapted from UNAIDS
Before you begin, you may want to check your knowledge on HIV and AIDS. The answers are given on page 200. For more information, you can reference the HIV and AIDS fact sheets and the HIV and AIDS glossary located at the end of the volume on pages 189 and 195. PART 1: Please answer the following questions by selecting the best answer. There is only one answer for each question. 1. Approximately how many people in the world are living with HIV? A. 2,000,000 B. 12,000,000 C. 40,000,000 2. In what region can the largest number of people living with HIV currently be found? A. Asia and the Pacific B. Sub-Saharan Africa C. Latin America and the Caribbean D. North America E. Central and Eastern Europe 3. What does the acronym HIV stand for? A. Hemo-insufficiency virus B. Human immunodeficiency virus C. Human immobilization virus 4. What does the acronym AIDS stand for? A. active immunological disease syndrome B. acquired immune deficiency syndrome C. acquired immunological derivative syndrome D. acquired immunodeficiency syndrome 5. What is the main means of HIV transmission worldwide? A. unprotected heterosexual sex B. homosexual sex C. intravenous drug use D. mother-to-child transmission 6. Spread of HIV by sexual transmission can be prevented by: A. abstinence B. practising mutual monogamy with an uninfected partner C. correct use of condoms D. all of the above 7. Women are most likely to contract HIV through: A. unprotected heterosexual sex B. injecting drug use C. contaminated blood
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8. HIV can be contracted from: A. condoms B. kissing C. mosquito bites D. drinking from the same glass as an infected person E. sharing a spoon with a person living with HIV F. sharing a toothbrush with someone who is living with HIV G. all of the above H. none of the above 9. Risk of contracting HIV is increased by: A. being infected with another sexually transmitted infection (STI) B. having poor nutrition C. having a cold 10. Pregnant women infected with HIV: A. can reduce chances of transmitting HIV to her unborn child by maintaining a low viral load and staying in good health B. can take medication to reduce the risk of mother-to-child transmission during childbirth C. all of the above 11. List the four main body fluids that, when infected, may transmit HIV. 1. 2. 3. 4. 12. List the four main ways HIV is transmitted. 1. 2. 3. 4. PART 2: Please state whether the statement is True or False. 1. If a person has HIV, they will always develop AIDS. 2. HIV is present in blood, sexual fluids and sweat.
3. Abstaining from (not having) sexual intercourse is an effective way to avoid being infected with HIV. 4. When a person has AIDS, his or her body cannot easily defend itself from infections. 5. A person can get the same sexually transmitted infection more than once.
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6. There is a cure for AIDS. 7. If a pregnant woman has HIV, there is a still a chance she will not pass it to her baby. 8. A person can get HIV infection from sharing needles used to inject drugs. 9. Many people with sexually transmitted infections, including HIV, do not have symptoms. 10. HIV can be easily spread by using someone's personal belongings, such as a toothbrush or a razor. 11. A person can look at someone and tell if he or she is infected with HIV or has AIDS. 12. It is possible to avoid becoming infected with HIV by having sexual intercourse only once a month. 13. A condom, when used properly, provides excellent protection against sexually transmitted infections, and can prevent transmission of HIV. 14. An effective vaccine is available to protect people from HIV infection.
15. A person can be infected with HIV for 10 or more years without developing AIDS.
16. You can get HIV by kissing someone who has it. 17. A person can be infected with HIV by giving blood in an approved health facility. 18. Ear-piercing and tattooing with unsterilized instruments are possible ways of becoming infected with HIV. 19. A person can get HIV by being bitten by a mosquito.
20. A person can avoid getting HIV by eating well and exercising regularly.
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Module
M.J. Kelly C. Desmond D. Cohen
The impacts of HIV/AIDS on development
1.1
About the authors

Michael J. Kelly is Chairperson of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He was Professor of Education at the University of Zambia, is a member of the Jesuit Order and specializes in the areas of policy development, education and development, educational planning and educational management. He also has particular expertise in curriculum development and teacher education. Christopher Desmond is an economist, specializing in the impact of HIV and AIDS on development, with a particular interest in economic impact and modelling, public health, policy and management issues related to the HIV and AIDS epidemic and affected children. He is a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. Desmond Cohen is an economist who was formerly Director of the HIV/AIDS and Development Programme of UNDP. He has worked in many countries in Africa for UN agencies on the impact of HIV and AIDS and has focused his work in recent years on the effects of HIV and AIDS on human resources and how to develop policies and programmes that sustain capacity in both the public and private sectors.
Module 1.1
THE IMPACTS OF HIV/AIDS ON DEVELOPMENT
Table of contents
Questions for reflection Introductory remarks 1. The challenges posed by HIV and AIDS 2. HIV, gender and culture 3. HIV/AIDS and poverty Individuals Households 4. AIDS, development and economic growth Subsistence agriculture The private sector The public sector 5. Implications for the education sector Poverty, HIV and AIDS, and education Supply and demand Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 1.1: The impacts of HIV/AIDS on development
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Aims
The aims of this module are to: alert you to the many social, cultural, economic and political factors that influence the spread and impact of HIV and AIDS; enable you to see the relevance for education of the interactions between the epidemic and the contextual factors within which it is embedded.
Objectives
At the end of this module you should be able to: present HIV and AIDS within a comprehensive socio-cultural and economic framework; identify relationships between HIV and AIDS on the one hand and other developmental issues in society on the other; distinguish between manifestations of the epidemics impacts, its immediate causes, its underlying causes, and its structural causes; give examples of ways in which HIV and AIDS magnify the scale of the challenges that the socio-cultural and economic context poses for education.
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Before you begin

Questions for reflection
Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. On what sectors, aside from that of health, do you think HIV and AIDS may be having a significant impact in society?
What reasons would you give for saying that AIDS is largely a disease associated with men or for saying that it is largely associated with women?
Are HIV and AIDS linked to poverty? If so, in what ways?
Does AIDS have an impact on economic growth?
In what ways does the education sector have an important role in fighting the impacts of HIV and AIDS on development?
Now look over your responses and identify those that might be of special relevance to education.
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Module 1.1
THE IMPACTS OF HIV/AIDS ON DEVELOPMENT
Introductory remarks
The first published information on AIDS appeared in June 1981. Within a few years cases of the epidemic were being reported with increasing frequency in almost every part of the world. In view of what we now know about the length of time between HIV infection and the appearance of AIDS, it seems certain that widespread HIV infection must have been occurring some time during the 1970s, if not earlier. Quite understandably, the first attempts to deal with the new disease were almost entirely medical and epidemiological1. While the epidemiological approach addressed issues of human behaviour, it did not extend to other major contextual factors affecting the spread of HIV or its impact on society. Several years were to pass before it was recognized that HIV and AIDS affect the functioning of society at every level. Likewise several years passed before it came to be recognized that the way society operates, and the way it is structured, have major implications for the AIDS epidemic. HIV and AIDS are a developmental issue that extends beyond medical and epidemiological concerns, and this has major implications for the response to the epidemic. Any response to the epidemic must take account of the contribution of society, and how society relates to successes and failures in dealing with the epidemic. The fact that the global response has so far had no more than very limited and partial success may be attributed in large part to a failure to pay adequate attention to this complex, two-way interaction: between the epidemic and society on the one hand, and between society and the epidemic on the other. A sustainable and comprehensive response to HIV and AIDS is a complex matter. The response consists of three components, each of which needs to be present and functioning at the same time: 1. a broad based conceptual framework; 2. an empowering environment where relevant action can take place; and 3. an inclusive package of programmes dealing with prevention: care, support and treatment; and mitigation of the epidemics negative impacts. Working from an educational perspective, this module outlines a number of the social, cultural, economic and political factors that influence the spread and impact of HIV and AIDS. It also draws attention to the way interactions between the
1
Medicine is the science of health in individuals. Epidemiology is study of the spread of disease in communities, nationally or internationally.
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epidemic and the contextual factors within which it is embedded have relevance for the education sector.
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1.
The challenges posed by HIV and AIDS

HIV and AIDS confront us with two challenges: The disease: This is the medical and epidemiological condition of HIV infection and/or AIDS in individuals and communities. The developmental problem: This arises from the social and developmental impacts of widespread HIV infection, when infected individuals are found across a country or region. The most immediate impacts of HIV and AIDS lie in the infection, illness or death of individuals. When infection becomes widespread in a community, it constitutes an epidemic. If the epidemic extends to several countries it is sometimes referred to as a 'pandemic'. HIV infection, the likely ensuing illnesses and the possibility of a premature and distressing death have immediate and devastating consequences for the person concerned and for his/her immediate family. This impact at the individual level must never be overlooked. Behind all the statistics and reports of impacts on socioeconomic situations are men, women and children, experiencing a heartbreaking mixture of fear and anxiety, physical pain and disability, isolation and rejection, loneliness and depression, anger and guilt. No matter how technical, theoretical or frequent your encounter with AIDS-related issues, never forget the individual human beings who are affected. Their personal situation motivates all of us to do what we can to understand the epidemic, to reduce its transmission, and to lessen its numerous impacts. Figure 1 presents an organizing or conceptual framework for thinking about and addressing HIV and AIDS. It consists of five boxes. Box 2 represents the condition of living with HIV or AIDS.
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Figure 1: Levels of causality for HIV and AIDS Manifestations of the impacts of HIV and AIDS Increased personal and household poverty National economies growing more slowly than in a no-AIDS situation Depletion in the national pool of skills and capacities Increase in the scale of management problems Overstretching of health systems Debilitated education systems Social systems and networks overwhelmed Substantial reduction in size of the agricultural workforce Chronic food insecurity Environmental degradation (soils, crop diversity, fishing grounds, water resources) Decline in social capital Growing management and governance problems Changing cultural norms, practices and expectations Changing population structure Increase in single-parent, female-headed and child-headed households Large number of orphans and vulnerable children Increased burden of childcare on the elderly and grandparents Inadequate protection of human rights AIDS deaths Opportunistic illnesses HIV infection Immediate causes Unprotected sex with an infected person Mother-to-child transmission Transfusions of infected blood Sharing piercing or injecting equipment with an infected person Underlying causes Permissiveness in sexual values and practices Ignorance Peer or social pressure Sexual abuse, violence and rape Commercial and transactional sex Substance abuse Personal poverty Low health and nutritional status Cultural practices
Structural causes Gender inequalities Poverty in society Joblessness Absence of recreational outlets 5 Migration War and conflict North-south relations Corruption Structural adjustment and HIPC conditionalities The first box in Figure 1 lists some of the ways in which HIV and AIDS impact on aspects of individual, social and economic life. We will be discussing some of these in the pages that follow. Note that there are many other impacts that are not
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shown in this box. The first activity in this module invites you to think of some of these yourself.
Activity 1
Make a list of some impacts of HIV and AIDS at individual, household or society level other than those shown in Figure 1.
Some possible answers for this activity (and for the activities that will follow) are provided at the end of the module.
Boxes 3, 4 and 5 of Figure 1 are important for our understanding of the epidemic. If we could deal properly with the issues appearing in these boxes we would be successful in stopping further transmission of HIV. But so far we have not managed to do this. One reason is that we tend to focus very strongly on HIV/AIDS itself and on the immediate causes of HIV transmission. At the same time we may fail to take account of factors that are working at a deeper level. These are the underlying and structural causes that enable HIV and AIDS to spread (see Figure 2). The immediate causes of HIV that appear in Figure 1 are like the surface roots of a tree. These roots are important but do not by themselves account for the vigorous life of the tree. Even if you cut away almost all the surface roots, a tree will continue to live because of the roots that go down deeper. The only way to kill the tree is to dig deep and cut all the roots. You must cut those spreading out fairly near the surface, or what Figure 1 calls the 'underlying causes'. But you must also cut the deep roots that go far down into the ground and enable the tree to survive even in the most difficult circumstances. These deep roots can be compared to the 'structural causes' that make it possible for HIV and AIDS to flourish. When people say that a multisectoral approach must guide the response to the AIDS epidemic, what they mean is that the response must address the causes of HIV and AIDS at all three levels the immediate causes, the underlying causes, and the structural causes. Important areas in the struggle with HIV and AIDS are a well-functioning, properly resourced health system, and an education system that ensures that every boy and girl can remain enrolled for several years in a school offering good quality education. Many governments with limited resources have found themselves strained or incapable of making the necessary investments in health and education. In the health arena, one outcome is clinics that do not have the medical supplies needed to treat sexually transmitted infections (STIs) or the opportunistic
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illnesses of persons living with HIV and AIDS. An outcome for education is a ceiling on the number of people who may be employed, leading to schools (especially those in rural areas) not having enough teachers, or school developments being curtailed because additional teachers cannot be employed, even though large numbers of qualified teachers are without employment. The limitations that various conditions impose on both of these sectors constrain their ability to strengthen their positive response to HIV and AIDS, and the constraints contribute to the continued occurrence of the epidemic. Figure 2: Contextualizing HIV and AIDS: underlying and structural causes
Source: UNAIDS, 2005.
Ignorance illustrates how factors that lead to HIV work their way up from below. As is often stressed, knowledge alone, when not accompanied by the adoption of safe practices, will not protect an individual from HIV infection, but ignorance can greatly increase individual risk. There is no way of telling by appearances alone whether or not a person is HIV-infected. A young person who is unaware of this and thinks that there will be bodily signs to show that an individual is infected is at heightened risk of a sexual encounter that could lead to HIV transmission. In addition, everybody needs to know how to protect themselves against HIV infection. Ignorance in this regard contributes to the possibility of being infected by HIV and hence is an underlying cause for the amount of infection that is occurring. The importance of proper knowledge also points out the benefits of teaching children about HIV and AIDS.
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Activity 2 invites you to continue your personal reflections by trying to relate some of the other underlying and structural causes to HIV and AIDS.
Activity 2
Write a short paragraph to describe the way in which each of the following might contribute to the spread of HIV.
Peer and social pressure
Substance abuse
Low health and nutritional status
Joblessness
War and conflict
Corruption
Before you move on to the material that follows, make your own attempt at linking each of the causes or situations presented in the bottom two boxes of Figure 1 with the occurrence of HIV and AIDS and subsequently with the impacts of the epidemic on individuals, households or sectors of society. You will find help for this in books by Barnett and Whiteside (2002), Jackson (2002), and Weinreich and Benn (2004) that provide extensive background for our understanding of HIV and AIDS, its many levels of causality and its many impacts. These books are listed in the Bibliography towards the end of the module.
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2.
HIV, gender and culture

When we hear the word 'gender' we almost invariably think of something that concerns women. But gender refers to men as much as to women. Since gender is rooted in such aspects of culture as norms, customs and practices, this section of the module will examine, from female, male and cultural perspectives, the framework within which HIV/AIDS occurs. The world has become increasingly aware of the female face of the AIDS epidemic. This is because of the steady annual increase in the proportion of women infected with HIV. This proportion has now risen to over 45 per cent. The feminization of HIV and AIDS is most pronounced in sub-Saharan Africa where an estimated 57 per cent of those infected at the end of 2005 were women. Indeed, in every country south of the Sahara, more than half of the infected are found to be women and girls. This situation is likely to worsen. Infection rates among young women in the age-range 15-24 are considerably higher than those of young men of the same age. Globally there were an estimated 6.2 million young women living with HIV and AIDS at the end of 2003, compared with 3.8 million young men, and in Africa the estimates were 4.7 million young women and 1.5 million young men. As these young people grow into mature adults, the proportion of infected women in the older age groups will steadily rise. HIV and AIDS have a disproportionately severe effect on women and girls for the following reasons: Physiological factors put them at higher risk of HIV infection. They have extensive, easily lacerated tissues in their vaginal area; they are exposed during sexual intercourse to a large volume of high-risk body fluids; sexually transmitted infections (STIs) may remain undetected. Because of poverty and/or early or frequent pregnancies, women and girls may experience a run-down health condition that in itself heightens their risk of infection. Women and girls are more vulnerable to HIV infection on social grounds. They have limited power to negotiate sex or the circumstances of sex. Though married and faithful, they remain vulnerable because their husbands may not be faithful or allow them to negotiate sex or condom use. Their male partners enjoy considerable economic as well as geographic freedom and mobility factors that increase the possibility of infecting the spouse with HIV. Their male partners tend to be considerably older, and therefore possibly more sexually experienced. Across Africa male partners have been found to be on average six years older than the women with whom they have intercourse. Women and girls are more vulnerable to HIV infection on economic grounds. Economically they are subordinate to men, with less access to capital or credit. Frequently they receive inadequate financial support from their partner but have to apply their own ingenuity, labour and resources to maintaining the household. They bear most of the financial and caring
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burden for young children and in some cases, can only ensure household and child survival through prostitution. Where AIDS care is needed, women and girls carry much of this burden. They take on responsibilities for the sick and orphans; they continue to provide care, attend to their household chores, and generate income even when they are personally infected or ailing; they receive inadequate support from social systems; they may be exposing themselves to situations of high-risk through caring for AIDS patients in the home; many suffer from burn-out or sicken and die at a young age.
The social, economic and care aspects of the vulnerability of girls and women to HIV infection are clearly related to cultural norms, expectations and practices governing womanhood. Equally, men are influenced by cultural beliefs, norms and practices governing manhood. Although the precise expression may differ from society to society, international experience shows that the following are usually true: Every society has different sexual expectations for women and men. In heterosexual relationships, men and boys are almost always regarded as being in a stronger decision-making position than women and girls. The majority of cultures ascribe to women a passive, subordinate role, particularly in the sexual sphere. Women are generally expected to be docile, submissive, accepting, unquestioning and faithful, and frequently it is regarded as preferable that they should not show themselves to be well-versed in sexual matters. In many cultures, sexual experience and having many sexual partners are seen as matters of male prestige.
It is taken for granted in many societies that boys should have many girlfriends, whereas a girl should stick to one boy. These different sexual expectations put strong pressure on young people, whatever their sex, to act accordingly. These 'macho' expectations put men and boys and their sexual partners at risk of HIV infection.
Even though they are nearly universal, these norms and expectations are not inevitable. They have been constructed by the societies in which they occur and are transmitted through the socializing processes of society. Since they have been socially formed, they can be socially changed. Ministries of education, working with community, religious and other leaders, have a key role to play in bringing about positive transformations in the image and practice of what it means to be male and what it means to be female. Ministries have scope to work here with the media and the entertainment world so that gender perspectives that reflect more closely the fundamental equality of men and women begin to prevail. Achieving this change will be a long and slow task, but it is something that can be progressively improved on with each new generation of young people entering the education system. This process calls for a rights-based education that will foster lived acceptance that men and women are diverse, complementary and equal.
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Activity 3
Try to obtain some primary school textbooks, say for grades 4 or 5 (or books for children). Read two or three chapters (or stories) and look at the illustrations. To what extent do the text and illustrations portray women and girls in more subordinate, passive roles while men and boys are shown as adopting active, leadership roles? Do you find much in the books that shows women and girls as either taking the lead or being at least as active and vigorous as boys and men? What gender message do you see being communicated by material like this?
In addition to gender, cultural norms and practices are critical factors in the response to the AIDS epidemic. Some of these have been singled out as contributing to the spread of HIV infection: forced early marriage of young girls; tattooing and scarification carried out with non-sterilized equipment; widow inheritance; widow-cleansing; the belief that AIDS comes from a sorcerers curse or the violation of a taboo. Moreover, urbanization, migration, globalization and declines in cultural and social control have contributed to changes in the way people view sexual relationships. These changes have been speeded up by cultural relationships between the developing and developed world, with developing countries adopting many of the standards, norms and expressions of the developed countries, not always with beneficial consequences. In many respects, the AIDS epidemic is a product of globalization. Its spread became possible because of growing world interconnectedness through rapid transportation, international trade routes, and large-scale population flows. Box 1 Excerpt from On India's roads, cargo and a deadly passenger
India's entry into the global economy over the past 15 years may also be furthering the spread of AIDS. With rising incomes, men have more money for sex; poor women see selling sex as their only access to the new prosperity. Cities are drawing more migrants and prostitutes, and Western influences are liberalizing Indian sexual mores. In response, cultural protectionists are refusing to allow even the national conversation about AIDS to reflect this changing reality (Waldman, 2005).
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But there are numerous elements in traditional and cultural life that can contribute positively to the struggle against the epidemic. If anti-AIDS strategies and campaigns are to make headway, they must take serious account of these and capitalize on their potential. These positive elements include: the potential that initiation periods offer for sound sexual education; the fairly widespread practice of male circumcision (a factor that almost certainly helps to reduce HIV transmissibility); the knowledge and accessibility of herbal and traditional healers and their approach to an infected person as an integrated human being who is a member of a concerned community; the sense of family, community, solidarity and participation; respect for the sacredness of human life; perspectives that underline the role of sexual relationships in the formation and strengthening of kinships. It is too simplistic to discredit the majority of cultural beliefs and practices as contributing to the spread of HIV. The truth is otherwise. Many of them can be powerful allies in the struggle against the epidemic. There is a need for more knowledge in this area and for approaches that are more sensitive to what the cultural context has to offer.
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3.
HIV/AIDS and poverty

Three facts are important for understanding the links between poverty and HIV/AIDS: Poverty does not cause AIDS. The cause of the disease is the human immuno-deficiency virus (HIV). HIV/AIDS is not a disease of poor countries. The disease first came to public attention in the United States, a very wealthy country, where it continues to infect more than a million individuals. Likewise, two of the wealthiest countries in Africa, Botswana and South Africa, are among the most severely affected countries in the world. HIV/AIDS is not a disease of poor people. Although across Africa, throughout Asia, in Latin America and in the Caribbean, there are countless individuals who are poor to the point of destitution, the great majority of these are not infected with HIV.
Nevertheless, HIV, AIDS and poverty are very closely intertwined. The poor are at higher risk of HIV infection. They are also more vulnerable to HIV infection. Furthermore, HIV and AIDS tend to make the poor poorer. These connections between HIV/AIDS and poverty are shown in Figure 3 and are developed below. Figure 3 Ways in which HIV, AIDS and poverty relate to each other.
AIDS and poverty
Poor are at high risk of HIV infection.
Poor are vulnerable to HIV infection.
Poor become poorer because of HIV and AIDS.
On health grounds
On socioeconomic grounds
Because of what it means to be poor
Costs increase.
Incomes and resources decrease.
Resources are spent on HIV and AIDS.
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Individuals
The poor are at higher risk of HIV infection for the following reasons: It is less easy for the poor to access health services, and this in turn increases the possibility of their having untreated STIs, a factor that greatly increases the risk of HIV infection. Poor people are more likely not to have information about their personal HIV status or the status of their sexual partner. There is a greater possibility that the poor will engage in unprotected sexual activity because they cannot afford to buy condoms, do not have the facilities for storing them correctly, or they have sex in conditions that make it difficult to use them properly. Some poor people may have to sell sex for income, especially women and girls. The poor are more vulnerable to HIV infection on health grounds because of: their poor health and low nutritional status; their limited access to health care; the non-availability of health services in places where the poor live; their inability to pay for treatment or afford the opportunity costs associated with health care; their increased exposure to other health hazards such as malaria, tuberculosis, or gastro-intestinal problems; the crowded and unsanitary conditions in which many of them are required to live, without access to safe water supplies. Poor people also live under the following conditions: There is less scope in their lives for real choices affecting such areas as their work, where and how they live, what they will spend their money on, and how they will occupy themselves during their free time. They live under considerable pressure to meet immediate needs and have few incentives to delay gratification. The pressures they experience in meeting their daily living requirements make it unrealistic and difficult for the poor to be concerned about a disease that may not affect them until after many years have passed.
Households
In addition, AIDS makes the poor poorer because it reduces incomes and resources, increases costs, and makes it necessary to divert household resources to payments for medical, care and funeral costs. Household economies are affected by the loss of jobs, the inability to maintain existing levels of farm production or other output, the need to use up savings, the time that must be devoted to attending to the needs of the sick, the increased costs associated with caring for orphans, the selling-off of capital assets needed for production purposes,
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high funeral costs, and the inability of family and other households to provide the same levels of support and assistance as in the past. The purchasing power of the market is affected because the disease reduces private incomes while increasing costs. There may also be a negative market effect when individuals die before they have finished paying for goods they have purchased. The literature provides extensive evidence of these impacts and the way they can even cause households to disintegrate and family members to disperse. See for example, Barnett and Whiteside, (2002: chapter 7) and Jackson, (2002: 330-342). Three further examples can be cited here. A study of AIDS-affected households in Zambia showed that in two thirds of the families where the father had died, monthly disposable income fell by more than 80 per cent. In Ethiopia, AIDS-affected households were found to spend between 11.6 and 16.4 hours per week in agriculture, compared with a mean of 33.6 hours for non-AIDS-affected households. In Zimbabwe, a bedridden AIDS patient was estimated to cost the affected household an additional US$23-34 per month. If you know a household in which a person is suffering from AIDS, keep its circumstances in the forefront of your mind as you do Activity 4.
Activity 4
Make a list of the ways in which the income and expenditure patterns of a household would be affected if one of its members developed AIDS. What strategies could the household adopt to cope with these changed circumstances?
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4.
AIDS, development and economic growth

The epidemic has a negative effect on economic growth because it cuts away at the necessary human, physical and social capital. The disease reduces the stock of human capital because it mostly affects adults in their economically productive years (those aged 15-49). Since significant development of human capital takes place at the household level, sickness and death of a household member, especially a parent, may leave the younger generation with nobody to pass on to them the necessary knowledge and skills. The readiness with which AIDS-affected families take children out of school causes further disruptions in basic human capital formation. HIV and AIDS lead to a reduction in physical capital because families have to draw immediately on savings, at both household and public levels. It also affects the incentive to save at household level. Earlier-than-planned-for pension payments and the early payment of terminal benefits steadily eat into private sector and national investments. A governments ability to save is constrained by increased expenditures arising from efforts to provide treatment and care for AIDS-related illnesses and to recruit and train public sector personnel to replace those lost to the disease. The epidemic reduces social capital the norms, networks, institutional memories and understandings that promote the smooth working of society because of the absence or premature deaths of those with the knowledge and experience needed for getting things done effectively and efficiently. As a result, governments may experience difficulty in providing basic social services, ensuring security, providing efficient economic management, and developing necessary regulatory and legal frameworks.
Subsistence agriculture
Consider the impact of the epidemic on agriculture. Agriculture is the main activity of a large proportion of the people in the world. This is especially the case in the developing countries of Africa and East and South-East Asia. The impacts of HIV and AIDS on agriculture put the lives and welfare of this vast number in jeopardy. According to global estimates from the Food and Agricultural Organization (FAO), it is possible that by 2020 the disease will have claimed 26 per cent of the agricultural labour force in Namibia, 23 per cent in each of Botswana and Zimbabwe, 20 per cent in each of Mozambique and South Africa, and 17 per cent in Kenya, representing staggering losses of agricultural labour. Most of those who have died are women who make up as much as four fifths of the agricultural workforce. The loss of labour is exacerbated by the time allocated to caring for the sick, since caregivers have to stop working in the fields in order to carry out this function.
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This labour loss has dramatic negative consequences. The impoverishment of rural households average treatment and mourning costs are estimated to consume more than three times the average annual farm income. A shift from labour-intensive crops to those that are less demanding and often less nutritious. A decline in the area of land being cultivated, with remote fields often being left fallow. A decrease in the range of crops being cultivated, leading to a decline in plant diversity. Livestock and other farm assets being sold to pay the medical costs of AIDS treatment and palliative care or being used at funerals. Failure to transmit agricultural knowledge and skills among and between generations, households and communities. Increased reliance on the labour inputs of the elderly and the young (often the very young). A dominant need to give priority to immediate survival. The final outcome is the production of less food and of foodstuffs that are less nutritious. The result is that the AIDS epidemic is leading to a chronic low-grade food crisis in many severely affected communities that are producers of their own foodstuffs.
The private sector

HIV and AIDS impact on the private sector by reducing productivity, increasing costs, diverting productive resources, and affecting the market for business products. During the asymptomatic phase of infection, an employees status has no real consequence for a firm. Once an employee starts to become ill, the employer incurs a number of costs: increased absenteeism, reduced performance levels of the infected worker, additional burdens on the healthy workers, inexperience of replacement workers, increased medical and insurance costs, extensive recruitment and training costs, and payment of funerals and benefits. The transport and mining sectors are particularly vulnerable to these costs. Both sectors require people to work far from where they normally live and this places them at risk, and both sectors stand to lose highly-skilled and expensive employees. In many parts of the developing world HIV and AIDS are also affecting the productivity and profitability of the commercial agricultural sector. As with mining and intensive factory production, the working conditions in the commercial agriculture and horticultural industries frequently place employees in situations that increase their vulnerability to HIV infection away from their families, in lowpaid or high-risk employment, living in single-sex overcrowded quarters, with few recreational outlets, and where the commitment to the long-term employment of unskilled workers is very limited. By accentuating the mobility of vulnerable individuals and failing to give them adequate care when in employment, the forces that promote large-scale mining, factory, agricultural and horticultural enterprises also contribute to the spread of the AIDS epidemic.
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The purpose of the activity that follows is to encourage you to relate some of the issues that have been considered to what goes on in schools and colleges.
Activity 5
1. What steps can the education sector take to equip school children with the skills that many of them will need in the changing AIDS-affected agricultural environment?
2. How can the education sector better sensitize learners to the HIV risks and vulnerabilities that many of them will encounter in the multinational enterprises that dominate todays commercial and industrial world?
The public sector

The government of any country affected by HIV and AIDS is faced with difficult decisions, while at the same time being affected itself. Government is often one of the biggest employers in a country. Provision of services and the running of the administration require that a wide variety of people be employed across the country. This means that infections will occur within the civil service and the associated costs will be incurred. Reduced productivity, however, has different implications than in the private sector. In the private sector, if an employee is not productive, this represents a cost to the organization. In the public sector, however, low productivity is a cost to the people requiring the service. HIV and AIDS therefore affect the ability of the state to deliver services. The severity of this reduced ability will be determined by the rates of infection and who it is that is affected, as the state is also likely to have critical posts within its civil service. The impact on the supply of service affects all aspects of government to a greater or lesser degree. The implications of the epidemic on demand, however, will vary across government sectors. Health is the most obviously affected sector. The rise in illness and death associated with the epidemic increases the demand for health services at a time when health professionals are themselves affected. Again, it is the double impact of increased demand at a time of reduced supply. Governments have difficult decisions to make with regard to the health sector. Even if steps are taken to maintain supply by training additional staff to replace those lost, prioritizations will
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have to occur. Health services in most countries heavily affected by HIV and AIDS were strained even before the increase in demand. If the capacity to meet the new demands is limited, decisions on who and what to treat will need to be made. The AIDS epidemic may, therefore, affect the health not only of those infected but also of others in the community. If governments decide to respond to the increased demand, the manner in which they respond will have a variety of implications. If the decision is made to provide comprehensive treatment in the form of antiretroviral (ARV) drugs, the resource requirements are great. The time of doctors and nurses, the use of facilities, and the costs of the drugs and tests provided make the costs of implementation significant. These costs, however, should not be considered in isolation. Providing ARV will reduce the level of illness, thereby reducing the demand on other areas in the health system and thus freeing up resources. The intervention will, however, need to be financed. The means of financing may well have macro-economic implications. While these are issues that need to be considered, they are difficult to predict and will vary according to the initial economic position in which a country finds itself. Other government sectors are similar to health in that they experience an increase in demand at the same time as a decrease in the ability to meet it. For example, welfare services, where they exist, face families requiring support as a result of illness or death and the demands of orphaned children or children living with, and possibly caring for, dying parents.
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5.
Implications for the education sector

Poverty, HIV and AIDS, and education
The close relationship between HIV and AIDS on the one hand and poverty on the other has several implications for education. Affected households are likely to have fewer disposable resources for spending on the education of their children. The need for children to work around the household and in its production activities may become so great that children are withdrawn from school or allowed to attend only erratically. Girls may be affected in this way more than boys. As a result, the provision of schooling should be tailored much more closely to the needs of the poor, in terms of what is taught, how it is taught and when it is taught. Because of the many ways in which it makes people poorer, and because their poverty makes the poor more susceptible to HIV infection, there is a possibility that HIV and AIDS will become more heavily concentrated among the poor. But because they are less likely to have access to more education, the poor are the ones who will have greater difficulty to benefit from the social vaccine of education. In other words, economic and social deprivation may combine to heighten the vulnerability of the poor to HIV infection. The possibility of this scenario presents educational policymakers and programmers with the challenge of ensuring the access of every child, but especially the poor child, to good quality schooling for as many years as possible.
Supply and demand

Increased poverty will have an impact on the demand for education; that is, the number seeking education. In addition to the factors already enumerated, demand for education faces a decline in high HIV settings because HIV: reduces the fertility of infected women; cuts short the lives of others before they have had all the children they otherwise would have had; and infects some children born to infected mothers. As a result, there are fewer children born and even fewer who survive to schoolgoing age. This leads to a reduction in the demand on the education system. The situation with regard to the demand for education does not mean that fewer teachers and other education personnel will have to be trained. In fact, the epidemic seems to lead to the opposite conclusion. Estimates suggest that, if education personnel have similar HIV prevalence to the general population, the loss of staff will far outstrip the reduction in demand. This means that simply to maintain the current standard of education would require an increase in training. Otherwise, the AIDS epidemic could lead to a decline in standards with resultant negative developmental consequences.
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In the education sector, losses in human resources reduce the capacity of the sector to supply educational services while the impact of HIV and AIDS on other socio-economic sectors creates new and different demands for the services that the education sector supplies. The education sector does not exist in isolation from other productive sectors and will be both a cause of adjustment in other sectors as human resources in the education sector are lost and require replacement, and will also as a sector have to adjust its own objectives and capacities in the light of the impact of HIV and AIDS on other socio-economic sectors. An effective response to the epidemic will be based on an understanding of the ways in which HIV and AIDS affect social and economic activity over time, given that the social and economic impact will differ between sectors, and these differences in impact will also intensify as the epidemic spreads.
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Box 2
Case study: HIV and AIDS impact on the education sector labour force
Consider below a broad categorization of the impact of HIV and AIDS on the education sector labour force: Reduced labour supply in education with a different age and gender composition Loss of skilled and experienced staff of all categories including, professional and manual workers across the education system Disruption of educational activities and increased costs for the education system due to increased levels of staff absenteeism and morbidity and early retirement of experienced staff Stigmatization and discrimination against staff with HIV or AIDS and losses of staff performance as a result, with effects on system performance and on staff morale Increased labour costs for the education system as a whole due to reduced labour productivity, and higher costs due to healthcare expenditure, absenteeism and covering for workers that are sick, funeral costs, pension and other termination payments etc. Replacement of staff in all categories, either temporarily or permanently, thus increasing recruitment and training expenditures and associated with changing levels of system capacity through losses of experienced categories of human resources Changes in the quality as well as the quantity of services provided by the sector with consequent effects on the social and economic system which feeds-back into the performance of the education system as a whole. Losses of key human resource capacities at all levels of the education system, which reduces the capacity of the sector to manage and respond effectively to the complex human resource problems that HIV and AIDS generate. Two important questions arise from the above: What are the most important ways in which attrition of human resources affects the capacity of the education sector to undertake the tasks that are expected of it? In what ways, and with what effects, have education sectors as service providers responded to the losses of human resources identified by broad categories above? For example, many of the ways in which schools are adjusting to losses of teachers due to AIDS, such as changes in class size, have effects on the quality of education that have other indirect impacts on labour productivity throughout the economy.
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Summary remarks
The above discussions have traced some of the impacts of individual illness and death on government and the broader economy, highlighting the economic and developmental implications. HIV and AIDS touch on every facet of society. It cannot be viewed in isolation as either a medical problem or a behavioural problem. Every response must take due account of the socio-economic context within which the epidemic occurs. Of particular importance are the poverty and gender dimensions. HIV/AIDS, poverty, and gender inequalities form a triplet whose members continually reinforce one another. HIV/AIDS boosts and is boosted by poverty and gender inequalities. Poverty boosts and is boosted by HIV/AIDS and gender inequalities. Gender inequalities boost and are boosted by HIV/AIDS and poverty. Ideally every intervention to deal with one of these three issues should include some intervention to respond to the other two. The complexity of the epidemic requires a multisectoral approach that takes account of the fact that many socio-economic and cultural factors determine the geographical, gender, age and socio-economic distribution of HIV in the population. Such factors also play a role in the impact of HIV and AIDS on individuals, families, communities and productive activities. HIV/AIDS and its impacts may be likened to a succession of waves. The first wave that struck was that of HIV infection, but because the infection went unnoticed for many years, the world was not immediately aware of what had happened. The wave of AIDS illness and death has been more obvious. This continues to break upon the world with unrelenting force. There is also the wave of stigma and discrimination with its unfailing power to undermine the dignity of people. In recent years the world has become aware of further waves of the HIV/AIDS impact: the huge number of orphans and vulnerable children; the sometimes neglected population of grandparents and elderly people who look after orphans and the sick; and the undermining of food security and nutritional systems (which will in turn aggravate the risk of HIV infection and progression from HIV to AIDS). These emerging problems call for creative approaches. When surveying the complex environment within which HIV and AIDS occur, the question repeatedly arises: what has the education sector done about this? What is it doing now? What could it be doing? For an educator, understanding the socio-cultural and socio-economic context of HIV and AIDS is not an end in itself. It is a call to action that will change the situation for the better.
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Lessons learned
Lesson One: The importance of going beyond the symptoms In addition to the obvious manifestations of HIV and AIDS and their immediate causes, there are many factors deep down in society, communities and individuals that facilitate the occurrence of HIV infection. The more thoroughly these are understood and taken into account, the greater the likelihood that responses to HIV and AIDS will be successful. Lesson Two: Poverty does not cause HIV/AIDS, but the two are closely intertwined. HIV infection is not confined to the poorest, even though the poor account for most of those infected in sub-Saharan Africa. The relationships between poverty and HIV are far from simple and direct and more complex forces are at work than just the effects of poverty alone. Lesson Three: HIV and AIDS impact on the development and economic growth of a nation. AIDS deepens poverty and increases inequalities at every level: household, community, regional and sectoral. The epidemic undermines efforts at poverty reduction, income and asset distribution, productivity and economic growth. AIDS has reversed progress towards international development goals because of the influence it has on all development targets. Lesson Four: HIV and AIDS reduce governments capacity to provide services and to respond to the disease. By debilitating and killing large numbers of adults of working age, AIDS reduces the operational effectiveness of government institutions in high prevalence countries. This seriously undermines the ability of state institutions to provide their mandated services to the people, and in turn to respond to the increased demand for public services generated by the epidemic. Lesson Five: HIV and AIDS raise questions about the role of education. The education sector has the potential to address many of the issues that underlie the transmission of HIV and its numerous subsequent impacts. However, there is a need for much re-thinking if it is to be successful in playing its role in this regard.
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Answers to activities
Activity 1 At the individual level, the epidemic undermines an individuals potential to lead a long and healthy life, to have access to education and knowledge, to be able to access the resources needed for maintaining a decent standard of living, and to take part in the life and activity of a dynamic community. At the household level, the epidemic makes the poor poorer, leads to such impoverishment of households that they may disappear as units of society, results in the sale of productive assets to cater for income loss and increased outlays. At society level, the epidemic leads to declines in productivity (in industry and agriculture because of sickness and death), rising production costs (because of increased medical and insurance costs and because of the costs of recruiting and training new workers), and uneasy relations within communities (because of stigma and discrimination). Activity 2 Peer and social pressures: men and boys are often under pressure to display a macho image, while girls often feel the need to show their peers that they are in a 'good' relationship. Pressures like these can lead to behaviours that carry the risk of HIV infection. The use of alcohol contributes in two ways to HIV transmission: first, it clouds the ability to think clearly and to exercise self-control, and thereby can lead to risky behaviour; second, the physical effects of alcohol on the body make an affected person more susceptible to HIV infection, and if the person is already HIV positive they make that person a more potent transmitter of the virus. Injecting drug users are also susceptible to infection in two ways: first, like alcohol, drugs cloud the ability to think clearly and exercise self-control; second, if injecting drug users share needles they can easily transmit the disease to one another through minute droplets of infected blood that remain in the needle after use. A person whose health or nutritional status is low is more susceptible to HIV infection than a person who is in good health or well nourished. In addition, there is a higher concentration of HIV in the body fluids of an infected person who is undernourished or whose diet does not contain the necessary micronutrients, and hence that person is a more powerful transmitter of the HIV virus. Joblessness is closely allied to poverty and poor nutritional status and contributes to the spread of HIV through this route. In addition, those without jobs may not see much hope for themselves in the future and hence may take risks that they would not take if they had secure jobs and reasonable incomes. They may feel that it is pointless trying to protect themselves against a disease that will not make its effects felt for several years when they do not have the income or resources to ensure that they can live a humanly decent life in the years in between. Points to consider here are the way war and conflict cause severe disruptions to the civilian population; the way they lead to inability to treat ordinary sicknesses, or
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cause increased hunger and poverty; the use of rape as an instrument of war; the high levels of HIV in armed forces, especially those who are engaged in active combat; the break-up of households; the refugee streams to which conflicts give rise, especially among women and children. Corruption promotes the spread of HIV and AIDS because it takes away resources that were intended to go to the relief of those who are infected, to programmes for prevention, or for responding to the needs of orphans and vulnerable children. Corruption may also mean that there is little effective leadership in the struggle against the disease or that leadership is entrusted to those who are less committed. Corruption may also result in policies being adopted, not because they promise to be the most effective, but because they are the ones to which most resources are attached (with the opportunities for unlawful personal profit that this provides). Activity 3 Income might drop because of inability to work or to carry out farming activities. Income might also drop because attending to a sick person occupies so much of the time of the one generating the income (e.g. a female marketer who cannot devote as much time as otherwise to her work of petty trading). Expenditure might rise because of the need to buy special items for the person who has AIDS better food, soft drinks, soothing creams, tablets for headaches, medicines for an upset stomach, extra soap and bleach for washing bed clothes, extra fuel for boiling water to help keep the person and the surroundings clean, etc. Expenditure might also rise because of the costs of visiting a clinic possibly clinic fees, but also the costs of transport to and from the clinic, the cost of the time spent at the clinic (which is time taken away from other productive work), the costs of medicines that may not be not covered by schemes for free antiretrovirals (e.g. antibiotic creams for thrush). Coping strategies would include using savings; borrowing from relatives, friends or even moneylenders; selling capital assets (e.g. radio, TV, bicycle, oxen), getting help from community and faith-based organizations. More radical coping strategies would include encouraging female members of the family to go into prostitution, arranging an early marriage for a daughter (so as to obtain the 'bride price' or lobola), taking children out of school to work on the farm or in other incomegenerating activities. Activity 4 Books that were published 10 or 15 years ago may show girls and women as teachers, nurses, house servants, cooks, clothes washers, etc. They appear in the background, playing roles that are important but not as prominent as many of those that are shown for men and boys: pilots, doctors, lawyers, drivers, school managers, business executives, sportsmen. More modern books may reflect the changes that are occurring in the way the different sexes are represented, but although this movement is making progress, many texts continue to represent women and girls as occupying 'inferior' positions while men and boys discharge the more 'superior' roles.
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The gender message that came across in the older style books was that women and girls were subordinate to men and boys. The newer style books show greater equality between the sexes and indicate how important it is that pupils be made aware of this from the time they commence school. Activity 5 Possible steps would include: integrating practical agricultural and horticultural education more firmly into the curriculum; developing a school agricultural plot (and not just a school garden) that pupils would manage in co-operation with the community; arranging for demonstrations from successful community farmers; arranging for department of agriculture extension workers to participate in the development of pupils agricultural skills; bringing the school closer to the community. By analyzing the connection between globalization (as practiced) and the spread of HIV and AIDS, pointing out how the ease of transport in todays world has contributed to the spread of the disease and how a multinationals lack of accountability to a local community leaves the livelihoods of that community dependent on decisions made elsewhere (and often in a far-off country) in which they do not participate and over which they have no influence.
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Bibliographical references and additional resource materials

Documents Barnett, T.; Whiteside, A. 2002. AIDS in the twenty-first century. Disease and globalization. Basingstoke, Hampshire: Palgrave MacMillan. Jackson, H. 2002. AIDS Africa. Continent in crisis. Harare: SAfAIDS. Morris, J.T. 2004. HIV/AIDS and hunger. In: Washington Times, 12 January 2004. Rugalema, G. with Weigang, S. and Mbwika, J. 1999. HIV/AIDS and the commercial sector of Kenya. Impact, vulnerability, susceptibility and coping strategies. Rome: Research, Extension and Training Division, FAO. ftp://ftp.fao.org/sd/sdr/sdre/hivken.pdf UNAIDS. 2005. AIDS in Africa: Three scenarios to 2025. Geneva: UNAIDS. www.unaids.org/unaids_resources/images/AIDSScenarios/AIDS-scenarios2025_report_en.pdf UNDP. 1999. Human Development Report 1999. New York: Oxford University Press. http://hdr.undp.org/reports/global/1999/en/ Waldman, A. 2005. "On India's roads, cargo and a deadly passenger". In: New York Times, 6 December 2005. www.nytimes.com/2005/12/06/international/asia/06highway.html WCSDG. 2004. A fair globalization: Creating opportunities for all. Geneva: ILO. www.ilo.org/public/english/wcsdg/docs/report.pdf Other reading Bond, V.; Kwesigabo, G. 2004. Forging the links against AIDS. HIV/AIDS research, policy and practice. HIV/AIDS Report Series No. 1. Stockholm: SIDA. www.sida.se/sida/jsp/sida.jsp?d=118&a=3213&language=en_US Kaiser Family Foundation. 2007. The Multisectoral Impact of the HIV/AIDS Epidemic A Primer. Menlo Park: Kaiser Family Foundation. Downloaded on 24 July 2007 from www.kff.org/hivaids/7661.cfm UNAIDS/WHO. 2006. Report on the global HIV/AIDS epidemic. December 2006. Geneva: UNAIDS www.unaids.org/en/HIV_data/epi2006/default.asp Weinreich, S.; Benn, C. 2004. AIDS. Meeting the challenge. Data, facts, background. Geneva: World Council of Churches Publications.
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Module
M.J. Kelly
The HIV/AIDS challenge to education
1.2
About the author

Michael J. Kelly is Chairperson of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He was Professor of Education at the University of Zambia, is a member of the Jesuit Order and specializes in the areas of policy development, education and development, educational planning and educational management. He also has particular expertise in curriculum development and teacher education.
Module 1.2
THE HIV/AIDS CHALLENGE TO EDUCATION
Table of contents
Questions for reflection Introductory remarks 1.The impacts of HIV and AIDS on the context for education The economic context for education has been affected at every level 2.HIV and AIDS constitute a systemic problem for education 3.The impacts of HIV and AIDS on an education system AIDS and the demand for education 4.HIV and AIDS affect what society expects from its education systems Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 1.2: The HIV/AIDS challenge to education
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Aims
The aims of this module are to: alert you to the wide variety of challenges that HIV and AIDS pose to a formal education system; and enable you to recognize these challenges within a unifying conceptual framework.
Objectives
At the end of this module you should be able to: describe ways in which HIV and AIDS affect the context within which education systems function; explain how the epidemic affects the ability of education systems to function; identify ways in which education systems are changing in response to HIV and AIDS; evaluate the need for further education system changes in response to the epidemic; present an organizing framework for the interaction between HIV and AIDS and education.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module see how your ideas and observations compare with those of the author. Identify some areas where the education ministry in your country has changed its management structures or procedures because of HIV and AIDS.
Identify any changes that have taken place in the staffing and organization of schools and educational institutions as a result of HIV and AIDS.
In what ways has the school curriculum in your country been changed to take account of HIV and AIDS?
How (if at all) has AIDS had an effect on the number of teachers in schools and the time they can give to actual teaching?
How (if at all) is the AIDS epidemic making it more difficult for the education ministry and schools to do their job?
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Module 1.2
THE HIV/AIDS CHALLENGE TO EDUCATION
HIV and AIDS are a new concern for education. Although the World Declaration on Education for All, adopted at the Jomtien Conference in March 1990, embodied worldwide consensus on a renewed global commitment to meeting the basic learning needs of all children, youths and adults, it mentioned neither HIV/AIDS nor orphans. It was only during the 1990s that awareness developed on the implications of the epidemic for education. Recognition that education could also be a significant player in the response to the epidemic grew even more slowly. Both aspects came to the fore at the World Education Forum held in Dakar in April 2000. Acknowledging that HIV and AIDS constitute one of the biggest threats to the global education agenda, the Forum considered: the impact of the epidemic on the education sector; and how HIV/AIDS-specific education can have a beneficial impact on the prevalence of infection. At the close of its deliberations, the Forum committed itself in the Dakar Framework for Action to implement as a matter of urgency education programmes and actions to combat the AIDS epidemic. The developments at Dakar bring out three points that lie at the heart of this module (see overleaf). This module will address these three issues and, more specifically, will examine how HIV and AIDS affect: the context within which education systems function; the way in which education systems function; what society expects from an education system. A comprehensive response to this threefold challenge implies the need for an education sector to move to a systemic approach. This module outlines the fundamentals of what this entails, while more detailed consideration is given in Module 2.1, Developing and implementing HIV/AIDS policy in education.
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Box 1
Excerpts from the Dakar Framework for Action
It is only in this century that education is coming to grips with HIV/AIDS, and because the area is so new there is still much experimentation, trial and error learning, and there are many pilot programmes being tested. The science of HIV/AIDS and Educationis still in its infancy. HIV/AIDS is a new disease that is only slowly being understood. Similarly, educations appropriate response is only slowly being understood. It will certainly require adjustment as more is learned about the disease and about the way education systems chose to respond to it. The epidemic has major impacts on the education sector. Specifically, it greatly enlarges the scale of existing management and systemic problems, while at the same time it undermines the capacity to deal with these problems. As was said at Dakar, what HIV/AIDS does to the human body, it also does to institutions. It undermines those institutions that protect us (UNESCO, 2000: 22). This negative impact of the epidemic on education is systemic. It affects education in the way in which it is organized and managed as a system. Hence the system in its turn has the responsibility to fight back and protect its functioning so that it can successfully deliver educational services in the way that is expected. Society has confidence in the ability of the education sector to help it in its struggle with HIV/AIDS. It recognizes that the struggle to overcome the epidemic is one that every sector must engage in. However, because of educations role in the formation of the young, society expects the sector to do something exceptional in helping it confront the epidemic.
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1.
The impacts of HIV and AIDS on the context for education

HIV and AIDS are transforming the environment in which education systems function. Major HIV- and AIDS-related changes have occurred and continue to occur in the economic, social, cultural and health situations of families and communities. These changes affect not only learners and educators but also education systems themselves.
The economic context for education has been affected at every level
Nationally, severely affected countries record slower economic growth than in an AIDS-free situation. At the business and industrial level, enterprises are experiencing serious losses in the workforce, higher costs, smaller markets, and reduced profitability. Households and families are encountering higher expenditures, reduced incomes, and in many cases increased poverty. All levels are being affected by the diversion of resources to health costs, reduced investments and savings, the loss of skills, and fewer economically productive young or middle-aged individuals to support the elderly and the very young. Cumulatively, these effects result in the availability of fewer financial resources, irrespective of their source, for education. The public sectors investment in education is less than it would be in an AIDS-free situation. The private sector has fewer resources at its disposal. Survival is the first concern of households and families, with educational expenditures not ranking high on their list of priorities. The AIDS epidemic has had major impacts on the social climate in which education systems operate: The composition of households is changing; more and more are headed by women or are lacking the presence of an adult. The epidemic is creating an ever-increasing number of orphans and vulnerable children. The silence, misunderstandings, isolation, stigma and discrimination that surround the epidemic have clouded social relationships with uneasiness and suspicion. Communities feel under pressure to provide support for affected families, especially those that care for the sick. A growing burden of childcare is being entrusted to grandparents and the elderly, and as traditional safety nets collapse there is an increase in the mobility of people in search of assistance and employment. The AIDS epidemic is also bringing changes in a number of cultural areas. Although there is still much reluctance to talk about sexuality, the topic is not as taboo as in the past. One outcome is a heightening of expectations that schools will offer
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HIV/AIDS and sexuality education to their students. Determined efforts are being made to end practices that favour HIV transmission, such as female genital mutilation, wife inheritance and widow cleansing. Because funerals have become so frequent, the time and resources spent on them are being reduced, while in some places burial rites have become shorter. Many of the health impacts are more apparent. In severely affected areas many suffer from extensive, chronic illness, with the situation being made worse in many cases by inadequate healthcare systems. A very high proportion of hospital beds are occupied by patients with AIDS up to two thirds in many institutions. AIDS-related spending on health services has increased at national and household levels. There is an increasing focus on gaining access to antiretroviral and other life-sustaining drugs. The epidemic is causing a gradual transformation of the entire social environment, affecting all sectors. However, the education sector is unique in the way that it encompasses a vast number of learners and educators, with a great prevalence of young people who, because of their age, are especially vulnerable to HIV infection. This makes the education sector more vulnerable than other sectors to HIV and AIDS. It also heightens the need for it to be more responsive to the way the epidemic is changing the context for educational provision.
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2.
HIV and AIDS constitute a systemic problem for education

There is a striking similarity between the way in which HIV/AIDS weakens and destroys the human body (Figure 1) and the way in which it undermines an education system (Figure 2). Figure 1 The course of HIV/AIDS in the human body HIV Human body Weakening and eventual break down of immune system Opportunistic illnesses Likelihood of premature death Orphans
When the virus enters the human body, the infection attacks the entire immune system, slowly destroying it. After a considerable period of time, the body is overcome by illnesses that its debilitated immune system is not able to fight. In the absence of antiretroviral treatment, premature death is probable, often resulting in children being left orphaned.
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Figure 2 The impact of HIV/AIDS on an education system HIV/AIDS Education system Disturbance and disruption in the system Sector-wide management constraints Reactive changes, adjustments, innovations Systemic turbulence
Similarly, the effect of HIV and AIDS on education in a seriously affected country is that it compromises the functioning of the entire education system. It magnifies the scale of existing management and systemic problems, as well as creating new ones. An example of an existing problem is ensuring the staffing of schools in rural areas; something that becomes more difficult when AIDS makes it necessary to ensure that every teacher who is ill is posted within reasonable distance of a suitable health facility. A new problem might be developing the learning materials for HIV preventive education as a new area in the curriculum (see Module 4.1, A curriculum response to HIV/AIDS). Because of the way it exhausts human resources, AIDS makes it more difficult to deal appropriately not only with issues originating from the epidemic itself, but even with ongoing routine matters. Managing these constraints leads in turn to a number of reactive changes, adjustments and innovations, all of which in their turn result in considerable turbulence across the system (Figure 2). Because of HIV and AIDS, changes have occurred in the way the system functions and operates. If infection and illness are extensive, these changes may be of such magnitude that the system might experience difficulty in pursuing and attaining its essential goals. This is happening in many countries where the AIDS epidemic is making it that much more difficult to attain the Millennium Development Goals (MDGs) and those of Education for All (EFA).
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3.
The impacts of HIV and AIDS on an education system

Essentially, an education system seeks to put in place arrangements that ensure that learners learn and educators teach in an environment that supports learning. In countries affected by the epidemic, HIV and AIDS have an increasingly negative impact on these three major areas: They affect learners, educators and the learning environment. The impact in any or all of these areas may be sufficient to make learning difficult, or even impossible; impede teaching; and create an environment that is not conducive to the provision of good quality education. Further, the epidemic has progressive major financial implications for the education sector and can have a significant negative impact on educational management and planning.
AIDS and the demand for education

Many developing countries are still struggling to meet the EFA goal of providing basic education for all. In a perverse way, AIDS makes this task easier because fewer children will be born, and some who are born will die young because of the HIV virus transmitted to them by their parents. On the other hand, HIV and AIDS make the achievement of EFA goals more difficult because children from affected families may not be able to make use of the available opportunities for schooling. This is very frequently because of school-related costs. Although recent years have seen several countries introduce free primary education, the reality is that those attending school continue to bear some costs. These may consist in parent-teacher association levies, or the cost of a school uniform and educational materials or supplies that must be provided for the school. In addition, there is always an opportunity cost for those attending school a cost that may be so significant that it will prevent those from poor households from attending school. Through the increasing dependence on child labour that it has created, AIDS has greatly increased these opportunity costs, especially for girls. These circumstances lead to three possible situations for children: non-attendance at school; highly irregular, stop-start school attendance; non-completion of school. In each case, children do not have access to sustained basic learning opportunities. They are deprived of their human right to education and, as Module 1.3, Education for All in the context of HIV/AIDS shows, they are denied the protection against HIV infection that a school education can provide. The demand for education is also affected in various ways by the enormous and growing problem of orphans. At the end of 2003, children under the age of 18 who had lost one or both parents to AIDS were estimated to constitute 10-19 per cent of all children in the countries of eastern and southern Africa. The financial problems that many of these children experience in school participation may be aggravated by their sense of emotional loss and the psycho-social distress of the
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disruption in their lives. But although orphaning is associated in many countries with low rates of school attendance, situations occur where the proportion of orphans attending primary school is as high as that of non-orphaned children. In almost all countries, however, young people left without one or both parents may experience unusual difficulty in accessing secondary and tertiary education. They find that the support that was extended to them as young children becomes less readily available as they grow older. As you have by now read a considerable amount of information, it would be good at this point to reflect on what you have read in relation to situations with which you are familiar. The activity that follows will help you do this. Please make sure that you do work through this activity. It will help you to come to a richer understanding of the impacts of the epidemic on education. Guidance to where you might look for answers is given towards the end of this module.
Activity 1
How AIDS affects the demand for education. Working at either national, sub-national (provincial, district or zone) or school level, try to find the information that will answer the questions below, and use this information to inform your own understanding of the impact of AIDS on the demand for education. Are all children entering primary school? If not, what are some of the reasons for this?
Are they entering at the prescribed age?
Are all children completing primary school?
Is drop-out increasing? If so, what are some of the reasons for this?
What is the drop-out pattern for girls?
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And for orphans?
Do children who have left school re-enter again at an older age?
Is there much movement of children from one school to another? What are the reasons for such movement?
Are there signs of families being broken up or migrating in search of employment?
Do orphaned young people in your area or country have greater access to secondary and tertiary education than other young people?
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AIDS and the supply of education

HIV and AIDS make it more difficult for an education system to ensure that there is a teacher in every class because: teachers and other educators are dying in increasing numbers and at comparatively young ages, and it takes time before they can be replaced; teachers who are ill are often unavoidably absent, and there is nobody to take over the affected classes; household sicknesses and family and community funerals are leading to increases in teacher absenteeism; rural posting of teachers is becoming more difficult because teachers who know they are HIV positive want to be posted near health facilities, most of which tend to be in towns or at the larger administrative centres; and teachers leave teaching to take up employment (often more lucrative) in other areas where AIDS has created vacancies. However, teachers are not the only ones affected. The epidemic affects personnel in other parts of the education system in similar ways. HIV prevalence among managers, planners, professional staff and support staff is likely to be as high as in comparable groups in the general population. The effects mount up to a severe depletion in the social capital available to the system the norms, networks, institutional memories, understandings and working arrangements that sustain its smooth functioning and make it possible for it to maintain its daily operations. Deprived of this social capital, systemic ability to address the difficulties experienced in schools is weakened. Simultaneously, the problem of addressing its internal needs becomes of greater concern to the system, thereby further constraining its ability to respond to what is happening in schools and institutions. Cost is an important factor in the supply of education. The AIDS epidemic affects the costs of education in various ways, such as the following: The additional training and posting costs for replacement teachers and other staff. Payments of salaries to absent or sick personnel. The loss of the training costs invested in teachers and students who die young. Frequent payments of death and funeral benefits. Premature payment of terminal benefits. The costs of ensuring orphans' and other vulnerable childrens access to education. The costs of teacher training in the relatively new curriculum area of HIV preventive education, and the development and dissemination of the necessary materials. Additional management costs for the establishment of HIV and AIDS units or AIDS-in-the-workplace training programmes. Time is a further factor in ensuring that the supply of education responds to known and envisaged needs. Two very different areas are worth noting. First is that educational managers are being required to give an increasing proportion of their time to responding to HIV and AIDS. Sometimes this may take
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them away from their other duties for prolonged periods as they participate in training sessions or workshops. In addition, HIV and AIDS make demands on their time through additional meetings, preparation for and follow-up of such meetings, epidemic-related paperwork, and responding to the concerns of colleagues. Relentlessly, the epidemic increases their burdens and jams up systemic capacity to address both ongoing and new issues. Second, schools, particularly those in rural areas, look to their communities to provide labour and inputs for school maintenance and development. The epidemic is reducing community capacity to do so. Because of the loss of community members to AIDS, those who are not infected find that they must give more time to maintaining their own levels of production, working on behalf of those who are ill, or assisting the families of those who have died. They no longer have time to participate in usual self-help activities for the benefit of the school.
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HIV and AIDS and the quality of education

Following a long period when the focus tended to be on quantity and numerical expansion, education systems are increasingly focusing on quality, by which they measure the level of their success. In this approach, central goals for every system are to ensure student learning achievements and appropriate personal formation. The ultimate aim of education systems and institutions can be stated even more briefly: to prepare every learner for a better future. Since the likelihood of a better future depends to some extent on the quality of learning, it will help you at this stage to reflect on what this means and how it can be undermined by HIV and AIDS. That is the purpose of the next activity which should help to expand your understanding of quality in education. Signposts to the answers follow immediately in the text (and are repeated towards the end of this module).
Activity 2
How HIV and AIDS affect the quality of education. Before you read further, make a note of any ways in which you think HIV and AIDS might constrain the achievement of quality in education.
HIV and AIDS obstruct every learners access to a better future. In the context of the epidemic, the learning achievement and personal formation of students are threatened by the following factors: Frequent teacher absenteeism, with classes being left for days, even weeks, to learn on their own. Shortages of teachers in specialized areas such as mathematics or science. Increased reliance on less qualified teachers. Learners are frequently absent, participate intermittently or drop out. A concern for the sick at home takes attention away from teaching and learning. Frequent periods of grief and mourning in schools, families and communities. Unhappiness and fear of stigmatization and ostracism on the part of both teachers and learners who have been affected by the epidemic. Uncertainty and anxiety in the relations between learners and teachers (who may be caricatured by the community as those responsible for the introduction of HIV). Teachers uneasiness and concern about their personal HIV status.
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These problems are accompanied by limited resources, generalized poverty, a sense of inappropriateness of the curriculum to real life, a lack of connection between the world of the school and the world of work, and some doubt about the value of school education when it seems likely that many will die young because of AIDS. On the other hand, however, it is also necessary to recognize that the introduction of HIV preventive education and life skills programmes may drive schools to work more purposefully for the personal formation of learners (see also Module 4.2, Teacher formation and development in the context of HIV/AIDS). Further, a number of these programmes are set in a rights-based framework and value highly learning to live together in a society that shows respect for every human being. Good programmes of this nature can assist learners in the formation of desirable values. This brings out one of the anomalies arising from HIV and AIDS: that, notwithstanding the devastation and suffering it brings, it can also set the stage for outcomes that are highly desirable in their own right.
AIDS and the management of education

The management challenges and inadequacies that education systems encounter have not all originated with AIDS; they existed long before the advent of the epidemic. But in almost every case, HIV and AIDS are making them worse. They are also creating new problems. Areas of particular concern include the following: Human resource planning and management in an environment of morbidity, mortality and considerable uncertainty (see Module 3.4, Projecting education supply and demand in an HIV/AIDS context).
Resource mobilization and financial flows, so that the funds allocated to dealing with the problems caused by HIV and AIDS are spent efficiently and effectively. HIV and AIDS issues in the workplace. Building capacity in response to personnel losses and fostering the ability to generate new approaches, skills and capacities that will enable the system to cope with the impacts of the epidemic. Devising and establishing an HIV- and management information system (EMIS). AIDS-informed educational
Promoting and harmonizing donor and partner involvement in such a way as to develop ownership of a system-driven response to the epidemic. Learning from experience through rigorous and regular monitoring and evaluation.
An overarching management concern is to mainstream HIV and AIDS within the system so that it caters in a long-term and sustainable way for the three key themes of: 1. prevention; 2. care, support and treatment; and 3. impact mitigation, encompassing both workplace issues and management of the response.
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Responding to this concern requires that the short-term programmatic issues identified earlier in this section be set within the long-term systemic framework of a comprehensive, prioritized plan of action (see, for example, Kenya (2004). Developing such a plan necessitates an evaluation of the impact of the epidemic on the education system and the systems preparedness to respond, identification of the form that the system response will take, and providing for the necessary monitoring, evaluation and reporting. Clearly, such a process and subsequent implementation make extensive demands on the management capacity of an education system. But in going through the process, management capacity is itself built up, as both Namibia and Kenya experienced as they developed prioritized plans of action for the education sectors response to HIV and AIDS. This is a good time to stop reading for a while. It is suggested that you try to work through the next activity, and that you do so conscientiously as this will greatly improve your understanding of what has been discussed so far.
Activity 3
Issues to be included in a comprehensive HIV and AIDS plan Try to identify some of the major issues that an education system should address within the framework of a comprehensive plan of action for dealing with HIV and AIDS.
Guidance on where to look for further ideas is provided towards the end of this module.
AIDS and the process of education

The process of education refers to all that goes on in a school or educational institution. In addition to everything that is officially and formally provided, it also includes the numerous unofficial activities that take place, as well as the many interactions occurring between the members of the educational community. It further encompasses the institutional culture that ill-defined but all-embracing ethos of a school or college, its way of prescribing how things are done here and of separating those who belong from those who do not. The module uses the word process in preference to curriculum because of the tendency to associate curriculum with formal classroom teaching and learning experiences. HIV and AIDS affect many aspects of institutional culture and activities. In school and college settings, the influence of the epidemic manifests itself in the following ways: More express institutional concern about the values it communicates and the practices it allows. HIV- and AIDS-related changes in rules, regulations and sanctions.
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More randomized teaching and learning, because of the periodic absence of teachers or the irregular attendance of learners. New teaching and learning areas catering for preventive and sexual health education and psycho-social life-skills. The training of teachers and tutors to deal with these new topics. Teaching methodologies that are more interactive and student-centred. Social interactions that are affected by the frequency of illness, death, funerals, caring for the sick, stigma, isolation, and orphanhood. A focus on AIDS-related co-curricular activities, clubs, information, announcements and other expressions of the schools organizational culture. Take some minutes now to work on the fourth and final activity.
Activity 4
The pros and cons of school boarding facilities In many developing countries, students live on the school premises or make private arrangements in boarding facilities near the school. Moreover, in some societies parents are particularly keen that there be school boarding facilities for girls. Make a list of the arguments for and against school boarding in circumstances of high HIV prevalence: For:
Against:
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4.
HIV and AIDS affect what society expects from its education systems
HIV and AIDS present educators with the challenge and the opportunity to improve and reform the existing system and to transform education. Although calamitous in many respects, the impacts of the epidemic do not necessarily lead to a developmental dead end. Instead, the epidemic presents a challenging opportunity for growth, reform and development. In many severely affected countries, vigorous responses to the AIDS epidemic are revitalizing communities with a renewed sense of purpose, accomplishment and cohesion. Developments that are being spurred by the epidemic are found also in education. For instance, the AIDS situation is leading to greater efforts to find ways to put an end to gender inequalities, in education as elsewhere. Likewise it has created a greater sense of urgency in efforts to attain the EFA goals. The challenge to education is to use the opportunity that the AIDS crisis presents to rethink and redesign many of its approaches to these and similar issues. Education systems have long been a prisoner of their past, with much stress on the academic. Because of the way AIDS consumes productive human resources and breaks the chain of transmission of skills from one generation to the next, the epidemic calls for a critical rethinking of this and other aspects of education provision. Thus a comprehensive education sector response to HIV and AIDS will embody opportunities for progress and reform in such areas as: greater involvement of the community; improving instructional practice; more interactive student-centred learning; greater focus on the acquisition of productive skills; managing the challenge of equity in favour of the poor, girls, rural children and those with special educational needs; decentralization in reality as well as in intent; enhanced and more mutually beneficial relationships between education ministries and teachers; deeper and more effective partnerships; improved information about the system through the application of a needsbased education management information system (see for more information Module 3.2, HIV/AIDS challenges for education information systems). In addition, society expects its education systems to use the resources at their disposal to halt the spread of HIV and AIDS; be involved in an appropriate way in care, support, and treatment; and work with other partners to mitigate the negative effects of the epidemic. In education, as in other domains where AIDS is prevalent, things cannot continue running as usual. The AIDS epidemic challenges every education system to plan and provide the kind of education that will prepare children and youths to live responsibly, productively, creatively and happily, and give them hope in the world they face a world that has changed very radically
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since the time when most of the current education systems were designed. A major responsibility for educational authorities is to analyze the consequences of the epidemic in order to adapt educational structures and provision to be more relevant to the needs of an HIV- and AIDS-affected environment.
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Summary remarks
Because HIV and AIDS did not become known in the world until the last quarter of the twentieth century, understanding how it impacts on education is an area that is new and developing. Knowledge is growing rapidly, but there is still much to learn. Impact assessments commissioned by education ministries provide the basis for much that is known about the way the epidemic affects education. The understandings arising from these studies are complemented by other country, sectoral and sub-sectoral investigations and analyses. Although there are differences between countries, the impact assessments and other studies bring out a number of features that constitute the challenge of HIV and AIDS to education (see Box 2 below). Box 2 The challenge of HIV and AIDS to education
The epidemic is resulting in significant changes in the economic, social, cultural and health environments in which education systems operate. The epidemic is having major sectoral impacts in terms of the demand for education, the supply of teachers and other educational personnel, the costs of providing education, the management of education, the process of education, and the quality of education. Education systems have a central role to play in responding to the epidemic. The epidemic is providing opportunities that challenge education systems to initiate reforms, and is stimulating them to move in directions that in themselves are good and desirable.
The majority of the observed impacts on the education sector are negative. These are occurring in an environment that is being restructured by the AIDS epidemic. This restructured environment is experiencing deeper and more extensive poverty, a wide range of economic problems, increased health concerns, and a transformation of many social structures. It is not possible to separate education from all of these or to say with absolute certainty that AIDS is responsible for one outcome, poverty for another, health for yet another, and so forth. But what is certain is that the features of the changing society that HIV and AIDS are creating conspire with the direct impacts of the epidemic to compromise the ability of education systems to deliver education in the quantity and quality that society expects. Figure 3 overleaf presents a simple structure for conceptualizing the challenges that HIV and AIDS pose for education.
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Figure 3 What HIV and AIDS do to an education system

HIV and AIDS affect : The context for education Economic
Social Cultural Health

The functioning of an education system Demand
Supply and costs Management and process Quality

Expectations for education Contribute to preventing the spread of HIV and AIDS
Greater community involvement Improved institutional practices in the classroom Attainment of equity goals Renewed stress on the acquisition of productive skills Improved information about the system
When the HIV virus is present in the human body, it inhibits the ability of the immune system to respond to what would in normal circumstances be manageable illnesses. When the virus is present in education, it inhibits the ability of the system to deliver what in normal circumstances would be achievable outcomes. The 2002 Education for All Monitoring Report identified one tangible aspect of this situation: countries where HIV/AIDS prevalence is high are experiencing severe problems in maintaining progress towards the attainment of the EFA goals (UNESCO, 2002: 147). A further aspect of grave concern is the way that factors arising from the AIDS epidemic combine with other forces to inhibit actual learning achievement and thereby lowers the quality of the education provided. Finally, it should be noted that the preceding pages have analyzed the AIDS and education situation as it manifests itself in severely affected countries. It is unlikely that all of these impacts will be experienced in countries where HIV prevalence is low. But the global history of HIV and AIDS shows that HIV levels can increase with dramatic rapidity, as happened in South Africa in the period 1990-1999. With large-scale failure in global prevention measures, the situation in countries with low prevalence levels could deteriorate quickly. Therefore, such countries need to be ready to respond to the epidemics potential to cause a variety of problems for their education systems, which could compromise their ability to function.
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Lessons learned
Lesson One: HIV and AIDS put education systems under stress. The epidemic adds wide-ranging new dimensions to the problems that education systems already confront and enlarges their scale, as well as adding new problems. In many systems, demand, supply, cost and other problems existed long before the advent of HIV and AIDS. The epidemic did not create these problems, but it has aggravated them and at the same time has added new ones. Lesson Two: There is a need to be alert to the impacts of HIV and AIDS in every facet of educational provision. The impacts of HIV and AIDS are not confined to teachers or to schools; they are to be found throughout the system. They can occur at every educational level, from pre-school to university. They can affect management, professional and administrative functions just as easily as teaching and learning. Concentrating on one facet while excluding the others will fail to give the whole picture. It is important to consider how the epidemic affects schools and how they should respond. But it is equally important to consider how the epidemic affects the integrated management of the system and how it should respond. Lesson Three: The impacts of HIV and AIDS on education cannot all be measured. Difficult as it may be to obtain the data, it is theoretically possible to enumerate the impacts of HIV and AIDS in terms of such factors as teacher morbidity and mortality, non-attendance rates, drop-out rates or numbers of orphans, one or both of whose parents have died from AIDS. It is not possible to quantify in the same way the trauma that HIV and AIDS cause to infected and affected individuals, the sense of loss and disruption that an orphan experiences when a parent dies, or the tensions experienced by a female employee with three major tasks on her hands: performing satisfactorily as an employee, managing a household, and caring for a spouse or relative who has AIDS. These impacts, which cannot always be measured, may be as detrimental to the functioning of an education system as those that are more easily measurable. Lesson Four: HIV and AIDS affect education as a system. HIV infects cells in the bodys immune system and undermines the systems ability to protect the entire body. Similarly, the disease enters education through the large number of individuals within the system, and by infecting them undermines the education systems ability to deliver its mandated services. This systemic problem requires a response that sees HIV and AIDS as a long-term systemic management problem that calls for a comprehensive, prioritized plan of action.
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Lesson Five: Knowledge about the impacts of HIV and AIDS on education is still in its infancy, pointing to the need for more research, further investigations, and continued analysis. Although much progress has been made, information on the way the AIDS epidemic affects education systems is still quite limited. There is a need for more knowledge and improved understanding. Practical research is required to extend the body of knowledge and to serve as a basis for response measures. But the need for better information should not inadvertently delay or derail action. Further, investigations should address issues that are likely to make a substantial difference to understanding, policy and action. In addition to the insights that would come from purpose-designed studies, knowledge gaps in this area could also be bridged by strengthening routine management information systems and adjusting them to take account of the epidemics intrusion into the education system.
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Activity 1 These data will be country specific, but some of the answers may be found in the EFA Global Monitoring Report (UNESCO, 2004) or on the UNESCO Institute of Statistics website at www.uis.unesco.org. Activity 2 Below are some are some of the ways in which HIV and AIDS can affect educational quality; the list is not comprehensive: Frequent teacher absenteeism, with classes being left for days, even weeks, to learn on their own. Shortages of teachers in specialized areas such as mathematics or science. Increased reliance on less qualified teachers. Learners are frequently absent, participate intermittently or drop out. A concern for the sick at home takes attention away from teaching and learning. Frequent periods of grief and mourning in schools, families and communities. Unhappiness and fear of stigmatization and ostracism on the part of both teachers and learners who have been affected by HIV or AIDS. Uncertainty and anxiety in the relations between learners and teachers (who may be caricatured by the community as those responsible for the introduction of HIV). Teachers uneasiness and concern about their personal HIV status. Activity 3 You may want to compare your ideas with those set out in Kenyas Education Sector policy on HIV and AIDS (Kenya, 2004). Activity 4 You may find it interesting to compare your ideas with the findings of Zimba and Nuujomo-Kalomo, 2002 (for full reference see Bibliography).
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Documents Kelly, M.J. 2000. Planning for education in the context of HIV/AIDS (Fundamentals of Educational Planning, No. 66). Paris: IIEP-UNESCO. http://unesdoc.unesco.org/images/0012/001224/122405e.pdf Kelly, M.J.; Bain, B. 2003. Education and HIV/AIDS in the Caribbean. Kingston: UNESCO Office for the Caribbean. Paris: IIEP-UNESCO. http://unesdoc.unesco.org/images/0013/001336/133643e.pdf Kenya, 2004. Education sector policy on HIV and AIDS (Kenya). Nairobi: Ministry of Education, Science and Technology. UNAIDS Inter Agency Task Team on Education. 2003. HIV/AIDS and education: a strategic approach. Paris: IIEP-UNESCO. http://unesdoc.unesco.org/images/0012/001286/128657e.pdf UNESCO. 2000. World Education Forum; The Dakar Framework for Action. Paris: UNESCO www.unesco.org/education/efa/ed_for_all/framework.shtml UNESCO. 2002. Education for All: Is the world on track? EFA Global Monitoring Report. Paris: UNESCO. http://www.unesco.org/education/efa/global_co/policy_group/hlg_2002_m onitoring_complete.pdf UNESCO. 2003/4. Gender and the Education for All; The Leap to Equality: EFA Global Monitoring Report. Paris: UNESCO. http://portal.unesco.org/education/en/ev.phpURL_ID=23023&URL_DO=DO_TOPIC&URL_SECTION=201.html World Bank. 2002. Education and HIV/AIDS: a window of hope. Washington, DC: World Bank. http://books.google.fr/books?id=oIUTARGCQKoC&dq=education+and+%22h iv+aids%22+a+window+of+hope&pg=PP1&ots=_WrQQq_Aau&sig=DGHUBJ5 yt55mw59hZUb2vvYcmN4&prev=http://www.google.fr/search%3Fhl%3Dfr% 26rls%3DSUNA%252CSUNA%253A200629%252CSUNA%253Afr%26q%3DEducation%2Band%2BHIV%252FAIDS%2 53A%2Ba%2Bwindow%2Bof%2Bhope%26meta%3D&sa=X&oi=print&ct=title &cad=one-book-with-thumbnail Zambia Ministry of Education. 2003. HIV/AIDS guidelines for educators. Lusaka: Ministry of Education. Zimba, R.F.; Nuujomo-Kalomo, E.N. 2002. Ensuring access to education for orphans and other vulnerable children through safe and supportive hostel boarding facilities. Windhoek, Namibia: UNICEF.
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Module
F. Caillods T. Bukow
Education for All in the context of HIV/AIDS
1.3
About the authors

Franoise Caillods is Deputy Director of the International Institute for Educational Planning, where she leads the research team on basic education and the HIV/AIDS and education team. Her activities and research work have been on strategic planning in education, microplanning and school mapping, secondary education financing, and education and training for disadvantaged groups. Tara Bukow currently works with the International Institute for Educational Planning on HIV and AIDS management and training issues. Formerly Publications and Communication Officer for the International Institute for Educational Planning UNESCOs Clearinghouse on the impact of HIV/AIDS on education, she has contributed to a number of publications on HIV and AIDS and education related topics.
Module 1.3
EDUCATION FOR ALL IN THE CONTEXT OF HIV/AIDS
Table of contents
Questions for reflection Introductory remarks 1. EFA timeline 2. EFA and the Millennium Development Goals Understanding the EFA goals in the context of HIV The EFA Development Index (EDI) The Millennium Development Goals 3. HIV and AIDS as an obstacle to attaining EFA 4. EFA and HIV prevention The impact of education on HIV EFA and promoting girls education 5. Using EFA to overcome the impact of AIDS Increasing the resources available for education Training and supporting large numbers of teachers in school Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 1.3: Education for All in the context of HIV /AIDS
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Aims
The aims of this module are to: present users with an overview of the Education for All (EFA) initiative; introduce the six goals identified in the Dakar Framework for Action, as well as the education-related Millennium Development Goals (MDGs); discuss how their implementation is threatened by the pandemic; and illustrate how the strategies implemented within their framework can assist in curbing the spread of HIV and the impact of AIDS. The ultimate aim of this module is to demonstrate that the fight against HIV and AIDS and efforts to promote EFA are intimately linked.
Objectives
At the end of this module, you should be able to: demonstrate knowledge and understanding of Education for All and its various objectives as listed in the Dakar Framework for Action and the Millennium Development Goals; appreciate the impact of HIV and AIDS on the implementation of EFA and explain how HIV and AIDS are an EFA issue; explain how strategies for EFA can ensure HIV prevention and slow the spread of the virus among children, youth and adults; identify EFA strategies and interventions that can assist in increasing learning opportunities for infected and affected children and youth.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. Do you know what Education for All is? Can you name two of the EFA goals?
Why is Education for All important to a countrys development? Does your country have an EFA Action Plan or a sector plan emphasizing EFA?
Identify some ways in which HIV and AIDS may be affecting progress towards EFA in your country.
Can you envisage how implementing Education for All can curb the spread of HIV and AIDS?
Name some interventions and policies that can help increase access of the poorest and disadvantaged groups to quality education in your country, and that could benefit AIDS-infected and -affected children.
You will find answers to these questions in the rest of the module. More information on EFA, including your countrys plan for EFA, can be found on the following web sites: http://portal.unesco.org/education/en/ev.phpURL_ID=43009&URL_DO=DO_TOPIC&URL_SECTION=201.html www.unesco.org/education/efa/db/index_national_plans.shtml
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Module 1.3
EDUCATION FOR ALL IN THE CONTEXT OF HIV/AIDS
In the absence of a cure, education is the best protection against HIV. Several studies have shown that a complete basic education can equip children with the cognitive skills and necessary knowledge to make an informed choice and bring about healthier behaviour. Educated children and educated girls in particular know more than other children about how they can become infected and how they can protect themselves. The more educated and better informed they are, the more likely they are to refuse risky practices and to resist pressure and intimidation by adults. Education is not a substitute for treatment, nor does it replace any other prevention campaign. But informing children and providing them with advice before they become sexually active is a means of stopping the spread of the epidemic. Yet Education for All (EFA) is far from being a reality. Some 100 million children all over the world are still out of school, 55 per cent of whom are girls. Although substantial progress has been made, several countries are at risk of not achieving the goal of universal primary education (UPE) by 2015 unless aggressive financial plans and policies are put underway. In Africa, where HIV prevalence is the highest in the world, enrolment ratios are amongst the lowest at primary and secondary education levels, particularly among girls and disadvantaged groups. Sub-Saharan Africa is home to most of the out-of-school children. Should UPE become a reality there would be fewer youngsters and young adults infected every year. Realizing the importance of education for economic and human development, the international community committed itself to attaining EFA in 2015. The present module examines the different goals set out in EFA. It then focuses on how the HIV/AIDS epidemic is affecting progress towards these goals. HIV/AIDS reduces the resources available to education and has an impact on the system and on learners in many different ways. The module then moves on to describe how EFA can help mitigate the pandemic. Ministries of education have representatives in almost every village in each of the countries and their teachers can deliver prevention messages to large numbers of the uninfected population; to children and youths, and also their parents. The more youngsters that are educated and convinced of the need to protect themselves, the more the spread of the virus can be controlled.
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By strongly emphasizing access to quality education for all children and youth, promoting appropriate learning opportunities for youngsters and adults, introducing life skills in educational programmes, and advocating gender equality in education HIV-prevention messages can be widely taught and effectively reinforced. At the same time, protecting the education system and maintaining its efficiency is essential for EFA and for fighting HIV and AIDS. Ministries of education must see HIV and AIDS as an EFA issue. The requisite skills, resources, capacity development and confidence-building must be made available to teachers and administrators everywhere if this strategy is to succeed.
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1.
EFA timeline
1990
The World Conference on Education for All convened by UNESCO, the World Bank, UNICEF and UNDP takes place in Jomtien, Thailand in March 1990. During this conference, delegates from 150 countries and 155 organizations reaffirm the right of all people to education and adopt the World Declaration on Education for All: Meeting Basic Learning Needs. The participants commit themselves to universalizing primary education and to massively reducing illiteracy rates by the end of the decade.
2000
These same countries and organizations attend the World Education Forum ten years later in Dakar, Senegal. The 1,100 participants restate their commitment to the goals of the World Declaration on Education for All and commit themselves to achieving the six goals listed in the Dakar Framework for Action, including free primary education of good quality by 2015. In the same year, the member states of the United Nations establish the Millennium Development Goals (MDGs) during a General Assembly or Millennium Summit in September.
2001
Two specific strategies particularly relevant to HIV and AIDS are developed within the framework of EFA. The flagship on the impact of HIV/AIDS on education aims at implementing, as a matter of urgency, education programmes and actions to combat the HIV/AIDS pandemic. It is based on a statement made in Dakar that "To achieve EFA goals will necessitate putting HIV/AIDS as the highest priority in the most affected countries, with strong, sustained political commitment; mainstreaming HIV/AIDS perspectives in all aspects of policy; redesigning teacher training and curricula; and significantly enhancing resources to these efforts" (Expanded Commentary on the Dakar Framework for Action, Strategy 7). Another programme, called FRESH (Focusing Resources on Effective School Health) is launched, aimed at promoting child-friendly schools and quality EFA by broadening the scope of school health programmes and improving their effectiveness; and identifying and addressing health-related problems that interfere with enrolment, attendance and learning.
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2002
The EFA Fast Track Initiative (FTI) is developed to accelerate progress in achieving the shared Education for All and Millennium Development Goals of universal completion of quality primary education. FTI forms partnerships between donor organizations and beneficiary countries to support commitment and adherence to the goals. Countries can apply for FTI funds once they produce a poverty reduction strategy paper (PRSP) and a credible national education sector plan. Once these plans are accepted by local development partners, countries receive funding to support their efforts towards UPE within the broad context of EFA and the second and third Millennium Development Goals. Reference to an HIV and AIDS strategy is an explicit condition for a countrys submission if they are to be accepted (EFA FTI Secretariat, 2005).
2003
The EFA Development Index (EDI) is introduced as part of the EFA Global Monitoring Report to aid countries in assessing progress towards the goals and to create a common scale for all countries.
2005
Eighteen countries have education sector plans endorsed and can apply for FTI funds. Many countries around the world show progress in enrolling more students in schools, and also in increasing the enrolment of girls. Yet progress is still slow. Some countries still face challenges, such as HIV and AIDS that risk throwing them off course.
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2.
EFA and the Millennium Development Goals

The World Declaration on Education for All, adopted in Jomtien and reaffirmed in Dakar in 2000, called on a learning environment in which everybody would have the chance to acquire the basic elements that serve as a foundation for further learning and enable full participation in society. This was considered necessary for essentially three reasons: First, education is a basic human right; second, it is a critical tool to empower those who suffer from multiple disadvantages, giving them access to self-respect, to the means to avoid illness, sustaining livelihood and enjoying peaceful relations; and last, but not least, education has been proven to increase productivity and to promote growth and other development objectives. Recognizing that economic growth was not in itself sufficient to reduce poverty and to promote human development, the Millennium Summit in September 2000 made an international commitment to work towards eliminating poverty and to promote sustained development. It identified a number of Millennium Development Goals, three of which are of particular relevance to education, gender equality and HIV/AIDS. These international commitments create a universal blueprint to guide the decisions of governments, donors and ministries of education when prioritizing the allocation of funds and resources, including to the education sector. Ministry of education staff and planners should understand each of the EFA goals in order to effectively design an EFA action plan or a sector plan that concentrates on aspects of the goals and provides sound reasoning as to how the plan will accelerate progress to reach these goals. In the next section, we present the EFA goals and MDGs within the context of HIV and AIDS.
Activity 1
Before we begin looking at the EFA goals and MDGs, take a minute to write down the goals that you know about. Then write down how AIDS could affect your countrys ability to achieve them.
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Understanding the EFA goals in the context of HIV

The six goals expressed in the Dakar Framework for Action are the following: Expanding and improving comprehensive early childhood care and education, especially for the most vulnerable and disadvantaged children. Ensuring that by 2015 all children, particularly girls, children in difficult circumstances and those belonging to ethnic minorities, have access to and complete free and compulsory primary education of good quality. Ensuring that the learning needs of all young people and adults are met through equitable access to appropriate learning and life skills programmes. Achieving a 50 per cent improvement in levels of adult literacy by 2015, especially for women, and equitable access to basic and continuing education for all adults. Eliminating gender disparities in primary and secondary education by 2005, and achieving gender equality in education by 2015, with a focus on ensuring girls' full and equal access to and achievement in basic education of good quality. Improving all aspects of the quality of education and ensuring excellence of all so that recognized and measurable learning outcomes are achieved by all, especially in literacy, numeracy and essential life skills. A brief description of each goal is followed by how this goal seems particularly relevant in a context of HIV. Goal 1: Expanding and improving comprehensive early childhood care and education, especially for the most vulnerable and disadvantaged children. Learning starts at birth. This calls for early childhood care and initial education (World Declaration on Education for All, 1990). Early childhood care and education (ECCE) refers to the range of programmes aimed at the physical, cognitive and social development of children from birth until age six or seven, just before they should enter primary school. ECCE programmes adopting a holistic approach to the development of a child have important positive effects on future learning and development possibilities. The benefits of quality ECCE continue well beyond initial education, setting the foundation for lifelong learning. ECCE can be delivered in many forms, such as government programmes, home care programmes and NGO and community initiatives. Factors that influence attendance in ECCE programmes include the education level of mothers, proximity to urban centres, and parents' income and work status. Except in a handful of countries, early childhood care and education programmes are not well developed in sub-Saharan Africa, where they often concern fewer than 10 per cent of the relevant age group (UNESCO, 2005). These programmes would be particularly helpful for low-income and disadvantaged children, among them HIV/AIDS-infected and -affected children. These children would be among those who would benefit most from the activities that support childrens psychosocial development, but also from the systems of care, health and nutrition that are often attached to them. Indeed, malnutrition during the first two to three years of life can damage the physical growth and brain development of the child for ever. Participating in ECCE is an opportunity for infected and affected children to receive the attention they deserve. Parents living with HIV, however,
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might be forced to neglect early childhood care and education due to reduced resources or constraints on their own health. Goal 2: Ensuring that by 2015 all children, particularly girls, children in difficult circumstances and those belonging to ethnic minorities, have access to complete free and compulsory primary education of good quality. Goal 2 of EFA requires that governments prioritize access to schools for all children, particularly children in difficult circumstances, such as AIDS orphans. Education is a human right, yet some 100 million children are still not enrolled in primary schools, 55 per cent of whom are girls. Most out-of-school children live in the rural areas of developing countries; most of them in sub-Saharan Africa. Education is not yet available for all and "primary school fees, a major barrier to access, are still collected in 89 countries out of 103 surveyed" (UNESCO, 2005: headline message). Enrolment and completion rates are the key indicators for measuring progress towards this goal. The gross enrolment rate (GER) is the number of students at a given level of school, regardless of age, as a proportion of the number of children in the same age group. The net enrolment rate (NER) is the proportion of the relevant age group enrolled in the level of education concerned. It excludes all pupils/students who are too young or too old for the education level concerned. These are both presented as percentages. Unlike the GER, the NER cannot exceed 100 per cent. The completion rate is the proportion of children of the relevant age groups who complete a full cycle of primary education. In 2003, only 59 per cent of the relevant age group was finishing primary education in Africa. This means that not only are many children deprived of access to primary schools, but a large number drop out before completing the first cycle and will more than likely remain illiterate. The graph below shows that completing six to nine years of basic education is necessary in most African countries before an adult considers him- or herself literate. Hence, having attended school does not necessarily mean that an individual has acquired all the cognitive skills that are normally expected from schooling. This is due in part to the low quality of the education provided a problem we shall return to below.
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Figure 1: Proportion of adults aged 22-44 who consider themselves literate according to their number of years of studies in Africa.
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13
Countries performing above average (13 countries) Countries performing on average (6 countries)
Countries performing below average(12 countries)
Source: calculations by the pole de Dakar and the World Bank on the basis of countries' household surveys.
Goal 3: Ensuring that the learning needs of all young people and adults are met through equitable access to appropriate learning and life skills programmes. EFA is sometimes understood as being synonymous with achieving primary education for all, but this is not the case. The Dakar Framework also emphasizes learning for young people and adults that will enable them to live safer, healthier, and more economically and socially productive lives. Adult education and life skills programmes can encompass many different disciplines, from health education and citizenship education to practical or entrepreneurship education that allows youngsters in or out of school to make a living. These are provided in a myriad of formal, informal and non-formal education programmes. Youngsters, adults and children who were denied learning opportunities or dropped out of school early can particularly benefit from education and training programmes that aim at increasing employability and income-generation capacities as well as at building individuals and communities capacities for sustainable livelihoods. Box 1 contains examples of education programmes that use technical and vocational training to improve livelihoods, health and incomes, but also incorporate an aspect of literacy training.
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Box 1
Lifelong learning in Africa and Asia
Junior Farmer Field and Life Schools for orphaned children aged 12-18 in Kenya, Mozambique, Namibia and Zambia Established by FAO, NGOs, UN agencies and local institutions, these specially designed rural schools teach orphans traditional and modern agricultural techniques as well as providing business skills and life skills training. Children also learn about HIV/AIDS and gender sensitivity and the schools also provide psychological and social support. The programme for skills development for youth and adults (EQJA) in Senegal This programme aims at providing practical and literacy skills to youngsters who have been denied literacy opportunities with a view to promoting equity and socio-economic integration. It focuses on several groups, among them females working in the food and agricultural sector, youngsters in Koranic schools, and apprentices in the informal sector. It calls on a variety of trainers, including teachers and local artisans. It draws on a network of partners across sectors, including craftspeople, and representatives of local authority associations and donors. Bangladesh Rural Advancement Committee (BRAC) This NGO uses micro-credit as well as education and health to provide sustainable community development. The BRAC programme incorporates micro-credit lending with technical and vocational education programmes. Borrowers are also required to have health check-ups when taking out a new loan, and they are required to keep their children in school throughout their programme participation.
Goal 4: Achieving a 50 per cent improvement in levels of adult literacy by 2015, especially for women, and equitable access to basic and continuing education for all adults. About one fifth of the world adult population is still illiterate (UNESCO, 2005). Illiteracy is significantly associated with extreme poverty. Addressing the literacy challenge is crucial for economic and social development, as it is for empowerment and increased political participation. Goal 4 addresses the need for adults to develop basic skills: reading and writing, numeracy and other life skills such as technical and practical knowledge or legal information useful to sustaining a livelihood and participating in society. Literacy, defined as the capacity to read, write and calculate, is the foundation for other life skills. Literate youngsters and adults are better able to read documents, posters, leaflets and newspapers that are useful for them in their day-to-day life. It has been found, for example, that in parts of Zambia illiterate women are not coming forward for anti-retroviral therapy because there are forms to be filled and signed. Elsewhere illiterates are refused access to vocational training that could help them to make a living. How often illiterate adults miss opportunities such as these we do not know, but it should no longer happen.
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Goal 5: Eliminating gender disparities in primary and secondary education by 2005, and achieving gender equality in education by 2015, with a focus on ensuring girls' full and equal access to and achievement in basic education of good quality. It is widely recognized that gender disparities fuel AIDS. Girls are more vulnerable to HIV infection than boys. They are more subject to pressure and intimidation by adults in search of safe sex. The proportion of girls among infected youngsters is much higher than that of boys. At the same time, education of women and girls contributes in many different ways to social and economic development. Educated mothers have fewer children, they are more prone to send their children to school and they contribute better to their familys health and nutrition. Educated girls are more likely to be empowered and to resist pressures for unwanted sex; they tend to marry later and this reduces the chances of early infection. Over the past ten years, countries have seen increasing numbers of girls attending school. The gender parity index (GPI), i.e. the ratio between boys and girls school enrolment rates, has increased globally over the past ten years, and many of the improvements were seen in developing countries. Another aspect of Goal 5 is the representation of women in different sectors of society, which is seen as a measure of gender equality. It has been agreed that any society in which women and girls do not actively participate cannot be considered satisfactory. In the education sector it had been shown that female teachers can encourage parents to send their daughters to school and thus facilitate girls access to education. Employing women as teachers enables them to be sensitive to the needs of girls. The overwhelming importance of girls' education in a context of HIV and AIDS will be discussed later in this module. Goal 6: Improving all aspects of the quality of education and ensuring excellence of all so that recognized and measurable learning outcomes are achieved by all, especially in literacy, numeracy and essential life skills. With all the energy and support for increasing access, educational quality is sometimes overlooked. As enrolment increases, schools become overcrowded, class size increases to unacceptable levels, and untrained teachers are recruited and do not receive adequate support within the school. Goal 6 reminds us that there can be no such compromise. There is no point in enrolling children unless learning occurs. It is increased learning not increased access that can lead to all the benefits expected from more education. HIV and AIDS can undermine the functioning of the education system and seriously compromise quality (a point that we will return to below). In the five years between 1995 and 2000, learning achievements in some countries of Southern Africa declined significantly (see Figure 2). How much of this decline is due to deterioration of teaching conditions after massive expansion of the system following in particular the introduction of free primary education and how much of it is due to HIV/AIDS is not known, but it is it likely that HIV/AIDS played a significant role in this trend. Quality is an important aspect of any education system. If parents do not think their children are benefiting from a relevant education, they will be less inclined to send
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them to school. Without relevant and quality education, the efforts of governments to enrol all children in school will be wasted. Figure 2 Changes in literacy scores between SACMEQ I and SACMEQ II in six African countries
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The EFA Development Index (EDI)

In order to assess global progress toward the goals, countries and agencies agreed at the Dakar Forum to use common indicators to summarize the progress of countries and to create a common scale by which to measure global progress. The use of certain indicators, such as the net enrolment ratios and completion ratios, were advertised as being better indicators of progress. The EFA Monitoring Report introduced the EFA Development Index, or the EDI, which is a composite of four indicators that measure four of the six goals: Table 1 Indicators for the EDI
Indicator Net enrolment rate (NER) Adult literacy rate (aged 15 and older) Gender parity index (GPI)* Survival rate to grade 5 Measures Universal primary education (UPE) Adult literacy Gender School quality Goal 2 4 5 6
* The GPI indicator for a given country is the mean of the GPI for primary school and the GPI for secondary school gross enrolment ratios and the adult literacy rate.
Calculating a countrys EDI involves calculating the arithmetical mean of the observed values for each of the indicators in Table 1. The EDI value falls between 0 and 1, 1 being the achievement of EFA.
The Millennium Development Goals

The MDGs were set by the member states of the United Nations during the Millennium General Assembly which met in September of 2000. The MDGs focus on the overall objectives of development and poverty reduction, of which education and health are essential components. Of the eight goals, three directly concern education and HIV/AIDS. They are underlined below. Goal 1: Eradicate extreme poverty and hunger: To halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day. Goal 2: Achieve universal primary education: To ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. This goal is similar to EFA goal 2. Goal 3: Promote gender equality and empower women: To eliminate gender disparity in primary and secondary education preferably by 2005, and to all levels of education no later than 2015. This goal is similar to EFA goal 5. Goal 4: Reduce child mortality: To reduce by two thirds, between 1990 and 2015, the under-five mortality rate. Goal 5: Improve maternal health: To reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Goal 5 is related to HIV/AIDS as regards mother-to-child transmission.
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Goal 6: Combat HIV/AIDS, malaria and other diseases: To halt and begin to reverse the spread of HIV/AIDS; to halt and begin to reverse the incidence of malaria and other major diseases. Reducing the spread of HIV/AIDS and other major diseases will increase the health of populations and produce stable environments for children and adults to access education and information and to progress. Goal 7: Ensure environmental stability: Reverse the loss of environmental resources. Goal 8: Develop a global partnership for development: Address the special needs of the least developed countries. Meeting these eight goals by 2015 represents an enormous challenge, and implementing them will require leadership, resources and, last but not least, management capacity. As your ministry develops education sector plans and education and HIV/AIDS strategies, references to the MDGs will allow you to see education in a larger perspective: the education goals cannot be achieved unless other goals are.
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3.
HIV and AIDS as an obstacle to attaining EFA

As was shown in Module 1.2, The HIV/AIDS challenge to education, the education sector is hit by HIV and AIDS from all sides. As the countrys economic growth slows down, and as competing demand on existing resources particularly from the health sector increases, the resources available for education are less than they would have been. On the other hand, the replacement of teachers, the cost of health interventions, including in some countries provision of anti-retroviral therapy, the production of materials, participation in funerals, and the additional support to be given to affected pupils lead to an increase in education costs. Teachers and administrators are in the group where the most AIDS deaths occur. They are not more likely than other educated adults to be infected2, but attrition rates due to AIDS in addition to existing problems of attrition may seriously compromise the system. As administrators at central, regional and local levels get sick and die or leave the education system to replace professionals that are lacking in other areas of the economy, HIV and AIDS threaten the capacity of ministries of education to function adequately and to provide bureaucratic support to schools.
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impact of teachers' sickness is also high on schools operation and teaching activities. As the sickness progresses, infected teachers become increasingly ill and tired. Their absences become more frequent and prolonged. Absent teachers are most often not replaced: either their classes are merged with others or the students are left unattended. Teachers are also affected by HIV and AIDS in their homes and communities, and may suffer from stress and the pressures of providing care to their own extended families. All in all, HIV and AIDS have the effect of reducing the length of the school year and the time allocated to covering the required syllabus. As instructional time declines, quality and learning deteriorate.
Learners themselves are threatened by the epidemic and are less likely to attend school. When the income-earning member of the family falls sick and stops working, the familys income declines. Household resources are strained to pay for medicines for sick family members or to support relatives, and education becomes too expensive for most families. They can no longer buy textbooks and materials. Nor can they pay fees of any kind. In addition, a lack of resources impacts on food security and may significantly reduce access to the levels of nutrition required to support effective learning. The situation worsens when one or both parents die. Children may be placed in a foster family, which does not necessarily have the resources to continue paying for their schooling, or they become heads of households and must start earning a living. In addition to being traumatized by the loss of one parent, HIV-infected and -affected children are at risk of falling into poverty or utter poverty. They attend school irregularly and eventually drop out before they become literate.
2
Evidence from research into teacher attrition and mortality in South Africa shows that HIV prevalence rates amongst teachers may be at the same level or even lower than the general population in equivalent age-bands (Badcock-Walters et al., 2005). Other studies on other countries show similar findings (Boler, 2004).
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As affected families become too poor to pay for the numerous expenses that schooling incurs, as children have to work to complement the family income and eventually have to drop out, and as quality deteriorates and average learning achievements decline, EFA is in great danger. Progress toward EFA will slow down or, in the worst cases, earlier achievements may be reversed.
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4.
EFA and HIV prevention

As mentioned above, the best protection against the rising prevalence of HIV in society is education at all levels and the cognitive skills and understanding this provides.
The impact of education on HIV

By promoting access to quality education for children and youngsters, and literacy and practical training for adults, the following can be said: Children and young adults will be equipped with the competence to read and write and thus continue to learn throughout their lives. They will be equipped with important skills such as critical thinking and the ability to process and evaluate information. Some data suggest that "receiving at least a primary school education can halve young people's risk of contracting HIV even if they are never exposed to specific AIDS education programs in the classroom" "Literate women are three times more likely to know that a healthy-looking person can have HIV and four times more likely to know the main ways of avoiding AIDS" (Global Campaign for Education, 2004: 4). The prevention messages can be taught in schools and complement whatever information children hear by other means; i.e. through the radio and other media in particular. The questions planners and educators must answer are how can preventive education be organized so as to be most effective? What should be focused upon to provide more and better education? Should preventive messages be introduced in all subjects, or should HIV/AIDS education be treated as a separate subject? Recent research indicates that the latter would be more effective. HIV/AIDS courses can be provided as part of the formal curriculum or after classes in AIDS clubs, be taught by teachers, health personnel or peers. These questions will be dealt with in Module 4.1, A curriculum response to HIV/AIDS, and Module 4.2, Teacher formation and development in the context of HIV/AIDS. It is nevertheless necessary to emphasize that preventive education is to be introduced as early as possible and certainly from primary education level. Peer education and AIDS clubs are particularly effective, provided there is adequate and appropriate support material available and a common message developed through training. Peers and teachers must also receive specific prevention education and training programmes. Literacy programmes and non-formal education for out-of-school youth and adults will inform mothers, parents and adults on the risks of HIV and how to protect themselves. Research has shown that women who have participated in literacy programmes have a better knowledge of health and family issues and are more likely to adopt preventive health measures. They are also more likely to know their rights and to protect themselves and their families. HIV/AIDS information and preventive education must reach all those who are sexually active, including the many youngsters and adults who have never attended school or dropped out early. UN agencies and NGOs found that the most successful programmes integrate literacy and life skills into training programmes designed to improve livelihoods. In this way, beneficiaries see the immediate benefits and results of participation. Some adults may already
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be infected and the education offered will provide them with advice and inform them on their rights and responsibilities. Of course there is no absolute guarantee that increased knowledge will change behaviour. But the chances that changes in behaviour will occur are higher if the messages come from different sources and converge; if school prevention education complements what the media are saying and what other prevention programmes of other ministries and NGOs may convey; and if certain cultural practices can be challenged. In some countries, data from the Health and Demographic Survey show in fact an ambiguous relation between the rate of HIV infection and the education level in the overall population (young and old people together). Secondary school graduates in South Africa, for example, appear to have a higher chance of being HIV-infected than uneducated people; urban people have a higher rate of infection than people living in rural areas. This is very likely due to the fact that more educated persons and people living in urban areas are more likely to migrate and travel than uneducated or rural persons; they are more likely to be separated from their families and to engage in risky relations. Many of them have been infected before having heard or read about HIV/AIDS. Teachers are a case in point. Earlier statistics showed that the proportion of HIV-infected teachers was higher than in the rest of the adult population; more recent statistics show that the reverse is now the case.
EFA and promoting girls education

Just as important, "education is crucial to give the most vulnerable members in society especially young women the status, the independence and confidence they need to assert themselves so that they can act on what they know about staying safe" (Global Campaign for Education, 2004 :4). EFA has girls education and empowerment as one of its major objectives. The majority of cultures around the world do not empower women and girls to get an education and to become active members of society. Traditional cultures of male dominance and the socially accepted submissive position of women make it difficult to be assertive without fear of the repercussions or abuse as a result. The education of women is not a priority in such circumstances. Furthermore, many women do not have access to health services or sexual health training. These attitudes, coupled with a lack of education, can make a woman unlikely to know how to protect herself from unwanted sex or afraid to demand condom use. Uneducated girls may not know the risks they are facing by engaging in risky behaviour. Furthermore, they often do not have the power to refuse sex. Girls are discriminated against, threatened with violence and sometimes raped. These young girls can also be courted by older men hoping to find a partner whom they believe has little chance of having been infected with HIV. In some cases, girls may be courted by their own teachers and give in to them in the hope of getting good grades (the so-called 'sexually transmitted grades' phenomenon). EFA is an instrument that can contribute to empowering women and producing active members of society. Research has shown that the more educated the parents, especially the mother, the more support a girl will receive to attend school. Finally, several studies have shown that the more educated the young girl, the more informed she is on HIV and AIDS and how to protect herself.
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Simply increasing access will not achieve gender equality. The education provided must be of high quality and must empower young girls. Schools need to become child-friendly, safe environments. When developing plans and policies to promote environments and societies supporting the education of girls as well as boys, ministries should keep in mind the following: Establish policies that do not tolerate school violence and follow through when prosecuting perpetrators. Include messages about teacher conduct in teacher training courses. Teachers must model the behaviours of equality and respect that we wish our children to practice. Train teachers to use education programmes that promote critical thinking, decision-making and communication. Provide teachers with access to information concerning HIV/AIDS and sexuality so that they feel comfortable discussing the subject with other adults as well as students. Encourage discussions in classrooms, where students can speak freely about their views on gender roles and HIV/AIDS. Promote the establishment of anti-AIDS clubs for pupils, and for teachers as well.
Box 2
Extract from a speech of The United Nations Secretary General's Special Envoy for HIV/Aids in Africa, Stephen Lewis, to a conference on UN Reform and Human Rights at Harvard Law School in February 2006.
How can we ever explain the fact that the funeral parlours and graveyards of Africa are filled with the bodies of young women in their late teens, 20s and 30s? How can we ever explain the fact that fewer than 10 per cent of pregnant women in Africa have access to prevention of mother-to-child transmission in the year 2006? How can we ever explain the fact that fewer than 10 per cent of the women in Africa know their HIV status in the year 2006? How can we ever explain the fact that grandmothers, aged, impoverished and failing, have become the last resort of orphan support in 2006? How can we ever explain the fact that young girls in a number of high-prevalence countries still don't have knowledge of how the virus is transmitted? How can we ever explain the fact that laws against sexual violence and marital rape, and laws to embody property rights and inheritance rights, are still not a part of the legislative fabric of several countries at the epicentre of the pandemic in 2006? How can we ever explain the fact that the women of Africa carry the continent on their backs, and reel under the burden of care, unacknowledged and uncompensated, while the world looks on with eyes of glass.
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Activity 2
Figure 3 below illustrates data from the Rwanda Health and Demographic Survey on HIV prevalence by place of residence and educational level. 1. Comment on the difference in the infection rates according to whether people live in Kigali, in other cities or in rural areas. Are you surprised to find that people living in Kigali have a higher chance of being infected than in other cities, or in rural areas? Why/why not? 2. Comment on the difference in the infection rates of people living in Kigali according to their educational level. Are you surprised by the difference in infection rates? Why/why not? Figure 3 HIV infection rates of women in Rwanda by urban and rural areas and by educational attainment, 2003.
30 25 20 No education 15 10 5 0 Kigali Other Cities Rural Areas Primary Secondary
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5.
Using EFA to overcome the impact of AIDS

The following section gives examples of how governments can prioritize actions to promote attainment of EFA, and how this will help mitigate the impact of HIV and AIDS by allocating more resources to education, by training teachers better and faster, and by taking different initiatives that will help educate infected and affected children and youngsters.
Increasing the resources available for education

To achieve EFA, more funds are being mobilized for education at national and international levels. International funds are increasingly mobilized in the framework of the Fast Track Initiative (FTI). In the latter framework, a compact agreement is reached between the recipient countries and donors according to which, on one hand, countries agree to develop an education sector plan and to spend a larger share of their budget on education and on primary education in particular. Funding agencies, on the other hand, commit themselves to mobilizing more resources, making them more predictable and more co-ordinated. Much remains to be done to increase funding, and lack of funds is not the only problem. But on the whole, low-income countries spent a lot more on education in 2002 than they did in 1990. Government spending on education as a proportion of GDP increased from 3.1 per cent in 1990 to 4 per cent in 2000 and 4.3 per cent in 2002. The international community also has started mobilizing itself. The downward trend noted in official development assistance (ODA) as a proportion of national income until the year 2000 has been reversed, and development assistance increased by 23 per cent between 2000 and 2002. Following the commitments made in the G8 meeting in 2005, ODA should continue to increase until 2010. Aid to education and aid to Africa in particular is expected to double. Let us hope that these commitments will be put into practice3. Beyond securing more funds, the challenge will be for countries to design the right policies and to strengthen their capacities to use such funds and effectively manage their education systems.
Training and supporting large numbers of teachers in school

In order to reach the Education for All objectives and enrol 100 per cent of school-age children by 2015, large numbers of teachers will have to be recruited and trained. According to some estimates, more than 1.3 million teachers will have to be recruited between 2000 and 2015 in sub-Saharan Africa. Recent research results have challenged the effectiveness of the present model of initial teacher training: it is long, expensive, and yet does not appear to have a significant impact on teacher practices and knowledge. Most teachers continue to teach using the methods that their own teachers practiced when they were in primary and secondary schools and that they see being practiced in many teacher
3 The Fast Track Initiative is helping an increasing number of countries but is still very limited.
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training colleges, even today frontal methods which do not encourage interaction or individualized teaching. In view of the high cost of traditional teacher training and the need to train large numbers of teachers, a new model of teacher training is emerging which combines short pre-service training with coaching and mentoring at school level and/or with distance education (Dembl, 2003; PASEC, 2002; Lewin and Stuart, 2003). Similarly, in-service teacher training as currently practised does not have much of an impact either. Hence, continuous in-service training of teachers is encouraged as part of a holistic model of continuing professional development and support for whole school development. Box 3 Training large numbers of teachers
The new primary teacher preparation programme in Guinea combines initial training with practice in associate schools. In the crash programme, teachers are trained in three phases: three months of coursework at the teacher training college, followed by nine months of supervised student teaching with full responsibility for a classroom in selected associated schools, and finally three months of further coursework at the teacher training college (TTC). The regular programme consists of two phases: nine months of coursework at the TTC, interspersed with three periods of practicum teaching followed by nine months of teaching with full responsibility for a class.
In countries where a significant number of teachers are infected by HIV and AIDS and their professional lifespan as teachers is shortening, a faster and cheaper way of training teachers is an option to be considered. The new mode of teacher training seems therefore particularly appropriate. Teachers also need to be regularly updated and supported in schools on several subjects including preventive education.
Activity 3
What policies are in place in your country to facilitate the recruitment of trained teachers in general and at school level in particular? What are the practices used in terms of replacing absent teachers? Have these been changed recently?
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Facilitating the education of poor and vulnerable groups

Children and youngsters affected by HIV/AIDS are at a disadvantage with regard to schooling because not only are they likely to suffer from the psychological trauma associated with the sickness of their parent, they also have to suffer from a decline in family and nutritional resources. When a family member living with HIV is confronted with AIDS, the family income declines and more resources are used to buy medicines. Hence, children and youngsters in affected families suffer from the following circumstances: They have difficulty in paying fees and other expenses that schooling entails contribution to parent-teacher associations, uniforms, textbooks, stationery, transport costs, examination fees. They may have to work to support their family. They live in greater poverty and suffer from malnutrition. They no longer have support for their studies. In the context of EFA, several countries have adopted specific measures to encourage the participation of poor and vulnerable children. These should benefit AIDS-affected children and they concern the following: Abolishing school fees Numerous low-income countries continue to charge tuition and other fees at primary level. These fees are sometimes legal and sometimes illegal; that is, the schools continue to raise fees when not enough funds are allocated by the central or local government to cover their expenses. Some countries apply targeted exemptions on school charges (e.g. for girls and/or orphans), but unless the missing funds are compensated by other sources, anecdotal evidence suggests that these exemptions may lead to some schools excluding the children concerned. It can also lead to stigmatization in the case of AIDS orphans. Realizing that families were spending an inordinate proportion of their income on education and that this was deterring them from sending their children to school, several countries have suppressed all school fees at primary level. The first country to do this was Malawi in 1991. Uganda was the next country to do so (1997), followed by Cameroon (1999), Lesotho (2000), Tanzania (2001), Zambia (2002), Madagascar and Kenya (2003), etc. More countries followed in 2004 (Benin, Mozambique) and 2005. The impact of this measure on enrolment has been obvious and overwhelming. In Malawi, gross enrolment ratios increased from 89 per cent to 133 per cent in one year. In Uganda, enrolment rose by 2.3 million children in one year. This led to greater equity as poor children benefited largely. Unfortunately, the end result has in some cases been a dramatic deterioration in teaching conditions when there were not enough teachers to teach the pupils, no classrooms to accommodate them or no textbooks. Also, not all costs have been suppressed: other charges, such as textbooks, stationery, meals, examination fees, etc., remained. Hence, the poorest children continue to drop out and be out of school.
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Increasing the quality of education through various measures such as: changing the curriculum and making it more relevant; introducing teaching in the mother tongue; improving teacher training programmes; distributing free textbooks for every child; introducing support mechanisms to teachers and head teachers; breaking the isolation of teachers and organizing clusters; giving more responsibility to head teachers and increasing accountability to communities. Many innovative programmes exist; too many to mention. Obviously, the greatest incentive for children to go to school is when learning is enjoyable and when what they learn is relevant to their situation and to that of their families and communities. Different measures introducing greater flexibility in school timetables and calendar As a result of greater community involvement, decentralization, and more diversified sources of financing, formal education has become somewhat more diversified and less rigid than it once was. Following decentralization some flexibility has been introduced, for example in the school calendar and timetable of certain schools in Mali, Senegal and Guinea to take into account specific climatic conditions, or in the curriculum. The involvement of communities in community schools also allows adaptation to local needs. Organizing school meals and food programmes Several countries in Africa and elsewhere in the world organize food programmes with the support of NGOs and international organizations such as the World Food Programme. They are meant to provide incentives to encourage parents to send their children to school, partly compensating the opportunity cost of child labour, as well as to fight child hunger while at school and facilitate concentration and learning. The effect of school meals on access and attendance rates has been demonstrated. The sooner food is provided to children preferably before they reach the age of three the better, hence the importance of ECCE programmes, but also the need to complement school meals with take-home rations that benefit the whole family. Giving scholarships to the children most in need This is another measure meant to encourage parents to send their children to school and compensate for the income foregone. Large scale scholarships schemes at primary and secondary levels are quite frequent outside Africa: i.e. in Asia and Latin America. Increasingly, stipends are given directly to families, as long as their children stay in school, to cover school charges and other living expenses. In some cases the scholarship schemes become social funds with an educational orientation, such as the Bolsa Escola
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and Bolsa Familia in Brazil, or other cash-transfer programmes elsewhere in Latin America. These programmes appear to be quite effective in increasing school attendance of low-income groups, but they require a fairly able administration to administer the scheme. In certain countries, NGOs have been successful in obtaining grants to fund a childs education. This has shown an improvement in the enrolment of orphans in schools (see Box 4). Such schemes must be carefully devised and implemented so as to avoid stigmatization of orphans and vulnerable children (OVC), robbery, and even attack of the beneficiaries by parents of 'unaffected children', etc. Box 4 Supporting HIV/AIDS-affected children
Mukuru Promotion Centre: A rehabilitation centre set up in the Mukuru slums of Nairobi, Kenya. The centre has four schools that cater for children and youth from the slums, as well as street children and AIDS orphans. The schools serve primary-school-age children who are unable to pay school fees. There are also health services and life skills projects, as well as skills training programmes in carpentry and masonry. Community-Based Options for Protection and Empowerment (COPE), implemented by Save the Children Federation Inc. This programme helps villages to set up committees to monitor orphans and provide assistance.
Encouraging non-formal education as a substitute or complement to formal education Education does not have to be viewed in the traditional way, i.e. in a school building with a teacher standing at the front of the classroom. Indeed, many successful education programmes fall into a category commonly referred to as non-formal education (NFE). They tend to respond better to the diversity of needs be they social, economic or cultural of OVC. Several NFE programmes exist within the framework of EFA that provide supplementary support services within schools to specific groups of disadvantaged children. In countries such as Tanzania and Uganda, a strong NGO and community network presence supports the education of AIDS orphans. There are many examples such as community volunteers making regular visits to provide assistance with housework, donations of food, or even some counselling support to children heading households or families supporting people sick with AIDS. Other NFE programmes develop learning opportunities parallel to the formal education system to tackle the needs of the most vulnerable groups who would have difficulty regularly attending a full day in a formal school in view of their specific personal or family circumstances. Some programmes are organized in nonformal settings for shorter hours; others provide accelerated courses (Box 5); others combine literacy courses with vocational skills and train youngsters on how to make a living (see Box 1 above).
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Box 5
Flexibility in schools
Adapting school schedules to suit the timeframes of girls or young people who have dropped out to care for family members can be a practical solution to increasing education. BRAC (formerly Bangladesh Rural Advancement Committee) schools schedule classes in two-hour blocks six times a week to accommodate the needs of girls and other community members. Community schools in Zambia offer the same education content as traditional primary schools in four years instead of seven. Their curriculum is recognized and therefore upon completion youngsters may be allowed to re-enter the formal education system. In addition to the normal curriculum, the course emphasizes life skills and health education. The Undugu Society of Kenya is a well-established institution that endeavours to address the plight of street children through non-formal education and training. The programme is designed to teach children basic literacy, numeracy and survival skills, and to give them a heightened sense of their own worth. The curriculum condenses the regular primary syllabus in three years of basic learning. The learners do not wear a uniform, they receive free textbooks and are provided with free lunch. After the basic education cycle, learners can attend Undugu vocational centres.
Activity 4
What is the policy in your country regarding fees at primary and local secondary levels? What policy exists to support poor and vulnerable children who cannot pay fees or other school-related charges?
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Activity 5
Do you know of any innovative approaches existing in your country that could be expanded to meet the needs of AIDS orphans?
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Summary remarks
HIV and AIDS have been challenging countries' progress to Education for All for the past ten years. A significant proportion of the children in the lowest income groups still do not have access to education or drop out before completing primary education. The quality of education has declined and the costs of education remain high. It is important for ministries of education to see HIV and AIDS as an EFA issue. Similarly, when planning for Education for All, policy makers and managers in ministries of education have to plan certain activities and programmes which will help limit the spreading of HIV and mitigate its impact. EFA and other international declarations were designed in part to help countries prioritize agendas and focus resources. Programmes and interventions must make sure that professional teachers are trained to deliver quality education for all, including HIV prevention, and that they are deployed where they are most needed. These programmes must also focus on the neediest of students and families to ensure that all children enrol and stay in school. To do this, the school system must address the needs of OVC affected by HIV/AIDS. Ministries of education should in particular: partner with community organizations and local NGOs that help children to remain in school; support community actions that fulfil the basic needs of out-of-school children and orphans. Child-friendly centres, like the one in Kenya (Box 4), provide stability and security for children, and improve access to schools; focus on the needs of all vulnerable and educationally marginalized children, not just on those of HIV-affected children or AIDS orphans. Children from impoverished or disjointed families can be as disadvantaged as orphans, if not more so. Besides, any special attention may further stigmatize them; provide foster families with financial incentives and non-monetary support for assuming care of orphan children. For example, counselling and traumatic support services can be helpful to the orphans and would give children and families a chance to properly grieve over their loss; subsidize school fees and increase government grants for schools where large number of OVC are enrolled. Well-targeted school feeding programmes can also helpfully complement abolition of fee policies.
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Lessons learned
Lesson One HIV/AIDS must be looked at in the context of EFA. If left unchecked, it will slow or even reverse a countrys progress towards meeting the universally agreed EFA goals. Lesson Two Equally, EFA and other sector plans must integrate measures to prevent the spread of HIV /AIDS so that adequate response strategies are found to support progress. Lesson Three EFA goals and MDGs should be referred to when developing an HIV/AIDS education strategy; and vice versa, HIV/AIDS is to be included in a countrys education sector plan and EFA action plan. Lesson Four Several of the measures introduced in the framework of EFA will make it easier for educationally marginalized children, including AIDS orphans, to continue their studies up to the end of basic education. These include free primary education; decentralization of management and financing responsibilities to local authorities and schools, allowing greater flexibility in schools timetables and in the local recruitment of teachers to replace missing ones; organization of scholarship schemes and nutrition programmes; and a variety of non-formal initiatives including community-led initiatives to support students after school. Lesson Five Before developing HIV-prevention programmes, ensure that a preliminary overview is taken of activities that may already be taking place in order to work with them. Lesson Six Just as literacy programmes are more effective when combined with micro-credit, rural development or health programmes, developing HIV-prevention programmes as a part of a larger multi-sectoral initiative can be successful when training young people and adults.
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Activity 1 Answers will be specific to your country. Activity 2 Question 1 The HIV-infection rates of women are much higher in Kigali than in other cities and strikingly more than in rural areas. This is probably linked to populations movements. Many people who live in Kigali do not originate from Kigali. Prostitution is also much more developed in the capital city than elsewhere, not to mention the violence and rapes that occurred during the genocide. The likelihood of having been infected by HIV is lower for those living in rural areas. Question 2 The population most at risk amongst women is the uneducated in Kigali. The rate of infection of these women is extremely high: among them are a lot of poor and marginal people, and probably also prostitutes. Obviously those who have completed primary and secondary education in Kigali know better how to protect themselves. The rates of infection of women living in other cities and especially in rural areas are much lower. There the education level seems to make little difference: whether one has received some primary education or not seems to make no difference at all; while, quite paradoxically, having studied in secondary education would increase one's chances of being infected. More information would be required to be sure, including on the number of cases concerned. There may be so few cases that the difference cannot be considered statistically significant. Many may have been infected before they heard of the danger of HIV and the way it is transmitted. Activity 3 Answers will be specific to your country. Activity 4 Answers will be specific to your country. Activity 5 Answers will be specific to your country.
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Documents Badcock-Walters, P. et al. 2005. Educator attrition and mortality in South Africa, 1997/98 to 2003/04. MTT. www.hsrc.ac.za/Factsheet-25.phtml Boler, T. 2004. Approaches to estimating the impact of HIV/AIDS on teachers. London: Save the Children and ActionAid International. www.aidsconsortium.org.uk/protected/downloads/hiv_aids.pdf Dembl, M.; coord. 2003. The reform of pre-service primary and teacher training in Guinea (FIMG). A study for the Association for the Development of Education in Africa (ADEA) biennial. Paris: ADEA. Dembl, M.; Miaro B. 2003. Pedagogical renewal and teacher development in sub-Saharan Africa: A thematic synthesis. A study for the Association for the Development of Education in Africa (ADEA) biennial. Paris: ADEA. EFA FTI Secretariat. 2005. Guidelines for Appraisal of the Primary Education Component of an Education Sector Plan. Washington DC: World Bank. www1.worldbank.org/education/efafti/documents/assessmentguidelines.p df Global Campaign for Education. 2004. Learning to survive. How Education for All would save missions of young people from HIV/AIDS. June 2004. Available on: www.campaignforeducation.org/resources/Apr2004/Learning%20to%20Sur vive%20final%202604.pdf. Kelly, M.J. 2000. Planning for education in the context of HIV/AIDS. Paris: UNESCOIIEP. http://unesdoc.unesco.org/images/0012/001224/122405e.pdf Lewin, K.; Stuart, J.S. 2003. Researching teacher education: new perspectives on practice, performance and policy. Multi-Site Teacher Education Research Project (MUSTER) synthesis report. Sussex: DFID. www1.worldbank.org/education/efafti/documents/assessmentguidelines.p df Ouma, W.G. 2004. Education for street children in Kenya: the role of the Undugu society. Paris: UNESCO-IIEP. http://unesdoc.unesco.org/images/0013/001390/139032e.pdf
PASEC. 2002. Evaluation du programme de formation initiale des matres de Guine (FIMG) et de la double vacation. Dakar: PASEC.
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Postlethwaite, T.N.P. 2004. Monitoring educational achievement. Fundamentals of educational planning N 81. Paris: IIEP-UNESCO. Schwille, J.; Dembl, M., in collaboration with Schubert, J. 2007. Global perspectives on teacher learning: improving policy and practice. Fundamentals of educational planning N 84. Paris: IIEP-UNESCO.
UNESCO. 2002. EFA Global Monitoring Report 2002: Education for All: Is the world on track? Paris: UNESCO. UNESCO. 2005. EFA Global Monitoring Report 2005. Education for All: The quality imperative. Paris: UNESCO.
UNESCO. 2006. EFA Global Monitoring Report 2006. Education for All: Literacy for life. Paris: UNESCO.
UNICEF. 2004. Girls, HIV/AIDS and education. New York: UNICEF. www.unicef.org/publications/index_25047.html
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Module
R. Smart
HIV/AIDS-related stigma and discrimination
1.4
About the author

Rose Smart is an independent consultant and the former Director of the South African National AIDS Programme, specializing in workplace issues, policy development and implementation, mainstreaming HIV and AIDS, community-based responses and affected children. She is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Module 1.4
HIV/AIDS-RELATED STIGMA AND DISCRIMINATION
Table of contents
Questions for reflection Introductory remarks 1. Definitions of stigma and discrimination 2. Causes and types of stigma and the language used Self-stigma Felt stigma Enacted stigma 3. Consequences of stigma and discrimination for programmes 4. Policies and laws: human rights and education Enabling and protective policies and laws Discriminatory and stigmatizing laws and policies 5. Confronting stigma and discrimination in the education sector Effects of stigma and discrimination in the education sector Local-level discrimination in the education sector Leadership within the education sector 6. Education as a tool to counter stigma and discrimination in the classroom Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 1.4: HIV/AIDS-related stigma and discrimination
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Aims
The aim of this module is to enable you to recognize AIDS-related stigma and discrimination and to equip you with strategies to challenge and reduce these within the education sector. In the first part we define stigma and discrimination; we discuss its causes and state how it affects populations. In the second part we look at stigma and discrimination within the education sector, and how the problem should be seen as a human rights issue. Then we examine AIDS-related stigma and discrimination in the workplace or at the ministry level and then within schools. In the final section we discuss how prevention programmes can be developed to effectively diminish stigma and discrimination.
Objectives
At the end of the module you should be able to: define stigma and discrimination; explain the causes, effects and consequences of stigma and discrimination; describe different forms of stigma and discrimination; apply a rights-based approach for confronting and reducing discrimination; understand how stigma poses obstacles to education and prevention programmes; explain strategies and practical actions to challenge and reduce AIDS-related stigma and discrimination in education systems.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. How would you define stigma and discrimination?
What is the difference between stigma and discrimination?
What are some of the causes of social stigma and discrimination?
What do you think are the effects of stigma and discrimination on a person living with HIV?
How can AIDS-related stigma and discrimination manifest themselves in the education sector?
How do stigma and discrimination hinder effective responses to HIV and AIDS?
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Module 1.4
HIV/AIDS-RELATED STIGMA AND DISCRIMINATION
At the end of 2004, 39.4 million people were living with HIV, and during that year 3.1 million died from AIDS-related illnesses. Since the onset of the disease in the early 1980s, HIV and AIDS have triggered responses of fear, denial, stigma and discrimination, often targeted at those groups seen as the most affected (injecting drug users, sex workers, etc.). In some cases, people living with HIV have been rejected by their loved ones and their communities, unfairly treated in the workplace, and denied access to education and health services this holds true for the industrialized as well as the developing nations. AIDS-related stigma can take many forms rejecting, isolating, blaming and shaming, and we are all involved in stigmatizing even if we dont realize it. Box 1 Quote from UNFPA Executive Director on World AIDS Day 2003
"After two decades the global AIDS epidemic shows no signs of abating Among the main reasons is the persistence of stigma and discrimination against those infected. This outrageous violation of basic human rights drives the disease underground, crippling efforts for prevention and care."
Fear of discrimination often discourages people from seeking treatment or from disclosing their HIV status, which makes prevention and management of the disease very difficult. The stigma attached to HIV and AIDS extends into the next generation, placing a heavy emotional burden on those left behind. It is especially hard for children who may already be grieving a parent or family member. AIDS-related stigma and discrimination remains one of the biggest barriers to effectively managing the AIDS epidemic. Within the education sector, children are refused access to school because they come from an AIDS-affected household. Teachers can be dismissed because of their HIV status.
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Box 2
Quote from Archbishop Njongonkulu Ndungane
"Stigma is the unfair, uneducated and unholy disgrace we have allowed to develop around the disease. Stigma destroys self-esteem, destroys families, disrupts communities and takes away all hope for future generations."
Stopping the stigma and discrimination against people and marginalized groups who are affected by HIV and AIDS is as important as developing a vaccine itself. Education plays a key role in diminishing stigma and discrimination. Strategies to address stigma are critical for HIV prevention and education programmes and must extend into communities to be effective. As we have seen with gender issues, stigma reduction should also be mainstreamed into every aspect of education policies, programmes and practices.
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1.
Definitions of stigma and discrimination

Box 3 Quote from Regional Consultation on Stigma and HIV/AIDS in East and Southern Africa (2001)
"HIV/AIDS-related stigma is a real or perceived negative response to a person or persons by individuals, communities or society. It is characterized by rejection, denial, discrediting, disregarding, underrating, and social distance. It frequently leads to discrimination, and violation of human rights."
There are a number of definitions of stigma and discrimination which can help us to understand these complex issues. Stigma: The holding of derogatory social attitudes or cognitive beliefs, a powerful and discrediting social label that radically changes the way individuals view themselves or the way they are viewed by others. Discrimination: An action based on a pre-existing stigma; a display of hostile or discriminatory behaviour towards members of a group, on account of their membership to that group. Disclosure: Refers to a process that results in a person living with HIV deciding to give others information about their status (and perhaps then also talking openly about living with HIV or AIDS). Disclosure is a positive response that has many benefits but it is made very difficult, or indeed impossible, in situations where stigma and discrimination are present. The benefits of disclosure could include: improved emotional and physical health through increased acceptance of status; better access to healthcare services and support; more opportunities to learn about HIV and AIDS; being able to enter into important discussions, e.g. about safer sex; becoming equipped to influence others to avoid infection; removing the mystery and silence surrounding HIV and AIDS; enabling others to show love and care. These benefits in turn contribute to reducing stigma and discrimination. This cause and effect cycle where disclosure is compromised because of stigma needs to be broken before any real progress in terms of HIV prevention, treatment, care and support, and impact mitigation can take place.
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Box 4
Extract from Siyamkela: HIV/AIDS-related stigma: A literature review
"Stigma has been identified as a complex, diverse and deeply rooted phenomenon that is dynamic in different cultural settings. As a collective social process rather than a mere reflection of an individuals subjective behaviour, it operates by producing and reproducing social structures of power, hierarchy, class and exclusion and by transforming difference (class, race, ethnicity, health status, sexual orientation and gender) into inequality" (POLICY Project, 2003a: 2).
Activity 1
The language of HIV and AIDS 1. In your local language(s), make a note of what word(s) best capture the concepts of stigma and discrimination.
2. Now list words in your local language(s) that are used for HIV and AIDS and what connotations these words have positive vs. negative, implying certain behaviours, reinforcing silence as opposed to openness, etc.
3. Now make notes on how language about HIV and AIDS can fuel stigma and discrimination.
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2.
Causes and types of stigma and the language used

The causes of AIDS-related stigma are multiple and include the following: Ignorance or insufficient knowledge, as well as misbeliefs and fears about HIV and AIDS. Moral judgements about people and assumptions about their sexual behaviour. Associations with illicit sex and/or drugs. Fear of death and disease. Links with religion and the belief that AIDS is a punishment from God. Self-stigma is, for example, self-hatred, shame, blame etc. Self-stigma refers to the process whereby people living with HIV impose feelings of difference, inferiority and unworthiness on themselves. Box 5 Quote from stigma-aids e-forum
"The way I saw myself fundamentally changed within a matter of minutes. I thought that I was marked, different from everyone else. I felt dirty, ashamed, guilty (although I wasnt sure why I felt guilty; it just felt like an appropriate response)."
Felt stigma are perceptions or feelings towards a group, such as people living with HIV, who are different in some respect. Enacted stigmas are actions fuelled by stigma and which are commonly referred to as discrimination.
Self-stigma
Manifestations of self-stigma include: feelings of shame, dejection, self-doubt, guilt, self-blame and inferiority; feeling that the person deserves to be in that particular situation; loss of self-esteem and confidence; social withdrawal and isolation; no longer dining with or expressing physical affection towards partners and family members; self-exclusion from services and opportunities, and refusing help that is offered;
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stopping work in the belief that one is no longer capable or worthy of employment; high levels of stress and anxiety;fear of disclosure; denial; Self-stigma is worse when an individual: is first diagnosed (especially with no or limited emotional support at the time of diagnosis); has a limited support system; already feels minimal self worth (this includes when dual or multiple stigmas are present); has preconceived irrational or mythical beliefs about HIV and AIDS. Overcoming self-stigma is assisted through: early referral to peer support; good quality pre-, post-test and on-going counselling; disclosure of HIV status to loved ones; encouragement to remain a productive member of the community; information about HIV and AIDS; access to antiretroviral treatment for those in need of medication; respect for the rights of all people diagnosed as being HIV positive; training and employment of positive persons. Box 6 Extract from Siyamkela: Measuring HIV/AIDS-related stigma preliminary indicators
Fear and moral judgement are considered to be the root sources of HIV/AIDS stigma. HIV/AIDS is associated with many different fears. People may fear the casual transmission of the virus, the loss of productivity of people living with HIV, that resources may be wasted on people living with HIV, living with the disease, or imminent death. Similarly, moral judgement may cause stigma. people living with HIV are often seen as self-blaming and convinced that they deserve it because the transmission of the virus is linked to stigmatised behaviour, which allows people to understand HIV/AIDS in terms of the concept of blame. It is important to note that HIV/AIDS stigma can be experienced not only by people living with HIV/AIDS but also by people who are suspected to be living with HIV/AIDS (POLICY Project, 2003b: 4).
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Felt stigma
Stigma can be blatant or subtle, but it is always value-laden and compromises the human rights of those affected. Stigma is characterized by denial, ignorance and fear. Other features of stigma include: pointing out or labelling differences "they are different from us"; separating 'us' and 'them' leading to avoidance, shunning, isolation and rejection; stereotyping; attributing differences to negative behaviour "his sickness is caused by sinful or promiscuous behaviour"; loss of status; overt abuse (may occur).
Enacted stigma
The effects of stigma are wide-ranging and may include actions taken by the person concerned in response to the stigma, and actions taken against the person concerned, which are discriminatory. Felt and enacted stigma can take many forms such as: physical and social isolation from family, friends and community; being kicked out of one's family, house, rented accommodation, school, and community groups; gossip, name-calling and insults; judging, blaming and condemnation; loss of rights and decision-making power; stigma by association e.g. the whole family is affected by the stigma; stigma by looks/appearance/type of occupation; loss of employment; impaired access to treatment and care; dropping out of school; depression, suicide, alcoholism; avoiding getting tested for HIV; break-up of relationships; violence; loss of perceived manhood or womanhood.
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Box 7
Extract from Love - and death - in the time of AIDS
Love in the time of AIDS meant embracing death together for a married couple in West Bengal as the duo preferred to end their miseries instead of dying a little of humiliation everyday. () Probir and Basanti Sarkar were a happy couple since their love marriage four years ago. But in an infection apparently caused by blood transfusion, Basanti was recently found to be HIV positive. The ordeal began with friends, neighbours and even family members socially boycotting them after she was diagnosed as HIV positive. ()It was alleged that Basanti was even prevented from boarding a cycle rickshaw by some neighbours because of her infection and no one wanted to provide the couple with a vehicle for taking her to hospital for admission. Probir, who was not infected, could not bear to see his wife living as a social outcast and after Basanti's discharge from hospital they took the drastic step. Thursday night after dinner, Probir gave his wife half a glass of poison and after he was sure that she had died, he hanged himself (Indo-Asian News Service Kolkata, September 10th, 2005).
Box 8
Extract from stigma aids e-forum
"In 2001, the Tanzanian media published a story of a primary school girl who was HIV-positive and as a result was forced by the school authorities to wear a red ribbon to show her sero-status as a warning to other pupils. The story became the best seller but it was soon forgotten and there was no serious media follow up on measures taken against the headmaster or on the feelings of the girl after she was stigmatised in this most inhuman manner. The media only concentrated on the sensational part of this gross violation of human rights and did not even mention that it was stigmatisation a discrepancy in reporting that reflects a serious problem in Tanzanian media involvement on AIDS issues" (HDN Key Correspondent Report, June 7th 2001).
Powerful metaphors related to HIV and AIDS reinforce stigma and re-affirm social inequalities, thus rendering already stigmatized groups even more stigmatized. Words like 'promiscuous' and 'risky' assign shame and blame and underline a moral tone that reinforces the notion of 'them' and 'us'. Words such as 'victim', 'AIDS carrier' and 'sufferer' stigmatize people living with HIV and create images of powerlessness. Prejudices are perpetuated by media portrayals of HIV-infected persons as helpless and hopeless. This media reporting compounds irrational fears and prejudices associated with HIV and AIDS by using the language of guilt versus innocence, and the metaphors of war and plague.
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The impact of stigma is mediated by gender and its impact is experienced more by women than men. This is rooted in the current social constructions of sexuality and sexual relations. In many cultures, where women are frequently perceived as vectors of illness, AIDS is seen as a womans disease. And, women may be blamed by their partners, families or community for not raising their HIV-positive son or daughter properly. Similarly, children may experience stigma related to their own HIV status or because they live in an AIDS-affected household. The latter is very common and is known as 'secondary stigmatization' or 'stigma by association'. These children may: be perceived as 'innocent victims'; be neglected/abused by their new parents; grow up without trust and love; become street kids; become introverted, or experience difficulty handling grief; experience depression, or loss of hope and a sense of future; be isolated by friends; effectively lose their childhood, as they are forced to accept adult responsibilities; not have access to school or any form of education.
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3.
Consequences of stigma and discrimination for programmes

Stigma and discrimination impede both willingness and ability to adopt HIV preventive behaviour, to access treatment and to provide care and support for people living with HIV. Fear of stigma impedes prevention efforts, including discussions of safer sex and preventing mother-to-child transmission. Because of the separation between 'us' and 'them', people avoid confronting their own risk and adopting preventive behaviours. Utilization of voluntary counselling and HIV testing (VCT) services and disclosure of HIV status are constrained because of the anticipated stigma and the actual experiences of people living with HIV. Resources like medicine, transport to health services, food and other amenities may be withheld because of a perception that people living with HIV are hopeless cases and will die anyway. These represent just some of the barriers created by stigma. On the positive side, the process of disentangling stigma reveals many opportunities for interventions. Box 9 Extract from Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia
There are five critical elements that programmes need to address:
creating greater recognition of stigma and discrimination; fostering in-depth, applied knowledge about all aspects of HIV and AIDS through a participatory and interactive process; providing safe spaces to discuss the values of and beliefs about sex, morality and death that underlie stigma; finding common language to talk about stigma; and ensuring a central, contextually-appropriate and ethically-responsible role for people with HIV and AIDS.
Source: Nyblade et al., 2003.
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Box 10
Example of a workplace programme from Positive Action at Work (Nairobi)
Positive Action at Work was launched on 29 November 2004 by the Kenya HIV/AIDS Business Council and the UKs National AIDS Trust. Positive Action at work seeks to address stigma as a barrier to successful implementation of comprehensive workplace HIV/AIDS programmes by using positive images in HIV awareness and education and by encouraging the discussion of prejudice and social exclusion. Materials, developed with peer educators, are available on www.gsk.com/positiveaction/at-work.htm.
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4.
Policies and laws: human rights and education

At sectoral, national and international levels, policies, laws, and conventions can either enable access to services and to exercising rights, or they can inadvertently perpetuate discrimination and stigmatization.
Enabling and protective policies and laws

Most countries have now enacted policies and laws to protect the rights and freedom of people living with HIV and to safeguard them from discrimination. Much of this legislation has sought to ensure their rights to education, employment, privacy and confidentiality, as well as rights to access information, treatment and support. In relation to education, the Convention on the Rights of the Child (CRC) commits signatory nations to strive to: make primary education compulsory and available free to all; encourage the development of different forms of secondary education; and take measures to encourage regular attendance at school. Similarly, the Millennium Development Goals (MDGs) aim at: Universal primary education (UPE) by 2015: that all children, boys and girls alike, be able to complete a full course of primary education; and achieving gender equality: that girls and boys have equal access to all levels of education. The AIDS epidemic represents a major challenge to the realization of these goals, not least because stigma creates enormous barriers to access to education and to gender equality, but also because this stigma and discrimination can create obstacles to prevention programmes in schools and in the workplace. As rightsbased institutions, schools should play a major role in protecting pupils and teachers against discrimination.
Discriminatory and stigmatizing laws and policies

In many countries, stigmatization is expressed through laws and policies directed at those living with HIV that claim to protect the general population. Examples of such discriminatory legislation include limitations on international travel and migration, compulsory screening and testing for HIV, compulsory notification of AIDS cases, prohibition of people living with HIV from certain occupations, and even isolation of people living with HIV from the general population.
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Box 11
Comment from stigma-aids e-forum
"While nearly a million HIV-positive American citizens enjoy the freedom to leave and travel outside their country, the United States government prohibits HIV-positive individuals from other countries entry to the United States! Without a doubt, this ban is the most blatant display of discrimination against HIV-positive people to date! This ban continues to fuel discrimination, while a worldwide community strives to stop the stigma and discrimination surrounding HIV and AIDS!" (Bradford McIntyre, Canada).
In most cases discriminatory practises, such as the compulsory screening of risk groups, both further the stigmatization of these groups and create a false sense of security among individuals who are not considered members of such groups or who are at high-risk of contracting HIV. Conversely, enabling programmes and laws can have an unintended discriminatory effect on the beneficiaries rather than an enabling one. For example, healthcare workers may perpetuate stigma during treatment, counselling and care of people living with HIV. In an education-related example, in spite of the many national and international subsidies and support programmes to support orphans education, children in Uganda were unhappy being singled out as orphans and said they felt ridiculed at school because of their subsidized uniforms or other forms of monetary assistance that made their status easily recognized (Munaaba, Owor et al., 2004). Box 12 Inadvertently perpetuating stigma
"Socially excluded groups are often at great risk for discrimination. During interviews in Botswana, Uganda and Malawi, children orphaned by HIV/AIDS reported several cases of discrimination. Some children claimed they were sent home from school due to unpaid school fees, or untidy uniforms and some said they did not go for fear of being teased or unaccepted" (Bennell, Hyde and Swainson, 2002).
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5.
Confronting stigma and discrimination in the education sector There are many forms of AIDS-related stigma and discrimination occurring
in schools and ministries of education across the world, with perhaps the most prominent discrimination being termination of employment or refusal to offer employment based on an employees actual or assumed HIV status. Other discriminatory practices involve: unequal training and/or promotion opportunities based on HIV status; inconsistent or absent practices to deal with instances of AIDS-related discrimination; breaches of confidentiality regarding an employees HIV status.
Box 13
Examples from stigma-aids e-forum
My colleague told me he hated HIV, and people with HIV, because when they came to his desk he had to disinfect everything. Someone suggested we should not recruit new staff from Africa because theyd all have HIV and die. A staff member asked why someone was having their contract renewed since he was dying (in fact, although this person had HIV he was extremely healthy). People in my team made jokes about AIDS assuming that nobody in the room had HIV. Some people suggested we test everyone and put them into separate vehicles when we travel so that if there is an accident the innocent negative staff wont be put at risk. Team members suggested that people who are living with HIV were only hired because we felt sorry for them - implying they were not competent.
Box 14: Debbie speaking to the National AIDS Trust, UK, 2002.
My foster son, Michael, aged 8, was born HIV-positive and diagnosed with AIDS at the age of eight months. I took him into our family home, in a small village in the southwest of England. At first relations with the local school were wonderful and Michael thrived there. Only the head teacher and Michaels personal class assistant knew of his illness. Then someone broke the confidentiality and told a parent that Michael had AIDS. That parent, of course, told all the others. This caused such panic and hostility that we were forced to move out of the area. The risk is to Michael and us, his family. Mob rule is dangerous. Ignorance about HIV means that people are frightened. And frightened people do not behave rationally. We could well be driven out of our home yet again.
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Activity 2
Stigma and discrimination in the education sector A. Consider how stigma and discrimination impact on HIV prevention, treatment, care and support, and impact mitigation programmes in your country for: 1. pupils.
2. teachers and other education sector employees.
B. Now select one impact on HIV prevention, one on treatment, care and support and one on impact mitigation and discuss possible interventions to prevent or reduce the impact.
C. Can you think of other barriers that stigma produces within the education sector, such as how stigma can affect the following: 1. the implementation of a policy of universal primary education; or 2. the morale and productivity of an infected teacher; or 3. the learning environment of children from an affected community?
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Effects of stigma and discrimination in the education sector

The effects of stigma and discrimination in the education sector can be very disruptive. For example: they can negatively affect teacher morale; they can result in reduced productivity (e.g. teacher absence); they can compromise employee health, in instances where stigma constitutes a barrier to access to treatment and care; they can result in the loss of human resources if infected employees leave;
they will undermine HIV prevention programmes.
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Local-level discrimination in the education sector

At the school level and in communities, children living in AIDS-affected households can be sent away from school, refused access to services and robbed of their property. We will discuss stigma and discrimination within the classroom further in this module. Strategies Education sector strategies to address stigma and discrimination in the workplace should include the following: Conducting an HIV and AIDS policy analysis to assess the extent to which policies address (or perhaps reinforce) AIDS-related stigma and discrimination. Informing all teachers, staff and employees of AIDS-related stigma mitigation policies and practices, so that there is widespread understanding of the consequences of discriminatory behaviour. Targeting prevention programmes specifically at school employees and staff in addition to programmes for students. Mainstreaming AIDS-related stigma mitigation policies into other functions, such as communication strategies and strategic plans. Protecting the rights of all employees who are infected or assumed to be infected with HIV and acting decisively when cases of stigma and discrimination do occur. Encouraging sensitivity and understanding among co-workers regarding AIDS issues. Encouraging HIV-infected teachers to disclose their status within a safe, accepting and supportive environment. Providing managers at all levels with clear guidance on which they can base managerial decisions when confronted with issues relating to HIV and AIDS. Ensuring that mechanisms are in place to protect the confidentiality of information related to teacher and staff health, including their HIV status. Involving people living with HIV in all workplace HIV and AIDS activities, as well as inviting them to share their experiences with parents and students. Encouraging school staff to form networks and associations with people living with HIV to promote acceptance and understanding. Monitoring the implementation of AIDS policies, including the stigma mitigation aspects of these policies, and monitor interventions for their sensitivity in relation to stigma.
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Leadership within the education sector

HIV and AIDS leadership and visible and vocal commitment have enormous potential to address stigma and discrimination. These should be evident in three areas: 1. Internally leadership on AIDS issues within the sector, the organization, and the school. 2. Externally leadership with other stakeholders. 3. Personally acting as a role model, for example by demonstrating solidarity with people living with HIV or getting tested for HIV.
Activity 3
Provision for AIDS-related stigma reduction in annual operational plans Develop an objective that could be one of the objectives in the annual operational plan of your ministry and that clearly states the desired outcome in terms of a stigma-free working and learning environment.
Select some of the stigma reduction workplace strategies that would be appropriate in your ministry or at school.
Then, using a simple work-plan template that consists of the headings in the example table below, develop a work plan for one year that includes the step-bystep activities that relate to the selected strategies. For example, what are the steps necessary to undertake analysis of a stigma reduction policy?
OUTPUT/ OUTCOME
ACTIVITY
TIME FRAME
RESPONSIBLE UNIT OR PERSON
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6.
Education as a tool to counter stigma and discrimination in the classroom

Education has a key role in lessening stigma and discrimination. It can affect change where the law cannot, such as in families and among friends. Furthermore, people working in education are ideally placed to pass on information that challenges the stigma related to HIV and AIDS. UNAIDS differentiates three types of education to promote HIV prevention and awareness: Public education: Information provided to the general public to increase knowledge of the disease. Can be done through media campaigns, newsletters. Professional education: By changing the attitudes of respected professionals, this can have positive effects on the behaviours and attitudes of others around them. An example would be workplace interventions within your ministry. Targeted or focused education: This refers to education programmes tailored to specific communities and groups, such as teen groups, workplace groups, religious groups or womens groups. Box 15 Extract from the Conference on HIV/AIDS and the Education Sector
My name is Mpho from the North West Province (South Africa), and Im seventeen years old. I believe that teachers can have a huge impact on the lives of learners who are affected and infected by AIDS. I lost my mother and a sister in 1999 and in 2000 I was raped by my father. A year later I discovered that Im HIV positive. The first person who knew about this was a teacher and the attitude that she had is the cause of my positive living in life (South Africa Department of Education, 2002: 10).
Prevention programmes must take into account the messages students are receiving from the community and at home. If not, the fears and misunderstandings that create stigma and cause discrimination will be perpetuated. If education is the best means of stopping the spread of HIV, these prevention programmes must successfully break this cycle.
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Box 16
Addressing stigma and discrimination through education
An effective way to address stigma and discrimination is through training and educating people and children about HIV and AIDS and about the causes and effects of stigmatization and discrimination. Below are some examples of education programmes that were effective in diminishing stigmatization. Prevention in schools through peer education HIV/AIDS life skills day camps (Tanzania) Designed by Global Service Corps and based in Arusha, these camps provide a framework for secondary school students to learn about HIV/AIDS, prevention, relationships and sexuality in a fun, creative, and ultimately sustainable manner. A primary goal of the camp is for the participants to form health clubs in their respective schools to share their knowledge of HIV/AIDS with the rest of the school. This way the discussion of HIV/AIDS can be continued throughout the year. Peer education and theatre Tabor Wegagen Anti-AIDS Association (Ethiopia) A programme established in conjunction with UNICEF over six years ago by a group of young people who came together to inform their peers about HIV and AIDS. Using the principles of peer education, the groups share information on HIV prevention and also engage in sensitization activities, such as theatre, to diminish stigma and discrimination.
Activity 4
Stigma and discrimination at school A) First read the three questions from a Save the Children UK study. Concentrate on how stigma impacts on the education and well-being of these children. Focus on who is stigmatized and by whom; where within the learning environment; and why the context and causes. 1. "They are laughing outside of the class. They laughing at the fact that her mother has AIDS. She is angry and going away. She feels angry and she also feels like beating them but she knows they will report her at the office."
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2. "You are afraid the teachers will tell all the other children at assembly. Then other children will start playing cruelly with you and tease you that your mother has got AIDS. Just like the one that I share a seat with. She shifted and sat somewhere else in the class after I told her. Then she went to tell the class teacher."
3. "Sometimes they'll chase us back home if we don't have exercises (books). They say they will chase us away, it is not their problem."
B) Now consider what a school could do to (a) prevent situations of stigma and discrimination from occurring and (b) to respond if they do occur. Make a note of your ideas below.
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Summary remarks
Stigma and discrimination are pervasive and destructive, and need to be recognized as significant obstacles to any effective education sector response to HIV and AIDS. Stigma is a systematic process that reinforces existing divisions in society. Discrimination can take away a persons rights. They are, however, difficult to tackle due to their dynamic nature; changing both when an individual progresses from HIV to AIDS and as the epidemic evolves in a learning community. Understanding the causes and consequences of stigma, as well as the different forms of stigma, can offer opportunities to challenge and reduce stigma and discrimination. There are a number of practical actions that an education sector or institution can take to create a caring, enabling, supportive and stigma-free environment, the benefits of which will rapidly become apparent.
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Lessons learned
Lesson One Stigma and discrimination are different but interrelated phenomena involving negative attitudes about a person or group of persons, and the actions resulting from the holding of these negative attitudes.
Lesson Two Stigmatization and discriminatory behaviour are hampering Education for All and Millennium Development Goals.
Lesson Three Failure to understand the types, features and effects of stigma will jeopardize HIV prevention programmes.
Lesson Four Education has a key role in diminishing discrimination and supporting the rights of all children. Lesson Five Stigma is an obstacle to successful prevention programmes and policies. These programmes and policies can unintentionally reinforce stigma and discrimination.
Lesson Six Education sectors should define the strategies to challenge and reduce stigma in learning situations and throughout the sector and should ensure that these become an integral part of their overall AIDS response.
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Activity 1 There is no one answer to this activity and you may want to discuss your answers with a colleague or mentor. Alternatively, referring to the section Causes and types of stigma and the language used might be useful. You may also want to try to analyze the language in one or two media articles about AIDS and decide if it is 'enabling' or 'discriminatory'. The two essays now published as a book, Illness as metaphor and AIDS and its metaphors (Sontag, 2001), also give some interesting insights into the language we use when talking about illness and more especially AIDS. See also Presentation of self in everyday life (Goffman, 1990) Activity 2 Teachers, other staff and pupils may not take personal protective action, despite receiving consistent correct prevention messages, as a result of perceiving AIDS to be a 'problem of those other people'. Infected staff may resist accessing treatment for fear of being identified as infected and being stigmatized as a result. Affected families may not apply for fee exemptions for their children for fear of being labelled. Activity 3 Supervisors and managers could attend sessions that focus on managing situations of stigma and discrimination against staff who are infected (or perceived to be infected). Policies, practices, protocols, etc. could be reviewed to ensure that they do not, even inadvertently, reinforce stigma. A person living with HIV, who is open about his/her status, could be given opportunities to interact with groups to open the debate and challenge some of the myths and misconceptions that feed stigma. Activity 4 Invite schools, teachers and other staff to provide pupils from affected families with uniforms, lunches, books, etc. so that they are the same as all other pupils (as being different often feeds stigma). Help address stigma by ensuring access to education for all members of society, including orphans, girls and youth. Affirm and show visible support for pupils and teachers who are infected or affected (i.e. becoming a positive role model) will challenge stigma. Make schools safe places where discrimination is not tolerated and where information is given to continue awareness. Have established referral procedures in place for teachers as well as clearly defined roles with respect to social and health workers to access the services needed to support vulnerable children.
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Be sure to consider human rights as the basis for education and prevention campaigns against HIV and AIDS. Participate in wider community-based activities that challenge stigma and discrimination. Children and communities need to be involved in the decisionmaking process when developing support programmes for poor and vulnerable children. Involve people living with HIV in school and community activities to promote a greater understanding of their situation and to diminish stigma and misconceptions about how HIV is spread. Consider your schools activities within the context of the community and/or related NGO activities within your country. Institute forms of participatory training for pupils, teachers and education sector staff. Use peer groups which have been proven effective. Take early and decisive action to address instances of discrimination.
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Documents ACORD. 2004. Unravelling the dynamics of HIV/AIDS-related stigma and discrimination: the role of community-based research. Case studies of northern Uganda and Burundi. www.acord.org.uk/b-resources.htm Bennell, P.; Hyde, K.; Swainson, N. 2002. The impact of the HIV/AIDS epidemic on the education sector in sub-Saharan Africa: A synthesis of the findings and recommendations of three country studies. Brighton: Centre for International Education, University of Sussex. Goffman, E. 1990. Presentation of self in everyday life. New York: Anchor. Kidd, R.; Clay, S. 2003. Understanding and challenging HIV stigma: Toolkit for action. Washington, DC: The Academy for Educational Development/The CHANGE Project. www.changeproject.org/technical/hivaids/stigma.html Munaaba, Owor et al., 2004. Comparative studies of orphans and non-orphans in Uganda. Boston: Center for International Health and Development, Boston University School of Public Health. Nyblade, L.; Pande, R.; Mathur, S.; MacQuarrie, K.; Kidd, R.; Banteyerga, H.; Kidanu, A. 2003. Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia. Washington, DC: The Academy for Educational Development/CHANGE Project. www.icrw.org/docs/stigmareport093003.pdf Parker, R.; Aggleton, P. 2002. HIV/AIDS-related stigma and discrimination: A Conceptual Framework and an Agenda for Action. Horizons Program. www.popcouncil.org/pdfs/horizons/sdcncptlfrmwrk.pdf POLICY Project. 2003a. Siyamkela. HIV/AIDS-related stigma: A literature review. Cape Town, South Africa: USAID; POLICY Project/South Africa; Centre for the Study of AIDS at the University of Pretoria; Chief Directorate: HIV, AIDS & TB, Department of Health. www.policyproject.com POLICY Project. 2003b. Siyam'kela: HIV/AIDS Stigma Indicators: A Tool for Measuring the Progress of HIV/AIDS Stigma Mitigation. Cape Town, South Africa: USAID; POLICY Project/South Africa; Centre for the Study of AIDS at the University of Pretoria; Chief Directorate: HIV, AIDS & TB, Department of Health. www.policyproject.com POLICY Project. 2003. Siyamkela. Measuring HIV/AIDS-related stigma tackling HIV/AIDS stigma guidelines for the workplace. Cape Town, South Africa: USAID; POLICY Project/South Africa; Centre for the Study of AIDS at the University of Pretoria; Chief Directorate: HIV, AIDS & TB, Department of Health. www.policyproject.com POLICY Project. 2003. Siyamkela. Measuring HIV/AIDS-related stigma preliminary indicators workshop report. Cape Town, South Africa: USAID; POLICY Project/South Africa; Centre for the Study of AIDS at the University of
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Pretoria; Chief Directorate: HIV, AIDS & TB, Department of Health. www.policyproject.com Save the Children (UK). 2001. The role of stigma and discrimination in increasing the vulnerability of children and youth infected with and affected by HIV/AIDS. UK: Arcadia. Sontag, S. 2001. Illness as metaphor and AIDS and its metaphors. USA: Picador. South Africa Department of Education. 2002. Report and Plan of Action. Government of South Africa- Department of Education, Plan of Action: Improving access to free and quality basic education for all, June 14, 2003. UNAIDS. 2003. HIV/AIDS-related stigma and discrimination and education fact sheet. Geneva: UNAIDS. UNAIDS; HDN; SIDA. 2001. Advocacy for action on stigma and HIV/AIDS in Africa. Regional Consultation Meeting on Stigma and HIV/AIDS in Africa, 4 - 6 June 2001, Dar-es-Salaam. www.hdnet.org/Stigma/Advocacy%20Statement%20%20final.htm USAID. 2004. Big issues in brief: Scaling up responses to HIV/AIDS: Stigma and HIV/AIDS a pervasive issue. Washington, DC: Synergy Project. www.synergyaids.com/documents/BigIssues_StigmaRevDec04.pdf
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Module
E. Allemano F. Caillods T. Bukow
Leadership against HIV/AIDS in education
1.5
About the authors

Eric Allemano coordinated field research on HIV and AIDS impact on education in four African countries for the International Institute for Educational Planning. A sociologist specialized in educational planning and evaluation, he has also served as a consultant to education projects funded by UNICEF, The World Bank and USAID. Franoise Caillods is Deputy Director of the International Institute for Educational Planning, where she leads the research team on basic education and the HIV/AIDS and education team. Her activities and research work have been on strategic planning in education, microplanning and school mapping, secondary education financing, and education and training for disadvantaged groups. Tara Bukow currently works with the International Institute for Educational Planning on HIV and AIDS management and training issues. Formerly Publications and Communication Officer for the International Institute for Educational Planning UNESCOs Clearinghouse on the impact of HIV/AIDS on education, she has contributed to a number of publications on HIV and AIDS and education-related topics.
Acknowledgements
This module has been pre-tested in a regional workshop in East Africa, as well as in the IIEP Annual Training Programme. Specific examples used in the module come from these trainings. IIEP and ESART would especially like to thank Mr. Gudmund Hernes for his valuable contribution to this module. Several examples and activities used in this module have been taken from his leadership trainings.
Module 1.5
LEADERSHIP AGAINST HIV/AIDS IN EDUCATION
Table of contents
Questions for reflection Introductory remarks 1. Leadership The meaning of leadership Qualities that make an effective leader The difference between leadership and management Discovering the potential to lead Moving from thought to action in the struggle against HIV and AIDS and making it happen 2. Advocacy What is advocacy? Be a model for change! Summary remarks Lessons learned Answers to activities
MODULE 1.5: Leadership against HIV/AIDS in education
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Aims
The aims of this module are to: highlight the paramount importance of good leadership in the fight against HIV and AIDS in education; present you with examples of leadership to enable you to understand the concept of leadership and the qualities that make a good leader; identify skills and resources needed to lead and advocate effectively; show the value of leadership and advocacy when motivating peers and subordinates to mobilize effective responses to HIV and AIDS in the education sector.
Objectives
At the end of this module you should be able to: understand why leadership is important when addressing HIV and AIDS impacts on the education sector; recognize the traits and skills of an effective leader; assess your own leadership abilities and identify areas for improvement; understand your own potential for leadership within your community or family life, at work and among your peers; develop an HIV and AIDS advocacy strategy at your level within the institution or within your community.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. Who was the best leader you ever had? What made him/her a good leader?
Who was the worst leader you ever had? What did he/she do wrong?
Can you think of any examples of how effective leadership has helped tackle HIV and AIDS a) in your workplace?
b) in schools?
c) in communities?
What is advocacy and what forms can it take?
How can advocacy help in promoting awareness and prevention of HIV and AIDS?
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Module 1.5
LEADERSHIP AGAINST HIV/AIDS IN EDUCATION
Enabling the education sector to respond effectively to the HIV and AIDS epidemic requires special efforts in policy design, curriculum development, teacher training and management. Overcoming the obstacles to mobilizing responses against HIV and AIDS at all levels of the education sector underscores the need for effective leadership and leadership development. This module aims to provide practical guidance to staff from senior levels of ministries of education down to the school level on how to develop their own leadership skills, so that necessary changes in work environments and practice can be implemented. The basic premise of this module is that leadership is essential to the success of responses to HIV and AIDS in the education sector; that while some people seem to be natural or born leaders, effective leadership can be learned and developed in each of us. The content of this module is based on the following principles: No significant institutional changes or innovations are achieved and sustained without strong leadership, commitment and advocacy for change. Mainstreaming HIV and AIDS in the education sector cannot be accomplished without leadership and open communication to promote the vision and transform it into action and institutional change. Individual leadership and skills can be learned and developed at all levels of the education sector. Advocacy, communication, negotiation and partnerships are essential tools for effective leadership. This module is intended to provide insights into good leadership and the qualities that make up a good leader. It provides practical guidance to staff from ministries of education down to the school level on how to recognize their own potential as leaders and how to develop their own leadership skills. It highlights ways that you can develop your own leadership style in order to influence positive changes in your institution, family or community life, and to acknowledge and confront the impact of HIV and AIDS. This module should be studied in conjunction with Module 1.2, The HIV/AIDS challenge to education in this volume, with Module 2.3, HIV/AIDS in the educational workplace, in volume 2; Module 4.5, School level response to HIV/AIDS in volume 4, and Module 5.3, Project design and monitoring, in volume 5.
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1.
Leadership
The meaning of leadership
Leadership is about questioning the status quo, challenging the process, giving direction, introducing innovations, and bringing about change. It is about seeing over the horizon, visualizing the final destination, and making something happen. It is about changing the way things are (UNAIDS, 2001). It is also inducing others to act effectively . The importance of leadership in development is well known. All countries that have made considerable progress in education, and more generally in economic development, have benefited from strong and inspired political leadership. At a micro level, such as the school level, the importance of a good head teacher in triggering change, motivating his colleagues and promoting quality is increasingly recognized. Leadership starts with identifying the right problems, having a vision of what the country or the institution can become and the changes that are required to go in the right direction. But having a vision is not enough. Leadership is also about inspiring others to take action. It implies guidance towards a particular goal. Effective leaders have an impact on the way their constituencies see and respond to the new challenges in their environment. Understanding what different members of their constituencies are feeling and what motivates them, effective leaders can inspire people and move them in certain directions.
Box 1:
Example of an extraordinary vision: that of Martin Luther King, Jr.
I have a dream that one day this nation will rise up and live out the true meaning of its creed: We hold these truths to be self-evident, that all men are created equal. I have a dream that one day on the red hills of Georgia, the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood. I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. I have a dream today! Extract from a speech that Martin Luther King, Jr. delivered on 28th August 1963 at the Lincoln Memorial in Washington, D.C.
Leadership is often assimilated to power and authority. When someone is given power and authority, he or she is expected to be a leader. Not everyone who has power however is an effective leader. But some of the skills required in the act of leading can be learnt (such as the skills of identifying problems, problem-solving, personnel management, communication, organizational design). Many believe that one is born as a leader, and those who become leaders (at different levels) are those who have the ability to lead. They have different innate characteristics and skills: charisma, sense of initiative, ability to inspire,
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communicate and move people. But again it is increasingly recognized that the act of leading can be taught and learnt. Leadership is not reserved to those with power and authority, not even to those in a position with assigned responsibility. Anyone with certain traits and skills can be a leader at his/her level and can influence others positively to take action and to make and sustain change. Leadership is particularly needed in an HIV and AIDS context. In the struggle against HIV and AIDS, leaders have to use their capacity to influence their constituents in a positive way to create a national, social environment that curbs the spread of the pandemic and cares for people living with HIV.
Box 2:
Examples of effective leadership
Examples of successful innovations and sustained reforms all illustrate the essential role of leadership. Setting an example, risk-taking, and being a pioneer are examples of leadership. In the political arena, the transition of South Africa from apartheid to democracy came about thanks to the leadership of Nelson Mandela and many of his allies and supporters. Nelson Mandela has also shown courageous leadership in the area of HIV and AIDS. In January 2005, former President Mandela announced that his only remaining son, Makgatho Mandela, had just died at age 54 of AIDSrelated causes, two years after his wife, Zondi, died of pneumonia. Mandela's announcement defied the taboos and silence about the AIDS epidemic. This 1986 Nobel Peace Prize winner encouraged people to speak out about HIV and AIDS, saying Lets not hide it because the only way to make it a normal disease, such as tuberculosis, as cancer, is to always openly say that someone died due to HIV/AIDS.
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Qualities that make an effective leader

As mentioned earlier, leadership is about setting a vision and establishing goals. It is about courage and persistence, a refusal to take no for an answer when it comes to introducing change. Successful leaders are usually thick-skinned and have generally had to overcome numerous set-backs and suffered criticism -- and even condemnation -- for going against established practices and theories. True leadership is associated with qualities such as creativity, innovation, energy, patience, and perseverance. At the same time a leader must master the skills of listening, empathizing, communicating, and supporting and promoting others. There are many characteristics of a leader, just as there are different types of leadership. In The Art of War, by Sun Tzu, written 2,500 years ago, the qualifications required to lead effectively were the following: Self-discipline, the statement of rules for the leader and the group. Empathy or, as we would say now, emotional intelligence -- in order to know others' needs. Responsibility, in relation to your own decisions and actions. Co-operation, in the work designated to achieve common goals. Example, to show the right way with attitudes.
This list remains valid. Yet the wide literature on the subject has extended the number of qualities required. Effective leaders: sustain their own mental health (especially through a balance of work and play); show courage, determination, decisiveness, innovation, trustworthiness, initiative, a readiness to seize opportunities, self-confidence, and energy; possess the drive to meet an internal standard of excellence; show accurate self-awareness and self-assessment (or a realistic evaluation of their strengths and limitations); are willing to engage in personal change; take responsibility for personal behaviours and actions; are able to follow where appropriate (instead of lead); have the ability to communicate effectively and empathize with others; are able to develop relationships with others based on trust and open communication;
In addition, leaders must have a fairly high degree of technical and intellectual competence in their own domain without necessarily having to be geniuses. They should strive to stay current with relevant trends and issues, and be comfortable working in complex environments. Of course all leaders do not have to master all these skills. In any case the national culture and history strongly influence the leadership style, expectation and performance. Some societies are more likely to accept strong leadership than others. Different organizations have different leadership styles and cultures as well. This has to be taken into consideration.
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Remember, a leader does not necessarily hold a high position. Leaders can be ordinary people with creative ideas and a willingness to go outside the beaten path to implement the policy and achieve the goals set. The following people can all be considered effective leaders at their respective level: A district officer who successfully promotes a policy supporting access of OVC to education; A school principal who ensure that schools are safe places where children want to be and where they really learn something worthwhile; A school principal who seeks to identify children who have never enrolled, the reasons for this and what can be done with the help of the community to encourage them to go to school; A school principal who establishes a school committee to determine the content and methods of HIV education; Members of parent-teacher associations that mobilize funds to replace the unpaid contribution of orphans and vulnerable children; A university student who starts an association to spread awareness about HIV and AIDS.
These people may not be known to many outside their communities, and they may not hold powerful positions, but they can still bring about positive change in their environments and institutions. A question to you is how could you, at your level, be a leader and contribute to the struggle against HIV and AIDS?
The difference between leadership and management

In the field of organizational change, the terms leadership and management are sometimes used loosely and even interchangeably. However, although there is an overlap between management and leadership in organizational contexts, the two terms are conceptually and operationally distinct. One way to remember the difference is to say that leadership is commonly stated to be about doing the right thing, and management is about doing things right. Leaders might develop vision, influence creation of a coalition or teams that understand and accept the vision and strategies, and energize people to overcome barriers. In contrast, managers might develop a strategy, list detailed steps and timetables for results, allocate necessary resources, build up delegation structures, develop procedures for guidance and methods for monitoring, and strive to change organizational structure. An effective leader is more likely to empathize with people, develop a vision that mobilizes people, and have a charismatic personality than a manager, but he may also need to be supported by a manager. Holman considers that leadership and management are different facets of leader-manager behaviour that are usually present to varying extents and integrated within an individual (Holman, 2003).
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Discovering the potential to lead

As mentioned above, effective leadership depends on specific traits and personal characteristics and abilities. The act of leading also implies a certain number of tasks to be performed. Mastering leadership is a skill like any other; it just takes time and a true commitment to bettering ones self, assuming or developing the qualities that make up a leader, and acquiring specific competencies. Research shows that leadership skills and traits can be learnt, and if already present they can be improved through practice, training and other developmental activities. Hopefully, reading this module should make you think about how you can work on some of the required traits and develop some of the necessary leadership skills. You must first assess your own capabilities, but also your weaknesses.
Activity 1
Develop your positive traits In the table below, look at the list of positive and negative traits, and answer the following questions: Table 1 Positive Traits Innovative Creative Focused Open-minded Supportive Self-assured Generous Unpretentious Trustworthy Negative traits Over-cautious Unimaginative Scattered Authoritarian Humiliating Insecure Arrogant Vain Corrupt
Which traits appear most important to you at the top of your organization?
Which traits appear most important to you at your level of your organization?
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Which ones correspond best to you?
Which positive traits correspond least to you, and hence which one should you develop?
Let us focus now on specific leaderships skills. The following points synthesize some of the most commonly cited roles, activities, abilities and skills of leaders operating in the context of organizational change (each of the terms is explained in Activity 2): Change agent and motivator Visionary and direction-setter Alliance broker/team builder Analytical and creative thinker Skilled communicator and guide Virtue and integrity
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Activity 2
How effective a leader are you? Read the list of six characteristics of a successful leader below. Rate yourself on each characteristic, using the following scale from 1 to 5.
1 = no experience or ability 2 = little experience or ability 3 = average experience or ability 4 = considerable experience or ability 5 = very high level of experience and ability
Ability to act as a change agent and motivator: Think of how you have been able to achieve innovations in your office, school or community by inspiring or motivating colleagues, friends, neighbours, community members, etc. How successful are you in selling your ideas or views? When you encounter opposition from others to doing things differently, do you persist with your efforts or do you give up easily? SCORE_____ Visionary and direction-setter: Identify at least one instance when you felt strongly about a problem situation and clearly outlined a course of action. How well were you able to articulate your vision of the problem and the solution to others? How well were you able to define a strategy to achieve the vision? SCORE_____ Alliance broker/team builder: Think of a situation in which there were antagonisms or strong divergence in opinions in your workplace. Did you take the initiative to propose a strategy and convince others to support you? How did you overcome doubts and opposition to your ideas? If this skill is difficult for you, why is it so, in your opinion? SCORE_____ Analytical and creative thinker: When confronted with a dilemma or a problem, how effective are you in identifying underlying causes? How often or how well do you come up with alternative solutions that others may not have identified? Do you find that others generally welcome your analyses and solutions to problems? SCORE_____ Skilled communicator and guide: Do you consider yourself articulate and convincing? Are you better at oral or written communication? What feedback have
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you had from colleagues about your speaking or writing skills? How comfortable are you speaking in public and chairing meetings? When given the opportunity, do you volunteer to head committees or organize meetings, or do you shy away from taking charge? How do you deal with people who are antagonistic to your point of view? Do you prefer diplomacy or confrontation? SCORE_____ Virtue and integrity: How do you rate yourself at practicing what you preach? How are you viewed in your workplace and community? Do friends and colleagues tend to look up to you? Do they come to you for advice? If people have doubts about you, how do you overcome these negative reactions? SCORE_____ Now, calculate your total score and turn to Answers to activities section on page 175 to see how effective you are as a leader.
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Moving from thought to action in the struggle against HIV and AIDS and making it happen
While the above-mentioned abilities are essential for designing a vision and introducing change, different steps are to be followed and these have to be planned. Furthermore, the planned actions have to take place in a proper sequence. The following eight procedures for managing change illustrate steps in preparing for, implementing and consolidating change. While applicable to the change process in many fields, we will explore how they can be used by educational leaders in an AIDS environment. As you will see, setting a vision, motivating groups, gaining trust, establishing effective communication and promoting strategic planning are the essential steps in this process for change. 1. Assessing the problem and urging others to take action Examine the situational realities; identify and discuss the extent of the problem, and assess possible opportunities. With regard to HIV and AIDS, there is an urgency to take action. A good leader should understand that it is necessary to promote action. It is also important that he/she understand the attitudes and feelings of his/her staff concerning existing issues before planning interventions. 2. Developing a vision and a strategy Create a vision and develop strategies to achieve that vision. As stated earlier, changing the status quo requires visualizing the final destination and making something happen. To reduce HIV and AIDS impacts on education sectors, you will need to develop such a vision and strategy, and you must be able to see what you would like to achieve. 3. Communicating the new vision Inform all those concerned of the new vision and the strategies to be put in place: why and how. The role proper communication plays in the success of your project cannot be overlooked, and this applies even more so when considering how to promote awareness and sensitivities towards people living with HIV or affected by AIDS. Communication reinforces the ideas that are motivating the change, and can bring others to support the cause. 4. Creating a coalition Look for partners and allies. Assemble a group motivated enough to lead the change; facilitate team work within the group. For many countries in Africa as well as elsewhere, HIV and AIDS remain taboo subjects. The more you can motivate your team to be open about HIV and AIDS and to reduce stigma and discrimination, the more you will increase chances for change. 5. Empowering broad-based action Identify the obstacles, their causes and try to remove them. For example, try to understand teacher reluctance to teach HIV prevention in schools, or the reluctance to be tested. Do not be afraid to support risk-taking and unconventional ideas or actions. 6. Creating short-term wins Recognize the achievements (the wins) and reward the people who made these possible. Plan their introduction or scaling up. Remember that HIV and AIDS are problems to be treated over the long term, but they also need short-term wins, or actions, such as giving all teachers training in preventive education, or providing all ministry staff with workplace support policies.
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7. Consolidating gains and producing more change Highlight successes in changing systems, structures and policies. Hire, promote and develop people who can implement the new vision; constantly review and reinvigorate the process with new projects, themes and change agents. 8. Anchoring new approaches in the wider culture When we say culture we mean the culture of people, the culture of your organization, school or community. If it is normal that everyone attend a funeral for a colleague, perhaps ministries could draw up work schedules by which not every employee (not every teacher in a school) attends the funeral, or by which some employees return to work while others stay at the funeral for the entire day. If there is little discussion over HIV within the office, organize regular meetings or put up sign boards to post messages. This will lead to more effective management and better quality of the service. It will show the connections between new behaviours and organizational success.
Activity 3
Understanding the organizational context for change Take a few moments to think about the questions below and make a note of your answers. Part 1: Attitudes of personnel within the institution where you work. 1. How does the staff in your institution (school, ministry, training institute, etc.) view its strengths and weaknesses in terms of its responsiveness to the challenges posed by the HIV/AIDS epidemic? What differences are there between men and women, senior and subordinate staff?
2. To what degree do the staff feel that the epidemic concerns them and their work? Do they believe that the situation of their unit, department or school etc. is improving or getting worse? What differences are there between men and women, senior and subordinate staff?
3. Do the staff trust their leaders and have a sense of loyalty towards them?
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Part 2: Information for members of the institution. 1. Is there a policy on HIV/AIDS for the ministry and the education sector? Has it been implemented? If so, do staff know about it?
2. Do the staff have access to the information they need to protect themselves from infection or know where to go for counselling, testing and treatment?
Activity 4
Analyzing the actions of a leader: Putting a vision into place at institutional level Read the example below in Box 3, and then answer the questions on the following page: Box 3: Being a Leader!
Charles came back from the HIV and AIDS training with lots of excitement and energy. He now understood how to put in place an HIV and AIDS programme within his department to teach his co-workers about HIV transmission, to lessen stigma and to put in place a workplace policy. When he came back to the Ministry, he went to his superior and discussed his experiences and his ideas. His superior was favourable to the implementation, but told Charles he could not give him any funds and that he could not liberate time during the work week. Charles called a meeting and began telling everyone how he was going to implement the project. He wanted them to be open about their views towards HIV and AIDS, and suggested that they should all be tested to start an open work environment. After one month, Charles noticed that people were not coming to meetings, no one had been tested and that, generally speaking, things had not changed. He became discouraged: why do people not care about HIV and AIDS? he thought, This is such an important issue.
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One day during lunch he spoke to a colleague who seemed a bit more interested in the subject, and with whom he felt he could speak openly. He explained his frustrations that no one was taking his initiative seriously. His colleague told him that the other colleagues felt that they did not need to learn about HIV transmission; that they were afraid to be tested and that implementing the programme took too much time and they had no incentive to do it since they were not getting paid to do it. He said that they also felt that Charles was just showing off, and that he was trying to receive praise from the Minister. This surprised Charles. He had not even thought about these things! He had been so encouraged by his own training that he thought everyone else would be too. In his eagerness, he overlooked an important part of leading such a change. He did not speak to colleagues to get their ideas on the subject, and to understand how such programmes could affect them.
What lessons do you derive from this example? Answer the following questions. 1. Did Charles act as a good leader? Why or why not?
2. Why did no one join his vision?
3. What could Charles have done differently?
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Activity 5
Developing an action planning matrix to strengthen leadership skills Action planning is a technique that provides a framework for setting goals and scheduling tasks needed to achieve the goals. An action planning matrix identifies the tasks to be accomplished in order to reach a certain goal. It encompasses the co-operation and support required (co-operation of subordinates, peers, superiors or mentors), the human and financial resources needed to carry out each step, and the time frame. Think of a project which you could introduce in your institution/organization and which will enable you to strengthen your leadership abilities. If your work situation does not allow for you to make important decisions or take major initiatives, then think of a project, or take a leadership role on an issue that concerns your community or any other organization to which you belong. Remember, this issue or initiative for which you choose to take a leadership role does not have to be on a grand scale. Rather, choose an issue about which you have strong feelings, as you will need to take initiatives, build alliances and organize team efforts to achieve your goal. Keep a diary of your efforts. If possible, identify a friend, colleague or mentor with whom you can discuss problems and progress in your action plan. Where possible, develop your action plan around an HIV/AIDS issue. After setting your goal (or vision), develop a work plan in which you describe how you will design and implement appropriate activities related to each of the action points. Refer to the eights points on page 161 to help you come up with specific actions to plan your project. Use the action planning matrix on the following pages to help you organize your thoughts.
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Action planning matrix

Name of project: Goal or vision:
Internal collaborators (Who within your organization could you speak with to help you?) External collaborators (Who exterior to your organization could you seek to help you?) Resource needs (human & financial) Time frames
Task (Under each heading below, state the main issue or problem for each task) Assessing the problem, establishing the urgency and urging others to act
Developing a vision and strategy
Communicating the new vision
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Creating a coalition
Empowering broad-based action
Creating short-term wins
Consolidating gains and producing more change
Sustainability: anchoring new approaches in the culture
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2.
Advocacy
What is advocacy?
Advocacy is a key instrument for leaders to bring about change. It is an umbrella term for (often unorganized and modest) activism related to a particular agenda. Advocacy is the act of pleading for or supporting; the work of advocating; intercession. Advocacy is to urge or support with vigorous arguments, especially in a public setting. It can also take place through buttonholing and lobbying or pressuring individuals and small groups in private settings on a one-to-one basis.
Public advocacy
Both leaders and ordinary citizens play public advocacy roles in different ways. Politicians and activists of many kinds commonly use the written word and vivid images to advocate for a cause. Box 4: Advocacy through a press release
The South African Council of Churches (SACC) has issued a strong statement in support of the continued public distribution of condoms to control HIV transmission. In the press release, dated 4 February 2005, Rev. Dr. Molefe Tsele, the General Secretary of SACC, expressed shock and dismay at continuing assertions that condoms don't work as a means of preventing the spread of HIV. Aidsmap News, 14 February 2005
Printed messages (written messages)

A leader who is a public official or an officer in an organization such as a labour union can use written means to advocate, such as press releases, e-mail messages to large lists of addressees, web-sites, leaflets, brochures and flyers distributed to the public. Private citizens can write letters to the editors of newspapers, publish articles, set up web-sites, wear badges, such as the AIDS red ribbon pin, or T-shirts printed with advocacy messages such as HIV exists, or paste bumper stickers on cars with statements like Elect Mr. X to Parliament. Because of the discrimination suffered by people living with HIV, many activist groups around the world have used these methods to sensitize the public or pressure politicians to pass laws protecting the rights of people living with HIV or provide better access to counselling, testing and care.
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Other forms of public written advocacy are the circulation of petitions. This means is frequently used to include an issue as an item in a referendum. Placards, posters, leaflets and banners are commonly used by political parties, social movements or individuals to advocate for a cause such as civil rights for oppressed groups or a withdrawal of troops from an occupied area.
Speaking and activism

Further examples of public advocacy include giving speeches. These can be informal and personal, such as those given by individuals who stand on a box at Speakers Corner in Hyde Park, London, and advocate their favourite cause, or it can be formal, for example a speech given by a world leader at the United Nations General Assembly, and broadcast live on television and radio to many parts of the world. Box 5: Advocacy through a speech
Friends, from my own experience reinforced in recent weeks by my impressions of the vast humanitarian crisis unfolding in much of southern Africa tells me three things. Firstly, that we need to reinvigorate the Global Movement for Children on the African continent. Secondly, that we cannot act on behalf of children in Africa without directly, honestly and boldly addressing HIV/AIDS. And thirdly, that traditional African strengths such as the extended family and community structures are collapsing under the weight of HIV/AIDS. Let me be frank: families and communities in many parts of Africa are no longer coping. In my opinion, leadership is key in changing all this, in agitating, leading and mobilising this movement for children. Carol Bellamy, former UNICEF Executive Director at the Africa Leadership Consultation
Be a model for change!

Personal involvement and actions are as effective as a strong statement about an issue or a cause, particularly if one is a head teacher, inspector or senior official in a ministry of education. When others see commitment and courage in leaders, they often try to emulate it. In Britain, the late Princess Diana did much to de-stigmatize HIV and AIDS when she made public visits to patients dying of AIDS-related causes in hospitals. Nelson Mandela, when visiting villages in his native South Africa, asked that all the sick, handicapped or mentally handicapped children be brought to the table to enjoy a meal with him. The community, generally ashamed of such children, was surprised, but then individuals and parents became proud to see their children and family members eating with Nelson Mandela. In a local school, a principal can play a valuable role in fighting stigma and discrimination by personally going to visit a teacher or pupil living with HIV who is out of school sick. Sharing a meal with a person living with HIV also makes a strong positive statement, as does setting up a tutoring programme for orphans and other vulnerable children (OVC). Think about how you can be a model for change in your own environment. Individuals and small groups can use a variety of approaches to advocate policy changes on HIV and AIDS issues. Below are some additional key actions you can take to advocate for HIV and AIDS awareness and action.
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Talk about AIDS: Raising AIDS issues at meetings and conferences can be a starting point to breaking down the barriers to discussing AIDS. If you are a head teacher, you have several options for advocating HIV and AIDS issues. For example, when you go to the District Education Office (DEO) to attend a meeting of your peers on school management issues, you have an excellent opportunity to mention the problems caused by teacher absenteeism, sick leave and death. You can ask the other head teachers how they deal with the problem, or you may ask them to act as a group in requesting the DEO to clarify ministry policy on the issues you raise. Similarly, if you are a ministry staff member, you can bring up the issue of sick leave or funeral attendance when workplace issues concerning HIV and AIDS trainings are discussed. Being a leader means not being ashamed to speak about such things, and facing the difficulties and problems in the community, even if it means talking about HIV and AIDS in your places of work, schools and communities. Engage new leaders and partners in HIV and AIDS work. If you are an HIV/AIDS focal point in your ministry of education, take the initiative of sensitizing leaders in the sector about the impmplications of HIV and AIDS for their work. For example, try having a meeting with the senior staff of the inspectorate to help them explore the ways that the AIDS epidemic affects their work and how their work can have an impact on preventing and mitigating the spread of HIV and AIDS. The inspection function is important in supporting curriculum innovations (including those on HIV and AIDS) as well as ensuring the quality of teaching and teacher management, all of which are sensitive to the AIDS impact. Target parliamentarians and policy-makers about AIDS issues. Among the most valuable allies to cultivate in mobilizing against AIDS are legislative bodies and policy-makers. Stigma and discrimination can be more easily overcome if members of parliament speak out on AIDS issues in parliament and in their districts. Policy-makers can review personnel regulations that may be working against persons living with HIV or AIDS and devise alternative measures that are more supportive. For example, many people who die of AIDS-related causes do not want the cause of death to be known because it may prevent the payment of death benefits or life insurance to relatives. Lobby and buttonhole. Discrete forms of advocacy are known as lobbying and buttonholing. Interest groups pushing for a new policy of some sort of change or initiative will often meet legislators, civic, religious or educational leaders one-on-one or in small private groups. Lobbyists and advocates of civic or private interests will often seek out a few key influential persons to bring on board their initiative.
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Box 6:
NGOs play an advocacy role in increasing resources for HIV/AIDS
Brazilian civil society and AIDS NGOs played a role in lobbying Congress and the Presidents Office to overcome resistance within the Ministry to the World Bank loans for AIDS, and launched simultaneous street demonstrations in sixteen states in 1999 to secure additional funding for AIDS treatment despite the recent devaluation and financial crisis. Although several government programs had suffered budget cuts in 1998, and although in the original proposal from the Ministry of Finance the largest cut was to fall on health care, the AIDS budget was not cut and in fact listed in the essential programs to be protected.. The number of Brazilian AIDS NGOs multiplied after the World Bank loan earmarked a stream of money to civil society for outreach, support, and prevention efforts; and their numbers in turn increased the visibility and political strength of the AIDS community in Brazil. Gauri and Lieberman, 2004
Work through the media to raise AIDS issues. If you are interviewed about your job, your school or your ministry by a journalist, take the opportunity to mention the ways in which your work is affected by HIV and AIDS. You need to create more public awareness about the issues, and thereby more support for solutions. Thus, the broadcast and printed media are important allies in developing solutions to the threats posed by HIV and AIDS. Mark World AIDS Day to plan events. 1st December is World AIDS Day and presents an excellent opportunity for advocacy at different levels, from the central ministry to teacher training colleges and primary schools. It is highly recommended to involve parliamentarians or the media.
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Activity 6
World AIDS Day as an advocacy opportunity 1st December is World AIDS Day. It is an excellent opportunity for advocacy at different levels. Involving parliamentarians, religious leaders and NGOs, as well as making use of the media, is highly recommended. Imagine you are a head teacher and form a committee to plan the World AIDS Day activities at your school or within your community. 1. To whom would you and the committee go for technical advice on formulating messages about HIV and AIDS for teachers, pupils, parents and members of the community?
2. How could the event be managed and funded?
3. What are dynamic and appropriate ways of involving teachers, pupils and people from the community?
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Summary remarks
The experience of politics, institutional governance, social reform movements to innovate show clearly the importance of leadership and advocacy in achieving goals. The example of Nelson Mandela illustrates the importance of leadership and advocacy in bringing about change and reform. However, leaders are not necessarily celebrities or high-level officials. Leaders are also people motivating change within their schools, families, offices, neighbourhoods and communities. Leadership skills can be learned, and developed. Characteristics such as being a change agent, a direction setter, or a team builder Because of the silence, stigma and discrimination surrounding HIV and AIDS, there are tremendous barriers to mainstreaming them into the operations of the education sector. Overcoming these obstacles requires forceful, committed and sustained leadership and advocacy.
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Lessons learned
Lesson One While often an innate quality in people, leadership skills and competencies can be learned and developed. Lesson Two Leadership is about the capacity to question the status quo when it is unacceptable. It implies confronting problems, communicating a vision on where to go, identifying and removing obstacles to change, having the capacity to redefine organizational goals, and modifying organizational culture. Effective leadership motivates people and makes them all want to achieve high objectives. Lesson Three Leadership is relational. An effective leader has to listen to others, understand their concerns, their worries and their motivations, before defining his or her strategy. She/he has to form alliances in action. Leadership is to be, to know and to do. Lesson Four Advocacy and communication skills are essential tools of all leaders. It is through advocacy and communication that one can be a model for change. Lesson Five Leadership is not only exercised at the top. Everybody can exercise leadership at his or her own level (in ones family, community, church, organization). Everyone should take responsibility for what happens where they are rather than wait for a proper decision to be made at the top level and for resources to be made available. This mobilization is essential in the response to HIV and AIDS.
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A regional workshop on HIV and AIDS was held by IIEP for division chiefs in a ministry of education in Eastern Africa. The answers to activities 2, 3 and 5 are taken from the discussions and outputs of this workshop. Though your answers will differ from those below, this information could be useful. Activity 1 The answers for activity 1 will be different for everyone and will surely vary according to your personal experiences, but also according to the country and the culture. The best way to answer these questions is to be your own judge. It is also recommended that you discuss these answers with others in your group. Activity 2 The answers below for activity 2 were provided by a District Education Office, who herself did the activity. Ability to act as a change agent and motivator: I feel that there are too many statutory and resource limitations to my being a major change agent. However, I am good at motivating my office staff and the head teachers in my district. I make periodic visits to schools and hold meetings for head teachers to share experiences. I encourage them to innovate at the school level. As far as HIV and AIDS go, I encourage my head teachers to hold school assemblies on AIDS and set up anti-AIDS clubs. This works, as these are extra-curricular initiatives. On the other hand, I have not pushed for inclusion of AIDS in the curriculum; even though some NGOs have offered to provide books, the Ministry has not provided guidelines on including AIDS in the curriculum. Furthermore, most of the parents feel that sex should not be discussed in the classroom. SCORE 3 Visionary and direction-setter: I see myself essentially as a competent administrator. I value fairness and accountability, but I am not a visionary. Policy is set at the ministerial level. I cannot create new policies or tell the Ministry what to do. I find ways of implementing policies within my means. SCORE 1
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Alliance broker/team builder: I am good at getting things done. When I dont have the staff or resources to do something, I look for assistance elsewhere. For example, I have developed a co-operative arrangement with the heads of several other district services. Thus, when the Agricultural Extension Service is going to send a Land Rover to remote areas where there is no bus service, I arrange for one of my primary education advisers to go along and visit schools in the villages. The agricultural extension agents provide valuable help to school gardens in my district. The larger ones contribute produce to our school lunch programme. I am an advocate of agricultural education and have successfully lobbied the Ministry of Education to increase its support for the agricultural training college in our district. SCORE 4 Analytical and creative thinker: I know the policies of our Ministry well. I once studied law and developed good analytical skills. These have helped make me a successful administrator. We have problems with growing teacher absenteeism and requests for sick leave. I have obtained a grant from the district office of the National AIDS Commission to hire substitute teachers or to bring back retired teachers to fill in for sick colleagues. SCORE 4 Skilled communicator and guide: I am not good at speeches and I dont like to show off. I prefer quiet diplomacy to confrontation in solving problems. Im not comfortable with politicians. Its difficult for me to speak out on AIDS issues, even though some teachers have been driven away from their schools by unsympathetic and prejudiced head teachers. I have sent notes to the Director of Primary Education about the issue, but not much progress has been made. SCORE 2 Virtue and integrity: Despite temptations, I manage my budget very carefully, as it is for the good of my staff and our schools. I have to say no to requests for favours of various kinds, including having grades changed so that a student can avoid repeating a year. I always turn down offers of cash for such favours. I am respected for my firmness. SCORE 5 Analysis: With a score of 19 out of a total possible of 30, The District Education Officer (DEO) is a moderately effective leader. She is brilliant as a trustworthy person (SCORE 5) and people will follow her example, as she is admired for her integrity. She must learn to leverage more support for change initiatives with this strength. Our DEO is also a good problem solver and alliance builder. However, she falls short on visioning (SCORE 1) and public advocacy (SCORE 2). However, with encouragement and support she can turn these weaknesses into strengths.
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Activity 3 Below you will find a matrix that displays the answers given by the workshop participants according to the units where they worked. Part 1: Attitudes
Section or Unit Office of the Minister and the Permanent Secretary Responsiveness of institution to HIV/AIDS The MoE sends a representative to monthly meetings of the National AIDS Commission (NAC). We get much pressure from outside groups to do more about HIV/AIDS. We hear little from the staff, either senior or junior, about HIV/AIDS. Our biggest problem is support staff who are sick. We are better at tracking staff attrition. Death is now the leading cause of leaving employment. Women more affected than men. Extent to which the staff felt concerned by HIV and AIDS There is no clear impact of HIV/AIDS on the staff of our cabinet. However, a number of secretaries and drivers ask for time off to take care of sick family members. The Ministers driver died of tuberculosis at age 31 six months ago. Little impact on my division. Most impact is felt at the school level, where requests for successive periods of sick leave have increased by 30% in the last 5 years. Female primary school teachers are the most affected. Do the staff trust their leaders The Minister and Permanent Secretary feel that the staff are loyal and that senior management has their best interests at heart. The Ministers approval of extended compassionate leave for staff who have sick relatives was very well received by all staff.
Division of Personnel
Staff were reluctant to do research on causes of attrition. Some feared that the real reason was to detect phantom teachers who were being paid a salary. My efforts are viewed with suspicion by some staff, especially junior level men.
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Division of Finance and Administration
Division of Primary Education
Office of the Chief Inspector
We have increased death benefits for the bereaved, which was well received by junior staff. I have hired temporary staff to process payments when regular staff are off sick. The ministry is not doing enough. My staff represents 85% of MoE employees and many face hardship caused by HIV/AIDS. Female teachers seem to be the most affected. I have been told to strengthen in-service training for primary teachers on HIV/AIDS. Unfortunately, there are no specific guidelines.
We have lost mainly support staff, such as cleaners and lower level clerks. More men than women. Overall, workload has increased and delays in transactions are more frequent. I am overwhelmed with requests for transfers, particularly rural teachers wanting to come to the capital or major towns. I am frustrated because many IST workshops and inspection visits are curtailed because DEOs are using resources budgeted for these purposes to fund funerals.
My staff at the Ministry is loyal. However, we have problems with the DEOs who are using vehicles and teacher in-service training funds for funerals, sometimes for persons who are not MoE staff! My staff is loyal but the Teachers Union is hostile. When I couldnt find posts for 540 teachers seeking transfers, the Union organized a strike.
The staff in the field are angry. I have been blamed for the lack of resources. I would welcome support to develop the confidence of my field staff.
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Part 2 Information: These responses will vary by country. Activity 4 Charles did have a vision and he was motivated to see it through. He was ready to take a chance and to lead a new project in order to change a situation he felt strongly about. However, he had been so enthusiastic about his own training that he thought everyone else would be too. In his eagerness, he overlooked an important part of leading such a change. He did not speak to colleagues to get their ideas on the subject, and to understand how such programs could affect them. He did not make them feel part of something. He failed to create a sufficiently powerful guiding coalition. Having emotional intelligence is one important aspect of a strong leader. Emotional Intelligence is the ability to empathize or relate to others by understanding their position on an issue and working with them to enable them to see the vision and to move ahead.
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Activity 5 Action Planning Matrix (as taken from the IIEP regional training course in Eastern Africa. The team chose the project concerning the development of a workplace policy)
Name of project or vision: Developing an HIV/AIDS in the Work Place Policy

Task (State main issue or problem for each task) Establishing a sense of urgency Teachers are increasingly absent, taking repeated sick leave before dying. I will collect data on attrition over the past decade to share with major stakeholders. Goal: create an awareness campaign before working on workplace policy. Creating a guiding coalition Identify MoE directors willing to take a proactive stance on HIV/AIDS prevention and mitigation; agree to support workplace policy. Link with external collaborators to develop a workplace policy action plan for the Ministry and the schools. Internal Collaborators External Collaborators Resource Needs (Human & financial) Time Frames
Teachers Union, Director of Human Resources and EMIS specialist in the MoE. District Education Officers. The Inspectorate. Boards of Governors
ILO, Ministry of Civil Service, Ministry of Health, National AIDS Commission (NAC).
A full-time consultant, three research assistants, a secretary. $4,500 grant requested from NAC.
Director of Finance; Chief Inspector of Schools; Deputy Commissioner for Primary Education
Head of social services committee of NAC; 3 HIV+ teachers, Deputy Chair, National Teachers Union; Director of Benefits, Civil Service Commission, ILO
$1,000 in travel, secretarial and meeting costs.
3 weeks of interviews and symposia with teachers living with HIV, and those on sick leave; presentations on school closings due to lack of teachers. TV, radio news. Launch a poster contest on HIV/AIDS in primary and secondary schools. Total: 2 months 1 month
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Developing a vision and strategy Meet with internal and external collaborators, including teachers living with HIV, to determine what the workplace policy should cover. Communicating the new vision Overcome silence, stigma about HIV/AIDS; create understanding of the epidemic as a workplace issue.
Head of Social Services Committee of NAC; 3 HIV+ teachers, Deputy Chair, National Teachers Union; Director of Benefits, Civil Service Commission, ILO Representatives of print and broadcast media. 3 HIV+ teachers, Deputy Chair, National Teachers Union; Director of benefits, Civil Service Commission, ILO; ministry personnel.
$500 in travel, secretarial and meeting costs.
3-5 meetings over 2 weeks.
$500 in travel, secretarial and meeting costs.
Empowering broad-based action Enact legal framework of workplace policy
ministry personnel, Teachers Union. NGO specialized in VCT, care for people living with HIV.
$1, 500 in reception, lobbying and dissemination workshop costs.
3_5 meetings over 2 weeks Programme of radio, TV and newspaper features about workplace policy.. ministry personnel sponsor debate in parliament about HIV/AIDS and workplace policy issues (1 week). 1 month to enact legislation 2 months to disseminate text via Teachers Union workshops
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Creating short-term wins Establish and run workplace policy in pilot schools, DEO and selected units of MoE Consolidating gains and producing more change Assess lessons learned about workplace policy during pilot phase; respond constructively to criticism and opposition Sustainability: anchoring new approaches in the culture Disseminate workplace policy throughout MoE and districts.
Director of Finance; Chief Inspector of Schools; Deputy Commissioner for Primary Education Director of Finance; Chief Inspector of Schools; Deputy Commissioner for Primary Education. Committee of staff and teachers living with HIV. Director of Finance; Chief Inspector of Schools; Deputy Commissioner for Primary Education. Committee of staff and teachers living with HIV.
Teachers Union, NGO specialized in VCT, care for people living with HIV. Teachers Union, NGO specialized in VCT, care for people living with HIV.
$5,000 for VCT and treatment costs of teachers and staff living with HIV. $1,500 for evaluation survey in MoE and pilot DEO and schools.
6 months pilot.
2 months.
Teachers Union, NGO specialized in VCT, care for people living with HIV.
$15,000 for VCT and treatment costs of teachers and staff living with HIV
On-going: 12 months and beyond.
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Activity 6 Guidance on formulating messages about HIV and AIDS can be obtained from the National AIDS Commission, which often has district-level offices. NGOs specialized in voluntary counselling and testing are also good sources of information. The ministry of education may have an HIV/AIDS coordination unit which could also provide materials. Local offices of the World Health Organization and UNAIDS are other possible sources. If you have Internet access, there are web-sites from which information can be downloaded. Here are a few: UNICEF: www.unicef.org/voy/ Kenya AIDS Information Project www.kaippg.org/ Africa Alive Youth AIDS Prevention Initiative www.africaalive.org/youthaids.htm Oxfam HIV/AIDS Prevention, Treatment and Care for young people www.iyp.oxfam.org/campaign/preliminary_findings/hiv_and_aids_prevention.asp
Planning and managing a World AIDS Day event is time-consuming. A committee of teachers, parents and community volunteers will be needed. Your National AIDS Commission and certain NGOs may have funds for such events. Alternatively, plan on raising money through school fairs, sporting events or asking local businesses and churches to contribute funds. Solicit your PTA or board of governors for assistance. You may want to hold a school assembly to launch the idea of marking World AIDS Day with speakers from NGOs working on AIDS issues. Try to involve sympathetic religious and community leaders as well. After the assembly, ask a senior teacher to be the chair of the organizing committee. Ask for volunteers among faculty and students.
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Documents Asia-Pacific Leadership Forum. 2003. The challenges of HIV/AIDS: Resources for effective leadership. Melbourne, Australia. Atkinson, D.E. 1997. Rehabilitation management and leadership competencies. Journal of Rehabilitation Administration. Vol. 21, No. 4. pp. 249-262. Atkinson, D.E. 2001. Leadership: Implications for developing leadership and leading change. A report for the 23rd Mary Switzer Memorial Seminar. de Waal, A. AIDS: Africa's greatest leadership challenge: Roles and approaches for an effective response. Gauri, V.; Lieberman, E.S. 2004. AIDS and the state: The politics of government responses to the epidemic in Brazil and South Africa. Unpublished. http://cyber.law.harvard.edu/blogs/gems/politicshiv/liebermanpaper.pdf Holman, C.D. 2003. Principles and Practices of Public Health Leadership, unpublished participant workbook from two-day workshop, 12-13 June 2003, Melbourne, Australia. Kotter, J.P. 1996. Leading change. Boston: Harvard Business School Press. UNAIDS. 2001. Together we can. Leadership in a world of AIDS. Geneva: UNAIDS. http://data.unaids.org/Publications/IRC-pub02/JC594-TogetherWeCan_en.pdf Villamayor, E. 2004. On the way towards a new leadership. Management Centre Europe.
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Useful links
Web sites:
Association for Qualitative Research/ Association pour la recherche qualitative: www.recherche-qualitative.qc.ca Bill and Melinda Gates Foundation: www.gatesfoundation.org/default.htm Catholic Relief Services: www.crs.org Centers for Disease Control and Prevention: www.cdc.gov The Department for International Development (DFID): www.dfid.gov.uk Eldis: www.eldis.org/go/topics/resource-guides/hiv-and-aids Family Health International: www.fhi.org Family Health International: Youth Area: www.fhi.org/en/Youth/YouthNet/ProgramsAreas/Peer+Education.htm Food and Agriculture Organization: www.fao.org
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GTZ: German Development Agency: www.gtz.de/en/ Global Campaign for Education: www.campaignforeducation.org The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM): www.theglobalfund.org/en/ Global Service Corps: www.globalservicecorps.org The Henry J. Kaiser Family Foundation: www.kff.org/hivaids/ International Bureau of Education: www.ibe.unesco.org/ IBE-UNESCO Programme for HIV & AIDS education: www.ibe.unesco.org/HIVAids.htm International Institute for Educational Planning: www.unesco.org/iiep International Institute for qualitative methodology: www.uofaweb.ualberta.ca/iiqm/ HIV/AIDS Impact on Education Clearinghouse: hivaidsclearinghouse.unesco.org/ev_en.php Kenya HIV/AIDS Business Council & UK National AIDS Trust. Positive action at work: www.gsk.com/positiveaction/pa-at-work.htm Mobile Task Team (MMT) on the Impact of HIV/AIDS on Education: www.mttaids.com OECD Co-operation Directorate: www.oecd.org/linklist/0,3435,en_2649_33721_1797105_1_1_1_1,00.html.
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Population Services International Youth AIDS: http://projects.psi.org/site/PageServer?pagename=home_homepageindex The Policy Project www.policyproject.com The United States Presidents Emergency Plan for AIDS Relief: www.pepfar.gov/c22629.htm UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org UNESCO EFA Background documents and information: www.unesco.org/education/efa/ed_for_all/background/background_documents.shtml www.unesco.org/education/efa/know_sharing/flagship_initiatives/hiv_education.shtml www.unesco.org/education/efa/index.shtml UNESCO Institute of Statistics website: www.uis.unesco.org United Nations Millennium Development Goals: www.un.org/millenniumgoals UNICEF United Nations Childrens Fund: www.unicef.org UNICEF Life skills: www.unicef.org/lifeskills UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org United States Agency for International Development: USAID: www.usaid.gov/ School Health: www.schoolsandhealth.org/HIV-AIDS&Education.htm World Bank EFA Fast Track Initiative: www.fasttrackinitiative.org/
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World Bank Multi-Country HIV/AIDS Program for Africa (MAP): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRHEANUTPOP/EXTAFRR EGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001234~pagePK:34004173~piPK:34003707 ~theSitePK:717148,00.html World Economic Forum: www.weforum.org/globalhealth World Health Organization: www.who.int/en/
World Vision www.worldvision.org/
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HIV and AIDS fact sheets

Fact sheet No. 1: A global overview
Global summary of the AIDS epidemic Number of people living with HIV in 2006 Total 39.5 million (Adults: 37.2 million; Women: 17.7 million; Children under 15 years: 2.3 million) People newly infected with HIV in 2006 Total 4.3 million (Adults: 3.8 million; Children under 15 years: 530 000) AIDS deaths in 2006 Total 2.9 million (Adults: 2.6 million; Children under 15 years: 380 000) Orphans due to AIDS in 2006: UNAIDS/WHO AIDS Epidemic Update: December 2006 GLOBAL SITUATION Although inadequate surveillance makes it difficult to discern the precise impact, patterns and trends of the epidemic, according, to UNAIDS, sub-Saharan Africa continues to bear the brunt of the global epidemic. Two thirds (63%) of all adults and children with HIV globally live in sub-Saharan Africa, with its epicentre in southern Africa, making it almost 25 million people living with HIV in sub-Saharan Africa. In the past two years, the number of people living with HIV increased in every region in the world. The most striking increases have occurred in East Asia and in Eastern Europe and Central Asia, where the number of people living with HIV in 2006 was over one fifth (21%) higher than in 2004. In Asia, national HIV infection levels are highest in South-East Asia, where combinations of unprotected paid sex and unprotected sex between men, along with unsafe injecting drug use, are the largest risk factors for HIV infection, with the highest levels of HIV prevalence in India and China. Latin Americas epidemics remain fairly stable, with Brazil continuing to set the example with its effective prevention and treatment programmes keeping the epidemic under control. The epidemics in Eastern Europe and Central Asia, though still relatively young, are nevertheless continuing to grow (UNAIDS, 2006). Total 15.2 million
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Fact sheet No. 2:
HIV, AIDS and the immune system
HIV stands for the Human Immunodeficiency Virus. HIV is the virus that causes AIDS, this virus is found in blood and bodily fluids of someone said to be living with HIV. HIV weakens the bodys immune system and if untreated will result in AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a range of medical conditions that occurs when a persons immune system is seriously weakened by HIV, to the point where the immune system can no longer protect the body from illness and the person develops any number of opportunistic infections and diseases. HIV affects the body by slowly attacking the immune system. The immune system is the body's defence system that fights off infection and disease by micro-organisms (bacteria and viruses). Amongst the cells that make up the immune system is one called a CD4 lymphocyte, or a T4 Helper cell. These cells send signals to the immune system that an invader or bacteria has entered the body and must be destroyed. HIV attaches to the surface of the CD4 lymphocyte and eventually destroys the cell. The cells are thus not able to protect the body from invading bacteria or viruses. Over time this leads to a progressive and finally a profound impairment of the immune system, resulting in the infected person becoming susceptible to infections and diseases such as tuberculosis, malaria or cancer. This is when a person is said to be diagnosed as having AIDS. In adults, the typical course from HIV infection to AIDS is as follows: Window Period: About 6 weeks to 3 months after becoming infected. A person develops antibodies to HIV and the body tries to defend itself. At this time some people will experience a flulike illness. Incubation Period: This is the time between infection and the development of disease symptoms associated with AIDS. The length of this period is different for everyone but it can take many years. On average, it usually takes from 7-20 years before AIDS symptoms will show up, depending on treatment. A person can live with HIV during this period for a very long time. Honeymoon Period: This is the time between the end of the window period and the end of the incubation period. During this period the person is living in relative harmony with the virus. The may have a few symptoms, but they do not look sick. During this time the antibody load is high and the viral load is low. AIDS: If a person is not receiving treatment or fortifying their immune system through good nutrition and health, the immune system eventually becomes overcome by HIV and cannot fight off infections. Following that almost all (if not all) infected persons progress to AIDS, the terminal phase of the illness.
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Fact sheet No. 3:
Transmission and Prevention
TRANSMISSION HIV is a weak virus that cannot survive outside the human body. It can survive only in bodily fluids. Although present in all body fluids, HIV is only present in sufficient concentrations to be transmitted and cause infection in the following four types of fluids: 1. 2. 3. 4. blood vaginal fluids semen breast milk
Rule of Thumb: In order to HIV to be transmitted there must be infected fluid and a port of entry into the body. A portal of entry is the way that HIV enters the body. This is either through a cut, sore, or opening in the skin or through the soft tissue called .mucous membrane, located in the vagina, the tip of the penis, the anus, the mouth, the eyes, or the inside of the nose.
HIV can only be transmitted from an infected person to another person by the following routes: Sexual intercourse (vaginal, anal or oral) - this is the most frequent mode of transmission Contact with infected blood, semen, cervical or vaginal fluids - in situations where the infected body fluid is able to enter a person's body From an infected mother to her child - during pregnancy or childbirth, or from breastfeeding
Anyone who has had unprotected sex, shares unclean instruments or uses dirty syringes is at risk of contracting HIV regardless of race, religion or sexual orientation. ACTIVITIES THAT CANNOT TRANSMIT HIV Being near a person with HIV Sharing a drinking cup with a person with HIV Hugging a person with HIV Kissing a person with HIV when blood is not present Shaking hands with a person with HIV Proper use of a condom during sex THERE IS NO RISK OF HIV TRANSMISSION FROM EVERYDAY CONTACT WITH AN INFECTED PERSON EITHER AT WORK OR SOCIALLY. PREVENTION The major route of HIV transmission is unprotected sex. The safest form of prevention is thus abstinence. However, in many instances, this is neither realistic nor desirable. Options such as limiting the number of sexual partners and/or using barrier methods, such as male and female condoms can reduce the risk.
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Fact sheet No. 4:

TESTING
Testing and counselling
The commonly used test for HIV infection tests for antibodies to HIV, it does not test directly for the presence of the virus. The period between infection with HIV and seroconversion (when the body develops antibodies) is called the window period. During this time the HIV antibody test will not detect the infection, even though the person is infected and infectious. HIV antibody testing is done for the following reasons: To screen donated blood and blood products, tissues, organs, sperm and ova. For epidemiological surveillance of HIV prevalence (usually anonymous and unlinked testing). To diagnose HIV infection. ELISA Usually HIV antibody testing is done using an ELISA test (Enzyme Linked ImmunoSorbent Assay). The test can be done on a number of body fluids, but is most often done using blood. The ideal testing process involves two tests, if the first is positive. This re-testing, using a different test allows for the positive test to be confirmed and excludes the possibility that the first test was perhaps a false positive. Pre- and post-test counselling are universally regarded as necessary accompaniments to all HIV testing where the person concerned will receive his or her test result. The 3 Cs are the standards for ethical HIV antibody testing: Informed Consent Counselling Confidentiality COUNSELLING HIV counselling is defined as a confidential dialogue between a client and a counsellor aimed at enabling the client to cope with stress and take personal decisions related to HIV/AIDS. Pre and post-test counselling Counselling at the time of having an HIV antibody test has two main functions: prevention and support. It allows those tested to adopt preventive measures, change their behaviour and inform others. For those who are positive, counselling serves to help them learn to live with the virus, and to access care and support at an early stage.
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Fact sheet No. 5:
Treatment and Care
Treatment, care and support needs are very different at different stages of HIV infection and these can be very difficult for the families of the infected persons. The primary objectives therefore are: 1. for the infected person
to reduce suffering and improve quality of life to provide appropriate treatment of acute intercurrent infections to render practical support to lend bereavement support
2. for families
The points at which a person who is HIV infected will require treatment and care may include: treatment for sexually transmitted infections treatment of opportunistic infections (tuberculosis, malaria, pneumonia) prophylaxis for opportunistic infections palliative care antiretroviral therapy (ART) Positive living Although there is no cure for HIV or AIDS, there are many treatments available and things you can do to stay healthy. This means taking control of aspects of your life such as maintaining your health. Ways that you can do this include maintaining: General Health: nutrition, rest, exercise, avoiding infections, avoiding drugs and alcohol. Studies have shown that these things strengthen our immune system. Psychological well-being: having a positive attitude, building self esteem, counseling, reducing stress. Spiritual well-being: having faith or a belief system, prayer, or meditation. Social well-being: having spousal or family support, peer support, a social system that protects one from discrimination, continuing productive work or advocacy. Studies have shown that women with breast cancer who were involved in support groups lived twice as long as those who were not. Physical well-being: at least three types of medical interventions: 1. Treatments to strengthen the immune system which could include traditional remedies like herbs and acupuncture, and so forth. 2. Treatment to prevent or alleviate symptoms and cure opportunistic infections like TB, pneumonia, diarrhea, skin conditions, and so forth. 3. Anti.retroviral therapy and protease inhibitors such as AZT, D4T, Indinavir, Nevirapine often not available in some countries except for treatments to reduce risk of mother-to-child transmission. Nutrition Good nutrition is very important if you are living with HIV. Nutrition is not a replacement for ART, but it can help a person stay healthy for longer, delaying the time when they will require ART and, once ART is started, good nutrition enhances the benefits of ART.
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References
Peace Corps. 2001. Life Skills Manual. Washington, D.C. Peace Corps. Joint United Nations Program on HIV/AIDS (UNAIDS) and World Health Organization (WHO). 2006. AIDS Epidemic Update: December 2006. Geneva. UNAIDS.
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HIV and AIDS glossary

by L. Teasdale
The terms below are defined within the context of these modules. Advocacy: Influencing outcomes - including public policy and resource allocation decisions within political, economic, and social systems and institutions - that directly affect people's lives. Affected by HIV and AIDS: HIV and AIDS have impacts on the lives of those who are not necessarily infected themselves but who have friends or family members that are living with HIV. They may have to deal with similar negative consequences, for example stigma and discrimination, exclusion from social services, etc. Affected persons: Persons whose lives are changed in any way by HIV and/or AIDS due to infection and/or the broader impact of the epidemic. Age mixing: Sexual relations between individuals who differ considerably in age, typically between an older man and a younger woman, although the reverse occurs. Diseases can be treated, but there is no treatment for the immune system deficiency. AIDS is the most severe phase of HIV-related disease. AIDS: The Acquired Immune Deficiency Syndrome is a range of medical conditions that occurs when a persons immune system is seriously weakened by HIV, the Human Immunodeficiency Virus, to the point where the person develops any number of diseases and cancers. Antibodies: Immunoglobulin, or y-shaped protein molecules in the blood used by the bodys immune system to identify and neutralize foreign objects such as bacteria and viruses. During full-blown AIDS, the antibodies produced against the virus fail to protect against it. Antigen: Foreign substance which stimulates the production of antibodies when introduced into a living organism. Antiretroviral drugs (ARV): Drugs that suppress the activity or replication of retroviruses, primarily HIV. Antiretroviral drugs reduce a persons viral load, thus helping to maintain the health of the patient. However, antiretroviral drugs cannot eradicate HIV entirely from the body. They are not a cure for HIV or AIDS. Asymptomatic: Infected by a disease agent but exhibiting no visible or medical symptoms. Bacteria: Microbes composed of single cells that reproduce by division. Bacteria are responsible for a large number of diseases. Bacteria can live independently, in contrast with viruses, which can only survive within the living cells that they infect. Baseline study: A study that documents the existing state of an environment to serve as a reference point against which future changes to that environment can be measured Care, treatment and support: Services provided to educators and learners infected or affected by HIV. Clinical trial: A clinical trial is a study that tries to improve current treatment or find new treatments for diseases, or to evaluate the comparative efficacy of two or more medicines. Drugs are tested on people, under strictly controlled conditions. Combination therapy: A course of antiretroviral treatment that involves two or more ARVs in combination. Concentrated epidemic: An epidemic is considered concentrated when less than one per cent of the wider population but more than five per cent of any key population practising high risk behaviours is infected, while, at the same time, prevalence among women attending urban antenatal clinics is still less than 5 percent.
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Condom: One device used to prevent the transmission of sexual fluid between bodies, and used to prevent pregnancy and the transmission of disease, HIV and sexually transmitted infections. Consistent, correct use of condoms significantly reduces the risk of transmission of HIV and other STDs. Both male and female condoms exist. The male condom is a strong soft transparent polyurethane device which a man can wear on his penis before sexual intercourse. The female condom is also a strong soft transparent polyurethane sheath inserted in the vagina before sexual intercourse. Confidentiality: The right of every person, employee or job applicant to have their medical information, including HIV status, kept private. Counselling: A confidential dialogue between a client and a trained counsellor aimed at enabling the client to cope with stress and take personal decisions related to HIV and AIDS. Diagnosis: The determination of the existence of a disease or condition. Discriminate: Make a distinction in the treatment of different categories of people or things, especially unjustly or prejudicially against people on grounds of race, sex, social status, age, HIV status etc. Discrimination: The acting out of prejudices against people on grounds of race, colour, sex, social status, age, HIV status etc; an unjust or prejudicial distinction. Empowerment: Acts of enabling the target population to take more control over their daily lives. The term empowerment is often used in connection with marginalized groups, such as women, homosexuals, sex workers, and HIV infected persons. Epidemic: A widespread outbreak of an infectious disease where many people are infected at the same time. An epidemic is nascent when HIV prevalence is less than 1 percent in all known subpopulations presumed to practice high-risk behaviour for which information is available. An epidemic is concentrated when less than one per cent of the wider population but more than five per cent of any so-called high-risk group is infected but prevalence among women attending urban antenatal clinics is still less than 1 percent. An epidemic is generalized when HIV is firmly established in the population and has spread far beyond the original subpopulations presumed to be practising high-risk behaviour, which are now heavily infected and when prevalence among women attending urban antenatal clinics is consistently one percent or more. Heterosexual: A person sexually attracted to or practising sex with persons of the opposite sex. High-risk behaviour: Activities that put individuals at greater risk of exposing themselves to a particular infection. In association with HIV transmission, high-risk activities include unprotected sexual intercourse and sharing of needles and syringes. Highly active antiretroviral therapy (HAART): A combination of three or more antiretroviral drugs that most effectively inhibit HIV replication, allowing the immune system to recover its ability to produce white blood cells to respond to opportunistic infections. HIV: Human Immunodeficiency Virus, the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. HIV testing: Any laboratory procedure such as blood or saliva testing done on an individual to determine the presence or absence of HIV antibodies. An HIV positive result means that the HIV antibodies have been found in the blood test and that the person has been exposed to HIV and is presumably infected with the virus. Homosexual: A person sexually attracted to or practising sex with persons of the same sex. Immune system: The bodys defence system that prevents and fights off infections. Incidence (HIV): The number of new cases occurring in a given population over a certain period of time. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new.
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Incubation period: The period of time between entry of the infecting pathogen, or antigen (in the case of HIV and AIDS, this is HIV) into the body and the first symptoms of the disease (or AIDS). Informed consent: The voluntary agreement of a person to undergo or be subjected to a procedure based on full information, whether such permission is written, or expressed indirectly. Life skills: Refers to a large group of psycho-social and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Log frame or logical framework: A matrix that provides a summary of what a project aims to achieve and how, and what its main assumptions are. It brings together in one place a statement of all the key components of a project. It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic of how the project is expected to work. It provides a basis for monitoring an evaluation by identifying indicators of success, and means of assessment. Maternal antibodies: In an infant, these are antibodies that have been passively acquired from the mother during the pregnancy. Because maternal antibodies to HIV continue to circulate in the infants blood up to the age of 15-18 months, it is difficult to determine whether the infant is infected. Mother-to-Child Transmission (MTCT): Process by which a pregnant woman can pass HIV to her child. This occurs in three ways, 1) during pregnancy 2) during childbirth 3) through breast milk. The chances of HIV being passed in any of these ways if the mother is in good health or taking HIV treatment is quite low. Micro-organism: Any organism that can only be seen with a microscope; bacteria, fungi, and viruses are examples of micro-organisms. Orphan: According to UNAIDS, WHO and UNICEF an orphan is a child who has lost one or both parents before reaching the age of 18 years. A double orphan is a child who has lost both parents before the age of 18 years. A single orphan is a child who has lost either his or her mother or father before reaching the age of 18. Opportunistic infection: An infection that does not ordinarily cause disease, but that causes disease in a person whose immune system has been weakened by HIV. Examples include tuberculosis, pneumonia, Herpes simplex viruses and candidiasis. Palliative care: Care that promotes the quality of life for people living with AIDS, by the provision of holistic care, good pain and symptom management, spiritual, physical and psychosocial care for clients and care for the families into and during the bereavement period should death occur. Pandemic: An epidemic that affects multiple geographic areas at the same time. Pathogen: An agent such as a virus or bacteria that causes disease. Peer education: A teaching-learning methodology that enables specific groups of people to learn from one another and thereby develop, strengthen, and empower them to take action or to play an active role in influencing policies and programs Plasma: The fluid portion of the blood. Post-exposure prophylaxis (PEP): As it relates to HIV disease, is a potentially preventative treatment using antiretroviral drugs to treat individuals within 72 hours of a high-risk exposure (e.g. needle stick injury, unprotected sex, rape, needle sharing etc.) to prevent HIV infection. PEP significantly reduces the risk of HIV infection, but it is not 100% effective. Post-test counselling: The process of providing risk-reduction information and emotional support, at the time that the test result is released, to a person who is submitted to HIV testing. Pre-exposure prophylaxis (PREP): The process of taking antiretrovirals before engaging in behaviour(s) that place one at risk for HIV infection. The effectiveness of this is still unproven.
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Pre-test counselling: The process of providing an individual with information on the biomedical aspects of HIV and AIDS and emotional support for any psychological implications of undergoing HIV testing and the test result itself before he/she is subject to the test. Prevalence (or HIV prevalence): Prevalence itself refers to a rate (a measure of the proportion of people in a population infected with a particular disease at a given time). For HIV, the prevalence rate is the percentage of the population between the ages of 15 and 49 who are HIV infected. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, occurring in a given population over a certain period of time, while the term prevalence applies to all cases old and new. Prevention of mother-to-child transmission (of HIV): Interventions such as preventing unwanted pregnancies, improved antenatal care and management of labour, providing antiretroviral drugs during pregnancy and/or labour, modifying feeding practices for newborns and provision of antiretroviral therapy to newborns all of which aim to reduce the risk of HIV transmission from an infected mother to her child. Prophylaxis for opportunistic infections: Treatments that will prevent the development of conditions associated with HIV disease such as fungal infections and types of pneumonia. Rape: Sexual intercourse with an individual without his or her consent. Retrovirus: An RNA virus (a virus composed not of DNA but of RNA). Retroviruses are a type of virus that can insert its genetic material into a host cells DNA. Retroviruses have an enzyme called reverse transcriptase that gives them the unique property of transcribing RNA (their RNA) into DNA. HIV is a retrovirus. Safer sex: Sexual practices that reduce or eliminate the exchange of body fluids that can transmit HIV e.g. through consistent and correct condom use. Serological testing: Testing of a sample of blood serum. Seronegative: Showing negative results in a serological test. Seroprevalence: Number of persons in a population who tested positive for a specific disease based on serology (blood serum) specimens. Seropositive: Showing the presence of a certain antibody in the blood sample, or showing positive results in a serological test. A person who is seropositive for HIV antibody is considered infected with the HIV virus. Sex worker: A sex worker has sex with other persons with a conscious motive of acquiring money, goods, or favours, in order to make a fulltime or part-time living for her/himself or for others. Sexual debut: The age at which a person first engages in sexual intercourse. Sexually Transmitted Infections (STIs): Infections that can be transmitted through sexual intercourse or genital contact such as gonorrhoea, chlamydia and syphilis. In many cases HIV is a sexually transmitted infection. Untreated STIs can cause serious health problems in men and women. A person with symptoms of STIs (ulcers, sores, or discharge) 5-10 times more likely to transmit HIV. Sexually transmitted infection management: Comprehensive care of a person with an STI-related syndrome or with a positive test for one or more STIs. Socio-behavioural interventions: Educational programmes designed to encourage individuals to change their behaviour to reduce their exposure to HIV infections in order to reduce or prevent the possibility of HIV infection. Stigma: A process through which an individual attaches a negative social label of disgrace, shame, prejudice or rejection to another because that person is different in a way that the individual finds the stigmatized person undesirable or disturbing.
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Stigmatize: Holding discrediting or derogatory attitudes towards another on the basis of some feature that distinguish the other such as colour, race, and HIV status. Symptom: Sign in the body that indicates health or a disease. Symptomatic: With symptoms Sugar Daddy/Mommy Syndrome: Comparatively well-off older men/women who pay special attention (e.g. give presents) to younger women/men in return for sexual favours. T- Cells: A type of white blood cell. One type of T cell (T4 Lymphocytes, also called T4 Helper cells) is especially apt to be infected by HIV. By injuring and destroying these cells HIV damages the overall ability of the immune system to reduce the reproduction of the virus in the blood or to fight opportunistic diseases. A healthy person will usually have more than 1,200 T-cells in a certain measure of blood, but when HIV progresses to AIDS the number of T-cells drops below 200. Treatment education: Education that engages individuals and communities to learn about anti retroviral therapy so that they understand the full range of issues and options involved. It provides information on drug regimen and encourages people to know their HIV status. Tuberculosis (TB): Tuberculosis is a bacterial infection that is most often found in the lungs (pulmonary TB) but can spread to other parts of the body (extrapulmonary TB). TB in the lungs is easily spread to other people through coughing or laughing. Treatment is often successful, though the process is long. Treatment time averages between 6 and 9 months.TB is the most common opportunistic infection and the most frequent cause of death in people living with HIV in Africa. Universal precautions: A practice, or set of precautions to be followed in any situation where there is risk of exposure to infected bodily fluids, such as blood, like wearing protective gloves, goggles and shields, or carefully handling potentially contaminated medical instruments. Vaccine: A substance that contains antigenic or pathogenic components, either weakened, dead, or synthetic, from an infectious organism which is injected into the body in order to produce antibodies to disease or to the antigenic components. Viral load: The amount of virus present in the blood. HIV viral load indicates the extent to which HIV is reproducing in the body. Higher numbers mean more of the virus is present in the body. Virus: Infectious agents responsible for numerous diseases in all living beings. They are extremely small particles, and in contrast to bacteria, can only survive and multiply within a living cell at the expense of that cell. Voluntary counselling and testing: HIV testing done on an individual who, after having undergone pretest counselling, willingly submits himself/herself to such a test. Workplace policy: A guiding statement of principles and intent taking applicable to all staff and personnel of an institution. This can often be part of a larger sectoral policy.
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HIV and AIDS knowledge test answers

The purpose of the knowledge test is to be sure you have the basics of HIV transmission. This test is in no way intended to replace the specialized information provided by WHO and UNAIDS. Should additionally clarifications be sought, please refer to the websites of these two organizations. PART 1. 1. Approximately how many people in the world are living with HIV? A. 2,000,000 B. 12,000,000 C. 40,000,000 Answer: C. According to the Global UNAIDS/WHO AIDS Epidemic Update: December 2006, the number of people living with HIV is approximately 39,500,000, or 40,000,000. 2. In what region can the largest number of people living with HIV currently be found? A. Asia and the Pacific B. Sub-Saharan Africa C. Latin America and the Caribbean D. North America E. Central and Eastern Europe Answer: B. In Africa south of the Sahara desert, an estimated 2.8 million adults and children became infected with HIV during 2006, bringing the total number of people living with HIV in Africa at years end to 24.7 million. Over the same period, millions of Africans infected in earlier years began experiencing ill health, and 2.3 million people at a more advanced stage of infection died of HIV-related illness. 3. What does the acronym HIV stand for? A. Hemo-insufficiency virus B. Human immunodeficiency virus C. Human immobilization virus Answer: B. HIV stands for Human Immunodeficiency Virus. HIV is the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. 4. What does the acronym AIDS stand for? A. active immunological disease syndrome B. acquired immune deficiency syndrome C. acquired immunological derivative syndrome D. acquired immunodeficiency syndrome Answer: B. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a range of medical conditions that occurs when a persons immune system is seriously weakened by HIV to the point where the person develops any number of diseases and cancers. 5. What is the main means of HIV transmission worldwide? A. unprotected heterosexual sex B. homosexual sex C. intravenous drug use D. mother-to-child transmission Answer: A. Though all of the answers above can transmit the virus, the most common means of transmission of HIV in the world today is through unprotected heterosexual sex.
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6. Spread of HIV by sexual transmission can be prevented by: A. abstinence B. practising mutual monogamy with an uninfected partner C. correct use of condoms D. all of the above Answer: D. Abstinence is the only 100% effective way to prevent HIV transmission, though proper use of condoms and staying faithful with your partner, (once you have both been tested for HIV) are also effective ways of preventing the transmission of HIV. 7. Women are most likely to contract HIV through: A. unprotected heterosexual sex B. injecting drug use C. contaminated blood Answer: A. In many cultures, women are at a higher risk of contracting HIV through unprotected sex than men. This is due to physical reasons, but also due to the social factors that keep them submissive to men. Biological reasons that make women more vulnerable to HIV infection through sexual intercourse include: 1. 2. 3. Women receive greater quantities of possibly infected fluids during a sexual encounter. Women have a surface area of mucous membrane (portal of entry) that is greater in size than mens. Very young women have more risk of infection during sex both because the cells in the vagina in underdeveloped women are more likely to receive the virus, and because tearing may cause bleeding which increases the risk of infection. If a woman has been circumcised or uses natural substances to dry out her vagina, the smaller or drier area may rupture more easily during sex.
4.
8. HIV can be contracted from: A. condoms B. kissing C. mosquito bites D. drinking from the same glass as an infected person E. sharing a spoon with a person living with HIV F. sharing a toothbrush with someone who is living with HIV G. all of the above H. none of the above Answer: H. The HIV can only be transmitted by an infecting fluid and a portal of entry into the body. A portal of entry is the way that HIV enters the body. This is either through a cut, sore, or opening in the skin or through the soft tissue called .mucous membrane, located in the vagina, the tip of the penis, the anus, the mouth, the eyes, or the nose. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another. There is no way to catch HIV by being near a person with HIV, or by sharing their cups or bathrooms, or by hugging them or kissing them when blood or a contaminated fluid is not present. There are no documented cases of HIV transmission through sharing toothbrushes. This practice could only present a risk if there was blood present on the toothbrush.
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9. Risk of contracting HIV is increased by: A. being infected with another sexually transmitted infection (STI) B. having poor nutrition C. having a cold Answer: A. In general, a genital sore or ulcer as in syphilis, chancroid, or herpes expands the portal of entry. Having a discharge, as in gonorrhea or chlamydia, means that more white blood cells are present. Since white blood cells are hosts for HIV, it means that more virus can be transmitted or received when the discharge is present. Quick and proper treatment of STDs and immediate referral of partners can be important strategies for HIV prevention. Often women do not have apparent symptoms of sexually transmitted diseases, so check.ups and partner referrals are very important. But men, too, may occasionally not have symptoms, even of gonorrhea; so, it is important that the man seek treatment. 10. Pregnant women infected with HIV: A. can reduce chances of transmitting HIV to her unborn child by maintaining a low viral load and staying in good health B. can take medication to reduce the risk of mother-to-child transmission during childbirth C. all of the above Answer: C. An HIV-infected pregnant woman can pass the virus on to her unborn baby either before or during birth. HIV can also be passed on during breastfeeding. If a woman knows that she is infected with HIV, there are drugs she can take to greatly reduce the chances of her child becoming infected. Other ways to lower the risk include choosing to have a caesarean section delivery and not breastfeeding or breastfeeding for only the first six months of the childs life. 11. List the four main body fluids that, when infected, may transmit HIV. 1. 2. 3. 4. Vaginal fluids Semen Breast milk Blood (using infected instruments for cutting, or sharing infected needles for drug use)
12. List the four main ways HIV is transmitted. 1. 2. 3. 4. Mother-to-child transmission Sharing needles for injections (drug use) or using contaminated instruments Blood transfusion Unprotected sexual intercourse
PART 2: the answers to part 2 can be found below. For more explanations, please refer to the HIV and AIDS fact sheets and glossary on pages 189 and 195. 1. If a person has HIV, they will always develop AIDS. (False)
2. HIV is present in blood, sexual fluids and sweat. (False: not present in sweat.) 3. Abstaining from (not having) sexual intercourse is an effective way to avoid being infected with HIV. (True) 4. When a person has AIDS, his or her body cannot easily defend itself from infections. (True) 5. A person can get the same sexually transmitted infection more than once. (True)
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6. There is a cure for AIDS. (False) 7. If a pregnant woman has HIV, there is a still a chance she will not pass it to her baby. (True) 8. A person can get HIV infection from sharing needles used to inject drugs. (True) 9. Many people with sexually transmitted infections, including HIV, do not have symptoms. (True) 10. HIV can be easily spread by using someone's personal belongings, such as a toothbrush or a razor. (False) 11. A person can look at someone and tell if he or she is infected with HIV or has AIDS. (False) 12. It is possible to avoid becoming infected with HIV by having sexual intercourse only once a month. (False) 13. A condom, when used properly, provides excellent protection against sexually transmitted infections, and can prevent transmission of HIV. (True) 14. An effective vaccine is available to protect people from HIV infection. (False)
15. A person can be infected with HIV for 10 or more years without developing AIDS. (True)
16. You can get HIV by kissing someone who has it. (False) 17. A person can be infected with HIV by giving blood in an approved health facility. (False) 18. Ear-piercing and tattooing with unsterilized instruments are possible ways of becoming infected with HIV. (True) 19. A person can get HIV by being bitten by a mosquito. (False) 20. A person can avoid getting HIV by eating well and exercising regularly. (False)
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The series
Wide-ranging professional competence is needed for responding to HIV and AIDS in the education sector. To make the best use of this series, it is recommended that the following order be respected. However, as each volume deals with its own specific theme, they can also be used independently of one another.
1.1 1.2 1.3 1.4 1.5
The impacts of HIV/AIDS on development M. J. Kelly, C. Desmond, D. Cohen The HIV/AIDS challenge to education M. J. Kelly Education for All in the context of HIV/AIDS F. Caillods, T. Bukow HIV/AIDS-related stigma and discrimination R. Smart Leadership against HIV/AIDS in education E. Allemano, F. Caillods, T. Bukow
Volume 2: Facilitating Policy
2.1 2.2 2.3
Developing and implementing HIV/AIDS policy in education P. Badcock-Walters HIV/AIDS management structures in education R. Smart HIV/AIDS in the educational workplace D. Chetty
Volume 3: Understanding Impact
3.1 3.2 3.3 3.4
Analyzing the impact of HIV/AIDS in the education sector A. Kinghorn HIV/AIDS challenges for education information systems W. Heard, P. Badcock-Walters. Qualitative research on education and HIV/AIDS O. Akpaka Projecting education supply and demand in an HIV/AIDS context P. Dias Da Graa
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Volume 4: Responding to the Epidemic
4.1 4.2 4.3 4.4 4.5 4.6
A curriculum response to HIV/AIDS E. Miedema Teacher formation and development in the context of HIV/AIDS M. J. Kelly An education policy framework for orphans and vulnerable children R. Smart, W. Heard, M. J. Kelly HIV/AIDS care, support and treatment for education staff R. Smart School level response to HIV/AIDS S. Johnson The higher education response to HIV/AIDS M. Crewe, C. Nzioka
Volume 5: Costing, Monitoring and Managing
5.1 5.2 5.3 5.4
Costing the implications of HIV/AIDS in education M. Gorgens Funding the response to HIV/AIDS in education P. Mukwashi Project design and monitoring P. Mukwashi Mitigating the HIV/AIDS impact on education: a management checklist P. Badcock-Walters
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The present series was jointly developed by UNESCOs International Institute for Educational Planning (IIEP) and the EduSector AIDS Response Trust (ESART) to alert educational planners, managers and personnel to the challenges that HIV and AIDS represent for the education sector, and to equip them with the skills necessary to address these challenges. By bringing together the unique expertise of both organizations, the series provides a comprehensive guide to developing effective responses to HIV and AIDS in the education sector. The extensive range of topics covered, from impact analysis to policy formulation, articulation of a response, fund mobilization and management checklist, constitute an invaluable resource for all those interested in understanding the processes of managing and implementing strategies to combat HIV and AIDS. Accessible to all, the modules are designed to be used in various learning situations, from independent study to face-to-face training. They can be accessed on the Internet web site: www.unesco.org/iiep Developed as living documents, they will be revisited and revised as needed. Users are encouraged to send their comments and suggestions (hiv-aids-clearinghouse@iiep.unesco.org). The contributors The International Institute for Educational Planning is a specialised organ of UNESCO created to help build the capacity of countries to design educational policies and implement coherent plans for their education systems, and to establish the institutional framework by which education is managed and progress monitored. The EduSector AIDS Response Trust (ESART) is an independent, non-profit organisation established to continue the work of the Mobile Task Team (MTT), originally based at HEARD, University of KwaZulu-Natal from 2000 to 2006, and supported by USAID. ESART is designed to help empower African ministries of education and their development partners, to develop sector-wide HIV&AIDS policy and prioritized implementation plans to systemically manage and mitigate impact.
Volume
Facilitating Policy
Foreword
The modules have been designed as self-study materials but they can also be used by training institutions in different courses and workshops. Most modules address the needs of planners and managers working at central or regional levels. Some, however, can be usefully read by policy-makers and directors of primary and secondary education. Others will help inspectors and administrators at local level address the issues that the epidemic raises for them in their day-to-day work. Financial support for the development of modules and for the publication of the series at IIEP was provided by the UK Department for International Development (DFID) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The Mobile Task Team (MTT) on the impact of HIV/AIDS on education, based at HEARD at the University of KwaZulu-Natal from 2000 to 2006, was funded by the United States Agency for International Development (USAID). The EduSector AIDS Response Trust, an independent, non-profit Trust was established to continue the work of the MTT in 2006. The editing team for the series comprised Peter Badcock-Walters, and Michael Kelly for the MTT (now ESART), and Franoise Caillods, Lucy Teasdale and Barbara Tournier for the IIEP. The module authors are grateful to Miriam Jones for carefully editing each module. They are also grateful to Philippe Abbou-Avon of the IIEP Publications Unit for finalizing the layout of this series.
Franoise Caillods Deputy Director IIEP

Now that you have understood how HIV and AIDS can impact your society, you can begin to establish policies and structures within the ministry that promote and sustain actions to reduce HIV-related problems in the workplace, and in the larger education sector. It is with this end in mind that Volume 2, Facilitating Policy has been designed.
Learners guide List of abbreviations MODULE 2.1: DEVELOPING AND IMPLEMENTING HIV/AIDS POLICY IN EDUCATION Aims Objectives Questions for reflection 1. 2. Introductory remarks Policy development Policy implementation Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 5 9 15 16 16 17 18 20 29 38 40 42 43
MODULE 2.2: HIV/AIDS MANAGEMENT STRUCTURES IN EDUCATION Aims Objectives Questions for reflection 1. 2. 3. Introductory remarks HIV/AIDS management unit (HAMU) HIV and AIDS committee Other education sector structures with potential AIDS-related roles Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
47 48 48 49 50 52 59 62 64 65 66 67
MODULE 2.3: HIV/AIDS IN THE EDUCATIONAL WORKPLACE Aims Objectives Questions for reflection 1. 2. 3. 4. 5.
71 72 72 73 74 75 78 82 89 106 109 110 112 113 115 119 125
New remarks IntroductoryText Policy Workplace policy on HIV and AIDS Policy development Programmes Human resources planning and development
Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
Useful links HIV and AIDS glossary The series
Learners guide
by B. Tournier
Background


The volumes
The modules

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Global Fund to Fight AIDS, Tuberculosis and Malaria Greater involvement of people living with or affected by HIV and AIDS Highly active antiretroviral therapy HIV and AIDS Management Unit Home-based care Health and development networks Health and family life education Highly indebted poor countries Human Immunodeficiency Virus Human resources International Bureau of Education International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa International Council of AIDS Service Organizations Injecting drug user Information, education and communication International Finance Corporation International Institute for Educational Planning International Labour Organization In-service education and training International Planned Parenthood Federation Knowledge, attitudes, practices and behaviour Monitoring and evaluation Multi-Country AIDS Program (World Bank) Millennium Development Goals Management information system Medium-to-large-scale project Ministry of Basic Education, Sport and Culture Ministry of education Ministry of Education and Sports Ministry of Higher Education, Training and Employment Creation Men who have sex with men Medium-term expenditure framework Mother-to-child transmission Mobile Task Team (MTT) on the Impact of HIV and AIDS on Education
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National AIDS Council National AIDS Co-ordinating Agency National Development Plan Non-formal education Non-government organizations National Task Force on Orphans Out-of-school youth Orphans and vulnerable children Programme Acceleration Funds (UNAIDS) Poverty Eradication Action Plan Post-exposure prophylaxis (US) President's Emergency Plan for AIDS Relief Prevention of mother-to-child transmission Pre-exposure prophylaxis Poverty reduction strategy paper Population Services International Parent-teacher association South African Church Council Southern Africa HIV and AIDS Information Dissemination Service School governing body Swedish International Development Cooperation Agency School management team Smaller project Strategic response framework Sexual and reproductive health Sexually transmitted infection Tuberculosis Terms of reference United Nations Joint United Nations Programme on HIV/AIDS United Nations Development Group United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations Population Fund United Nations General Assembly Special Session on HIV/AIDS
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Module
P. Badcock-Walters
Developing and implementing HIV/AIDS policy in education
2.1
About the author

Peter Badcock-Walters is Director of the EduSector AIDS Response Trust and was the founding Director of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He specializes in strategic planning, policy development, implementation design and research, with a particular interest in systemic response, information-based decision support systems, process facilitation and training.
Module 2.1
DEVELOPING AND IMPLEMENTING HIV/AIDS POLICY IN EDUCATION
Table of contents
Questions for reflection Introductory remarks 1. Policy development The role of an education sector HIV and AIDS policy Key issues Policy development in a workshop setting Sector-wide involvement Guiding principles Policy themes Policy outcomes, review, adoption and dissemination 2. Policy implementation National education sector HIV and AIDS policy implementation planning objectives Policy implementation themes Adaptive framework: national versus decentralized planning Implementation planning in a workshop setting Planning templates Prioritization and costing Process outcomes Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 17 18 20 20 21 23 25 26 26 27 29 29 29 30 31 33 36 36 38 40 42 43
MODULE 2.1: Developing and implementing HIV/AIDS policy in education
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Aims
The aims of this module are to: clarify the role and importance of HIV and AIDS policy in the education sector and describe why and how such a policy should be developed and what it might include; demonstrate how implementation of an education sector HIV and AIDS policy and other strategic education activity can be planned, costed, actioned, monitored, reported and used strategically to unlock resources.
Objectives
On completion of this module, you should be able to: identify the issues involved, participate effectively in, or even lead an inclusive, sector-wide HIV and AIDS policy development process for the education sector and advocate its principles and outcomes; identify the need for national implementation planning frameworks, sub-national (decentralized) activity planning, costing and monitoring, and have the skills to participate in, or even lead, such planning and report on its outcomes.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. Why is an education sector HIV and AIDS policy necessary?
Should such a policy govern the entire education sector or just the formal system managed by the ministry of education?
How should the education sector be defined and what should it include?
What are the key challenges in implementing an HIV and AIDS policy?
Should a policy be implemented at all levels of the sector/system? Why?
Should a policy be regularly reviewed, updated and monitored? Why?
What would happen if there was no education sector HIV and AIDS policy?
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Module 2.1
DEVELOPING AND IMPLEMENTING HIV/AIDS POLICY IN EDUCATION
This module will treat the impact of HIV and AIDS on the education sector as a systemic management challenge for education. Very many ministries of education (MoEs) have assumed HIV and AIDS to be a public health issue and have consequently deferred to the leadership of the ministry of health in this connection. This response has resulted in a one-dimensional focus on the prevention of HIV and AIDS, to the virtual exclusion of a more comprehensive approach targeting prevention; treatment, care and support; workplace issues; and management of the response. This module will describe an inclusive policy development process involving as many key stakeholders in the sector as can be identified and engaged. Policy development is often, (perhaps historically) seen as the business of government and not as the interactive consensus-building activity it can more appropriately become. In the AIDS era, given the comparatively limited resources and infrastructure of MoEs in developing environments, it is critical that operational partnerships be developed to multiply response capacity. Involvement in sector policy development is therefore the logical expression of this commitment and should be taken very seriously. Conversely, it should be recognized that stakeholder groups not engaged in this process could become opponents to its adoption and implementation, rather than allies. Education sector HIV and AIDS policy development will be presented as a component of the wider national sector policy framework of each country, and the module will stress that any education sector HIV and AIDS policy development must be undertaken in that context. This context extends to wider education sector policy and planning, and relationships with other social sector ministries; this multi-sectoral or cross-sectoral context is of considerable importance in respect of response to issues of orphaning, vulnerable children and food security as well as the roll-out of antiretroviral therapy (ART). Any substantive policy begins from a principled position and develops within a conceptual framework that gives practical application to these principles. A number of examples of contemporary education sector HIV and AIDS policy development will be discussed and their approaches compared. The issue of implementation will be discussed in some detail, as any education sector HIV and AIDS policy development process, regardless of its merits, may be regarded as an academic and fruitless exercise if effective implementation does not follow. The module will discuss the process of prioritized national implementation planning in order to develop indicative costs at the macro-level and will create a framework for decentralized implementation, roll-out planning and action. The process holds the key to delivery and also provides the opportunity for
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more detailed costing at the meso- and micro-levels, and will accommodate inevitable variation in policy priorities at these levels. It should be recognized from the outset that, ironically, the HIV and AIDS crisis presents a unique opportunity to identify and address challenges for wider systemic reform. In normal circumstances, engineering change in complex systems is slow, difficult and often unsatisfactory. System-wide crisis, for whatever reason, represents an opportunity to cut across the density and complexity of long-established bureaucratic structures and identify key functions that may be changed and which will have a dynamic, knock-on effect. One example will illustrate the point: Increased teacher mortality will add to attrition and may upset the delicate balance of teacher demand and supply over time, to the extent that training colleges may not be able to keep up with the demand for replacement stock. In this event, the MoE may have to confront a number of policy options to balance the equation, including, perhaps, reducing the period of pre-service teacher training. If this confronting of options were to occur, it would also represent an opportunity to reconsider the business and goals of teacher training and revise curriculum (and also address other long-standing issues of concern in this process). This module is organized in two complementary sections: the first deals with education sector HIV and AIDS policy development, while the second deals with the implementation of such a policy at national and sub-national levels. This module should be studied in conjunction with Module 1.2, The HIV/AIDS challenge to education, in volume 1; Module 2.2, HIV/AIDS management structures in education, in volume 2; Module 4.3, An education policy framework for orphans and vulnerable children; and Module 5.4, Management checklist: mitigating HIV/AIDS impact on education.
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1.
Policy development
Box 1 Definition of policy Policy (n), pl policies 1 a plan of action adopted or pursued by an individual, government, party, business etc. 2 wisdom, shrewdness, or sagacity. Archaic: wisdom or prudence. Originally from OF policie, from L polta administration, POLITY (Collins Concise English Dictionary, 21st Century Edition).
The role of an education sector HIV and AIDS policy

It is useful to note that the dictionary definition refers to policy as a plan of action. This confirms the earlier contention that the role of policy is to frame and guide action, and not merely provide inert documentation to grace the bookshelves of the system. Throughout the module this view of action will be reinforced, and good, flexible and responsive policy will be shown to be central to the development of a comprehensive response to the HIV and AIDS impact. It is also no coincidence that in its archaic context, policy was seen to be synonymous with wisdom and prudence. Wisdom and prudence are qualities that should permeate any policy of substance, an education sector HIV and AIDS policy in particular. An education sector HIV and AIDS policy is intended to guide a comprehensive and explicit education sector response, within a national HIV and AIDS policy framework and within an international set of agreements, conventions and principles. In other words, an education sector policy will acknowledge and be contextualized by national policy frameworks and guidelines, but will deal with those issues of substance and detail that are specific to the education system and sector. This means that the necessary generalities of a national HIV and AIDS policy (where these exist, and which are often underpinned by a health ministry approach) will be supplemented by policies that specifically address the functions and structures of the education system, and are competent to guide regulation and legal frameworks within that system. The emphasis on international agreements and conventions is also important inasmuch as an increasing number of such agreements now inform every aspect of educational access, provisioning and quality, as well as workplace policy and other commitments to gender, human rights, and in particular the rights of the child. In other words, any policy that does not take account of these issues will be judged inadequate and will not be taken seriously by the international community. An education sector HIV and AIDS policy should inform every function of the education system and sector management, including the development of regulations that gives legal effect to policy. In particular, an education sector HIV and AIDS policy should have the effect of making routine educational management sensitive to HIV and AIDS and of protecting the affected and infected. In other words, the policy should lay down a number of achievable goals, objectives and guidelines that make planning, budgeting, managing, monitoring and reporting at every level of the system
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sensitive to the direct and indirect impacts of HIV and AIDS. In practical terms, this means providing guidance for the development of a regulatory framework that makes such sensitivity a routine function of every educational managers job. The same framework would apply to managers and other professionals in the wider education sector, who would similarly be bound by the provisions of such policy.
Key issues
There are a number of key issues that must be recognized and considered over the course of this module and in subsequent application. Identification of education sector interest groups, their role and importance: While MoEs have both the mandate and responsibility to deliver quality teaching and learning in an accessible environment, they have to recognize that there are many other interest groups in the sector with real capacity, responsibility and power. These groups might include teacher unions, private and independent basic education providers, representative parent bodies (at various levels), representative student bodies, including student teachers, higher education, independent or private colleges, non-government organizations (NGOs), community-based organizations (CBOs), faith-based organizations (FBOs), academics, researchers, funders and other development partners. While the situation will vary from country to country, it is reasonable to suggest that some or all of these interest groups will contribute to a comprehensive policy development process and will add value to the final outcome. Equally important, they will be pivotal in implementing the education sector HIV and AIDS policy or in contesting it if they are not seriously engaged or consulted. Policy development as an advocacy intervention: The process of policy development, its adoption and dissemination should be recognized as a national advocacy intervention of some magnitude, particularly if all the key interest groups have been involved and are supportive. The event of launching a policy on an issue as important as HIV and AIDS in education, and backing this with an achievable action plan for implementation, sends a national and international signal of great significance; one moreover which might well have the effect of mobilizing international support and funding. Flexibility of an adaptive policy framework: It is no longer possible in the AIDS era to contemplate an education policy cast in stone particularly one dealing expressly with the management and mitigation of HIV and AIDS. The dynamics of HIV and AIDS impact in medium- and high-prevalence countries and the unpredictability this dynamic brings to planning suggest that at best this requires a flexible policy framework capable of accommodating regular revision and change. For the education sector, where policy is traditionally an unquestioned edict from above, this approach represents a radical departure from tradition and one that may take some time to accept. Certainly, experience of education sector HIV and AIDS policy development indicates considerable reservation amongst MoE officials about the concept of regular, possibly annual, review. Notwithstanding this reservation, it is imperative that policy be seen as a flexible, even responsive, guiding framework, within which implementation planning can be contextualized and decentralized delivery achieved.
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Process steps and workshop programmes: In another departure from more traditional approaches, this module advocates a short, proactive and inclusive approach to policy development, and later implementation planning. These process steps and workshop programmes are described in some detail below, but it is important here to note that the dynamics of the HIV and AIDS era demand a level of response quite different to that of old. Innovation and speed are of the essence, and experience to date suggests that, properly managed, innovation and speed in no way reduce the quality of the output. Comprehensive approach to policy themes: Prevention, treatment, care and support, workplace issues and response management. As has already been noted, it is imperative that the education sector move beyond the almost exclusive focus on prevention of the last two decades and accept the need for a more comprehensive approach. What is required is the development of the political will and structural capacity to manage the response process. It is likely, for example, that the limited success of prevention strategies to date is due in part to the lack of a systemic context and support structure that would sustain and monitor such strategies. Follow-up steps including ratification, approval and development of regulations: It should be clearly understood that the development of a draft education sector HIV and AIDS policy is merely the first step in a long process to implementation. Any draft, no matter how comprehensive, must be subject to a process of review within the MoE, wider government and their partners. This process may take a good deal of time and lead to requests for revision and change before official approval and ratification of the policy, and its formal adoption and publication. Monitoring and evaluation and sector-wide reporting: There are problems associated with policy development and its implementation. The most common are associated with monitoring and evaluation, closely followed by information access and reporting. Some reasons for this are the lack of adequate skills and resources, or the lack of a structure mandated for this purpose. Addressing these difficulties should be a primary objective of the policy implementation process, and the process should also aim to motivate and mobilize the internal and external resources required to address the difficulties. Defining the education sector: If an education sector HIV and AIDS policy is to accommodate the needs of the entire sector and govern its collective response, there has to be consensus regarding the scope of application of the policy. In other words, there has to be agreement on what the education sector includes and excludes. Every country then needs to agree to a comprehensive definition of its education sector for the purpose of policy development and to define levels, divisions and sub-sectors for inclusion. Examples from three southern African countries may serve to provide some insight into the issues involved: Republic of Kenya Education Sector Policy on HIV and AIDS; Scope of Application: The Education Sector Policy on HIV and AIDS applies to learners, employees, managers, employers and other providers of education and training in all public and private, formal and non-formal learning institutions at all levels of the education system in the Republic of Kenya. Republic of Namibia National Education Sector Policy on HIV and AIDS; Scope of Application: The Namibia National Education Sector Policy on
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HIV and AIDS applies to the entire education cycle, from pre-primary to post secondary and tertiary education, including both the private and public sectors. Republic of Zambia National HIV and AIDS Policy for the Education Sector; Scope of Application: The National HIV and AIDS Policy for the Education Sector applies to all learners, employees, managers and providers of education and training in all public and private, formal and non-formal and traditional learning institutions at all levels of the education system in the Republic of Zambia.
Policy development in a workshop setting

In the most general terms, policy development has historically been the province of specialist working groups or commissions, usually established by governments, and has been characterized by political, legal and sectoral imperatives. The concept of consultation has long been entrenched, but more often than not the policy development process has been lengthy, with consultation taking place only in the period leading up to the final drafting of such a policy. In the AIDS era however, the circumstances have changed quite profoundly. As the magnitude of the crisis is felt, more and more governments in general and MoEs in particular have recognized the need to develop sector specific HIV and AIDS policy to guide response as a matter of greatest urgency. As a consequence, the rules have been open to change and the policy development process itself has been subject to considerable pressure often for the better. One outcome of this change has been the development of a rapid policy development process pioneered by the Mobile Task Team on the impact of HIV and AIDS on education (MTT). Used in a number of African countries with considerable success, this approach involves bringing together a group of participants, representative of the wider education sector, to develop an initial draft policy in a matter of five days. This rapid policy development process reverses the traditional approach, in which a first draft may only emerge after a long period of consultation, review, and often opaque deliberation. The rapid policy development process concentrates on getting 80 per cent of the work done in the opening round in order to provide a tangible output for much wider review and more immediate public consultation. It should be stressed that this rapid policy development process is only one approach, and that other options exist. Whichever direction a given education sector elects to take, the key issues remain the same. On the basis of experience to date, a set of steps and a tightly managed facilitation process are required to ensure success. The identification and invitation of a group broadly representative of the MoE and other education sector interest groups. This group should not exceed 60 in number, and for credibilitys sake not less than 40. This decision is a critical step and requires the greatest political and development sensitivity.
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Selection of participants who could and should be included, as well as all key divisions of the MoE: HIV and AIDS directorate/management unit Planning Education management information systems Human resources Higher education Curriculum and teacher training Student union Parent body representatives NGO, CBO and FBO partners Providers of private and non-formal education People living with HIV from the sector Development partners Specialist facilitators
Establishment of key and transparent criteria for invitation and involvement, including the capacity of the participants to represent their interest group, enhance the policy development process and contribute to its adoption (and later implementation) by mobilizing the support of the interest group involved. Development of a five-day programme designed to ensure the desired outcomes (i.e. draft a five-year national implementation planning framework) and assurance that invitations and background information including copies of the education sector HIV and AIDS policy are sent out carrying the signature of the minister of education or his/her most senior official. Confirmation that an experienced professional facilitation team is available to manage and guide the process, and ensure the desired outcomes. Finally, confirmation that participants are expected to attend the full workshop and not come and go at will. To support this approach, assurance that a venue is selected far enough away from the participants homes and offices to keep them in place and involved. The programme should be designed to maximize participation and focus on the practical development of a comprehensive, draft education sector HIV and AIDS policy. The following work flow (by day) illustrates the type of programme that might be used.
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Box 2
Day-by-day work flow of a programme
Day one Official opening: optimally by a minister or permanent secretary (with media coverage) Participant introductions, expectations and concerns Workshop objectives, process and output Understanding the policy: education sector HIV and AIDS policy review Understanding the issues: HIV and AIDS impact mitigation as systemic issue Comparative experience: country models of policy implementation planning Day two Introduction to implementation planning: outcomes-based approach Guiding principles: what, who, when, how and where? HIV and AIDS education sector policy themes Group work: national implementation framework planning by theme Setting objectives by a policy goal Prioritization for delivery Template-based action planning First plenary report back: group progress reports and plenary critique Day three Group work: Implementation framework planning and plenary critique and inputs Template-based action planning continues Second plenary report back: review indicators of success, timeframes, technical assistance and budget requirements; group work continues to finalize draft planning. Identify cost centres Third plenary report back/presentation by policy theme, goal and objective, using PowerPoint templates supplied Day four Policy theme group plenary review Policy theme group revision of priorities and sequencing Plenary introduction to decentralized implementation and national responsibilities implications for planning Plenary review: implementation costing and budgeting per national norms Groups, rapporteurs and resource persons prepare final presentations
Sector-wide involvement
If policy is to have sector-wide application, it is necessary to identify and involve all the interest groups with a stake in its success if they are to support it. The greater the number of interest groups, the longer and more complex the process may be. The key principle therefore is representativity: in other words, ensuring limited but effective representation from as many groups as possible without unnecessary duplication. The interest groups involved have an obligation to engage with their areas of concern/expertise (and represent their constituencies) as well as the wider sector-policy context. This interest group involvement is also an opportunity to create and empower advocates from every sub-sector as champions of the policy.
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Guiding principles
An education sector HIV and AIDS policy must be guided by a set of principles that entrench the rights and responsibilities of every interest group in the sector. In addition, these principles must accord with the countrys national HIV and AIDS policy or guidelines, and must conform to international conventions, national laws, policies, guidelines and regulations. In particular, the principles must take into account gender issues, learners with special needs, and recognize the universality of human rights. To be effective, these principles must address all of the key issues in the education sector including: access to education; access to information; equality; privacy and confidentiality; access to care, treatment and support; a safe workplace and learning institution; fair labour practices; gender sensitivity/responsiveness; greater involvement of people living with HIV; partnerships. Excellent examples of the application of such principles may be found in the Republic of Kenyas Education Sector Policy on HIV and AIDS, the Republic of Ugandas draft Education Sector Policy on HIV and AIDS and the draft Education Sector Policy on HIV and AIDS of the Republic of Zambia.
Policy themes
To be comprehensive, an education sector HIV and AIDS policy must address four internationally recognized policy and implementation themes: prevention; treatment, care and support; workplace issues; management of the response. By addressing all four of these themes, the danger of undue or one-dimensional focus on any one to the exclusion of others is avoided. The inclusion of all interest groups and directorates of the MoE also means that the importance of all these themes, and the issues within them, will be protected. It is likely that many of the interest groups involved will have a single-theme focus, but within the wider group (and plenary interrogation) these interests will merge to provide a comprehensive picture within which each element is adequately addressed. A goal for each theme should be set, which describes the desired outcome once the policy is implemented. These four goals, taken together, should describe an optimal situation in the education sector brought about by the successful implementation of the policy at every level and in every area. Theoretically at least,
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this outcome will be achieved by the end of the planned implementation period (probably set at five years) if everyone plays their part, if resources are available and if effective monitoring and reporting provide an insight into activity and progress. For each overarching theme goal, a set of objectives and activities should be listed to address each key issue, focus attention and provide a checklist for implementation. For example, in the Kenyan Education Sector HIV and AIDS Policy, under the theme heading Care and Support, 21 separate objectives are contained under six sub-headings. These sub-headings include: Scope; Access to health services; Psychosocial support; Community mobilization; Orphans and vulnerable children (OVC); and Financial support. Taken as a cluster of issues and objectives, these comprehensively address all the activities that would be required to achieve the theme goal, which reads (and anticipates within five years): An education sector in which care and support is available for all, particularly orphans and vulnerable children (OVC) and those with special needs.
Policy outcomes, review, adoption and dissemination

Assuming the political will, professional process management, adherence to these and any other steps that might be required, a workshop programme of this kind can be expected to produce a first draft of an education sector HIV and AIDS policy for circulation and review. It should be recognized, however, that adherence to the principles of access and consultation does not stop after the first round; it should be expected that the draft will be engaged by very many education and political interest groups, and that a great deal of further comment will be forthcoming. This is all to the good, as the wider the engagement the wider the chances of the policys acceptance and success. The key to the success of this second round of comparatively uncontrolled comment and input is ensuring its capture and processing within a clearly defined period. For this purpose, a simple instrument can be developed and attached to the published draft which will enable others to record their comments and views in a structured and common format. These instruments can then be mailed to a secretariat established for this purpose, and the input categorized and recorded. Some mechanism must be agreed for the purpose of accepting or rejecting this input, and optimally the structure of this mechanism should be representative of the wider sector; importantly, a deadline must be established beyond which comments will not be accepted, to ensure closure. The closure of the second round of comment and input does not, however, signal the end of the debate; indeed, there may be many drafts before final adoption and it is therefore important that each one be clearly dated and numbered. As has been remarked throughout this module, the policy should be seen as a flexible framework subject to regular review and change. Thus the education sector should be able to make further comment at any point and be assured that some further round of review and revision lies ahead. For practical and legal purposes, it will be the MoE that ultimately accepts and adopts the draft education sector HIV and AIDS policy. It is, after all, the mandated ministry of government and has both the legal power and resources to give effect to the policy; it is also responsible for the parliamentary and other processes
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required. Most importantly, in the implementation phase of the policy development process, the MoE will have the responsibility of establishing the legally-binding regulations that flow from this policy. These are central to the whole process as it is these regulations that govern the management and administration of education and guide workplace policy and practice. Once adopted, and when the MoE has committed itself to the legal process involved, the education sector HIV and AIDS policy must be shared with the sector and the nation. This is a considerable logistical challenge but it should be seen in the first instance as an opportunity for advocacy on a grand scale. Publication and release provide an opportunity for the minister of education perhaps with the countrys president or prime minister to launch the policy with due fanfare and open a series of media engagements to interrogate and disseminate its contents. This should confirm the MoEs commitment to transparency and access and should be supported by the most extensive publication possible of the policy, in a format designed for easy reading and consumption. In the final analysis, the policy should be available in every classroom and should constitute the basis for classroom-level codes of conduct, committing both the teacher and the learner to their collective responsibilities towards one another.
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2.
Policy implementation
Box 3 Definition of implement Implement (n) 2 a means to achieve a purpose; (vb) 3 to carry out; put into action: to implement a plan. Originally from LL implmentum, lit.: a filling up, from L implre to fill up, satisfy, fulfil implementation (n) (Collins Concise English Dictionary, 21st Century Edition).
National education sector HIV and AIDS policy implementation planning objectives
The dictionary definition is unambiguous: Implementation means achieving, carrying out, and putting into action (in this case a policy). Its Latin roots confirm the character of the word and its intention; it means literally to satisfy and fulfil (needs and expectation). In other words, it appropriately signals that implementation is designed to meet the many expectations raised by an education sector HIV and AIDS policy. The first objective is to demonstrate how national implementation of an education sector HIV and AIDS policy can be planned, costed, actioned, monitored, reported and used strategically to mobilize resources. The second objective is to develop an understanding of national implementation planning frameworks, sub-national (decentralized) activity planning, costing and monitoring. The third objective is to develop the skills to undertake such planning, co-ordinate its implementation and report its outcomes.
Policy implementation themes

As indicated in the previous section, an education sector HIV and AIDS policy addresses four internationally-recognized policy and implementation themes. These are prevention; treatment, care and support; workplace issues; and management of the response. Policy implementation is therefore divided on the same basis, and identifies the goals that were set for each of these themes. Each of the four goals will be realized by the achievement of a number of objectives. In each case, the theme goal describes the desired outcome that will be realized once all of the themes objectives have been achieved. Each theme represents a major set of activities in its own right. Some of the interest groups and even directorates within the MoE will have greater interest and expertise in some of these than in other areas. For this reason, each interest group is encouraged to associate itself in the workshop process with the theme in which it is most interested and knowledgeable.
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The strength of the final outcome a comprehensive implementation plan relies on this blend of interest and expertise and on the fact that everyone involved, regardless of specific interest or expertise, will have to deal holistically with the entire plan in the plenary interrogation process, assuming joint responsibility and ownership and committing to its success.
Adaptive framework: national versus decentralized planning

In the same way that an education sector HIV and AIDS policy must be seen as adaptive to changing needs, implementation planning must be adaptive to changing circumstances over time. A national education sector HIV and AIDS policy and implementation planning should provide a flexible framework within which sub-national needs and priorities can be met and dealt with effectively. While a national policy framework is designed to address the wider policy imperatives of the country (or sector), it cannot easily take account of the widely differing circumstances, needs and priorities of different parts of the country in relation to one another. Different areas of any country or levels or parts of the education system may have widely differing levels of capacity, development, provisioning or quality; the same will be true for the variability of HIV prevalence within countries and communities. In short, there has to be sufficient flexibility within the national policy and implementation framework to accommodate quite different applications of the plan, based on these local circumstances, provided they recognize and subscribe to the same national principles, goals and objectives. In practical terms this means that adaptive policy can be segmented by theme and prioritized quite differently in different areas or at different levels of the system. It also means that decentralized planning may be played out in quite different time-bound, locally costed or regional action plans designed to mobilize internal and external resources most efficiently for the area or level concerned. Implementation will roll out in short-, medium- and long-term phases, and the dynamics of the AIDS era may require considerable adaptability to changing circumstances. The implementation can and should be driven by constant monitoring, evaluation, consultation and review. The action planning templates used to plan implementation can also be used to track progress using key indicators and identifiers, and show how such activity can be monitored and reported at every level. This process is strategically important and must be led and managed by a dedicated team with a clear mandate. Once the national implementation planning framework exists, this should be taken forward into a second round of sub-national workshops at a level best suited to support action and delivery. For many countries this may be the district level, and these workshops may be aggregated into provincial or regional workshops for the purpose of planning. This second round should follow hard on the heels of the ratification and dissemination process to harness the latent energy in those interest groups that were involved in the national planning process and are available to play a role in the decentralized rollout of workshops. Each of these sub-national workshops should mirror the national process described earlier in this module, including a maximum participation of 60 persons at each. At this level more than ever, representivity and participation will be the key to successful implementation; moreover, it is at this level that exclusions and invalid assumptions will be identified and addressed. In short, this is not as much
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an exercise in development democracy as in adding value to the development process.
Implementation planning in a workshop setting

The module has already shown that it is possible, indeed desirable, to develop preliminary outcomes of major strategic significance in a short period and in a workshop setting. The same approach is proposed for the planning of implementation. Evidence shows that considerable success can be achieved provided the objective is to develop a national implementation planning framework, of the kind described above, and not a detailed set of decentralized plans. The latter objectives are more appropriately the business of a second round of decentralized workshops in which locally representative and inclusive groups of stakeholders meet to consider local needs and priorities. On the basis of experience to date, a set of steps is required to ensure success in workshopping the implementation planning of any policy. First, as described above, a group broadly representative of the MoE and other education sector interest groups must be identified and invited to participate; this group should not be more than 60 in number and, for credibilitys sake, not less than 40. Ideally, this number should include the core group responsible for the original development of the education sector HIV and AIDS policy. Second, the key criterion for invitation and involvement should be the capacity of the interest group involved to enhance the planning process and contribute to its implementation. Preliminary planning should therefore identify all those groups, organizations, departments, partners, and even other ministries including persons living with HIV who would have a role to play in implementation, and ensure that these attend. Third, participants should feel valued and representative of their constituencies; in other words they should be taken seriously and feel they are being taken seriously. Fourth, develop outcomes (i.e. framework) and including copies out carrying the senior official. a five-day programme designed to ensure the desired draft five-year national implementation planning ensure that invitations and background information of the education sector HIV and AIDS policy are sent signature of the minister of education or his/her most
Fifth, ensure that an experienced professional facilitation team is available to manage and guide the process to ensure the desired outcomes. Finally, ensure that the invitation makes it clear that participants are expected to attend the full workshop and not come and go at will. To support this approach, ensure that the venue selected is of a significant distance from the participants homes and offices so as to oblige them to remain throughout the duration of the workshop. The programme should be designed to maximize participation and focus on the practical outcomes of the workshop; the following day-by-day workflow illustrates the type of programme required.
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Box 4
Proposed day-by-day workflow of a workshop
Day one Official opening: optimally by a minister or permanent secretary (with media coverage) Participant introductions, expectations and concerns Workshop objectives, process and output Understanding the policy: education sector HIV and AIDS policy review Understanding the issues: HIV and AIDS impact mitigation as a systemic issue Comparative experience: country models of policy implementation planning Day two Introduction to implementation planning: the outcomes-based approach Guiding principles: what, who, when, how and where? HIV and AIDS education sector policy themes Group work: national implementation framework planning by theme Setting objectives by policy goal Prioritization for delivery Template-based action planning First plenary report back: group progress reports and plenary critique Day three Group work: implementation framework planning and plenary critique and inputs Template-based action planning continues Second plenary report back: review indicators of success, timeframes, technical assistance and budget requirements; group work continues to finalize draft planning. Identify cost centres Third plenary report back/presentation by policy theme, goal and objective, using PowerPoint templates supplied Day four Policy theme group plenary review Policy theme group revision of priorities and sequencing Plenary introduction to decentralized implementation and national responsibilities Implications for planning Plenary review: implementation costing and budgeting per national norms Groups, rapporteurs and resource persons prepare final presentations Day five Process review and key point summary Policy theme presentations: action plans by prioritized objectives Plenary discussion and review: comments from invited expert review panel Next steps: agreement on way forward Draft implementation plan dissemination and adoption process Process for decentralized implementation planning by sub-region Responsibilities and budgeting Official closure and thanks by a minister or permanent secretary (with media coverage)
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Planning templates
A planning template provides a logical framework or discipline for the recording of key planning information. Many countries and MoEs will already have their own variants of this template, but care must be taken to ensure that all the elements shown in the example overleaf are included. The point of using this simple device is to ensure that everyone involved in the implementation process of planning, budgeting, management and monitoring is able to derive all the key information they need in order carry out their role or function. The planning template must identify the policy theme goal and specific objective (linked to the education sector HIV and AIDS policy) and must be completed in full and cross-checked. Any gaps or invalid assumptions will render the template useless and compromise the work that will need to be done to complete the remainder of the template. The following points should be considered, with reference to the sample template below. Overall responsibility for the goal and objective addressed by the planning template must rest with the senior accounting officer responsible. However, for practical purposes there is little point in identifying the permanent secretary on every occasion, so it is sensible to identify the most senior official with direct-line function responsible for the type of activity described. Each action or activity in the strategy column of the template must be described in sufficient detail to be clear and understandable to everyone involved. Responsibility for each action must be apportioned to a responsible organization or agency. This may be a MoE directorate for example, an NGO or related social sector agency. Whichever it is, it must be identified sufficiently clearly to allow that sub-unit or directorate to be contacted and held accountable if required. Objectively verifiable indicators are simple indicators of achievement that will confirm whether or not the action or activity has been successfully undertaken; for example, "90 teachers trained for one week in life skills teaching" clearly means that 90 teachers have to be trained as described for the activity to be judged to be successful. It is a simple qualitative measure. Key assumptions allow comment on the necessary preconditions for success; taking the last point for example, if only 60 teachers are available for training, the objective, activity and objectively verifiable indicators would all have to be changed to accommodate this reality. Starting and completion dates must be indicated. Funding sources must be identified; this may be as simple as saying that they are from the internal MoE budget (although it should be specified from which directorate, line function, etc.) or by mentioning a donor funding programme. However, one should refrain from saying donor funding if there is no certainty as regards the source or the amount. Other inputs and remarks provide the opportunity to add any necessary information that might assist the planning process; for example, information on the fact that the 90 teachers are
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available only between May and July would be strategically important and should be added. Finally, the identity of any actual or prospective partners must be revealed in order to ensure communication, role allocation and adequate project monitoring. This information may also lead to other partners being identified once there is a better understanding of who is involved and what their role may or may not be.
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A sample education sector HIV and AIDS policy implementation planning template Goal: Objective: Responsibility: Time frame Start End
Strategies: actions/activity 1
Responsible organization/ agency
Objectively verifiable indicators
Key assumptions
Funding source
Other inputs
Remarks
Partners
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Prioritization and costing

Each theme will inevitably have a long list of planned or proposed actions for implementation in the short, medium and long terms. This is as it should be, but it does require that the implementation planners make some choices and organize the list to take account of what is the most important in terms of available resources. This is to some extent what happens in the real world of education budgeting and planning; the key difference is that in this event, widely representative interest groups have the opportunity to debate the priority ranking and reach some measure of consensus. The key question is which of these objectives and activities are more or less important than the others and in which order should they be actioned? The process answer is somewhat more complicated, given that some of these objectives and activities cost a great deal less and are much easier to achieve than others. Taken together, these issues require that the process achieves an acceptable measure of compromise that satisfies the greatest number of interest groups involved. It is vital therefore that the prioritization process takes account of: strategic imperatives (i.e. those objectives or activities which, by common assent, are most important in the greater scheme of things); sequential imperatives (i.e. which actions must be completed before others can be initiated); Comparative ease and cost of implementation; Comparative importance relative to other objectives and activities. A number of simple but effective workshop techniques can be used to facilitate the prioritization process once the objectives and activities have been developed by theme. Ironically, this is a testing process principally, because each interest group including those from within the MoE has its own concerns and prejudices. In the event, this may be the most fruitful of the workshop processes and outcomes since it forces participants to look beyond their own interests and work for the greater good.
Process outcomes
The national education sector HIV and AIDS policy implementation planning workshop described above should produce the first draft, prioritized plan for ratification and costing. This should cover the four policy themes discussed earlier, and may add a number of cross-cutting objectives and activities such as the reduction of stigma and discrimination. It should identify all the actions required within a comprehensive and holistic plan, guided by the policy and its principles, and allocate responsibility for these together with timeframes and verifiable indicators of achievement. This should provide a framework for decentralized implementation planning by region or district, within which these sub-national areas can reorder their own priorities and action planning to suit local conditions and needs. The overarching goals and objectives will, however, remain central to this decentralized planning process, and only in exceptional circumstances will entirely new objectives be developed in a given area.
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The publication of the draft education sector HIV and AIDS policy implementation plan should bind the education sector to a collective commitment to action and to facilitate partnerships. The process will inevitably involve circulation of the draft, review and ratification, and finally dissemination into the education sector and the development community. A core sectoral team, competent to carry forward the process of revision and costing, should be appointed without delay to initiate the indicative costing of this plan. This costing framework should provide the assumptions and guidelines necessary for the decentralized workshops to develop more detailed costing of sub-national plans, which together should be re-aggregated at the national level to provide a second round of more accurate estimation of the national cost of roll-out.
Activity 1
What is meant by a principle? Give five examples of principles that might guide education sector HIV and AIDS policy.
How might these principles guide policy development and provide the basis for monitoring and evaluation.
Give a working definition of the education sector, and provide a clear description by level, sub-sector and education type.
Discuss and list all possible/likely education sector partners who should be involved in education sector HIV and AIDS policy development and explain why they should be involved.
If out-of-school youth have not been included in the education sector definition, describe at least three ways in which this group could be successfully engaged by the sector policy.
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Summary remarks
This module confirms that an education sector policy should be seen as an active rather than a passive instrument of government and governance, and that in the AIDS era it has elevated importance in confirming that the pandemic is first and foremost a management challenge. In this respect, it is important that developing and implementing policy be seen as an opportunity in a crisis to build on the sector HIV and AIDS response to remedy many other long-standing systemic and infrastructural problems. The module has described an inclusive policy development process involving as many key stakeholders in the sector as can be identified and engaged. It confirms that policy development in the AIDS era is the business of every stakeholder and not simply that of government. More to the point, it confirms that the involvement of sectoral partners in interactive consensus-building can add real value to the process of policy development and implementation. In effect, the approach presents an opportunity to cement partnerships and trust, and multiply the sector's potential to respond. Conversely, we have emphasized that the exclusion of any stakeholder group or tier of education could lead to non-adherence or even opposition to the policy implementation process. This prospect should be avoided at all costs when in fact the process could spin off an important network of sectoral allies and 'champions'. We have argued too that education sector HIV and AIDS policy development must be seen as a detailed reinforcement of the wider national sector policy framework of each country, and an expression of the intent of linked international policies, conventions, guidelines and protocols. What may be less evident is the extreme importance of sound sector policy and planning in underpinning the role of education in its relationship with other social sector ministries; we have stressed that this multisectoral or cross-sectoral context is critical in respect of inclusive response to issues of child and family vulnerability, food security and ART roll-out, for example. But perhaps the most important point to make in summary is to reinforce the central need to see policy development, national and decentralized implementation, monitoring, evaluation, reporting and review as a strategic continuum. Policy without time-bound and measurable implementation is of as much use as a motor-vehicle without a motor: Possibly nice to look at; perhaps even a model of technical advancement and design; but absolutely useless in terms of its intended function. Put differently, the true measure of the value and viability of policy is the measurable success of its implementation all the way to ground-level. We have outlined an inclusive process to address these components and shown that implementation at the national level may also be of limited value if it is not played out at the real point of delivery. In this respect the challenge increases exponentially, as it is at this point of delivery that even the best-intentioned of policies encounters the reality of systemic and infrastructural constraints. Here we emphasize again that the need to mount a decentralized HIV and AIDS response may open the way in terms of thinking, planning and resourcing to addressing long-standing systemic dysfunction at different levels of the education sector. The process of costing and quantifying logistical support may well open the
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way to the resolution of issues that have simply not seen the light of day until now, and that may often be resolved with remarkably little expenditure and effort. This last point speaks to the issue of giving practical effect to the expression of political will. Finally, it is probably fair to say that as a direct consequence of HIV and AIDS impact on the education sector and its associated community structures, the business and regularity of policy development and implementation will never be the same. Evidence from a number of African countries that have undertaken these steps with considerable success confirms that the entire conceptual and regulatory framework of educational planning and management can be, and has been, irrevocably changed. And they have demonstrated, in the process, the value of inclusive partnerships and intense commitment of every sector stakeholder to this strategic challenge.
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Lessons learned
Lesson One: It is vital for the successful management of the HIV and AIDS epidemic that the education sector develop a policy which should govern the entire education sector. It is for this reason that it is important to begin the process by agreeing on an inclusive definition of the sector and then identifying all those institutional and organizational components of it. The exclusion of any part of the sector may at best create tensions and at worst alienate it from the goals of the policy. Lesson Two: All stakeholders should be involved in the development of the policy. Apart from ensuring that no part of the sector is left out, this approach also represents a real opportunity to create a sector-wide network of 'champions' for the policy and help the stakeholders concerned to develop a more holistic understanding of a comprehensive response. Lesson Three: Policy development should not be seen as an academic exercise of limited relevance to the implementation of a response. Instead, it should be seen from the outset as a dynamic management tool with a clear value and function. One example of this relevance is the importance of sector policy in translating national and international policy, principles and protocols into a relevant set of guidelines for the education sector. A second example is the policys role in framing legally binding regulations to govern the roles and functions of those civil servants working within the sector, to ensure that they undertake those activities assigned to them in relation to the HIV and AIDS response. Lesson Four: Policy should be regularly reviewed and updated. This approach is in marked contrast to the practice and traditions of many education ministries, which regard such policies as a set of commandments. It is imperative that the policy development process provide the opportunity for stakeholders to see the need for regular review based on sector monitoring and analysis. This approach is driven both by the unpredictability of the AIDS era and the need to reposition ideas and attitudes about policy in the minds of all those concerned. Lesson Five: Monitoring and evaluation systems are essential. Without the ability to monitor the success of implementation there is no way that response can be measured and policy informed. Key to this is the identification of simple indicators of achievement in the implementation planning process and the establishment of practical systems to monitor, measure and report these. Such systems must be integral to the day-to-day business of educational managers at every level, add value to their existing activities and not be so onerous as to create resistance. In short, monitoring and evaluation indicators and systems must be central to the implementation process from the outset and not seen as a complex
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addition once the design is complete. Finally, the system must determine how, and how often, monitoring and evaluation will be reported, and to whom. Lesson Six: Dynamic, responsive sector policy provides a flexible framework within which an integrated and comprehensive sector response can be framed with due attention to national and international policy and guidelines. Without this policy, the education sector has no way of dealing systematically with the erosive impact of HIV and AIDS, or of fulfilling its mandate to provide teaching and learning to underpin socio-economic development.
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Activity 1 1. A principle is a general rule that you apply in a given context, and which entrenches the rights and responsibilities of every interest group in the sector. Key issues in the education sector include the ten listed on page 11 of this module. To confirm that the listed issues have been addressed in country policies, read any five from those available of the MTT website (www.mttaids.com). 2. Principles can mirror those described in national and international policies and conventions, and must entrench the rights and responsibilities of every interest group in the sector. Each principle forms the basis for a goal that the policy must achieve and therefore guides not only policy development but implementation at every level. To be effective, these principles must address all of the key issues in the education sector. Every policy goal based on these principles will have a set of contributing objectives; each one of these may encompass a set of activities which will be time-bound and identify some indicator(s) of achievement. Measurement of these indicators over time provides the basis for the monitoring and evaluation of the implementation of this policy. 3. Please refer to page 8 of this module to read on the scope of application of the education sector policies of Kenya, Namibia and Zambia. 4. Likely partners who should be involved in HIV and AIDS education sector policy development are listed on page 9 of this module. However, you may want to add others in addition to those given. 5. Out-of-school youth (OOSY). For example: Motivate the policy development group/workshop to revise the sector definition to include OOSY. Review the principles underpinning the policy and identify those that point to the need to include all children/learners in and out of school in the policy. Review the existing national and educational policies as well as international conventions and declarations to establish the urgency to address the needs of OOSY. Find and review research work to confirm the particular problems/needs of OOSY in terms of comparative risk and vulnerability. Identify organizations/ministries/NGOs working with OOSY to present the case for inclusion. Publish the draft policy and open it for public comment and input to ensure that this stakeholder group can make appropriate representation for inclusion.
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Documents Kelly, M.J. 2000. Planning for education in the context of HIV and AIDS. Fundamentals of Educational Planning, No. 66. Paris: IIEP-UNESCO. http://unesdoc.unesco.org/images/0012/001224/122405e.pdf UNAIDS Inter Agency Task Team on Education (IATT). 2003. HIV and AIDS and education: a strategic approach. Paris: IIEP-UNESCO. http://unesdoc.unesco.org/images/0012/001286/128657e.pdf UNAIDS. 2005. AIDS in Africa: Three scenarios to 2025. Geneva: UNAIDS. http://www.unaids.org/unaids_resources/images/AIDSScenarios/AIDSscenarios-2025_report_en.pdf Republic of Kenya. 2004. Education Sector Policy on HIV and AIDS. Republic of Namibia. 2003. National Education Sector Policy on HIV and AIDS. Republic of Zambia. 2005. National HIV and AIDS Workplace Policy for the Education Sector. www.mttaids.com/site/files/5562/Zambia_HIV_Policy_Nov04.pdf Tools and resources A number of intervention tools and resources are available for download on the MTT website (www.mttaids.com), they include: Rapid Appraisal Framework/Assessment TOR Data Analysis Criteria and HIV and AIDS Impact Indicators Policy Development Framework/Country Samples Prioritised Implementation Planning Templates Budget Planning & Implementation Costing Tools Partnership/Programme Database Template District Education Management & Monitoring Information Systems (DEMMIS) Monitoring and Evaluation Options Educator Mortality/Attrition Research Models & Templates Educator Demand & Supply Modelling
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Module
R. Smart
HIV/AIDS management structures in education
2.2
About the author

Module 2.2
HIV/AIDS MANAGEMENT STRUCTURES IN EDUCATION
Table of contents
Questions for reflection Introductory remarks 1. HIV/AIDS management unit (HAMU) 2. HIV and AIDS committee Members and memoranda 3. Other education sector structures with potential AIDS-related roles Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 49 50 52 59 60 62 64 65 66 67
MODULE 2.2: HIV/AIDS management structures in education
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Aims
The aim of the module is to enable you to describe the roles, composition and functions of different HIV and AIDS management structures within an education sector.
Objectives
At the end of the module, you should be able to: describe the different education sector structures with AIDS-related responsibilities; define the terms of reference for a national education sector HIV and AIDS management unit; analyze the different options for placement of the unit; identify typical barriers faced by many HIV and AIDS management units; discuss the mechanisms and processes institutionalizing the different structures; for formalizing and
discuss the mechanisms and processes for formalizing and institutionalizing inter- and intra-sectoral HIV and AIDS co-ordination and communication; describe a capacity audit to inform a skills development plan for the members of an HIV and AIDS management structure; propose the composition and functions of a sub-national HIV and AIDS management structure.
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Before you begin

Take a few moments to think about the questions below, make a note of your ideas and answers in the spaces provided. As you work through the module, see how your responses compare to those put forward by the author. Why is it necessary to have an HIV and AIDS management structure, or structures, within a ministry of education?
What are the options for placement of the unit; e.g. in human resources (HR), in policy and planning, or in an employee assistance programme (EAP), etc.?
In light of the placement options, what is the optimal profile of the person to head the structure? Should this be a dedicated or part-time position? Why?
What processes are necessary to formally establish an HIV and AIDS management structure?
What links should a national HIV and AIDS management unit have with other structures, and what partnerships should it form to fulfil its functions?
What are the critical skills that members of an HIV and AIDS management unit require in order for them to operate optimally?
What are the different or additional functions of an HIV and AIDS management structure at sub-national and school levels?
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Module 2.2
HIV/AIDS MANAGEMENT STRUCTURES IN EDUCATION
The module covers the structures that should be in place to facilitate an AIDS response the policies, plans, procedures and programmes in an education sector. For the purpose of the module an important distinction is made between an internal HIV and AIDS structure comprising education sector officials, which is referred to as an HIV and AIDS management unit (HAMU), and a broader consultative body that includes both education sector officials and other stakeholders, referred to as an HIV and AIDS committee. In different contexts these bodies will have different names, such as AIDS Control Unit (Kenya), Multisectoral HIV/AIDS Committee (Botswana), Education AIDS Steering Committee (Ghana) and so on. Experiences from many countries have confirmed the need to establish HIV and AIDS management structures to direct, guide and monitor the education sectors AIDS response. However the form taken by these structures varies considerably from one situation to another, as well as at national and sub-national levels. So, whilst the module proposes two types of structure, these structures may not always be consistent with the models chosen by education sectors in different countries. When discussing the functions of HIV and AIDS management structures, reference will be made to internal functions, referring to functions related to the sector as a workplace and employer, and external functions, referring to AIDS-related activities and programmes that are linked to the core responsibilities of the education sector, namely to fulfil the educational needs of citizens and the human resource requirements of a countrys economy. Both internal and external functions are important foci for an HIV and AIDS management structure, and both need to be adequately represented within the terms of reference of such structures.
External AIDS response refers to those elements of a comprehensive response that are linked to the core functions of education and that focus on beneficiaries (like pupils), partners and education sector communities (like school communities). Internal AIDS response refers to those elements of a comprehensive response that are linked to the sectors role as an employer and as a workplace. The focus therefore will be on staff managerial, teaching, and administrative and support staff.
MODULE 2: The Challenge to Education
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Box 1
Extract from MTT concept paper
The HIV/AIDS management unit must become the Ministrys Joint Operational Command Centre in the fight against HIV/AIDS and have somewhat exceptional powers and mandates to effectively play this role" (Badcock-Walters, 2001: 5).
Box 2
Example of HIV and AIDS management structures the institutional arrangements at national level in Botswana
1. A Multi-sectoral HIV/AIDS Committee The committee has specific tasks. Provide overall guidance and administration of the Ministry of Education (MoE) HIV/AIDS response strategy. Provide the necessary structure and resources that will ensure efficient, quick and comprehensive implementation of the MoE HIV/AIDS response strategy. Ensure that activities proposed in the strategy documents are undertaken as per the proposed workplan. Oversee the consolidation and co-ordination of the strategic plan and ensure consistency in its implementation. Provide necessary guidance/assistance to any HIV/AIDS consultancies that are taking place in the sector, including the organization of meetings for the dissemination of the outputs of the consultancies. 2. An HIV/AIDS Co-ordination Unit 3. Two MoE technical committees, one comprising heads of departments, the other consisting of departmental representatives. The technical committees have specific tasks. Advocate for mainstreaming of HIV/AIDS within the activities of the ministry. Develop guidelines for MoE HIV/AIDS policy implementation in all departments and divisions/institutions. Develop HIV/AIDS education campaign programmes for institutions and workplaces. Co-ordinate the establishment and training of HIV/AIDS peer educators. Co-ordinate the implementation of HIV/AIDS campaigns and programmes to ensure effective participation at all levels. Advise the co-ordinating committee on policy matters related to HIV/AIDS. Prepare quarterly HIV/AIDS departmental progress reports. Identify and mobilize resources required for the MoE HIV/AIDS programme. Collaborate with the national AIDS co-ordinating agency (NACA) and other partners in HIV/AIDS prevention, care and advocacy. Monitor the execution of and provide guidelines for consultancies on studies that may be required for MoE HIV/AIDS activities. Monitor and evaluate the progress and impact of HIV/AIDS activities in the MoE departments/divisions and institutions.
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1.
HIV/AIDS management unit (HAMU)

As described above, the optimal scenario for an education sector is to have an operational unit of education sector officials the HIV and AIDS management unit and a broader, representative stakeholder consultative and advisory body the HIV and AIDS committee. Each is dealt with separately below. The structure, placement and functions of this unit will largely determine its success or lack of success. Key factors in this regard will be: clearly defined mandates, roles, responsibilities and functions; the involvement of key role players; clear lines of communication and accountability; a well developed, disseminated and budgeted plan; and active and visible involvement of leadership and management in a range of prevention, care and support, and rights activities. The functions of an education sector HAMU could include: policy development; advocacy; co-ordination; fostering partnerships and linkages; information dissemination and exchange; communication, liaison and networking; planning; resource mobilization; facilitation and/or implementation of programme activities; technical support (e.g. to the districts); advisory; reporting; and monitoring. The unit should include officials with the following portfolios: Those who will be involved in the development, implementation, and monitoring and evaluation of the ministrys AIDS policy and programme. Senior management. Representatives from all divisions within the ministry, and, where possible, from different geographic areas as well. Special interest groups, such as trade unions, women groups and people living with HIV. People who have the relevant skills that the AIDS programme requires.
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Ideally the unit should be staffed with a number of dedicated positions; however this tends to be the exception rather than the rule. More often the unit is headed by a full-time co-ordinator with most, if not all, of the other members having other functions in addition to their AIDS-related ones. This situation requires that the co-ordinator have seniority, a clearly defined mandate and multiple skills, as well as a solid AIDS background if s/he is to make such a structure functional. His/her skills should include: advocacy, networking and co-ordination; leadership qualities, and credibility with key sectors and stakeholders; project management and planning skills including HR and financial management experience; good inter-personal, negotiation, facilitation and communication skills; fund-raising or resource mobilization experience; good organizational abilities; and report writing skills, and monitoring and evaluation experience. A HAMU will usually have both internal and external functions, and so will require the involvement of officials who can lead on each of the following: Policy development; Planning; Workplace HIV prevention, and treatment, care and support; Employee assistance programmes; Occupational health and safety; Curriculum development; Human resources; Management of an education management information system (EMIS) and other data; Special programmes; Labour relations. Measures or indicators of the success of a HAMU may be: an AIDS management system established; a workplace prevention, treatment, care and support programme designed and implemented; analysis of data; common milestones and implementation indicators identified; roles of staff comprising the unit assigned in writing; a permanent secretariat established; mechanisms in place for timely technical support (to districts); and agreed guidelines on various aspects of an education sector AIDS response for use by districts.
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Activity 1
Establishing (or strengthening) a HAMU Develop a submission to management for either the establishment of a HAMU within your national ministry of education or the strengthening of an existing HAMU. Use the following headings in the submission. Purpose (of the submission)
Background
Motivation
Implications (policy, HR and financial)
Recommendation
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Box 3
Extract from the Ministry of Education (Ghana) Workplan for addressing HIV prevention
INTERVENTION AREA 4: DECENTRALIZED IMPLEMENTATION AND INSTITUTIONAL ARRANGEMENTS Objective: To establish a strong and functional education sector institutional mechanisms for development, implementation and coordination of HIV/AIDS interventions at national, regional, district and community levels Strategy: 4.1.0 Strengthening the institutional capacity of education sector to effectively and efficiently manage education sector HIV/AIDS responses at the national, regional and district levels Activities: 4.1.1 Create office space at the national, regional and district levels. 4.1.2 Establish HIV/AIDS desks and appoint HIV/AIDS focal officers at the national, regional and district levels. 4.1.3 Recruit Technical Coordinator (for 12 months), one National Coordinator, Project Officers and Support Staff. 4.1.4 Procure equipment and logistical materials to strengthen the capacity of National, regional and district level HIV/AIDS focal offices to implement, monitor and evaluate HIV/AIDS interventions (Vehicles, Computers). 4.1.5 Establish and sustain operations of Education AIDS Steering Committees at the national, regional and district levels. 4.1.6 Conduct orientation workshops/seminars on the implementation modalities of HIV/AIDS interventions in the education sector. 4.1.7 Identify and prepare an inventory of Education sector partners (including public, private NGOs, FBOs, CBOs) active in responding to the HIV/AIDS epidemic at the national, district and community levels. 4.1.8 Conduct a two-day integrated planning meetings with Partners. 4.1.9 Develop operational guidelines/manuals for partners responding to the HIV/AIDS epidemic at the district and school levels. 4.1.10 Establish school-community liaison groups to strengthen partnerships between schools and communities. 4.1.11 Develop HIV/AIDS education networks at district level in collaboration with District Response Initiative. 4.1.12 Establish AIDS resource centers in schools to be accessed by education sector population (staff, pupils, students, workers) and communities. 4.1.13 Mobilize resources to for implementation of Education Sector HIV/AIDS responses at the national, regional and district levels. 4.1.14 Establish HIV/AIDS and Education Sector Web site as well as a Documentation Center. 4.1.15 Organize resources to attend short courses for Coordinators.
Source: MoE (Ghana), 2000: 8
As indicated in the above example it is critically important to build into strategic and operational plans the establishment and maintenance of HIV and AIDS management structures.
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Activity 2
Provision for a HAMU in annual operational plans 1. Develop an objective that could be one of the objectives in the annual operational plan of your ministry and that clearly states the desired outcome in terms of a permanent, functional HAMU. 2. Then, using a simple workplan template (see below), develop a workplan for one year that relates to the submission done as activity one. The workplan could therefore be for (a) the establishment or (b) the strengthening of a HAMU. ACTIVITY TIMEFRAME RESPONSIBLE PERSON/UNIT OUTPUT OUTCOME OR BUDGET
3. Ensure that the workplan also includes any process steps to institutionalize or formalize the HAMU and any activities related to the co-ordination and communication roles of the structure, both within the ministry and beyond (intra- and inter-sectoral).
A HAMU will function better if the staff that comprise it are appropriately skilled. It may therefore be useful to conduct a capacity audit and to use the results as the basis for a skills development plan. Areas to be tested may include: basic knowledge of HIV, AIDS and other sexually transmitted infections (STIs); in-depth knowledge about selected aspects, like voluntary (HIV) counselling and testing (VCT), highly active antiretroviral therapy (HAART), legal and human rights issues; attitudes towards people living with HIV, homosexuality and men who have sex with men (MSM), etc.; communication, networking and advocacy skills; project management, including financial controls, and budgeting skills; understanding of research and of legal issues; monitoring and evaluation; and knowledge of referrals to health and social services.
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There are many potential barriers to the establishment and functioning of an effective HAMU, such as: no provision at policy level for its establishment; denial, at all levels of the need for an additional structure; no common vision of what needs to be done; a lack of commitment from top management and/or unions to be involved; the lack of a uniform approach by management and organized labour; apathy from employees and lack of involvement in the activities of the AIDS programme; inappropriate attitudes, particularly to people living with HIV; for members of the HAMU, competing demands on their time the AIDS portfolio is just one of many; the lack of a formal mandate for the AIDS work that the members are expected to do; AIDS is not part of their job description or a key performance area against which their performance will be evaluated; inadequate resources (financial and material) for AIDS-related activities; inability to design and/or implement a comprehensive workplace HIV and AIDS programme; and inadequate information about supportive community services. Box 4 Extract from Education Sector Policy on HIV and AIDS (Kenya)
Role of the AIDS control units (ACUs) The education sector commits itself to establishing well-staffed, strong and sustainable ACUs at all levels of the education and training system. ACUs at all levels of the system need to be accountable and responsive to the needs of learners, employers, stakeholders and other staff in the sector.
Source: Republic of Kenya, 2004.
It is important to identify potential barriers to the establishment of and HAMU, and to develop strategies to address these, in a proactive way. Typically the HAMU at national level will be replicated in some form at provincial/regional/district level and at school level. The process of establishing such sub-national structures creates ownership and commitment, and whilst some uniformity is desirable, flexibility is also important. The process may include some or all of the following steps: Consulting the national policy; Consulting any existing guidelines; Consulting with stakeholders at different sub-national levels; Considering existing structures;
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Identifying stakeholders and organizations to be represented; Mobilizing resources (human, material and financial as required); Defining terms of reference; Identifying the capacity needs of members. Box 5 Example of terms of reference for an AIDS co-ordinator at school level (from Botswana)
Under the supervision of the Head of Pastoral, the HIV/AIDS Co-ordinator will co-ordinate, lead, direct and guide HIV/AIDS national responses at a school level. Oversee implementation of all HIV/AIDS-related activities including health issues at a school level. Establish and chair the School HIV/AIDS Committee. Be responsible for the School Health Programme. Design and facilitate the development of rights-based, gender and cultural school-based HIV/AIDS projects/programmes. Develop a school-based HIV/AIDS action plan in line with the ministry's strategic plan for teachers, students and all employees in the school. Monitor and evaluate the effectiveness of school-based projects/programmes. Build a resource on HIV/AIDS-related and health materials for use by the school population. Liaise with partners and stakeholders involved in the fight against HIV/AIDS. Submit reports to the Chief Education Officer at the Regional Office or as required. Represent the school in various HIV/AIDS forums at local and national level.
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2.
HIV and AIDS committee

An education sector HIV and AIDS committee has a distinctly different role to the HAMU, but each should complement the other. Box 6 Example of an HIV and AIDS advisory committee
Extract from the National policy on HIV/AIDS for the education sector, Ministry of Basic Education, Sport and Culture and Ministry of Higher Education, Training and Employment Creation (Namibia) HIV/AIDS Advisory Committee and implementation plans Each educational institution should establish its own HIV/AIDS Advisory Committee as a committee of the governing body. The HIV/AIDS Advisory Committee should: be set up by the governing body and consist of representatives of: o education sector employees; o parents or caregivers of learners or students at the institution; o Learners or students; o Local medical, health care and social services practitioners; o Traditional healers; o The local Regional AIDS Committee for Education (RACE); and o The support and counselling services. elect its own chairperson; advise the governing body on all matters relating to HIV/AIDS; be responsible for developing and promoting a plan for the implementation of this policy at the educational institution, and monitor, evaluate and review the plan and its implementation from time to time, especially as new scientific and medical knowledge about HIV/AIDS becomes available; advise and be consulted on provisions relating to the prevention of HIV transmission in the Code of Conduct.
Source: Republic of Namibia, 2003.
An HIV and AIDS committee should be member-owned, with a clearly stated commitment to shared objectives and means of action. The structure should be jointly developed, with shared responsibility and shared action; it should be representative, involving all relevant stakeholders, including people living with HIV. The structure of the HIV and AIDS committee will be defined by what work needs to be done; what groups (or sub-committees) need to be formed to do the work; what the roles and responsibilities are of these groups; how the groups will govern themselves; and how communication will take place between the various groups and other education sector structures.
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Members and memoranda

In identifying key constituencies to be represented on the HIV and AIDS committee, start with all the constituencies that are present on other education sector bodies, and then consider what additional constituencies with AIDS-related roles and responsibilities should be represented. It may be useful to define what is expected of members by means of a memorandum of understanding that states the organization's commitment to the goals, objectives and activities of the committee; what the organization expects in return for its participation in the committee; how much time the organization's representative can commit; and the level and kind of resources that the organization can contribute (funds, in-kind contributions, volunteer time, expertise, etc.). The overarching role or purpose of the HIV and AIDS committee is likely to be to support the education sector AIDS response. Individual functions may include a number of the following: Enable role players to interact and build alliances. Promote co-operation and collaboration. Co-ordinate advocacy action on matters identified by members. Mobilize capacities for HIV prevention, care and support. Identify emerging issues and appropriate responses. Generate and share information, and maintain essential communications. Provide both formal and informal opportunities for enhancing the skills of members. Assess progress being made and identify problems needing to be addressed.
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Box 7
Example of the terms of reference of an HIV and AIDS committee
Extract from working document, Department of Education, Eastern Cape Province, South Africa The functions of the HIV/AIDS Co-ordinating Committee shall complement those of the HIV/AIDS Unit. The HIV/AIDS Co-ordinating Committee is NOT an implementing body. Its functions will be as follows. Advocacy Support the role of the HIV/AIDS Unit with advocacy Provide a focal point for advocacy across the department and within the education sector in the province Co-ordination Co-ordinate the initiation and delivery of activities Provide senior management with a single point of contact with all focal point officers on HIV/AIDS Enable greater integration/mainstreaming of prevention, management and mitigation interventions Communication Provide a regular link with districts and allow for two-way feedback on policy and implementation issues Communicate with stakeholders in association with the Communications Unit Facilitation Facilitate information sharing Facilitate resource sharing Facilitate management level decision-making on programmes Advisory Advise senior management on provincial HIV/AIDS issues in general and specifically within the education sector Support the role of the HIV/AIDS Unit with strategic advice Provide senior management with current information on programme implementation Monitoring and reporting Monitor and report on a departmental strategic plan/workplan on HIV/AIDS
Outputs or measures of the success of the HIV and AIDS committee may be mutually acceptable working arrangements, agreed plans, and mechanisms for including diverse and non-traditional partners.
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3.
Other education sector structures with potential AIDS-related roles

Too often the existence of a HAMU and/or an HIV and AIDS committee is seen as absolving all other standing and statutory education sector bodies of any responsibility in this area. It is however feasible and practical to consider amending the scope of these bodies to include AIDS-related roles, particularly in those areas where in the body has influence or a mandate to operate. These bodies include: political or parliamentary bodies and committees; national structures on topics such as curriculum development, guidance and counselling, and teacher training; forums that bring together representatives from regional or district level as well as development partners and other stakeholders; teacher service commissions, teacher unions and student representative bodies; and school governing boards or parent teacher associations at school level. Box 8 Example of AIDS-related functions assigned to structures
Extract from the Ministry of Education and Sports (MoES) Uganda HIV/AIDS Action Plan 2003/6 (draft 2003). Objective 9: To promote joint planning, co-ordination, monitoring and evaluation of HIV/AIDS activities in the education sector. Outcome 9: A functional committee and defined mechanisms for joint planning, co-ordination, monitoring and evaluation of HIV/AIDS activities in the education sector. Motivation: MoEs will use the HIV/AIDS Committee and its Task Teams with the support of full time advisors to create stronger programme development and management capacity within the sector.
Source: MoES (Uganda), 2003.
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Activity 3
Terms of reference for an education sector HIV and AIDS committee Draft the terms of reference for an HIV and AIDS committee that will support your ministrys AIDS response, using the following headings: Name of the structure Mandate or goal Guiding principles Accountability Membership and representation Functions and/or responsibilities Modus operandi (quorum, frequency of meetings, secretariat, etc.) Operating budget
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Summary remarks
The AIDS epidemic represents an extraordinary challenge to education sectors across Africa. Whilst many aspects of a comprehensive and holistic AIDS response can emerge from the traditional functions of the sector, having a strong institutional framework to direct and guide the response is necessary. The form that this institutional framework will take will vary from country to country, but it is likely to consist of both an operational type of structure (referred to as the HIV and AIDS management unit) and a more consultative body (referred to as the HIV and AIDS committee). The module has explored aspects of these two bodies, with practical exercises that allow for better understanding of such structures within different countries and contexts.
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Lessons learned
Lesson One There are opportunities to mainstream AIDS into the functions of existing education sector structures. However, because of the seriousness of the epidemic it is imperative to create dedicated HIV and AIDS structures. It is optimal to have a structure within a ministry of education, consisting of education sector officials and with a clear mandate to direct the ministrys AIDS response (an HIV and AIDS management unit). Another consultative body should include other stakeholders (an HIV and AIDS committee). Lesson Two The placement of an HIV and AIDS management unit, its terms of reference and methods of co-ordinating and communicating within and outside of the ministry are critical decisions that will affect (positively or negatively) the units operations. Lesson Three Investing in building the capacity of those participating in HIV and AIDS management structures will pay dividends. Lesson Four Creating multiple layers of HIV and AIDS management structures at national, district and school levels is time consuming and requires human resources, but it will have long-term benefits, particularly as much of an education sectors AIDS response must be delivered at local level. Lesson Five All processes related to establishing and maintaining HIV and AIDS management structures should be included in routine education sector policy, planning and monitoring processes.
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Activity 1 Refer to the section HIV and AIDS management unit for information to include or adapt for the submission. Activity 2 Below is an example of what might appear in an annual operational plan. Objective: A well-staffed, strong and sustainable HIV and AIDS management unit established within the national ministry of education
Activity Task team set up with mandate to investigate options and develop a concept paper on the HIV and AIDS management unit Concept paper submitted to Management Committee for approval Human resource implications of the unit actioned such as position created and advertised, job description written, etc. Interview panel established and interviews held Head of unit appointed and inducted Timeframe Responsible person/unit Output/Outcome Budget
Activity 3 Refer to the Botswana (Box 5) and Eastern Cape (Box 7) examples for information that could be used in developing the terms of reference.
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Documents Badcock-Walters, P. 2001. Role, function and options for the establishment of an HIV/AIDS Management Unit in the Namibian Basic and Higher Education Systems. HEARD, University of Natal: MTT. IFC; Golder. 2004. HIV/AIDS guide for the mining sector. www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/ref_HIVAIDS_section1/$FILE /Section+1b.pdf ICASO. 1997. HIV/AIDS Networking Guide. Toronto: ICASO. www.icaso.org/publications/NetworkingGuide_EN.pdf ILO. 2002. Implementing the ILO Code of Practice on HIV/AIDS and the world of work (2002). Geneva: ILO. MoE (Ghana). 2000. Workplan for addressing HIV/AIDS prevention. Accra: MoE. MoES (Uganda). 2003. HIV/AIDS Action Plan 2003/6 (draft 2003). Unpublished. Rau, B. 2004. HIV/AIDS and the public sector workforce: an action guide for managers. Arlington: FHI. http://info.worldbank.org/etools/docs/library/134438/ALGAF/Algaf_cd/algaf _docs/Resources/AIDS%20and%20the%20Public%20Sector%20Workforce%2 0(2003).pdf Republic of Kenya. 2004. Education sector policy on HIV and AIDS. Republic of Namibia. 2003. National policy on HIV and AIDS for the education sector. Namibia: MoBESC; MoHETEC. Republic of Zambia. 2005. National HIV/AIDS Workplace Policy for the Education Sector. www.mttaids.com/site/files/5562/Zambia_HIV_Policy_Nov04.pdf
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Module
D. Chetty
HIV/AIDS in the educational workplace
2.3
About the author

Dhianaraj Chetty is an independent consultant, specializing in education planning and higher education management and has been involved in the design and development of national and international HIV and AIDS responses in the higher education sub-sector. He is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Module 2.3
HIV/AIDS IN THE EDUCATIONAL WORKPLACE
Table of contents
Questions for reflection Introductory remarks 1. Policy What types of policies can exist in the education sector? Education sector HIV and AIDS policies Institution specific/human resources (HR) policies 2. Workplace policy on HIV and AIDS What is a workplace policy on HIV and AIDS? Why does an organization need an HIV and AIDS workplace policy? 3. Policy development Conceptual framework for policy development Policy components Mainstreaming Cross-cutting issues Implementation Practices that continue to work against the spirit of the policy 4. Programmes Content and management of a workplace programme Key considerations/components for developing and implementing a successful HIV and AIDS-in-the-workplace programme 5. Human resources planning and development Human resources management capacity and confidence Deployment, recruitment, appointment and transfers Human resources management monitoring of absenteeism and ill-health 107 Analysis of job descriptions Strengthening information systems and information exchange Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 2.3: HIV/AIDS in the educational workplace
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Aims
The aim of the module is to: enable users and trainees to develop an understanding of the role of workplace policy as a response to HIV and AIDS in the education sector; facilitate the design and establishment of appropriate workplace programmes, as well as explain how to assess their progress.
Objectives
At the end of the module, participants will be able to: identify the connections between education sector policies on HIV and AIDS, national policy on HIV and AIDS, institutional policies on HIV and AIDS and the other policy or regulatory procedures that affect the world of work; design and implement an HIV and AIDS in the workplace policy process relevant to their own context; distinguish between a workplace policy and a workplace programme; facilitate the establishment of a workplace programme.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. How has your organization addressed the issue of HIV and AIDS on the workplace? Can you think of possible impacts on staff?
What is the difference between a workplace policy and an institutional policy? What role can they play in the response to HIV and AIDS in your institution?
How are workplace policies related to workplace programmes? How do they differ? Does an organization need one of each? Why or why not?
Why is it important to have an HIV and AIDS-in-the-workplace programme?
What kinds of HIV and AIDS-in-the-workplace programmes can ministries of education and educational institutions realistically implement? What are the priority needs that should and can be addressed?
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Module 2.3
HIV/AIDS IN THE EDUCATIONAL WORKPLACE
The education sector is the largest public sector employer in most countries. While there is some debate about levels of HIV infection and HIV-related attrition among education sector employees, it is widely accepted that HIV is a serious threat to the health of many employees in this sector in many countries. One way of addressing this controversy is by allowing institutions to take a position on the subject and taking action to reinforce that position. An HIV and AIDS workplace policy enables an institution, an organization, or a ministry to make a statement about its role in protecting the legal rights of its employees and diminishing the impact of HIV and AIDS within the workplace. This module will examine the linkages between education sector policies on HIV and AIDS, national policy on HIV and AIDS, institutional policies on HIV and AIDS and the other policy or regulatory procedures that affect the world of work. The module will highlight the importance of linkages to wider human resources policies within government and propose a range of options for developing HIV and AIDS workplace policies and programmes The module will also examine (a) the rationale for a workplace policy; (b) the rights and obligations inherent in the policy; (c) the process of developing a workplace policy; and (d) the roles and responsibilities of all stakeholders. Using selected examples, the module will discuss the key components of a workplace policy. As an exercise, learners will be expected to outline a workplace policy process relevant to their own context. The module provides an overview of the various components of a workplace programme, and then looks in more detail at components of prevention and impact mitigation strategies.
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1.
Policy
What types of policies can exist in the education sector?
Policy has different meanings and authority depending on the context. Policy may refer to the following: a document approved by the permanent secretary or director general of a ministry; a document approved specifically by parliament or a legislative authority and formally known as an act or statute; a document known as standing orders, administrative circular or guidelines issued by a line department of the national ministry. A workplace policy can take the form of any of these provided that it carries the support of social partners in the sector, especially trade unions and other employee organizations. Where they exist, education sector policies on HIV and AIDS have integrated a range of workplace-related issues. Typically, they cover protection from discrimination and stigma, fair labour practices, establish and promote confidentiality and reasonable accommodation. Why then is it necessary to have a workplace policy as a stand-alone instrument? The answer to this question and the options available to education sector managers and employees are examined in the next section. For the purposes of this module, there are four main types of HIV and AIDS policies that need to be presented for clarity. These are the national HIV and AIDS policy, the education sector HIV and AIDS policy, an institutional policy and a workplace policy. National HIV and AIDS policy: This provides a framework for leadership and co-ordination of the National multisectoral response to the HIV and AIDS epidemics. This includes formulation, by all sectors, of appropriate interventions in order to prevent transmission of HIV and other sexually transmitted infections (STIs), protect and support vulnerable groups, and mitigate the social and economic impact of HIV and AIDS. It also provides for the framework for strengthening the capacity of institutions, communities and individuals in all sectors to arrest the spread of the epidemic. Education sector policy: The Education Sector Policy on HIV and AIDS formalizes the rights and responsibilities of every person involved, directly or indirectly, in the education sector with regard to HIV and AIDS: the learners, their parents and caregivers, educators, managers, administrators, support staff and the civil society. Institution specific/human resources policy: (sometimes a HR policy): A policy that defines an institution's position with respect to HIV and AIDS prevention and management. It establishes who will do what within the institution and why. Workplace policy: A guiding statement of principles and intent taking into account all staff and personnel of an institution. This can often be part of the larger institutional policy.
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Let us now look briefly at these types of policies, specifically those that fall within the education sector.
Education sector HIV and AIDS policies

The response to HIV and AIDS in the education sector has for the past decade or more been focussed on two objectives: (1) making the sector aware at all levels of the impacts the epidemic is having and will have on the supply of and demand for education and the quality of education; (2) ensuring that learners are provided with the knowledge, skills and values they need to understand the threat of HIV and AIDS and to cope with living in an AIDS-affected world. More recently attention has turned towards mitigation and management of the epidemic, particularly in countries where a generalized epidemic has placed increased strain on already fragile education systems. In the realm of management, developing capacity and the tools to manage the epidemic are an equally high priority. Education sector HIV and AIDS policies have been recognized as an increasingly effective tool as part of a comprehensive response. Sector level policies, which are treated in Module 2.1 Developing and implementing HIV/AIDS policy in education, are now in existence in Kenya, Uganda, Zambia, South Africa, Namibia and a number of other countries. Education sector policies on HIV and AIDS have usually been designed to be consistent with the policy frameworks at country level and international conventions. Of these national policy frameworks, the National Policy/Strategy on HIV and AIDS, often driven by the ministry of health or the national AIDS commission, provides the umbrella for all other interventions. Where multi-sectoral responses have been well implemented, specific attention has been given to the management of HIV and AIDS in the public sector more generally. Criticism has been levelled at the public sector for the slowness with which governments have recognized the threat to both individuals and systems within the public sector. With a few exceptions, teachers the largest component of public sector employees in most developing countries have received little, if any, attention. In contrast, enterprises in the private sector have taken a much more pro-active stance in assessing the risks, the impacts of the epidemic, and management interventions in the workplace. Though the context differs, organizations in the private sector have a lot to offer by way of experience in developing workplace policy and programmes.
Institution specific/human resources (HR) policies

Education sector workplaces are often subject to multiple legal provisions. For example, teachers in Kenya are employed by the national ministry but are also governed by the Teacher Service Commission, a statutory body that manages recruitment, selection and disciplinary matters. In South Africa, teachers are employed under specific legislation that is distinct from non-teaching personnel, who are mainstream public sector employees. Furthermore, teachers conditions of
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service are set at a national level, but the employer is a provincial government. In most education systems, semi-autonomous institutions such as universities, training institutes or statutory bodies also tend to have institution-specific terms and conditions of service. In Uganda, primary school teachers are appointed and managed by district authorities, not the national ministry. These differing institutional arrangements have an immediate bearing on how roles and responsibilities are allocated within the broader structure of the entire organization.
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2.
Workplace policy on HIV and AIDS

What is a workplace policy on HIV and AIDS?
Like any policy, a workplace policy on HIV and AIDS should be understood as a guiding statement of principles and intent. The policy defines an organizations approach to HIV and AIDS and clearly maps out the way(s) in which the organization will deal with the epidemic in the workplace and how it affects personnel. Like other organizational policies, a workplace HIV and AIDS policy must be an integral part of the organizations HIV and AIDS management system, informing the continuous process of planning, implementing, reviewing and improving the processes and actions required to meet the policy goals and targets. In this light, workplace policies will overlap with some of the above-mentioned policies. Certain aspects of workplace policy on HIV and AIDS will also overlap with codes of conduct and ethics that govern the professional standards of behaviour and practice of teachers and other employers. These codes of conduct are increasingly important in managing cases of misconduct, including sexual abuse of learners, rape, harassment or other behaviours that may increase the risk of HIV infection amongst children and other employees. In practice, most of these allegations should be referred to the criminal justice authorities as a criminal matter. At the same time, ethical standards within the profession may result in a teacher being subjected to a disciplinary process or possibly disbarred from further employment if found guilty.
Why does an organization need an HIV and AIDS workplace policy?

It sends a clear message that HIV and AIDS constitute a serious workplace issue and that there is a high level commitment to dealing with it. It provides guidance to managers and all stakeholders. It provides a set of standards for practice and guidelines for all interventions in the workplace. It sets out the organizations commitments in terms of financial and human resources. It protects rights and specifies the responsibilities of employers, employees, dependants and social partners in the workplace. It allocates responsibilities within the organization for the management of the epidemic and accountability for decision-making and resource allocation. It sets standards of ethical and social behaviour for everyone in the organization. It informs both affected and infected people of the resources and services available to them. It provides linkages to and consistency with other national policies and international conventions.
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It provides a framework within which external partners (NGOs, FBOs, donors) can operate effectively. It provides a framework within which all interventions can be monitored.
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Activity 1
Workplace policies in the education sector
Review the workplace section of the education sector HIV and AIDS policy developed by Kenya. Assess whether it is appropriate to the context of your own education system. You can access it on the UNESCO HIV/AIDS and Education Clearinghouse at the following website: UNESCO HIV and AIDS and Education Clearinghouse
What does the process of policy development entail?

There is no hard and fast template for policy development for the education sector, and practices differ across education systems. Box 1, which covers curriculum, workplace, and a range of others issues, can give you practical insights.
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Box 1
The Kenyan experience of developing and education sector policy on HIV and AIDS
In late 2003, the Mobile Task Team (MTT) worked alongside a core team of focal point officers at ministerial level and UNESCO to develop an education sector policy on HIV and AIDS that would integrate workplace issues. The process began with a stakeholder consultation and involved as many as possible of the key departments at ministerial level, officials representing other levels and sub-sectors of the system and institutions, plus a range of non-government stakeholders and partners. After an initial discussion and analysis of the major concerns related to HIV and AIDS in the education sector, working groups began by reviewing existing examples of education sector policies from elsewhere in Africa and a range of Kenya-specific data and policy-related information. All participants agreed on a set of core principles and then drafted an allocated section of the document. In this process, it is useful to assign participants with the appropriate expertise to deal with a particular section. As a result, curriculum specialists focused on prevention issues and union representatives and members of the Teacher Service Commission concentrated on workplace issues. Over the period of four-and-a-half days, each section of the document was reviewed and debated intensively until the ministry and other education stakeholders could reach a consensus on key issues. The resulting consultation document was then submitted to review and inputs from a further three stakeholder meetings at national level and finalized for adoption in 2004. The Kenyan model has a number of important outcomes aside from producing a readily usable consultation document. It helps to build a sense of cohesion around HIV and AIDS between departments, institutions and stakeholders who may be working together for the first time. It begins the process of clarifying roles and responsibilities in the sector. It builds capacity in understanding the education sector response and it provides an opportunity for mobilizing human and material support. Lastly, whilst the task may be unusual for some stakeholders, the sense of ownership of the policy document that the process inculcates is a major advantage.
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3.
Policy development
Conceptual framework for policy development
It is possible to define a generic conceptual framework for a policy development process if such a process does not exist in your organization or if it is necessary to prepare participants to better understand the process. The outline below comprises six steps that include the majority of the activities related to policy development. This framework can also be used in conjunction with the policy development and implementation processes outlined in Module 2.1, Developing and implementing HIV/AIDS policy on education. Step 1 Establish a policy task team Leadership on HIV and AIDS employer and employees Establish a task team Provide training to the team if necessary Risk assessment or situation analysis Draft the policy Assemble information and data to inform policy Establish consensus on the goals and principles and key areas Social dialogue Implement a consultation process Review the document and take new inputs Finalize the policy Define indicators for monitoring Define implementation strategy Policy implementation Launch the policy publicly Disseminate to all employees and other stakeholders Implement the policy Develop programmes Implement programmes Promote organizational and cultural change related to HIV and AIDS Promote partnerships and alliances Monitor the policy Track and report on indicators/evaluation Review when necessary
Step 2
Step 3
Step 4
Step 5
Step 6
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Policy components
The major headings and expected content in any workplace HIV and AIDS policy should include:
Introduction
Rationale for the policy; Context in which the policy is being developed.
Scope
Persons and institutions covered by the policy.

Goals and objectives
Statement on the organizations goals in its response to HIV and AIDS (e.g. reducing infections, improved care and support, etc.)
Principles
Statements on the rights that are inherent in the policy e.g. confidentiality, access to care, non-discrimination, etc. These statements are usually consistent with international conventions but may include specific provisions, such as a commitment to a multi-sectoral approach or poverty eradication. Greater involvement of people with AIDS (GIPA) and gender issues should be given specific attention.
Co-ordination and management structure
Outlines of the institutional arrangements that will govern, plan, manage and report on the organizations response to the epidemic.
Roles and responsibilities
Statements on the organizations expectations of the employer, employees, managers, trade unions and external partners.
HIV and AIDS and HR management
The organizations position on how it will address the following issues in the context of HIV and AIDS: Recruitment Selection Appointment Job security
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Voluntary HIV testing and counselling (VTC) Confidentiality and disclosure Protection against discrimination Employee benefits (housing, medical insurance, pensions, sick and compassionate leave entitlements) Access to training Incapacity and reasonable accommodation Grievance procedures Retirement
Options
If a comprehensive education sector policy or a public sector workplace policy on HIV and AIDS already exists, such a document should serve as a guide for the education sector workplace HIV and AIDS policy and for workplace programmes. In the absence of either alternative, even a simply formulated set of guidelines on HIV and AIDS in the workplace will lay the groundwork for a more sustained engagement with the key issues.
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Box 2 Key Questions Does an organization need policy before anything else? No. Organizations often decide to put in place a policy framework well after ad hoc initiatives have already taken root. For example, a trade union in the sector might partner with a local or international NGO to start a peer education project amongst teachers at local level. A member of staff with counselling skills who sees the need for psychosocial support may set up a support group. These initiatives should be welcomed and supported as long as they meet a felt need and are generally compliant with the ethics of working on HIV and AIDS. The absence of policy should not inhibit this kind of response. What the policy will do when it is in place is provide clear guidance and legitimacy for the continuance and development of these interventions and any others that follow. Does policy by itself solve the problem? No. Policy by itself is not an adequate response to the difficulties of responding to HIV and AIDS. It is a necessary and powerful tool that can be used to move an organization towards fundamental change. Creating a policy is not enough and too many policies are not backed by the necessary leadership, resources and commitment to make them a reality. Without such leadership there is a real danger of policy failure in the case of HIV and AIDS or any other initiative that requires fairly far-reaching changes in the way organizations behave towards employees and stakeholders. To counteract this risk, the built-in requirement of rigorous monitoring and a policy review will provide the critical feedback to judge whether the policy is reaching its objectives. Moreover, if your organization follows the norm of annual implementation planning, that process too should provide opportunities for adjusting the response accordingly.
Mainstreaming
In the case of workplace policy, mainstreaming HIV and AIDS issues into sector activities should flow from the strategies used in the development and implementation of the sector policy or similar initiatives elsewhere in the public sector. To a degree, addressing HIV and AIDS from a workplace perspective has the significant advantage of being universal, and policies from one sector can easily be adapted for use in the education sector. Unlike the nature of the teaching process, where the qualities of the individual count so heavily, the law applies the same standards to all employees and employers. In education, the challenge is to move managers, and employees too, to see education sector staff as people at risk and not merely as providers of a service.
Cross-cutting issues
The policy development process will highlight issues that need to be considered within each section of the document. In the education context, three issues have repeatedly been singled out as cross-cutting priorities: gender, GIPA and advocacy. HIV and AIDS have differential impacts on men and women, boys and girls in social, economic and physiological terms. In recognizing these differences, workplace policy development must take careful account of the gender dynamics and socio-economic status in the education context. For example, as primary caregivers in most families, women have to deal with various pressures that are time and energy consuming. The involvement of people living with HIV in the
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development process and implementation should be encouraged as early as possible. Organizations specifically representing teachers living with HIV are beginning to take root, and the perspectives they bring to the development process are critically important. Advocacy is the act of supporting or pleading a cause. In HIV and AIDS policy development, advocacy and leadership must be a component of all the core policy elements.
Implementation
Implementation is the real test of the policy in terms of the commitment that employees, the employer and social partners are willing to make. In education, the challenge will be to reach every workplace in communities that have widely differing social and cultural strengths and barriers. By far the most important success factor is the role of leadership, at all levels of the system and from all partners. School principals, head teachers, rectors and vice chancellors hold the keys to success at institutional level. Translating the policy into reality at regional, provincial, zone or district level requires leadership from managers, inspectors and the other senior officers who manage the delivery of education on a day-to-day basis. 1. Costs Policies entail a commitment of resources human, material and financial. In some systems, government will not approve a new policy unless it is costed and the financial implications have been accepted. In the education sector, it is important to note that many of the costly interventions and services that are needed are usually provided through the public health system, private or non-government providers. For example, in Senegal, non-government providers initiated most voluntary and confidential counselling and testing (VCCT) centres. Uganda too has a well-developed network of non-government providers of VCCT. In effect, the real challenge in education is to find ways to reduce the direct costs to the sector by using partnerships, referrals and existing programmes and services as effectively as possible. For example, the health sector should be the obvious source of information education communication (IEC) and behaviour change communication (BCC) materials and programmes. The human costs of the policy in terms of management time will be significant. If co-ordinators at head office or school level are not given the time to promote a workplace HIV and AIDS response and manage it accordingly, the objectives of the policy are undermined and there is an increased risk of policy failure. Given the size and scope of the education sector, it is often a challenge to find the funding necessary for a programme to adequately cover the sector. If funding for the entire sector is not available, this should not inhibit the development of smaller, localized or ad hoc projects, which can then be scaled up when more funding is found or can be made available.
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2. Dependants There is considerable debate about the extent to which employers have a responsibility towards the dependants of their employees in the context of HIV and AIDS. The issue has come to a head particularly in cases where antiretroviral (ARV) drug treatment is being provided to employees but not to their partners or spouses. It is also possible that the employee will have children who are infected. There is as yet no easy solution to this question, but new initiatives are emerging in the public sector that may set a precedent. For example, both Uganda and Zambia have a framework in place concerning the provision of treatment for public officers.
Practices that continue to work against the spirit of the policy

Despite the existence of the policy and formal commitment to its values and objectives, practices that work against the spirit of the policy often continue. Stigma and discrimination are an obvious example. (See Module 1.4, HIV/AIDS related stigma and discrimination). Despite two decades of awareness raising and education, stigma and discrimination against infected and affected people continues to be a concern in many societies. Job security is not assured and many people can be fired or let go due to their HIV status. As a social contract in the workplace, policies are fundamental to protect peoples rights. Care must be taken when implementing workplace policies and programmes that they adhere to the principles in the policy declarations as well as acknowledge and address stigma and discrimination when they arise.
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Activity 2
Implementing and adopting policy
As a manager at ministry level, you are responsible for ensuring that all levels and institutions in a district-based system of education adopt and implement the workplace policy on HIV and AIDS. In three pages, outline a strategy for adopting the policy. Develop your strategy. Include trade unions, people living with HIV and teachers as the priority groups in your strategy. You will present your plan to the permanent secretary or your supervisor (feel free to decide who might be the appropriate one). Your proposal should provide a brief assessment of the situation, the steps to be taken, and an outline of the human and financial implications for the ministry.
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4. Programmes
Content and management of a workplace programme
A distinction should be drawn between a workplace policy and a workplace programme. A workplace policy is a guiding statement of principles and intent. Policies also capture the legal rights and obligations of the stakeholders and role players. They may also outline modes of implementation. A workplace programme is a set of practical plans and systems for implementation. These plans generally follow on from policy development. Aspects of programmes may be developed before policy is finalized. Two broad objectives are served by HIV and AIDS-in-the-workplace programmes. 1. Creation of a supportive environment that promotes the wellbeing and rights of infected and affected employees, so that they are as healthy and productive as possible. Managing and reducing the effects of HIV and AIDS on sector or workplace function.
2.
Achieving the first objective is key to addressing objective two. If employees fear discrimination or do not expect support, they will seldom disclose their HIV-related problems, and this makes it more difficult to manage the effects of the problems. As part of a comprehensive response to HIV and AIDS within the organization, the workplace programme should address (1) prevention needs; and (2) treatment, care and support. In a low HIV prevalence environment, prevention, advocacy, awareness raising and reducing stigma are likely to be more important than care and support issues, while in a high HIV prevalence setting, the main focus of the workplace policy will be management of staff health, access to testing and counselling and care and treatment. With respect to policy, the organization is expected to outline its position and commitments in the following areas, including the listed topics:
Prevention
HIV and AIDS education (awareness raising, advocacy, peer education, training at all levels) Prevention services (condom distribution, prevention of mother-to-child transmission (PMTCT)) Voluntary (and confidential) counselling and testing (VCCT) Opportunistic infection management (Tuberculoses, etc.) Sexually transmitted infection (STI) management Workplace safety, accidental exposure and compensation
Treatment, care and support

Treatment awareness and education
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Access to treatment Home-based care (HBC) Antiretroviral therapy (ART) Post-exposure prophylaxis (PEP) Wellness management Counselling and other psycho-social support: employee assistance programmes Basic assistance Social support Referral mechanisms All education sector employees, including non-educators, ought to be covered by HIV and AIDS-in-the-workplace programmes. Programme design should also consider pre-service trainees. Apart from the direct benefits for employees and employers, workplace programmes can play an important role in equipping staff to contribute more effectively towards learner programmes. They can also contribute to national HIV and AIDS programme goals to prevent and mitigate the effects of the epidemic on society. As the education workforce is relatively skilled, empowered and part of an organized system, there are strong possibilities that workplace HIV and AIDS programmes can be effective.
Key considerations/components for developing and implementing a successful HIV and AIDS-in-the-workplace programme
Several general issues should be considered in workplace programme development. The scope and coverage of workplace programmes is a key question to be considered in planning ministry workplace programmes. Things to consider could be: Are all education sector employees to be covered by the workplace programmes? Groups that should not be overlooked include non-educator staff and senior or management staff. These groups should be made aware of their risks and also could give important support to the programme. Should pre-service trainees be covered by HIV and AIDS-in-theworkplace programmes? Even if they fall under separate higher education ministries or largely autonomous institutions, trainees and recent graduates, due to their age and circumstances, are often at very high risk of infection. Targeted interventions are needed to ensure that the design of the programme covers key groups and workplaces, and uses appropriate methods. Certain sector employees may be more at risk than others, or may be more difficult to replace if they become ill or die.
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Strong, visible leadership by senior management and political leaders tends to be key to successful workplace programmes. This should be actively cultivated as part of a programmes development if it does not already exist. Successful implementation of HIV and AIDS-in-the-workplace programmes also depends on buy-in from all key stakeholders. The design and implementation process of a workplace programme should be as inclusive as possible, incorporating inputs from all key stakeholders including unions and staff associations. Adequate structures and capacity will be important to ensure the success of the development and implementation of a workplace programme. The need for specific, dedicated HIV and AIDS programme staff with adequate skills must be considered. Active involvement of human resources and line managers is necessary to provide key expertise and authority, as well as skills to address areas such as human resource management and training issues. There is likely to be a need to prioritize interventions, even if resources and capacity are dedicated to the programme. The design and implementation of successful programmes must take cognisance of limited resources, capacity and skills, and of the challenges of implementing the full range of components of a comprehensive workplace programme. Programmes will therefore often have to start with a basic set of core interventions that can be extended in later phases of the programme. Prioritization should be planned and use appropriate criteria. Building of partnerships and referral networks is another determinant of success for workplace programmes, especially in resource-limited settings. These partnerships can help to ensure access to services and interventions that could otherwise not be delivered given the limitations on resources and expertise. An integrated approach to interventions is important for effectiveness, efficiency and sustainability. Different workplace components (e.g. prevention and care) often reinforce each other and increase success. Activities that can be linked to existing HR management and development interventions are more likely to be implemented and sustained. Involving people living with HIV in planning and implementation can add a lot of value and effectiveness to a programme, and can provide greater visibility for the issues and concerns of people living with HIV. Finally, community and family outreach should also be considered. Workplaces can provide resources and expertise to communities, and vice versa. Outreach can allow for a more holistic approach to prevention, care, support and treatment for employees, which are often affected by their home environment. Effective responses to families and communities needs have benefits for society and will also make employees feel more supported.
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Activity 3
Organizational HIV and AIDS audit Activity 3 below sets out the key components of an HIV and AIDS workplace programme to allow you to assess whether your ministry has them in place. The audit can be used as a quick reference guide of issues to be considered in planning a programme, or can be adapted to serve as a tool to monitor and manage your programme. (You may wish to refine this tool for use in planning and managing your own organizations HIV and AIDS programme.) HIV and AIDS audit Instructions: Use the following template to conduct a rapid HIV and AIDS audit to assess the response of your workplace or sector to HIV and AIDS workplace issues. In the Status column, rate current progress. 0 none 1 - Plan in place 2 - Partly implemented 3 Fully implemented 4 Evaluated and shown to work In the Action Required column, mark X where action is important and XX were action is a priority. 1. Identify three or four priority programme components in the table that you think need the most attention. If working with others, report these to other members in your group. As a group, prioritize the three or four most pressing or common issues and programme components identified by your members. These may include key gaps in information about your sectors workplace response that you need to fill.
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ACTIVITY 3: ORGANIZATIONAL HIV and AIDS AUDIT

GROUP: _______________________ 1. HIV and AIDS AUDIT TEMPLATE NAME: _________________________
PROGRAMME COMPONENT
BRIEF DESCRIPTION MANAGEMENT AND LEADERSHIP
STATUS
ACTION REQUIRED
Workplace HIV and AIDS policy HIV and AIDS co-ordinator(s) and structures Surveillance and impact assessment Plans and budget Leadership commitment Legal compliance and HR systems
Drafted; accepted; disseminated; review process in place? Appointed; adequate time allocated; appropriate committees in place? Assessment planned; partially done or complete; Ongoing monitoring of impact? In process; developed and costed; accepted and budgeted? Commitment at Board/top management level including formal budgeting, accountability? Policies reviewed for compliance; HR guidelines in line with policy? IMPACT MANAGEMENT Guidelines; training and support for managing HIV and AIDS issues? Critical vulnerabilities identified and covered by training or other responses? Effective management and monitoring? Medical and pension benefits reviewed; affordable but effective options in place?
Management guidance Skills and succession plans Ill-health and absenteeism management Employee benefits
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PROGRAMME COMPONENT
BRIEF DESCRIPTION WORKPLACE PREVENTION PROGRAMME
STATUS
ACTION REQUIRED
Prevention programme Peer education Condom promotion and distribution STI management VCT Universal precautions
KAPB monitored, reaches key targets e.g. managers, recruits, ongoing and varied awareness raising? Identified; trained; active; supported? Occur regularly; well monitored; female condom programme? STI treatment promoted; good access to services; STI rates monitored? Promoted regularly; counsellors and services available; uptake monitored? Guidelines, equipment and training provided? Post exposure prophylaxis available?
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TREATMENT, CARE AND SUPPORT Counselling and psychosocial support Home-based care Medical care ARV/HAART Positive living and nutrition Wellness/employee assistance programme
1. Partnerships 2. Community prevention, care, support
Access for employees in crisis and to prevent crises? Systematic referral and effective HBC available for terminally ill? Opportunistic infections treatment and prevention affordable and accessible? ARVs available; sustainable financing; referral and support systems in place? Sustained programme; nutrition supplements available? Effective; efficient; acceptable to employees?
OUTREACH/ EXTERNAL PROGRAMME Other public and private employers and services; communities; PLWA? Families and communities involved and supported? 1. 3. 2. 4.
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2. GAPS IDENTIFIED BY PARTICIPANT/GROUP The programme components in my organization that require the most action are:
________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

3. PRIORITY COMPONENTS IN ORGANIZATIONAL RESPONSE List below the programme components that you would prioritize in a workplace plan.
________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
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HIV prevention programme components and interventions in the education sector to be used in workplace programmes
Levels of HIV infection are often unclear and vary among countries and sites within countries. Accordingly, types of HIV risk situations faced by educators and other sector employees are also often unclear and varied. However, in the absence of better data, it should be assumed that educators face similar levels of risk to other adults in their communities. Risk of HIV infection among employees is influenced by factors such as their level of knowledge about HIV, their beliefs and attitudes towards risk, and their personal actions to reduce their exposure to risk. Home and community norms regarding sexual behaviour and gender also determine how vulnerable someone is to HIV infection. Importantly, staff may face structural/environmental risk, for instance when their work separates them from stable partners through placements far from home, or through travel. Factors such as educators status and opportunities for more sexual contacts, as well as concentration of teaching forces in urban areas also heighten the risk of infection. On the other hand, greater access to information and understanding about HIV and AIDS, as well as socio-economic stability and greater ability to act on knowledge reduces risk of infection. Workplace prevention programmes should ideally include several of the following components:
1. Awareness/information education communication/behaviour change communication
Behaviour change communication (BCC) seeks to promote and sustain behaviour change in specific groups and the population as a whole, using targeted messages and a variety of channels and the media. It aims to promote safer sexual behaviour, increase awareness and access to prevention-support mechanisms and care and treatment services; promote positive living among people living with HIV, and reduce stigma and discrimination. These activities can be delivered through a number of initiatives, such as training and social events, seminars, group discussions, theatre, videos, posters and pamphlets. Before implementing a BCC intervention, consider the following points that will influence the programmes success. Clearly identify target groups and target situations. Adapt approaches according to the cultures, beliefs, languages and educational levels of target groups to ensure they are appropriate and acceptable. Deliver positive messages. BCC should aim to be optimistic and highlight the benefits of HIV awareness and safety as well as living positively with HIV. Avoid moral lessons and scare tactics. In order for BCC to work, people must feel empowered to take positive actions to protect themselves, and not feel embarrassed, ashamed or singled out by certain actions they may have engaged in. Avoid fuelling stigma and discrimination by citing high-risk groups or pointing out negative behaviours of people and groups. Design attractive user-friendly materials to capture the attention of target groups. Require participation by all members of staff. BCC activities should be made compulsory (during work hours) for all staff, to ensure engagement with the materials.
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Sustain BCC programmes throughout the year to increase buy-in from staff members. It is important to remember that success of BCC programmes is unlikely if programmes are sporadic or one-day events.
2. Peer education
Selected members of a group are trained to become peer educators, and it becomes their task to facilitate change in the group by promoting awareness and information/education on safe sexual behaviour. The underlying premise of peer education interventions is that peer education is based on trust and understanding between peers. There is also the notion that the experiences of other piers can be used as examples to encourage more responsible attitudes and reduce high-risk behaviour. Several factors tend to be vital for the success of peer educator programmes. Selection of peer educators. They need appropriate communication skills, and must be able to motivate colleagues, win their trust, and act as role models. Support ongoing skills development for peer educators. This is important to maintain credibility, motivation and effectiveness. Numbers of peer educators. Adequate numbers need to be trained and maintained for ongoing effectiveness. Integrated with other programmes, peer education interventions should ideally combine prevention with care and support, such as VCCT, home-based care and ART, to maintain motivation, credibility and effectiveness of the educators.
3. Condom use, promotion and distribution
Condom use, promotion and distribution involve:

1. 2. 3. educating people about condoms, their use and purpose; promoting awareness and acceptance of their role in safer sexual activities; ensuring reliable and sustainable access to condoms.
Condom promotion and distribution should ideally be integrated with other prevention initiatives such as BCC and STI treatment. Peer education is also a good vehicle for education on condom use, and negotiating safe sex. When planning condom provision and distribution, especially for educators, consider the following. In many communities, misinformation and beliefs about condom use persist. These can hamper the acceptance of condom promotion as a prevention intervention. Condom demonstrations could diminish this. Programmes should highlight the need for consistent condom use. Condom use is much less effective if it is erratic or if it stops when a relationship becomes stable but before the partners have established their HIV status. Brand choice impacts acceptance. A generally unpopular brand of condom could prove equally unpopular in education institutions, even if they are free. Appropriateness of the provision of free or subsidized condoms should be decided.
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Creative distribution mechanisms that avoid stigmatization and respect privacy are critical. Leaving a bowl of condoms in full view of the staff room, for example, is not effective. Maintaining promotion, as well as a consistent supply and stock, is vital. It is important to identify reliable condom supply sources at central and local levels. Monitoring the reliability of supply and uptake is key to ensuring that condom programmes are effective. Monitoring is often neglected. Condom uptake and use may be monitored through a survey of knowledge, attitude, practice and behaviour (KAPB) studies.
4. Treatment for sexually transmitted infections (STIs)
Effective diagnosis and treatment of STIs other than HIV not only reduces STI illnesses and complications, but also substantially lowers the risk of HIV transmission. STI intervention involves: providing information and training on general reproductive health and the types of STIs that are prevalent in societies; promoting the treatment and prevention of such infections. STI treatment can also serve as a vehicle to promote behaviour change. Increasing access to STI treatment requires consideration of both the funding and delivery of treatment. A variety of mechanisms may be available, including public or private providers, medical insurance, or in-house funding and delivery of treatment. Syndromic treatment is a cornerstone of effective STI treatment. Syndromic treatment involves the recognition of particular signs and symptoms of STIs, and treatment according to ministry of health guidelines and drug protocols that are known to be effective. One of the challenges of implementing syndromic treatment of STIs is that health workers, and notably private practitioners, do not provide consistent or effective treatment in many health systems. Other common shortcomings include stigmatization, unreliable drug supply or use of less effective drugs, and inadequate counselling to promote effective treatment and behaviour change. These examples emphasize the challenge to organize effective and affordable delivery systems. Education and other sectors often have to build partnerships and referral networks to promote access to treatment. Training and partnerships with traditional healers have been key components of effective STI services to increase co-operation and effective treatment.
5. Voluntary (and confidential) counselling and testing (VCCT)
VCCT is confidential HIV testing of a person who has undergone pre-test counselling, consents to the test, and will have post-test counselling. VCCT programmes need to promote voluntary testing and then make provision for pre- and post-test counselling and reliable testing. The duration and models of post-test counselling vary (e.g. single sessions or post-test clubs). However, it is important to note that post-test counselling in many services is limited and is often not adequate without other counselling and psychological support. A workplace VCCT programme may be provided by public, private or NGO services. VCCT has a major role to play in HIV prevention by helping to modify the behaviour of employees to avoid infection. Furthermore, knowledge of HIV status enables infected staff to live positively and access treatment for opportunistic infections more effectively, as well as ARVs, when they need them.
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Several factors influence the success of VCCT. It is important that services be provided in places and in a manner that is acceptable to employees, assure confidentiality and do not result in stigma. VCCT promotion and marketing is much easier if employees can be assured that they can get benefits such as counselling, treatment (if necessary) and follow-up support once they are tested. Clear and active linkages with other HR, care and support services within workplace programmes are therefore important. The quality of counselling and testing needs to be assured, and unnecessary delays between testing and providing the results should be minimized. Careful choices should be made about whether in-house or other service models are most acceptable and efficient. Counsellors should receive support to deal with stress, burnout and other issues. Monitoring and evaluation of quality, uptake, success and needs arising from VCCT will be important.
6. Universal Precautions and post exposure prophylaxis
Universal precautions (UP) are a standard set of infection control practices to be used to prevent infection (with HIV, Hepatitis B, etc.) through accidental exposure to blood/bodily fluids. They constitute one way of working towards the establishment of a safe working environment for education sector employees. Though instances of exposure to HIV through blood or bodily fluids occurs less frequently in schools than in hospitals, workplace programmes provide an opportunity for staff and personnel to learn about UP to better protect themselves and others should an accident happen. Examples of UP include (as taken from the World Health Organization (WHO) website): Using new, disposable injection equipment for all injections is highly recommended. Sterilizable injection should only be considered if disposable equipment is not available and if the sterilizing process can be documented with time, steam and temperature indicators. Discarding contaminated syringes immediately in puncture- and liquid-proof containers that are closed, sealed and destroyed before completely full. Documenting the quality of the sterilization of all medical equipment used for percutaneous procedures. Washing hands with soap and water before and after procedures; use of protective clothing such as gloves, gowns aprons, masks, goggles for direct contact with blood and other body fluids. Disinfecting instruments and other contaminated equipment. Proper handling of soiled linen. (Soiled linen should be handled as little as possible. Gloves and leak-proof bags should be used if necessary. Cleaning should occur outside patient areas, using detergent and hot water.) In case of accidental exposure, post-exposure prophylaxis (PEP) should be provided. PEP is a short course of ART for HIV that reduces the possibility of infection after a person is known to have been exposed to HIV. When administering such programmes, however, it is important not to create exaggerated fear of accidental exposure in the education sector, as this can lead to increased stigma and neglect of people who need assistance after such incidents. Application of UP and PEP must be seen as educating people in how to proceed in extreme circumstances and is especially important for employees
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in clinics and hospitals where contact with infected fluids is frequent, and sometimes for travelling employees who may not have access to safe or protective medical equipment.
7. Prevention of mother-to-child transmission and reproductive health services
Prevention of mother-to-child transmission (PMTCT) and other reproductive health services for women is covered as a care and support strategy. For more information on PMTCT, please see Module 4.4, HIV/AIDS care, support and treatment for education staff. However, they are extremely important parts of prevention interventions. Many families are concerned with this issue and do not have accurate information as to the process of transmission and the risks involved. Promoting PMTCT (and its benefits), in particular, may encourage employees to engage in HIV and AIDS prevention issues and care and to seek out VCCT services. Workplaces should seek to promote and improve access to PMTCT and reproductive health services for their employees and their families. Building referral networks and partnerships is usually vital for feasibility and success.
8. Reducing structural and environmental risk
Safe behaviour and avoidance of HIV infection are much more difficult if structural/environmental factors facing employees are not addressed. For instance, employees who travel a lot for work purposes are often at risk of infection, and hence should be targeted by prevention interventions. Further deployment policies and practices, and/or poor accommodation that make it more difficult for employees spouses and families to live with them should be reviewed, given that such living arrangements increase the risk of infection. Community and family outreach intervention programmes can address community norms that could put employees at risk of HIV infection. These interventions are also important for diminishing stigma and discrimination.
9. Potential care and support interventions
The main components of care, support and treatment interventions these interventions are listed below. Positive living, including nutrition VCCT Medical care Opportunistic infection treatment and prophylaxis HBC ART Counselling and psychosocial support Pension and death benefits Wellness/employee assistance programme Counselling and co-ordination For more information on care and treatment strategies and interventions, see Module 4.4, HIV/AIDS care, support and treatment for education staff.
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Activity 4
Identifying the feasibility of workplace prevention programme interventions in the education sector As you can see, a comprehensive workplace policy requires many different interventions, though it may not be feasible to include all of the interventions we have listed. Therefore, you must prioritize the programmes you wish to develop. There are many factors to keep in mind as well, including cost, target audience, staff capacity and continuation of such initiatives. Now that you have looked over many possible interventions for your organizations workplace programme, please take a minute to answer the questions at the end of the module. Common challenges to implementing workplace strategies Once you have chosen the priority areas on which to focus, you can begin taking steps to implement prevention programmes in the workplace. Remember to keep the scale reasonable and implement programmes gradually to ensure their continuity. As you are implementing these programmes, remember that the quality and accessibility of education services can be undermined by HIV and AIDS in several ways. Below are some common challenges that the education sector or the human resources division faces when trying to implement aspects of a workplace policy. Some of these effects can be reduced by improving care, support and treatment for infected and affected employees. However, some will benefit from improving aspects of human resource and education management in general, as HIV and AIDS will not necessarily be the only, or most important, reason of absenteeism, attrition, skills shortages, low morale and poor productivity in the sector. Instructions: Review the list of prevention programme components and interventions discussed on page 27 and then discuss the following questions. (If you are a manager at institution, district or region level, you can interpret the term sector below as district, for example, if that is more useful. However, it will still be valuable for you to identify and give reasons for changes needed at higher levels within the sector). 1. Which of the components are already being implemented in the sector?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________ d. ______________________________________________________ ______________________________________________________ ______________________________________________________
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2. Which key target groups should be covered by prevention programmes in your sector?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________

3. What key improvements are needed to make existing interventions more effective?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________

4. Which extra interventions can/should realistically form part of your workplace response at (a) school; (b) district/regional; and (c) head office level? Whom would these interventions target?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________
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5. Which interventions cannot realistically be provided by the education sector alone?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________
6. Of the above interventions that cannot be provided by the education sector alone, which ones can be developed using partnerships with other sectors or partners? List the intervention and the partners for each.
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________
7. When you review the above answers, what would you propose as the most important core package of prevention interventions that the sector should provide?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________ b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________
8. List the key recommendations that you would make to sector leadership to ensure effective prevention of HIV contraction among employees and trainees?
a. ______________________________________________________ ______________________________________________________ ______________________________________________________
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b. ______________________________________________________ ______________________________________________________ ______________________________________________________ c. ______________________________________________________ ______________________________________________________ ______________________________________________________
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5.
Human resources planning and development

HIV and AIDS highlight the need to ensure that sufficient numbers of skilled teachers, managers and other staff are available for the education system to achieve its goals of accessibility and quality of education. Planning may need to take into account a range of reasons for skills shortages, and different options for filling skills gaps most efficiently. In this regard, HIV and AIDS may often present an opportunity to increase the efficiency of education HR planning and sector skills development strategies. Several options may need to be considered. Recruitment and retention strategies. In a number of education systems, skills shortages, and attrition may in large part be due to difficulties in retaining trainees and experienced teachers, rather than teacher deaths. Retained staff can be better at maintaining institutional memory and experience and can play important roles in keeping systems working efficiently. Staffing norms and skills mixes. These may also require consideration, especially in services that face high demand. The extra stress of HIV and AIDS on service delivery often gives organizations an opportunity to review whether existing procedures make sense. Succession planning and career development. These can be important tools to ensure that if employees leave, there are sufficiently experienced staff to take over from them. Trainee prevention-and-impact-management skills. Integration of prevention activities and impact management skills into the curriculum of pre- and in-service trainees should be considered as a way of avoiding future losses of skills and build skills in HR impact management that trainees can use within the teaching service.
Human resources management capacity and confidence

Experience suggests that organizations in which there is a good pre-existing level of HR management skills and systems can manage HIV and AIDS impacts more effectively, even before extensive HIV and AIDS-related programmes are initiated. Increasing the capabilities and confidence of HR and line managers in general HR management, as well as specific issues related to HIV and AIDS, can be an important component of the workplace HIV and AIDS response. These improvements can be achieved by providing training, support, mentoring and coaching. Specific skills may be prioritized, such as providing key managers and staff with training in how to process pension applications efficiently.
Deployment, recruitment, appointment and transfers

Inefficiencies in deployment, recruitment, appointment and transfer systems often cause substantial delays, costs and disruption in educational services. Posts that were blocked and frozen without consideration of the epidemic can be a further problem. As more teachers become ill and/or are lost to the epidemic, weaknesses in staffing become increasingly urgent to address. Traditionally under-served areas and communities warrant specific consideration as they can be further disadvantaged by shortages of
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trained and experienced professionals due to HIV and AIDS. To address such problems, it may be necessary to consider issues such as incentives for staff to work in under-served areas, and appropriate balances between centralized and decentralized decision-making in relation to recruitment and appointment. Another important consideration is that systems may need to accommodate staff who have to be transferred to centres where ARV or other treatment is available.
Human resources management monitoring of absenteeism and ill-health

Absenteeism and ill health can cause disruption and stress in education workplaces. In some systems, it is unclear whether or not absenteeism is a problem due to or independent of HIV and AIDS. The truth is, this does not matter. The important thing is for ministries and other employers to systematically manage and monitor absenteeism and ill health of employees. To effectively manage absenteeism and ill health, and possibly to understand the repercussions of HIV and AIDS on absenteeism, it is desirable for employees to disclose their HIV or health status as early as possible. However, in order to encourage employees to be tested and know their sero status, it is imperative to ensure that they have supportive environments for disclosure. Provision of access to treatment and support services should therefore be promoted. Sick and compassionate leave entitlements will often need review. The objectives of such reviews will be to flag absenteeism problems early so that they can be actively managed for the benefit of the employees and the overall functioning of the workplace. Systems should also encourage ill employees to retire at the right time for them and the employer. This will often require a review of care and support systems, including pension benefits and leave-related systems. If these are not well managed, employees often work for as long as possible, even if they cannot perform effectively. Alternatively, infected staff may retire too soon, leading to premature loss of education capacity. Performance management systems can be a useful mechanism to allow objective judgement of when it is fair and appropriate to retire or re-deploy employees.
Analysis of job descriptions

Job and process design can be shaped or modified in several ways that may help to moderate HIV and AIDS impacts on service delivery and management. Strategies may include the following: Simplifying tasks and their required sets of skills. This can facilitate easier cover for employees that are absent or lost to the system. For example, teaching aids or assistants may be able to perform certain functions when a qualified teacher is not available. Team work and multi-skilling can result in a better understanding of other peoples functions and make it easier for other staff to cover key responsibilities for short or longer periods. Teamwork and multi-skilling appear to be natural strategies that many schools adopt to cover for absent teachers or managers. Systematic review of qualifications frameworks and requirements. Requirements for unnecessarily high qualifications or specialization to perform tasks that less skilled personnel could do make it difficult to cope with absences. Deployment and over-manning strategies. Deployment of staff with specialized skills to cover more than one post, or the allocation of extra numbers of staff
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with key skills can also be used to ensure that back-up for critical employees is available if they are absent, leave the system to change jobs, or die. Relief staff systems. This is a strategy that has been widely used in education, mainly in relation to maternity leave. However, HIV and AIDS have highlighted the need to make sure that such systems are affordable, efficient and of adequate quality to respond to larger numbers of absent staff or vacancies. Redeployment and reasonable accommodation. Law may require the reassigning of staff with disability or special needs to more manageable duties.
Strengthening information systems and information exchange

Important benefits can be derived from strengthening mechanisms for generating and sharing information in workplaces and the education sector. Information and knowledge transfer systems seek to ensure that more employees have an understanding of the education sector, its jobs and functions, and recent developments in the workplace. This enables them to step in and take over from colleagues more easily, and perhaps remain in the system longer. These systems can often be useful as a part of general skills development strategy in a workplace or sector. Strengthening management information systems is another mechanism for managing the impacts of HIV and AIDS on education staff. Well-managed information systems allow for the identification, management and monitoring of HIV and AIDS impacts and interventions that are targeted at education staff. Effective workplace management will usually need central and decentralized information systems to facilitate design, monitoring and refinement of the management response. (For further information on AIDS-related information systems: EMIS and DEMMIS, see Module 3.2, HIV/AIDS challenges for education information systems). Effective workplace responses will usually require consideration of other HR management information systems, including payrolls and pension fund systems.
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Summary remarks
The development of a workplace policy for the management of HIV and AIDS is a vital step in preparing a response to the epidemic within institutions and organizations. The workplace policy must be synchronized with other sector policies and with national and international policies on HIV and AIDS. Following the development of a policy, the crucial next step is to develop and implement workplace programmes that will put into practice the principles established in the policy. These programmes should not focus only on prevention, but should embrace care, support and treatment interventions, as well as measures to manage and mitigate the impacts of the epidemic.
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Lessons learned
Lesson One Workplace policy is a necessary part of the comprehensive response to HIV and AIDS in the education sector. It defines an organizations approach to HIV and AIDS and clearly maps out the way(s) in which the organization will deal with the epidemic. Lesson Two HIV and AIDS workplace policies and programme development and implementation require high levels of leadership, commitment and participation. This commitment must come from three key stakeholders: employees, employers and social partners. Lesson Three Workplace policy in the education sector must take into account the differing profiles of employees and the institutional arrangements within which they are employed. Lesson Four Workplace policy should be consistent with and support other national level initiatives on HIV and AIDS in the public sector, as well as international standards on good practice in the workplace. Lesson Five Policy is not a pre-requisite for urgent action against HIV and AIDS, but should be used as a means of mobilizing stakeholders and resources; guiding the actions of all stakeholders and clarifying the roles and responsibilities. Lesson Six Leadership at all levels of the education system is the key to successful policy implementation. Lesson Seven HIV and AIDS-in-the-workplace programmes, consisting entirely of prevention interventions, will often be inadequate, particularly in high prevalence countries. A comprehensive workplace response links prevention, care, support and treatment and impact management interventions and strategies. Lesson Eight Many components of workplace HIV and AIDS programmes can have spin-off benefits in other areas such as HR management and HIV and AIDS interventions targeted at learners and communities. Lesson Nine Prioritization of interventions becomes a key issue. The range of prevention, care, support and treatment and impact management strategies is wide and most education ministries and institutions will lack resources and capacity to implement them all at once. Lesson Ten The successful implementation of workplace policy and/or programme response requires a consultative and collaborative process of decision-making between all key stakeholders that relies on their buy-in and co-operation.
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Lesson Eleven The building of collaborative, inter-sectorial networks and partners will often be vital in achieving certain goals of the programme and to the success of an HIV and AIDS-in-theworkplace programme. Lesson Twelve Like workplace policies, effective, active leadership support and the creation of adequate capacity and structures are of central importance to implementing workplace programmes. Structures should involve not only dedicated HIV and AIDS programme staff, but also HR managers without their active involvement, programmes will not have the capacity or technical expertise to address many important programme areas.
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All answers are country specific and will be dependant upon your own workplace environment. A useful policy reference document is the Kenya Education Sector Policy on HIV/AIDS. For more information you can also consult the ILO website (www.unaids.org/en/Cosponsors/ilo/default.asp).
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Documents Smart R. 2004. HIV/AIDS guide for the mining sector (draft for pilot testing) IFC and Golder. www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/ref_HIVAIDS_section1/$FI LE/Section+1b.pdf ILO. 2002. Education and training manual Implementing the code of practice on HIV/ AIDS and the world of work. Geneva. Rau B. 2002. Workplace HIV/AIDS programmes An action guide for managers. North Carolina. Family Health International/USAID. www.fhi.org/en/hivaids/pub/guide/workplace_hiv_program_guide.htm Rau B. 2004. HIV/AIDS and the public sector workforce An action guide for managers. North Carolina. Family Health International/USAID. http://info.worldbank.org/etools/docs/library/134438/ALGAF/Algaf_cd/alga f_docs/Resources/AIDS%20and%20the%20Public%20Sector%20Workforce %20(2003).pdf
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Useful links
Web sites:
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The Policy Project www.policyproject.com Population Services International Youth AIDS: http://projects.psi.org/site/PageServer?pagename=home_homepageindex The United States Presidents Emergency Plan for AIDS Relief: www.pepfar.gov/c22629.htm UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org UNESCO EFA Background documents and information: www.unesco.org/education/efa/ed_for_all/background/background_documents.s html www.unesco.org/education/efa/know_sharing/flagship_initiatives/hiv_education.s html www.unesco.org/education/efa/index.shtml UNESCO Institute of Statistics website: www.uis.unesco.org United Nations Millennium Development Goals: www.un.org/millenniumgoals UNICEF United Nations Childrens Fund: www.unicef.org UNICEF Life skills: www.unicef.org/lifeskills UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org United States Agency for International Development: USAID: www.usaid.gov/ School Health: www.schoolsandhealth.org/HIV-AIDS&Education.htm
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World Bank EFA Fast Track Initiative: www.fasttrackinitiative.org/
World Bank Multi-Country HIV/AIDS Program for Africa (MAP): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRHE ANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001234 ~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html World Economic Forum: www.weforum.org/globalhealth World Health Organization: www.who.int/en/ World Vision www.worldvision.org/
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by L. Teasdale
The terms below are defined within the context of these modules. Advocacy: Influencing outcomes - including public policy and resource allocation decisions within political, economic, and social systems and institutions - that directly affect people's lives. Affected by HIV and AIDS: HIV and AIDS have impacts on the lives of those who are not necessarily infected themselves but who have friends or family members that are living with HIV. They may have to deal with similar negative consequences, for example stigma and discrimination, exclusion from social services, etc. Affected persons: Persons whose lives are changed in any way by HIV and/or AIDS due to infection and/or the broader impact of the epidemic. Age mixing: Sexual relations between individuals who differ considerably in age, typically between an older man and a younger woman, although the reverse occurs. Diseases can be treated, but there is no treatment for the immune system deficiency. AIDS is the most severe phase of HIV-related disease. AIDS: The Acquired Immune Deficiency Syndrome is a range of medical conditions that occurs when a persons immune system is seriously weakened by HIV, the Human Immunodeficiency Virus, to the point where the person develops any number of diseases and cancers. Antibodies: Immunoglobulin, or y-shaped protein molecules in the blood used by the bodys immune system to identify and neutralize foreign objects such as bacteria and viruses. During full-blown AIDS, the antibodies produced against the virus fail to protect against it. Antigen: Foreign substance which stimulates the production of antibodies when introduced into a living organism. Antiretroviral drugs (ARV): Drugs that suppress the activity or replication of retroviruses, primarily HIV. Antiretroviral drugs reduce a persons viral load, thus helping to maintain the health of the patient. However, antiretroviral drugs cannot eradicate HIV entirely from the body. They are not a cure for HIV or AIDS. Asymptomatic: Infected by a disease agent but exhibiting no visible or medical symptoms. Bacteria: Microbes composed of single cells that reproduce by division. Bacteria are responsible for a large number of diseases. Bacteria can live independently, in contrast with viruses, which can only survive within the living cells that they infect. Baseline study: A study that documents the existing state of an environment to serve as a reference point against which future changes to that environment can be measured Care, treatment and support: Services provided to educators and learners infected or affected by HIV.
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Clinical trial: A clinical trial is a study that tries to improve current treatment or find new treatments for diseases, or to evaluate the comparative efficacy of two or more medicines. Drugs are tested on people, under strictly controlled conditions. Combination therapy: A course of antiretroviral treatment that involves two or more ARVs in combination. Concentrated epidemic: An epidemic is considered concentrated when less than one per cent of the wider population but more than five per cent of any key population practising high risk behaviours is infected, while, at the same time, prevalence among women attending urban antenatal clinics is still less than 5 percent. Condom: One device used to prevent the transmission of sexual fluid between bodies, and used to prevent pregnancy and the transmission of disease, HIV and sexually transmitted infections. Consistent, correct use of condoms significantly reduces the risk of transmission of HIV and other STDs. Both male and female condoms exist. The male condom is a strong soft transparent polyurethane device which a man can wear on his penis before sexual intercourse. The female condom is also a strong soft transparent polyurethane sheath inserted in the vagina before sexual intercourse. Confidentiality: The right of every person, employee or job applicant to have their medical information, including HIV status, kept private. Counselling: A confidential dialogue between a client and a trained counsellor aimed at enabling the client to cope with stress and take personal decisions related to HIV and AIDS. Diagnosis: The determination of the existence of a disease or condition. Discriminate: Make a distinction in the treatment of different categories of people or things, especially unjustly or prejudicially against people on grounds of race, sex, social status, age, HIV status etc. Discrimination: The acting out of prejudices against people on grounds of race, colour, sex, social status, age, HIV status etc; an unjust or prejudicial distinction. Empowerment: Acts of enabling the target population to take more control over their daily lives. The term empowerment is often used in connection with marginalized groups, such as women, homosexuals, sex workers, and HIV infected persons. Epidemic: A widespread outbreak of an infectious disease where many people are infected at the same time. An epidemic is nascent when HIV prevalence is less than 1 percent in all known subpopulations presumed to practice high-risk behaviour for which information is available. An epidemic is concentrated when less than one per cent of the wider population but more than five per cent of any so-called high-risk group is infected but prevalence among women attending urban antenatal clinics is still less than 1 percent. An epidemic is generalized when HIV is firmly established in the population and has spread far beyond the original subpopulations presumed to be practising high-risk behaviour, which are now heavily infected and when prevalence among women attending urban antenatal clinics is consistently one percent or more. Heterosexual: A person sexually attracted to or practising sex with persons of the opposite sex.
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High-risk behaviour: Activities that put individuals at greater risk of exposing themselves to a particular infection. In association with HIV transmission, high-risk activities include unprotected sexual intercourse and sharing of needles and syringes. Highly active antiretroviral therapy (HAART): A combination of three or more antiretroviral drugs that most effectively inhibit HIV replication, allowing the immune system to recover its ability to produce white blood cells to respond to opportunistic infections. HIV: Human Immunodeficiency Virus, the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. HIV testing: Any laboratory procedure such as blood or saliva testing done on an individual to determine the presence or absence of HIV antibodies. An HIV positive result means that the HIV antibodies have been found in the blood test and that the person has been exposed to HIV and is presumably infected with the virus. Homosexual: A person sexually attracted to or practising sex with persons of the same sex. Immune system: The bodys defence system that prevents and fights off infections. Incidence (HIV): The number of new cases occurring in a given population over a certain period of time. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new. Incubation period: The period of time between entry of the infecting pathogen, or antigen (in the case of HIV and AIDS, this is HIV) into the body and the first symptoms of the disease (or AIDS). Informed consent: The voluntary agreement of a person to undergo or be subjected to a procedure based on full information, whether such permission is written, or expressed indirectly. Life skills: Refers to a large group of psycho-social and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Log frame or logical framework: A matrix that provides a summary of what a project aims to achieve and how, and what its main assumptions are. It brings together in one place a statement of all the key components of a project. It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic of how the project is expected to work. It provides a basis for monitoring an evaluation by identifying indicators of success, and means of assessment. Maternal antibodies: In an infant, these are antibodies that have been passively acquired from the mother during the pregnancy. Because maternal antibodies to HIV continue to circulate in the infants blood up to the age of 15-18 months, it is difficult to determine whether the infant is infected. Mother-to-Child Transmission (MTCT): Process by which a pregnant woman can pass HIV to her child. This occurs in three ways, 1) during pregnancy 2) during childbirth 3) through breast milk. The chances of HIV being passed in any of these ways if the mother is in good health or taking HIV treatment is quite low.
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Micro-organism: Any organism that can only be seen with a microscope; bacteria, fungi, and viruses are examples of micro-organisms. Orphan: According to UNAIDS, WHO and UNICEF an orphan is a child who has lost one or both parents before reaching the age of 18 years. A double orphan is a child who has lost both parents before the age of 18 years. A single orphan is a child who has lost either his or her mother or father before reaching the age of 18. Opportunistic infection: An infection that does not ordinarily cause disease, but that causes disease in a person whose immune system has been weakened by HIV. Examples include tuberculosis, pneumonia, Herpes simplex viruses and candidiasis. Palliative care: Care that promotes the quality of life for people living with AIDS, by the provision of holistic care, good pain and symptom management, spiritual, physical and psychosocial care for clients and care for the families into and during the bereavement period should death occur. Pandemic: An epidemic that affects multiple geographic areas at the same time. Pathogen: An agent such as a virus or bacteria that causes disease. Peer education: A teaching-learning methodology that enables specific groups of people to learn from one another and thereby develop, strengthen, and empower them to take action or to play an active role in influencing policies and programs Plasma: The fluid portion of the blood. Post-exposure prophylaxis (PEP): As it relates to HIV disease, is a preventative treatment using antiretroviral drugs to treat individuals hours of a high-risk exposure (e.g. needle stick injury, unprotected needle sharing etc.) to prevent HIV infection. PEP significantly reduces HIV infection, but it is not 100% effective. potentially within 72 sex, rape, the risk of
Post-test counselling: The process of providing risk-reduction information and emotional support, at the time that the test result is released, to a person who is submitted to HIV testing. Pre-exposure prophylaxis (PREP): The process of taking antiretrovirals before engaging in behaviour(s) that place one at risk for HIV infection. The effectiveness of this is still unproven. Pre-test counselling: The process of providing an individual with information on the biomedical aspects of HIV and AIDS and emotional support for any psychological implications of undergoing HIV testing and the test result itself before he/she is subject to the test. Prevalence (or HIV prevalence): Prevalence itself refers to a rate (a measure of the proportion of people in a population infected with a particular disease at a given time). For HIV, the prevalence rate is the percentage of the population between the ages of 15 and 49 who are HIV infected. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, occurring in a given population over a certain period of time, while the term prevalence applies to all cases old and new. Prevention of mother-to-child transmission (of HIV): Interventions such as preventing unwanted pregnancies, improved antenatal care and management of labour, providing antiretroviral drugs during pregnancy and/or labour, modifying
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feeding practices for newborns and provision of antiretroviral therapy to newborns all of which aim to reduce the risk of HIV transmission from an infected mother to her child. Prophylaxis for opportunistic infections: Treatments that will prevent the development of conditions associated with HIV disease such as fungal infections and types of pneumonia. Rape: Sexual intercourse with an individual without his or her consent. Retrovirus: An RNA virus (a virus composed not of DNA but of RNA). Retroviruses are a type of virus that can insert its genetic material into a host cells DNA. Retroviruses have an enzyme called reverse transcriptase that gives them the unique property of transcribing RNA (their RNA) into DNA. HIV is a retrovirus. Safer sex: Sexual practices that reduce or eliminate the exchange of body fluids that can transmit HIV e.g. through consistent and correct condom use. Serological testing: Testing of a sample of blood serum. Seronegative: Showing negative results in a serological test. Seroprevalence: Number of persons in a population who tested positive for a specific disease based on serology (blood serum) specimens. Seropositive: Showing the presence of a certain antibody in the blood sample, or showing positive results in a serological test. A person who is seropositive for HIV antibody is considered infected with the HIV virus. Sex worker: A sex worker has sex with other persons with a conscious motive of acquiring money, goods, or favours, in order to make a fulltime or part-time living for her/himself or for others. Sexual debut: The age at which a person first engages in sexual intercourse. Sexually Transmitted Infections (STIs): Infections that can be transmitted through sexual intercourse or genital contact such as gonorrhoea, chlamydia and syphilis. In many cases HIV is a sexually transmitted infection. Untreated STIs can cause serious health problems in men and women. A person with symptoms of STIs (ulcers, sores, or discharge) 5-10 times more likely to transmit HIV. Sexually transmitted infection management: Comprehensive care of a person with an STI-related syndrome or with a positive test for one or more STIs. Socio-behavioural interventions: Educational programmes designed to encourage individuals to change their behaviour to reduce their exposure to HIV infections in order to reduce or prevent the possibility of HIV infection. Stigma: A process through which an individual attaches a negative social label of disgrace, shame, prejudice or rejection to another because that person is different in a way that the individual finds the stigmatized person undesirable or disturbing. Stigmatize: Holding discrediting or derogatory attitudes towards another on the basis of some feature that distinguish the other such as colour, race, and HIV status. Symptom: Sign in the body that indicates health or a disease. Symptomatic: With symptoms
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Sugar Daddy/Mommy Syndrome: Comparatively well-off older men/women who pay special attention (e.g. give presents) to younger women/men in return for sexual favours. T- Cells: A type of white blood cell. One type of T cell (T4 Lymphocytes, also called T4 Helper cells) is especially apt to be infected by HIV. By injuring and destroying these cells HIV damages the overall ability of the immune system to reduce the reproduction of the virus in the blood or to fight opportunistic diseases. A healthy person will usually have more than 1,200 T-cells in a certain measure of blood, but when HIV progresses to AIDS the number of T-cells drops below 200. Treatment education: Education that engages individuals and communities to learn about anti retroviral therapy so that they understand the full range of issues and options involved. It provides information on drug regimen and encourages people to know their HIV status. Tuberculosis (TB): Tuberculosis is a bacterial infection that is most often found in the lungs (pulmonary TB) but can spread to other parts of the body (extrapulmonary TB). TB in the lungs is easily spread to other people through coughing or laughing. Treatment is often successful, though the process is long. Treatment time averages between 6 and 9 months.TB is the most common opportunistic infection and the most frequent cause of death in people living with HIV in Africa. Universal precautions: A practice, or set of precautions to be followed in any situation where there is risk of exposure to infected bodily fluids, such as blood, like wearing protective gloves, goggles and shields, or carefully handling potentially contaminated medical instruments. Vaccine: A substance that contains antigenic or pathogenic components, either weakened, dead, or synthetic, from an infectious organism which is injected into the body in order to produce antibodies to disease or to the antigenic components. Viral load: The amount of virus present in the blood. HIV viral load indicates the extent to which HIV is reproducing in the body. Higher numbers mean more of the virus is present in the body. Virus: Infectious agents responsible for numerous diseases in all living beings. They are extremely small particles, and in contrast to bacteria, can only survive and multiply within a living cell at the expense of that cell. Voluntary counselling and testing: HIV testing done on an individual who, after having undergone pre-test counselling, willingly submits himself/herself to such a test. Workplace policy: A guiding statement of principles and intent taking applicable to all staff and personnel of an institution. This can often be part of a larger sectoral policy.
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The series
1.1 1.2 1.3 1.4 1.5
2.1 2.2 2.3
3.1 3.2 3.3 3.4
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4.1 4.2 4.3 4.4 4.5 4.6
5.1 5.2 5.3 5.4
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Volume
Understanding Impact
Foreword

Supporting policy development and implementation requires a detailed understanding of the issues influencing people and organizations. In volume 3, you will begin to look at what it means to collect data and information to inform the actions your ministry will undertake and to improve on what has been implemented.
Learners guide List of abbreviations MODULE 3.1: ANALYZING THE IMPACT OF HIV/AIDS IN THE EDUCATION SECTOR Aims Objectives Questions for reflection Introductory remarks 1. Objectives of impact assessment Scope of impact assessment and data collection 2. Methodology Projections (using new or existing sources of data) 3. Presenting results Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 3.2: HIV/AIDS CHALLENGES FOR EDUCATION INFORMATION SYSTEMS Aims Objectives Questions for reflection Introductory remarks 1. Impact of HIV and AIDS on education 2. Annual data collection processes 3. The need for complementary and local-level EMIS 7 11 17 18 18 19 21 23 23 28 28 39 43 44 45 48 51 52 52 53 54 57 61 62
4. District-level education management and monitoring information system (DEMMIS) 5. Data availability and reporting options 6. DEMMIS implementation planning 7. Prerequisites for successful DEMMIS implementation 8. Management checklist Summary remarks Lessons learned Answers to activities Appendix Bibliographical references and additional resource materials MODULE 3.3: QUALITATIVE RESEARCH ON EDUCATION AND HIV/AIDS Aims Objectives Questions for reflection Introductory remarks 1. Conducting qualitative research to better manage the situation 2. Collecting, processing and analyzing qualitative data in the context of education and HIV/AIDS 3. Associating qualitative and quantitative research Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 3.4: PROJECTING EDUCATION SUPPLY AND DEMAND IN AN HIV/AIDS CONTEXT Aims Objectives Questions for reflection Introductory remarks
63 65 67 71 73 75 76 77 83 86 89 90 90 91 92 94 100 109 113 114 117 121 125 127 127 128 129
1. Using projections, forecasting, simulation models and scenario building 130 2. Simulation models: projecting enrolments 134 3. Simulation models used in education 136 4. Supply and demand in projections and simulations: taking HIV and AIDS into account 138 5. The bigger picture: what are the strengths and limitations of a simulation model? 142 6. Types of education models 143 7. Incorporating HIV and AIDS into education models 145 8. Integrating the impact of HIV and AIDS on teachers in the simulation model 147 Summary remarks Lessons learned Answers to activities Appendix Bibliographical references and additional resource materials Useful links HIV and AIDS glossary The series 150 151 152 153 158 159 163 169
Learners guide
by B. Tournier
Background


The volumes
The modules

Your feedback
We hope that you will appreciate the modules and find them useful. Your feedback is important to us. Please send your feedback on any aspect of the series to: hiv-aids-clearinghouse@iiep.unesco.org - it will be taken into account in future revisions of the series. We look forward to receiving your comments and suggestions for the future.
Enjoy your work!
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Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People living with or Affected by HIV and AIDS Highly active antiretroviral therapy HIV and AIDS Management Unit Home-based care Health and Development Networks Health and family life education Highly indebted poor countries Human Immunodeficiency Virus Human resources International Bureau of Education International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa International Council of AIDS Service Organizations Injecting drug user Information, Education, and Communication International Finance Corporation International Institute for Educational Planning International Labour Organization In-service education and training International Planned Parenthood Federation Knowledge, attitudes, practices and behaviour Monitoring and evaluation Multi-Country AIDS Program (World Bank) Millennium Development Goals Management information system Medium-to-large-scale project Ministry of Basic Education, Sport and Culture Ministry of education Ministry of Education and Sports Ministry of Higher Education, Training and Employment Creation Men who have sex with men Medium-term expenditure framework Mother-to-child transmission Mobile Task Team (MTT) on the Impact of HIV and AIDS on Education
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Module
A. Kinghorn
Analyzing the impact of HIV/AIDS in the education sector
3.1
About the author

Anthony Kinghorn is a medical doctor, a director of Health & Development Africa, and specializes in assessing HIV and AIDS impact and response, with a particular interest in mainstreaming, OVC, as well as public health, economic, policy and management issues related to the HIV and AIDS epidemic. He is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Module 3.1
ANALYZING THE IMPACT OF HIV/AIDS IN THE EDUCATION SECTOR
Table of contents
Questions for reflection Introductory remarks 1. Objectives of impact assessment Scope of impact assessment and data collection 2. Methodology Projections (using new or existing sources of data) Surveys Behavioural surveillance Biological surveillance HIV seroprevalence testing Qualitative research Costing and economic evaluations Dealing with uncertainty 3. Presenting results Key considerations for impact assessment presentations and reports Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 19 21 23 23 28 28 29 30 31 31 33 38 39 39 43 44 45 48
MODULE 3.1: Analyzing the impact of HIV/AIDS in the education sector
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Aims
The aim of this module is to familiarize learners with the issues and options involved in conducting assessments of the impacts of HIV and AIDS on the education sector. The module also prepares learners to develop strategies that are appropriate to fulfil their objectives for an assessment.
Objectives
At the end of the module you should be able to: understand the role that impact assessments can play in programme development, advocacy and policy-making and planning; structure the assessment to focus on the issues that are most important to your work and the intended or anticipated results; choose an appropriate methodology to use when conducting an impact assessment; identify the sources of key data, information, and issues on HIV and AIDS and their impact on education; identify the key HIV and AIDS impact parameters that should be assessed in their own contexts; recognize the risks of uncertainty in conducting assessments and interpreting results.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What is an impact assessment of HIV and AIDS on the education sector?
Name some objectives that your ministry or institution might have when conducting an impact assessment.
What data or information would you want to collect to structure your assessment? How would you collect it?
Do the education sector or education institutions in your country have sufficient information and data to develop an evidence-based, prioritized response to HIV and AIDS? What are the critical information gaps?
What role can impact assessments play in advocating new policy measures in the education sector with respect to HIV and AIDS?
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Module 3.1
ANALYZING THE IMPACT OF HIV/AIDS IN THE EDUCATION SECTOR
HIV and AIDS impact assessments have been widely used in recent years as a way to mobilize responses to HIV and AIDS in the education sector and to refine planning in responses to HIV and AIDS. Traditionally, education sector impact assessments have covered two main areas: Internal or supply-side impact reflects the susceptibility and vulnerability of sector employees and also the vulnerability of education delivery due to HIV and AIDS. External or demand side impact reflects the impact on the demand for education services, ranging from changes in the expected numbers of children requiring education to the different needs of learners, for example prevention skills or support for orphans and vulnerable children (OVC). Impact assessments and monitoring activities are likely to be most relevant in countries where there is a high prevalence of HIV and AIDS. However, they are also relevant in high prevalence areas of countries where the overall epidemic is less severe. Issues raised by this module may also be useful to guide situation analyses, or monitoring and evaluation frameworks for prevention and care in specific circumstances of low-prevalence countries. Much of the response to HIV and AIDS in the education sector is based on understanding gained from impact assessments or studies of particular dimensions of impact. However, analysis of impact is often criticized for shortcomings. These include: the cost of assessments; the time required and possible delays when finalizing results; studies with results that are too shallow or too comprehensive and detailed for some key uses; the perception that studies confirm what is known already; methodological limitations and debates; limited ability to provide the answer for HIV and AIDS programmes and simplify challenges;
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further detailed planning and budgeting is often required after an impact assessment; and failure to lead to action. In this module, the process of setting up an education sector impact assessment is presented. The objectives, scope and methodologies are explored, focusing particularly on what data your ministry should collect in order to achieve the objectives of your assessment and how you can use it effectively to influence stakeholders and partners within the education sector. This module should be studied in conjunction with Module 1.2 - The HIV/AIDS challenge to education, Module 3.2 - HIV/AIDS challenges for education information systems, Module 3.3 - Projecting education supply and demand in an HIV/AIDS context, and Module 5.3 - Project design and monitoring
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1.
Objectives of impact assessment

Impact assessments provide information to guide better planning and management. The objectives of an impact assessment and the questions that need to be answered will influence the type of information that should be collected and the methodology employed. Impact assessments are often intended to strengthen advocacy around HIV and AIDS. This advocacy may aim to stimulate or strengthen mainstreaming of HIV and AIDS into the strategies and actions of the education sector or of other partner sectors to address various aspects of impact. Typically, top leadership/management is targeted by advocacy initiatives as they are the decision-makers who have the greatest ability to act and/or introduce change. Various limitations of available data and information often impede planning efforts to confront HIV and AIDS within education systems. These limitations in information include: types and size of impacts (on education sector employees, service delivery and needs, quality, access, gender equity, programmes, policies e.g. EFA); susceptibility and vulnerability of staff or learners; and adequacy of responses to HIV and AIDS. Before beginning an impact assessment of any kind, you must have clear objectives. It must be decided what the ultimate goal of the study is. The goal of such assessments is to understand how HIV and AIDS is impacting systems internally (on the health of employees, on their vulnerability) and externally (on the learners). It is helpful to ask yourself, are you interested in improving data collection to improve planning and procedures within the ministry, or are you interested in using the study to advocate more support to schools and teachers? These are just examples of things that you should think about before launching any assessment of HIV and AIDS. Once the objectives are clear, choosing the scope and methodology will be easy.
Scope of impact assessment and data collection

Once you have clearly decided your objectives, you can decide on the scope or range of your impact assessment. Impact assessment can involve collecting information on a wide range of HIV and AIDS issues that influence an education system in different ways. Table 1 highlights information that can be generated to assess impact within the education sector. Collecting detailed information on all these areas can often be demanding. Therefore, as stated above, it is important to decide in advance the objectives and the priority questions to be answered in order to ensure that resource requirements and the length of time of the assessment are appropriate. HIV and AIDS are often not the only, or necessarily the biggest, challenges to education systems. There has been increasing emphasis on ensuring that the
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scope of impact studies includes obtaining data to contextualize HIV and AIDS impacts in relation to: other education and development policies, i.e. Education for All, workplace policies; other challenges to education apart from HIV and AIDS, such as poverty and learner vulnerability, or general staff attrition or absenteeism. Including the above issues in impact assessments is important as: HIV and AIDS-related needs compete with other needs for resources. Prioritization and resource allocation must therefore be based on a sound understanding of the types and size of challenges facing education; responses can be designed with a more holistic approach that takes advantage of potential synergies between responses to HIV and AIDS and other challenges. For example, measures to address attrition due to HIV and AIDS may be relevant to other important causes of attrition, and vice versa.
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Table 1: HIV and AIDS information that can be generated to assess impact. Risk of HIV infection, illness and death (Susceptibility) a) Employee susceptibility Factors putting staff at risk of HIV infection, e.g. conditions of employment, insufficient HIV-related knowledge Levels of infection among staff Employee illness & death rates Current situation & future scenarios Impact of illness and death (Vulnerability of individuals or system) a) Implications for employees Welfare of infected or affected employees b) Implications for delivery of education services Costs or disrupted delivery related to e.g. absenteeism, training, pension, death or medical benefits, vacancies, work disruption etc. Effects on quality & productivity Teacher training/staffing implications Critical vulnerabilities e.g. certain posts/skills groups/processes c) Factors that increase vulnerability Limitations of HR management & development systems
External impact Internal impact on learners and the needs to be met by on employees and on the delivery of education systems education
a) Learner susceptibility to HIV infection E.g. risks due to low HIV-related knowledge or skills, unsafe school environments and community circumstances Expected numbers of infected & sick learners b) Expected trends in school-age population growth
a) Implications for infected or affected learners/OVC Material deprivation, stress and other obstacles to learners development and rights b) Implications for education and development goals Access, enrolment and performance Loss of investment in education c) Factors that increase vulnerability Fees, regulations or other factors Limitations of support systems in education or its partners
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The scope of work of impact assessments will also often cover several crosscutting or generally applicable themes. These include: Gender issues: By investigating how men, women, boys and girls are all affected by the impacts you choose to analyze, you can see differences in risk and as a result better target these groups when developing response measures. For example, women can often be affected by HIV and AIDS more than men as they must care for ill relatives or raise orphans of family members, while a boy might have to leave school to work should he become the oldest male in his family due to AIDS. Rights of infected and affected people: The International Declaration of Human Rights states that all people have rights to health and well-being, education, and recognition before the law. HIV and AIDS raise many specific issues in relation to the rights of infected and affected people in institutions and communities. Using impact assessments to analyze how these rights are upheld or denied could be an effective tool for advocacy and is often needed to guide planning in critical areas. Option appraisal: This explores which responses are the highest priority, and the most feasible, efficient and cost-effective options for responses. Option appraisal could, for example, assess the affordability and effectiveness of different ways to provide antiretrovirals (ARVs) for employees. The number and types of options that should, or can, be investigated will often be influenced by whether guidance is being sought for an initial, general strategy or to refine existing strategies and planning. Response analysis: This can involve evaluating existing HIV and AIDS response programmes and/or coping strategies in education and its partner sectors, as well as responses in human resources (HR) and other areas of management and planning. Recommendations: These can be relatively high-level strategic recommendations, or they may be more specific, relating to micro aspects or particular components of the response, depending on the requirements of the sector. To promote mainstreaming, it may be useful to identify particular recommendations for specific education sub-sectors and components, not only the HIV and AIDS programme and unit. For example, if one response programme involves creating voluntary, counselling, testing and support networks for teachers, perhaps the recommendation could be for teacher training colleges to conduct similar programmes. Keep recommendations realistic and prioritize them to avoid an overwhelming list. It is important to remember that recommendations, initiatives and policies must be flexible enough. They cannot assume that all institutions can or should respond in exactly the same way. There are several other issues to consider when deciding the scope and depth of any impact assessment. The education components and/or sectors to be covered in the assessment: Which level of the system interests your assessment? (schooling, higher education, teacher education, management). Whether the assessment is to have a developmental or a HIV and AIDSspecific focus. The level of analysis: Will your study produce analyses at a regional, district or national level? This should be decided when determining what information the assessment will focus on and analyze. This depends on
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your questions. For example, it should be noted that aggregated nationallevel data can hide important impacts in certain districts, and small samples of schools or districts may over- or under-represent impact. Finality and detail of recommendations intended for the assessment. Recommendations may be developed further through a follow-on process once key information is available. The time and resources available to conduct the assessment. Whether the assessment is largely operational/action-orientated or academic research. And finally, with regard to scope, increasing attention is being given to more targeted investigations of: specific impact areas and uncertainties that need more accurate information to facilitate planning decisions, such as a better understanding of orphans school attendance and dropout; specific intervention options, in order to appraise the feasibility, effectiveness and cost effectiveness of the various options for response management.
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2.
Methodology
Several different methodologies can be useful in providing data and information for assessments on HIV and AIDS impact and related issues. The choice of methodology will depend on factors such as the types of questions the study has to answer, and data availability and reliability. For most assessments, a mix of methodologies (triangulation) is likely to be desirable. In this module we will look at the following methods: Projections (using new or existing sources of data) Surveys Behavioural surveillance Biological surveillance HIV seroprevalence testing Qualitative research Costing and economic evaluation
Projections (using new or existing sources of data)

A projection is a means of extrapolating on the basis of past trends. They do not attempt to predict what will happen in the future; they only present what would happen if certain conditions prevailed. In the case of HIV and AIDS, projections provide an idea of current and future levels of infection, death and illness among education sector employees, as well as of the number of orphans in the population. Projections can also help to provide estimates of current and future teacher supply and demand, as well as cost or other implications of ARV treatment for education sector employees. Most importantly, however, projections can be used to guide decision making for implementing policy and response programmes. Projections are made using models. These models are often calibrated, or adjusted, using HIV prevalence survey data taken mainly from antenatal clinics but also from other sources where available. Similarly, projections can be checked against illness and death/attrition data, for example among education sector employees. However, it should be noted that these sources of data may not always provide a very accurate picture of infection rates and other impacts in a workforce or even a countrys population. Modelling involves many assumptions. It is important to be careful when working with projections as there may be uncertainties about the accuracy of projections, and this may lead to inappropriate responses. To reduce the risk of such inappropriate responses, researchers can try one of two approaches. The first is to improve the data used to calibrate the projections, and then to improve the information that tracks whether the projections are being confirmed or contradicted by reality so that adjustments can be made. The use of scenarios, or scenario building, and sensitivity analysis is a second important approach. These assess how important key uncertainties are, and thus whether projections seem adequately reliable or too hazardous as a basis for planning decisions. Scenarios and
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sensitivity analyses are produced by changing important assumptions used in modelling (within a realistic range of estimates). Simple scenarios can be produced using excel spreadsheets. For example, they may ask What if the level of HIV infection is 18 per cent or 12 per cent, not 15 per cent or How many staff would require funding for ARV treatment if only half, not all, actually have access to ARV treatment? The new results will help to assess whether the resulting policy and planning decisions would be very different and thus avoid the risk of making the decision before better information is available. This type of projection tends to be most useful where levels of impact are expected to change substantially. Overall, projections provide guidance for planning and advocacy. But projections should always be used with due understanding and consideration of their limitations. Whether a particular set of projections is accurate enough to assure a policy decision depends on the particular policy decision to be taken. Furthermore, their feasibility should be assessed for each type of planning and policy decision. It is important to note that in many cases it may not be advisable to spend large resources to produce new, customized demographic projections for an education sector impact study. For example, it may be unlikely that greater accuracy will change key planning decisions. Or it may be that new projections will probably be as unreliable as existing general population projections due to a lack of key calibration data (for more information on projection models see Module 3.3, Projecting education supply and demand in an HIV/AIDS context). Utilizing existing data to assess impacts and trends can be less costly than primary data collection. Routine data from EMIS, payroll, pension fund, other HR databases, DEMMIS and informal district information systems can be used to ascertain key information, particularly on enrolment trends and patterns as well as staff and personnel deaths, retirement and other attrition. Initially, the availability and reliability of these data may be problematic, and this must be considered when opting for this approach and interpreting results. But use of routine data can lead to strengthening of basic information systems. This strengthening can have spin-off benefits and allows for better ongoing monitoring and management of impact.
Surveys
School surveys (that is, specific surveys of samples of schools) are often employed to assess the nature and extent of a range of HIV and AIDS impacts and responses in education. However, there are several challenges to using surveys for impact assessment. These include ensuring an adequate sample size and avoiding selection bias; ensuring quality of collected data, particularly around sensitive issues or taboo subjects; assuring validity of subject responses; assuring data analysis is sufficient to identify issues and associations with rigour. A limitation of school surveys is that they do not reach out-of-school populations. However, other surveys (e.g. demographic and health surveys (DHS) or alternative
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population-based/household surveys) or their datasets can add information, such as numbers of orphans.
Behavioural surveillance
Behavioural surveillance involves the development of standardized questionnaires for staff and/or learners to generate indicators of knowledge, attitudes, practices and behaviour (KAPB) that can then be measured and monitored over time. The objectives of KAPB studies include: identifying knowledge gaps; identifying existing behaviours (which include risky behaviour, e.g. frequently changing sexual partners, condom use, etc.); identifying cultural and other practices (e.g. wife inheritance); identifying attitudes and beliefs (which includes staff/learners views on HIV and AIDS); identifying key groups, situations or risk factors to target; identifying sources of information and services; assessing manager and supervisor preparedness and effectiveness of responses; tracking levels and trends using baseline and follow-up studies; and increasing awareness and advocacy . Well-designed KAPB studies can provide useful information for designing prevention interventions. They can identify what groups to target and what information and/or activities are the most needed within the community. Once the response is in place, the tools used in the KAPB study for data collection can then be altered slightly to track the programmes effectiveness. KAPB studies can be expensive or sometimes misleading if they are used in isolation. It takes time to develop questionnaires that accurately measure what the study aims to evaluate, and they should usually be pre-tested. They may not give enough information on the causes for certain attitudes and behaviours to guide the design of interventions. Furthermore, there are often concerns that respondents give answers that they feel they should give, rather than answers that are true reflections of actual attitudes, practices and behaviours. KAPB studies also give very limited indications of levels of infection, as they are technically closer to qualitative assessments and research. They can, however, be linked to blood or saliva HIV surveys in order to overcome this limitation. This combination can also indicate links between levels of infection and different knowledge, behaviour, attitudes and practices, which can be useful to design responses. KAPB study questionnaires give limited opportunity for subjects to mention and discuss issues that the people who chose the questions did not know about or expect to be important. This can lead to important limitations. In addition, KAPB give limited opportunity for participation in developing recommendations and responses, though this can be addressed through other aspects of work in a community or schools.
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Biological surveillance HIV seroprevalence testing

Surveys using blood or saliva tests can be employed to assess levels of HIV infection (and other tests can be used for other STIs). They have usually been unlinked and anonymous to encourage participation and protect confidentiality, but increasing opportunities for treatment make it desirable to encourage participants to use surveys as an opportunity to learn their HIV status. Surveys using biological tests are useful when it is imperative to have a more accurate idea of prevalence in order to inform policy or planning decisions. They can also give extra plausibility to impact assessments. However, they can be costly and complex to do well and ethically. Furthermore, their results have limitations. A single seroprevalence survey alone will usually not give a clear sense of trends, and thus whether infection rates are climbing, falling or stable. It is also vital that there be buy-in to ensure that participation in the study is high. Even if a relatively low proportion of employees or participants refuse to be tested, results could be misleading. For example, if 20-30 per cent of education sector employees refuse, they may include a disproportionate number of employees who already know that they are infected or at high risk and are afraid that positive tests could have negative implications for them. Thus, the results for the other 70-80 per cent could significantly underestimate levels of infection. Success is much more likely if participation is encouraged by the existence of a credible programme or plan to provide support for infected employees. The sensitive nature of HIV seroprevalence data makes it vital that there be a clear HIV and AIDS policy, or HIV and AIDS in the workplace policy ensuring confidentiality, non-discrimination and established networks of support and counselling for affected employees.
Qualitative research
Qualitative research does not aim to generate statistical measures of impact or risks. Instead, it aims to give the participants a chance to express and explain their views and perceptions of priorities. In addition to identifying the what, participants can also explain the why and how. In order to do this, the research uses techniques such as personal testimony, focus group discussions and informant interviews. These typically use open-ended questions that allow participants to express themselves more freely and fully than they would through surveys or questionnaires which aim at producing quantitative measures (statistics) of certain risks and impacts. Qualitative research often alerts decision-makers to issues which they may not have anticipated or asked about in a survey. The research can provide rich information relatively quickly about the priority issues to be addressed. This may include information on challenges and successes, as well as suggestions to guide the planning of responses. They can also highlight key reasons for failures of HIV and AIDS interventions. Qualitative research is very useful when interpreting quantitative data. In addition, qualitative research can also help to identify and understand key impacts that are difficult to quantify. For example, these impacts may include the
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implications of illness and deaths in employees families and communities for their morale and productivity, and what the impacts are on staff and students if a teacher is ill with an AIDS-related illness. Some quotes that illustrate the rich information that can be provided through conducting qualitative research are shown below in Box 1. Box 1 Quotes resulting from qualitative research
I have a long-term relationship now that I have been transferred away from my wife so that I am not tempted to sleep with many women. Some colleagues have many short relationships to preserve their marriages. I dont know who is more at risk, we may all be infected. We feel protected by our HIV/AIDS knowledge when we are in our classroom. But when we are in the hostels or in town, we dont know how to apply it. It is a different world out there. The greatest disruption occurs if a financial manager is absent or leaves. No-one else can do their job and they are hard to replace. The HIV/AIDS programme has a vehicle but it is always being used by the Regional Director. On the surface it may appear that [orphan] problems are as simple as the inability to pay fees or discipline issues but you later discover that their problems have deeper roots.
Source: A Kinghorn. Personal Communication. From impact assessment focus group data from Botswana, Zimbabwe, Namibia, Mozambique 1999-2004.
Qualitative research does involve challenges however. It can be misleading and inaccurate if interviews are not conducted by researchers experienced in data collection and analysis. For example, an anecdote about an extreme case may be presented as if it were the norm. In addition, as qualitative research does not provide statistics it may have less credibility with some stakeholders. (For more information on projection models see Module 3.3 Qualitative research on education and HIV/AIDS)
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Costing and economic evaluations

Costing and economic evaluations are often considered to be crucial components of assessments. They can answer questions such as the following: What is the size of various HIV and AIDS-related costs (e.g. teacher training, pensions, medical care, absenteeism, lost investment in learners), and how do these costs affect the response to HIV and AIDS? Which costs can be managed? What are the highest costs to the sector and which are thus priorities to manage? Which responses are affordable and which responses are likely to be cost-effective or offer potential savings? There are various limitations and methodological issues that must be considered before commissioning cost estimations or economic evaluations, and interpreting results. These include the following: Available data and methodologies may not be able to provide accurate cost estimations or economic evaluation. Costs and benefits may be overor understated. Direct, quantifiable costs may often seem relatively small, especially when compared to some initial expectations. This difference could distract attention from important non-financial impacts and undermine the commitment of key players who are mainly interested in budgetary or high-cost issues. Methods and their results often involve value judgments that may not be immediately obvious. In particular, costs that cannot easily be translated into monetary measures may not be considered significant. For example: the effects of lower morale and higher stress among staff may be down-played because they are not costed; if there is no system for teacher replacement, teacher absenteeism may not incur direct financial costs to the sector, but can cause real costs to learners, whose education is disrupted; costs that fall on households or other sectors such as health may also not be considered important by educational planners, but may have large implications for a country and its people. There are often particular technical challenges related to important cost components such as pensions (which may require full actuarial valuation) and medical care. These challenges may be complicated by the fact that required information may not always be accessible to ministries of education from the relevant partner ministries. Overall, the resources and time required for extensive investigations of costs should be weighed against their likely benefits. Care should be taken to ensure that results are presented in a way that recognizes important limitations or assumptions that can result in misinterpretation.
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Activity 1
Education sector HIV/AIDS impact assessments (30-40 minutes) The checklist below and the questions that follow are intended to help you to define the scope of work and methods for risk or impact assessments by your ministry. 1. Read each area of impact information listed in the first column of the checklist. 2. Put a cross (X) in the second or third column depending on whether there is enough information available to guide action in the sector. Place more than one X to indicate more important information gaps. 3. Notes/key information needs or issues to consider in the fourth column are to remind you of things to consider for further investigation or ideas about the best method to collect the missing information. Now answer questions A, B, C and D. When you have finished your answers, compare them with those of other members of your group (if applicable). Which are the priority gaps in knowledge about HIV/AIDS impact and responses? (where did you put the most Xs?) List the areas that need the most information? (in other words, in what priority areas among those you have chosen would an impact assessment be the most useful?): _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Are there any other priority areas you would add? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
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What are the main uses of the impact assessments you propose and who are the key target audiences? What could be the uses for policy advocacy and planning purposes? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ What approaches and methods are likely to be the best way to obtain the information for in the impact assessment? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
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Impact information 1. Internal impact HIV/AIDS knowledge, attitudes, practices and behaviour; risks related to work and living circumstances Levels of HIV infection Access to effective prevention interventions e.g. condoms Illness and attrition rates Current and future death and attrition rates of employees Current and future rates of illness and absenteeism Causes and levels of absenteeism and staff loss for reasons other than HIV/AIDS or illness Skills availability Adequacy of supply of skilled staff Appropriateness of current training and skills development approaches Expected training costs Employee medical and pension benefits Type, scale and delivery mechanisms for healthcare requirements for employees with HIV/AIDS Expected costs of healthcare options Pensions and other benefits costs and options for staff who are sick or die and their dependents. Absenteeism Cost and quality impacts of HIV/AIDS and other causes of absenteeism Adequacy of sick and compassionate leave systems Cost , feasibility and efficiency of relief systems or alternatives to cover for absent staff Work processes and places Critical posts and processes vulnerable to disruption HR systems HR information systems adequacy at each level to track and manage impact Adequacy of systems such as recruitment, appointment, deployment and transfer Managers skills and support to manage staff with illness or other crises Overall impacts
Enough information
Not enough information
Notes/key information needs or issues to consider
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Impact information Overall impact on costs, accessibility and quality of education Priority of HIV/AIDS responses and consistency or competition with other education priorities 2. External impact Infection and illness of learners Risks faced by learners Levels on infection and illness among learners Scale of potential loss of investment in education due to premature death or illness of learners/graduates Access to effective prevention interventions Systems to promote equitable access to education by infected or ill learners Affected learners Numbers of OVC Priority needs and indicators of vulnerability of OVC Implications for access, quality and efficiency of education and priority of various obstacles and vulnerabilities Effectiveness, efficiency and equity of current responses for addressing OVC needs Options for response to OVC needs 3. General and cross-cutting issues Vulnerable institutions and groups Institutions, regions, communities or groups where impact is more severe than average. Protection of rights of infected and affected staff Gender differences in susceptibility and vulnerability of staff or learners HIV/AIDS response analysis Efficiency, effectiveness and appropriateness of HIV/AIDS programme to meet needs at each level Where and how to integrate HIV/AIDS issues into general education, development and poverty reduction plans Where to mainstream HIV/AIDS response into operations of other programmes and sub-sectors
Enough information
Not enough information
Notes/key information needs or issues to consider
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Dealing with uncertainty

Since all sources of information and methods have limitations, remaining uncertainty is inevitable. No programme response can be perfect. It is vital that decision-makers consider the decided responses appropriate despite any remaining uncertainty. Fortunately, there are a number of approaches to dealing with such uncertainty. Conducting sensitivity analyses and scenario planning (as covered above) are possible ways to limit uncertainty in assessments. These analyses give a sense of what is feasible and which response options seem most appropriate, even if impact levels are higher or lower than estimated. Prioritizing HIV and AIDS-related interventions that are in-line with other priorities is another approach that can be adopted. In many areas, HIV/AIDS may highlight issues that needed attention prior to the onset of HIV and AIDS. In this way, HIV and AIDS responses can be thought of as opportunities for education ministries and institutions. Establishing specific teams or units to monitor the programme progress and adjust responses accordingly can also lessen uncertainty. Improving data collection informing the priority areas as identified by impact assessments. This strategy may involve more in-depth analysis of available data, as well as better collection and monitoring of information in priority areas.
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3.
Presenting results
Key considerations for impact assessment presentations and reports
The impact assessment team should be given a clear idea of which target audiences should be reached, and should develop a strategy with the ministry of education to ensure that the reporting process and materials are effective in reaching them. Presentations and/or reports should be tailored to their target audience. Impact assessments can result in reports and presentations that are too technical or detailed for some audiences or too superficial for others. Exaggeration of the scale and significance of impact should be avoided so that credibility is not undermined. Care must be taken when making recommendations to decision makers. This may require a greater or lesser emphasis on various perspectives on a problem, including human and societal impact, education implications, costs and cost effectiveness of proposed responses. Arguments are also often more persuasive when they are accompanied by solutions and/or practical recommendations.
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Activity 2
Data interpretation The questions below are intended to help you develop confidence in identifying what kinds of data can be produced by impact assessments and how to interpret information/data that can be generated by assessments using various methodologies. Look carefully at each of the following five data slides and answer these three questions for each one. 1. What important things do the data tell you? 2. Who could use the data? 3. Are there limitations of the data that you would need to keep in mind?
Data slide 1:
Total teacher deaths as a percentage of teachers (Namibia)

Projection - with ARVs Actual death rate -School survey
Projection - No ARVS Actual death rate - pension data
4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 2004 1995 1996 1997 1998 1999 2000 2001 2002 2003 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Source: Republic of Namibia, 2002.
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Data slide 2:
Reasons for educators leaving school in 2002
0,30%
0,10%
0,20%
0,20% 0,30% 0,20%
1,80% 0,40%
0,40%
Died after accident/violence - (0,1%)
Left because of illness- (0,2%)
Unknown reason- (0,2%)

Died after short illness- (0,2%)
Reached retirement age- (0,4%)
Early retirement- (0,3%)

Died after long illness (>3mths)- (0,4%)
Left to work elsewhere- (1,8%)
Other- (0,3%)
Source: Schierhout, Kinghorn, Govender, Mungani, and Morely,2003.
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Data slide 3: Number of sexual partners in the past years reported by sexually active teenagers (National probability sample survey of 2,204 12-17 year olds, Johannesburg).
Source: Africa Strategic Research Corporation, 2001.
Data slide 4: Proportion of grade 10 learners who had experienced school interruption of a year or more
14% 12% 10% 8% 6% 4% 2% 0% both parents alive

Source: Schierhout et al., 2003.
double orphans
maternal orphans
paternal orphans
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Summary remarks
Previously, impact assessments produced a range of information on the implications of HIV and AIDS for education that assisted in advocacy, informed policy and planning, and helped to identify the key issues that needed to be investigated further. However, assessments were criticized for consuming substantial resources and taking too much time. It was also felt that they did not always provide the information or momentum for responses that had been hoped for. To improve efficiency and usefulness of impact assessments, there has been an increasing focus on ensuring that objectives (in relation to planning and/or advocacy) are clear and that assessment scope and methodologies serve these stated objectives. Assessments of HIV and AIDS impacts are also being more thoroughly integrated with investigation of other core educational planning agendas, such as employee attrition and absenteeism due to causes other than HIV/AIDS. Previous experience has also highlighted the need to identify where exhaustive research and assessment of impacts is really likely to be cost effective. In some cases, processes that draw mainly on previous research and informed intuition may be adequate and less expensive. Increasing focus has been turned to improving the quality, analysis and use of routine data from EMIS, DEMMIS and other systems (see Module 3.2 - HIV/AIDS challenges for education information systems), rather than conducting formal impact assessments. Nevertheless, impact assessments remain important sources of information for policy and planning decisions within the education sector, and when done properly can be useful for planning actions within the sector related to HIV and AIDS as well. Before impact assessments are commissioned, it is important to ensure that their objectives are clear and that an assessment is required to achieve them. The methodology and scope of assessments need to be appropriate to achieve the objectives. Prior attention needs to be given to defining the key target audiences, presenting results with greatest effect and ensuring that the assessment feeds effectively into a process that can result in action.
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Lessons learned
Lesson One Assessments can be very influential when designing programme responses and interventions to HIV and AIDS impact on the education sector. However they must have well-prioritized objectives, a sound methodology, and make efficient use of resources. Lesson Two There must be a clear understanding of the key information to be collected and the anticipated needs and uses of the impact assessment. Lesson Three When planning an assessment, an understanding of implications and limitations of methodologies and how to manage them within the context of the study, is vital. Lesson Four Successful impact assessments do not focus specifically on HIV and AIDS, but rather consider and link to general education challenges, contexts and strategies. Lesson Five The presentation or packaging of reports and findings needs to be carefully considered to make them accessible and credible for key target audiences. Lesson Six Process is critical. For impact assessments to be successful, it is vital that there be active involvement of education officials in the assessment for buy-in, efficiency, quality and skills transfer. It is also imperative to ensure that the impact assessment is clearly situated in a process that leads to action. For example, it could lead directly to a defined process to develop or review HIV and AIDS plans, or for advocacy. Lesson Seven Assessments should also be seen as part of the response to HIV and AIDS. Waiting for assessment results should not become a reason to delay action in areas where it is clearly required.
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Activity 1 Part A and B These answers will vary according to groups, countries and institutions. Part C Another way of phrasing this question is: Once you have decided what impact to measure, what information should be collected? What will the results be used for? To whom should the information be presented? How should the information be presented to be most effective? And for what results? (Examples may include advocacy to top leadership; educational planning; other) Part D For this question, use the section on page 10 concerning methodologies for impact assessments to determine the best way to collect data on the impact you are focusing on. (e.g. comprehensive, detailed impact assessment; rapid appraisal; focused in-depth investigation of the key area; school survey; strengthen routine data collection and analysis; other) Activity 2 Model answer to data slide 1: Important information provided: The graph provides estimates of teacher deaths from unspecified causes (as a percentage of all teachers in the system) and gives us some idea about where we are in terms of the death rate among teachers in the Namibian education sector. Two types of data are represented here: the projected estimates of teacher deaths (in ARV and no-ARV scenarios) and real estimates from pension data and school survey data. Without ARVs death rates among teachers could be expected to almost double in comparison with 2002 levels, i.e. they could get a lot worse than at the time of the study. ARVs can dramatically reduce death rates. But the projection reminds us that deaths cannot be avoided completely. Some people may begin treatment too late and in others the treatment may be ineffective (due to a resistant virus or not taking the treatment properly). Overall, the death rates are not overwhelming for any single year (and so they can be overlooked). However, it would be worth remembering that ongoing losses do add up. Some workplaces may also still be hard hit if they do lose a teacher.
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Who could use it: HR managers and planners; teacher training institutions; education sector unions and staff associations; HIV and AIDS programme and advocacy initiatives. Limitations to keep in mind: School survey data from 2001 suggest that the total percentage of teacher deaths was approximately 1.5 per cent. Pension data points to teacher deaths sitting at about 1.2 per cent. Projected estimates in a no-ARV scenario put teacher deaths at about 1.4 per cent, so projections seem to be reasonably realistic. However, pension and school survey data are collected over one year, so the accuracy of estimations may not be sustained. Generally, one would need to monitor data over several years to actually know what the situation is. Actual levels of uptake for ARV treatment are likely to be a major determinant of actual death rates. Model answer data slide 2: Important information provided: This school survey gives quite a detailed understanding of the reasons why educators have left the education system in a sample of schools in two provinces of South Africa. Such data are not always available from routine information systems. This information helps give an idea of the level of illness and death that might be AIDS-related, and how their contribution compares to those of other causes of attrition among educators. This helps develop AIDS response strategies that are integrated with broader HR management and planning challenges. Controversially, the graph also cites finding another job as a the number one reason for leaving teaching. This could be an interesting item to explore, especially since these people could be replacing other people that are leaving work in other parts of the education sector due to HIV- or AIDS-related illnesses. Who could use it: HR planners and managers; teacher training institutions. Limitations to keep in mind: Surveys can provide unreliable information if they are not well designed, executed and analyzed. In many cases, for example, informants do not reliably recall cases or causes of death or illness that happened over one year ago. Surveys often do not report cause of death or illness with certainty. However, certain responses to high levels of illness, death or attrition will be useful regardless of the specific cause. So absolute certainty may not be critically important. With surveys of this nature, there is no way of assuring that informants are telling the truth. Sometimes it is clear their reasons for wanting to keep information veiled, as is often the case when dealing with HIV and
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AIDS, so questionnaires must be developed in a specific manner to assure that the research is really getting to the core of the assessment. Model answer data slide 3: Important information provided: The graph shows the number of partners of young adults in Johannesburg, by age. For example, of the young adults questioned, approximately 43 per cent of 12-14 year olds have had one partner in past year or during the year 2000-2001. The graph shows that many children in the younger age groups are already sexually active with at least one partner. Who could use it: Planners of prevention, care and support programmes; managers monitoring the effectiveness of programmes; advocacy groups, unions, educators, school headmasters, parent-teacher groups. Limitations to keep in mind: There is no information on the sample of young adults, i.e. their background, race, sex. There could be considerable variations of informants not telling the truth. There is no way to know if and how the study clearly explained the notion of sexual partners to the informants. It can be assumed that they were referring to relations involving sexual intercourse, as this is the most prevalent way of transmitting HIV, but it is not stated. Model answer data slide 4: Important information provided: The information in this graph shows the percentage of grade 10 learners in two provinces of South Africa that have interrupted their schooling for a period of more than one year. It shows that double orphans have the highest percentage of interruptions, followed by paternal orphans. Non orphans have lower interruptions overall. Who could use it: Planners of prevention, care and support programmes; managers monitoring the effectiveness of programmes; advocacy groups, unions, educators, school headmasters, parent-teacher groups. Limitations to keep in mind: The information does not prove a direct link to the impact of HIV and/or AIDS. This graph cannot represent the children who have never attended school.
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Documents Bennell, P. 2005a. The impact of the AIDS epidemic on teachers in Sub-Saharan Africa. In: Journal of Development Studies, 41(3), 440-466. www.eldis.org/fulltext/teachermortality.pdf Bennell, P. 2005b. The impact of the AIDS epidemic on orphans and other directly affected children in Sub-Saharan Africa. In: Journal of Development Studies, 41(3) 467-488. http://ideas.repec.org/a/taf/jdevst/v41y2005i3p467-488.html Government of Rwanda. Terms of reference for an assessment of the impact of HIV/AIDS on the education sector. Harrison, D.; Steinberg, M. 2002. Behaviour change: the cornerstone of HIV prevention. South Africa. Henry J. Kaiser Family Foundation. www.kaisernetwork.org/aids2002/docs/DavidHarrisonPaper.pdf Kinghorn, A.; Kelly, M. 2005 The impact of the AIDS epidemic. Articles by Paul Bennell: Some Comments. In: Journal of Development Studies, 41(3), 489-499. http://ideas.repec.org/a/taf/jdevst/v41y2005i3p489-499.html Republic of Namibia. 2002. The impact of HIV and AIDS on education in Namibia. Executive and extended summaries. Namibia: Ministry of Basic Education, Sports and Culture. Schierhout, G.; Kinghorn, A.; Govender, R.; Mungani, J.; Morely, P. 2003. Quantifying effects of illness and death on education at school level: Implications for HIV/AIDS responses. Final report submitted to Joint Centre for Political and Economic studies, USAID, AusAID, DFID. www.jeapp.org.za/article.php?cat=education&id=11
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Module
W. Heard P. Badcock-Walters
HIV/AIDS challenges for education information systems
3.2
About the authors

Wendy Heard specializes in education planning, project management and the development and improvement of Education Management Information Systems (EMIS) to measure and monitor the impact of HIV and AIDS on the education sector. She is Programme Manager of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on Education. Peter Badcock-Walters is Director of the EduSector AIDS Response Trust and was the founding Director of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He specializes in strategic planning, policy development, implementation design and research, with a particular interest in systemic response, information-based decision support systems, process facilitation and training.
Module 3.2
HIV/AIDS CHALLENGES FOR EDUCATION INFORMATION SYSTEMS
Table of contents
1. 2. 3. 4. 5. 6. 7. 8. Introductory remarks Impact of HIV and AIDS on education Annual data collection processes The need for complementary and local-level EMIS District-level education management and monitoring information system (DEMMIS) Data availability and reporting options DEMMIS implementation planning Prerequisites for successful DEMMIS implementation Management checklist Summary remarks Lessons learned Answers to activities Appendix 54 57 61 62 63 65 67 71 73 75 76 77 83
MODULE 3.2: HIV/AIDS challenges for education information systems
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Aims
The aim of the module is to: alert participants to the challenges that HIV and AIDS pose to Education Management Information Systems (EMIS); provide illustrative examples of how EMIS can be adapted to meet this challenge; consider complementary systems for providing HIV and AIDS-sensitive data for educational planning.
Objectives
At the end of this module you should be able to: identify and describe the function of EMIS in an AIDS era; identify suitable data elements, sources and collection strategies to support a HIV and AIDS-sensitive EMIS, or its development; integrate HIV and AIDS-sensitive data into routine EMIS procedures; identify appropriate tools and techniques to analyse the impact of HIV and AIDS on the education sector at school and district levels.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. How does HIV and AIDS impact on the education sector?
How can the education sector collect data on the impact of HIV and AIDS on teachers, managers and learners?
What suitable HIV and AIDS data are currently available for educational planners?
What data should be collected to regularly monitor, measure and report on HIV and AIDS impact?
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Module 3.2
HIV/AIDS CHALLENGES FOR EDUCATION INFORMATION SYSTEMS
Traditionally EMIS (education management information system) is considered to be the means by which all within the education sector are provided with the data and information required to support their functions. For example, district managers need to know to what extent learner enrolment is increasing or decreasing in particular schools to enable them to plan how many teachers are needed. Regional or national managers also need to know how fast learner enrolment is growing so as to ensure correct resource planning. This module should be studied in conjunction with Module 1.2, The HIV/AIDS challenge to education; Module 1.3, Education for All in the context of HIV/AIDS; Module 2.1, Developing and implementing HIV/AIDS policy in education; Module 3.1, Analyzing the impact of HIV/AIDS in the education sector; and Module 4.3, An education policy framework for orphans and vulnerable children.
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Activity 1
What data are required and what are they used for? Consider what data are used for in the education sector and then indicate five or six applications of these data. Write your responses in the table below. In the education sector data are used to: 1 2 3 4 5 6 7 8 9
It should be clear after completing Activity 1 that data are used for a wide range of applications and these all have implications for educational planning and management. Data are generally used to improve planning and reporting; to measure, monitor and evaluate; to identify trends, to show the extent of impact, to predict or project trends and scope; and to support advocacy. Educational planners, human resource directors, finance and system managers at every level need regular input, performance and output data. EMIS strives to provide information on whether all eligible learners are receiving a quality curriculum from suitably qualified teachers within a reasonable timeframe and in a healthy and stimulating environment.
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Figure 1 The data EMIS provides
Learners Age, gender, grade, repeaters, achievements
Teachers & other staff Age, gender, qualification, experience, teaching level and area
Schools Infrastructure, facilities, resources, curriculum
Consider how EMIS collects data in these three areas? How much detail is collected? How are questions asked? How often are data collected? Do you receive the data or information needed to equip and support you to effectively do your work?
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1.
Impact of HIV and AIDS on education

Through EMIS, all those working within the education sector are informed of what the real situation is. Educational planners and managers need to be provided with data to support their functions and assist with informed decision-making. They need regular data to inform planning, monitor the system, implement policies, and inform areas requiring new policies or policy reform. This is demanding enough, but is further complicated by AIDS and all the challenges it brings. Managers and planners also need key indicators on the impact of HIV and AIDS in order to inform system management and project implications over time. Quality data and value-added information would alert managers to the issues raised by the impact of HIV and AIDS. Information that is easily accessible and presented in a usable format not only creates political awareness but also has a role to play in mobilizing commitment and support for an effective response to challenges and needs. EMIS needs to consider how HIV and AIDS is impacting on learners, schools and teachers and other staff as well as how it affects the demand, supply, cost and quality of education.
Activity 2
Looking at how HIV and AIDS impact on different groups within the education sector. For each of the three groups (learners, teachers and other staff, and schools) in the table below, make a list of how HIV and AIDS impact on that specific grouping.
LEARNERS
TEACHERS AND OTHER STAFF
SCHOOLS
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The AIDS impact is broad and far-reaching. HIV and AIDS tend to explode the scale of existing problems such as access to education, increased absenteeism amongst learners and teachers, increased drop-out and increased poverty, leaving fewer resources for educational needs. A systemic response is required which includes a comprehensive prioritized plan of action based on dependable data, monitoring evaluation and regular review. Seen as a systemic management problem, HIV must be measured and monitored as a 'routine' problem to inform sustained strategic responses. EMIS within ministries will need to be adapted to take account of the impacts and provide data to feed into the planning and costing cycles. The challenge related to EMIS is adjusting or amending it to take into account HIV and AIDS: Can EMIS ask different questions? Should EMIS ask questions differently? When and how often should questions be asked? Can data be drawn from different sources? Do we need to monitor and report more frequently?
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Activity 3
Data required to track the HIV and AIDS impact on education Using the results from Activity 2, consider the area of impact and compile a list of data elements that are required to measure and monitor the HIV and AIDS impact across all levels. Once the data elements are identified, indicate the frequency with which they are to be reported annually, quarterly, monthly, every two to three years? When considering the frequency, remember that there is a trade-off between cost, capacity and need for the data, so try to strike a balance and consider the utility and utilization of the data. Learners
IMPACT
DATA ELEMENT
FREQUENCY
Teachers and other staff

TEACHERS AND OTHER STAFF
DATA ELEMENT
FREQUENCY
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Schools
SCHOOLS
DATA ELEMENT
FREQUENCY
Activities 2 and 3 indicate that HIV and AIDS have added new challenges to EMIS. Additional datum items that need to be regularly reported upon have been identified and it is also apparent that annual data collection processes may not be entirely adequate. HIV and AIDS reporting can be complex and sensitive given the issues of stigma and discrimination, privacy and confidentiality. For instance, there is almost no other way of confirming whether teacher attrition is due directly to AIDS without conducting HIV-testing which comes with its own difficulties. It is, however, argued that the education sector does not need to rely on detailed and accurate HIV and AIDS reporting, nor 'the exact number of teacher or student deaths due to AIDS', but it does need to consider issues of impact. The issue is gross attrition and trends, not the actual number of AIDS deaths. For EMIS, the key issue is the loss of a resource, not necessarily how it was lost. HIV and AIDS have provided the opportunity to reconsider how EMIS functions, what data are collected, and how they are collected, processed and disseminated. The EMIS reform may not necessarily mean asking more EMIS questions, but rather asking the important ones or posing them correctly.
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2.
Annual data collection processes

EMIS generally relies on schools to complete a questionnaire on an annual basis. The data provided by schools are generally compiled into a database and these data are then used to report on the status of education within the given academic year. Some countries across Africa are already incorporating HIV-sensitive questions into these school-based questionnaires or censuses. These may include reporting on the number of orphans or children receiving targeted grants, teacher and learner mortality, or the introduction of AIDS-clubs or other related activities. Box 1 Does the data collection tool administered by your ministry currently include HIV-sensitive questions?
The following website www.mttaids.com has a document posted that provides illustrative examples of how countries are introducing HIV- and AIDS-sensitive questions into their annual data collection tools. Visit the site to download the document and consider if any of the questions can be adopted and adapted by your ministry.
At best, a conventional EMIS captures annual snapshots of the education system and often there are delays in providing feedback to the data suppliers and sharing information with the different levels of educational management, including regional and district offices. If an EMIS were populated with the required information at the necessary intervals, it would generate a set of early warning signals in terms of impending system malfunction or failure. Unfortunately this is not the case with most EMIS in developing and under-resourced countries. Often very little value is added to data or serious analysis undertaken or shared with stakeholders or the information providers. However, education management and the implementation of new policies or strategies must continue, and the lack of reliable data and monitoring means that these processes are often based on estimations, unfounded assumptions or projections. Several ministries are engaged in the process of decentralization where tasks are being delegated to managers at a more local or decentralized level in an attempt to improve service delivery. However, all too often it is these managers who have no access to data or information provided from schools and consequently they are left to their own devices. EMIS is failing to provide the local-level manager with direct access to data and information needed for management, let alone information with reliable evidence of the impact of HIV and AIDS or that which is required to guide response to any crisis in time to avert large-scale systemic failure (Badcock-Walters, 2001).
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3.
The need for complementary and local-level EMIS

There is a real need to develop and introduce HIV-sensitive data-collection systems to allow for more regular reporting. In addition, these should be decentralized in order to provide local-level managers with direct access to data and information to effectively manage the schools for which they are responsible. Much of the data that are needed to report on HIV and AIDS impact are readily available at schools; the information simply needs to be systematized and regularized. Improved EMIS and decision-support information are good for education in the broadest sense, as well as for HIV and AIDS management and mitigation in particular. The need for current, accurate and complete data is probably the greatest motivation for considering a local-level EMIS. Data collected and processed closer to the source of the data are more accurate and complete. The issue of school enrolment lies at the centre of most educational policy and planning decisions. It is the enrolment figure that drives the need for teachers, school buildings, facilities, curriculum, and management structures. Learner enrolment is the single most important education statistic for system managers and planners. Learner enrolment figures are provided by schools and are best collected and collated at district level. They are crucial for the district-level manager. It is therefore imperative that a district-level manager has direct access to detailed, accurate and up-to-date information on learner numbers, since this is the preeminent cost driver of the education system. The manager needs to be able to measure the effect this has on the demand for and supply of teachers and the general provision of education. It is therefore proposed that a simple and accessible district-level education management and monitoring information system (DEMMIS) be implemented to supply information that will assist the district manager to understand and manage issues at a local level. Box 2 Advantages of decentralization
a) The work of EMIS will attract more attention and coverage. Districts can collect more data than the centre requires and use them to their own advantage. b) The quality of data should improve. c) The routine workload of the central EMIS unit will be lower, thus allowing them to provide more assistance to the districts and co-ordinate the work. d) The central EMIS will only require summary statistics, and districts will have the details they require.
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4.
District-level education management and monitoring information system (DEMMIS)

A DEMMIS has been developed to capture a limited number of key management and AIDS proxy indicators on a monthly basis in schools. DEMMIS is designed to facilitate the processing and analysis of these data at the local level and guide immediate management response at the school, circuit and district levels. This system has already been piloted in a district in KwaZulu-Natal, the South African province most affected by AIDS, as well as in Zimbabwe, Zambia and Kenya. DEMMIS focuses on systematically collecting and using information that is routinely available and maintained by schools. It is a purpose-built information system designed to capture statistics on learners, teachers and other staff on a monthly basis. These statistics provide data (by gender and grade in the case of learners) on: enrolment; absenteeism and permanent attrition (including reasons for this); loss of contact time due to absenteeism both of teachers and learners; drop-out; pregnancy and other rates; incremental orphaning rates; reduction in school fees. Schools are required to work from class registers, teacher log books, leave applications and financial records maintained at the school. The data are captured at month-end in the school, using simple forms that provide a two-page summary for submission via the district manager to the district office. The school retains a copy to reinforce institutional record-keeping and management. The district office is then informed on a monthly basis of changes occurring within the schools, and from this data initial crude estimates of the impact of AIDS impact can be developed and areas requiring management intervention highlighted. DEMMIS is supported by comprehensive sets of HIV and AIDS fact sheets and a management checklist. The fact sheets aim to provide accurate information on HIV and AIDS and can be presented in a question-and-answer format that provides answers to the most frequently asked questions. The management checklist provides guidance on management options and responses to indicators of irregularity, dysfunction or even crisis in the monthly data, and the trends emerging from these. A well-maintained DEMMIS is an invaluable management tool. District managers can have complete monthly figures for the learning sites they manage. These figures provide a useful set of time-series data for the analysis of trends on a monthly rather than a yearly basis. This facilitates a rapid-response mechanism which, in view of the growing threat to the system, is clearly required. EMIS is often criticized for providing information that is inaccurate or incomplete. By introducing DEMMIS, the district (typically much closer to the schools) is able to
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check and verify the figures provided. Often the suppliers of information (such as the school management team) have little consideration of the value of the information that is provided for capture in EMIS and therefore forms may be completed in a haphazard or rushed manner. With DEMMIS, this information can be checked more easily and measured against more regular reporting trends. The management is also far closer to the data source and is in the best position to judge the accuracy and completeness of the data provided. Through this local-level tool, a range of basic education indicators, as well as AIDS-sensitive indicators, is made available, alerting management to possible problems and failures within the system. Management can in turn respond rapidly and provide the necessary assistance to stop further degradation of the system. The capture of local-level information is a process that should both complement and supplement the EMIS processes. The central EMIS system will be enhanced by the provision of timely and strategic information that has been validated and checked by local-level managers.
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5.
Data availability and reporting options

DEMMIS asks schools to report on a monthly basis on the following listed items (see below), which can then easily be turned into a simple summary sheet. Table 1 Proposed data items for the introduction of DEMMIS
LEARNERS Number of learners (by grade and gender) Number of days lost through absenteeism (by grade, gender and reason for absenteeism) Number of learners who left school (by grade, gender and reason for leaving). Number of learners who entered the school (by grade and gender). Number of learners newly orphaned (by grade and gender) Number of learners who did not pay fees or were exempt from fees (by grade and gender). Additional questions on curriculum or co-curricular options as well as financial grants or support offered may be included. TEACHERS AND OTHER STAFF Number of members of staff (by gender, source of remuneration and post held) Number of days lost through absenteeism (by gender and reason for absenteeism) Number of days' leave taken (by gender and category of leave granted) Number of staff who left school (by gender and reason for leaving, including resignation and retirement). Number of new members of staff (by gender, source of remuneration and post held) These questions could also be modified to track members of the school governing body or parentteacher association if required.
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Activity 4
Possible questions to be included in a monthly DEMMIS Using the results from Activity 3, consider what questions are to be asked of schools in order to collect the required data elements. Structure the questions so that they can be included in a standard monthly data collection instrument. Group your questions under the headings below: Learners
Teachers and other staff
Schools
Through the monthly collection of these data, the district office, educational planners and managers will have access to a time series of basic school-level indicators, including proxy indicators of HIV and AIDS impact, to guide interventions, measure and monitor impact, and consider areas of intervention that may be required. Some of the management reports that could be generated are: enrolment patterns within an academic year; temporary and permanent absence of teachers and learners by reason; reason for children leaving or dropping out of school; loss of contact time between teachers and learners; orphan rates within schools; pregnancy rates of learners; reduction in school-fee income; teacher attrition at school; mortality rates of teachers and learners. All of these reports could be disaggregated by gender and grade, if appropriate, and tracked month by month across the academic year.
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6.
DEMMIS implementation planning

There are basic principles that should guide the introduction of DEMMIS: Expected tasks must neither be unnecessarily duplicated nor onerous. It should dovetail with existing functions of officials concerned. It should generate locally relevant and useful information. Data should inform and direct district management interventions. Information must be readily available in the average school. Indicators must not be hard to capture. Information produced by DEMMIS must be readily consumable by locallevel officials and communities. Information must be able to be fed back into EMIS. When considering the implementation of DEMMIS, it is important to begin with the end in mind. That is to say, be clear on what you want the system to deliver. What decision-making is to be supported? What aspects need to be tracked and monitored? What are the reporting requirements? How often does the required information change, and how frequently does it need to be collected? The answers to each of these questions will assist in identifying the required data elements and the frequency of data collection. DEMMIS, like any other MIS (management information system), needs to follow the accepted cycle of management information systems development.
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Figure 2 Management information system implementation
Feedback and review
Needs analysis
Publication and dissemination Putting it all together Publication Distribution Presentation Training Reaching the user
Data collection Questionnaire design & review Pre-testing Printing of the data collection tool Distribution Training in completion of form Submission Follow-up
Data processing Data analysis Compilation Reporting Trend analysis Programme design Programme testing Programme implementation Training Data capture Regular maintenance
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Activity 5
Planning for DEMMIS Consider all the steps for implementing a management information system. Draw up an action plan for the implementation of a DEMMIS pilot. Use the template provided below.
ACTIVITY TIME FRAME START END LEAD PERSON DEPENDENCIES RESOURCES REQUIRED COST MEASURABLE INDICATOR
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The human resource requirements for the successful implementation of DEMMIS, as with any management information system, should not be overlooked. The key persons are those required to assist with the survey design, the design of the data capture and reporting system, and the monthly data capture of the returns. The survey, the DEMMIS data capture and the reporting system design require a specific level of technical expertise and should be done with the central EMIS unit. The monthly data capture requires that the designated official be familiar with the keyboard (a skill that can easily be acquired) if a computerized system is to be used. While DEMMIS can be purely a paper-based system, the introduction of computers to assist with data capture and analysis is recommended given their flexibility in manipulating data and generating reports.
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7.
Prerequisites for successful DEMMIS implementation

In reviewing the experiences of DEMMIS pilot schemes and the implementation of general EMIS, some conditions for success should be taken into consideration. An enabling environment: It is critical to the success of DEMMIS implementation that there be general support from all those involved and a climate of positive political will. Schools must be willing to co-operate and provide the data regularly; teachers within the school should be willing to play their part; district officials must understand what will be required of them and also the benefits they will reap. EMIS officials need to also understand and consider the benefits of DEMMIS. In short, everyone will be required to work together to ensure the success of DEMMIS. Central to creating and ensuring an enabling environment is a basic understanding of what the data are to be used for and also what value there is for individuals and the education sector as a whole. School record-keeping: Since DEMMIS is dependent on the data provided by schools, it is important that the systems used to collect the required data elements be in place and effectively implemented. School-level managers should be encouraged to implement daily maintenance of the records, i.e. this should not be left to the last day of the month. It is recommended that standardized forms are used in the schools as this avoids any confusion and limits errors in reporting. DEMMIS also has as its purpose to strengthen record-keeping. Detailed working procedures and guidelines: There needs to be clarity in terms of what is expected of the various role players. Within the bureaucracy of the education sector, persons at different levels rely on detailed working procedures and guidelines that describe their functions and responsibilities. Data utilization: Only collect data that are to be utilized and required to feed into the planning and management needs. Do not collect data just for the sake of it and do not be tempted to expand the data collection instrument unnecessarily. Archiving and filing: At school and district-office levels it is important that effective filing systems be implemented and maintained. In seeking clarity at a later stage it may be important to refer to the original documents, and for this reason these should be easily accessible. Accuracy and completeness of data: Schools should be encouraged to provide accurate and detailed data. When training in the completion of the DEMMIS form is provided, these aspects should be highlighted. Before submitting the return, schools should check that all totals tally. Much time is lost in following up on questions with regard to inaccurate or incomplete returns.
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Information sharing: It is critical that information be shared as soon as possible. This process has several benefits: evidence is made available showing that the submissions are being processed and the data are being utilized; it allows feedback on a process and assists in addressing issues of data quality, among others. Central to the implementation of DEMMIS is the need to consider that effective EMIS has specific users who demand specific information in order to inform decisions for which they are accountable.
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8.
Management checklist
HIV and AIDS have compromised the ability of system managers to guide and direct the business of education at all levels. Because of HIV and AIDS, education is no longer business as usual. Given the far reaching impacts of HIV and AIDS, it will be a key factor in every aspect of planning and administration and will have to be considered in almost every management decision. The local and district levels of management are critical since they are more directly linked to the provision of teaching and learning. It is at these levels that managers are directly in touch with the realities of the classroom and the communities from which teachers and students are drawn. It is important that these managers be empowered with factual information and data on how HIV and AIDS affect classroom activities and the impact felt in their local area. While the DEMMIS data may indicate an understanding of how HIV and AIDS are affecting schools, managers need to consider what can be done to address the issues. A management checklist should be designed to identify the areas of HIV and AIDS impact and provide practical ideas about how they should be tackled rapidly and responsibly. Managers at the local level are to be encouraged to be more creative in problem solving. Many of the issues that these managers face will be new or unique, but more often than not they will be confronted by old problems on a new scale. Sometimes there are no simple or obvious answers, and new and innovative approaches are required.
Activity 6
Management checklist to provide early warning signals Consider the management of teachers at district level and for each specific area listed below. Consider and present your findings as a composite district-level management checklist What signs or signals would point to an impending problem? What checks and controls need to be put in place? What action is required? What are the broad planning and management issues?
The management checklist, together with the DEMMIS data, aims to provide early warning signals that all may not be well within the district and that specific interventions are required. The checklist will also assist in report preparation,
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contingency planning, providing counselling and general communication as well as monitoring. The demand for information is to be stimulated by sustained evidence of useful, value-added information and enhanced capacity to make informed decisions.
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Summary remarks
HIV and AIDS are constant companions to the management of education and other social systems; however the impact on education can be mitigated through better management practices. Educational planners need to be made aware of management issues and provided with the tools and techniques to obtain the data they need to control and pursue with greater effectiveness what they are trained to do. The role of EMIS and the provision of data through complementary systems such as DEMMIS allow local-level management to be informed of broad management issues that will also generate proxy indicators of the HIV and AIDS impact to warn of impending system failure and areas of concerns that need addressing.
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Lessons learned
Lesson One EMIS/DEMMIS can help educational planners by providing them with data to support their functions and assist with informed decision-making. Quality data on the demand, supply, cost and quality of education can alert managers to the issues raised by the impact of HIV and AIDS and allow them to plan effective responses. Lesson Two Much of the data that are needed to report on HIV and AIDS impact are already available in schools; the information simply needs to be systematized and regularized. Lesson Three DEMMIS is designed to facilitate the processing and analysis of these data at the local level and guide immediate management response at the school, circuit and district levels. Lesson Four The advantage DEMMIS has over EMIS is that the district (typically closer to the schools themselves) is able to verify the figures provided against a comparatively intimate knowledge of the schools and district environment. This can contribute to and enhance the quality of EMIS data, as well as enrich it with additional elements and the validation of time-series trends.
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The solutions provided in this section are provided as illustrative examples. Solutions are subject to country-specific details and experiences. Activity 1
In the education sector data are used to: 1 2 3 4 5 6 7 8 9 improve educational planning measure monitor and evaluate identify trends show the extent of impact (of a programme or problem) predict or project trends and scope improve or support reporting and accountability support advocacy assign resources teachers, materials, schools and finances
Activity 2
LEARNERS Change in enrolment Absenteeism Increased drop-out Increased morbidity Increased pressure household chores and responsibilities Less money available More orphans Child-headed households Change in curriculum
TEACHERS AND OTHER STAFF Absenteeism Increased drop-out Increased morbidity Increased pressure extended families Less money available Support to orphans Increased need for providing counselling New curriculum Increasingly need to take on the role of parent/s Filling in for colleagues Change in staff
SCHOOLS Change in enrolment Change in curriculum Difficult to predict uncertainty Financial pressures
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Activity 3
Learners
IMPACT Change in enrolment Absenteeism Increased drop-out Increased morbidity Increased pressure household chores and responsibilities Less money available More orphans Child-headed households Change in curriculum
DATA ELEMENT Enrolment by grade and gender over time Number of days lost through absenteeism Cause for absenteeism Number of children who stopped schooling. Reason for stopping school Covered in # 2 and #3 Not feasible to be collected at school level rather conduct sample study with individual students School fees or levies not paid Number of orphans by gender and grade Type of orphaning Number by grade and gender Curriculum offered Co-curricular activities Participation in subjects and activities M M M M M
FREQUENCY
M M/A M/A M/A M/A
Teachers and other staff TEACHERS AND OTHER STAFF Absenteeism Increased drop-out Increased morbidity Increased pressure extended families Less money available Support to orphans Increased need for providing counselling New curriculum Increasingly need to take on the role of parent/s Filling in for colleagues Change in staff
DATA ELEMENT Number of days lost through absenteeism Cause for absenteeism Number of teachers/staff that left school. Reason for leaving school Covered in #1 Number of teachers/staff supporting extended families Number of teachers/staff facing financial pressure Number of teachers/staff supporting orphans An indication of numbers or reported cases Details of curriculum An indication of numbers or reported cases Linked to #1 Number of temporary members of staff appointed/required Number of new members of staff
FREQUENCY M M M M M M M M/A M/A M/A
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Schools
SCHOOLS Change in enrolment Change in curriculum Financial pressures
DATA ELEMENT Enrolment by grade and gender Details of curriculum Reduction in fees and levies collected
FREQUENCY M M/A M/A
N.B.: M=monthly; A=annually Activity 4 Learners Report on learner enrolment by grade and gender Report on days lost through absenteeism Report on causes of/reasons for absenteeism Report on learner leaving school Report on cause of/reason for leaving school Number of learners not paying fees or levies Number requiring/receiving financial assistance Number of orphans by different category of orphanhood Number of child-headed households Learner-involvement in curriculum or specific subjects and/or cocurricular activities Staff and teachers Report on staff numbers by grade and gender Report on days lost through absenteeism Report on causes of/reasons for absenteeism Report on staff leaving school Report on cause of/reason for leaving school Number of orphans supported Number of learners being counselled School Enrolment numbers by grade and gender New curriculum and co-curricular activities offered Reduction in fees or levies collected
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Activity 5
ACTIVITY Design and test instrument for user needs analysis Conduct user needs analysis Agree on data elements and reporting requirements Design data collection tool Approval of data collection tool Popularization of DEMMIS Agree on pilot schools/districts DEMMIS orientation training and completing DEMMIS form Distribution of DEMMIS forms Design and testing of DEMMIS system System installation and training Capture of DEMMIS return Data analysis and generation of reports TIME FRAME START END LEAD PERSON DEPENDENCIES RESOURCES REQUIRED COST MEASURABLE INDICATOR Tool used for user needs analysis Evaluation report on pilot test of tool Report on findings of user needs analysis Listing of data elements Document of consultation process Data collection tool Approval granted Reports on information sessions List of schools/district Training material Persons trained Forms reach schools System tested System installed Staff trained in system administration Return submitted and captured Reports available
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Activity 6 For illustrative purposes, a management checklist for teacher absenteeism is provided.
Signs Increase in absenteeism amongst teachers? Increase in multi-grade classes? Loss of contact teaching time? Increase in sick-leave taken by teachers? Increase in applications for compassionate leave? Extended sick leave taken by teachers? Members of school staff attending more funerals? Loss of family members amongst school staff? Staff experiencing family trauma? Increase in applications for possible early retirement or medical boarding? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No
Checks and controls Application for leave completed, approved, submitted and processed Check reported absenteeism rates Secondment of teachers if required and appropriate Track how delivery of curriculum is being affected
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Action required Process leave form Consult leave regulations for teachers Ensure that leave is available. Ensure that teacher completes required leave form/s. Submit application form to regional office, personnel section Application for leave is logged in PERSAL system. Report absenteeism in excess of 10 working days Make application for secondment of teachers Inform personnel section within region of extended absenteeism
Investigate how curriculum offered at the school is being affected. Does this involve specialist teachers? Are schools required to introduce multigrade classes? Consult regulations as to when secondments can be put in place. Submit detailed report together with full motivation for appointment of secondment to provincial office Contact personnel section within province to follow up on application Keep school management team informed of progress
Planning and management issues: Required to keep detailed and accurate attendance records for all teachers Resource: Introduction of monthly DEMMIS return Develop a detailed register of teachers available for secondment or relief work Resource: Introduction of register of teachers Encourage the use of voluntary counselling and testing (VCT) services Resource: Local VCT services Implement AIDS awareness and education programme Resource: Work with the departmental HIV and AIDS team and the Department of Health
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Appendix
Example of a DEMMIS form for secondary schools in Kenya
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Documents Badcock-Walters, P.J. 2001. Management of HIV/AIDS at the education district level: The case for collection of local indicators. South Africa. MTT. Badcock-Walters, P.J; Heard, W; Wilson, D.C. 2004. Developing district-level early warning and decision support systems to assist in managing and mitigating the impact of HIV/AIDS on education. South Africa. MTT. Chapman, D.W; Mhlck, L.O. 1993. From data to action: Information systems in educational planning. Oxford: IIEP-UNESCO; Pergamon Press. Heard, W. 2003. Examples of HIV/AIDS sensitive questions used by EMIS across Africa. South Africa. MTT. Heard, W; Badcock-Walters, P.J; McKay, E. 2004. MTT Concept paper 2: DEMMIS: A local level management tool. Heard, W; Smart, R; Badcock-Walters, P.J. 2001. District managers resource kit. Durban: HEARD University of KwaZulu-Natal. Kelly, M.J. (SJ). 2000. Planning for education in the context of HIV/AIDS. Paris: IIEP-UNESCO. McKay, E; Heard, W. 2004. MTT Concept paper 1: Education Management Information Systems in the era of HIV an AIDS: An introduction. Durban: MTT. Ross, K.N.; Mhlck, L..O. 1990. Planning for quality of education. Oxford: UNESCO/Pergamon Press.
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Module
O. Akpaka
Qualitative research on education and HIV/AIDS
3.3
About the author

Patricia Dias Da Graa is Programme Specialist at the International Institute for Educational Planning. Her research and training activities mainly include education information systems at local and national level, development of indicator systems for educational planning, projection methods and techniques.
Module 3.3
QUALITATIVE RESEARCH ON EDUCATION AND HIV/AIDS
Table of contents
Questions for reflection 91
Introductory remarks 92 1. Conducting qualitative research to better manage the situation 94 Why is the qualitative approach particularly appropriate in the context of HIV/AIDS? 94 How may qualitative research help educational planners and administrators to deal better with the effects of the epidemic? 96 2. Collecting, processing and analyzing qualitative data in the context of education and HIV/AIDS 100 Data collection techniques 100 Sorting, processing and analyzing qualitative data 105 3. Associating qualitative and quantitative research 109 Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 113 114 117 121
MODULE 3.3: Qualitative research on education and HIV/AIDS
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Aims
The aims of this module are to: explain the value of qualitative research for educational planners and administrators in the context of education and HIV and AIDS; introduce you to use of the different techniques applied in qualitative research.
Objectives
After completing the module, you should be able: to explain the relevance of qualitative research in the context of education and HIV/AIDS and its usefulness for educational planners and administrators; to identify the various techniques qualitative research assignment; that can be used in a
in collaboration with researchers, to apply these techniques for collecting, processing and analyzing data that contributes to improved management of education when faced with the AIDS epidemic; to determine how quantitative and qualitative research should complement each other.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What difficulties are you confronted with when trying to find out how the AIDS epidemic impacts on the education system in your country and how it reacts?
Can you identify the benefits of greater insight into action undertaken in education in your country to cope with the situation brought about by HIV and AIDS?
What methods of research/investigation do you know that enhance understanding of what occurs in education systems confronted with the AIDS epidemic?
Do you consider that the data in your possession enable you to understand problems such as that of orphans and vulnerable children (OVC)?
What do you think would be the most useful to understand the impacts of HIV and AIDS on education systems: a statistical survey or qualitative research?
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Module 3.3
QUALITATIVE RESEARCH ON EDUCATION AND HIV/AIDS
The AIDS epidemic constitutes a real development problem from which no country is immune and which affects sub-Saharan Africa in particular. According to UNAIDS statistics (December 2004), 39.4 million people were living with HIV in the world in 2003. According to the same source, AIDS-related deaths were put at 3.1 million. HIV and AIDS affect supply and demand in education no less than its quality. It compromises the attainment of various aims and especially the provision of quality education for all (see Module 1.2, The HIV/AIDS challenge to education, and Module 1.3, Education for All in the context of HIV/AIDS). It is thus urgently necessary for education ministries and, in particular, for educational planners and administrators, to give due attention to HIV and AIDS in their work. The challenge is both to limit the impact of HIV and AIDS to satisfy the educational needs of learners more effectively, and to develop innovative educational solutions. This presupposes that planners and administrators in education have at their disposal data taken, for example, from periodic administrative reports, school statistics and studies, and, in particular, qualitative research. Supposing that you wish to examine HIV- and AIDS-related initiatives in your region, you may do so in different ways: using a statistical questionnaire; counting the activities carried out in a given period; interviews; or classroom observation of a lesson on HIV prevention. While the first two methods are essentially quantitative, the last two are qualitative. So what do we mean by qualitative research? According to the definitions proposed by different researchers, qualitative research is a scientific approach to information gathering, which is designed to observe social interaction and understand individual perspectives. It provides information on the experience of individuals, why they adopt certain attitudes, and the kind of incentives that may lead them to change. Qualitative data are non-numerical; they may consist of detailed descriptions of situations or types of interaction, personal testimony and statements obtained directly from individuals about their experience. As in the case of any research, qualitative research is conditioned by its own goals and concerns and by working hypotheses. Its findings cannot be regarded as generally applicable to the national context, but it provides much information relevant to the understanding of phenomena. It is no easier for the fact that it is based on non-numerical data. It calls for the scientific discipline required in any kind of research.
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In this module, we shall study together in turn: why qualitative research may contribute to improved management of the education situation caused by HIV and AIDS; how to collect, process and analyze qualitative data in the context of education and HIV/AIDS; and the benefits that may be gained from associating qualitative and quantitative research to obtain the data needed to improve planning and management in such a context. In the course of the module, we shall use the term approach to refer to the strategic emphasis of research and the term techniques to describe the means used to carry it out.
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1.
Conducting qualitative research to better manage the situation

In this first part, we shall begin by seeing how the qualitative approach is especially appropriate in studies concerning HIV and AIDS, and then how it may help educational planners and administrators to deal better with the effects of the epidemic.
Why is the qualitative approach particularly appropriate in the context of HIV/AIDS?

Figure 1 The qualitative approach The qualitative approach
Can overcome certain kinds of resistance and is suited to delicate issues such as HIV and AIDS. Aims at a fuller understanding. Pays due regard to the context the socio-cultural context in particular. Is conducive to the involvement of the social groups concerned.
Overcoming certain kinds of resistance HIV is a sensitive issue. Fear of stigmatization or shame may block all communication. However, the qualitative approach is especially suited to delicate issues; it is responsive to the complexity of situations and human behaviour; it is attentive to different modes of communication (spoken language, body language, written records, etc.). In a qualitative research assignment, for example, it will be easier for school heads to acknowledge that certain persons living with HIV are absent, whereas with other approaches they might not disclose such absences to avoid bringing shame upon these persons or their school.
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Fuller understanding Qualitative research is concerned with the 'why' and the 'how', and seeks to grasp what is actually happening rather than just regulations and norms: It studies knowledge and insights regarding HIV and AIDS. It makes it possible to identify the needs and anxieties of the persons involved and unlock the real experience of others; it explores the concerns of all interested parties affected in one way or another by the epidemic. It distinguishes, like Randall (1988), between what people say they have to do (the rules), what they say they do (the norms), and what they actually do (reality). It takes account of the constant interaction between points of view and processes, and accepts contradictions. The qualitative approach provides for the study of persons and essential elements as a single whole and not as variables. The aim of understanding lies at the heart of the qualitative approach with a far greater emphasis on processes and the significance of attitudes, points of view and actions than on their frequency.
Typical questions that may very well be addressed in a qualitative approach to research are "Why do teachers, although well informed, continue to have high risk sexual behaviour patterns?"; "What sense do families who take in OVC have of their responsibilities with regard to the education of these children?"; and "Is HIV/AIDSrelated absenteeism perceived in schools as something different from absenteeism in general?".
Due regard paid to the context the socio-cultural context in particular
Qualitative research is intended to give meaning to phenomena studied in their context, which may, for example, differ in an urban as opposed to a rural environment, or depending on whether socio-cultural groups are more or less responsive as regards matters relating to sexuality. It is especially recommended for analyzing AIDS-related social representation, whose crucial significance in processes involving the stigmatization of people living with HIV and their entourage is fully acknowledged (see Module 1.4 on HIV/AIDS-related stigma and discrimination). Qualitative research offers a better grasp of the changing social experiences of different groups and of attitudes vis--vis seropositivity and the illness. The techniques used in qualitative research (discussed in the following section), such as personal testimony, interviews, and accounts of past experiences help ensure that due regard is paid to this cultural context. Thus information obtained from people living with HIV and members of the community will be of assistance in providing contextual data that can help to answer the questions addressed by research, which are important in establishing a programme for preventive education, such as "What are the attitudes of parents and communities vis--vis teachers living with HIV, and how open are they in discussing HIV-related sexual issues with young people?"
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Social groups that are affected are more likely to be involved. In qualitative research, the relation between the researcher and the persons asked to contribute to the research is often of a personal nature. It provides those concerned with an opportunity to say why they think and act as they do, and they feel more appreciated for who they are. The groups concerned are not mere objects but real protagonists of research. Thus evaluation of the work of peer educators via a qualitative approach will involve them and lead them to consider both their relations with their companions and with adults (school authorities, teachers, parents) and the restrictions that they encounter. Ready adaptability to varied and unorthodox situations The qualitative approach is an open and flexible process as has been indicated above. It offers opportunities for exchanging tools or the sample to adapt to a situation which, when work began, was not considered to be so important. It provides for the study of a restricted number of groups (microobservation). It offers freedom to use several techniques to capture the reality of a given situation. Each of these techniques allows for a certain degree of flexibility, in order to adapt to the individuals or groups that are the subject of research. Indeed, when confronted with an issue as delicate as HIV, the ability to be very flexible is often required: if necessary, this may involve disregarding interview guidelines prepared beforehand to concentrate on listening to a teacher living with HIV or his/her partner, or to conduct the interview in several stages if the interviewee feels tired. However, this kind of adaptability is not tantamount to lack of order or selection criteria as we shall see below (see Section 3).
How may qualitative research help educational planners and administrators to deal better with the effects of the epidemic?
Qualitative research provides information needed for national, regional and local planning in the context of education and HIV/AIDS. Such research: may help to establish the goals and aims of national/regional/sectoral programmes on the basis of the real life experiences of those concerned; contributes to the identification of needs (that are not solely quantitative), such as those of students that are being discriminated against or teachers obliged to replace sick colleagues (see Module 4.2 on Teacher education and development in the context of HIV/AIDS); describes and examines social phenomena such as stigmatization that planners have to take into account in their work;
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provides a multidimensional perspective on a social situation an aspect that is essential in the context of HIV and AIDS. Qualitative research supports the implementation of strategies and plans, in that it identifies sources of blockage in the current situation, for example in the implementation of strategies for the education of OVC; provides a basis for taking up the ideas of different players in education with a view to improving a programme or service, such as care of educational staff living with HIV; contributes to the identification of positive strategies, and useful models for expanding and/or duplicating them, such as the involvement of community radio in preventive education.
Activity 1
A regional work plan A has been devised on behalf of OVC in primary education. Improve this plan A using data derived from qualitative research. Plan A provides for: the delivery of school materials for OVC in primary schools in the region at the start of the school year; exemption from payment of the financial contribution to the association of pupils parents; the donation of clothes at the end-of-year festive season. Under the plan, OVC normally receive school materials and clothes from NGOs or associations. Some data obtained from qualitative research are that: teachers do not always know which children in their class are OVC; the lack of school materials is glaring in the case of OVC, but also noted among other pupils; families that take in OVC ask some of the boys and, above all, many girls to stay at home to help with the housework; the death of parents has a psychological and social impact often reflected in acute anxiety, loss of self-confidence, a sense of stigmatization and apathy in the classroom; the work of the NGOs or associations involved in the support offered to OVC is compartmentalized. Recommended exercise: Spend 15-20 minutes preparing a plan B that takes into account the data derived from qualitative research. When you have finished, you can compare the result with the answers suggested by the author at the end of this module.
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Qualitative research makes it easier to monitor the impact of the epidemic on the education system and on the quality of education in particular. The importance of monitoring and evaluation for planners and administrators is fully acknowledged. In the context of education and HIV/AIDS, the qualitative approach may: provide information on trends in the side effects of HIV and AIDS which hamper the provision of education and/or the quality of the services offered; identify practices in managing the absence of sick teachers and the solutions offered by various players in the system; explore changes in attitudes vis--vis school education in families affected by the epidemic; look for relations between difficulties experienced by pupils at school and their OVC status; identify changes that have occurred in school management which might be profitable for the system in general. Qualitative research is conducive to collaboration with other sectors. Depending on the problems that become apparent during research, educational administrators may be justified in establishing an intersectoral team for joint actions. With information derived from qualitative research, it is easier to clarify the roles of various agencies, for example in caring for educational staff affected by HIV and AIDS (social and health services, NGOs and associations involved in preventive action, elected representatives and religious officials). The foregoing points are summed up in the diagram below.
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Figure 2 The role of qualitative research
Qualitative research Is conducive to collaboration
Helps to improve the effectiveness of preventive education and of advocacy. Makes it easier to monitor the impact of the epidemic.
Supports the implementation of strategies and plans.
Provides information needed for planning.
Activity 2
Are you convinced that qualitative research is relevant and helpful to educational planners and administrators in the context of education and HIV/AIDS? If you feel that the qualitative data derived from research may assist you with your work and consider that this type of research is interesting, notwithstanding certain limitations (see below), it is suggested that we progress to Section 2 on Collecting, processing and analyzing the data concerned. If you are sceptical, try to analyze your reservations in terms of the following two questions: List the reasons for your scepticism.
Imagine the arguments that someone in favour of qualitative research might use to counter them.
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2.
Collecting, processing and analyzing qualitative data in the context of education and HIV/AIDS
Data collection techniques
Individual interviews, group discussions and observation are the techniques most frequently used and referred to in the literature on the qualitative approach. However, there are many others that we shall now review in brief. Individual interviews Aim: elicit personally expressed detailed observations regarding the subject of research Target groups: of special interest for use with policy-makers and those who have been personally and substantially affected by the existence of HIV and AIDS (such as people living with HIV or those close to them). Different approaches depending on whether the interview is structured (or directed) with a list of predetermined questions, some of them closed (as in quantitative research), others open; semi-structured (or semi-directed) with a list of topics or important points for discussion. Here, the principle is to let the interviewee talk freely and then return to points that have not been covered or need to be explored further; free (or non-directed), in which the person is asked to speak very freely on a topic while the interviewer intervenes solely to make a fresh start or rephrase something in order to facilitate communication and get the interviewee to expand on what has been said. None of these kinds of interview should be confused with either a conversation or any form of therapeutic exercise. Advantages: confidentiality, flexibility, a wide variety of interesting information on complex situations, interest on the part of those who are encouraged to express themselves and who feel listened to. Thus during an interview of this kind, a teacher living with HIV in private education in Togo was able to explain the discrimination to which he was subject. Limitations: time-consuming (ranging from around 15 minutes to 2 hours), calls for training in listening and is language dependent (though it is also important to observe body language which is sometimes more communicative than words, and to be attentive to what is not said and consider the meaning of this kind of silence). Certain interviewees may not tell the truth, especially where a subject such as HIV is concerned. Tape-recorded interviews are not often willingly accepted and call for lengthy transcriptions, while note-taking requires training so that interviewers remain attentive to what is said. It is vital not to rely on ones memory and to write notes on completed interviews immediately or every evening.
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Focus-group discussions Aims: gather a broad range of ideas, opinions and experience relating to the focal points of the research. Target group: a group with a certain degree of homogeneity (in terms of age, sex, social status or professional activities), such as mothers of pupils asked to talk about school drop-out among girls, one of whose parents is sick. No more than 15 persons. Approaches: these are semi-structured discussions in which the group moderator possesses a guide prepared in advance containing the topics or important points for discussion (as in the case of a semi-structured individual interview). Moderators use the guide very flexibly (topics may be added or left out depending on the group concerned). They are meant to encourage the development of group dynamics in which interaction between participants is direct and to the point so that everyone will want to contribute. Discussion should be focused on the group, and not on the moderator who merely encourages the group members to elaborate on what is said. Advantages: flexibility, the emergence of fresh ideas, intensive provision of a variety of data in a relatively short period (usually between one-and-ahalf and two hours), the participants occupy centre stage and are thus likely to contribute later to the implementation of a plan or programme. Thus focus groups with teachers in Burkina Faso revealed how they could contribute, alongside peer educators, to the preventive education of pupils. Limitations: certain dominant individuals may prevent others from speaking or significantly influence them; even in a homogeneous group, some members may be reluctant to share their experience; the skill of the moderator is a key factor in creating group dynamics. If discussions are not tape-recorded (considering the attendant difficulties already indicated), an assistant should note what is said and by whom.
Activity 3
Prepare the main outlines of a guide for a group discussion with heads of area education authorities on problems encountered in managing teacher absenteeism caused, among other things, by HIV and AIDS.
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Participant or non-participant observation Two kinds of observation techniques can be distinguished, participant or nonparticipant, depending on whether the researcher is observing with or without intervening directly or indirectly. Here are two examples: the activities of AIDS clubs organized in schools and life in families that take in OVC. Depending naturally on the aims of the research, the first example might be the focus of non-participant observation and the second of participant observation. Aim of the observation: to record (in writing or with a tape-recorder or camcorder) the proceedings seen or heard in real life situations occurring in the presence of the researcher. Target situation: any situation relevant to the issues addressed by the research. In non-participant observation (also referred to as uninvolved or external), the situation is in general arranged beforehand, as in the case of talks on preventive education organized in AIDS clubs. Approaches: non-participant observation involves structured and methodical observation of behaviour and conversation in a natural environment. While observation is selective solely in terms of its relevance to the focal points of the research, it is not totally all-inclusive, so, where it is written, there is something be gained from a table that: notes the elements for observation, specifies the successive periods of time involved, distinguishes between the actions/involvement of the various players, depending on circumstances. In participant observation (practised notably in anthropological research), in which researchers are fully involved in the life of the group being studied and assume an active role over and above that of their research function, tables are also used but on a less regular basis. What is observed is often recorded in the researchers log book. Advantages: the subjects of the research can readily be viewed from very close range, and behaviour and situations recorded just as they occur without the need for an intermediary. Limitations: the presence of the researcher exerts a greater or lesser influence that depends on circumstances but is rarely non-existent. The role of the researcher in the group being studied requires careful thought. Projective composition Aim: elicit personal observations regarding subjects about which people might be reticent or even totally uncommunicative. Target group: may be used with any group capable of writing short essays (corresponding roughly to at least initial secondary school level). Pupils accustomed to written composition are particularly at ease with this kind of technique. Approaches: ask group members to write an essay on a given subject as spontaneously as possible, explaining that it is not a school exercise and that mistakes do not matter, but without elaborating further on the subject concerned (which might influence the outcome). The activity
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should be kept anonymous with a request for just some items of information age, sex, locality and class (in the case of pupils). The subject text should be short and readily understood by those for whom it is intended, and describe a situation well-known to them or at least not one they have never experienced: the environment is familiar, but those surveyed are not questioned directly. All members of one class may be given the same subject, or two or even three different subjects. Here are two examples of projective composition given to pupils in their second year of secondary school in Burkina Faso: 1. On a rainy day, a girl in your class accepts when a man offers to drop her off at school. In the evening, she is glad to see that he is waiting for her again with his fine car. Before she gets in he says, "I have a nice present for you but Ive forgotten it at home. Come with me and Ill give it to you. My wife is not there". Say how the girl will react and the advice you would give her. 2. A pupil in your school often misses lessons. It is rumoured that he may have AIDS. Imagine how pupils in his class might react and their reactions to him. 3. One variant of projective composition exists in the form of sentences for completion, such as: "One associates AIDS with.". The respondent is expected to answer quickly. Advantages: a technique for fast information gathering requiring no special form of training, which costs little in terms of time or money and enables members of the group concerned to express attitudes and opinions of which they are not always aware. Limitations: the technique has to be used almost exclusively with young school pupils, and calls for lengthy processing and analysis.
Activity 4
Prepare an exercise in projective composition for pupils in their third year of secondary school. The subject of composition will be sexual relations between teachers and pupils (of either sex).
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Visualization in participatory programmes (VIPP) This method is customarily employed to stimulate a group. It may also be used during a qualitative research assignment. Aim: to enable each member of the group to take part in the process of reflection, identification of problems and research, and elicit the views of each. Target group: any group of school pupils (at initial secondary school level at least). The method may be used with seven or eight persons, though ideally there should be 15-20 participants. It is possible with 40 participants divided into sub-groups of two or three persons who discuss and agree to prepare two or three cards. Approaches: ask an appropriate question, such as "What perceptions do teachers have of AIDS?". Distribute the same given number of cards (two or three) to each participant or group of participants. Comply with certain rules when filling in cards (just one idea per card in no more than three lines). Gather in the cards, display them and ask participants which cards go with which others, discuss the outcome and rearrange them in accordance with the groups wishes. Each idea counts and no card should be rejected. The group should agree on a title for each set of cards. It is possible to elaborate on one of these sets by repeating the exercise afresh or using another technique. Advantages: everyone is involved and has a say, including the shyest, while a rich variety of ideas are expressed on which it is possible to expand, with scope also for a focus on taboo subjects. Limitations: the interest and variety of the discussions if not somehow recorded may be lost once a title is agreed; some apathy may set in if the moderator wishes to elaborate on group discussions several times. As in the other methods described above, there is no substitute for a good moderator. Other techniques Many other techniques may be used to collect qualitative data that provide greater insight into the real life experience and perceptions of various people as regards HIV and AIDS, the significance of their attitudes and the processes at work in the context of education and HIV/AIDS. Among them are the following: Case studies and stories providing a basis for further thought and discussion inspired by particular cases. Accumulating songs or drawings that encourage understanding of social representation in a given socio-cultural context. Collating minutes of meetings or a variety of texts, analysis of which will help, for example, to clarify trends in managing people living with HIV in the education system. Appropriate techniques should be selected in accordance with the issues addressed by research, the target group and the human, organizational and financial means available. It is also possible to combine several methods to study the same phenomenon (this is known as triangulation) and corroborate the findings.
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By means of the different techniques described above, you are going to gather a mass of information. The aim is not to gather it for the sake of doing so but to achieve the goals of the research and answer the questions confronting it. For this purpose, the data collected have to be sorted, processed and analyzed.
Sorting, processing and analyzing qualitative data

In the interest of clarity, there is a need to distinguish between data sorting, processing and analysis. In reality these different operations overlap, especially in qualitative research in which the process is continuous and progresses frequently back and forth, and are always closely related to the focus of research and its working hypotheses.
Stages in the sorting of data

This sorting involves: looking for information concealed in the database; causing data to reveal information that validates or invalidates something, or gives rise to doubts or further questions concerning the research topics at issue; clarifying acquired knowledge. Sorting of data may begin when it is being collected and continues when collection has finished. Work on codes begins with the preparation of guides for interviews or group discussions, but qualitative data sorting is a continuous process and it is possible to add codes or discard some of them in the light of information obtained during data collection. Encoding always takes place when collection has been completed.
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Figure 3 The sorting process
Sorting
Building up an ordered database Structuring and condensing data Noting words, phrases, expressions Preparing the thematic data handling grid
Building up an ordered database: establishing the list of documents and interviews, entering the different kinds of output (individual interviews, group discussions, observation, personal testimonies, etc.). Structuring and condensing data: identifying important topics for the issue under consideration or recurrent topics; classifying data in accordance with research already carried out in the same area, and with the central questions underlying it and the expected outcomes; drafting summaries and rearranging data; developing visual methods of condensing data: graphs, diagrams. Noting words, phrases and expressions used by those active in the research, which provide for greater insight into social, interpersonal and behavioural dynamics and which will help you, when presenting the results, to report verbatim what has been said by protagonists in the field. Preparing the thematic data handling grid, which will normally consist of several columns and several rows (even though there is only one in the following example!):
Issues Screening Variables Fear Access difficult Wish to participate Code F AD WTP Information Screening remains uncommon. Of interest to those who wish to know their status but still gives rise to fears The test is for those at risk or who have been exposed to risk.
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From these various starting points you may prepare codes and encode the various forms of output. A fundamental rule is that codes must no longer be changed once encoding has begun, although you may take different data classified under the same code and establish sub-categories within that heading. For example, code 3 = support offered to children affected by HIV and AIDS. Within that category you may take code 3 data and distinguish between the support provided by school heads and teachers (31), support offered by other pupils (32) and that available from agencies external to the school, such as health services, NGOs, etc. (33).
Limitations and advantages of the various types of processing

Two main types of processing may be envisaged: Processing by hand: use of different coloured highlighters, cards for grouping together texts specific to each issue, summaries for interviews, use of the thematic data handling grid, and encoding by hand. A computer and word processing software might be used for part of the work. Computerized processing with qualitative data processing software (MAXqda, Atlas, Nud*Ist/NVivo, SAS, Anthropac, etc.), entering codes for words (or topics, paragraphs), picking out relevant passages, data management and organization, constructing links between the codes or textual content.
Processing By hand Advantages Easy to perform Very good knowledge of the topic Great flexibility for analytical purposes Low cost Computerized Takes less time Possible to combine qualitative / quantitative Better data management for the future Facilitates classification and analysis Limitations Lengthy, painstaking work Comparative analysis is more difficult if groups are diversified. Preservation of the analysis is somewhat complex. Cost of entering data Is painstaking. Need to learn about the software and, of course, how to access it It is not possible for communities to take part in this stage of the research
Software for qualitative data processing and analysis may be very helpful, but the quality of the analysis still depends today on the person who performs it.
Some basic rules for sound qualitative analysis

Follow the plan for analysis that was drawn up at the outset, when the questions for research were first devised, hypotheses were formulated, techniques were decided on and resources (such as guides and tables, etc.) were prepared.
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Note all significant facts and not just those that correspond to the expectations of the researcher. The discipline required in qualitative and quantitative research is the same. Establish the relations between various elements (whether in an interview or a text) and link up elements derived from several methods or groups. Creating these associations is essential to the analysis and provides for an accurate record of the complexity and dynamics of situations. Arrange and interpret non-numerical data to identify trends enabling the phenomenon studied to be understood and explained. In this interpretation, it is important to be aware of its limits and ready to cast doubt on any prior assumptions in the analysis. Proceed in a repetitive manner, as in the whole qualitative research process: from the initial findings return to the research issues and hypotheses formulated at the outset, reformulate the latter if necessary, identify new areas for investigation and examine matters in greater depth, etc. Compare and contrast data derived from different sources or by means of different techniques, and undertake comparisons between material obtained from observers or interviewers if several such sources have contributed to data collection, so as to eliminate as far as possible any subjectivity on the part of the one or more persons who have collected data. As much as possible, get results checked by those who took part in the research, which will help to ensure the credibility and validity of the findings. Three attributes that should be developed during sorting, processing and analysis: Scientific discipline Ability to establish associations Imagination You will undoubtedly agree that these three skills are also required by educational planners and administrators, so you are already developing them in your daily work. Even though qualitative research may contribute substantially to the understanding of social, health-related and economic phenomena, and especially to the attention paid to HIV and AIDS in education, it does however have certain limitations. Those most frequently cited relate to: the lack of statistical representations of the population on the basis of such research; the fact that the conclusions reached by such research cannot be regarded as generally applicable; the difficulty to replicate the research. Associating the two kinds of research thus seems increasingly instructive. It is this association that we shall study in the final section.
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3.
Associating qualitative and quantitative research

In either kind of research, there is a need for: a clear definition of the aims of the research and the questions it should address; a search for information on research/studies already carried out; the formulation of hypotheses; a research plan with precise indications concerning the approach, the sample, the instruments, the framework for analysis, the training of research assistants: (moderators, interviewers, investigators) and the plan for presenting the results; considerable scientific discipline and an essential lack of any value judgement or moral appraisal, mainly as regards HIV and AIDS. However, some consider that the differences between the two types of research are such that they are incompatible. Different processes We shall restrict ourselves here to a description of the two processes conducted differently in quantitative and qualitative research, namely the formulation of hypotheses and the constitution of samples.
Activity 5
Can you think of other processes that are carried out differently in the two kinds of research? Note them below.
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In the formulation of hypotheses Quantitative research: hypotheses are formulated before the beginning of the work, in which the main aim of the established process is to test them and invalidate or confirm them. Qualitative research: the hypotheses are the outcome of initial activity (bibliographic research, initial information gathering); they guide the work, but the purpose of the data obtained is not necessarily to confirm or invalidate hypotheses and/or preconceived theories. Because of the repetitive nature of the process, fresh hypotheses may be formulated as work proceeds. In the constitution of samples In the quantitative approach, the sample is based on statistical calculations, the main concern being to achieve a statistical representativeness in which it is highly probable that each individual in the population under consideration will be included in the sample. In the qualitative approach, there is a very wide variety of samples as follows: homogeneous; snowball samples: the selection of new persons, depending on the information obtained (for example, the discovery of key players); samples that depend on the criteria that one wishes to study; samples based on quotas (the identification of major sub-groups, followed by selection); case or deviant samples, etc. Concern for sociological representativeness is greater than for statistical representativeness, but certain qualitative samples may also be constituted as a matter of course, like quantitative research samples. The constitution of the sample is closely related to the aims of research and the questions addressed by it. Thus in a study in Burkina Faso on the impact of HIV and AIDS on the education system, schools were identified for the study in accordance with certain criteria: urban/rural environment; primary/secondary and technical schools; and public/private education. Comparisons were thus possible with reference to these various criteria. The factor that determines the size of the sample (aside from the budget and the duration of the study) is often saturation: information becomes repetitive and confirmatory, and no new information is derived from fresh interviews.
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Activity 6
Establish a sample for individual interviews in the capital, as part of a qualitative approach, on the impact of HIV and AIDS on the education system in your country.
However, the boundaries between the two types of approach are not always distinct and relations between the two are no longer viewed in the same terms as some 15 years ago. They are increasingly regarded as complementary. Complementary approaches The current question asked in much research concerns its main thrust qualitative or quantitative which does not preclude reliance on both types. Any particular research model or combination of models that is selected should be geared to the goals of research. What are the advantages that one can expect from different approaches to understand better the impact of HIV and AIDS on the education system? Different and complementary insights are possible as a result of combining these two approaches. The strengths of one compensate for the weaknesses of the other so that the strengths of both have a combined impact. It is of interest to turn to qualitative research for a better understanding and interpretation of quantitative findings. For example the estimated prevalence rate on the basis of a campaign to screen HIV in schools in a region has decreased, and the quantitative approach will seek to assess the differences from one year to the next with respect to the sex of those concerned, the environment (rural or urban), and exposure to preventive education, while the qualitative approach will be concerned to understand the attitudes of young people vis--vis the preventive education they receive, with due regard for the variables targeted by the quantitative approach (sex, age, etc.). Qualitative research may give rise to hypotheses for a quantitative study or a quantitative study may be necessary after qualitative research; The association between the two types of research provides for a better grasp of the complexity of the real situation and thus for strategies and decisions that are appropriately geared to the situation created by the AIDS epidemic in the field of education.
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How are these associations and dovetailing of the two kinds of research to be achieved? In the light of the aims of the research, formulate the questions that you intend it to address. Identify those questions that will involve the quantitative approach and those calling for a qualitative approach; for example, when planning a campaign to screen young people, the quantitative approach will help answer questions such as the following: What is the proportion of pupils in lower secondary education who have already undergone screening? What is the proportion of those who would do so if it were free of charge? Does willingness to undergo screening vary according to sex, the type of school, the environment, etc? On the other hand, to answer questions concerning attitudes vis--vis the prospect of the test, the fear to which this may give rise and the expectations of young people if the test proves positive, a qualitative approach is essential. Identify the types of information that are easier to obtain with a particular approach. Use techniques characteristic of both types with different samples: for example, a questionnaire (with closed questions and a few open ones) with a representative sample of teachers, and semi-structured interviews with inspectors and educational advisers. Turn to one particular group if necessary to obtain an answer to a particular research question, using means characteristic of both approaches, such as a questionnaire with closed (or multiple choice) questions and group discussions with parent associations, for example, to study their role in preventive education. Plan to quantify certain findings obtained using qualitative techniques, for example in the case of projective compositions for all second-year classes in selected secondary schools; in such a situation, it is important to specify clearly how the interpretation of the information will be circumscribed. Make experimental processes part of a qualitative research assignment: select cases that are similar but different in terms of operational variables (variables that clarify differences such as sex, age, socioprofessional category, place of residence) or, in a predetermined experimental context, amass decisive qualitative evidence (via interviews or observation); integrating material in this way calls for very considerable research experience and the establishment of a complex set of research conventions in order to reach scientifically valid conclusions. Include observations made at different times (for example, before teacher training and afterwards). Other combinations may be envisaged provided that qualitative and quantitative techniques form part of a continuum in line with the aims of the research.
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Summary remarks
It is not possible to make do with quantitative data if the impact of HIV and AIDS on the education system is to be addressed comprehensively. Qualitative research yields data that are important for improving educational management in the context of HIV/AIDS. It constitutes an essential foundation for effective work by educational planners and administrators, by enabling: the real social and educational situation to be perceived in terms of the outlook and experience of different players in the education system disrupted by the epidemic; greater understanding of how and why these players are affected by HIV and AIDS; proposals for action to be gathered that emanate from interested parties who will be expected in certain cases to implement them. A qualitative approach does not imply methodological imprecision or non-scientific research. Drawing up aims and issues for research, as well as the formulation of hypotheses (even if they do not serve the same purpose as in quantitative research), and the preparation of a research plan all have to be performed with the same discipline in order to yield results that are fully valid. However, the desire to understand the processes and context underlying the issues addressed by research and to elaborate on information are such that qualitative research is special, among other things for its flexibility, which is particularly helpful when examining a delicate subject such as HIV/AIDS and for the repetitive nature of the process involved. Those engaged in qualitative research are constantly retracing their steps to examine more closely topics that emerge from information gathering, reformulating questions and hypotheses as appropriate, or modifying their sample. HIV and AIDS have a clearly perceptible impact on the organization of the education sector, the quality of services and the educational requirements of communities, but also on many other sectors (health, the economy, etc.). The qualitative approach is conducive to the involvement of different sectors, breaking down the isolation in which the education sector and those responsible for it might otherwise become entrenched, and may also be combined with quantitative approaches.
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Lessons learned
After working with this module, you should have assimilated the following lessons: Lesson One Qualitative research is especially appropriate in the context of HIV/AIDS. It is suited to the treatment of delicate issues, and enables certain forms of resistance to be overcome. It seeks a deeper understanding of what others actually experience, the processes and the significance of their attitudes, behaviour patterns, etc. It pays due regard to the context and in particular the socio-cultural context and is especially recommended for analyzing social representation associated with AIDS. It is conducive to the involvement of the social groups concerned, who are regarded as real protagonists and not mere objects of research. It is easily adaptable to varied and unorthodox situations. Lesson Two Qualitative research helps you to deal better with the effects of the epidemic in the following ways: By providing information required by national, regional and local planning in the context of education and HIV/AIDS. By contributing to the implementation of strategies and plans. It makes it easier to monitor and assess the impact of the epidemic on the education system, and especially on the quality of education. It contributes to better preventive education among young people and more effective advocacy at different levels. By encouraging collaboration with other sectors.
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Lesson Three
Individual interviews
Group discussions
Projective composition Selection of techniques in line with the focus of research, its target groups and the human, organizational and financial means available. Scope for combining several techniques with the same target group.
Participant or non-participant observation
Minutes of meetings, or a variety of textual material
Accumulating songs or drawings
Case studies and histories, testimonies, etc.
VIPP method
Lesson Four Data sorting, processing and analysis are in most cases overlapping operations in qualitative research. Three kinds of skills are essential in carrying them out, namely scientific discipline, the ability to establish associations, and imagination. Among the rules for quality analysis, remember that you should first and foremost: establish relations between constituent elements (whether in an interview or a text), as well as between elements derived from several methods or groups; proceed in a repetitive fashion; compare and contrast data obtained from different sources or by means of different techniques; interpret non-numerical data in order to identify trends from which it is possible to understand and explain the phenomenon studied. Lesson Five In spite of the undeniable differences between quantitative and qualitative research, in terms of both purpose and processes the current tendency is to regard them as complementary. Different insights are possible when they are combined. In combination, they provide for a better grasp of the complexity of real situations, especially in the case of HIV and AIDS.
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Strategies and data collection instruments may be combined in different ways, such as: using both types of technique with different samples; using resources characteristic of both approaches to focus on the same group; providing for the quantification of certain results obtained by means of qualitative techniques; incorporating experimental processes within qualitative research. These combinations are used in accordance with the goals of research and the questions underlying it, and are envisaged when the plan for research is first drawn up.
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Questions for reflection 1. Difficulties often encountered: a total or partial lack of statistical data; HIV/AIDS = a taboo, a wall of silence that prevents information from circulating; difficulty in distinguishing between what is attributable to HIV and AIDS and what is attributable to other problems (for example in the case of absenteeism); lack of co-ordination between bodies involved in fighting HIV and AIDS, lack of familiarity with the action of NGOs, etc. 2. With better understanding it is possible to evaluate work already carried out, to avoid duplication, to identify and repeat fruitful initiatives, to strengthen the capacity of those who take action, to determine what action is best, to mobilize funds, to optimize management of disruption caused by the HIV epidemic, and to improve planning, etc. 3. Questionnaire surveys, individual interviews, group discussions, minutes of meetings, reports by inspectors and educational advisers, beginning-ofschool-year reports, school statistics, testimonies, case studies, observation and many other techniques to be described in the module. 4. Statistical data concerning OVC are neither very reliable nor conducive to an understanding of the problems experienced by such children, irrespective of whether the former are school or family related, economic, psychological or health related, etc. It is possible to conduct qualitative research that is geared to getting a better grasp of these problems. 5. It is possible to combine these two types of research (quantitative and qualitative), as will be seen in Section 3. Activity 1 The improved plan A will take account of the data derived from qualitative research, while also providing for actions already identified, such as: measures in schools that enable teachers to identify OVC in a way that avoids discrimination or prevents them from becoming stigmatized; action targeting families that take in OVC so that the former become fully aware of the importance of education and school provision for these children, and if possible collaboration with NGOs that develop programmes of income-generating activity; psychological support for those who may need it, which in turn presupposes the training or even intensive training of staff able to provide such support;
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the introduction of decentralized formal arrangements for a co-ordinated consistent drive to combat HIV and AIDS, which will establish mechanisms for monitoring the various actions entailed. The foregoing are no more than mere proposals, and everyone may visualize measures geared to the context in which they work. Activity 2 Doubts, misgivings Possible reasons for your scepticism: 1. Qualitative research is not scientific, lacks objectivity and the data collected are not reliable. 2. Not all these data are required for a constructive plan and excessive concern for the views of the various protagonists confuses the issue 3. The findings of qualitative research cannot be taken to apply to the entire population. 4. People living with HIV are unwilling to identify themselves through fear of being stigmatized or rejected, so it will not be possible to involve them in research. 5. Too much time and energy are required and the results are not exploited for a variety of reasons, particularly financial reasons. Arguments of those who support qualitative research 1. Such research calls for the same scientific discipline as the quantitative approach in the various stages of preparing, collecting, sorting and analyzing data (for further details, see the beginning of the third section and the reference bibliography). 2. Many plans are devised but only rarely carried through because they have been imposed and do not take account of the real life experience of the protagonists and the reasons for their behaviour/attitudes. 3. It is true that the results of qualitative research may not apply to all circumstances and this is indeed one of its real limitations. It is for this reason that it is helpful to combine the two types of research (qualitative and quantitative). 4. Involving people living with HIV in a research undertaking relevant to them is possible provided that this occurs on a firmly confidential basis and that they can reasonably hope that they will be better provided for as a result of the research carried out. 5. Any research calls for time, energy and a minimum of resources. The results of qualitative research may help to mobilize financial support.
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Activity 3 Guide for a group discussion with heads of area education authorities on teacher absenteeism due, in part, to HIV and AIDS. Topics Examples of questions for discussion
Causes of absenteeism What are the various types of absenteeism and the among teachers reasons for each? Reactions from the How do heads/other colleagues react? environment vis--vis How do pupils react? absences due to health What do the parents of pupils/parent associations problems say/do? Administrative and What are the main concerns of heads when dealing with education/teaching these absences? measures in the event What administrative measures are most frequently of a health problem adopted and why? What is the opinion of the heads of area education authorities regarding the measures introduced? What difficulties do they face in dealing with this absenteeism? What are the For pupil attainment? consequences of the For the schools image among parents and teachers? absenteeism For life at school? Possible improvements How can the community help? What organizational arrangements can be established by area education authorities? How should one involve the entire educational community in managing absenteeism due to health problems and how may other kinds of absenteeism be reduced? Activity 4 An exercise in projective composition on the subject of sexual relations between teachers and pupils (of either sex) to be given to pupils in their third year of secondary school. A friend of yours tells you that one of his professors probably has AIDS. Imagine what your friend thinks about this situation, how does the class behave and what measures do the school authorities take? A young male teacher has noticed a particularly attractive girl in his class. He would very much like to go out with her. Some time later, you learn that they are going out together. What do pupils in the class think and say about this intimate relationship between them? Clearly, these are no more than two examples. Dont forget the instructions regarding the subject: the text should be short and readily understood by those for
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whom it is intended, with simple vocabulary and syntax. Ensure that it describes a situation familiar to the person writing it, or at least not totally unfamiliar. Activity 5 Other customary differences in the processes of quantitative and qualitative research:
Quantitative research The data collected numerical form. are always
Qualitative research in As a rule, data are not numerical.
Data collection is by means of Collection may be based on numerous predetermined closed or multiple-choice techniques, with open questions. questions. Emphasis on causal relationships Emphasis on processes and meaning
Interpretation of data by means of Interpretation of data on the basis of statistical operations to assess the comparisons, and by relating one reliability of the associations observed element to another to discover underlying explanations
Activity 6 Sample for individual interviews in a qualitative approach, on the impact of HIV and AIDS on the education system. There are five categories of persons with whom individual interviews might be conducted in the capital: Authorities and officials at the ministries of education, health and social Affairs, ministerial committees to combat AIDS and sexually transmitted diseases, the capital city regional (or provincial) director. Associations, NGOs, teacher unions. School heads. Other resource persons: religious leaders, researchers, persons living with HIV. Technical and financial development partners.
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Documents Boutin, G. 1997. Lentretien de recherche qualitatif. Sainte Foy: Presses de lUniversit du Qubec. Denzin, N.K.; Lincoln, Y.S. 1998. Collecting and interpreting qualitative materials. London: Sage Publications. Deslauriers, J.-P. 1991. Recherche qualitative: guide pratique. Montreal: Mc GrawHill. Fielding, N. 1998. Computer analysis and qualitative research. London: Sage Publications. Gauthier, B. et al. 2003. Recherche sociale : de la problmatique la collecte des donnes, (3me d). Sainte Foy: Presses de lUniversit du Qubec. Mace, G. 2000. Guide dlaboration dun projet de recherche. Quebec: Presses de lUniversit Laval. Marcotte J.-F. (sous la direction de). 2000. "La recherche qualitative : objectivit et subjectivit en sociologie" In: Revue internationale de sociologie et des sciences sociales, Esprit critique, 2,(12), December 2000. Paille, P.; Mucchielli, A. 2003. Lanalyse qualitative en sciences humaines et sociales. Paris: Armand Colin. Poupart, J. et al. 1997. La recherche qualitative, enjeux pistmologiques et mthodologiques. Montreal: Gatan Morin diteur. Quivy, R.; Van Campenhoudt, L. 1995. Manuel de recherches en sciences sociales. Paris: Dunod, Bordas. Silverman, D. (Ed.). 1997. Qualitative research: theory, method and practice. London: Sage Publications. UNICEF. 1998. Manuel lusage des facilitateurs et formateurs impliqus dans des activits de groupe participatifs. Paris: UNESCO. USAID, Bureau de lAfrique, Division du dveloppement durable, Projet SARA, 2001. Recherche qualitative pour des programmes de sant amliors. Washington, DC: USAID. Van der Maren, J.M. 1995. Mthodes de recherche pour lducation. Montreal: Presses de lUniversit de Montral.
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Module
P. Dias Da Graa
Projecting education supply and demand in an HIV/AIDS context
3.4
About the author

Patricia Dias Da Graa is Programme Specialist at the International Institute for Educational Planning. Her research and training activities mainly include education information systems at local and national level, development of indicator systems for educational planning, projection methods and techniques.
Module 3.4
PROJECTING EDUCATION SUPPLY AND DEMAND IN AN HIV/AIDS CONTEXT
Table of contents
Questions for reflection Introductory remarks 1. Using projections, forecasting, simulation models and scenario building Projecting Forecasting Simulations and simulation models Scenario-building 2. Simulation models: projecting enrolments Projecting enrolments at ministry level Projecting enrolment at local level 3. Simulation models used in education Tailoring simulation models to country needs 4. Supply and demand in projections and simulations: taking HIV and AIDS into account Demand for education Supply of education Quality and quantity of data Collecting the data 5. The bigger picture: what are the strengths and limitations of a simulation model? Simulation models as a policy dialogue tool Limited data, limited indicators, limitations of the simulation model 6. Types of education models 7. Incorporating HIV and AIDS into education models Pupil projection models in the context of HIV and AIDS Integrating the impact of HIV and AIDS on pupils in the simulation model Student mortality Orphans Absenteeism and drop-out Selecting the criteria 8. Integrating the impact of HIV and AIDS on teachers in the simulation model Planning versus awareness Summary remarks Lessons learned Answers to activities
MODULE 3.4: Projecting education supply and demand in an HIV/AIDS context
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Appendix Bibliographical references and additional resource materials
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Aims
This module has been developed for educational planners and other ministry staff involved in the management and prevention of HIV in the education system. It is designed to be 'non-technical' and does not attempt to teach users to develop simulation modules or to use computer software programs or tools. This course is concerned primarily with understanding the methods of projecting school enrolment, human, physical and financial resources within an education system operating under the impact of AIDS. It will help you to establish hypotheses that take into account the impact of the AIDS epidemic and thus create scenarios to contribute to policy analysis.
Objectives
At the end of the module you should be able to: explain the usefulness of simulation models in education planning and policy analysis, as well as in the organisation of policy dialogue; assess the strengths and weaknesses of projection models for education under AIDS conditions; understand the difference between the types of education models used in planning and policy development; explain how assumptions about the supply and the demand of education in an AIDS environment can affect policy decisions.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What methods/tools does your ministry currently use to plan for future: enrolments teachers budgets class construction
Discuss the strengths and weaknesses of these tools.
How do they inform education policy development?
How could the impacts of the AIDS epidemic be integrated into the projections and simulations?
With respect to your country, what would be some important aspects to take into account to evaluate the evolution of HIV prevalence?
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Module 3.4
PROJECTING EDUCATION SUPPLY AND DEMAND IN AN HIV/AIDS CONTEXT
This module introduces enrolment projections and simulation models and discusses how they can be used to create likely scenarios integrating HIV and AIDS conditions in order to help planners and decision-makers implement effective response policies and plans. It explains what a simulation model is and how using such models to effectively plan and monitor student flows and financial resources can help to improve the management of education systems affected by the AIDS epidemic. For more in-depth technical work on projections/simulations throughout all the modules, you are invited to refer to the IIEP training materials on projection techniques and simulation models (see Bibliographical references and additional resource materials). In the first part, we discuss the practice of using projections, forecasts and simulation models. We then focus on using these projections and models in terms of education, while taking into account the impacts of HIV and AIDS on the supply of and demand for education. We then explore the strengths and limitations of enrolment projections and simulation models when considering the availability and quality of data needed for school enrolment, human, material and financial issues particularly integrating HIV- and AIDS-related factors. In the final section, we evaluate the usefulness of simulation models in informing policy dialogue. Ministries of education must be familiar with the specific impacts of HIV and AIDS on the students, educators and school staff in their education system at all levels. It is important to understand the general percentage of teachers being lost due to AIDS, and the approximate number of children being orphaned each year, or the number of children that have been forced to drop out of school due to AIDS affecting their home lives. The role of the planner is to inform the decision-maker of the medium- and long-term consequences of letting the education system develop as it has done in the past under the strain of HIV and AIDS and to demonstrate the impact of various decisions and policies that could be envisaged. Projections of student enrolment, teachers and school buildings are essential in this process. The simulation model is a very useful instrument to develop enrolment projections and for discussing policy and strategy options with the various partners concerned. When trying to estimate the impact HIV and AIDS is having on school enrolments and resources, these simulations and projections can be extremely helpful.
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1.
Using projections, forecasting, simulation models and scenario building

Projecting
Strictly speaking, projecting means extrapolating on the basis of past trends. Enrolments are projected on the assumption that the trend whether growth or decline will continue to evolve as it did in the past. A simple and rapid method to creating a projection is to estimate, on the basis of past statistics, an arithmetical or geometrical rate of increase (or decrease), which is then extended into the future by applying it to the most recent data values. Projections do not attempt to describe what will happen in the future. They only try to present what would happen if such and such conditions were to prevail. Typical examples of projections are: population projections; enrolment projections; economic projections; manpower projections.
Forecasting
Forecasts, contrary to projections, try to estimate the most likely future. Their objective is to provide information on future trends, with a fairly high confidence level. But, of course, the future can never be certain. The methods used can be similar to those outlined for projections. Greater care, however, is normally taken in the analysis and interpretation of past trends over a longer period of time, with a view to identifying possible changes in the trend, and the seeds of change or those changes which are hardly visible in the present but which could become very significant in the future. Some common examples of forecasts include: the weather forecast (note that nobody is interested in weather projection). economic forecasts and manpower forecasts. These differ from manpower projections in the sense that only one scenario is proposed. However, in the present times of high economic uncertainty, globalization and rapid technical change, preparing manpower forecasts has become a very difficult exercise and very few planners risk making them. In fact, manpower forecasts have been replaced by manpower projections, working with different, contrasted assumptions (i.e. simulations).
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Simulations and simulation models

A simulation model is the representation of the behaviour of a system through a set of mathematical formulae which allow the development of one variable, or set of variables, to be linked to the development of another. Simulations aim at exploring the consequences of different policy options on one variable. In other words, simulation models allow planners to test different assumptions or hypotheses on certain conditions or variables in a school system to see how the results improve or affect the system. Box 1 Simulation models: what they can do?
Just like projections, simulations and simulation models do not attempt to predict what will happen in the future. Their purpose is to inform decision-makers and other major players in society of what would happen if such and such developments were to take place, or if such and such measures were to be taken. By highlighting the consequences of different options, they can contribute to the selection of the most desirable one, bearing in mind all the conditions and constraints.
For example, a range of assumptions or hypotheses regarding the evolution of drop-out rates for a particular school or grade may be explored in order to see how each of the options would affect trends in school completion. Assuming these rates remain constant gives one result, while assuming that these rates will evolve in line with past or future trends may give quite another. Box 2 shows another example using an assumption made concerning HIV prevalence in order to measure workforce needs. To give an HIV-specific example of a simulation model, we can explore the consequences of making different assumptions on flow regulation after basic education (assumptions made on the transition rate to secondary general education, to vocational education or to working life) in order to determine how they affect enrolment growth. Box 2 Determining recruitment needs and costs for the teacher workforce
We can make assumptions based on the HIV prevalence rate of the teaching workforce in a given country. It is possible to simulate the impact of HIV and AIDS on teachers by varying the HIV prevalence rate within the model, thus resulting in different scenarios. This exercise can be useful in determining the recruitment needs (and costs) of replacing teachers who have left the system due to AIDS-related illness or death.
It is possible to develop a model of enrolment projections which links school admissions to the school-age population, and the number of pupils enrolled in the
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different grades to enrolment in the lower grades the previous year. It is then possible to incorporate a hypothesis of the increase in drop-out due to HIV and AIDS1. Once enrolment has been projected it is possible to estimate the number of teachers required by applying a pupil-to-teacher ratio then the number of new classrooms required. This used to take a long time to compute by hand but it has now become very easy and quick, thanks to computers, particularly micro-computers. It is customary when creating simulation models to develop several variables. However, although the rapidity of computers makes it possible, it is not advisable to prepare too many of them or to try and combine all possible options. Each variant should have its own logic and coherence, and represent a certain philosophy of the development of the system as a whole. This whole we can also refer to as a scenario. We will now talk about scenario-building.
Scenario-building
A scenario is a series of events that we imagine happening in the future and a description of what it would be like then. The starting-point of a scenario is: "What would happen if?" The ultimate aim of scenario-building is to provide information in a consistent and coherent way, in order to assist policy-makers in formulating strategies and options and to feed a public debate, and to influence policy decisions. It involves the following steps: Identifying the key variables: Choose variables that importance to your HIV policies, e.g. percentage of pupils due to HIV and AIDS, orphans and teachers in teachers absenteeism due to illness; HIV prevalence etc. are of the most dropouts, absent long-term illness; of teaching staff,
Performing an explanatory analysis of major evolutionary trends: Think about what has been happening over the past few years, e.g. does a link exist between student absenteeism and drop-out or the orphan's status? What is the trend of the evolution of these links? What are some strategies for improving these situations? Making fundamental hypotheses on key variables and players strategies: Decide what actions the ministry can take to improve conditions, e.g. how are strategies for supporting school attendance improving attendance? Will the expenditures on orphans improve their educational opportunities at school? Making the choice of possible futures: Determine whether the trend will keep the same pace or accelerate in the future, etc.
In countries with adult HIV rates above 5 per cent there are rapidly growing numbers of orphans and vulnerable children. In cities they may be considered street children. In highly affected areas, these children make up a substantial portion of the school-aged population. However, in the absence of support for school fees, nutritional support and other basic needs, many of these children fail to enrol in school or drop out before completing the cycle.
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Constructing the scenarios: Translate the chosen variables and their expected links into the model using specific values for the projected year based on the hypothesis proposed in step 4. The various decisions and assumptions made at each level should be coherent, thus producing a coherent scenario. It should be relevant and realistic, exploring worthwhile and reasonable options, and it should be transparent, easily readable and understood by the concerned stakeholders.
Activity 1
Has any prospective projection work been carried out recently in your country or region? How was education taken into account in such work?
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2.
Simulation models: projecting enrolments

Projections of enrolment are an integral part of the educational planning process. Taking place just after a thorough diagnosis of the current conditions of education in a country, simulation models and projections play a crucial role in policy analysis and decision-making. Projecting enrolment takes place both upstream, i.e. at the ministry level, as well as downstream, or at the local or district level for the most important educational policy decisions.
Projecting enrolments at ministry level

Upstream, simulation modules demonstrate the effects on school enrolment of different strategic options available to the political authorities. For example, what would be the effect on the number of pupils to be enrolled if the decision was taken to declare primary education universal by the end of the decade, or to extend the duration of compulsory basic education? How many pupils would have to be accommodated? What would be the likely effect of such developments on the demand for further schooling, and the number of pupils to be accommodated at the secondary and even higher education levels? Considering enrolment in an area with high HIV prevalence levels, ministry staff could use simulations to know the number of students the school system will have to accommodate in future years, or calculate the number of teachers, the number of classrooms, and the budgetary resources required.
Projecting enrolment at local level

Downstream, the projection of enrolment serves as a means of verification and evaluation, using the most recent and up-to-date data to adjust assumptions and work out any remedial or additional action which may be needed. AIDS is a long-wave epidemic. The epidemic and its impact will last for the foreseeable future. This makes it necessary for planners and managers to be conscious of the future impact and its implications in terms of demand (demographical impact on the school-age population), supply (teacher attrition) and education quality (pupil drop-out, financial and human resources allocation). This epidemic is making forward planning very important. Most education simulation models cover a period of 15 to 20 years. They contribute to the development of different scenarios, which can form the basis for a policy dialogue with the various stakeholders those who decide, those who finance, and those who implement. Significant changes in past trends provoked by actions proposed are more likely to be felt in the long term because of the time it takes to implement certain measures and to change behaviour patterns of parents, students or teachers. The effects of many events or decisions cannot be seen immediately, and it may take as much as 10 to 15 years before their full impact is felt. In education, the effect of a decision regarding admission policy will start to have a significant
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impact on the number of pupils enrolled at that level only three or four years later. Furthermore, it may take 10 to 15 years before the consequences of such a measure on the entire education system can be fully assessed, and a whole generation (some 20 to 25 years) before the educational profile of the active population will start changing and the impact on development will be felt. In the same way, the consequences of adopting a laissez-faire attitude and not making decisions may turn out to be disastrous some 10 to 15 years later.
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3.
Simulation models used in education

Several simulation models have been developed specifically to be used in education. Some examples of their uses are below: To estimate the future number of pupils enrolled by level of education. To assess the number of teachers to be trained and the number of schools to be built each year. To estimate the cost of the development of the education system in the future. To estimate the number of pupils graduating at different levels with a view to comparing this to the planned manpower requirements of the society. To assess how HIV and AIDS will affect teacher workforce needs or pupil enrolments. Using a simple spreadsheet software (such as Excel or Lotus), educational planners can build their own model of enrolment projections (IIEP, 2005), and project relatively simple scenarios to determine the number of teachers required by educational level, the number of schools that will be required, as well as future recurrent and capital expenditures.
Tailoring simulation models to country needs

Building a model of your own to analyze policy choices for your education system can be time-consuming and challenging, and fortunately you do have to build it yourself. Models already exist and they can easily be adapted to suit the specific conditions of your country. These models differ according to: scope: the educational levels covered (basic education and teacher training, or all educational levels, including higher education); number of sub-models: these can include sub-models for enrolment, teachers, recurrent expenditure/total expenditure, outputs; constraints incorporated: satisfaction of the social demand for education, the level of resources allocated to the education sector (the whole sector or to primary and secondary education), or the satisfaction of manpower needs. The most common models are those which evaluate the impact of various assumptions concerning the demand for education, such as the evolution of admission rates and flow rates on the number of pupils at different levels, and then on current expenditure as well as total educational expenditure (considered demand-driven). Other models include assumptions on the supply side of education or the resources available for education and establish the extent of possible expansion of the education system at different levels (these are resourcedriven). The choice of model depends on the planners objectives and needs (IIEP, 2005) and can be created according the specific requirements. When developing a national AIDS strategy for education, these models are essential for promoting a dialogue between the senior officials and the financial
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backers, as well as between those who are responsible for preparing the major orientations (senior officials), those who decide on policies, those responsible for funding (ministry of finance, funding agencies), and all those who are responsible for implementing the selected strategies (regional and local administrators, teachers, parents and their representatives, and communities).
Activity 2
Does an educational simulation model exist in your ministry?
Is it specially built to reflect the functioning of your education system, or is it a generic model proposed by external consultants?
Has it been adapted or used to reflect assumptions and scenarios related to the impact of HIV and AIDS?
Who currently uses the simulation model in the ministry?
According to you, who should have access to it? For what reasons?
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4.
Supply and demand in projections and simulations: taking HIV and AIDS into account
Demand for education
The different assumptions made about admissions, flow rates and HIV impact on students will each have a different effect on the following: the total number of students in school; the number of graduates expected to leave the system; the internal efficiency of the system; equality or disparity in the educational opportunities of different regions and population groups.
Supply of education
These, in turn, together with the impact of HIV and AIDS on teachers, determine such factors as: the requirement for teachers, buildings and equipment, and teaching and learning materials; the pressure on higher levels of education; budget forecasts; the labour market supply. The effects of the different trends are illustrated in Figure 1. What the policy-maker wants to know is the specific effect of the possible alternatives within this roughly illustrated complex set of relationships. It means entering data on these different domains, as well as factoring in the impacts HIV and AIDS may be having on pupils and teachers.
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Figure 1 The effects of changes in new admissions, flow rates and impact of HIV and AIDS on students, from a supply and demand perspective
Demand
Supply
Intake
Enrolment Graduates leaving
Requirements for teachers buildings and equipment
Repetition
Primary and secondary Budget forecasts
Drop-out
Internal efficiency Labour market supply
Promotion
Disparities
Pressure on higher levels of education
HIV and AIDS impact on pupils
HIV and AIDS impact on teachers
The chain of operations to be executed in order to estimate resource requirements is shown in Figure 2. Necessary human resources or material means are projected from the number of students enrolled, based on certain assumptions, and from assumptions about teaching conditions (class organization, monitoring or material conditions). Subsequent recruitment has to be determined by making a hypothesis about the teacher attrition rate (retirement, long-term sickness, death, including proportions due to HIV and AIDS). The funding needs are then projected with regard to the necessary resources and a cost system.
Figure 2 Estimation of resource requirements
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Figure 2 shows the important number of variables needed to feed the simulation model. The question then becomes: "What should you do if there is no data or not enough?" In the face of HIV, ministries must try and strengthen the national as well as local EMIS in order to integrate information on schools functioning in the particular contexts of the AIDS epidemic.
Quality and quantity of data

A simulation model like the one depicted in Figure 1 can require a lot of data. Using correct and accurate data is not always an easy task, and it is obvious when doing simulations that the availability of the data is an essential issue. Be cautious when choosing your variables. A projection model becomes more complex the more variables are built into it. This may make it more realistic, but it also increases the demands for specific data. The data, therefore, must be reliable and precise. It is already a challenge to put common educational variables into a mathematical model. HIV andAIDS issues will be even more complicated due to a higher complexity of factors as well as lack of data. There is little use in constructing a sophisticated model containing a lot of variables and linkages if it is then too difficult to collect this particular data or quantify qualitative issues. Box 3 The importance of data
The validity and usefulness of a projection model depends on: the validity of the assumptions made and how closely they correspond to real conditions; the quality of the data available for the base year and for the other past years; whether or not the mathematical construction of the model takes into consideration all the variables and factors that influence the variables to be estimated. The lack of accurate data on HIV- and AIDS-related impacts on schools and education systems makes it difficult to develop accurate simulation models. For example, when analyzing teacher attrition, calculating the number of teachers who have not reached retirement but have left the system due to long-term illness or death can give an approximate picture of the impact of HIV and AIDS on teachers, because it shows us how many teachers will need to be replaced.
Collecting the data

Of course in some countries this data may not be complete or is not available, while in others HIV- and AIDS-specific data cannot be found. By using even the basic population census data, teams can develop simple projections and models that can be manipulated according to different assumptions. These assumptions can then produce scenarios that will inform the policy decisions to be taken and hopefully implemented.
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How should the data collection be performed then? First, you must decide if you are interested in supply or demand data. Try and take variables that are easily collected or that you can access. Some possibilities are listed below: School census: this is an annual information collection process concerning all educational establishments; Surveys based on a sample: even small budgets can allow for sample surveys and they can be useful to collect additional, more complex, and more qualitative data (for example on the reasons for dropping out); Data from other departments in the ministry of education: for example information on graduates to be used for exams, on staff in the human resources department or on education budgets in the financial department; Surveys and/or data from other ministries or organizations: think outside the ministry to partners and other organizations responsible for collecting data such as population census for literacy rates, teacher trade unions, or national AIDS programmes.
Activity 3
What data do you need for your own national simulation model? On pupils, teachers, the conditions of teaching and the HIV context?
What is available? Is it reliable?
From which other sources other than the statistics service can you acquire data on teachers, deaths and movements?
Which recent surveys could contain relevant data for your model?
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5.
The bigger picture: what are the strengths and limitations of a simulation model?
Simulation models as a policy dialogue tool
Simulation models should be used to inform decision-makers and other stakeholders of what would happen if a particular development were to take place, or if a particular measure were to be taken or decision made. The assumptions in your projection model are more than numerical alternatives. They actually stand for alternative educational policies. When used and presented properly, simulation models can stimulate discussion around certain issues or promote awareness for particular challenges facing the education system, like how HIV are AIDS affecting schools. Depending upon the specific measures chosen, each policy will have an impact on the intake of students into the system, student flow, the availability of teachers, or the budget. For the educational policy-maker, projections are useful in that they help to provide an understanding of what the results of policy measures are likely to be or, conversely, what type of policy measures will be needed to bring about politically desirable results.
Limited data, limited indicators, limitations of the simulation model

An indicator is a combination of raw data. In order to develop complex models, much raw data will be needed. A simulation model is only as good as the indicators that are found in it. The indicators you will use, therefore, depend upon: the availability of raw data to combine to make specific indicators; the difficulty to design a formula conceptualizing how this indicator or variable will function within the whole system, or in the case of HIV and AIDS how to concretely formalize the impact.
Activity 4
Following a big teacher management reform, the ministry needs to have the estimation of the cost of the education system for the next ten years (in particular to guarantee replacement of teachers in long-term sickness), integrating HIV and AIDS impact on teachers' attrition. Give an example of indicators that you want to produce in order to meet the needs of the ministry. If possible, discuss in the group on their relevance and the way to formulate it in the model.
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6.
Types of education models

Your choice of model will depend on the defined objectives of the forecasts, on the type of expenditure, and on the links among the variables. One should always look for a method that: is close to the current system of organization and management of the country; explicitly takes into account the political objectives in its estimates; is simple. This means that a generic model usually is not the best approach to select. At the same time, however, in a case of lack of expertise, it can be feasible to use an existing straightforward model as the technical base on which the national model will be built. When there is a choice, it is recommended to build the model within the country and with educational experts that know perfectly their system, its functioning and its objectives. The educational models integrating the impact of HIV can be grouped into two main categories. The first one can be considered a sort of sensitization model, which can be an important tool for raising awareness on the impact of AIDS. The objective of this model is to study the consequences of HIV on teachers and enrolment without a planning purpose. It is based on a set of hypotheses about HIV, which gives the projected number of orphans, teachers and the cumulative loss of teachers due to AIDS, the methodological approach being to focus on comparing scenarios 'with AIDS' and 'without AIDS' and the gaps between the expected number in each one. A typical question would be "What is different about the education sector (in particular the number of pupils, of available teachers) due to HIV and AIDS than would have otherwise been the case?", not "What will be the teachers' requirements according to the school functioning and the requirements for other resources?" The second type of model is a planning oriented model. A planning oriented model projects the needs of teaching staff and physical and financial resources based on hypotheses on enrolment and school conditions. This can then allow planners to simulate the different conditions of improving the quality of education, whether they are pedagogical or organizational conditions. In the country context, the planning oriented model can give information for the resource needs estimates, the breakdown between public and private sectors, and in all cases the evaluation of all means necessary for the functioning of the system. The population projection used in the model should been given to the educational planners by the national statistics bureau or other demographic specialists. Educational planners are not expected to prepare population projections as if they were demographers and should use population projections built by the latter2. When integrating HIV and AIDS impacts into the models, the Metropolitan-Doyle model has been "extensively used in Southern Africa by many sectors for the past
2 For some examples of projection models on population and HIV/AIDS, see the Assa 2000 model (www.mrc.ac.za/bod/complete.pdf), Doyle/Metropolitan Life Model, Spectrum/AIM, UNAIDS (www.epidem.org/publications.htm), UN projections etc.
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eight years and have performed well when used in practical applications at the sub-group and general population level. The model is continually reviewed in the light of new demographic and population statistics, as well as interventions that may influence the course of the epidemic and result in changing incidence of infection, morbidity and mortality. The model is able to consider various interventions into the epidemic. These include behavioural changes (increased condom usage, reduced numbers of partners, etc.) and medical interventions (improved treatment, vaccinations, treatment/cure of HIV positive and AIDS sick individuals)" (Coombe, 2002: 43 [footnote 18]). The job of the planner is to run different simulations using the various available projection models and bearing in mind the possible variation of the estimates.
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Incorporating HIV and AIDS into education models

Pupil projection models in the context of HIV and AIDS
The component on pupil projection built into the training simulation model is based on the flow model. Projection by means of the flow model is not the only method used in educational planning. Other methods can be used, such as linear regression3 or enrolment rate trends. Some of these may be more convenient, less time consuming and require fewer data. However, none possesses the great advantage of student flow analysis that of introducing and highlighting the factors of population growth, higher intake rates, and variations in promotion, repetition and drop-out rates. It best explains enrolment trends within a given cycle or between cycles of the education system and provides sufficiently detailed results for our planning purposes while allowing planners to build linkages within the level of education but also between the cycles, showing the interplay of the factors that explain changes in enrolment. When developing student flow simulation models to measure the impacts of HIV and AIDS on the system, we must integrate the impacts on pupils into the model.
Integrating the impact of HIV and AIDS on pupils in the simulation model
The first issue to be dealt with in measuring the impact on the education sector is that of the demographic effect of the epidemic on the number of children before they even reach school age. As already stated above, this issue has to be already integrated in the population projection used in the model and given to the educational planners by the national statistics bureau. The school-age population will be calculated taking into account the demographic impact of AIDS.
Student mortality
The model then has to tackle the issue of the impact of the disease on students. As many studies demonstrate, school-age children are not dying of AIDS until they reach upper secondary level or even higher education. This is due to the incubation period of the disease, which last seven to ten years. In Botswana, fewer than 1 per cent of primary schoolchildren are likely to be infected (1 per cent in Uganda, 0,44 per cent of the less than 15 years-old in Sub-Sahara Africa) and no more than 0,2 per cent have AIDS-related sicknesses (Bennell, Hyde and Swainson, 2002: 48). It means that the incidence of HIV-positive pupils on enrolment will not often be integrated in the education models unless it appears to be an important issue in the country.
Orphans
3. Linear regression is based upon the straight line that best corresponds to the scattered data points on a graph. In this case, the data points represent past enrolment rates, and the trend for future rates is estimated by extending that line.
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On the other hand, the impact of the disease on students can be measured through the first intake or the admission rate of children into the early grades. Children who become orphans or who have one or both parents living with HIV may have less opportunity to go to school due to an increased burden of household responsibilities, reduced financial support and health, i.e. experience nutritional and psychological effects.
Absenteeism and drop-out

Another result of the impact on students living in HIV-affected households is increased pupil absenteeism. As it is well-known, absenteeism results in low school achievement, grade repetition and subsequent drop-out. As for intake rate, specific country studies may be needed to help planners propose a link between the numbers of pupils living in HIV-affected households and the evolution of drop-out rates.
Selecting the criteria

It is difficult to obtain information on how many children are concerned, and how much they are affected by these situations compared to those who are not. Furthermore, in some countries and regions where a significant share of children are suffering from poverty, orphans do not stand out and can even be seen as no more of a burden than the non-orphans. Therefore it is not easy to select the important criteria to be used in the model, or to find complete and accurate data of such specific circumstances, and to build the mathematical link with the evolution of enrolment. Planners have to be aware of the possible wide margins of error of the projections. A critical eye is therefore essential when interpreting the results. The model we will use in this training material is a fictitious exercise where we have to assume that the selected criteria are the relevant ones and are available in the country. The impact of HIV and AIDS on first intake is taken into account through the admission rate stated in the hypothesis of a specific projection. The second impact on absenteeism is translated into two variables: the percentage of students affected by HIV and AIDS in their family and the drop-out rate of those students.
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8.
Integrating the impact of HIV and AIDS on teachers in the simulation model
The impact of HIV and AIDS on teachers is manifold: absenteeism, morbidity and mortality. All schools suffer from these impacts. However, one or two teacherschools are certainly the most vulnerable and should receive particular assistance. With respect to the teachers themselves, they can be differently affected by the epidemic according to the country and even to the regions within the country. The various criteria that can be used in models to highlight differently affected groups are: sex, level of school, age, educational background, marital status, and teacher attrition rates. As for enrolment projections, the simulation model selects a specific situation where it estimates the number of HIV-positive teachers for each year, the number of new HIV infections, how many are entering long sickness, and attrition because of death or other reasons. Then, the number of teachers to be replaced is calculated, and finally the number of new teachers to be recruited is projected. A separate part of the model on staff expenditures takes into account the salary cost according to the status of the teacher (active or inactive due to long-term sickness).
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Box 4
Examples of educational simulation models integrating the impact HIV and AIDS
Two examples of educational models integrating the impact of HIV and AIDS on enrolment and teachers4, and that are complementary to the planning oriented model are presented below. The EdSida model The EdSida model is an Excel-based spreadsheet focusing on the supply and demand of education that may be modified to produce HIV impact analyses relevant to a particular country. Country-specific projections on school-age population produced by UN Population Division are integrated in the model as well as the projection of the number of school-age children who have lost their mother or both parents due to AIDS (UNAIDS methodology). With this model, you have the possibility to manipulate such factors as: relative risk of HIV infection in teachers versus general population teacher attrition due to AIDS-related illnesses as well as other causes chance of a teacher taking up other vacated jobs compared to other professionals According to plans for recruitment, you must enter the number of new teachers by age, and sex. Then you can enter the school-age population and the enrolment rate by sex to obtain the total enrolment, the pupil-to-teacher ratio and the number of orphans due to AIDS. The projection of such expenditures can estimate the future cost of new teacher training and of absenteeism due to HIV-related illness. Consulting Assistance on Economic Reform (CAER) This is a slightly modified version of the model developed by Al-Samarrai (1997). The demographic data can () be used to calculate the flow of students and teachers under two scenarios: the absence of the AIDS epidemic and the presence of the epidemic (Malaney: 2000). This model has two parts. Part A in the model template estimates enrolments by grade, based on information on the estimated projected population of the official first school intake age for every year of the projection. Due to lower reproductive age population, lower fertility rates among HIV-infected women, and higher infant and child mortality rates, the with-AIDS scenario will have a lower population in this first school intake age. Gross enrolment rates for Grade 1 for the base year and flow rates for each grade will enable the calculation of changing enrolments over time. Part B focuses on teachers and is based on assumptions about their numbers entering the system every year, their mortality rate and their attrition. As with the previous model the results are compared to the primary and secondary enrolments through the pupil-to-teacher ratio.
Another example can be studied with the model of the Department of Agricultural Economics (Purdue University) where the impact of the AIDS pandemic for educational attainment and human capital accumulation is translated by a simple education and skills transition matrix. Channing Arndt, HIV/AIDS and Macroeconomic Prospects for Mozambique: An Initial Assessment. 2002. www.agecon.purdue.edu/staff/arndt/mozam_AIDS_dp.pdf
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Planning versus awareness

These two models presented in Box 4 are very interesting and important tools; they can be used to alert decision-makers and make them aware of the educational components affected by the HIV virus. As stated above, these tools are complementary to the planning-oriented models, which planners will use to anticipate actions in order to meet the necessary resource requirements. With the same examples presented above we can now explain in further detail why the first type of projection, or the sensitization model, is not a planning tool: There is a lack of direct links between the projection of pupils and the teachers component the pupil-to-teacher ratio is the only one. The pupil projection method used in EdSida (Education et VIH/Sida) is not the best technique if one wants to simulate the different conditions (classes, examination, graduation etc.) for improving the quality of education; in the CAER study, flow rates are taken into account, but the other conditions are not. EdSida deals only with primary level. There is no breakdown between the public and private sectors, important information for the resources needs estimation. No simulation is possible on the conditions of schooling (pedagogical and organizational). With the exception of the human resource element i.e. the teachers there is no information given on resources necessary for the functioning of the system, preventing any exhaustive evaluation.
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Summary remarks
This module presented the technical issues of the architecture of education projections. The main elements highlighted were the complex relationships within the educational model, the tricky question of modelling or quantifying qualitative issues and the difficulty of data collection, especially in an AIDS-affected context. It also identified how a simulation can measure the effect of changing the decision variables; in particular that which HIV incidence would hypothetically have on future enrolments and teacher requirements. It is this ability to change the factors and their relative weightings, affecting the evolution of enrolment and teacher numbers that is the necessity of using simulation modules. It becomes possible to identify realistic policy options to meet the objectives of the education system. In light of HIV and AIDS, the educational planner therefore increasingly needs to engage in the preparation of simulations to test the impact of various possible measures to increase prevention and awareness of HIV. The option or scenario to emerge from the policy dialogue as being the most desirable will be the one that is not only or not necessarily the best technically, in view of the known constraints, but the one which has the support of the majority of the players, and therefore has the best chance of being implemented.
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Lessons learned
Lesson One: Simulation is not a prediction of the future. The purpose is to inform decision-makers and other major players in society what would happen if such and such developments were to take place, or if such and such measures were to be taken. Lesson Two: Simulation is a tool for educational development strategies. For the educational policy-maker, projections are useful in that they help to provide an understanding of what the results of policy measures are likely to be or, conversely, what type of policy measures will be needed to bring about politically desirable results. Lesson Three: Simulation is a tool for policy dialogue. Models can indeed be useful for promoting a dialogue between the senior officials and the financial backers, as well as between those who are responsible for preparing the major orientations (senior officials), those who decide on policies, those responsible for funding (ministry of finance, funding agencies), and all those who are responsible for implementing the selected strategies (regional and local administrators, teachers, parents and their representatives, and communities). Lesson Four: Simulation models are demanding in the quality and quantity of data. The availability of the data is an essential issue. A projection model becomes more complex the more variables are built into it. This may make it more realistic, but it also increases the demands for different accurate data. This data, to be used in your model, has to be reliable and precise. Particular attention must be paid when creating simulations that integrate AIDS and its impact on the system. Lesson Five: Selecting a good model is based on clear objectives of the simulation, variables' relevance, and data availability. It must be clear whether the model is to have a planning or an awareness goal. The relevant model needs to be close to the current system of organization and management and explicitly take into account political objectives. The planner has to verify carefully the validity of the assumptions made and how closely they correspond to real conditions, as well as the availability and the quality of the data for the base year and for the other past years.
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Activity 1 Answers to this activity will be specific to your country. Activity 2 Answers to this activity will be specific to your country. Activity 3 Answers to this activity will be specific to your country. Activity 4 The following indicators could be discussed:
Teachers and HIV - rate of sero-conversion - rate of starting extended sickness - death rate - attrition rate for retirement and other reasons % of active HIV-positives teachers
Raw data: - new HIV infections - number of teachers leaving their position - number of active teachers living with HIV number of active HIV-negative teachers
Recruitment needs - attrition rate for teachers living with HIV - attrition rate for HIV-negatives Teachers in long-term sickness - death rate - attrition rate for retirement and other reasons - % of long-term sickness/active teachers Teachers on the payroll
-
Raw data: number of teachers to be replaced new teachers to recruit, of which for HIV reasons
Raw data: - new entrance in long-term sickness - number of teachers in long-term sickness
Raw data: - total teachers on the payroll
active teachers
- inactive teachers (long-term sickness)
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Appendix
Comparison of projections with and without the impact of HIV and AIDS Two simulation results are proposed. The first one summarizes the results of a first simulation exercise, assuming everything remains equal, that is to say assuming all intake ratios, promotions and repetition ratios remain the same as in 2003. The second one has the same context, assuming everything remains equal, but integrates the impact of HIV and AIDS on pupils and teachers.
1. Model not integrating the impact of HIV and AIDS
Pupils Primary level Gross intake rate grade 1 New intakes in grade 1 Total enrolment Gross enrolment rate
2002 89,2%
2003 91,0%
2004 91,0%
2005 91,0%
2006 91,0%
2007 91,0%
2008 91,0%
2009 91,0%
2010 91,0%
2011 91,0%
2012 91,0%
2013 91,0%
2014 91,0% 213,363 1,084 266 93,9%
193,110 198,683 200,288 201,907 203,538 205,183 206,332 207,488 208,650 209,818 210,993 212,175 989,620 93,2% 1,000 886 93,5% 1,012 616 93,9% 1,021 048 93,9% 1,029 383 93,9% 1,037 318 93,9% 1,045 051 93,8% 1,052 456 93,8% 1,059 454 93,9% 1,066 027 93,9% 1,072 179 93,9% 1,078 221 93,9%
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Classrooms Public classrooms New classrooms to be built To renovate Teachers - primary level Number of public teachers New teachers to be recruited Budget (millions RD$) 01 Staff expenditures 02 Recurrent expenditures 03 Materials and supplies Total recurrent budget 04 Machines and equipment 05 Construction and repairs 06 Current transfers 07 Other projects Total investment budget Grand total
2002 0
2003 27,432
2004 27, 750 318 2,743
2005 27,984 234 2,775
2006 28,214 230 2,798
2007 28,431 217 2,821
2008 28,644 213 2,843
2009 28,849 205 2,864
2010 29,045 196 2,885
2011 29,231 185 2,905
2012 29,405 174 2,923
2013 29,577 172 2,940
2014 29,750 173 2,958
25,012
25,692
26,000 993
26,223 1 001
26,444 997
26,654 999
26,859 997
27,057 993
27,244 988
27,420 982
27,585 985
27,747 990
27,910 989
1,807 2 86 1,895 25 138 16 180 2,075
1,981 13 54 2,047 16 193 6 215 2,262
2,053 13 54 2,120 103 565 6 674 2,795
2,123 13 55 2,191 109 568 6 683 2,874
2,195 13 55 2,263 109 567 6 682 2,945
2,268 13 55 2,337 110 569 6 685 3,021
2,343 14 56 2,412 110 569 6 686 3,098
2,419 14 56 2,489 111 569 6 686 3,175
2,496 14 57 2,567 111 568 6 686 3,252
2,575 14 57 2,646 112 567 6 685 3,331
2,656 14 57 2,727 112 569 7 688 3,415
2,739 14 58 2,810 113 572 7 691 3,502
2,824 14 58 2,896 113 572 7 692 3,588
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2. Model integrating the impact of HIV and AIDS

Pupils - primary level Gross intake rate grade 1 New intakes in grade 1 Total enrolment Gross enrolment rate Students with HIV in family % students with HIV in family Drop-outs due to HIV Impact on drop-out rate of all students 2002 91,0% 2003 91,0% 198,683 2004 91,0% 200,288 2005 91,0% 201,907 2006 91,0% 203,538 2007 91,0% 205,183 2008 91,0% 206,332 2009 91,0% 207,488 2010 91,0% 208,650 2011 91,0% 209,818 2012 91,0% 210,993 2013 91,0% 212,175 2014 91,0% 213,363
989,620 1,000,886 1,011,723 1,018,575 1,024,844 1,030,422 1,035,697 1,040,598 1,045,065 1,049,087 1,052,674 1,056,133 1,059,574 93,2% 140,000 8,9% 11,000 1,11% 93,5% 150,000 9,4% 12,000 1,20% 93,8% 97,732 9,7% 7,996 0,79% 93,7% 101,043 9,9% 8,451 0,83% 93,5% 104,329 10,2% 8,915 0,87% 93,2% 107,576 10,4% 9,388 0,91% 93,0% 110,820 10,7% 9,873 0,95% 92,8% 114,050 11,0% 10,368 1,00% 92,6% 117,256 11,2% 10,873 1,04% 92,4% 120,435 11,5% 11,387 1,09% 92,2% 123,584 11,7% 11,909 1,13% 92,0% 126,736 12,0% 12,674 1,20% 91,7% 127,149 12,0% 12,674 1,20%
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Classrooms Required classrooms Classrooms to be built Classrooms to be renovated Number of public sector teachers % HIV-positive teachers New entrants into long-term illness leave Needed teachers Needed teachers due to HIV/AIDS Budget (millions RD$) 01 Staff expenditures 02 Recurring costs 03 Materials and supplies Total recurrent budget 04 Machines and equipment 05 Constructions and repairs 06 Current transfers 07 Other projects Total investment budget Grand total
2002 0
2003 27,432
2004 27,727 295 2,743
2005 27,923 196 2,773 26,159 9,1% 726 1,237 299
2006 28,102 179 2,792 26,327 10,5% 721 1,293 364
2007 28,262 160 2,810 26,477 11,5% 713 1,347 420
2008 28,414 153 2,826 26,619 12,2% 707 1,384 461
2009 28,558 144 2,841 26,752 12,7% 703 1,408 493
2010 28,691 132 2,856 26,873 13,1% 701 1,425 516
2011 28,813 123 2,869 26,984 13,4% 700 1,434 532
2012 28,924 111 2,881 27,083 13,6% 700 1,447 545
2013 29,033 109 2,892 27,179 13,7% 701 1,460 555
2014 29,141 108 2,903 27,274 13,8% 702 1,487 562
25,012
25,692 5,8%
25,976 7,5% 705 1,179 245
1,807 2 86 1,895 25 138 16 180 2,075
1,981 13 54 2,047 16 193 6 215 2,262
2,061 13 54 2,128 102 550 6 0 658 2,786
2,139 13 54 2,207 107 546 6 0 660 2,867
2,220 13 55 2,288 107 542 6 0 655 2,943
2,303 13 55 2,371 108 541 6 0 655 3,027
2,387 13 55 2,456 108 541 6 0 655 3,111
2,473 13 56 2,542 108 538 6 0 653 3,195
2,560 14 56 2,629 108 537 6 0 652 3,281
2,648 14 56 2,717 109 534 6 0 649 3,367
2,736 14 56 2,806 109 535 6 0 651 3,457
2,826 14 56 2,896 109 537 6 0 653 3,549
2,918 14 57 2,989 110 545 6 0 662 3,650
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The differences are the following:

1. Pupils Without AIDS Without taking into account the impact of HIV and AIDS on the student flow, we obtain a gross enrolment rate in 2014 of 93.9 per cent, slightly higher than in 2004 (93.5 per cent). With AIDS When HIV and AIDS conditions are taken into account, we see that the gross enrolment rate in 2014 will be 91.7 per cent, a 2.3 per cent decrease of the expected rate. 2. Teachers Without AIDS In the first scenario, the system needs to recruit 989 teachers in 2014. With AIDS If the impact of HIV and AIDS is measured, we can see that (though the number of pupils decreases) there would be a need for 1,487 teachers would be, 50 per cent more than the expected number. This could be due to the higher teacher attrition rates. 3. Budget Without AIDS The current expenditures in 2014 would be 2,896 million. With AIDS The expenditures would be 2,989 million, a 3 per cent budget increase.
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Documents Al-Samarrai, S. 1997. A Simulation Model for Educational Development. Brighton: Institute for Development Studies, University of Sussex. http://unesdoc.unesco.org/ulis/cgibin/ulis.pl?catno=109095&database=ged&gp=0&mode=e&lin=1 Boler, T. 2004. Approaches to examining the impact of HIV/AIDS on teachers. UK: UK Working Group on Education and HIV/AIDS. www.aidsconsortium.org.uk/protected/downloads/hiv_aids.pdf Bennell, P.; Hyde, K.; Swainson, N. 2002 The impact of the HIV/AIDS epidemic on the education sector in sub-Saharan Africa. Brighton: Centre for International Education, University of Sussex Institute of Education. Coombe, C. 2002. HIV and the education sector: the foundations of a control and management strategy in South Africa. Briefing paper. Paris: IIEP-UNESCO. www.harare.unesco.org/hivaids/view_abstract.asp?id=163 Croutch, L. 2001. Turbulence or orderly change? Teacher supply and demand in the age of AIDS. Pretoria: Department of Education. IIEP. 2005. Projections and simulations: tools for policy dialogue and educational development strategies. Material prepared for the Advanced Training Programme in Educational Planning and Management. Paris: IIEP-UNESCO. Unpublished. Malaney, Pia. 2000. The Impact of HIV/AIDS on the education sector in South Africa. (CAER II Discussion paper No. 81). Cambridge, MA: Harvard Institute for International Development. UNAIDS. 2002. "Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact". Reference Group on Estimates, Modelling and Projections. In: AIDS, 16(9), W1-W14. www.aidsonline.com/pt/re/aids/abstract.00002030-20020614000024.htm;jsessionid=HQ7WhGQXLWT4ZX9T8xTHCFKxzRJhkT1tlCvPvd1Vfx thMtLh5kQ1!-1323538283!181195628!8091!-1
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Useful links
Web sites:
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World Bank Multi-Country HIV/AIDS Program for Africa (MAP): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRHE ANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001234 ~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html World Economic Forum: www.weforum.org/globalhealth World Health Organization: www.who.int/en/
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by L. Teasdale
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High-risk behaviour: Activities that put individuals at greater risk of exposing themselves to a particular infection. In association with HIV transmission, high-risk activities include unprotected sexual intercourse and sharing of needles and syringes. Highly active antiretroviral therapy (HAART): A combination of three or more antiretroviral drugs that most effectively inhibit HIV replication, allowing the immune system to recover its ability to produce white blood cells to respond to opportunistic infections. HIV: Human Immunodeficiency Virus, the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. HIV testing: Any laboratory procedure such as blood or saliva testing done on an individual to determine the presence or absence of HIV antibodies. An HIV positive result means that the HIV antibodies have been found in the blood test and that the person has been exposed to HIV and is presumably infected with the virus. Homosexual: A person sexually attracted to or practising sex with persons of the same sex. Immune system: The bodys defence system that prevents and fights off infections. Incidence (HIV): The number of new cases occurring in a given population over a certain period of time. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new. Incubation period: The period of time between entry of the infecting pathogen, or antigen (in the case of HIV and AIDS, this is HIV) into the body and the first symptoms of the disease (or AIDS). Informed consent: The voluntary agreement of a person to undergo or be subjected to a procedure based on full information, whether such permission is written, or expressed indirectly. Life skills: Refers to a large group of psycho-social and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Log frame or logical framework: A matrix that provides a summary of what a project aims to achieve and how, and what its main assumptions are. It brings together in one place a statement of all the key components of a project. It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic of how the project is expected to work. It provides a basis for monitoring an evaluation by identifying indicators of success, and means of assessment. Maternal antibodies: In an infant, these are antibodies that have been passively acquired from the mother during pregnancy. Because maternal antibodies to HIV continue to circulate in the infants blood up to the age of 15-18 months, it is difficult to determine whether the infant is infected. Mother-to-Child Transmission (MTCT): Process by which a pregnant woman can pass HIV to her child. This occurs in three ways, 1) during pregnancy 2) during childbirth 3) through breast milk. The chances of HIV being passed in any of these ways if the mother is in good health or taking HIV treatment is quite low.
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Sugar Daddy/Mommy Syndrome: Comparatively well-off older men/women who pay special attention (e.g. give presents) to younger women/men in return for sexual favours. T- Cells: A type of white blood cell. One type of T cell (T4 Lymphocytes, also called T4 Helper cells) is especially apt to be infected by HIV. By injuring and destroying these cells HIV damages the overall ability of the immune system to reduce the reproduction of the virus in the blood or to fight opportunistic diseases. A healthy person will usually have more than 1,200 T-cells in a certain measure of blood, but when HIV progresses to AIDS the number of T-cells drops below 200. Treatment education: Education that engages individuals and communities to learn about anti retroviral therapy so that they understand the full range of issues and options involved. It provides information on drug regimen and encourages people to know their HIV status. Tuberculosis (TB): Tuberculosis is a bacterial infection that is most often found in the lungs (pulmonary TB) but can spread to other parts of the body (extrapulmonary TB). TB in the lungs is easily spread to other people through coughing or laughing. Treatment is often successful, though the process is long. Treatment time averages between 6 and 9 months. TB is the most common opportunistic infection and the most frequent cause of death in people living with HIV in Africa. Universal precautions: A practice, or set of precautions to be followed in any situation where there is risk of exposure to infected bodily fluids, such as blood, like wearing protective gloves, goggles and shields, or carefully handling potentially contaminated medical instruments. Vaccine: A substance that contains antigenic or pathogenic components, either weakened, dead, or synthetic, from an infectious organism which is injected into the body in order to produce antibodies to disease or to the antigenic components. Viral load: The amount of virus present in the blood. HIV viral load indicates the extent to which HIV is reproducing in the body. Higher numbers mean more of the virus is present in the body. Virus: Infectious agents responsible for numerous diseases in all living beings. They are extremely small particles, and in contrast to bacteria, can only survive and multiply within a living cell at the expense of that cell. Voluntary counselling and testing: HIV testing done on an individual who, after having undergone pre-test counselling, willingly submits himself/herself to such a test. Workplace policy: A guiding statement of principles and intent taking applicable to all staff and personnel of an institution. This can often be part of a larger sectoral policy.
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The series
1.1 1.2 1.3 1.4 1.5
2.1 2.2 2.3
3.1 3.2 3.3 3.4
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4.1 4.2 4.3 4.4 4.5 4.6
5.1 5.2 5.3 5.4
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Volume
Responding to the Epidemic
Foreword
The modules have been designed as self-study materials but they can also be used by training institutions in different courses and workshops. Most modules address the needs of planners and managers working at central or regional levels. Some, however, can be usefully read by policy-makers and directors of primary and secondary education. Others will help inspectors and administrators at local level address the issues that the epidemic raises for them in their day-to-day work. Financial support for the development of modules and for the publication of the series at IIEP was provided by the UK Department for International Development (DFID) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The Mobile Task Team (MTT) on the impact of HIV/AIDS on education, based at HEARD at the University of KwaZulu-Natal from 2000 to 2006, was funded by the United States Agency for International Development (USAID). The EduSector AIDS Response Trust, an independent, non-profit Trust was established to continue the work of the MTT in 2006. The editing team for the series comprised Peter Badcock-Walters, and Michael Kelly for the MTT (now ESART), and Franoise Caillods, Lucy Teasdale and Barbara Tournier for the IIEP. The module authors are grateful to Miriam Jones for carefully editing each module. They are also grateful to Philippe Abbou-Avon of the IIEP Publications Unit for finalizing the layout of the series.

Volume 4 is a concrete tool to help you plan and implement specific actions to address the challenges you are facing with respect to HIV and AIDS. It will prepare you to develop a response in key areas of your education sector.
Learners guide List of abbreviations MODULE 4.1: A CURRICULUM RESPONSE TO HIV/AIDS Aims Objectives Questions for reflection Introductory remarks 1. HIV/AIDS education 2. Integrating education on HIV and AIDS in the regular curriculum 3. Implications of integrating HIV/AIDS education into the regular curriculum Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials Appendix 1 Appendix 2 Appendix 3 Appendix 4 7 11 17 18 18 19 21 23 31 34 41 42 44 49 51 53 54 56
MODULE 4.2: TEACHER FORMATION AND DEVELOPMENT IN THE CONTEXT OF HIV/AIDS Aims Objectives Questions for reflection Introductory remarks 1. The context of HIV and AIDS 2. Teacher formation and development 3. Challenges involved in incorporating HIV and AIDS education into the curriculum 4. The curriculum response to HIV and AIDS 5. Models of programme delivery 6. Programme delivery at the pre-service level 7. Programme delivery at the in-service level 8. Teaching methodology 9. Counselling and care 10. Management and institutional issues 11. Education as a moral enterprise Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 4.3: TEACHER FORMATION AND DEVELOPMENT IN THE CONTEXT OF HIV/AIDS Aims Objectives Questions for reflection Introductory remarks 1. Concepts and definitions 2. OVC and the education sector 3. Developing policy-level response to OVC in the education sector Summary remarks Lessons learned Answers to activities Appendix: Orphan statistics for sub-Saharan Africa Bibliographical references and additional resource materials
59 60 60 61 63 65 68 70 73 76 78 79 81 82 83 86 87 89 91 93 97 98 98 99 100 102 107 110 121 122 123 128 129
MODULE 4.4: HIV/AIDS CARE, SUPPORT AND TREATMENT FOR EDUCATION STAFF Aims Objectives Questions for reflection Introductory remarks 1. Positioning HIV and AIDS within a workplace wellness programme 2. AIDS-related needs for care, support and treatment 3. Components of a comprehensive workplace wellness programme 4. The role of education sectors and institutions in providing care, support and treatment for infected staff Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials MODULE 4.5: SCHOOL LEVEL RESPONSE TO HIV/AIDS Aims Objectives Questions for reflection 1. 2. 3. 4. 5. 6. Introductory remarks The role of schools as part of a national response to HIV and AIDS Integrating education on HIV and AIDS in the regular curriculum How schools can protect the quality of education How schools can provide care and support for learners How schools can provide care and support for teachers and other staff Lead and manage an effective response at school level Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
133 134 134 135 137 141 140 141 150 152 153 154 155 159 160 160 161 162 164 167 173 179 185 192 198 199 200 203
MODULE 4.6: THE HIGHER EDUCATION RESPONSE TO HIV/AIDS Aims Objectives Questions for reflection Introductory remarks 1. Why should tertiary and higher education institutions be concerned with HIV and AIDS? 2. What makes tertiary and higher education institutions or higher education institutions able to contribute effective responses to HIV and AIDS? 3. Mainstreaming HIV prevention and management of AIDS 4. Gender mainstreaming 5. Developing institutional leadership on HIV and AIDS 6. Developing an institutional HIV and AIDS policy 7. Integrating HIV and AIDS into academic and non-academic programmes 8. Research 9. Financial resources 10. Community outreach programmes 11. Monitoring and evaluation Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials Useful links HIV and AIDS glossary The series
207 208 208 209 210
214 215 217 219 221 223 225 227 228 229 231 232 233 235 237 241 247
Learners guide
by B. Tournier
Background


The volumes
The modules

Your feedback
Enjoy your work!
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Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People living with or Affected by HIV and AIDS Highly active antiretroviral therapy HIV and AIDS Management Unit Home-based care Health and development networks Health and family life education Highly indebted poor countries Human Immunodeficiency Virus Human resources International Bureau of Education International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa International Council of AIDS Service Organizations Injecting drug user Information, Education, and Communication International Finance Corporation International Institute for Educational Planning International Labour Organization In-service education and training International Planned Parenthood Federation Knowledge, attitudes, practices and behaviour Monitoring and evaluation Multi-Country AIDS Program (World Bank) Millennium Development Goals Management information system Medium-to-large-scale project Ministry of Basic Education, Sport and Culture Ministry of education Ministry of Education and Sports Ministry of Higher Education, Training and Employment Creation Men who have sex with men Medium-term expenditure framework Mother-to-child transmission Mobile Task Team (MTT) on the Impact of HIV and AIDS on Education
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Module
E. Miedema
A curriculum response to HIV/AIDS
4.1
About the author

Esther Miedema is a former UNESCO Associate Expert of Education (Indonesia, the Philippines and Mozambique). Her main expertise is in education and social development, integration of sexual and reproductive health, and HIV and AIDS into basic education and teacher training curricula, and non-formal education.
Acknowledgements
This module explores some of the main planning implication of integrating HIV and AIDS education into the curriculum and builds on previous work done with IBE-UNESCO on HIV and AIDS and curriculum development. In exploring the various implications for planning and during the writing of the module in general, the inputs and feedback of the following people have been critical: Ms Franoise Caillods (Deputy Director, IIEP-UNESCO), Professor Michael Kelly (University of Zambia) and Ms Christine Panchaud (HIV/AIDS Programme Specialist, IBE-UNESCO). The module would not have been the same without their contributions and I am very grateful for their support. I would also like to thank IIEP staff for their practical support to me during the writing of the module. A big thank you to all.
Module 4.1
A CURRICULUM REPSONSE TO HIV/AIDS
Table of contents
Questions for reflection Introductory remarks HIV/AIDS education Current findings relating to HIV/AIDS teaching and learning good practices and shortcomings Core topics to be addressed Adaptation to different age groups Opposition to change 2. Integrating education on HIV and AIDS in the regular curriculum Curriculum framework Approaches to integrating HIV and AIDS education into the curriculum Factors affecting the choice of curricular approach 3. Implications of integrating HIV/AIDS education into the regular curriculum Teacher training and support Peer education Teacher wellbeing Preparation and distribution of teaching-learning materials Time allocation Service provision Community involvement Schools that provide a child-friendly environment Assessment 1. Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 19 21 23 23 28 29 31 31 31 33 34 34 35 35 36 36 36 37 38 38 41 42 44 49
MODULE 4.1: A curriculum response to HIV/AIDS
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Aims
The aims of this module are to:
provide an overview of current concepts relating to quality, curriculum-based sexual and reproductive health (SRH), HIV and AIDS education; provide an overview of the necessary steps in integrating HIV and AIDS-related education into a school curriculum, as well as the implications thereof for, among others, teacher training, community involvement, time allocation and assessment.
Objectives
At the end of the module you should be able to:

explain the need for integration of comprehensive SRH, HIV and AIDS education into the curriculum; describe some of the main characteristics of quality SRH, HIV and AIDS education and some of the main shortcomings of current (SRH) HIV and AIDS teaching and learning and teacher training; identify some of the main planning implications of including SRH, HIV and AIDS education in the curriculum; describe what is meant by life skills and give examples of life skills that young people need to protect themselves from and cope with the impact of HIV and AIDS; list and provide a brief clarification of the broad planning steps involved in integrating HIV and AIDS education into the curriculum.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What are the most important, core topics young people need to learn about in order to become competent in dealing with issues relating to sexual and reproductive health (SRH), HIV and AIDS?
Is SRH, HIV and AIDS education currently taught in primary and secondary schools in your country? If so, how has it been integrated into the curriculum?
Has teacher shortage and mortality (due to HIV and AIDS) affected the quality of teaching and learning, including teaching/learning about SRH, HIV and AIDS in your country? If so, how?
What steps need to be taken to ensure that all learners in both rural and urban areas have access to youth-friendly health services and information?
What steps need to be taken to involve community members in the development, design and monitoring of SRH, HIV and AIDS education?
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What makes a school child-friendly for both girls and boys? What needs to be done to make primary and secondary schools in your country more childfriendly for both girls and boys?
What kind of indicators relating to quality education can be incorporated in or linked to the education management information system (EMIS)
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Module 4.1
A CURRICULUM REPSONSE TO HIV/AIDS
Every day thousands of children and young people all over the world are infected with HIV, the majority of whom are in sub-Saharan Africa. Over 14 million children have lost one or both of their parents to the disease. Hard won developmental gains and life expectancy are eroded and progress toward achieving Education for All (EFA) and the Millennium Development Goals (MDGs) is severely hampered. Ministries of education are becoming increasingly aware that, with no vaccine or cure for HIV and AIDS in sight, education can be an effective way to protect young people. This module will look at SRH, HIV and AIDS education and how this can best be integrated in the formal school curriculum. The module concentrates on issues relating to teaching and learning about SRH, HIV and AIDS, the main question for educational policy-makers and planners always being what are the implications for policy and planning? And which resources are required to ensure that quality (SRH, HIV and AIDS) education is provided to all learners? To start off with, the module will provide an overview of current findings regarding HIV/AIDS teaching and learning in schools; examples of good practices as well as some of the common shortcomings. The remainder of the module will build on the lessons learned described in this first section. The first section will also focus on the core HIV and AIDS-related themes that should be addressed in an education programme. The core themes suggested in this module build on the four pillars of education (see UNESCO, 1996), i.e. learning to know, learning to do, learning to be and learning to live together. These four pillars provide a sound basis for developing the main themes of HIV and AIDS education. The issue of age and appropriate learning on SRH, HIV and AIDS will also be discussed in this section, as well as possible opposition to SRH, HIV and AIDS education. In the second part a description will be given of the different curricular approaches to integrating HIV/AIDS education in the regular curriculum. The different curricular approaches have different implications for planning and the user will be encouraged to consider some of the possible steps that need to be taken to ensure full integration of SRH, HIV and AIDS education according to a particular curricular approach. Finally, the module will explore some of the implications for educational planners of integrating education on HIV and AIDS into the regular curriculum, such as the implications for teacher training and support (including peer education), time allocation, creation of child-friendly environments, learners access to youth-friendly (health) services, and community involvement. Attached to the module is a tool developed by IBE-UNESCO that can be used to guide the diagnosis of the current status of HIV/AIDS education. References of other relevant publications and tools are given in Appendix I.
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It is important to note that although out-of-school youth are an extremely important target group, this module will not explicitly deal with non-formal SRH, HIV and AIDS education. Having said that, much of what applies to teaching-learning about SRH, HIV and AIDS within the formal curriculum can also be relevant to the (development of) the non-formal education (NFE) curriculum.
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1.
HIV/AIDS education
Current findings relating to HIV/AIDS teaching and learning; good practices and shortcomings
Various studies into the quality of HIV/AIDS education programmes have been carried out in recent years1. These studies look into how ministries of education, schools and teachers in a range of countries and continents address HIV/AIDS education. They describe the progress made, but also identify a range of common shortcomings related to the delivery of HIV and AIDS education. The Deadly inertia report provides an overview of the quality of delivery and content of HIV and AIDS education within the framework of the quality of education in general (Global Campaign for Education, 2004). The report makes a very important point, stating that in practice [it] is impossible to teach children about HIV in classrooms that lack the essential ingredients for successful teaching and learning about any subject (Global Campaign for Education, 2004: 5). In most of the 18 countries studied, it was found that classrooms were overcrowded and management systems under-resourced. Box 1 below summarizes a number of shortcomings in the delivery of HIV and AIDS education as outlined in the above-mentioned reports. Box 1 Examples of common shortcomings in the delivery of HIV/AIDS education
HIV/AIDS education has been added to an already overcrowded curriculum. HIV/AIDS education is often added to the existing syllabus of a particular mandatory subject, but no provisions are made to make sure that HIV/AIDS education is taught or that learning outcomes are assessed in meaningful way. No specific time or far too little time is allocated to the teaching of the subject. Teachers are not adequately trained or supported to apply the necessary interactive pedagogical methods. Teaching and learning materials often are not available.
Source: IBE-UNESCO, 2006: tool 4.
Different studies, including those mentioned above, have also identified shortcomings relating to the contents of HIV and AIDS education.
Examples include: Global Campaign on Education (2004), Deadly inertia, a cross-country study of educational responses to HIV/AIDS; IBE-UNESCO (2005), The Quality Imperative, an assessment of the curricular response to HIV/AIDS in 35 countries; and Action Aid (2003), The sound of silence; difficulties in communicating on HIV/AIDS in schools.
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Box 2
Some common shortcomings relating to the content of HIV/AIDS education
Teaching of HIV and AIDS is often selective; it does not address sexual and reproductive development or health, nor (sexual) relationships, negative or conflicting messages on condoms and practicing of safer sex. Education does not adequately challenge stigma and discrimination surrounding HIV and AIDS, which in turn strengthens the silence surrounding HIV/AIDS. Education on HIV and AIDS is often still too knowledge-based. Little attention is paid to the development of learners abilities to deal with daily problems. Teaching-learning of life skills needs to be better understood in order to be better implemented.
Although the work of educational planners has less to do with content and pedagogy per se, these educational aspects will have implications for planning. For example, SRH, HIV and AIDS education should be less knowledge-based than it currently is, and be taught using more interactive teaching-learning methods than are currently used. This has implications for teacher training and support/supervision both in terms of content and time. Where possible, ministries of education should aim to continue to improve the delivery and content of HIV/AIDS teaching and learning. Other than reviewing the delivery and content of HIV/AIDS-related education and comparing these to the attention points highlighted above, ministries of education can also build on the increasing body of knowledge on what does work, i.e. what are the main characteristics of effective HIV and AIDS education. Some of these characteristics are listed in Box 3 below. Box 3 Characteristics of effective HIV/AIDS education Focus on life skills aimed at reducing risk-tasking behaviours, particularly by delaying first sexual intercourse and encouraging protected intercourse. Concentrate on personalizing risk through active participation of learners by using appropriate role-playing and interactive discussions. Provide clear messages on sexual activity and discuss in a straightforward manner the possible results of unprotected sex, and in equally clear terms provide comprehensive information on the ways to avoid such an outcome. Explain where to turn for help, support and services (such as peers, school staff and facilities, and outside facilities). Provide occasions to model and practice communication and refusal skills useful for self-protection and to build self-confidence.
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Address pressure from peers and society. Reinforce values, norms and peer-group support for resisting pressure, both at school and in the community. Provide sufficient time for classroom work and interactive teaching methods such as role-playing and group discussions. Select teachers and peers who believe in the programme and provide systematic training and support. Start at the earliest possible age with adapted messages and teaching methods, and certainly before the onset of sexual activity.
Source: IBE-UNESCO, 2005a.
The final goal of SRH, HIV and AIDS education is to enable learners to become SRH, HIV and AIDS competent, i.e. to be able to apply relevant skills, knowledge and demonstrate healthy attitudes to take positive actions to protect themselves, promote their own and others well-being and health, and develop and maintain positive social relationships.
Activity 1
Using the examples of shortcomings and characteristics of good SRH, HIV and AIDS education listed in the boxes above, analyze 2-3 shortcomings and/or characteristics of quality education relating to the delivery of education which are most relevant to your country. List the necessary steps to respond to these shortcomings or that work towards achieving the selected characteristic of quality SRH, HIV and AIDS education.
The lessons learned regarding current shortcomings as well as the findings on characteristics of quality HIV and AIDS education form the starting point for the following sections. To begin with, we will look more closely at the contents of HIV and AIDS education. In Chapters 2 and 3 more attention will be paid to the delivery
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of education on HIV and AIDS and the implications for teacher training, assessment and textbook development.
Core topics to be addressed

The four pillars of education learning to know, to do, to be and to live together can be seen as forming the founding blocks for education throughout life. These four pillars are also highly relevant for (developing) education on SRH, HIV and AIDS. For example, learners need to learn the correct information (learning to know), how to use the correct information and skills (learning to do), value/respect others, irrespective of their status, gender, etc. (learning to live together), and how to deal with and value themselves (learning to be). As mentioned above, the overall aim of SRH, HIV and AIDS-related teaching and learning is to build the competencies of learners to apply relevant skills and knowledge and demonstrate healthy attitudes to take positive actions to protect themselves and others from the spread and impact of HIV and AIDS, to promote overall health, wellbeing and positive social relationships. To help learners to become competent in coping with HIV and AIDS, teaching-learning should focus on the four core themes described below. These are the themes that are recommended for integration into the curriculum to jointly form a comprehensive SRH, HIV and AIDS education programme.
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Box 4
Core HIV and AIDS teaching-learning themes
1. Basic knowledge on health, SRH, STIs, HIV and AIDS, and care and treatment.This thematic topic is aimed at the development of basic knowledge on health, SRH, HIV and AIDS as well as important information processing skills. 2. Human rights, stigma and discrimination Stigma and discrimination greatly increase the silence and fear surrounding HIV and AIDS as well as the suffering of people with/affected by HIV/AIDS. This core topic should focus on, among others, teaching learners about childrens and human rights as applying to themselves and others, irrespective of their HIV/AIDS status. 3. Relationships and gender issues Increasingly, the HIV/AIDS epidemic is feminizing, with women accounting for more than half of HIV-positive adults worldwide. Gender inequity and general power discrepancies in relationships increase the risk of HIV infection as well as the impact of HIV and AIDS. The main expected learning outcome of this third topic would be the development of a critical understanding of the different vulnerabilities and risks men and women face, the equal rights of men and women. Equal participation of boys and girls in this module is essential. 4. Life skills Though learners are expected to learn a range of skills through the other three thematic topics described above, it is recommended to include a fourth theme in the HIV and AIDS teaching-learning programme which pays attention to a specific set of additional life skills. Life skills are generally defined as abilities that help promote mental wellbeing and competence in young people as they face the realities of life. Life skills are taught with the aim to empower people to take positive actions to protect themselves and to promote health and positive social relationships. Examples of life skills are skills in problem-solving, critical thinking, decision-making, negotiation, as well as skills such as selfawareness, empathy, and coping with stress and emotions. Life skills requiring additional attention in SRH, HIV and AIDS education can be organized into three categories: a) Critical thinking skills, including self- and social awareness, setting goals and solving problems; b) Social skills, including building positive relationships, challenging gender stereotypes, stigma and (sexual) violence, coping with loss and stress; and c) Communication and negotiation skills, such as being able to voice ones concerns and needs, being able to say no and to have that respected.
Source: IBE-UNESCO, 2006: tool 4; UNESCO Bangkok, no date.
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With regard to life skills, it has to be noted that there still remains much to be clarified and defined in the area of life skills education. Open questions include the kind of skills that different groups of children and young people actually need, for example besides life skills such as effective communication, orphans and other vulnerable children may also need to learn basic entrepreneurial and/or vocational skills. Other issues to be clarified are how young people best learn different skills, which pedagogical approaches and assessment methods are most appropriate to support learning of life skills, and what the implications are for teacher training and support. Monitoring and evaluation of (life skills) education can serve to inform future policy and programming.
Adaptation to different age groups

Existing education programmes on SRH, HIV and AIDS are often not age specific. Either the age group is not well defined or the programme and accompanying materials are designed for too large an age group despite the fact that literacy levels and learning needs differ per age group. At the same time, it has to be kept in mind that in developing countries there may be a very wide range of ages in any one class. This places additional demands on teachers and thus on teacher training and support. HIV/AIDS education programmes need to be developed in a spiral way; increasing the levels of complexity and detail as pupils climb up the educational ladder. It goes without saying that the information required by a young learner at primary school is different from that required by an adolescent at secondary school level. Education on SRH, HIV and AIDS should start as early as possible, and in any case before the average age of sexual debut. SRH, HIV and AIDS teaching-learning should be provided until at least the end of compulsory schooling, but preferably longer, i.e. until the end of secondary school and during tertiary education. Deciding at which age to start education on prevention, care, treatment and mitigation of sexually transmitted infections (STIs), HIV and AIDS can be guided by, for example, information on the average national age of onset of sexual activity.
Activity 2
Review recent research into the average age of sexual debut in your country. Compare this with the average age of school debut and school completion or drop-out. Based on these indications of the age of sexual debut, at what age should education on SRH, HIV and AIDS begin in your country?
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Opposition to change
Often those responsible for providing HIV/AIDS education encounter opposition from, for example, learners parents, other teachers, school principals and church leaders. Many people believe that teaching youngsters about sexual health and sexuality will encourage promiscuity and sexual experimentation. Studies from around the world show, however, that young people who have been provided with correct information and have learned relevant skills actually delay sexual debut. In addition, when they do start having sexual relationships they are more likely to practice safer sex. It is important to accept that adolescence is a time when many young people will experiment with sex and that equipping them with information and skills is crucial if they are to protect themselves and others. The issue of opposition to curricular change was addressed during the UNESCO Bangkok workshop on Building Capacities of Curriculum Specialists for Educational Reform (see Lao, 2002). The participants (directors and curriculum specialists from 11 countries in East, South-East Asia and Mekong sub-regions) considered it was possible to anticipate and address some forms of resistance to curricular change and delivery. They formulated the following three key recommendations for addressing opposition. I. Clearly define and communicate on the role of stakeholders in the process of consultation on curricular change. It was considered impossible to consult all stakeholders on every issue. For this reason, sometimes consultations should be about informing stakeholders on what the reform will be about, without necessarily asking for their input. Agreement on all issues by all stakeholders will also be extremely difficult. Ministries of education will have to strike a balance between teaching-learning content that is relevant to learners i.e. enables them to deal with real life problems and that which is supported by the community. II. Engage stakeholders through the curriculum development process The most efficient consultation was found to be one that engaged stakeholders throughout the curriculum development process, and not only at the beginning. Involving local authorities and other stakeholders in a participatory manner throughout the process was considered not to ensure continuity and transparency, but also implied that sufficient time was made available to consult all relevant stakeholders. Involving stakeholders during the implementation of curricular change is also important, for example in the design and implementation of teacher training and monitoring of SRH, HIV and AIDS teaching and learning. III. Communicate and market policy changes When a public is misinformed or insufficiently informed, this can lead to a lack of understanding of the changes and eventually to resistance. It is therefore important to communicate on (plans for) curricular change through several sources and to a variety of stakeholders, including those that are sceptical of the proposed changes.
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Box 5
Dealing with opposition policy and planning recommendations Guidelines on the involvement of key actors and stakeholders during development, implementation, monitoring and evaluation of SRH, HIV and AIDS education are developed. Involvement of various actors and stakeholders and the adequacy of the guidelines are monitored.
Activity 3
Set up a tentative list of stakeholders that should be involved in the development and delivery of SRH, HIV and AIDS-related education within the regular curriculum.
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2.
Integrating education on HIV and AIDS in the regular curriculum

A great many countries have integrated SRH, HIV and AIDS education into the national curriculum. The lessons learned regarding HIV and AIDS teaching and learning mentioned at the beginning of this module include those related to the manner in which the topic has been integrated into the (existing) curriculum. This section will build on these lessons learned. The section begins with a brief description of curricular frameworks, which ideally, provide a basis for curricular development. This is followed by a description of the possible curricular approaches to integrating SRH, HIV and AIDS education into an existing curriculum and examples of the principal factors that can affect integration, as well as educational policy-making and planning. Finally, we will look into some of the main implications of integration and the choice of curricular approach for educational policy makers and planners.
Curriculum framework
Though curriculum frameworks can vary significantly between countries, most clarify the structure of the planned curriculum, i.e. the teaching-learning aims, contents and methods. Most frameworks describe the following aspects: Context Statement of national education policies Overall learning objectives and/or outcomes Structure of the education system and learning areas Standards of required resources Teaching methodology Assessment of teaching-learning outcomes
A countrys curriculum framework should provide the necessary background for reflection on and decisions relating to curricular innovation, such as the integration of a new subject. A curriculum framework is not a static document, however. During the process of curricular innovation a ministry of education may find it necessary to adapt the framework to new contextual factors and teaching-learning needs.
Approaches to integrating HIV and AIDS education into the curriculum

Though different countries may use different terms to describe a particular curricular approach, it has been found that SRH, HIV and AIDS education is usually integrated using one of the five curricular approaches described in Box 6 below.
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Box 6
Curricular approaches
SRH, HIV and AIDS education can be included in the curriculum: a. as a stand-alone subject: The topic SRH, HIV and AIDS is clearly labelled and earmarked in the school timetable. It addresses all relevant issues relating to SRH, HIV and AIDS education. An example of a country that uses this approach: Benin. b. integrated in one main carrier subject: Teaching and learning of most of the relevant material is addressed in one main carrier subject, e.g. social science. Examples of countries that use this approach: Brunei, Chile, China, Colombia, Nigeria, South Africa and Vietnam. c. as a cross-curricular subject: SRH, HIV and AIDS education is integrated in a limited number of subjects (in no more than 1/3 of the total number of subjects in the curriculum). These subjects bear a close affinity with the topic and teaching-learning on SRH, HIV and AIDS within these few subjects is clearly defined and divided. Examples of countries that use this approach: Cambodia, Brazil, Malawi, Malaysia, and Mozambique. d. infused through the curriculum: Teaching-learning on SRH, HIV and AIDS is included across a broad range of subjects (in more than 1/3 of the total number of subjects in the curriculum). This approach has generally been found to be less effective than the other approaches. Examples of countries that use this approach: Botswana and Kenya. e. as an extra-curricular topic: Extra-curricular activities are activities that schools arrange outside the regular curriculum. Extra-curricular activities often offer greater opportunity for more active interaction between learners, teachers and the community. On the downside, because extra-curricular activities are less structured, they are often irregular. In addition, because outcomes are generally not assessed or credited, teachers may be less motivated to devote time to facilitating these activities, in particular when overtime is not compensated. Examples of countries that use this approach: Botswana, Bahamas, Indonesia. Source: IBE-UNESCO, 2006: tool 5; IBE-UNESCO, 2005a: Appendix B.
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Factors affecting the choice of curricular approach

Which curricular approach to the integration of SRH, HIV and AIDS education is most feasible and relevant in a particular context depends on a number of factors, which also have implications for planning. Main factors affecting integration include: 1. The possibilities to integrate HIV and AIDS education depend on the stage of curriculum reform or innovation in a country. For example, if a ministry of education is in the process of reviewing the overall primary education curriculum, then the inclusion of the subject SRH, HIV and AIDS will generally have fewer specific implications; teacher training, textbook development etc. are likely to be done in light of the overall reform, and development of SRH, HIV and AIDS education can therefore be carried out as part of the general process. N.B. At any stage of curriculum reform/innovation it may be necessary to budget resources for technical assistance or gaining access to technical resources to develop the contents of SRH, HIV and AIDS education, including teacher training. Examples may include involving a teacher and/or curriculum development specialist from a neighbouring country with experience in delivering/designing SRH, HIV and AIDS education, or finding good models of SRH, HIV and AIDS teacher training and teacher/learner materials. 2. Centralized or decentralized curriculum design: at what level is curriculum designed and/or what degree of flexibility exists to adapt content to the local context? These issues will also have implications for policy-making and (financial) planning, for example deciding in which subject SRH, HIV and AIDS education will be integrated may need to be done at higher (policy-making) levels in the ministry of education. Education delivery may also be (partly) decentralized, in which case one will need to reflect on the implications for planners at different levels of the system. Despite the general recognition of the importance of enabling young people to protect themselves from HIV and AIDS and, therefore, the importance of HIV and AIDS education, opinions vary widely about the best way of including the subject in the curriculum. Curricula are often overloaded already, which pleads against the introduction of a new subject. For this reason, and because they are less disruptive of existing arrangements, the integration approach is often advocated. Experience shows, however, that behavioural skill development and internalization of values require practice and extended open discussion. No matter what kind of curricular approach is used, dedicated and scheduled time is therefore needed. Despite the fact that the different curricular approaches all have certain advantages, it has been found that explicit and officially timetabled approaches of the separate subject type or modifications of it are widely recommended based on the failure of the infusion or integration approaches (UNESCO Bangkok and IBE, 2005).
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3. Implications of integrating HIV/AIDS education into the regular curriculum

Teacher training and support
Inadequate teacher training and support is one of the primary reasons why delivery and possible impact of HIV and AIDS education has been hampered. SRH, HIV and AIDS are topics that people generally find difficult to discuss, especially with young people and children. Teachers are no exception. Learners need to see the relevance of learning about HIV and AIDS for their own lives. This is an important reason why learning about these subjects requires active and participatory teaching-learning methods. These methods are new to a great many teachers. Many if not most teachers use classical, teacher driven pedagogical approaches, especially when they need to manage large and/or multi-grade classrooms. When the curriculum is overcrowded, teachers will also be less inclined or able to take the time to facilitate active learning activities on SRH, HIV and AIDS. The subject may be skipped altogether if there is no specific time allocation and if it is not made examinable. It has been found that teachers with a solid understanding of the subject content are better able to teach in a participatory, learner-centred manner (IBE-UNESCO, 2006: tool 4). The curricular approach chosen will affect teacher training. It will, for example, affect the number of (new and practising) teachers that will need to be trained, as well as the content of the (pre- and in-service) training. If a stand-alone subject or main carrier subject approach is used to integrate HIV and AIDS education into the curriculum, then fewer teachers will need to be trained than would be the case if a cross-curricular approach were used. If a cross-curricular approach is used, (trainee) teachers of the selected disciplines will need to learn how they can enable learners to establish linkages between the lessons learned across the selected carrier subjects. It goes without saying that both pre- and in-service teacher training on SRH, HIV and AIDS education needs to be comprehensive. It is recommended that where possible educators with desirable characteristics be selected for teaching SRH, HIV and AIDS, i.e. teachers who are willing and able to discuss these topics in an open manner, who are trusted by learners (in the case of in-service training), etc. Pre- and in-service teacher training should cover the same core themes that are addressed in SRH, HIV and AIDS education and should include ample time for trainees to try out participatory teaching methods and facilitate active learning. Training on relevant assessment methods is also critical, both in pre- and in-service training. During training, (trainee) teachers will also need to become familiar with the teaching-learning materials designed for SRH, HIV and AIDS education. For example, they may need to learn how to use teaching-learning tools designed for role-plays, student fieldwork, case studies and games. Finally, where pre-service training will need to focus on enabling trainees to teach the HIV and AIDS-related curriculum, in-service training will need to focus on enabling teachers to teach the modified curriculum, i.e. following integration of SRH,
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HIV and AIDS education. During in-service training, teachers will therefore need to learn, for example, which changes have been made to the old curriculum, what the implications of these changes are for the teaching of the old curriculum, and what the implications are for assessment/examination. The success of curricular change largely depends on teachers and the extent to which they understand and support the changes. For the reasons highlighted above, it is important that the implications of curricular change for teacher training be thought through carefully and that teachers be active partners in the consultation process on curricular change. Because teachers may encounter resistance to their teaching on SRH, HIV and AIDS from both colleagues and the community, it is important that they be supported by the school principal and key community members. These actors should therefore also take part in the consultation process as well as in (a number of) teacher training sessions.
Peer education
In addition to training and use of teachers to facilitate learning about SRH, HIV and AIDS, some countries also make use of peer educators. Peer education here refers to young people imparting information to others of a similar age group, background, culture and/or social status. Studies suggest that people are more likely to hear and personalize messages, and thus to change their attitudes and behaviors, if they believe the messenger is similar to them and faces the same concerns and pressures. Peer education can support young people in developing positive group norms and in making healthy decisions about sex (Mason, 2003: 1). Peer education can best be used to complement rather than substitute teacher facilitated education. Peer education can be used during both intra- as well as extra-curricular activities. However, factors relating to the curriculum (does the curriculum allow for the use of peer-led education?), teaching-learning climate and available resources (e.g. to train and support peer educators) will effectively shape how peer education is used in schools. Like teachers, successful peer educators require quality training and support!
Teacher wellbeing
As is explained in the IIEP/ESART Module 4.4 on HIV/AIDS care, support and treatment for education staff, there are many reasons why a ministry of education should establish and implement a workplace or wellness programme. Antiretroviral therapy (ART) and highly active antiretroviral therapy (HAART) are not yet widely available, and education sector staff living with HIV will therefore experience evermore frequent illnesses and will become progressively incapacitated (IIEP Module 4.4 - HIV/AIDS care, support and treatment for education staff:6). HIV/AIDS has profound psychosocial implications, which, if not managed appropriately, can be as debilitating as the physical effects of the disease. HIV/AIDS has negatively affected the quality of teacher education. It has led to the absenteeism of both the students and their lecturers from colleges due to illness or funeral attendance. The death of the lectures and their students in colleges due to HIV/AIDS has lead to a cumulative loss of skilled labour and potential skilled labour (IBE-UNESCO, 2004: Zimbabwe). The wellbeing of teachers has a profound effect on the quality of their work, i.e. teaching practice and, subsequently, the teaching-learning environment. For
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teachers to be effective, it is therefore critical that the impact of HIV and AIDS on teachers is prevented and mitigated as effectively as possible.
Preparation and distribution of teaching-learning materials

The choice of curricular approach and the availability of relevant teaching-learning materials, i.e. teacher training manuals, teacher handbooks, pedagogical aids and learner materials, will determine the resources that will need to be allocated to this expenditure post. It will be necessary to assess the availability and quality of existing materials and what the costs of updating these might be. Key questions include: in how many subjects will teaching about SRH, HIV and AIDS take place? Are local languages used to teach about SRH, HIV and AIDS? If so, how many different sets of the same type of material will need to be developed (e.g. in how many different languages will the material for teaching learners in grade x of primary education need to be printed)? What is the capacity of national publishers to publish good quality materials at a competitive price? How can materials best be distributed and when?
Time allocation
An important shortcoming of much of the education on SRH, HIV and AIDS is that there is not specific time allocation and that teaching-learning on the subject is fragmented and irregular. It is important when integrating SRH, HIV and AIDS education into the curriculum that a specific amount of time be allocated to the subject and that it be clearly scheduled in the school timetable. Deciding on the time that will be allocated to HIV and AIDS education can be guided by the following considerations: Participatory teaching-learning methods, which are strongly recommended to teach this subject, require more time than classical teaching methods, whether peer educators are used to facilitate some of the teachinglearning on the subject or not as they may require more time as they get used to their new roles. Whether or not some sub-themes are covered in other school subjects, e.g. childrens rights and human rights. The amount of time that education authorities are willing to spend on the subject, taking into account that the curriculum is often already overloaded and that, should time be taken off other subjects, subject specialists will need to be convinced of the importance of HIV and AIDS education.
The IBE-UNESCO Curriculum Manual on HIV and AIDS education provides guidelines for the minimum time required to complete the four different thematic modules during an average school year (160 days or 32 weeks). It is important to note that this minimum time should not be seen as time added to the existing curriculum and school calendar, but as part of the curriculum.
Service provision
In order for education on SRH, HIV and AIDS to be effective, it is important that learners have access to youth-friendly health services, information and counselling. Young people in both urban and rural areas should either be able to access these services in schools themselves or in a youth-friendly centre close by.
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The FRESH programme provides a range of tools to support the provision of school health programmes. This set includes a tool to guide the provision of (schoolbased) youth-friendly services. Should these services be provided in schools, a number of issues need to be considered and planned for. Some of the main points for consideration are listed in Box 7. If these are not provided in schools, ministries of education will need to work closely with, for example, ministries of health and youth to verify whether the services learners have access to are youth-friendly.
Box 7
Characteristics of youth-friendly services
I. Provider characteristics
Specially trained staff Respect for young people and students Privacy and confidentiality honoured Adequate time for client and provider interaction Peer counsellors available
II. Health facility characteristics
Separate space and special times set aside Convenient hours Adequate space and sufficient privacy Comfortable surroundings
III. Programme design characteristics
Youth involvement in design and continuing feedback Drop-in clients welcomed, and appointments arranged rapidly No overcrowding and short waiting times Affordable fees Communication on available services by trusted adults and peers Wide range of services available Necessary referrals available Educational material available on site and to take
Source: UNESCO, 2004b.
Community involvement
The involvement of the community in curriculum design and delivery is not only important in light of preventing opposition to HIV and AIDS education, but also as a general way of building support for education on this topic and harmonize communication taking place in schools, families and communities. If messages on HIV transmission and prevention are contradicted in the community, this can greatly undermine the effectiveness of education. As much as possible, a ministry of education will need to build partnerships with relevant actors and stakeholders so as to create and maintain broad support for its (new) education programme.
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In part 1 of this module under the heading opposition issues, a number of recommendations are mentioned which can guide the basic planning of community involvement in HIV and AIDS education development and delivery. Planners will need to reserve resources for continued involvement of the different actors and stakeholders, e.g. through regular national, provincial and local forums. Appendix 2 contains a tool for the planning of public participation, taken from the Education for Sustainable Development Toolkit (see McKeown, 2002, www.esdtoolkit.org). The tool can serve as a guide in determining the public participation needs of a community. The planning tool is based on five steps in which planners determine the type of project and the reason for public participation, identify the goals of the process, answer questions about the process, select a process, and follow up with evaluation of the process McKeown, 2002: 56 on www.esdtoolkit.org). The tool looks at three main types of projects, namely fact finding, setting goals, and implementation, and describes the kinds of public participation that work well for each of the five steps.
Schools that provide a child-friendly environment

Access to quality education is essential to preventing and mitigating HIV and AIDS. For SRH, HIV and AIDS education to be effective however, is it equally important that a school environment be child-friendly, that it models equality and fairness, and protects the rights of all children equally (UNICEF, 2004: 10). Box 8 Characteristics of a child-friendly school
Gender-sensitive for both girls and boys, Protects children; there is no corporal punishment, no child labour and no physical, sexual or mental harassment, Involves all children, families and communities; it is particularly sensitive to and protective of the most vulnerable children, Healthy; has safe water and adequate sanitation, with separate toilet facilities for girls and boys. Source: UNICEF, 2004. Ensuring that schools meet these standards will require resources, not only to establish and implement, for example, teacher conduct policies and build separate toilet facilities for girls and boys, but also to monitor whether schools meet these standards. Ministries of education will need to incorporate and budget for developing child-friendly schools in strategic and (annual) work plans.
Assessment
Assessment of teaching and learning is done for different reasons. It may be done to give feedback to learners and teachers on learners progress or report on learner progress to parents, caregivers and school management. It can also be done in the process of awarding national qualifications and accreditation of individuals, and/or to evaluate the education system itself. No matter what the
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purpose however, assessment can both positively and negatively affect learning, pedagogy and the curriculum. As was mentioned earlier, the absence of assessment of teaching and learning was considered a general shortcoming of current HIV and AIDS education; mandatory (summative) examination of teaching and learning should be done to ensure that teachers and learners take the subject SRH, HIV and AIDS seriously. Making the subject examinable can also strongly increase the likelihood that it is taught as has been mandated by the curriculum. To assess learner progress, it is best to have a balanced assessment package including both formative and summative assessment. Teacher training needs include training in conducting different types of assessment. Besides assessing learner outcomes, ministries of education will also need to monitor the quality of delivery and coverage of HIV and AIDS education and related services (e.g. counselling, access to youth-friendly health services and information), and the quality and coverage of teacher training and support. Monitoring the quality and coverage of teachers pre-service and in-service training and implementation of SRH, HIV and AIDS education in schools is important for planners as it will enable them to adjust resource allocation so as to enable the system to meet the targets set in the ministrys strategic/annual work plans. The following are some examples of issues that need to be monitored annually when implementing SRH, HIV and AIDS education programmes. Some issues are not directly related to the teaching-learning process itself, such as clean and safe sanitary facilities. These matters are, however, strongly related to the success of education (on HIV and AIDS) and need to be included in the assessment process.
Issues to monitor include:
Number of male/female trainee teachers educated in SRH, HIV and AIDS (preand in-service); Number of male/female trainee teachers trained facilitating SRH, HIV and AIDS education, i.e. active, learner-centred teaching-learning pedagogies (pre- and in-service); Active involvement of community members in SRH, HIV and AIDS education (e.g. involvement to be measured through parent-teacher meetings, involvement of community members in (extra-curricular) teaching); Frequency of supervision sessions for male/female SRH, HIV and AIDS teachers; Frequency of refresher trainings for male/female SRH, HIV and AIDS teachers; Number of male/female learners who received SRH, HIV and AIDS education (e.g. male/female attendance of lessons and, in case a school works in shifts, provision of SRH, HIV and AIDS education during different shifts); Number of hours spent teaching SRH, HIV/AIDS education per school year (does this meet the requirements as stipulated in the curriculum?); Number of SRH, HIV and AIDS education activities conducted in out-of-school settings; Number of schools in rural and urban areas with a trained male/female counsellor; Number of learners counselled per school/district, number of follow-up sessions;
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Number of schools in rural and urban areas with separate, clean and safe sanitary facilities for female and male learners; Number of vulnerable children supported who continue attending school (grants to orphans and vulnerable children (OVC), for example exemption from payment of school fees); Number of male/female teachers in urban/rural areas who attended an orientation session on HIV and AIDS and workplace policy and/or received reader-friendly information on work place policies.
Ideally, monitoring and evaluation of learning outcomes as well as the issues mentioned above should be linked to or integrated in the overall education management information system (EMIS) (where this has not yet been done). Please see Module 3.2 on HIV/AIDS challenges for education information systems for further information. In addition, some of the issues mentioned above may be measured through and/or complemented by qualitative research on, among others, the impact of HIV/AIDS on education (see Module 3.3 on Qualitative research on education and HIV/AIDS).
Activity 4
The ministry of education in your country is in the process of deciding which curricular approach to use to integrate SRH, HIV and AIDS education into the regular curriculum for both primary and secondary levels. Based on what you have read above and reflecting on what you know about the present curricular structure in your country, what would you consider to be the main policy-making and planning implications of the stand-alone subject and cross-curricular approach? What are the advantages and main challenges of the two different curricular approaches with regard to policy-making and planning?
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Summary remarks
The aim of this module was to provide the reader with an overview of: the characteristics of quality SRH, HIV and AIDS education; the approaches to integrating SRH, HIV and AIDS education into a school curriculum; and the implications of integration of SRH, HIV and AIDS education for teacher training, textbook development and assessment/examination methods.
The module was based on the lessons learned from evaluation reports on current HIV and AIDS education around the world. These evaluations identify a range of important shortcomings that have contributed to the piecemeal implementation of HIV and AIDS education. In sum, it has been found that implementation of HIV/AIDS education fails in the following key areas: Content: teaching is not comprehensive, e.g. the realities of sexual transmission are not covered and stigma and discrimination are not adequately addressed. Delivery: HIV and AIDS education is not fully integrated into curricula, and implementation therefore remains piecemeal. Training: the Global Campaign for Education found that in only three of the 18 countries had Ministries of Education made systematic attempts to train teachers about HIV and AIDS (Global Campaign for Education, 2004: 5). Materials: insufficient quantities of (good) materials are reaching schools.
By paying particular attention to the lessons learned from experience of HIV and AIDS education around the world in the development/revision of strategic plans and (annual) work plans, educational planners can make a critical contribution to the improvement of HIV and AIDS education.
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Lessons learned
Lesson One Education on HIV and AIDS is often still too knowledge-based (for example see IBE-UNESCO, 2005 and Global Campaign for Education, 2004). More attention needs to be paid to the development of learners abilities to deal with daily problems and (risky) situations relating to and affecting their wellbeing and health. At the same time, more study needs to be done into the teaching-learning of life skills in order to better understand how the learning of life skills can be facilitated. Teacher training needs to be comprehensive and last sufficient time to ensure that teachers are able to facilitate the learning of skills through participatory pedagogic methods and not only facts through, for example, rote learning. Resources are also needed to monitor the teaching and learning of life skills so that teaching-learning practices can be improved. Lesson Two Studies have demonstrated that where SRH, HIV and AIDS education is not fully integrated into the curriculum, teaching and learning may fall short due to incomplete delivery (for example see IBE-UNESCO, 2005). To ensure effective implementation, it is recommended that: SRH, HIV and AIDS education be fully integrated into the national curriculum of primary and secondary level schooling, i.e. that a specific amount of time be allocated to the subject and that the teaching-learning outcomes be assessed and accredited. teacher training courses be designed to be in line with and meet the challenges that the chosen curricular approach can present. Lesson Three Community commitment to and involvement in HIV and AIDS education is of critical importance. This involvement is essential not only as a means to prevent opposition to education on SRH, HIV and AIDS, but also to work towards harmonization of messages learners hear in school and those that are disseminated in the community (for example see Kirby et al., 2005 and Global Campaign for Education, 2004). In order to gain and maintain understanding and support of the public and other important (education sector) actors for SRH, HIV and AIDS education, national guidelines on the involvement and informing of relevant stakeholders during the process of development, implementation and monitoring of SRH, HIV and AIDS-related education should be established and followed up on. Resources (human, financial, technical) need to be reserved to make community involvement possible. Lesson Four The lack of (adequately) trained teachers has severely hampered the implementation of quality HIV and AIDS education (for example Global Campaign for Education (2004). Training of and support for teachers are essential building blocks in the MoEs response to
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the HIV/AIDS epidemic. Therefore, it is recommended that sufficient resources be allocated to ensure that: all trainee teachers receive comprehensive training on SRH, HIV and AIDS. Also in the case of teacher training, outcomes should be made examinable and accredited; guidelines are designed for selection of SRH, HIV and AIDS teachers and, where relevant peer educators (including those that will facilitate extracurricular activities); courses on participatory teaching methodologies and relevant (formative and summative*) assessment methods are incorporated into pre- and inservice teacher training programmes. Lesson Five Monitoring and evaluation of the delivery and impact of HIV and AIDS education is critical to its success (see IBE-UNESCO, 2005). The absence of assessment of teaching and learning is considered a general shortcoming of current HIV and AIDS education. Pre- and in-service teacher training should include training on assessment methods. The success of HIV and AIDS education also largely depends on assessment of, among others: the involvement of relevant actors during the process of development, implementation and evaluation of SRH, HIV and AIDS education; coverage and quality of teacher training and support; access to youth-friendly (health) services and information in and/or close to the school. The guidelines should specify, among others, the frequency of monitoring and evaluation, reporting and use of monitoring and evaluation findings for the adjustment of programmes/approaches. Monitoring and evaluation of HIV and AIDS teaching-learning indicators should be done within the framework of the overall ministry of education data collection system (EMIS). Guidelines on use of relevant, complimentary data from, for example, the ministry of health, universities and non-governmental organizations should be included.
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Answers to questions Question 1 Please refer to subheading 2 in section 1 Core topics. If there are additional topics that are particularly important in your country, i.e. relating to sexual and reproductive health, HIV and AIDS, please add these or make special mention of them under the heading of one of the core themes. For example, if female genital cutting and/or male circumcision is a relevant topic in your country this topic should be addressed (e.g. under the core theme relationships and gender issues), not only in case of female genital cutting as a human rights topic, but also from a health perspective. Question 2 Please refer to box 6 to assess what are the main curricular approaches that are used to integrate (new) subject matter into a curriculum to verify which approach best matches the one used in your country (refer also to the curriculum framework and/or HIV and AIDS Education strategy). Question 3 Impacts of teacher absenteeism and mortality on the quality of teaching/learning (on SRH, HIV and AIDS) can differ per country, but some common impacts are: HIV and AIDS lead to absenteeism of teachers due to illness, caring for sick relatives or funeral attendance; less experienced younger teachers, volunteers and untrained teachers are recruited in response to the teacher shortage; the psychosocial impact of HIV and AIDS on teachers as a result of (repeated) periods of grief and mourning, the loss of friends and family, and the mental and financial burden that is forced upon them can lead to poorer teaching performance.
Question 4 Short-term solutions can include the use of retired teachers, volunteers from the community, grade 12 (i.e. final year of secondary school) school-leavers as relief teachers. The number of shifts per school day can be increased or multi-grade classes can be created. Finally, having substitutes on stand-by and giving extra lessons on Saturdays can serve as short-term stop-gap measures2. It is important to note that these measures could be implemented to respond to a crisis situation as bringing in under/unqualified teachers can contribute to a loss of quality of teaching/learning. More long-term solutions therefore need to be found. Examples of more long-term solutions are:
2 The short-term and long-term solutions are mainly based on the findings of the IBE-UNESCO Capacity-Building Seminar HIV/AIDS, Teacher Shortage and Curriculum Renewal in the Southern Africa Region (November 2003, Swaziland).
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Teacher training Re-organization of teacher training in order to have teachers in the field after a shorter training period, either by shortening altogether pre-service training or by reorganizing pre-service training to have trainees teaching sooner (for example in Malawi: 16 weeks training, 10 weeks in the field, 16 weeks training). The use of information technologies to complement teacher instruction is another solution that has been mentioned in Namibia. In Swaziland, a part-time diploma programme may be introduced for unqualified personnel who are already in the classroom. Provision of Anti-retroviral therapy (ART) Provision of antiretroviral treatment to teachers could also greatly reduce the rise in death rates and cumulative loss of teachers. A projection presented by Namibia shows that providing ART to HIV-positive teachers will keep many of them from falling sick, and ultimately reduce significantly mortality related to AIDS. Data collection, stigmatization and review of sick-leave plans Better data on teacher attrition and absenteeism is critical to planning. However, it has to be taken into account that teachers who are sick are often reluctant to declare it officially. Important reasons why teachers can be averse to taking official sick leave are stigmatization, existing sick-leave schemes and the fear of loosing ones salary once the permitted sick-leave (usually six months) period is over. Stigma and discrimination in the workplace and sick leave schemes for (HIV-positive) teachers are, therefore, two critical issues that need to be tackled. Question 5 I. Provider characteristics
Specially trained staff:

- Training of selected staff, e.g. by ministry of health trainers and/or NGO staff - Recruitment of trained staff - Definition of tasks and responsibilities of staff, clarification of functions and services versus other school functions.
Privacy and confidentiality respected:

- Elaboration of school and youth services policy on confidentiality of learners and teachers.
Respect for young people and students and adequate time for client and provider interaction:
Question 6 As is described in the section on opposition on pages 1011, there are three basic steps that need to be taken to involve community members and other relevant actors in the process of curricular design and delivery. These can be further broken down into activities, for example: I. Clearly define and communicate on the role of stakeholders in the process of consultation on curricular change. Develop guidelines on the involvement of key actors and stakeholders during development, implementation, monitoring and evaluation of SRH, HIV and AIDS education (these guidelines should be linked to or
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integrated in the overall documentation of the implementation strategy for the curricular innovation that is planned. Carry out a stakeholder analysis to explore who is affected by and/or can influence the process and outcome of curricular change/SRH, HIV and AIDS education to determine which actors or representatives thereof need to be involved in the curricular change process. Ensure that all relevant stakeholders (within and outside the ministry of education) are informed of the intention of integrating SRH, HIV and AIDS education into the curriculum and that involvement of community members and other important actors is considered key to the process.
II. Engage stakeholders throughout the curriculum development process To sustain the involvement of stakeholders, ask them to volunteer for different aspects of the project through task forces, committees, etc. Ensure that volunteers maintain communication with other actors (e.g. by circulating committee schedules and reports).
III. Communicate policy changes Disseminate regular progress reports, which, because they contain stakeholder input and opinions, acknowledge that they were heard. Make these reports widely available to the public through newspapers, popular local publications, and Internet to further validate the opinions, as well as the time and energy that stakeholders have spent in the process. Monitor the process and outcomes of the stakeholder involvement. Have the goals of the involvement been achieved?
Question 7 Box 8 mentions a number of characteristics of child friendly schools. To answer this question one can look into the possible policy-making and planning measures to take in order to realize these characteristics. For example: - School is gender-sensitive for both girls and boys: Develop policies to promote inclusion and equity in the school environment by guaranteeing the continuing education of pregnant or parenting girls, and address issues such as abuse, discrimination and harassment by staff and among learners. Policies aimed at getting and keeping girls in school should be developed and implemented in co-operation with children, families and communities. Separate and clean sanitary facilities in all schools can help towards ensuring that girls keep going to school when they are menstruating, Question 8 Please refer to the text box on page 18 for examples of factors relating to quality of education which need to be monitored and which should ideally be linked to the EMIS.
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Answers to activities Activity 1 Example: Delivery: characteristic of quality education (see Box 3): Provide [learners] occasions to model, practice communication and refusal skills useful for self-protection and to build self-confidence. This characteristic of quality education has implications for teacher training and classroom delivery. Leading questions may be: to what extent does current preand in-service teacher training cover the teaching-learning of various communication skills? Do trainee teachers get sufficient time and support to practise the necessary teaching skills? Are trainee teachers assessed and credited in these areas? There are also important implications relating to classroom delivery, e.g. what is the current learner-teacher ratio? How does this compare with international benchmarks relating to acceptable and optimal pupil-teacher ratios, in particular when applying active and participatory teaching-learning methods (40:1 is considered the minimal acceptable norm for pupil:trained teacher ratio and 1:20 as the best acceptable [Education International, 2002])? Activity 2 Answers to this activity depend on average age of sexual debut for females and males. It is important to remember that education on SRH, HIV and AIDS should start before the onset of sexual debut. Activity 3 The involvement of educational and non-educational stakeholders during the different stages of curriculum design and delivery varies from country to country. During the process of consultation the following groups of people can be involved: curriculum specialists, area experts, teachers, learners, school principals, textbook producers, teacher unions, academics, as well as representatives of parents, business, trade and industry, religious groups, and local government units. For more detailed information on the different stages of curricular design and which stakeholders can be involved, please refer to the UNESCO Bangkok and IBE-UNESCO publication Leading and Facilitating Change, A resource pack for capacity building (2005). Activity 4 The answers given below are general implications, advantages and challenges, i.e. they may vary from country to country. Stand-alone subject: Teacher training: A stand-alone subject can basically be taught by one teacher per school. However, if the school is very large (e.g. has multiple grades and shifts), it may be necessary to train (and recruit) more than one teacher per school. It will have to be decided whether a new teacher will be appointed to teach this subject or whether suitable teachers can be identified at the school level (preferably by learners). If the latter is done, the workload of the selected teachers will need to be
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reviewed and it is likely that in most cases these teachers will need to be relieved of their other (teaching) tasks. Material development and distribution: Specific materials will need to be developed for the stand-alone subject, i.e. teacher training materials; teacher handbooks, teaching aids (including, for example, making condoms available to teachers and (older) learners), and learner materials for different grades. HIV and AIDS strategic plans and (workplace) policies should be distributed to all teachers. Cross-curricular approach: Teacher training: If SRH, HIV and AIDS education is integrated into, for example, social science and biology, in-service training will need to be geared toward teachers currently teaching these two topics. Pre-service training on SRH, HIV and AIDS education will need to be given to all trainee biology and social science teachers. Material development and distribution: Additional materials will need to be developed to guide teaching and learning on SRH, HIV and AIDS within biology and social science. As with a stand-alone subject, teacher handbooks, learner books etc. will need to be developed. Syllabi for biology and social science will need to be reviewed; integrating the teaching on SRH, HIV and AIDS will require making space for the new teaching-learning contents (by removing certain other less urgent lessons/sub-topics). Examples of the general advantages and challenges of the two different curricular approaches are given below.
Box 9
Examples of the advantages and main challenges of SRH, HIV and AIDS being taught as a stand-alone and cross-curricular subject Advantages * It is possible to recruit and train suitable teachers. * It can be cost-effective as there are a limited number of teachers to train and support, and a limited number of textbooks to develop and distribute. * Monitoring of the quality of education is simplified. Challenges * It is critical that the subject be made mandatory otherwise there may be a risk that teachers will not take the time to teach it. * The start up costs can be quite high due to the need for training of specialized teachers. * The cross-curricular approach involves training larger number of teachers as well as development and distribution of a large number of textbooks. * Monitoring of the quality of education is more complicated.
Curricular approach Stand-alone subject
Cross-curricular subject
* In principle this approach allows for a sharing of responsibility between teachers for delivering the various aspects relating to the topic.
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Documents Boler, T.; Adoss, R.; Ibrahim, A.; Shaw, M. 2003. The sound of silence; difficulties in communicating on HIV/AIDS in schools. London: ActionAid. Boler, T.; Aggleton, P. 2005. Life skills based education for HIV prevention: a critical analysis. London: Save the Children and ActionAid International. www.actionaid.org/assets/pdf/life_skills_new_small_version.pdf Education International. 2002. Educational International Quarterly, Volume VIII, 3-4,Double Issue, September-December, Belgium. Fountain, S.; Gillespie, A. 2003. Assessment strategies for skills-based health education with focus on HIV prevention and related issues. New York: UNICEF. www.unicef.org/lifeskills/index_10489.html Global Campaign for Education. 2004. Deadly inertia? A cross-country study of educational responses to HIV/AIDS. www.campaignforeducation.org/resources/Nov2005/ENGLISHdeadlyinertia. pdf IBE-UNESCO. 2004. Executive report on the Capacity-Building Seminar HIV/AIDS, Teacher Shortage and Curriculum Renewal in the Southern Africa Region (November 2003, Swaziland). Geneva: IBE-UNESCO. IBE-UNESCO. 2005a. The quality imperative; Assessment of curricular response in 35 countries for the EFA monitoring report 2005. Geneva. IBE-UNESCO. 2005b. HIV/AIDS teaching-learning materials appraisal tools, Geneva: IBE-UNESCO. IBE-UNESCO. 2006. Manual for integrating HIV and AIDS education in school curricula. Geneva: IBE-UNESCO Kelly, M.J. 2000. Planning for education in the context of HIV/AIDS. Paris: IIEP-UNESCO. Kirby, D.; Laris, B.A.; Rolleri, L. 2005. Impact of sex and HIV education programs on sexual behaviors of youth in developing and developed countries. Working Paper 2. Research Triangle Park, NC: Family Health International. www.fhi.org/NR/rdonlyres/e4al5tcjjlldpzwcaxy7ou23nqowdd2xwiznkarhhnpt xto4252pgco54yf4cw7j5acujorebfvpug/sexedworkingpaperfinalenyt.pdf Mason, H. 2003. Peer education: Promoting healthy behaviors. Washington, DC: Advocates for Youth. http://www.advocatesforyouth.org/PUBLICATIONS/factsheet/fspeered.pdf McKeown, R. 2002. Education www.esdtoolkit.org for sustainable development toolkit.
Ministry of Health of Jamaica. 2004. Youth.now: Adolescent sexual decisionmaking counselling protocol http://pdf.dec.org/pdf_docs/PNADC076.pdf. UNESCO. 1996. Learning, the treasure within. Report to UNESCO of the International Commission on Education for the Twenty-first Century. Paris: UNESCO.
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UNESCO Bangkok. (no date). Life skills on adolescent reproductive health: Package of lessons and curriculum materials. www.unescobkk.org/index.php?id=1599&type=98 UNESCO. 2004a. Quality education and HIV/AIDS. Paris: UNESCO UNESCO. 2004b. Characteristics of Youth-Friendly Services. FRESH Tools for Effective School Health. Paris. UNESCO. http://portal.unesco.org/education/fr/ev.phpURL_ID=37084&URL_DO=DO_TOPIC&URL_SECTION=201.html UNESCO Bangkok and IBE-UNESCO. 2003. Building the capacities of curriculum specialists for educational reform, Final Report of the Regional Seminar, Vientiane, 9-13 September 2002. UNESCO Bangkok and IBE-UNESCO. 2005. Leading and facilitating change; A resource pack for capacity building. A resource pack for capacity building. Discussion paper 1. Bangkok. UNESCO. UNICEF. 2002. HIV/AIDS education: a gender perspective. New York: UNICEF. http://portal.unesco.org/education/en/ev.phpURL_ID=25673&URL_DO=DO_PRINTPAGE&URL_SECTION=201.html UNICEF. 2004. Girls, HIV/AIDS and education. www.unicef.org/publications/index_25047.html New York: UNICEF.
WHO. 2003. Information Series on School Health. Skills-based health education including life skills: An important component of a Child-Friendly/HealthPromoting School. Geneva: WHO. www.who.int/school_youth_health/media/en/sch_skills4health_03.pdf
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Appendix 1
Impact of sex and HIV education programs on sexual behaviors of youth in developing and developed countries. By: Kirby, D. Laris, B.A. and Rolleri, L. (2005), Family Health International The above mentioned publication summarizes a review of 83 evaluations of sex and HIV education programmes that are based on a written curriculum and are implemented among groups of youth in school, clinic, or community settings in developing and developed countries. The review analysed the impact programmes had on sexual risk-taking behaviours among young people. It addressed two central research questions: 1) What are the effects, if any, of curriculum-based sex and HIV education programmes on young peoples sexual risk behaviours, STI and pregnancy rates, and mediating factors such as knowledge and attitudes that affect those behaviours? 2) What are common characteristics of the curricula-based programs that were effective in changing sexual risk behaviours? Analysis of curricula that were found to be effective led to the identification of 17 common characteristics of the curricula and their implementation. Five of the 17 characteristics relate to the development of the curriculum; eight involve the curriculum itself; and four describe the implementation of the curriculum. The common characteristics are summarised in the box below.
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Curriculum development process 1. Involved multiple people with different backgrounds in theory, research and sex/HIV education to develop the curriculum 2. Used a logic model to develop the curriculum that specified the health goals, the behaviours affecting those health goals, the risk and protective factors affecting those behaviours, and the activities addressing those risk and protective factors 3. Assessed relevant needs and assets of the target group 4. Designed activities consistent with community values and available resources (e.g. staff time, staff skills, facility space and supplies) 5. Pilot-tested the program Curriculum content 6. Created a safe social space for youth to participate 7. Focused on clear health goals the prevention of HIV/STIs and/or pregnancy 8. Focused narrowly on specific behaviours leading to these health goals (e.g. abstaining from sex or using condoms or other contraceptives), gave clear messages about these behaviours, and addressed situations that might lead to them and how to avoid them 9. Addressed multiple sexual psychosocial risk and protective factors affecting sexual behaviours (e.g. knowledge, perceived risks, values, attitudes, perceived norms and selfefficacy) 10. Included multiple activities to change each of the targeted risk and protective factors 11. Employed instructionally sound teaching methods that actively involved the participants, that helped participants personalize the information, and that were designed to change each group of risk and protective factors 12. Employed activities, instructional methods and behavioural messages that were appropriate to the youths culture, developmental age and sexual experience 13. Covered topics in a logical sequence Curriculum implementation 14. Whenever possible, selected educators with desired characteristics and then trained them 15. Secured at least minimal support from appropriate authorities such as ministries of health, school districts or community organizations 16. If needed, implemented activities to recruit youth and overcome barriers to their involvement (e.g. publicized the program, offered food or obtained consent) 17. Implemented virtually all activities with reasonable fidelity
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Appendix 2
Planning public participation Type of Project Step 1: Reason for public participation The public shares local knowledge and creative thinking with government agency. Step 2: Identify goals of the process Increase information and creativity related to a specific project. Step 3: Answer questions about the process Q3: Amount of Q2: What type of Q1: Who public interaction is are influence? participant appropriate? ? Depends on Information Everyone. Take steps sharing. Emphasize quality of contributions. two-way exchange: to ensure citizens hear what wide agencies are doing; representagencies hear what ation of citizens think of sociotheir plans, and economic listen to alternative groups. plans. Discuss and Interested Deliberation. debate citizens. Emphasize more intensive exchange, competing using well-reasoned values; form collective arguments and vision; make group problemrecommendatio solving. ns to agency. Step 4: Public participation processes Public comments. Surveys Public meetings. Informal consultations. Public notice and comment procedures. Public hearings. Small-group discussions. Series of workshops. Citizen advisory committees. Citizen juries. Mediations. Negotiations. Step 5: Evaluate the process
Q4: What is government agency's role? High control. Agency defines what information is needed and how it will be used.
Fact Finding - To gather the best information and ideas from many sources.
Did better information contribute to better decisions? Did participation processes increase information and ideas on the issue?
Were goals created? If there was conflict, was it resolved? If there was a need for more trust, was trust increased? Were decisions Small-group High influence; Low control. Interest Deliberation. Reduce Implementation Groups are implemented? discussions. Agency groups. Emphasize creative forge conflict; - Implement the directly Series of workshops. If there was provides agreements problem-solving; affected by the build trust; project and conflict, was it Citizen advisory technical among participants have reduce conflict project; groups implement resolved? committees. resources and themselves access to the best will play strong decisions and mistrust If there was a Citizen juries. assurance to about information and role in that could need for more trust, Mediations. implementation back the analysis. implementimpede was trust Negotiations. responsibilities. participants' implementation ation. increased? agreement. Source: McKeown, 2002. (Adapted from Beierle and Cayford, 2002. Democracy in Practice: Public Participation in Environmental Decisions. Resources for the Future). Setting goals - People reflect on what they want for the community The public represents a broad range of values. Identify and incorporate public values into decisions Moderate control. Agency allows deliberations to evolve without overt control.
MODULE 4.1: A curriculum response to HIV/AIDS 53
Appendix 3
IBE-UNESCO Diagnosis tool of current curriculum situation Level of schooling: Primary level/specify age-groups:____________ Dimensions of HIV and AIDS education HIV and AIDS education included in the curriculum Curricular approach Current situation Diagnosis What could / should be changed? What is good?
Yes No Stand alone One carrier subject Cross-curricular Infused Extra-curricular Comments: Quote curriculum : Disciplines D1: D2: D3: D4: D5. Provide list : hours/year
Goals Total time per school year specifically allocated to HIV/AIDS in each related disciplines Learning material available Teaching material available
Provide list :
Teachers/staff in charge of HIV and AIDS education Teacher/staff training
List:
In-service Describe : Pre-service Describe :
Status of HIV and AIDS education
Compulsory Assessed Examinable Comments :
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IBE-UNESCO Diagnosis tool of current curriculum situation Level of schooling: Secondary level/specify age-groups:____________ Dimensions of HIV and AIDS education HIV and AIDS education included in the curriculum Curricular approach Current situation Diagnosis What could / should be changed? What is good?
Yes No Stand alone One carrier subject Cross-curricular Infused Extra-curricular Comments: Quote curriculum :
Goals
Total time per school year specifically allocated to HIV/AIDS in each related disciplines Learning material available
Disciplines D1: D2: D3: D4: D5. Provide list :
hours/year
Teaching material available
Provide list :
Teachers/staff in charge of HIV and AIDS education Teacher/staff training
List:
In-service Describe : Pre-service Describe :
Status of HIV and AIDS education
Compulsory Assessed Examinable Comments :
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Appendix 4
Glossary Assessment Formative assessment is generally defined as a means to provide feedback to the teacher and learners regarding present understanding and skill development of learners. Formative assessment is considered an integral part of classroom teaching, which provides necessary inputs for both the teacher and learner to modify and enhance the teaching-learning process. Formative assessment can make use of both formal and informal assessment procedures. Summative assessment is used to evaluate learning achieved at different times during the school year(s) for the purposes of reporting to parents, other teachers, learners themselves, and other interested parties, including school boards or accreditors of national qualifications. Source: IBE-UNESCO, 2006.
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Module
M.J. Kelly
Teacher formation and development in the context of HIV/AIDS
4.2
About the author

Michael J. Kelly is Chairperson of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He was Professor of Education at the University of Zambia, is a member of the Jesuit Order and specializes in the areas of policy development, education and development, educational planning and educational management. He also has particular expertise in curriculum development and teacher education.
Module 4.2
TEACHER FORMATION AND DEVELOPMENT IN THE CONTEXT OF HIV/AIDS
Table of contents
Questions for reflection 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Introductory remarks The context of HIV and AIDS Teacher formation and development Challenges involved in incorporating HIV and AIDS education into the curriculum The curriculum response to HIV and AIDS Models of programme delivery Programme delivery at the pre-service level Programme delivery at the pre-service level Teaching methodology Counselling and care Management and institutional issues Education as a moral enterprise Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 61 63 65 68 70 73 76 78 79 81 82 83 86 87 89 91 93
MODULE 4.2: Teacher formation and development in the context of HIV/AIDS
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Aims
The aims of this module are to: clarify what is meant by teacher formation and development; show why teacher formation and development should deal with HIV and AIDS and issues arising from the AIDS pandemic; highlight the actions that must be taken for the integration of these areas in programmes of teacher education and development; outline the broad areas in which teacher educators and teachers need to develop HIV competence; draw attention to the potential of management and institutional factors within the teacher development setting to facilitate or inhibit the control of HIV and AIDS.
Objectives
At the end of this module you should be able to: identify the challenges that HIV and AIDS pose for teachers and tutors in their capacity as educators; explain why teacher formation and development programmes should incorporate issues relating to HIV and AIDS; specify the principal elements of a comprehensive education programme for addressing HIV and AIDS; identify school management areas relating to HIV and AIDS that should be included in teacher formation and development programmes; outline the broad planning steps involved in ensuring that prospective teachers become AIDS-competent; plan, in a meaningful way, for the inclusion of HIV and AIDS issues in ongoing teacher development programmes; identify potential HIV and AIDS hazards facing members of the teaching profession and ways of avoiding these.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What do you think is meant by teacher formation and development? In what ways does teacher formation differ from teacher training?
Why should HIV and AIDS be of concern in teacher formation and development?
What are the major challenges that teachers face in providing education in the areas of HIV and sexuality?
Are schools and teachers able to cope with the demands that the introduction of HIV and AIDS, life-skills and sexuality education has imposed on them, or are they being expected to do too much in this area? Explain.
Should HIV and AIDS and related issues be a required examinable subject area in school or in teacher preparation programmes? Explain.
How successful have in-service training programmes been in equipping teachers to incorporate HIV and AIDS and related issues into their teaching?
Identify some areas where the management must take account of HIV and AIDS in the daily running of a school or teacher education institution.
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Describe any practices in teacher preparation programmes that should be reexamined because of the way they increase the participants risk of HIV infection.
Describe any areas in teacher preparation programmes that should be strengthened because of the way they reduce participants risk of HIV infection.
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Module 4.2
TEACHER FORMATION AND DEVELOPMENT IN THE CONTEXT OF HIV/AIDS
As the HIV and AIDS pandemic spread during the 1980s, education systems in high-income countries quickly took steps to incorporate HIV prevention education into their curricula. The response in middle- and low-income countries was slower, but by the late 1990s several education ministries had initiated HIV prevention programmes. Investigations in 2001 showed that most interventions focussed on learners only, with few programmes to equip teachers to deliver the new curricula that embodied HIV and AIDS education (Akoulouze, Rugalema and Khanye, 2001). The investigations also showed lack of analysis of the systemic implications of the pandemic and its relevance for educational planning. The challenges that were identified in 2001 still persist. HIV and AIDS, sexuality and life-skills education is being introduced quite rapidly into school programmes, but teacher preparation and development programmes are not keeping pace with these advances. As a result, schools are endeavouring to infuse the subjects of HIV and AIDS, sexuality and life-skills into their curricula before anything similar is undertaken in teacher preparation institutions or, in many cases, in university faculties of education. In several countries, attempts are made through in-service training (INSET) to redress this situation, but for the greater part INSET programmes have not offered the fullness of knowledge or depth of comprehension needed to bring serving teachers to the level of competence required for teaching in this area. Programmes that are offered tend to be unsystematic, ad hoc, and poorly followed through. These shortcomings point to the need for the thorough integration of issues of HIV and AIDS, sexuality and life-skills into all teacher preparation programmes. Ideally, in countries where HIV prevalence is high, these areas would constitute an independent academic discipline; while in countries where HIV prevalence is low (below 1 per cent of the general population) it might be sufficient to incorporate HIV and AIDS issues consistently into various parts of the teacher preparation programmes. There is also a need for in-service programmes that are sufficiently comprehensive and systematic to deliver essential content, skills and materials to serving teachers and to motivate them to take action. To show why this is necessary, the module will first examine the meaning of teacher formation and development in the context of the AIDS pandemic, and why HIV and AIDS and teaching about them should be matters of concern within these processes. The module will then examine the challenges that one confronts when incorporating this area into the curriculum. This will lead to the consideration of three interrelated areas: an outline of a suitable curriculum; the development of educators competent in its delivery; and the importance of on-going professional
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support from education ministries and university departments, and of systematic monitoring and evaluation programmes. The module will also consider critical HIVand AIDS-related management and institutional issues that affect the learning process, in teacher education institutions and in schools. Finally, the module will briefly consider the importance of developing the reflective and critical abilities of teachers so that, in the context of HIV and AIDS, they can become more effective agents of social change and better role models for their students. Throughout the course of the module, short exercises will invite users to return to some of the questions for reflection given above and to relate what is being proposed to their understanding and experience.
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1.
The context of HIV and AIDS

An understanding of the context of HIV and AIDS will help you appreciate why the module refers to teacher formation and development rather than to teacher training. The gravity of the current AIDS situation cannot be over-emphasized. The United Nations Secretary-General has identified the pandemic as the greatest challenge of our age and has pointed to the fact that HIV and AIDS are affecting people at an accelerating rate on every continent. In June 2001, the world set for itself the target of containing the disease by 2015, but world leaders have acknowledged that this goal will not be attained. Indeed, instead of being contained, the pandemic seems to be spreading. Almost 5 million people became infected with HIV in 2005, raising the numbers who are believed to be carrying the virus globally to more than 40 million, half of them women. In the same year, 3.1 million individuals died from AIDS-related diseases. Currently, Africa is the most seriously affected region in the world. This situation could change, but because of the way the disease progresses and makes its impacts, it is inevitable that AIDS will still be affecting Africa 20 years from now. But if, by 2025, millions of Africans (as well as millions in other continents) are still becoming infected with HIV, it will not be because nothing could be done to prevent this. Rather it will be because not enough will have been done to apply the lessons learned in the first 25 years of the pandemics history. Action taken today on the basis of these lessons has the potential to stop the spread of the pandemic. One crucial lesson is that a good basic education itself ranks among the most effective and cost-effective means of HIV prevention (World Bank, 2002: 1). Moreover, the provision of HIV and AIDS education greatly enhances that effectiveness. The most critical element would appear to be education itself, i.e. enlarging young peoples opportunities to participate in educational programmes, particularly in schools. The available evidence suggests that improved knowledge, desirable behaviours, and declining infection rates have occurred among those who attended school, even though this was at a time when the curriculum did not contain much, if any, education on HIV, sexuality or reproductive health, and the education provided was not always of high quality. What appears to have contributed to the improved knowledge, desirable behaviours and declining HIV infection rates was not what students learned in school, but the fact that they attended and learned in a school setting (please refer to Module 1.3, Education for All in the context of HIV/AIDS, where a number of these ideas are further developed). Furthermore, beneficial outcomes have been reported from educational programmes that incorporated HIV and AIDS, reproductive health, sexuality and life-skills into the curriculum. These positive outcomes, which have been found in several different communities and cultures, in high-, middle- and low-income countries, include the following: improved and successful negotiating skills; first intercourse taking place at a later age; reduced sexual activity;
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greater fidelity to one partner; and increased condom use. Moreover, there is no evidence that the inclusion of reproductive health and sexuality topics in the school curriculum increases sexual activity, leads to promiscuous behaviour, or increases the risk of HIV infection. With all that has been said above still in mind, turn now to Activity 1 which asks about reactions to sexuality education.
Activity 1
Reactions to providing sexuality education Identify some places where you have heard or read that providing sexuality education in schools promotes promiscuity. What is your reaction, as an educator and as a member of a community, to the provision of such education?
The beneficial outcomes identified above are among the principal reasons why teacher formation and development programmes should be concerned with HIV and AIDS. Such programmes have the potential to: 1. help prevent the spread of HIV infection among learners and educators in the teacher preparation institution itself; 2. help prevent the spread of HIV infection among learners in the institutions where the newly qualified teachers will teach; and 3. protect the education sectors capacity to provide adequate levels of quality education. Basically, what is being said here is that providing HIV and AIDS, sexuality and lifeskills education can help curtail the rate of HIV infection, not only among those attending schools but also among the educators, whether these are tutors, qualified teachers, or student-teachers who are still going through their formation programmes. This reduction is a powerful reason why every programme concerned with the formation of teachers should make provision for training in this area. It is also important to bear in mind that the great majority of those undergoing initial teacher formation are young, in their late teens or early twenties, and these are the ages where the prevalence of HIV infection is particularly high. The susceptibility of these young people to infection may be further increased by campus cultures and lifestyles that may be open to activities, behaviours and
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practices that increase the possibility of HIV transmission. Although their levels of AIDS awareness may be high, student-teachers still need to extend their knowledge and understanding, and on the basis of this understanding to develop values, attitudes and skills that will enable them to pass safely through situations that expose them to the risk of HIV infection. Their success in doing so will further equip them to be effective and credible teachers in the broad field of HIV prevention.
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2.
Teacher formation and development

Traditionally, the initial preparation of teachers has been referred to as teacher training. The model underlying this designation emphasizes the knowledge and skills teachers need to acquire in order to become effective in transmitting a recognized body of knowledge and skills to their students. The training period ensures the expertise of the trainees in the subjects they are to teach and equips them with a variety of techniques that will make them skilled in dissecting their teaching areas into easily assimilated chunks of information, transmitting these chunks to their students, and evaluating (through oral, written and practical assignments) whether or not students have in fact assimilated them. This training perspective is necessary and must be continued. But in the context of HIV and AIDS it is not sufficient. Something further is required, not merely in relation to HIV and AIDS themselves, but in relation to other school disciplines, particularly in countries where HIV prevalence is high (1 per cent or above in the general population). The AIDS pandemic is so catastrophic, complex and allencompassing that a teacher needs to be engaged not just as an academician or communicator of knowledge, but as a person and human agent. For centuries many of the worlds best teachers have endeavoured to mobilize their students around values, those concepts of the desirable that have a motivating force for an individual. In the context of HIV and AIDS, this should be the pattern for all teachers. Their aim should be to prepare their students for life in a society that is endeavouring to rid itself of the infection and to influence them in ways that will enable and motivate them to live in a fashion that will reduce their risk of HIV infection, contribute to the care, support and treatment of infected or affected persons, and play some part in mitigating the damaging consequences of so much sickness and death. If student-teachers are to achieve this aim in their teaching years, their preparation programme needs to pay adequate attention to their personal development. As indicated in a proposed compulsory core module for all professional teacher education programmes in South Africa, the programme should provide opportunities that will enable prospective teachers to explore, understand and clarify their values, attitudes, inhibitions, prejudices, anxieties and fears. In addition to technical training on what to teach and how to teach it, studentteachers should be enabled to develop a self-understanding that would increase their potency to act as responsible persons and to form mature interpersonal relationships with others. Teacher formation in the context of HIV and AIDS refers, therefore, to an initial academic and technical training of prospective teachers (what to teach and how to teach it) that is infused by such an engagement with the pandemic that it initiates the transformation of student-teachers into committed, responsible and effective agents of positive social change. This formation process cannot be accomplished in the short period of initial teacher preparation. Rather it is a lifelong process which must be provided as part of teachers continuous growth process. Teacher development, then, consists in on-going formation that is nurtured by the never-ending acquisition of new knowledge and skills, new understandings of oneself, and new ways of relating to
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others. This development provides serving teachers with the space, information and encouragement they need in order to develop their capacity to respond positively to HIV and AIDS in their own lives, and to help their students do the same.
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3.
Challenges involved in incorporating HIV and AIDS education into the curriculum
The challenges encountered when striving to incorporate HIV and AIDS issues into a school curriculum are partly professional and partly personal. In their professional capacity, educators draw attention to the following: Their lack of preparation and professional competence. Many educators allege that they are not equipped to teach about HIV and AIDS. Some may show, through their teaching and responses to questionnaires, that their knowledge and understanding are deficient. Very few have been exposed to this area in their initial training programmes. In-service programmes are often found to be superficial, piecemeal and ad hoc, and do not always form part of a comprehensive programme. Tutors in teacher preparation programmes, and even lecturers in universities, are not always conversant with the issues, and few have received any special training to enable them to serve as qualified and effective instructors. The absence of a universally agreed curriculum framework for use in schools and for which college and university programmes should serve as a preparation. The already overcrowded curriculum and the lack of adequate time to give HIV and AIDS the necessary attention. The inadequacies of teaching and learning materials within the system and their very restricted availability within individual institutions. Teacher uneasiness with the assumption that countering HIV and AIDS among young people is a special responsibility that the education sector must assume virtually on its own. The lack of support from head teachers, school supervisors and inspectors, and the lack of policy on making HIV and AIDS and life-skills education an examinable area of study. The attitudes of parents, school management committees and parentteacher associations, who may agree to the inclusion of HIV and AIDS in the curriculum but oppose the discussion of sexuality and other necessary sexual matters. Responding to these challenges implies a series of determined steps. If it is conceded that in a world with HIV and AIDS schools should provide HIV preventive education for all learners, then education policy-makers and planners must adopt measures that will: build the requisite capacity of lecturers and tutors in university faculties of education and teacher preparation institutions; incorporate an HIV and AIDS education curriculum into the programme for teachers undergoing initial formation as an integral, required and examinable part of their programme; devise a suitable curriculum for the various levels of schooling, making this an integral, required and examinable component of the school programme;
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ensure the development, production and dissemination of sufficient quantities of support teaching and learning materials; make available the monitoring and evaluation back-up that is provided for other subject areas so that HIV and AIDS education is accorded professional standing on a par with other subject areas; promote partnerships that will facilitate collaboration across sectors, with private agencies, and with community and family representatives; implement HIV and AIDS policies for staff and students in all teacher preparation institutions. At the personal level, educator reluctance to treat HIV and AIDS and sexuality in depth is a major constraint. Cultural factors, fears and personal sensitivities contribute in complex ways to the disinclination of many educators to do so. Culturally, many are unwilling to deal with sexuality, especially in mixed classes or with children of the opposite sex, because of taboos that prohibit open discussion on sex and sexuality, particularly with young people. Family, community and (sometimes) faith-based silence on sexual development gives rise to many fears among educators: fear of causing offence to parents or community leaders; fear that they might be accused of encouraging promiscuity among children; fear that their teaching might be interpreted as the sexual solicitation of children; fear that if children subsequently engage in sexual activity, they will be held responsible. Personal sensitivities also contribute to educator reluctance to deal with HIV and sexuality. Many, aware that as parents or community members they do not talk about these things within their families, feel equally inhibited in trying to do so with groups of learners. Some are conscious of the discrepancy between their personal way of living and what they are expected to propose to the learners. Others who know or suspect that they themselves are, or that somebody in their families is, infected with HIV are reluctant to deal with an issue that is so close to home. In response to these misgivings, the following actions should be taken at various levels. Establishing a strongly supportive institutional environment that, in turn, is rooted in clear, widely disseminated and well-accepted education sector policies. Mobilizing the support of parents, community leaders, governing boards and similar gatekeepers for teaching about HIV and AIDS, sexuality and life-skills. Encouraging the participation of partner organizations and significant members of the community in certain aspects of teaching. Creating an institutional culture that places a high premium on the nonabuse of learners, the safety in every respect of girls and young children, and zero tolerance for violence, stigma and discrimination. Promoting the professionalization of education on HIV and AIDS, sexuality and life-skills, so that educators can engage with this area more dispassionately.
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Ensuring full understanding and acceptance by all parties of the research evidence that teaching about sexuality brings beneficial and not harmful results. The activity that follows asks you to discuss certain issues with fellow teachers. This can be done with individual teachers or with a group of teachers. If you do not have easy access to teachers, you might be able to hold the discussions with some other educators, with traditional or religious leaders, with parents, or with some others in society who are concerned about the education of young people in the areas of HIV, sexuality and reproductive health.
Activity 2
Discuss with fellow teachers the professional and personal misgivings they experience when teaching HIV and AIDS, sexuality and life-skills, and take special note of any points additional to those proposed above. In particular, explore with them the extent to which they were prepared for such teaching in the course of either their pre-service or in-service training.
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4.
The curriculum response to HIV and AIDS

The curriculum response to HIV and AIDS should promote a holistic and comprehensive understanding of the pandemic, appropriate to the level of development of the learner. The response should then ensure the integration into classroom activities of good quality skills-based education on sexual health and HIV and AIDS, including life-skills. This section gives some indication of the areas that such a curriculum should address. It is not intended to serve as either a prescriptive or comprehensive curriculum guide. Rather, its principal purpose is to draw attention to the complex range of knowledge and competencies required for teaching in this area, and thereby to highlight the challenge arising in teacher preparation and development. It should also be noted that integrating good quality skills-based education on sexual health and HIV and AIDS (including life-skills) into classroom activities in schools necessitates corresponding attention to these areas in teacher preparation and development programmes. However, the reason for adapting a school curriculum in this way is not the same as for adapting the curriculum in a teacher preparation institution. In schools, the primary purpose is to promote the development of the knowledge, skills, attitudes and values that will enable learners to protect themselves against HIV infection (and understand a variety of issues relating to care, support, treatment and impact mitigation). In teacher institutions, the primary purpose is to equip learners with the knowledge, skills and commitment needed for teaching in these areas, though a very important secondary purpose is also to further develop the knowledge, skills, attitudes and values needed for self-protection and a broad AIDS response.
Broad curriculum content

In a world with HIV and AIDS, schools owe it to their pupils, and teacher preparation institutions owe it to their students, to: 1. make them well informed. Surveys repeatedly bear out the need to pass on correct information on HIV and AIDS and their transmission, and to dispel the myths, false beliefs, wrong attitudes, macho images and false sense of security that can lead young people to adopt risky behaviour; 2. position learner understanding of HIV and AIDS within a framework which takes account of the personal and society-wide factors and pressures that constrain personal freedom and make an individual more vulnerable to HIV infection; 3. facilitate the development of self-awareness and self-esteem, and the clarification of values; 4. deepen understanding of the meaning and implications of sexuality and relationships, of what it means to be male or female, and of the role of physical sexual activity;
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5. promote understanding of the meaning of gender and gender roles, and foster deeper appreciation of equality between the sexes, the extent to which this is negated by extensive gender power imbalances throughout society, and what could be done to correct this situation; 6. promote the negotiation, decision-making, stress-management and other life skills needed to put understanding and knowledge into practice in the sexual sphere and other areas of interpersonal encounters; 7. help learners understand that responding to HIV and AIDS extends beyond prevention narrowly conceived to care, support and treatment for those who are infected or affected, as well as to alleviating the negative impacts that the pandemic has on individuals, households, communities and society; 8. deal with the ABC approach (abstain, be faithful, use condoms) within the framework of responsible living and overall risk reduction. This involves highlighting the role and value of abstinence in its broadest sense (delaying the age of first sexual encounters, not having sex before marriage, remaining abstinent for a specified period, resuming abstinent behaviour, etc.) and the skills needed for this. It also includes transmitting risk-reduction skills that facilitate the avoidance of casual and commercial sex, encouraging a reduction in the number of concurrent partners, and discouraging sexual relations with older individuals and also the practice of unprotected sex; 9. create an institutional culture that encourages the development of lifeaffirming attitudes and values, enshrines gender equity in principle and practice, proscribes substance abuse (drunkenness, drug taking), stresses the importance of a healthy life-style (exercise, nutrition and a positive approach), and shows zero tolerance towards violence, stigma and discrimination; 10. foster a responsibility-promoting climate, in which individuals are empowered to take charge of their own lives in an ethical human response that embodies the professional ethics that should guide teachers, and the responsible choices that should guide teachers and students alike. It can be seen that this schema extends well beyond an approach that is narrowly confined to behaviour change. Consensus is growing worldwide that it is ineffective to limit HIV prevention messages to messages about sex, abstinence, fidelity and condom use (and, in certain societies, needle exchange and change from intravenous to oral drug use). This is because such a narrow approach does not take account of the personal and societal factors that restrict the freedom of an individual to make alternative, risk-free choices. Analysts are becoming increasingly aware that the narrow focus of HIV and AIDS programmes on personal behaviour change is one of the reasons for the current limited success in halting the spread of HIV infection. Condom advocacy is the classic example. Countless women who have remained faithful within marriage have contracted HIV from their husbands because gender imbalances (in this case, womens inferior power status in relation to men) do not allow them to negotiate the circumstances of sex or the use of condoms. To be effective in HIV prevention and in their overall response to the pandemic,
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education programmes must take account of this and similar factors, such as poverty, that constrain the freedom and choices of individuals. Hence they must extend beyond biological and narrowly conceived behavioural factors to include consideration, appropriate to the level of the learners development, of such issues as poverty, gender power roles, urbanization, migration, and north-south relationships. The activity that you are now asked to undertake is intended as a 'reality check' that brings to light what schools actually try to cover in these areas.
Activity 3
Examine the syllabus or materials used in school teaching of HIV and AIDS and related areas in order to find out the extent to which they deal with such matters as constraints on the ability of individuals to make fully autonomous choices, factors that increase personal vulnerability, or a very rationally conceived ABC prevention model. Find out from teacher educators in your locality, or from the curriculum materials being used, the extent to which HIV and AIDS issues are present in pre-service teacher education programmes. What topics feature most prominently in these programmes?
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5.
Models of programme delivery

Clearly, the AIDS pandemic gives rise to so many areas of concern that it would be necessary to structure the various topics within a more limited number of themes such as HIV and AIDS, sexuality, human rights and vulnerability. What would seem to be important is, firstly, that the education system recognize the need to embody these themes in the curriculum, and, secondly, that it should do so in an appropriate and effective way. In the relatively short period since HIV and AIDS became an education concern, education ministries have developed various models for including them in the curriculum. In a given institution, some of these models may run concurrently. The following are commonly used models. 1. Integration across the curriculum: HIV and AIDS, sexual and reproductive health, and life-skills are seen as cross-cutting issues that should be addressed in all subject areas and become examinable as parts of those subjects. 2. The separate subject model: HIV and AIDS and the related areas are designed as a freestanding separate examinable subject. The health and family life education (HFLE) initiative in Caribbean schools approximates to this model. 3. The carrier subject model: HIV and AIDS and the related areas become an integral part of an existing carrier subject (such as health education). 4. The co-curricular model: HIV and AIDS are not formally dealt with in the teaching curriculum, but are treated in assemblies, clubs (anti-AIDS clubs, etc.) and associations, drama and entertainment programmes, special events, and other areas of the non-formal curriculum. Integration across the curriculum seems to be the most commonly adopted formal approach, while elements of the co-curricular model can be found in many schools. Integration is preferred because: it is a way of ensuring that every learner repeatedly encounters HIV and AIDS issues; integrating HIV and AIDS across the curriculum reflects the reality of life, where the pandemic and its consequences are integrated into every facet; it can be difficult to make room in an already overcrowded timetable for a new subject; there are not enough teachers with the competencies needed for teaching a purpose-designed HIV and AIDS subject. Because of the way this model would allow issues such as poverty, gender imbalances, social and personal vulnerabilities, and the socio-economic context of HIV and AIDS to be rooted in disciplines such as social science, history, religious education or literature, it would seem to be appropriate for delivering much of the broader curriculum framework outlined in the preceding section.
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Each of the models, however, has its advantages and its disadvantages. To clarify what these are, you are now invited to undertake Activity 4.
Activity 4
Outline the advantages and disadvantages of each of the models for the inclusion of HIV and AIDS in a school curriculum. Find out which of these models schools in your area are following, and discuss with teachers and learners how effective they find them.
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6.
Programme delivery at the pre-service level

Clearly it is the responsibility of the curriculum authorities in each school system to determine what is best for their circumstances, having regard to their human and other resources and also to the level of HIV infection in their environment. But teachers who are to treat the range of areas outlined in Section 4 whether these be integrated across the school curriculum, presented as a separate subject, or piggyback on a carrier subject will need purposeful, intensive and comprehensive preparation. However, the method of delivery of a programme for those undergoing their initial teacher training are very likely to differ among countries according to HIV prevalence levels or the way in which the pandemic is developing. Where the prevalence of HIV is high (1 per cent or more of the general population) or is growing (as in Eastern Europe and parts of Asia), the need is for every teacher to be well versed in all that relates to HIV and AIDS. This need could best be responded to by giving HIV and AIDS and related issues the status of a separate, required, examinable module or subject in the curriculum for the preparation of teachers at all levels. This course should cover the basics that curriculum developers and HIV and AIDS analysts consider as the necessary minimum. It could be supplemented, at least in certain institutions (especially university education faculties) by an optional course that deals with many of the areas in greater depth. Where HIV prevalence is low (less than 1 per cent) and stable, the need remains for every teacher to acquire a minimum level of AIDS competence. This could be achieved by developing suitable required and examinable modules to form part of other subject areas. In effect, this is to use the carrier subject model at the teacher education level. Additionally, where HIV prevalence is low, institutions could offer supplementary optional modules or fully developed courses that would allow more extensive treatment of selected areas. Whichever option is adopted, the first requirement will be to build the capacity of lecturers in the teacher preparation institutions to deliver AIDS-related programmes. Numerous pre-service and in-service training programmes relating to HIV and AIDS have encountered problems because the lecturing staff were not themselves AIDS-competent. AIDS-competence requires that lecturers have a theoretical and practical understanding of the pandemic and its implications, appropriate to the level of their other professional qualifications. The first priority is to develop such AIDS-competence in education staff at universities and in teacher education institutions.
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7.
Programme delivery at the in-service level

The number of people to be reached makes the challenge of developing AIDS-competence in serving teachers a formidable task. In-service training programmes have met with no more than limited success in reaching significant numbers and in developing the requisite understanding and teaching skills. The problems experienced by participants are common to those frequently experienced in in-service training and workshop programmes: Insufficiently focused content. Too much being covered. A one-off set of training sessions with no follow-up. No training programme as such, but merely a poorly co-ordinated series of training opportunities (often associated with the availability of funding for this purpose). Little support for participants when they return to the workplace. Issues of local relevance not dealt with. Interests and concerns of participants not taken into account at the planning level. Communication methods not directed to the aspirations and potential of adults of some experience and prior training. Promoting the AIDS competence of serving teachers would be facilitated in the following ways: Formulating, in collaboration with representatives of serving teachers and teacher unions, a well-defined in-service HIV and AIDS programme or curriculum that clearly specifies the understandings, skills and attitudes that are to be developed over time and that will lead to an acknowledged qualification that merits salary increment. Providing intensive and extensive training to a core group of trainers who, in co-operation with ministry of education inspectors or standards officers (or AIDS units), would subsequently have responsibility for HIV and AIDS in-service programmes in sub-regions of a country or state. Developing a sufficient quantity of materials, many of which would be suitable for self-study, others providing support for classroom work, and making these freely available to participating teachers. Organizing teachers at school cluster or zone level for the sake of peergroup study and support in areas of the in-service HIV and AIDS curriculum. Ensuring that the core trainers and other qualified personnel follow up on training activities by support visits to participants in their schools and colleges. Providing incentives and acknowledgement for teachers who exercise in their classrooms the AIDS competencies developed during training programmes.
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Establishing from the outset monitoring and evaluation procedures that will help in keeping the in-service training programme on track and in adjusting it to changing needs. Many of these measures could be implemented by a more planned and rational use of existing resource centres. Adopting them will require an increase in the resources at the disposal of teacher training or HIV and AIDS units. An education ministrys preparedness to make these resources available (or to seek them from co-operating partners) would give a clear indication of its commitment to a dynamic response by the education sector to HIV and AIDS. The ideas that have been presented here will lead you to reflect on training programmes that you have participated in and the value they added to your personal development. The activity that follows is designed to help you extend that reflection to the many other programmes and workshops offered by education ministries.
Activity 5
Obtain from your education ministry information on the HIV and AIDS in-service training courses offered during the past two years. Who were the trainers at these courses?
How many teachers did they reach?
What was the content of the training?
To what extent were these courses adequate in terms of building the capacity of serving teachers to teach HIV and AIDS and related areas?
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8.
Teaching methodology
A positive aspect of the impact of HIV and AIDS on school systems has been the way it has stimulated developments along directions that for other reasons are considered desirable. A notable example is the greater sense of urgency that the pandemic has created in efforts to attain the Education for All (EFA) goals. In the area of the curriculum, responding to HIV and AIDS has led to another beneficial outcome: greater focus on interactive and participatory teaching methodologies. These methodologies avoid excessive use of teacher lectures (chalk and talk) and place greater reliance on learners playing an active role in the learning process. The methodologies involve a variety of approaches and activities such as talks, role plays, case studies, stories, games, discussions, quizzes, field visits, participatory process drama, making visual presentations for self-expression or to stimulate discussion, and question and answer sessions. A characteristic of this interactive approach is that the teacher is no longer the sole purveyor of information or understanding, but shares with others the role of facilitating learning sessions. At times the co-facilitators may come from among the learners themselves (peer educators) and at other times they may come from elsewhere (parents, community leaders, health experts, persons living with HIV, etc.). Information coming from various surveys shows that, in fact, a large proportion of young people learn about sexuality and reproductive health matters, as well as HIV and AIDS, from their peers, the media and para-professionals who are not teachers. In some situations, learners feel more comfortable and confident when they learn about these matters from health or social workers. Further, the most significant learning experiences for many young people occur when they hear a person living with HIV giving a personal testimony and speaking about aspects of the pandemic. All teacher preparation institutions should prepare student-teachers for such interactive methodologies and provide occasions for outsiders to participate in the training and formation activities. It is also desirable that the programme of inservice training, referred to in Section 7 above, provide for such exposure. In both instances, the experience is likely to result in more effective classroom interaction, not only in the field of HIV and AIDS and their related areas, but also in other subject areas. But adopting interactive methodologies does not mean that all forms of teacherdirected and teacher-led learning must be abandoned. There will always be room for these. In particular, a curriculum that makes provision for the broad areas outlined in Section 4 above will provide much scope for the more traditional forms of teaching and learning. Hence curriculum delivery in the area of HIV and AIDS, in schools and teacher preparation institutions alike, will require a judicious combination of teacher-led and learner-centred methodologies.
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9.
Counselling and care

The HIV and AIDS pandemic has given rise to two special challenges for schools in countries with high levels of HIV: providing counselling services; and responding to the special needs of orphans and vulnerable children. The experience of HIV and AIDS in ones immediate family is almost invariably extremely traumatic. This is partly because of the distress of seeing a loved one die a slow AIDS death, partly because of the stigma and silence that are attached to the disease, and partly because of the way HIV and AIDS affect every aspect of the life of an affected individual. Learners and educators both experience the traumatic effects, to the detriment of their personal well-being and ability to learn or teach as the case may be. Especially affected are children who lose one or both parents to the disease. Sensitively conducted investigations have revealed the extent of the psychological scarring from which such children suffer (FHI, 2002). In addition, many children find themselves in grave economic difficulty following the loss of a parent or guardian, given the long period of illness, the costly medical attention and the reduction in income that precede an AIDS death. As the nature of the challenge continues to unfold, preliminary studies have revealed how psychologically fragile many orphaned children tend to be, how they associate with one another for security and understanding, and how they may not profit from the socialization processes that go on in families, schools and communities. Clearly these are two areas to which every teacher should be sensitive. It would be unrealistic to expect regular teachers to be equipped with the counselling skills needed for dealing with traumatized children, orphans or teacher colleagues. Nevertheless, the teacher preparation programme should give some attention to these issues, so as to sensitize participants to their occurrence and to prepare them for some of the distressing realities that they are likely to encounter in their professional lives.
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10. Management and institutional issues

In a world with HIV and AIDS, institutional managers need to ask themselves some searching questions: 1. What aspects of this institution or of our practices facilitate the spread of HIV? And therefore what measures should we put in place to change these aspects? 2. What aspects of the institution or of our practices inhibit the spread of HIV? And therefore what measures should we put in place to promote these? These questions are relevant to teacher formation and development in the context of HIV and AIDS. Aspects that facilitate the spread of HIV could include the social and living arrangements in the college or training institution, and practices that are condoned (such as ease of access by sugar daddies to young female students). They could also include the way students are placed for the periods of teaching practice, which are integral to good teacher preparation. Within the education sector as a whole, posting individuals away from their spouses or from the support of their families for significant periods, or requiring teachers to be away from home overnight to collect their salary payments in cash, or paying generous allowances to workshop participants in fashionable venues, could also be seen as factors that heighten the HIV vulnerability of individuals. It is the responsibility of the management to subject these and similar practices to scrutiny under an HIV and AIDS lens to make sure they are not unwittingly increasing the HIV vulnerability of trainees and employees. One tragic outcome could be that HIV is contracted during the years of training, but does not manifest itself as AIDS until several years later. Such an outcome runs counter to the very purpose of the teacher preparation institution. On the other hand, there are aspects and practices that inhibit the spread of HIV. One is an institutional culture that is very alert to the disease and its potential to spread, and that mobilizes the entire institution in efforts to contain it. What was said in Section 4 above about the institutional culture that schools should seek to promote bears repeating in the context of teacher education establishments. These establishments will encourage aspects that inhibit the spread of HIV and AIDS if they take steps to create an institutional culture that encourages the development of life-affirming attitudes and values, enshrines gender equity in principle and practice, proscribes substance abuse (drunkenness, drug taking), stresses the importance of a healthy life-style (exercise, nutrition, positive approach), and shows zero tolerance for violence, stigma and discrimination. It could be hoped that teachers who experience such an environment during their period of formation would themselves endeavour to create a similar atmosphere in the schools where they will eventually teach. Other issues that should be explored during the period of pre-service formation, and subsequently as part of on-going teacher development, include the following: Education sector policy: It is essential that every teacher be familiar with the HIV and AIDS policy that several ministries of education (and other education
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employers) have established. These policies have been developed in response to the gravity of the AIDS situation and show a commitment to responding in a humane and effective way to the pandemic within the education sector and its institutions. In certain instances, a ministrys policy may be spelled out at greater length in HIV and AIDS guidelines for educators. Teachers should be made aware of these, where they exist. Workplace policy: In addition to a general sector policy, many education ministries have developed workplace policies dealing with HIV prevention; care, support and treatment of affected personnel; and occupational health and safety. Again, it should be an integral part of the preparation and on-going development of teachers to ensure that they become familiar with the contents of such a policy and know how to apply it in the situation of their own institutions. Professional ethics: HIV and AIDS workplace policies usually imply attention to a code of conduct and the maintenance of a high standard of professional ethics in personal behaviour, especially in dealings with children. The AIDS context suggests that prospective teachers should be enabled to explore the expected standards through a variety of interactive techniques (case studies, role playing, etc.) that will deepen their commitment to understanding and maintaining behaviour appropriate for a trusted professional. Among other things, this will contribute to the credibility of the teacher as a role model in the classroom when dealing with matters of behaviour. Partnerships: No matter how well disposed or informed, teachers cannot respond to all the demands that HIV and AIDS create. Instead, they must work closely with a wide range of partners, and their preparation programmes should help them explore how such partnerships could be made to work. Some partnerships will be within the education sector itself, for example with parent-teacher associations or school governing bodies. Others will involve public service areas such as health and social welfare, the community, non-governmental organizations, or traditional or religious leaders. Partnerships involving community members and organizations can be of crucial importance in helping overcome the gap that often exists between the school and the community and in facilitating the transformation of both school and community into safe, HIV-free areas, free from stigma and discrimination, and where the infected and affected are assured of care and support. The final activity in this module asks you to reflect on unintended hazards or benefits arising from teacher training and management programmes. Because the issues are country- or even locality-specific, no set answers can be given. But that may be all the more reason why you need to think hard on the situations with which you are familiar. Good things and bad things can be happening without our being aware of them, but in the circumstances of HIV and AIDS it is better to bring such matters to the surface.
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Activity 6
Can you identify any aspects (other than those mentioned above) in the training, posting or management of teachers that: (a) facilitate the spread of HIV and AIDS; and
(b) inhibit its spread?
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11. Education as a moral enterprise

The previous section referred to the presumption that teachers serve as suitable behavioural role models for their students. Societys expectations for schools and for teachers are very high in this regard. While acknowledging the importance of academic achievement, most parents believe that, in addition to promoting academic excellence, schools and teachers should positively influence the way in which their students live and relate to each other and the wider world. This leads parents to favour schools that show care and concern for individual students, are orderly and well-run, emphasize moral values and standards, and equip students for life in a changing and complex world. Moreover, parents wish to see these expectations for schools reflected in the personal lives of teachers. HIV and AIDS have heightened these expectations. The apparently uncontrollable pandemic, with its many negative consequences, has accentuated the importance of the teacher as one who can provide pastoral care to young people in need, serve as a role model in many areas of personal behaviour, and be a catalyst for change in promoting understanding and tolerance in a climate beset by stigma and discrimination. This does not come naturally to teachers or anybody else. Neither is it something that can be achieved by simple prescription. As Fullan, the renowned expert on educational change, said: What is important cannot be mandated (Fullan in Tuohy, 1999: 1). Instead it is something whose growth within the prospective and serving teacher must be nourished during the periods of initial formation and on-going development. Ensuring that the climate of schools and teacher institutions reflects the institutional culture referred to in Sections 4 and 10 will help in establishing a suitable environment for this transforming formation and development. But it will be necessary also to provide opportunities that allow teachers, whether they are students or qualified teachers, to get in touch with what HIV and AIDS mean in their lives. This implies that, in addition to academic content, programmes must seek to develop teacher capacity to reflect critically on HIV and AIDS in ways which engage the person and promote motivation. The desirable outcome would be teachers who are empowered to take charge of their own lives and to guide the lives of the young people entrusted to them in an ethical human response to the crisis. Promoting this reflective capacity is a challenging task for which pre-service and inservice programmes on their own would hardly be adequate. These programmes need to be supported by inputs from a wide variety of stakeholders, especially people living with HIV, those with counselling skills, religious personnel, and representatives from affected communities. They need to be structured and delivered outside the normal programme bounds so that they can be more effective in enabling teachers to confront HIV and AIDS intellectually and emotionally. If the programmes succeed in having teachers internalize HIV/AIDS in this way, there is a greater likelihood that teachers will cease to view it as a distant problem which is the concern of others. Instead, seeing it as something real and belonging to themselves, they will be more likely to serve as positive models for their students and credible guides for the way they should behave.
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Summary remarks
The literature gives much attention to what schools must do in an era of HIV and AIDS, and cites numerous school-based HIV prevention programmes. It gives much less attention, however, to what teacher formation institutions should do. Educators found it intuitively right to respond to the emergency of HIV and AIDS by establishing as a matter of urgency school programmes for the protection of the window of hope that learners in primary and secondary schools are seen to constitute. But this sense of urgency did not extend to programmes that would prepare teachers for these new and demanding responsibilities. Even after almost a quarter of a century of global experience of HIV and AIDS, school programmes remain somewhat haphazard. Some systems give evidence of little more than an uncoordinated range of pilot projects. Others have developed curriculum modules, but for the greater part these are very narrowly conceived within the framework of rational behaviour change models, individuals who control every aspect of the choices they make, and a simplistic straight-line ABC perspective. Very few school programmes have gone back to the roots to examine comprehensively how the subject of HIV and AIDS should be mainstreamed into a school setting, what this implies for curriculum content and delivery, and how teachers are to be prepared for their role in schools which are part of a world with HIV and AIDS. A number of significant steps need to be taken to improve this situation. It needs to be determined how the subject of HIV and AIDS can be mainstreamed in the organizational and teaching aspects of schools, at least in countries with a generalized HIV pandemic. The curriculum needs to be transformed so that, going beyond the mere adding on of HIV-related topics, it reflects both broad HIV and AIDS concerns and more sharply focussed behaviour-related issues. There is a need to build the capacity of university and teacher-education staff to prepare new teachers for the delivery of this curriculum. A comprehensive programme of in-service training should be designed, and a cadre of trainers developed who will build the capacity of serving teachers to deliver the new curriculum. Support learning and teaching materials that are appropriate to the various levels ought to be developed and disseminated. HIV education must be established as a professional subject in its own right on a par with other school disciplines. Mainstreaming HIV and AIDS in the organizational life of a school needs to be matched by its mainstreaming within teacher formation institutions, whether university or other. This requires that HIV and AIDS concerns take centre stage, so that all that goes on within the institution is informed by and takes full account of relevant HIV issues. The purpose is twofold: to ensure that staff and students routinely understand the relevance for HIV and AIDS of what they do as members of an institution; and to establish policies, programmes and activities which effectively address the concerns arising from the pandemic.
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As with other developments in education, this agenda is not likely to move from paper to reality in the absence of understanding and commitment on the part of senior management in education ministries and partner organizations. Such commitment should lead, in turn, to a prioritized, costed, and time-bound plan of action. Until this is done, teacher formation and development in the context of HIV and AIDS will remain marginalized, with the outcome being failure to capitalize on the potential of education systems to respond as meaningfully as they should to the pandemic.
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Lessons learned
Lesson One: In a world with HIV and AIDS, the curriculum and the methods of curriculum delivery cannot be the same either in schools or in teacher preparation and formation institutions as they would be in a world without the pandemic. The saying with HIV and AIDS it can no longer be business as usual applies as much to the curriculum used in schools and teacher preparation institutions as it does in other domains of society. In countries where HIV and AIDS are a major problem, there is need for these subjects to be mainstreamed into the entire curriculum at both school and teacher preparation levels; for the curriculum to be re-worked to take account of the impacts of the pandemic; and for it to be redeveloped around the pandemic as a central issue. Lesson Two: The curriculum response to HIV and AIDS in schools, and therefore in teacher preparation programmes, needs to extend further than sexuality, sexual reproductive health (SRH) and life-skills, and should include attention to the factors, such as gender inequality, that render individuals vulnerable to HIV infection by constraining their ability to make free choices. The sexuality, SRH and life-skills approach is valid and necessary, but it is not sufficient. As long ago as 1999, UNAIDS noted that the global response to the pandemic suffered from the major weakness of failing to address the importance and centrality of social contexts, including government policy, socio-economic status, culture, gender relations, and spirituality (UNAIDS/PennState Project, 1999: 24). The global response still fails to accommodate this insight, and in consequence there is inadequate productive guidance for school systems and teacher preparation programmes. Incorporation in the curriculum of the broader view advocated by UNAIDS could bring two highly significant benefits: it could make education programmes more effective, and it could address some of the factors that make teachers reluctant to teach in this area. Lesson Three: The successful introduction of the subject of HIV and AIDS in school systems demands that a suitable planning cycle be identified and followed. The steps to be taken follow one another logically: 1. Determine what is to be taught (the curriculum content) and how it is to be taught (the curriculum model and mode of delivery). 2. Build the capacity of third-level lecturers and tutors to provide training, and simultaneously develop learning and teaching materials. 3. Make use of this cadre of highly specialized personnel, incorporate the new areas as an integral part of pre-service programmes, and provide comprehensive and systematic in-service training for serving teachers. 4. Introduce the new curriculum areas into all schools. The process is like building a house: one begins by laying down the foundations of a well-defined curriculum. On these, the walls of expert teacher educators, a competent teaching force, and a good supply of teaching-learning resources can be
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built. Only then can the roof of teaching that can promise positive learning benefits in schools across a country or state be placed. Lesson Four: There is equal need to adopt a suitable planning cycle and comprehensive programme that will build the capacity of serving teachers for the effective delivery of an allembracing HIV and AIDS curriculum. Existing in-service programmes are rarely comprehensive or systematic enough to make serving teachers competent in the delivery of an HIV and AIDS curriculum. Although the planning cycle is basically the same as that for pre-service training, greater determination is needed in the case of in-service activities, because of the strong tendency to deliver these on an ad hoc, unplanned basis, and frequently in response to the availability of funds as almost the sole rationale for mounting them. Lesson Five: Teacher formation and development would be better adapted to respond comprehensively to HIV and AIDS if training establishments and schools developed institutional cultures that were single-minded in mobilizing institutional resources to respond to every dimension of the pandemic and to contain its spread. HIV and AIDS is an area where there can be no divorce between the issues discussed or messages communicated in the classroom and what goes on in the other dimensions of institutional life. An understanding of the coherence between these will make better educators of those undergoing pre-service or in-service training. It will also help learners to develop a deeper sense of personal responsibility for halting the spread of the disease, providing care and support for those infected or affected, and working towards the alleviation of the negative impacts of the pandemic. Lesson Six: HIV and AIDS constitute an extraordinary situation that demands an extraordinary response on the part of every person, including teachers. The struggle against HIV and AIDS is the greatest challenge of our age. Success in overcoming the AIDS pandemic demands exceptional personal, moral and social commitment on everybody's part; teachers are no exception. Their professional life centres around young people who constitute the generation that provides hope for tomorrow but are also the generation most at risk of HIV infection today. Because of this, a great deal is expected of teachers. The future of millions of people depends in a real way on their dedicated response to all that the AIDS pandemic represents. To generate this commitment, teacher preparation and development programmes need to form prospective teachers so that they will become technically expert HIV and AIDS pedagogues who are personally dedicated to rolling back the pandemic and ushering in a world free of HIV and AIDS.
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Activity 1 Answers to this activity will depend on your personal perspective. However, you may like to refer to Fact Sheet 05, Why young people need to learn about HIV/AIDS and sex, contained in the HIV/AIDS and Education Toolkit for ministries of education produced by UNESCO Bangkok and UNAIDS (the full reference appears under UNESCO (2003) in the bibliographical references given at the end of this module). Activity 2 You may want to refer to the paper by Tijuana et. al., referred to in the bibliographic references at the end of this module, which points out that teachers are a crucial link in providing valuable information about reproductive health and HIV/AIDS to youths, but that to do so effectively they need to understand the subject, acquire good teaching techniques, and understand what is developmentally and culturally appropriate. Teacher attitudes and experiences affect their comfort with, and capacity to teach about, reproductive health and HIV/AIDS. The pre-service setting offers an opportunity for future teachers to explore their own beliefs and concerns about these topics, while in-service training allows those already teaching to assess their views and increase their competence and confidence. Activity 3 If you do not have access to the syllabus or materials from your own country, you can visit the International Bureau of Educations (IBE's) Global Curriculum Bank for HIV/AIDS Preventive Education database at the following address: http://databases.unesco.org/IBE/AIDBIB/. This is an international databank of curriculum material and related documentation for HIV/AIDS education at primary and secondary levels of schooling. The website gives information on sexuality and/or HIV education for Malawi, Nigeria, Zimbabwe, and some developed countries. To access the documentation, type CURRICULUM SCHOOL SYLLABUS in the box marked Documentation Type that appears when you open the website page. Activity 4 A number of curriculum appraisal tools have been (or are being) developed by IBE. They can be accessed on: www.ibe.unesco.org/AIDS/Manual/Manual_home.htm.
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Activity 5 The answers to this question will be specific to your country. Activity 6 The answers to this activity will be specific to your country.
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Bibliographical references
Documents Akoulouze, R.; Rugalema, G.; Khanye, V. 2001. Taking stock of promising approaches in HIV and AIDS and Education in Sub-Saharan Africa: What works, why and how. A synthesis of country case studies. ADEA Biennial Meeting, Arusha, Tanzania, October 7-11, 2001. FHI. 2002. Voices from the communities. The impact of HIV/AIDS on the lives of orphaned children and their guardians. Lusaka: Family Health International. www.fhi.org/NR/rdonlyres/ei54mv6aqotbinqbndhkwigey54kjthile5u6rzsif35 pra7bbpcmbbwqfws54cj4lckd6r2bxm44j/ZambiaVoicesCommunity.pdf Gachuhi, D. 1999. The impact of HIV/AIDS on education systems in the Eastern and Southern Africa region and the response of education systems to HIV/AIDS: Life Skills Programmes. Paper presented at the Sub-Saharan Africa EFA Conference, Johannesburg, December 1999. Kelly, M.J. 2000. Planning for education in the context of HIV/AIDS. (Fundamentals of Educational Planning, No. 66.) Paris: IIEP-UNESCO. Kelly, M.J. with Bain, B. 2003. Education and HIV/AIDS in the Caribbean. Paris: IIEP-UNESCO. Ministry of Education, Swaziland. 2001. Study on the impact of the schools HIV/AIDS intervention programme in Swaziland. Swaziland: Ministry of Education. Ministry of Education. Zambia. 2003a. HIV/AIDS guidelines for educators. Lusaka: Ministry of Education. Ministry of Education, Zambia. 2003b. Interactive methodologies manual for HIV/AIDS prevention in Zambian Schools. Lusaka: Ministry of Education. Tijuana, A.; Traore, J.; Finger, W.; Daileader Ruland, C.; Savariaud, S. 2004. Teacher training: Essential for school-based reproductive health and HIV/AIDS education. Focus on Sub-Saharan Africa, Youth Issues Paper 3. Arlington, USA: FHI YouthNet Program. www.fhi.org/NR/rdonlyres/edmorint32vc5lxl5c6y53r2g7iutkutepccbk3gwna jd66qrpzmksekk6oqex4grokei6hgj23usg/YI3.pdf Tuohy, D. 1999. The inner world of teaching: Exploring assumptions which promote change and development. London: Falmer Press. UNAIDS Inter Agency Task Team on Education (IATT). 2002. HIV/AIDS and education: a strategic approach. Paris: IIEP-UNESCO. UNAIDS; PennState Project. 1999. Communications framework for HIV/AIDS: a new direction. Geneva: UNAIDS. http://data.unaids.org/Publications/IRCpub01/JC335-CommFramew_en.pdf UNESCO. 2003. HIV/AIDS and education: A toolkit for ministries of education. Bangkok: UNESCO/UNAIDS. www2.unescobkk.org/elib/publications/aids_toolkits/index.htm
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World Bank. 2002. Education and HIV/AIDS: a window of hope. Washington, DC: World Bank.
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Module
R. Smart W. Heard M.J. Kelly
An education policy framework for orphans and vulnerable children
4.3
About the authors

Rose Smart is an independent consultant and the former Director of the South African National AIDS Programme, specializing in workplace issues, policy development and implementation, mainstreaming HIV and AIDS, community-based responses and affected children. She is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. Wendy Heard specializes in education planning, project management and the development and improvement of Education Management Information Systems (EMIS) to measure and monitor the impact of HIV and AIDS on the education sector. She is Programme Manager of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on Education. Michael J. Kelly is Chairperson of the EduSector AIDS Response Trust and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He was Professor of Education at the University of Zambia, is a member of the Jesuit Order and specializes in the areas of policy development, education and development, educational planning and educational management. He also has particular expertise in curriculum development and teacher education.
Module 4.3
AN EDUCATION POLICY FRAMEWORK FOR ORPHANS AND VULNERABLE CHILDREN
Table of contents
Questions for reflection Introductory remarks Concepts and definitions Definition of a child Definition of an orphan Definition of a child orphaned by AIDS Vulnerability 2. OVC and the education sector AIDS impacts on the education of OVC The role of education in supporting OVC 3. Developing policy-level response to OVC in the education sector Laws governing the sector and provisions (international and national) for protecting the rights of children National education policy, strategic plans and guidelines that include an explicit focus on OVC Education sector structures that include an OVC mandate National education sector consultations that include an OVC focus Management information systems and impact assessments that cover OVC Mechanisms for defining and identifying the most vulnerable children Monitoring and evaluating the OVC-related aspects in all M&E processes related to education policy implementation Targeted issues-based advocacy State support for OVC, specifically in terms of education An OVC focus in the education components of PRSPs and HIPC initiatives in EFA plans and in funding applications 1. Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 4.3: An education policy framework for orphans and vulnerable children
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Aims
The aim of this module is to enable ministry planners to increase awareness of the jeopardy facing all children with regard to their right to education, but in particular those who have been orphaned or made vulnerable as a result of HIV and AIDS. Once planners can understand the challenges facing orphans and vulnerable children (OVC) affected by AIDS, they can then implement important policy and programme interventions to increase and sustain education for OVC. By following a framework, this module guides users in the development of their own education and HIV and AIDS policies that successfully address the OVC issue.
Objectives
At the end of this module, you should be able to: describe and define the concepts of orphans and vulnerability in the context of HIV and AIDS; identify the policy-level challenges that education sectors must face, particularly in African countries, that have implications for orphans and other vulnerable children; propose recommendations for action to address the challenges, improve the situation for OVC, and to realize their right to education; recognize that education sector responses to OVC needs should not be confined to classrooms but should include psychosocial interventions and socio-economic contexts in order to fully address their educational needs; identify and list those interventions that contribute to the care and support of OVC.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. When are children vulnerable? What is the definition of an orphan?
What actions will ensure that the needs and rights of OVC are represented in education policies, plans and programmes?
What strategies and/or advocacy initiatives can be put in place in education sector structures to ensure that OVC realize their education rights?
How can EMIS (education management information systems) be modified to capture data on OVC?
What mechanisms can be put in place for schools, teachers and communities to formalize opportunities to recognize and respond to signs of vulnerability in school children?
What action should be taken to monitor and evaluate the roles and responsibilities of the sector in respect of OVC?
What actions can be initiated to strengthen the education-related aspects for OVC in development instruments, like poverty reduction strategy papers (PRSPs)?
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Module 4.3
AN EDUCATION POLICY FRAMEWORK FOR ORPHANS AND VULNERABLE CHILDREN
In their 2003 publication, entitled Accelerating action against AIDS in Africa, UNAIDS summarized the impact of the AIDS epidemic on the education sector as follows: Good quality education is a powerful weapon against HIV/AIDS. Yet, across subSaharan Africa, only 57 per cent of children are enrolled in primary school. The added impact of the HIV/AIDS epidemic on the education system is undermining the fundamental right of every child to education, increasing the number of HIV/AIDS-related school drop-outs and raising young people's vulnerability to HIV infection. In high prevalence countries, substantial numbers of teachers are ill, dying, or caring for sick family members. Management of the education system is also threatened by illness and death of qualified persons. Pupils who are orphaned or in vulnerable situations for whatever reason, but particularly because of HIV and AIDS, constitute a problem that is receiving specific attention in the education sector. Increasing numbers of local, national and international organizations are involved in researching the OVC issue, advocating for and supporting such children. While this research has led to the identification of problems and issues relating to the needs of OVC and the formulation of policies designed to address the issues, there is now a critical need to move these policies into practice within the education sector. The EduSector AIDS Response Trust (ESART) is developing a body of knowledge to support education sectors that are faced with the multiple challenges posed by the AIDS epidemic. Policy is a central component of this body of knowledge. Generally, there is an
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inadequate focus on OVC in the existing and planned policy development processes of education sectors. This module has been developed to address this important gap. We begin by presenting the accepted norms and definitions concerning children, orphans, vulnerability and childrens rights. We then explore the impact of HIV and AIDS on OVC and the role education can play to protect and support these children and to minimize the negative impact of the epidemic on their lives. In the final section, we examine the adapted framework.
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1.
Concepts and definitions

Definition of a child
Although children are defined differently in different countries, in most international and national conventions and laws, a child is a boy or girl up to the age of 18. In terms of the Convention on the Rights of the Child, a child under 18 may be considered an orphan if he or she has lost a mother, father or both parents, usually regardless of the cause of death of the parent or parents. Eighteen years of age is generally accepted as the age when adulthood begins. However, in all countries there are legal exceptions, for example the age at which a child may be married, make a will or consent to medical treatment. In South Africa, a child may consent to a medical intervention such as an HIV test without parental consent at age 14. In Sri Lanka, Sri Lankan Kandyan and Muslim laws regulate the minimum age for marriage, and girls as young as 12 years old may be married with parental consent. In Ethiopia, a child may make a will when she/he reaches the age of 15. In the context of HIV and AIDS, the definition of a child has particular relevance in the light of the following: The age at which compulsory education ends. Any differences between girls and boys, for example in relation to marriage and the age of sexual consent. Legal capacity to inherit and to conduct property transactions. The ability to lodge complaints or seek redress before a court or any other authority.
Definition of an orphan
The definition of an orphan varies from country to country (see Table 1). The main variables are: age children up to 15 or up to 18 years; parent lost mother, father, or both parents.
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Table 1 Definitions of orphans from selected African countries

Botswana Ethiopia Namibia A child under 18 years of age who has lost one (single parents) or two (married couple) biological or adoptive parents. A child under 18 years of age who has lost both parents, regardless of how they died. A child under the age of 18 who has lost either a mother, a father, or both parents or a primary caregiver due to death, or a child who is in need of care. A child who has lost one or both parents. A child under the age of 18 years who has lost one or both parents.
Rwanda Uganda
Definition of a child orphaned by AIDS

The biennial report Children on the brink (COB) a joint publication of UNAIDS, UNICEF, and USAID has become the standard reference for definitions and estimates related to OVC. This report defines a child orphaned by AIDS as a child under 18 years of age who has lost at least one parent to AIDS. Other variables presented in the estimates of OVC include: orphans as a percentage of all children; number and percentage of children orphaned as result of AIDS compared with total orphans; a breakdown of children who are maternal, paternal or double orphans. The recent trend is to define orphans due to HIV and AIDS in terms of the death of one or both parents. It was also found that it is more detrimental, in terms of educational attainment, for an orphan to lose a mother rather than a father (Boler, Carroll, 2003; Bennell, Hyde, and Swainson, 2002; Subbarao, Mattimore, Plangemann, 2001).
Vulnerability
Vulnerability is a complex concept to define, as is illustrated in local/community definitions of vulnerability, which often include disabled or destitute children; in policy and support provision definitions, which list categories of children; and in working definitions, which are used in various documents (see Table 2 below). There rarely is consensus about and certainly no universal definition of vulnerability. A major concern is that the orphan estimates do not reflect children who are vulnerable but still living with parents, or children vulnerable due to other causes or in addition to AIDS. Countries seeking to quantify the current and future burden of OVC may need to supplement their data on orphans with information from a situation analysis that covers all vulnerable children. There is a body of evidence that challenges the assumption that orphans are the most vulnerable children. Using non-enrolment and non-attendance rates in
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schools as proxies for vulnerability, studies by Ainsworth and Filmer (2002) and Huber and Gould (2003) found that in many countries poor children (rather than orphans) were most likely not to be enrolled in or to be out of school. Though generalizations across countries (28 countries in four regions in the Ainsworth and Filmer study) can be challenged, the link between poverty and vulnerability seems well established, suggesting that policies to raise enrolment among the poor will also have a positive impact on disadvantaged OVC. These findings seem to suggest that poverty at the community level is a main factor driving the conditions in which vulnerable children find themselves, and that if poverty is addressed, the quality of many childrens lives would be improved.
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Table 2 How children are defined as vulnerable in selected countries

Botswana Street children Child labourers Children who are sexually exploited. Children with handicaps Children in remote areas from indigenous minorities Rwanda Children under 18 years exposed to conditions that do not permit fulfilment of fundamental rights for their harmonious development, including: Children living in households headed by children; Children in foster care; Street children; Children living in centres; Children in conflict with the law; Children with disabilities; Children affected by armed conflict; Children who are sexually exploited and/or abused; Working children; Children affected/infected by HIV/AIDS; Infants whose mothers are in prison; Children in very poor households; Refugee and displaced children; Children of single mothers; Children who are married before the age of adulthood. South Africa - local community definition Child who is orphaned, neglected, destitute or abandoned. Child who has a terminally ill parent or guardian. Child who is born of a teenage or single mother. Child who is living with a parent or an adult who lacks incomegenerating opportunities. Child who is abused or ill-treated by a step-parent or relatives. Child who is disabled. South Africa working definition for rapid appraisal Zambia -Community committees identify OVC to qualify for the public welfare assistance scheme in terms of the following criteria: A child who is orphaned, abandoned, or displaced. A child, under the age of 15 who has lost his/her mother (or primary caregiver) or who will lose his/her mother within a relatively short period. Double/single orphans Does not go to school From female/aged/disabled-headed households Parent(s) is(are) sick. Family has insufficient food. Household below average standard
When it comes to understanding and defining vulnerability and the vulnerable child, what is recognized and agreed upon is that AIDS creates increasing poverty, is frequently accompanied by stigma and discrimination, and presents children with
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unique psychosocial threats. All of these factors generate levels of vulnerability that are more profound than would occur in the absence of AIDS.
Box 1
Testimonies of orphans from Ingwavuma & East Rand, South Africa
"Every day is a struggle to go through. You wake up, go to school, get chased away and you are never sure of whether youll eat before you sleep." "Others when their mother is sick they are afraid to go to school in case their mothers die."
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2.
OVC and the education sector

AIDS impacts on the education of OVC
In households affected by HIV and AIDS, attendance of children at school often decreases as their labour is needed for subsistence activities and, in the face of reduced income and increased expenditure, money allocated for school expenses is used for basic necessities and health requirements. In those cases where children are not withdrawn from school, their education often competes with the many other duties that children in an affected household have to assume; this is particularly true for female children. Also, stigmatization may cause affected children to withdraw from school rather than tolerate exclusion or being ridiculed by teachers and peers. Affected and orphaned children are often traumatized and suffer a variety of psychological reactions to parental illness and death. They endure exhaustion and stress from both work and worry, as well as insecurity and stigmatization as it is either assumed that they too are infected with HIV or that their family has been disgraced by the illness. Loss of a home, dropping out of school, separation from siblings and friends, increased workload and social isolation may all impact negatively on current and future mental health.
Activity 1
There are many OVC in your community in need of care and support. Please list some ways to assist them to remain in school.
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The role of education in supporting OVC

As rights-based institutions, schools should play a major role in protecting pupils and teachers against discrimination. In addition, schools have undeniable advantages in the following areas: The identification of vulnerable children and orphans. The provision of psychosocial support to all children, but especially to those who are orphaned, who are facing orphanhood, or who are living in households affected by HIV/AIDS. Monitoring of the wellbeing of OVC. Schools also have the potential to provide a range of education-related services to OVC, such as: delivering a daily meal to their pupils; providing after-school supervision for those who have no other adult supervision; linking children in particularly difficult circumstances to other relevant services to meet specific needs. Box 2 Extract from Kenyas National programme guidelines on orphans and other children made vulnerable by HIV/AIDS
Strengthen response to reduce OVC vulnerability through: Enrolling and retaining OVC in educational institutions like schools, non-formal schools and village polytechnics through mobilising sufficient resources for tuition fee waivers, accessible bursary facilities, educational supplies and feeding programmes.
These functions do not represent a departure from the traditional functions of the education sector; rather they demand an innovative way of looking at, and then fulfilling, existing functions. Schools can be adapted to provide a range of support for these pupils, but for this to occur schooling must be available to all children and every effort must be made to ensure that all children remain in school. Teachers and older children can be sensitized and trained to support vulnerable children; food and clothing, especially uniforms, can be provided for children in especially difficult circumstances. Maintaining childrens schooling is an important intervention in that it retains childrens connection to their peers, to familiar adults and to an institutional identity. Furthermore, children associate going to school with leading a normal life and being integrated into a community. Being able to attend school provides children and society with future knowledge and skills. Keeping older children in school could also help to prevent vulnerability to HIV infection by protecting children and reducing the childs need to seek shelter, food and clothing through, for example, risky encounters with unscrupulous adults. In summary, apart from the accrued personal and social benefits of education for work and national development, attending school provides stability, institutional
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affiliation and normalization of experience for children. Additionally, it places OVC in an environment where adults and older children are potentially available to provide material, social and emotional support.
Activity 2
Identifying and monitoring OVC With your knowledge of the education system in your country, consider the present role of the school in the identification and monitoring of OVC. Make a note of your responses under the headings below. Identification:
Monitoring:
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3.
Developing policy-level response to OVC in the education sector

In most African countries, government responsibilities for orphans and other vulnerable children have traditionally been placed within the purview of ministries such as that of gender, youth or social welfare often the Cinderella ministries in government. Any responsibility for OVC within the education sector, if it has existed at all, has been linked to responsibilities for youth who are out-of-school. It is important to begin thinking about how the education sector can assume certain responsibilities for OVC within its mandates in order to begin mainstreaming the issue into policies and programmes, like some other issues related to HIV and AIDS. An education sector HIV and AIDS policy framework can either be narrowly or more broadly defined. Let us now explore a framework (adapted from the POLICY Project OVC framework3) that consists of ten elements that collectively constitute a comprehensive policy-level response to OVC by an education sector.
Laws governing the sector and provisions (international and national) for protecting the rights of children
In all countries, constitutions define the rights of citizens, including children. In addition most countries have child-specific legislation, such as childrens acts, that give substance to these rights. Further, almost all countries are signatories to international conventions and agreements, such as the Convention on the Rights of the Child and the Universal Declaration of Human Rights, which elaborate the nations obligations to its children. The Convention on the Rights of the Child (CRC) is the framework that guides programmes for all children, including OVC. The CRC brings together childrens human rights outlined in other international instruments by articulating the rights more completely and providing a set of guiding principles that fundamentally shape the way in which we view children. All the rights are interconnected and are of equal importance. Some important pillars of the CRC are: 1. the right to survival, development and protection from abuse and neglect; 2. the right to have a voice and be listened to; and In 2002, the POLICY Project commissioned a policy-level analysis of country responses to orphans and other vulnerable children (OVC). No distinction was made as to the causes of vulnerability or orphaning, however the role of the AIDS epidemic in creating ever increasing generations of OVC was acknowledged. The analysis identified 12 policy elements that collectively constitute a framework that can be used to benchmark existing OVC policy-level responses or to guide the development of emerging responses to the OVC crisis. The policy framework has since been widely accepted and used to advance the OVC policy dialogue, particularly in African countries. This module has been developed by adapting the 12 policy elements from the original analysis to apply to the education sector.
3
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3. that the best interests of the child should be a primary consideration. In relation to education, the CRC commits signatory nations to strive to: make primary education compulsory and available free to all; encourage the development of different forms of secondary education; take measures to encourage regular attendance at school. Box 3 Extract from the Dakar EFA Goals (2000)
ensuring that by 2015 all children, particularly girls, children in difficult circumstances and those belonging to ethnic minorities, have access to and complete free and compulsory education of good quality.
Nations have also ratified international instruments that include a number of education-related targets, such as the Millennium Development Goals and the Education for All goals. In addition, in June 2001, all nations adopted the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) Declaration, binding themselves to the development (by 2003) and the implementation (by 2005) of national policies and strategies that would, amongst other commitments, ensure the enrolment in school of orphans and girls and boys infected and affected by HIV/AIDS on an equal basis with other children. Finally, in all countries there are laws that regulate the education sector decisions in stipulating, for example, the ages at which children must attend school, admission procedures, provision of universal primary education (UPE), specifications for children with special education needs, and so on. These international and national instruments entrench principles such as a childs right to education and non-discrimination in access to education, and yet in every African country there are thousands of school-age children who are not in school, even in those countries that have introduced free primary education. This is therefore the first policy element where recommendations can be made for action to improve the access for orphans and vulnerable children. Table 3 Selected universal primary school enrolment figures
COUNTRY Kenya Malawi Tanzania Uganda Enrolment (pre fee abolition) 5.9 million 1.9 million 1.4 million 2.5 million Enrolment (post fee abolition) 7.2 million (increase of 22% or 1.3 million in first week of 2003) 3 million 3 million 6.5 million (2000)
Source: UNICEF, 2003.
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Activity 3
What steps can be taken to ensure that OVC are included in laws relating to children and childrens rights?
National education policy, strategic plans and guidelines that include an explicit focus on OVC
Most countries have education policies that dictate how the sector should operate. Linked to these policies are strategic plans and guidelines that typically provide the detail of how the policy should be implemented. Some countries also have HIV and AIDS policies for their education sector. These policies typically cover life skills education for pupils, workplace HIV and AIDS programmes for staff, and management and mitigation strategies. The policies and related strategies and guidelines may, but often do not, include recognition of the growing numbers of OVC, and of how the education sector could respond within its areas of comparative advantage. As long as OVC are missing as a priority or are subsumed within broadly framed care and support targets in general education sector policies and in sectoral AIDS policies, strategies and guidelines, there is a risk that the education rights of this ever-growing group of children will be compromised.
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Box 4
United Nations Report on AIDS-related policies for OVC (from the SecretaryGenerals Report of 24th March 2006)
Data from high-prevalence countries indicate some progress in the development of child-focused policy frameworks on AIDS but substantially less success in delivering essential services to children orphaned or made vulnerable by AIDS. Among 26 countries in sub-Saharan Africa, 22 report that they have national policies in place to address the additional HIV and AIDS-related needs of orphans and other vulnerable children, although country reports, on average, rate the level of national commitment to these vulnerable children as 5 or below on a scale of 1 to 10. Among the 18 countries with national policies, 14 report having reduced or eliminated school fees for AIDS-affected children and having implemented community-based programmes to support orphans and other vulnerable children. Countries are increasingly opting for strategies that aim to address the needs of all vulnerable children, as targeting children living with HIV for special services may be stigmatizing and therefore counterproductive.
Education sector structures that include an OVC mandate

Typical structures that exist to co-ordinate and facilitate the work of an education sector include political or parliamentary bodies and committees; national structures on topics such as curriculum development, guidance and counselling, and teacher training; forums that bring together representatives from regional or district levels, as well as development partners and other stakeholders; teacher service commissions, teacher unions and student/pupil representative bodies; and school governing boards or parent-teacher associations at school level. Also within the sector, there may be one or more structures with a specific AIDS mandate, such as an AIDS committee or task team.
Box 5
Extract from the South African Schools Act, No 94 of 1966
The governing body of a public school must: a. Promote the best interests of the school and strive to ensure its development through the provision of quality education for all learners at the school. h. Encourage parents, learners, educators and other staff at the school to render voluntary services to the school. k. At the request of the Head of Department, allow the reasonable use under fair conditions of the facilities of the school for educational programmes not conducted by the school.
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A case can be made to include a focus on OVC in the terms of reference of all of these structures, and yet in most countries this is the exception rather than the rule, and it requires real creativity to recognize any OVC focus in the functions of these structures. In addition to the structures that exist to support the functions of the education sector, there will be multi-sectoral AIDS structures outside of the sector, such as the National AIDS Co-ordinating Agency (NACA) in Botswana, or even a structure brought into being specifically to address the problem of OVC, such as the National Task Force on Orphans (NTFO) in Malawi. There is always a critical need for strong education sector representation in these structures, yet there are more examples where the presence of the education sector is minimal or totally absent than there are of the opposite scenario. Box 6 Key conference questions and/or themes at the South African conference on AIDS and the education sector (2002)
What is the role of the education sector in preventing the spread of HIV among learners and students? How can the sector ensure that all learners and students, especially orphans and vulnerable children affected by HIV/AIDS, receive education and achieve their full potential? How can the sector, which is the biggest employer in our country, protect its educators and therefore the viability and quality of the education service in the face of HIV/AIDS? How can the education sector continue to improve access to and the quality of education services in the face of HIV/AIDS? What needs to be done? Who is responsible? Who is accountable?
National education sector consultations that include an OVC focus

All countries hold consultations or conferences for their education sector. These may have a specific theme, such as the implementation of a new policy, or the introduction of life skills education into school curricula; or they may be more general, such as planning to meet national education targets. There are also regional and international education conferences, such as those convened by UNESCO, which are attended by national education sectors. Whilst there has been a trend in recent years for these consultations to have AIDS as a theme, the programmes may, and often do, neglect OVC as an important focus. Finally, there are although outside of the education sector international, regional and national AIDS conferences. The International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) in Nairobi in 2003 was the
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first to have a satellite session on AIDS and education, but the presentations did not deal in any depth with OVC. The conference programme itself was very lean on OVC and education.
Management information systems and impact assessments that cover OVC

Educational planning and budgeting is, or certainly should be, based on supply and demand data. In most countries, education sectors arguably have good data systems when compared to other sectors. In the system, known as the Education Management Information System (EMIS), information is gathered and analyzed annually on pupil enrolment, pupil drop-out, the number of pupils repeating, teacher/pupil ratios, teacher attrition, facilities at schools, provision of infrastructure, and so on. As far as AIDS-related impact indicators and OVC are concerned, apart from a few pilot studies, these regular assessments do not capture any information about OVC. In a few countries, as a result of catastrophes, like the war in Uganda, questions have been added to their EMIS questionnaires in an attempt to track children such as war orphans. In addition to regular education sector information collection and analysis, and in order to better understand and plan for the impact of AIDS, ministries of education often commission AIDS-impact assessments. Whilst these go into great detail to describe and model teacher mortality and morbidity and may make the link between the changing enrolment rates and the increasing numbers of children unable to attend school for a range of reasons (including orphanhood), most impact assessments are silent with regard to OVC. Specifically, they do not model or cost scenarios such as programmes to keep these children in school, programmes that would ensure them not only a primary or basic education, but also transition to secondary school, and interventions that would meet other needs they may have, such as nutritional support. This is therefore an area with great potential to include a much stronger emphasis on OVC. For more information on EMIS, see Module 3.2 HIV/AIDS challenges for education information systems.
Mechanisms for defining and identifying the most vulnerable children

In most countries, very few schools have instituted mechanisms, such as registers, that identify orphans and other vulnerable children. When information is collected about the home circumstances of children, it is usually linked to identifying who will be responsible for paying school fees. Rarely can teachers provide the names of children who have been orphaned, who are living with sick caregivers, or who are vulnerable for any other reason. This gap is in part due to the lack of available services to which to refer these children for support, and is compounded further by a lack of support for the teachers themselves. Yet, despite the lack of formal mechanisms to identify OVC, teachers readily identify indicators of vulnerability, such as the appearance of childrens clothing, hunger, repeated and prolonged absenteeism, and poor or declining performance at school.
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Box 7
Information gathered to identify OVC in Zimbabwe
In Zimbabwe, information by grade and gender is collected to identify OVC as follows: Single orphan Double orphan Neglected/abandoned Sick parents Sick pupil Very poor parents Child-headed household Other reasons
There are a number of creative ways in which vulnerable children can be identified, such as setting essay topics that provide children with opportunities to record their personal experiences, using drawings to explore childrens coping strategies, introducing a suggestion box where children can post letters to teachers anonymously, and communication books to allow caregivers and teachers to communicate with one another about a particular child. Community-based surveys, in addition to raising awareness and strengthening community involvement, are also useful to capture/quantify out-of-school OVC.
Monitoring and evaluating the OVC-related aspects in all M&E processes related to education policy implementation
Monitoring and evaluation (M&E) are critical elements of successful programmes, because they: determine programme effectiveness; identify and address problems; show impact; gather evidence of activities and results; strengthen fiduciary responsibility and accountability; show transparency. In 2003, UNAIDS produced a report on progress on the global response to the AIDS epidemic. Using the UNGASS targets, a set of global/regional and national indicators was developed. In the set of nine national programme and behaviour indicators, there is one that deals with OVC and the education sector, namely the ratio of current school attendance among orphans to that among non-orphans aged 10-14.
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Box 8
United Nations monitoring of orphan participation in education (from the Secretary-Generals Report of 24th March 2006)
Although there has been some improvement in rates of school attendance, orphans (aged 10-14) continue to lag behind non-orphans. In sub-Saharan Africa, 70 per cent of non-orphaned children who live with at least one parent currently attend school, in comparison with 62 per cent of children who have lost both parents. Only 19.5 per cent of street children are being reached by outreach services. Overall, the limited data available indicate that fewer than 10 per cent of households supporting children orphaned or made vulnerable by AIDS are reached by community-based or public sector support programmes.
This is but one way in which progress towards national and international education targets can be tracked. Other indicators might reflect education sector programmes that will benefit OVC, such as school feeding schemes, fee exemptions and psychosocial support programmes. For more information on monitoring and evaluation see Module 5.3 on Project design and monitoring.
Targeted issues-based advocacy

Advocacy is a set of targeted actions directed at decision-makers in support of a policy issue. Few people, particularly those working in government, recognize the power of advocacy; and yet all of the policy-level recommendations made in this module will be enhanced if supported by advocacy. This is particularly true where the advocacy is part of a systematic, strategic approach rather than simply ad hoc or eventbased. Box 9 Possible advocacy themes
Taking a rights-based and child-centred approach. Good quality free and compulsory basic education for all orphaned children. Keeping children in school protects them from HIV infection. Elimination of stigma and discrimination against OVC. Scaling up early childhood development programmes to accommodate very young OVC.
Valuable lessons about advocacy for the education rights of OVC can be learned from successful advocacy initiatives that have resulted in the implementation of
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programmes to prevent mother-to-child transmission, and in improving access to life-saving antiretroviral treatments for persons living with HIV.
State support for OVC, specifically in terms of education

Universal primary education (UPE) has been introduced in a number of countries in the past decade or so, and has resulted in impressive increases in enrolments. UPE has clearly benefited many OVC who would otherwise never go to school or would drop out of school at some point. While these policies may have removed, in theory, the requirement to pay school fees, they have not, in reality, removed the obligation to pay for at least some aspects of schooling, such as contributions to school development funds, uniforms and books. These costs often represent significant barriers to education for OVC. Box 10 The South African Schools Act, No 84 of 1996
The South African Schools Act, No 84 of 1996 entrenches childrens right to education by stipulating that public schools are not allowed to suspend pupils from classes, deny them access to cultural, sporting or social activities, or refuse to issue school reports if parents have not paid school fees.
OVC may also remain outside of the formal education sector as a result of demands to care for ailing caregivers or their siblings, work on the family farm, or enter the labour market to support their families. For these children, state support needs to take the form of skills-building and vocational training, which should ideally be accompanied by basic education and literacy training. This is an area where there is potential for partnerships with non-governmental organizations (NGOs) that have the necessary expertise to provide this sort of training.
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Activity 4
What actions can be initiated to facilitate state support for OVC?
An OVC focus in the education components of PRSPs and HIPC initiatives in EFA plans and in funding applications
Mainstreaming AIDS into sectoral policies, plans and programmes is increasingly recognized as the only effective way to address both the causes and consequences of the epidemic. This requires a change of the current mindset to one that sees the epidemic as a long-term development issue with roots that are common to many other development challenges. It therefore makes abundant sense to include AIDS as a priority in PRSP and HIPC (highly indebted poor countries) initiatives. Examples where this has been done include Ugandas Poverty Eradication Action Plan (PEAP) and Namibias National Development Plan (NDP) 2001-2006. Box 11 The case of Malawi
In Malawi, where free primary education was introduced in 1994, HIPC funds have been allocated to cover education-related expenses for some OVC. In 2003, 450 pupils in public secondary schools benefited from these funds.
Also, wherever there is an opportunity to mainstream AIDS, there is likely to be a similar opportunity to prioritize OVC in general, and OVC and education in particular. The following policy directive from the Uganda AIDS Commission is a good example: Sector ministries to revise and develop strategic action plans. These plans should describe the comparative advantages and planned interventions of each ministry in the fight against HIV/AIDS, including the problem of orphans in Uganda.
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Within the Education for All Fast Track Initiative, which is assisting countries in their efforts to give every girl and boy a complete primary education by 2015, there are resources to improve the quality and efficiency of primary education systems, which, in turn, can benefit OVC. Finally, there are opportunities to include education-related activities for OVC in funding proposals, such as the Namibian proposal to the Global Fund, which includes: the provision of material support (such as school uniforms and shoes) to ensure OVC's access to education; expanding the existing school feeding programme for vulnerable children to cover OVC who are enrolled in the school-based counselling services; and the development, production and dissemination of curricula, necessary training materials and teaching aids for psychosocial support for OVC.
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Summary remarks
This section of the module briefly highlights the key areas where intervention has implications for advancing the rights of orphans and other vulnerable children to education. These include: strengthening education systems to respond to the AIDS epidemic in general and to the issue of OVC in particular; building capacity in education sector personnel, like teachers, to deal with the multiplicity of factors facing AIDS-affected children and their families and communities; improving co-ordination, communication and consultation to, in turn, improve OVC responses; developing new, perhaps non-traditional, partnerships to deliver quality education that includes support for OVC; creating awareness of and promoting childrens rights to education; removing or reducing stigma so that OVC are readily identified and can be targeted for support; scaling up small, localized successes; sustaining responses in the face of ever-escalating numbers of OVC. Meeting the challenges at the policy level will create an enabling framework for action, which, when coupled with successful implementation, will constitute a giant step forward in securing the rights of every African child to education and to the development of his or her "personality, talents, and mental and physical abilities to their fullest potential" (Convention on the Rights of the Child: Article 29).
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Lessons learned
Lesson One: Education needs are the same for all children, including OVC. While AIDS has a negative impact on education systems, an additional impact of the epidemic is the number of OVC created. Within the classroom, education needs of OVC do not differ from those of other pupils. There is no evidence suggesting that pupils are treated differently by teachers on the basis of their orphaned status. The greater need of OVC is for psychosocial support. Lesson Two: Policies to raise school enrolment among the poor will have a positive impact on disadvantaged OVC. The Ainsworth and Filmer (2002) study has shown that there is a well-established link between poverty and vulnerability. In countries instituting universal free primary education, enrolments have increased permitting access to schooling for OVC and poverty-affected pupils who were previously unable to attend school. Lesson Three: Potentially schools have an important role to play in minimizing the impact of the epidemic on children. Academic institutions, especially schools, can play a vital role in the following areas: They provide a sense of community and contribute to the socialization of children as they interact with their peers, both in the school and the community. In those schools where school feeding programmes operate, at least one meal per day is provided to the child. They can provide psychosocial support and counselling. They can monitor the status of children. They can identify possible organizations and individuals to support children and their families.
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Question 1: When are children vulnerable? How would you define an orphan? Refer to subheading 1, Concepts and definitions, in the text. Also, check your national policies. Question 2. What actions will ensure that the needs of OVC are represented in education policies, plans and programmes? Ensure that the childrens sector is strongly represented at all policy, planning and strategy sessions. Reflect OVC as a priority special-needs group in all sectoral policy, planning and strategy processes, in the same way that children with disabilities are catered for in such processes Question 3. What strategies can be put in place in education sector structures to ensure that OVC realize their educational rights? Insert or elevate the issue of OVC in the terms of reference of all education sector structures. Hold these structures accountable, particularly the legally mandated structures, for implementing strategies to ensure that OVC realize their educational rights. Ensure appropriate representation from the education sector on all multisectoral HIV/AIDS bodies, and an appropriate reflection of the OVCrelated roles and mandate of the education sector in national HIV and AIDS policies, strategies and plans. Ensure that the education rights of OVC are part of broader childrens rights advocacy initiatives. Where necessary, build the capacity of organizations and individuals to conduct advocacy. Increase childrens participation in advocacy activities; in particular ensure that the voices of orphans and other vulnerable children are heard. Question 4. How can EMIS be modified to capture data on OVC? Improve school record keeping to record and track OVC enrolled in school. Schools are required to keep detailed personal records of pupils/students/learners. Review EMIS data to include OVC-related information and ensure feedback to those who can use this information for planning and programming. Include OVC assessments and modelling in education sector AIDS impact assessments, and, again, use this information for planning and programming.
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Question 5. What mechanisms can be put in place to formalize opportunities to recognize and respond to signs of vulnerability in school children? In teacher training programmes, both pre-service and in-service, include skills on how to identify vulnerability in children and how to offer the support these children require. Provide support for teachers to act when they identify OVC, and information about services to which they can refer children with specific needs. Strengthen programmes that address factors causing vulnerability, such as school-based nutrition programmes. Enhance collaboration between schools and other sectors that can provide services and support, such as social welfare, health, labour, agriculture and NGOs. Initiate processes to recognize and deal with discrimination against OVC, and ensure that identification does not inadvertently cause discrimination and increase vulnerability. Implement procedures to improve the tracking of OVC, linked for example to detailed profiles of pupils that should be initiated upon the childs registration at school. Question 6. What action should be taken to monitor and evaluate the roles and responsibilities of the sector in respect of OVC? Review education sector targets and monitoring and evaluation programmes to adequately reflect the roles and responsibilities of the sector in respect of OVC. Report on progress related to OVC and education at national, regional and international level. Question 7. What actions can be initiated to include OVC and education in development instruments, like PRSPs? Conduct an analysis of PRSP activities, and use the results to lobby for a focus on OVC and education. Ensure that appropriate targets are set to track OVC and education within processes such as PRSPs and that sustainability plans are in place. Ensure that education-related activities are included in funding proposals.
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Activity 1 Establish systems of support related to direct responsibilities, such as education, including alternative/flexible education, counselling and psychosocial support (PSS), after-school supervision, protection from discrimination and recreation as well as support related to more indirect responsibilities, such as facilitating referrals for shelter, food, clothing, healthcare, access to social security, protection from exploitation, and skills-building and income-generation. Provide material support with: school fees and bursaries such as providing information to children and caregivers on how to access bursaries or fee exemptions; school uniforms such as donations of old uniforms, collecting uniforms from pupils who are leaving school, etc. Create safe spaces for children to: talk to teachers; do homework; access peer support. Provide psychosocial support to: help children who are caring for ill parents and/or siblings; help bereaved children deal with grief and loss. Provide education support to: help children catch up with school work following any long absences; create alternative learning situations for infected and affected children who cannot participate in normal schooling (for whatever reason). Collaborate with agencies offering services and support to children by: finding out about other organizations in the area that help vulnerable children and their families; keeping contact details of organizations easily accessible to children; inviting organizations to deliver talks at the school, explaining what services they offer and how they can be reached. Create teacher support teams to support one another and to share lessons and experiences with colleagues.
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Activity 2 Identification activities Create and institutionalize a system of OVC identification that includes the following: Agree on definitions and signs, for example: children who have lost a parent/primary caregiver; children with a sick parent/primary caregiver; children dropping out of school (or in and out of school); school work deteriorating; appearance that is changing/worsening; no school lunch; teasing/targeting by peers; psychological or behavioural problems. Use school activities to collect information in a non-threatening manner, such as: setting essay topics that provide children with opportunities to talk about personal experiences; establishing a suggestion box at school where children can post letters to teachers about anything they want the school to know. Establish ways of communicating with caregivers, for example: introduce communication books where caregivers and teachers can communicate with each other about concerns regarding the child. Keep and analyze records: of absenteeism; of whether children are repeatedly late for school; of children who struggle to complete their homework. Respond to the following warning signs: hunger; dirty, unkempt appearance; falling asleep; withdrawal.
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Monitoring activities Monitor OVC in the following ways: Follow up on referrals and find ways to work with other agencies and community child support structures. Keep a register of OVC and school records of childrens home circumstances, such as: who is caring for the child; where is the child living; current parental status of the child, or knowledge of the parents; whether the child getting a meal every day; whether the child feels safe with the current caregiver; whether they have a choice of who they live with; who would they like to live with? Identify specific needs (e.g. food) and have an action plan to address the needs. Report on each child on a regular basis. Activity 3 Review the national education sector laws to ensure that they comply with the Constitution, any child-specific legislation, and the international conventions and agreements that have been ratified. Investigate and address all barriers to the full enjoyment of childrens rights to education. Prioritize implementation of the legal provisions related to education, specifically those related to OVC. Activity 4 Ensure that provisions for free primary education, where these exist, are enforced, supervised and monitored. Incorporate basic education into skills-building and vocational and other training for children and youths who are not in school. Ensure that girls benefit as much as boys from formal and non-formal education opportunities. Ensure that all artificial barriers, such as the need for uniforms and payment of levies that deny entry into schools, are removed.
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Appendix: Orphan statistics for sub-Saharan Africa
Source: UNAIDS/UNICEF/USAID, 2004.
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Documents Ainsworth, M.; Filmer, D. 2002. Poverty, AIDS and childrens schooling: A targeting dilemma. Policy Research Working Paper 2885. Washington, DC: World Bank, Africa Region. http://wwwwds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2002/10 /12/000094946_02100204022275/additional/124524322_200411171 82553.pdf Barnett, T; Whiteside, A. 2002. AIDS in the twenty-first Century: Disease and globalization. New York: Palgrave Macmillan. Bennell, P.; Hyde, K.; Swainson, N. 2002. The impact of the HIV/AIDS epidemic on the education sector in sub-Saharan Africa: A synthesis of the findings and recommendations of three country studies. Brighton: Centre for International Education, University of Sussex. Boler, T.; Carroll, K. 2003. HIV/AIDS and education: Addressing the educational needs of orphans and vulnerable children. UK: ActionAid International and Save the Children Fund. www.aidsconsortium.org.uk/Education/Education%20downloads/Efucation OVC%20paper%20(small).pdf Convention on the Rights of the Child, Article 29. www.ohchr.org/english/law/crc.htm Coombe, C. 2003. Mitigating the impact of HIV/AIDS on education systems in Southern Africa. Pretoria, South Africa. Giese, S.; Meintjes, H.; Croke, R.; Chamberlain, R. 2003. Health and social services to address the needs of OVC in the context of HIV/AIDS: research report and recommendations. Pretoria : Children's Institute and national Department of Health. Huber, U.S.; Gould, W.T.S. 2003. The effect of orphanhood on primary school attendance reconsidered: The power of female-headed households in Tanzania. Liverpool, UK. University of Liverpool. Pharoah, R. (Ed.). 2004. A generation at risk? HIV/AIDS, vulnerable children and security in Southern Africa. Monograph N 109. Pretoria: Institute for Security Studies. www.iss.org.za/Monographs/No109/Contents.htm Smart, R. 2003. Policies for orphans and vulnerable children: A framework for moving ahead. Washington DC: Futures Group. www.policyproject.com/pubs/generalreport/OVC_Policies.pdf Subbarao, K.; Mattimore, A.; Plangemann, K. 2001. Social protection of Africas orphans and other vulnerable children. Washington, DC: World Bank, Africa Region. http://siteresources.worldbank.org/AFRICAEXT/Resources/African_Orphans. pdf
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UNAIDS/UNICEF/USAID. 2004. Children on the brink 2004. A joint report on orphan estimates and a framework for action. UNAIDS/UNICEF/USAID www.unicef.org/publications/index_22212.html UNICEF. 2003. The state of the worlds children 2004. Geneva, Switzerland: UNICEF. www.unicef.org/sowc04/
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Module
R. Smart
HIV/AIDS care, suppor t and treatment for education staff
4.4
About the author

Module 4.4
HIV/AIDS CARE, SUPPORT AND TREATMENT FOR EDUCATION STAFF
Table of contents
Questions for reflection Introductory remarks Positioning HIV and AIDS within a workplace wellness programme AIDS-related needs for care, support and treatment Components of a comprehensive workplace wellness programme Nutritional advice and support Lifestyle education and harm reduction Treatment of minor ailments Treatment of sexually transmitted infections (STIs) Reproductive health services for women Prevention of opportunistic infections Surveillance for and prevention and treatment of opportunistic infections Highly active antiretroviral therapy (HAART) Psychosocial support and support group activities Family support 4. The role of education sectors and institutions in providing care, support and treatment for infected staff 1. 2. 3. Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
MODULE 4.4: HIV/AIDS care, support and treatment for education staff
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Aims
The aim of this module is to enable participants to plan and implement a comprehensive care, support and treatment programme for educators and other education sector employees who are infected or affected by HIV and AIDS.
Objectives
At the end of the module, participants will be able to: explain the care, support and treatment needs of education sector employees who are infected or affected by HIV and AIDS; describe the components of an optimal programme for care, support and treatment in the workplace; design a context appropriate AIDS care, support and treatment workplace programme for an education sector institution; apply this learning to their own contexts to identify specific recommendations to strengthen their ministrys AIDS care, support and treatment workplace programme.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. Why is it important to have a workplace HIV and AIDS programme?
Why is it necessary to include care, support and treatment as part of a workplace HIV and AIDS programme?
What are the links between HIV prevention, and care, support and treatment?
What are the care, support and treatment needs of education sector employees who are either infected or affected by HIV and AIDS?
What, if any, are the special needs for care, support and treatment of female employees who are infected or affected?
What is the minimum package of care, support and treatment that should be provided by any workplace?
What care, support and treatment programmes can ministries of education and educational institutions (e.g. schools) realistically provide for their employees?
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What are the likely implications (positive and negative) for ministries of education and educational institutions of providing care, support and treatment to infected and affected employees?
What are the options for delivering a workplace care, support and treatment programme?
What are the implications for education sectors in developing countries, and for their AIDS responses, of rapidly increasing access to antiretroviral therapy for persons infected with HIV?
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Module 4.4
HIV/AIDS CARE, SUPPORT AND TREATMENT FOR EDUCATION STAFF
This module covers the care, support and treatment needs of infected and affected teachers and other education sector employees; the components of a comprehensive treatment, care and support programme; policy provisions for treatment, care and support programmes; and tools for designing a contextspecific treatment, care and support programme. A care, support and treatment programme is one part of a comprehensive sectoral or institutional response to HIV and AIDS. Other components that need to be in place and that need to complement the care, support and treatment programme are the following: A range of strategies that aim to manage and mitigate the impact of the epidemic on the sector or institution. A range of prevention interventions that aim to prevent new HIV infections among staff. A range of interventions for clients and beneficiaries, such as pupils. Care refers to the steps taken to promote a persons well-being through medical, psychosocial, spiritual and other means. Support refers to services and assistance that could be provided to help a person deal with difficult situations and challenges. Treatment is a medical term describing the steps taken to manage an illness or injury. The care, support and treatment component of a workplace HIV and AIDS programme is commonly referred to as a 'wellness programme'. A wellness programme can be defined as a multifaceted, multidisciplinary workplace care, support and treatment programme into which AIDS has been integrated and that aims to benefit: the institution by keeping HIV-infected employees healthy and fit to work for as long as possible; HIV-infected employees by delaying the onset of illness and AIDS, preventing opportunistic infections and providing a range of treatment, care and support services and options; AIDS-affected employees by providing support services and options; all employees by creating an enabling, caring and supportive working environment.
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There are many reasons why an institution should establish and implement a wellness programme. These include the following: Until there is widespread availability of antiretroviral therapy (ART) and highly active antiretroviral therapy (HAART), employees living with HIV will experience evermore frequent illnesses and will become progressively incapacitated. AIDS is a disease with profound psychosocial implications, which, if not managed appropriately, can be as debilitating as the physical effects of the disease. Wellness programmes delay the need for ART. For example, with appropriate prophylaxis (measures designed to preserve health and prevent the spread of disease), episodes of illness can to a large extent be prevented, and if they do occur they can often be managed at primary healthcare level. Where HAART is available, wellness programmes can promote adherence, prevent side effects and the onset of resistance to antiretroviral drugs. Wellness programmes can mitigate the impact of the epidemic on the staff and on the institution as a whole. Box 1 Supporting sick colleagues
Educators and other staff who develop AIDS-related illnesses need understanding from their colleagues. Increasingly they will need days off work or become exhausted during the day and need to lie down for some time. During these times, other members of staff will have to cover for them, and this will have an impact on their own work and wellbeing. The scale of the HIV epidemic is so great in the country that, until we all practice safer sex, these things will form part of a new reality with which we have to live. Educators often feel overburdened already and find it hard to see how they could do more work. Such feelings are very understandable. This emergency makes exceptional demands on all South Africans. Perhaps we should remember that one day our healthy colleagues might have to cover for us, unless we protect ourselves from infection. The most important part of our work is to educate people to accept, love and support those with HIV, so that we do not have to hide away or be silent. The more we hide away, the more pressure we feel, the sicker we get and the faster we die. (Valencia Mofokeng, HIV-positive widowed mother and leader of the Orange Farm Anti-Aids Clubs support group for people living with HIV/AIDS, in Reconstruct, 7 November 1999.)
Source: Department of Education - South Africa, 2000: 15
This module on care, support and treatment for educators and other education sector employees should be studied in conjunction with Module 1.4 on HIV/AIDSrelated stigma and discrimination and Module 5.1, Costing the implications of HIV/ AIDS in education.
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1. Positioning HIV and AIDS within a workplace wellness programme

Ideally, a workplace wellness programme should not be AIDS-specific; rather it should be broad-based, covering a range of wellness initiatives such as drug and alcohol avoidance, stress reduction, smoking cessation, counselling, and the management of chronic diseases (e.g. hypertension and diabetes). Situating AIDSrelated services within such a programme can enhance acceptability by employees and reduce possible stigma that may be associated with a dedicated AIDS wellness programme. Education sector institutions may have existing programmes that can integrate HIV and AIDS components. Examples of these are employee assistance programmes (EAP) run by qualified practitioners in education ministries in many countries. Accepting that the above scenario is the ideal, the balance of the module will concentrate on the AIDS-specific components that could be included in a workplace wellness programme. Box 2 Example of an employee assistance programme
The Employee Assistance Programme in the Eastern Cape Department of Education (South Africa) fulfils the following AIDS-related functions. Assistance to employees, from Head Office (HO) level down to the districts, including providing counselling for those infected and affected by HIV. Support to establish support groups. Workshops for school managers to create awareness of the EAP services. Referrals to external psychologists (as there are no psychologists in the department). Liaison with other units to assist staff who are infected or affected. Visits to employees families. Lunch-hour talks for HO staff held jointly with other units.
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2.
AIDS-related needs for care, support and treatment

A wellness programme should ideally reflect a continuum of care that covers: those employees who are uninfected but at risk; asymptomatic HIV-infected employees; employees with early HIV disease; employees with late-stage disease or AIDS; employees with terminal illness; affected employees; possibly dependants and family members. Obviously the needs and demands are different at each point along the continuum. The framework below lists some of the key needs, demonstrating the links between prevention on the one hand, and care, support and treatment on the other. Table 1 Key needs of infected and affected employees
Target group All employees Needs General life skills and HIV prevention Sexually transmitted infection (STI) prevention and care Promotion of voluntary counselling and testing (VCT) Access to VCT Access to HIV testing Counselling and psychosocial support Support groups and networks of people living with HIV Wellness management (including protecting the immune system, safer sex and harm reduction, and improved lifestyles) Prophylaxis for opportunistic infections Treatment of opportunistic infections Effective pain relief Management of symptoms HAART Support with succession planning Assistance with material needs and household tasks Spiritual and emotional support, and bereavement support Advice about wills and inheritance Preparation for death and the funeral Support for children orphaned by AIDS
Infected employees
Infected employees early HIV disease
Infected employees late stage HIV disease or AIDS
Affected employees and affected families
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3.
Components of a comprehensive workplace wellness programme

A workplace wellness programme should contain the following AIDS-related components.
Nutritional advice and support

For those living with HIV, nutritional difficulties such as malnutrition, malabsorption (faulty absorption of nutrient materials from the alimentary canal), and oral, oesophageal and gastrointestinal infections are frequent, and therefore good nutritional status is critical for continued health. A wellness programme could provide: advice on what foods to eat and not to eat, how to use food to boost the immune system, how to fight opportunistic infections, how to prepare and store food safely, and how to maintain ones appetite; support for good nutritional status in the form of nutritional supplements, vitamins and trace elements. Box 3 Extract from Kenya Education sector policy on HIV/AIDS (October 2003)
2.0 Access to health services 2.2 All learning institutions and workplaces shall facilitate access to information on health and when and where staff and learners should seek treatment promptly for STIs, tuberculosis and other opportunistic infections. 2.3 All learning and training institutions and workplaces shall promote the role of nutrition and food security for positive living.
Lifestyle education and harm reduction

Often referred to as positive living, this is a way of living in which people living with HIV take control of their physical, mental and spiritual health. It involves: diet and healthy nutrition; limiting unhealthy practices such as alcohol consumption and smoking; regular exercise, relaxation and meditation; avoiding stress; safer sex practices to prevent HIV transmission and re-infection;
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making plans for the future; sharing problems. A wellness programme could provide positive living advice and support for people living with HIV.
Treatment of minor ailments

HIV disease is typically asymptomatic for many years following infection. However, at some point infected employees will develop symptoms such as diarrhoea and skin rashes. These minor ailments associated with HIV disease can usually be managed at primary healthcare level. Traditional medicines are also very effective in treating many HIV-related symptoms and conditions. A wellness programme could raise awareness of and promote early treatment for minor ailments, and then facilitate access to the relevant health services.
Treatment of sexually transmitted infections (STIs)

The existence of an untreated STI can not only facilitate transmission from an HIVinfected person to his or her partner during unprotected sex, but can also increase the risk of re-infection for an infected person who is re-exposed to HIV. This intervention should involve STI screening, treatment and education, including HIV prevention education, and contact tracing and treatment of sexual partner/s. A wellness programme could raise awareness of and promote early health-seeking behaviour for STIs.
Reproductive health services for women

This includes family planning, counselling about dual protection (against pregnancy and HIV/STIs), prevention of mother-to-child transmission (PMTCT) services, information about and referrals for pregnancy termination (in countries where this is available), and information and support for women employees returning to work after maternity leave. A wellness programme could provide information for female staff and facilitate access to these services for women.
Prevention of opportunistic infections

Taking tuberculosis (TB) preventive therapy can reduce the risk of HIV-infected persons becoming sick with TB. Prophylaxis is also possible for other opportunistic infections, such as pneumocystis carinii pneumonia. A wellness programme could raise awareness of the opportunities for prophylaxis of opportunistic infections and facilitate access to services that provide prophylaxis, and manage clients receiving prophylaxis.
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Surveillance for and prevention and treatment of opportunistic infections

For people living with HIV, knowledge of the signs and symptoms of opportunistic infections is important, as is understanding the importance of seeking early treatment. TB is the most common opportunistic infection and the most frequent cause of death in people living with HIV in Africa. TB can be cured as effectively in those who are HIV-positive as in those who are HIV-negative (using the same drugs for the same amount of time). The directly observed treatment short-course strategy (DOTS) is the ideal way to ensure that employees with TB complete their treatment. A treatment supporter can be a health worker, employer, co-worker, shopkeeper, traditional healer, teacher, or community or family member. Because of the association of TB and HIV, every TB patient should be offered HIV counselling and testing by a trained counsellor. A wellness programme could educate staff on the signs and symptoms of opportunistic infections, provide DOTS for staff with TB, and promote and facilitate access to voluntary counselling and testing (VCT) for staff with TB.
Highly active antiretroviral therapy (HAART)

HAART involves treatment with two or more antiretroviral drugs (ideally with three drugs to delay and prevent the onset of drug resistance) for people with advanced HIV disease and evidence of a compromised immune system. In addition to the other components of a wellness programme, it is important to include HAART because it: promotes wellness; delays the onset of late-stage AIDS disease; prevents disease progression and opportunistic infections; decreases infectiousness; greatly improves the quality of life and life expectancy; decreases absenteeism, hospital admissions and the cost of treatment of opportunistic infections; strengthens prevention through increased uptake of VCT, PMTCT and behaviour change. There is an optimal time to start HAART often between five and eight years after the initial infection, and then for the rest of the employees life. Therapy is likely to extend the employees working life by five to eight years on average. Some employees will do very well on HAART, but some may not be able to tolerate the medication as a result of side effects or drug toxicity, or may not adhere to the medication, resulting in treatment failure. A wellness programme could provide information about HAART, facilitate access for eligible staff to services providing HAART, and provide support for compliance for staff taking HAART.
Psychosocial support and support group activities

Psychosocial support is arguably as important as medical care for people living with HIV. It can take the form of one-on-one counselling or support-group activities.
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Traditional healers can also play an important part in providing psychosocial support. Support groups are groups of people who are facing similar challenges and who have decided to meet regularly to share experiences and to help each other. Support groups require: privacy, so that members feel confident to share and disclose often intensely personal matters; a time to meet that suits the schedules of the members; a skilled facilitator; carefully considered membership criteria and methods of operating. Post-test clubs are sometimes established by groups of people who have undergone an HIV test. They function to provide support for their members, as well as to provide HIV- and AIDS-related information. A wellness programme could provide on-going counselling for infected and affected staff and could facilitate the establishment of support groups.
Family support
The objective of family support is to render holistic support to affected families, in particular for future and succession planning. Some of the issues that need to be provided for are the following: How property or money will be managed in the event that the employee becomes disabled, who will inherit, and whether a power of attorney should be prepared. Decisions about employee benefits and personal insurance. Planning for future medical care. The drafting of a will. Deciding about a living will. Deciding about who will have custody of the children and who will be their legal guardian. Extract from Uganda Ministry of Education and Sports; HIV/AIDS strategic plan (April 2001)
Box 4
Objective 7: To promote/build partnerships with NGOs/CBOs and other stakeholders for effective implementation of AIDS education, counselling/testing and health services in education institutions. 1. Initiate and foster partnerships with other stakeholders for effective implementation of AIDS education, counselling and care in educational institutions. 2. Establish a consortium composed of representatives from key organisations involved in AIDS education, counselling and care in the
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education sector. 3. Convene meetings and identify areas of collaboration and organisations with the capacity to implement such activities. 4. Develop an agreement for collaboration and partnerships with these organisations.
A wellness programme could provide advice and support to infected and affected staff in their future planning. Box 5 Succession planning in Uganda: early outreach for AIDS-affected children and their families
The components of a succession planning programme should include: counselling for HIV-positive parents on sero-status disclosure to their children; creation of 'memory books'; support in appointing standby guardians; training for standby guardians. legal literacy and will-writing; assistance with school fees and supplies; income-generation training and seed money; community sensitization on the needs and rights of AIDS-affected children.
A wellness programme requires partnerships with services and agencies, such as clinics, social welfare agencies and other government departments, for any services and support that can not be provided at the workplace. It also requires the establishment of referral networks to these services and agencies. Home-based care is one of the options for caring for employees with late-stage HIV disease, and many institutions are entering into partnerships with NGOs providing home-based care services. A wellness programme could investigate the services provided by other institutions that staff may require; it could then enter into partnership with those organizations able to provide the necessary services, and could establish effective referral mechanisms to facilitate access by staff to these services. The World Health Organization (WHO) depicts a generic HIV and AIDS continuum of care in the diagram below, indicating the multiple referrals and partnerships that need to be established for effective care, support and treatment.
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Figure 1 The HIV and AIDS continuum of care
Source: UNAIDS; WHO, 2002.
Activity 1
Wellness programme audit and planning tool Look at the elements in the wellness programme checklist below and decide one by one whether they are present in your work environment. Mark with a tick ( ) those that are present and with a cross (x) those that are absent. Then decide which components are priorities for improving your education sectors or institutions wellness programme. These may be components that are currently absent as well as those that are present but that should be improved or strengthened. Ensure that the checklist is used when developing your education sectors or institutions HIV and AIDS plan or when making recommendations to management regarding your sectors or institutions HIV and AIDS programme.
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Wellness programme checklist

PRESENT OR ABSENT PROVISION FOR A COMPREHENSIVE WELLNESS PROGRAMME WITHIN THE HIV/AIDS POLICY Provision for a comprehensive wellness programme within the HIV and AIDS policy Wellness programme popularised and promoted to staff People living with HIV involved in planning and promoting the wellness programme Regular education, for all staff, on healthy living and harm reduction Vitamin, mineral and other nutrient supplements provided or access facilitated for infected staff Access facilitated to comprehensive STI treatment Prophylaxis provided or access facilitated to prevent common opportunistic infections Treatment provided or access facilitated for minor ailments Pregnant staff have access to HIV testing and to PMTCT programmes Surveillance for TB encouraged and treatment for staff with TB provided or access facilitated Regular VCT promotion campaigns, with management taking HIV tests publicly TB and STI clients encouraged to have HIV tests, with pre- and post-test counselling Access to VCT easy (times and location) and services acceptable to staff HAART available on a cost-sharing basis for infected staff meeting treatment criteria EAP at all institutions, providing on-going counselling services EAP practitioners trained in HIV and AIDS or programme has access to services of AIDS counsellors Mechanisms in place to ensure confidentiality for staff using EAP services Structured support programme in place for counsellors Support group/s established and meeting regularly Counselling extended to families and dependants of infected staff members Counselling extended to families and dependants of infected staff members Legal assistance available for succession planning and family support Support and counselling provided/facilitated for dependants, including orphaned children Partnerships and referral processes established with relevant NGOs and service providers Staff with terminal HIV disease access home-based or hospice care Reasonable accommodation available for staff unable to fulfil normal duties Budget for wellness programme available, as part of workplace HIV and AIDS programme budget M&E of workplace HIV and AIDS programme includes wellness programme indicators Monitoring of wellness programme includes feedback from beneficiaries (e.g. people living with HIV) PRIORITY AREAS FOR IMPROVEMENT
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Activity 2
Checklists for wellness programmes Choose one of the checklists below, each of which relates to a different aspect of a wellness programme, and add/amend it so that it can apply to your context.
Checklist One: Establishing an effective counselling service
Convince decision-makers of the need for and value of a counselling service. Consider the pros and cons of establishing an on-site service versus outsourcing the service or referrals to community services (which are often perceived as more accessible and acceptable options). Integrate HIV counselling into broader counselling services. Select counsellor trainees who have warm and caring personalities, are good listeners, are respected by others, and are motivated and resilient. Train them and follow up the training with supervised practice and ongoing in-service training. Provide regular and structured psychological support to the counsellors to maintain quality of counselling and prevent burn-out. Be sensitive to the location and time of the service provision, in terms of accessibility and ensuring that they do not become stigmatized. Have adequate supplies of information materials and condoms. Run campaigns to promote the services. Provide counsellors with adequate referral services to other counsellors, and for HIV testing, for treatment, antenatal care, family planning, social support and orphan care. Set up clear counselling standards and protocols, including mechanisms to ensure confidentiality.
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Checklist Two: Basic requirements for a PMTCT programme Family planning/reproductive health and contraceptive service. Antenatal, delivery and postpartum care services that are adequate and accessible, and a functioning referral system in case of complications. Information campaigns and community-based efforts to increase acceptance of PMTCT programmes. Adequate VCT services, including reliable tests and trained AIDS counsellors, for all female employees who are pregnant or thinking of becoming pregnant and their male partners. Adequate supplies of male and female condoms. An affordable, feasible antiretroviral treatment regimen to prevent mother-tochild transmission of HIV. Counselling about breast-feeding, including information on alternative infant options. Follow-up of all women, children and their families to help them deal with issues such as nutrition. Referral to other HIV prevention, treatment and care programmes.
Checklist Three: Involvement of people living with HIV in a wellness programme Senior management collaborates regularly and publicly with people living with HIV in creating AIDS-related wellness programmes. Support groups are established and run by appropriately skilled and supported people living with HIV. People living with HIV and who are successfully on HAART educate others considering treatment. Newly-diagnosed HIV-infected employees are given counselling by other people living with HIV (who have had similar experiences). People living with HIV provide first-hand experience of what makes (or doesnt make) a service client-friendly. Experienced people living with HIV are involved in selecting clients for treatment, alongside physicians and other community members, ensuring equity in selection when resources are limited. Selected people living with HIV are trained to assist in the education of clinical and support staff, to ensure that training is grounded in real-life experiences, and to equip staff to offer appropriate treatment and support. The visibility of people living with HIV and using treatment successfully acts as a powerful tool for combating stigma, encouraging people to come forward for HIV testing, counselling and treatment. Training is conducted for people living with HIV on personal empowerment, communication and presentation skills, HIV and AIDS facts, the legal aspects of HIV and AIDS, and skills for organizing and conducting policy dialogue to enable them to more effectively contribute to the wellness programme.
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4.
The role of education sectors and institutions in providing care, support and treatment for infected staff
Education sectors and institutions are not in the business of providing health services, however the AIDS epidemic challenges us to redefine traditional functions and develop creative approaches to ensure that comprehensive programmes are implemented both inside and outside of the workplace. For example, ministries of education have the potential to modify the work circumstances of infected staff to enable them to continue working, to access health and social services, to deal with health challenges such as starting on HAART, and so on. In the workplace, wellness programmes can be delivered in one or a combination of the following ways: In-house programmes and on-site services Third-party health insurance plans (e.g. medical aid) Contracts with a stand-alone AIDS management programme Referrals to public, private and NGO health facilities and social services
Box 6
Supporting sick learners
Learners and students are expected to attend classes in accordance with legal requirements for as long as they are able to function effectively and pose no medically significant risk to others in the school or institution. Every school with sufficient facilities should have an area where learners and educators who are feeling unwell can lie down during the day for short periods. This will enable learners who are sick to stay in school for longer. If and when they become ill or pose a medically significant risk to others, they should be allowed to study at home and academic work should be made available for this. Where possible, parents should be allowed to educate them at home. Some learners with HIV/AIDS may develop behavioural problems or suffer neurological damage. Such learners should be assessed and, where possible and appropriate, placed in specialized residential institutions for learners with special education needs. Some extra-curricular activities can be very stressful for learners with HIV. Educators need to be sensitive to this and excuse such learners from participation when necessary. Medicines often have to be taken at set times in order to be properly effective. Educators need to be aware of this and allow learners with HIV to slip out of class to take medication when necessary. Schools should help learners with HIV to form a support group or to link with one in the community. Source: Department for Education - South Africa, 2000: 14-15.
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Activity 3
Testing the feasibility of workplace wellness programme components for the education sector 1. Discuss each of the ten components of a wellness programme (see below), listing what your sector or institution (i) is already doing; (ii) can do immediately with little or no resources (financial, human or material); (iii) can do, but only with the injection of resources and/or training; (iv) cannot do because this is beyond the scope of the sectors or institutions competency or mandate. Nutritional advice and support Lifestyle education and harm reduction Treatment of minor ailments Treatment of STIs Reproductive health services for women Surveillance for and prevention and treatment of opportunistic infections HAART Psychosocial support and support group activities Family support Referral networks and partnerships 2. Review the final list of activities that are beyond the sectors or institutions scope and mark those that would be possible in partnership with one or more partners (such as an NGO, a health service provider or other ministries or institutions). Make a list of these potential partners and identify what they can bring in terms of the wellness programme to the partnership. 3. Now, looking at the lists that have been generated, agree on what should constitute a minimum package for a workplace wellness programme that can realistically and feasibly be provided in your particular context. 4. Create a set of recommendations to management to approve not only a minimum package but also those additional activities that are deemed to be priorities, specifying what the necessary resource inputs may be to achieve them and where partnerships are required to support these activities.
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Summary remarks
The care, support and treatment needs of staff who are infected or affected by HIV and AIDS are numerous and variable. A workplace care, support and treatment programme has significant benefits, not only for infected and affected employees, but also for the sector or institution. A workplace care, support and treatment programme, often referred to as a 'wellness programme', should be an integral part of a comprehensive sector or institutional response to AIDS, and the AIDS-related components should, as far as possible, be integrated into broader wellness initiatives. A wellness programme is thus a multifaceted and multidisciplinary intervention that includes AIDS-related components such as: nutritional advice and support; lifestyle education and harm reduction; treatment of minor ailments; treatment of STIs; reproductive health services for women; surveillance for and prevention and treatment of opportunistic infections; HAART; psychosocial support and support group activities; family support; referral networks and partnerships. Education ministries and institutions, though they may not be able to provide some of the health-related services, can still plan, implement and monitor a number of important aspects of a wellness programme.
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Lessons learned
Lesson One It is not enough to have a strong workplace HIV prevention programme for employees. Instead, such a programme should be at one end of a continuum of prevention and care, support and treatment. Lesson Two Education ministries and institutions must be prepared to think out of the box when designing their wellness programmes there are many activities and interventions that can be implemented effectively either at sector or institutional level. Lesson Three Having a non-stigmatized, acceptable and accessible wellness programme for infected staff can be a powerful incentive for staff to learn their HIV status, and, if positive, to be able to benefit from the programme. Lesson Four Promoting and providing holistic wellness programmes for infected employees can enhance their quality of life and extend their productive working lives. The benefits for affected employees will be significant too in terms of productivity and morale. Lesson Five Institutions should start with a minimum wellness package and build on this over time. They should also work in partnership with other organizations to facilitate access to services that infected and affected employees may need.
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Activities 1 and 2 There are no right or wrong answers to Activities 1 and 2, and the responses will depend on individual country contexts. You may, however, want to share your answers with a senior colleague or your mentor. Activity 3 A minimum package at ministry level may consist of: lifestyle education and harm reduction (targeted at all staff); established referral networks and partnerships for nutritional advice and support, treatment of minor ailments, treatment of STIs, reproductive health services for women, surveillance for and prevention and treatment of opportunistic infections and family support; benefits to cover HAART, or a cost-sharing arrangement; psychosocial support from a trained counsellor possibly within a broadbased employee assistance programme; on-site or community-based support group activities.
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Documents Department of Education. 2000. The HIV/AIDS emergency. South Africa's Department of Education Guidelines for Educators. Pretoria: Department of Education. Evian, C. 2002. Primary AIDS care for primary health care personnel providing clinical and supportive care of people with HIV/AIDS. Houghton: Jacana Education. Smart, R. 2004. HIV/AIDS guide for the mining sector: A resource for developing stakeholder competency and compliance in mining communities in Southern Africa. Ontario: Golder Associates. www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/ref_HIVAIDS_section1/$ FILE/Section+1b.pdf Horizons. 2003. Research summary; succession planning in Uganda: Early outreach for AIDS-affected children and their families. Washington, DC: Population Council. www.popcouncil.org/Horizons/ressum/orphans/orphanssum_methods.ht ml ILO. 2002. Implementing the code of practice on HIV/AIDS and the world of work (Module 7). Network of African people living with HIV/AIDS. (undated). A healthy diet for better nutrition for people living with HIV/AIDS. Nairobi, Kenya: Network of African people living with HIV/AIDS. Orr, N.M. (Undated). Positive health. Metropolitan. Southern Life. (Undated). Future positive financial planning with HIV/AIDS. The Canadian AIDS Treatment Information Exchange. 1999. Managing your health. Available on: www.catie.org UNAIDS; WHO. 2000. Fact sheets on HIV/AIDS for nurses and midwives. Geneva: UNAIDS: WHO. http://data.unaids.org/Publications/ExternalDocuments/who_factsheets_nurses-midwives_en.pdf UNAIDS; WHO. 2002. Report on the Global AIDS Epidemic. Geneva: UNAIDS: WHO. www.unaids.org/en/HIV_data/2006GlobalReport/default.asp
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Module
S. Johnson
School level response to HIV/AIDS
4.5
About the author

Saul Johnson is a medical doctor and epidemiologist, a director of Health and Development Africa, and has been working in the HIV and AIDS field for the last 10 years, with a particular interest in supporting systemic responses to the HIV epidemic. He is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Module 4.5
SCHOOL LEVEL RESPONSE TO HIV/AIDS
Table of contents
Questions for reflection 1. 2. Introductory remarks The role of schools as part of a national response to HIV and AIDS Five critical priorities Integrating education on HIV and AIDS in the regular curriculum Risk factors for HIV infection Find ways to prevent HIV infection Check school capacity to prevent HIV infection How schools can protect the quality of education Asses the threat to quality education Find ways to protect quality Make sure the right structures are in place to protect quality Find ways to deal with absenteeism How schools can provide care and support for learners Steps to support vulnerable and infected learners How schools can provide care and support for teachers and other staff Types of support that teachers may need Structures to implement policy Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials
3.
4. 5.
MODULE 4.5: School level response to HIV/AIDS
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Aims
The aims of this module are to guide school heads and school management teams in primary and secondary schools. It is aimed at this target audience because the module deals with a school level response. Obviously each school requires assistance in various ways from districts and regions. However, the module takes as its starting point the school and those who work in it. It may also be a useful resource for planners and managers working at district or regional levels, but does not address their role in detail here.
Objectives
At the end of the module you should be able to: understand the ways in which HIV and AIDS can affect the school community; know the areas where a response is needed at school level: HIV prevention among learners and teachers; protecting or maintaining the quality of education in the face of the epidemic; care and support for vulnerable learners and learners infected with HIV; care and support for teachers infected with HIV or affected by AIDS; managing and leading the response at a school level;
generate ideas about how to develop a holistic response to HIV and AIDS at a school level in different contexts.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. How bad is HIV in the community in which you work? How do you know this?
What are the three major challenges facing schools in your community? (You may want to make a longer list, and then prioritize).
Which of these problems do you think is made worse by HIV? Why?
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Module 4.5
SCHOOL LEVEL RESPONSE TO HIV/AIDS
Since the late 1970s, the Human Immuno Deficiency virus that causes AIDS has spread quickly across the world. Despite efforts to contain it, HIV has become an epidemic. Throughout this time people have lived with HIV. Parents with HIV have sent their children to school. Teachers with HIV have been teaching, and learners with HIV have been trying to learn. Now it is time to step back and ask ourselves the following questions: How do HIV and AIDS affect the education sector in general? How do HIV and AIDS affect schools specifically? It is important to be aware that the HIV epidemic is very different in different countries. Much of this module assumes a generalized HIV epidemic, similar to that found in most Southern African countries. In this setting the impact of HIV on the education sector is profound. However, in countries with more concentrated HIV epidemics, the impact of HIV on the education system may be less severe and not all the approaches taken in this module are relevant. It is important to carefully consider your own context, and apply those parts of this module that seem most appropriate to your setting. The effect on the education sector The HIV epidemic is a slow process. It slowly destroys families and school systems, and changes the way schools work. At first only a few learners in a school have no parents or struggle to pay their fees. Only a few teachers are often ill. Over time, however, more and more people become ill. Their problems add up to a considerable drain on the education system. The effect on schools Many schools already experience great problems. Schools can no longer depend on healthy learners, stable families and sufficient teachers to build a strong economy. Learners may be affected by the epidemic in the following ways: children may be orphaned, their families may not be able to pay school fees, they may not have
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uniforms, they may be hungry and they may not be accepted by the school and the community. Teachers themselves are also affected by the epidemic. They may die or they may be unable to work hard because of stress and chronic illness. They may also be overstretched because their colleagues may be sick or dying. The education system is already struggling to provide enough teachers, managers and other staff to replace those who are ill or deceased.
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1.
The role of schools as part of a national response to HIV and AIDS

In this section you will: learn how to do a risk assessment for a school; answer questions that help to check the capacity of a school to prevent the spread of HIV. Schools have an important role to play as part of a national response to the HIV/AIDS epidemic. The first thing that schools need to do is to find out how HIV and AIDS are affecting their school. This can be done by doing an HIV and AIDS risk assessment of the school and the wider community. A risk assessment is helpful for two reasons: 1. It can help you to understand clearly how the epidemic can affect your school and the wider community. 2. It can help you to think about the positive actions your school can take to address the effects of HIV and AIDS.
Activity 1
The following questions in the checklist below can help a school look at its own situation and decide how great the risk is. When answering the questions, try not to just give your opinion. Take time to think and talk to others before you decide on your answers.
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Risk assessment Check the risk to the school Has the number of orphans increased in the community? Does being an orphan affect their attendance at school? Does the number of orphans affect payment of fees and contribution to the parent teacher association? Is there a drop in the number of children enrolling for school? How many learners have dropped out? Is the pressure to earn money keeping learners out of school? Are there more girls dropping out of school than boys? Do older learners in a class increase the threat of HIV infection? Are teachers regularly out of school attending funerals? Is teacher absenteeism increasing? Is the quality of education in classrooms suffering? Are teachers being trained to deal with HIV and AIDS-related issues in the classroom? Are teachers willing to take responsibility for identifying learners at risk? Are there unsafe places in your school? Check the risk to the community Is sexual violence and abuse a problem in the community? Do community members talk openly about HIV and AIDS? Are HIV and AIDS awareness programmes working well? Are family incomes decreasing because of unemployment, the high cost of medical care and funerals? Are children who lose their parents looked after by their families? Do they have to fend for themselves? Do foster families care for these children as they would care for their own children? Is the local community able to care for children at risk? What support grants or methods are available in your community for children at risk and their foster families? Number of dropouts: YES NO NOT SURE
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Once a school has done a risk assessment it should have a clearer picture of the difficulties that it faces. It may be helpful to think about difficulties in a different way and to turn these into key challenges.
Activity 2
Use the information from the risk assessment to define the key challenges that the school faces. For example, a key challenge may be to provide training for teachers in HIV and AIDS so they that can respond to questions from learners. The key challenges are:
Five critical priorities

An important way for a school to respond to HIV and AIDS is to work out an action plan. AIDS policy and action plan will be discussed in more detail in Section 4. However it is important to think of critical priorities as preparation for developing a policy and action plan. There are five critical priorities that schools must take into account when they work out an action plan. 1. Prevent the spread of HIV. 2. Work together to continue to protect the quality of education. 3. Provide care and support for learners affected by HIV and AIDS. 4. Provide care and support for teachers affected by HIV and AIDS. 5. Manage and lead a response at school level.
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2.
Integrating education on HIV and AIDS in the regular curriculum

In this section you will: understand that schools can play an important role in preventing the spread of HIV; become aware of the factors that increase the risk of infection in schools ; read about practical ways to prevent HIV infection in schools; All schools face the immediate challenge of preventing HIV from spreading, especially among young people. Most infections happen in young people, especially women, either in school or soon after they leave. There are many ways to try to make young people aware of HIV through TV, radio and billboards. Many young people have heard messages of abstinence, staying faithful to a partner and using condoms from non-governmental and other organizations that try to make them aware of safe sex practices. However, schools need to make prevention of HIV a priority.
Risk factors for HIV infection
Activity 3
Here are some questions you can think about to find out what factors increase the risk of HIV infection in a school or in community. Are there any other factors that put people at risk? How can the following factors increase the risk of HIV infection in a school or community? -silence about HIV or AIDS; -judging people who are infected; -alcohol and drug abuse; -young people having sex with older men or women for money or gifts; -learners having sex with each other; with teachers; -sexual harassment and sexual bullying; -beliefs that men have more rights than women. Are there any other factors that put people at risk?
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Activity 4
Zaneles story Read the following case study. Zanele had to leave school in Grade 9 because she was pregnant. Her mother died two years ago and she lives with her aunt who is unemployed. She looks after her four-year-old boy. She is HIV-positive and has started to get sick quite often. She gets very depressed and sometimes goes out drinking. She has often thought of killing herself but then she remembers her child. Zanele used to be one of the top learners at the school she attended. Then she met an older man, a friend of her uncles. He started offering to take her out in his car and bought her gifts. At first they were small gifts, but soon they got more expensive. Zanele enjoyed the attention and soon got used to getting nice clothes and money from him. When he wanted to have sex with her, she agreed. Sex became a regular thing and often happened after they had been out shopping. A few months later she fell pregnant. She was scared to tell him because she didnt know how he would react. Eventually she told him and he got angry and accused her of sleeping with the young men who stood outside the school gates after school. Zanele didnt know what to do. She kept her pregnancy a secret and only told her aunt when it was obvious that she was pregnant. Her aunt said that she and the baby could still stay with her. During Zaneles pregnancy, she found out that she was HIV-positive. She has been living with HIV for the last four years and has recently started to get sick. The father of her child has never spoken to Zanele again and has never helped her in any way to support the child. Sometimes she sees him with other young girls from the school she used to go to. She wonders whether they realize that they could end up like her. What factors increased the risk of HIV infection for Zanele?
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Find ways to prevent HIV infection

There are a number of practical ways to prevent HIV infection among learners and teachers, for example: Provide correct information Teachers and other staff need to be given correct, basic knowledge. Teacher training institutions need to include information (in-service and pre-service programmes) about HIV and AIDS. Staff members need to understand how HIV and AIDS will affect their lives and their families. This information should encourage them to act responsibly and protect themselves from becoming infected or infecting others. Young people, especially adolescents, are especially at risk of being infected with HIV as they are often given wrong information about sex and HIV from their classmates. This is why it is important to provide people with accurate information. Develop skills that will help learners and staff to act positively: Skills for decision-making, negotiation and condom use; Skills to access appropriate services for the treatment of sexually transmitted infections (STIs) and other infections, and for counseling; Skills for positive living; Skills to promote gender equality. Encourage HIV testing and safer sex practices One way to prevent the spread of HIV is to make it easy for people to get tested. It is important to encourage those who have been tested and who know their HIV status to act responsibly. Teachers and other staff need up-to-date information about how to access services for a variety of sexual health issues. Young people in particular need access to clinics that are youth-friendly so that they can get help quickly and non-judgemental advice about issues such as STIs and contraception. These clinics should also help them to get free condoms and make them feel more comfortable about using them. Set up peer education Many young people find it hard to resist sexual pressure. They look for approval from adults and their peers. Sometimes they will do almost anything to get approval, including having unprotected sex. The problem is that unsafe sexual behaviour usually happens outside the school premises. For this reason, trained peer educators are more suitable to talk to young people about issues like this. There are a few ways to make sure that a peer educator programme is successful. These include the following:
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Be clear about the objectives of your programme. Include young people in the planning stage. Take time to appoint the right person to coordinate the programme. They should be trusted by young people in the school. Select young people who are highly motivated to be part of the programme. Let the learners at the school be involved in deciding who would make good peer educators. Provide sufficient training for the peer educators, as well as ongoing support. Link the peer educators with other services, for example local clinics and counselling services. Monitor the activities of the peer educators on an ingoing basis. Speak out against sex between young girls and older men in your community Many young girls are at risk because of their social or economic position. They may be tempted to have sex with older men, including teachers, in exchange for gifts. Unsafe sexual behaviour like this must be discouraged. In this way, schools can help to change behaviour and keep young people safe. Ensure that life skills training is effective Schools should make sure that a life skills programme is in place that helps learners to resist pressure, understand healthy and positive sexual relationships and build selfworth. A programme like this should include correct information about hygiene, good nutrition, how the body works and sexual health. It should teach young people about sex, encourage boys and girls to respect and protect their bodies and to build healthy relationships. Schools should involve parents and members of the community in their life-skills programmes so that everyone understands and supports the messages of these programmes. Make schools safer places Schools need to make sure that the physical space is safe for learners. They need to make sure that there are no unsupervised areas where drug abuse, bullying, sexual harassment or even rape can take place. It is also important that schools take some responsibility for the safety of the learners on their way to and from school, as well as in the school. Work in partnership with others Young people are at greatest risk outside school. Changing behaviour is not easy. Schools need the support of the community. This means that schools need to become
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part of a network to help protect learners and teachers. This involves finding out which traditional authorities, parents, non-governmental organizations (NGOs), communitybased organizations (CBOs), faith-based organizations (FBOs) and other government departments work in the area. It may be possible to form relationships and to work with them. Schools also need to work with youth organizations, community structures and religious organizations to prevent the spread of HIV.
Check school capacity to prevent HIV infection
Activity 5
A school can check its capacity to prevent the spread of HIV by answering YES or NO to the following questions. YES Does the school have a functioning life-skills programme? Does the school take action against bullying, harassment and inappropriate sexual relationships? Are boys and men encouraged to be caring and respectful? Does your school recognize the role that young people can play in preventing the spread of HIV? Has your school done anything to make young people partners in prevention? Does a school have a code of conduct and is it observed? Do students ever speak of sexually transmitted grades? Have you encouraged members of the surrounding community to become partners in prevention? The following questions require more detailed responses: What has been done to improve the skills of teachers who teach life skills? NO
What materials do they need for self-study, distance education, peer group learning and in-service education and training (INSET) in school?
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What is done in the school to prevent such practices as sexually transmitted grades?
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3.
How schools can protect the quality of education

In this section you will: find out what it means to protect the quality of education; use a checklist to find out whether the quality of education in a school is threatened; think of ways in which schools can protect the quality of education. HIV and AIDS affect the personal lives of both learners and teachers. When learners and teachers experience hardship in their lives, this disrupts the learning process in every school. This is why it is important to protect the learning process and to plan for quality education. The HIV epidemic affects the quality of education in the following ways: When teachers become ill, learning is affected. Learners are left without consistent teaching and colleagues often have to take double classes. Teachers who are carrying a double load experience higher stress levels and can feel demotivated. Learners and the school as a whole can feel demotivated. Learners do not get the attention that they deserve. Normally the everyday routines and the education process help children to grow. When these are affected, schools can stop functioning effectively. Then educational quality can suffer. The curriculum alone cannot provide quality education, but it can help to improve the quality of life of the learner. The school environment alone cannot provide quality education, but it helps to keep children healthy and safe. Regular attendance alone cannot ensure quality education, but it can help learners to succeed. Schools need to think of ways to protect the quality of education. For example they need to ask the following questions: How do you replace human resources that are lost? How can schools fund assistance at short notice when teachers are sick or absent? What are the training needs of replacement teachers and staff who come in to help? How do these issues affect the development planning of your school? How do schools ensure education for orphans and children at risk? How do the lives of learners improve because they have attended classes?
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In what ways are children better off because they have spent a morning at school?
Asses the threat to quality education

It is not always easy to see a direct link between HIV and the problems at school. It may be more helpful to take a general look at how widespread illness and death affect the quality of education.
Activity 6
Check whether the quality of education is threatened in your context. Here is a list of the most common problems a school might face. Read through them and give each problem a score (tick the box): 5 for a big problem; 4 for a growing problem; 3 if you have this problem but are coping with it; 2 if this problem only affects a small part of the school; 1 if this is not a problem for you. Teachers Many teachers are off sick at the same time. There is no quick replacement for teachers who are off sick. Some teachers who are too sick to teach cannot be replaced until they have passed away. It is difficult to find educated members of the community who can replace absent teachers. Many teachers are unmotivated and tired, or are absent because of involvement in other activities. Many teachers are struggling with illness and death in their families. Some teachers cannot cope with the workload. Some teachers do not adhere to a code of conduct and ethics. Learners There is a problem with learner absenteeism. A growing number of learners are demotivated and tired. A growing number of learners have emotional problems. A growing number of learners experience illness and death in their families. 1 2 3 4 5
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A growing number of learners have learning difficulties. A growing number of learners cannot cope with the workload and fall behind. Finance and facilities Classes are overcrowded. Books and learning materials are lost because classrooms are not well organized. It is a struggle to collect school fees and contributions to the parent-teacher association. There are no resources for replacing absent teachers. The maintenance of the school grounds is poor. There is no clean water. Toilet facilities are poor. There are no special toilet facilities for girls. Look back at your list and answer these questions: What are the biggest problems affecting the quality of education in your context?
What support do schools need from the district office to maintain the quality of education?
What support do schools need from the wider community?
In the end, whose responsibility is it to provide quality education in the face of HIV?
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Find ways to protect quality

There are a number of ways in which schools can protect the quality of education despite the difficulties that they face.
Activity 7
Look at the following ways that schools around the world have tried to maintain quality education. Put a tick next to those that would be realistic in your context. Add any other ways you can think of to protect the quality of education. 1. Using volunteers from the community as teaching assistants to help teachers to manage large classes 2. Providing at least one meal a day at school 3. Keeping half-day school hours to allow older learners to go to work 4. Arranging apprenticeships with local businesses to support learners who cannot afford school fees or uniforms 5. Structuring the curriculum around flexible timetables. This allows teachers to do their work in shifts. 6. Investing in self-study materials that allow older learners to study in study groups or with class assistants.
Other ways:
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Make sure the right structures are in place to protect quality

It is important to have the right structures in place in a school that can help to protect education quality. Two examples of such structures are a school management team and school governing body. Other structures will be discussed in Section 4. 1. The school management team (SMT) is made up of the school head and other senior teachers who deal with management issues on a day-to-day basis. For example a SMT can decide what to do if a child is hungry or distressed at school because of problems caused at home by HIV and AIDS. 2. The school governing body (SGB) or parent-teacher association (PTA) is an elected body of parents and teachers. The SGB/PTA can make decisions on issues such as expenditure, fundraising, hiring of teachers and creating additional teaching posts (outside of South Africa these last two may not be in the competence of such bodies). For example, SGBs can be involved in developing an HIV and AIDS policy and action plan. These structures may be similar in schools in other contexts or they may be slightly different and called by different names such as support groups.
Find ways to deal with absenteeism

Teachers try to help when their colleagues are frequently absent. They do not always cope with the extra work and the children miss out on teaching time. Schools need to find ways to deal with absenteeism in the short, medium and long terms.
Activity 8
Look at the following short-, medium- and long-term responses to absenteeism. Which of these responses are appropriate, sustainable and cost-effective in your context? Tick the correct box(es). Short-term response Teachers combine classes to cover for those who are ill. SMTs and teachers discuss stresses related to absenteeism and look for immediate ways to support each other. SGB members arrange visits to those who are ill. Contact NGOs, CBOs, FBOs for more ideas for coping with absenteeism Contact the district and the ministry to find out what support they can offer. Appropriate Sustainable Cost-effective
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Medium-term response School head works with other schools in the area and creates a local list of retired teachers and volunteers who can help at short notice. Schools form a cluster group and together set a fixed rate to pay replacements for their help. SGBs budget for paying short-term replacements. District officials work together with school heads and unions to set up clear guidelines for managing short and long absences of teachers. School heads link up with learning support services to get ongoing support for teachers who are affected by HIV. Long-term response Districts create posts for class assistants. Look at how assistants can play a greater role in the classroom.
Appropriate
Sustainable
Cost-effective
Appropriate
Sustainable
Cost-effective
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4.
How schools can provide care and support for learners

In this section you will: understand more about how the lives of children are affected by HIV and AIDS; learn about important steps to take to support vulnerable children and infected learners; know how to do a school survey to identify vulnerable children; plan to make a home visit to collect more information; decide how to prioritize which children need help most; prioritize actions to keep vulnerable children in school. The lives of many children are disrupted by HIV and AIDS. Some learners may be infected with HIV. However, a much larger number will be affected by HIV and AIDS in many different ways. For instance, children more and more have to deal with family members who are ill or who die. These children are increasingly affected by the epidemic and face a number of difficulties. They may be dealing with the emotional trauma of watching their parents, relatives or caregivers get sick and die. They may get depressed or suffer from anxiety. They may also worry about whether they too are infected. They may fear death and worry about the future should a parent or guardian die. We refer to these children as vulnerable children. Vulnerable children may also suffer materially. They may not get proper food, clothing and toiletries. Orphaned children often have to work to support their brothers and sisters. It is more likely that girls will be taken out of school or will drop out to care for sick parents or siblings and perform domestic chores. These children find it difficult to attend school regularly if they have to look after the home and care for younger siblings. They often do not have the money to pay school fees or buy school uniforms. Not only do these children experience great hardship, they may also be blamed because someone close to them has been sick or has died of AIDS.
Steps to support vulnerable and infected learners

There are some important steps you can take to support vulnerable children and infected learners. Step 1. Identify children in need by doing a school survey There are many children that need care and support. To understand what problems they experience, you need to collect information about these children in a careful and confidential way. One way to do this is through a school survey.
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A teacher is probably the best person to do this survey. For example, they could ask learners in their class who may be experiencing any problems to come and talk to them privately. Once these survey sheets are completed, teachers should pass them on to their school management team or another structure that is responsible for deciding what to do. It is important to bear in mind that when vulnerable children are identified, they should not be singled out. This may result in stigmatization. Investigating a learners background should be handled sensitively and in a way that will not cause them more problems than they already have. Teachers should be sensitized to this issue.
Activity 9
Look at the example of a school survey form below. Adapt or change this form to suit the context that you work in. You may want to take some things out or add other things instead.
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Example of a survey form
Grade 1 Names
Problems faced by learners Has lost Lives with Poverty, relatives unemployed a parent X x x X X x
Dudu D Elsie P Mark V
Suspected abuse/ emotional neglect x
Chronically ill
Often absent
Other problems and comments Guardian has disclosed to staff. Struggles to accept death of father. Seems a happy, wellbalanced boy.
Possible action
Referral
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Step 2. Draw up a combined list from all the class surveys The school management team should combine all the class surveys and draw up one list of all the vulnerable children at that school. Then the team should decide how to prioritize the children that need help most. The SMT should repeat the survey every six months to keep information on learners up-to-date. Step 3. Arrange a household visit to collect more information Some of the vulnerable children may still attend school. Others may attend erratically, have dropped out altogether, or have never attended. For this reason it is important to visit the households of children who are attending school as well as those who are not. Some of the children who are not attending school may be homeless. One or two members of the SMT or SGB from a specific school, preferably female, should conduct a home visit to collect information and assess how best to offer care and support to vulnerable children at that school. The member(s) should fill in a form for each household visited.
Activity 10
Look at the following example of a form to collect important information on a household visit. Think about things that you would add or take out if you used this form in your context. Name and address of household: Household visited by: Date of first visit: Number of children: 0-6 years 7-12 years 13-18 years 19 years and older Is this a child-headed household? General observations Main issues discussed during visit How many children live here? Number of children enrolled in school Number of children attending school regularly this week.
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Step 4: Decide which children need help most It is difficult to decide which children need help most. Prioritizing is not a decision that someone can do alone. A decision about priorities needs to be made by a SMT or another kind of support group. It is important for the school management team or support group to make sure that it takes on children and actions according to its capacity. If there are actions that the school cannot take on, then it must know where to refer a child or household for help. Step 5: Prioritize actions to help children stay in school There are a number of actions4 that can help to keep children in school. The following list of actions is like a menu of possibilities. A SMT or support group would not have to do all these things. It is important to be realistic about what actions can be taken to help children in need. Sometimes it is the small, simple actions that can make the biggest difference. At home Give clothes Accept and care for people living with HIV Cook meals and give food Go shopping Look after young children and listen Read or tell children stories Listen to a childs problems Help with food gardens or in the fields Take a child for immunization or treatment Help to get financial support or food Other actions: At school Find extra school uniforms Find extra books and stationery Check that children have safe transport to and from school. Help provide breakfast and lunch for children at school Supervise homework Help organize a school-fee exemption Follow up on a child that has been absent. Talk about HIV and AIDS in schools Other actions:
Taken from COS Project Poster: Join a Circles of Support Group Project.
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Activity 11
Think about the following questions: Which children do you think need help most in the context in which you work?
Which actions are most realistic for this context?
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5.
How schools can provide care and support for teachers and other staff
In this section you will: learn how to protect the rights of teachers living with HIV or AIDS; be made aware of the physical, medical, emotional and social needs of teachers; consider different ways in which schools can support infected and affected teachers; think about the kind of structures you will need to create a caring and supportive school environment. No one is immune from the effects of the HIV epidemic. This includes teachers. Teachers living with HIV or AIDS have the right to protection. The law in most countries protects the right of teachers living with AIDS. Universally agreed human rights principles protect teachers against: Unfair discrimination: Everyone affected by HIV and AIDS should be treated fairly and sympathetically. Teachers also need to be protected from unfair discrimination by colleagues at school. Some teachers may discriminate against a fellow teacher because he or she is HIV-positive. For example, they may refuse to work with a teacher because of his or her HIV status. Unfair dismissal: This means that teachers cannot be dismissed if they are HIV-positive. In addition, no one can be prevented from teaching or being promoted because of their HIV status. Coercion: No teacher can be forced to have an HIV test as a condition for appointment or continued work. Unfair labour practices: Every teacher should have the right to leave if they are sick. Schools need to make adequate provision to deal with increased absenteeism at school. Teachers not necessarily HIV-infected are nevertheless affected by HIV and AIDS. The HIV epidemic puts more pressure on teachers to take on the role of caregivers, counsellors and community facilitators. They may not always play the role of social workers, but there is a great need for them to be caring and to know where to get professional support.
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Teachers must also be realistic about the kind of support and care they can offer both to colleagues and their learners. This is important so that they can respond to social problems at school but also take care of their own well-being. Teacher stress can cause many problems. It can: increase absenteeism bring on illnesses lead to alcohol and drug abuse make it more difficult to be good, caring role models.
Laws protecting teachers
Activity 12
Think about the following questions: What laws in your country protect the rights of teachers living with AIDS? How can you find out more about these laws?
What can be done to resolve situations where teachers are discriminated against because of their HIV status?
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Types of support that teachers may need

Teachers who are infected and affected by HIV and AIDS need support in the following ways: Physical and medical support: A teacher who is HIV infected is constantly struggling to fight disease and illness. When a teacher develops AIDS, he or she may feel ill more often during the working day. Like other ill teachers they will need time off work or a rest room to lie down. These teachers will also need medical treatment. Emotional and social support: Teachers who get sick may experience a number of different feelings: Depression and hopelessness. A teacher may lose interest in his or her work and feel that nothing matters. Feelings of loneliness. A teacher can feel this way if he or she has no support. Worry about the future. A teacher may worry about children or a partner that he or she will leave behind. Anger or guilt. A teacher may feel angry towards a partner for infecting him or her or guilty if they infected someone else. Grief. Teachers will have to deal with death in some way. It may be the death of a loved one, a colleague, a friend or even one of their learners. They will feel strong emotions such as shock or disbelief, anger, and eventually acceptance.
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Activity 13
Think about the following question: In what other ways do you think teachers in your context may need support
Schools can support teachers in the following ways: Reinforce teachers positively Teachers can make a very big difference in childrens lives. When teachers are aware of this, it can reduce their own stress. Schools need to recognize and reward teachers that provide care and support for learners and colleagues. Provide teachers with knowledge An important way to fight discrimination is to make sure people have the correct knowledge about HIV and AIDS. Teachers need to develop their own knowledge and gain skills in counselling. This will give them more confidence in making a difference in the lives of others and can prevent them feeling hopeless and not knowing what to do. Make sure teachers have someone to talk to A powerful way to reduce stress is to talk about feelings and problems. Teachers should be able to get professional help from a doctor, psychologist, spiritual leader or counsellor. Support groups are a healthy way to build relationships between colleagues. These groups help people to share ideas and solve problems together. Encourage teachers to manage their own stress levels Here are some practical ways for teachers to manage their stress levels: Get enough sleep Eat healthy food that is high in fibre and low in fat and sugar Don not drink too much coffee or tea
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Get regular physical exercise, even if it is just a half-hour walk in the afternoon Practise relaxation exercises such as deep breathing Don not abuse alcohol because it weakens the body and reduces ability to deal with stress. Contact Alcoholics Anonymous for support. Reduce or stop smoking. Smoking does not relieve stress it actually increases it because nicotine is a powerful stimulant. Smokers could form a support group to help them to stop. Take time out to enjoy activities with friends and family. Play and laughter are great stress-relievers. Make time for yourself to do the things you enjoy. Engage in spiritual activities such as praying, making music or going to church. Build supportive and appreciative leadership School managers can play a very important role by supporting staff and showing them they are appreciated. School managers need to ask themselves some questions: How do they see their staff? Do they focus more on negative behaviour than positive behaviour? Do they acknowledge staff members often enough? Are they too stressed themselves to notice? Structures to create a caring environment Schools should also consider setting up certain structures to create a caring, supportive environment for teachers. These structures can include: Teacher support team It is possible to make the whole environment of a school more caring by setting up a structure like a teacher support team. This team is made up of teachers and perhaps someone like a spiritual leader too. It can do the following practical things to help teachers: Find out where teachers can get help. Make a list and share information about all the service providers in their area. Invite speakers for monthly staff workshops. Topics could include managing personal finances, relaxation techniques, personal relationships, coping with depression, addiction and losing weight. Provide a box into which teachers can put suggestions for future speakers. Start a walking club, a teachers choir, a book club or a drama group. Management and leadership issues have to be dealt with by your SGB. Make sure the teacher support team does not become a staff grievances committee. Its function should be to plan activities that can help teachers in their role as caregivers.
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School management team (SMT) A school management team (SMT) can ensure that teachers feel supported and acknowledged. There are a number of ways to do this: Have an open-door policy. Listen to teachers. Acknowledge staff regularly and sincerely. Think of ways to reduce teacher stress. Set a good example by supporting staff members. Encourage staff members to support one another. Discuss a code of conduct and what it means for all teachers vis-a-vis other colleagues, as well as vis-a-vis learners. School governing body (SGB) with a vision The role of a SGB is to make the idea of a caring school environment a reality. There are a number of important questions that an SGB can ask: In what ways are we already a caring school? In what ways can we become more of a caring school? What opportunities do we have to be more supportive of our staff? What threatens our ability to be more supportive of our staff? How can we make a caring school part of our school development plan and mission?
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Activity 14
Think about the following questions: What structures already exist at school or district level in your context?
What structures are realistic at a school or district level?
Do teachers know about ARV roll-out programmes in your context?
How can teachers be supported to access counselling and treatment?
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6.
Lead and manage an effective response at school level

In this section you will: consider what is needed to lead and manage an effective response; learn why it is important to have a living HIV and AIDS policy; use a template for an HIV and AIDS policy if you do not have one already; think about the kind of structures needed to implement the policy; understand why an action plan is needed to implement policy successfully. An effective response to the epidemic requires leadership and management. Every school needs to identify good leaders and managers to drive an effective response. Two powerful tools that schools can use to manage a response are: 1. an HIV and AIDS policy; and 2. an action plan. In countries where the HIV epidemic is a national emergency, every school should have an HIV and AIDS policy. This policy should be in line with the national guidelines issued by the ministry of education of that country. The policy must agree with the Constitution and the law. An effective HIV and AIDS policy states very clearly what the school believes. It also clearly lays out the schools aims. It should deal with other critical properties discussed in Section 1.
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Activity 15
Some schools may already have an HIV and AIDS policy but some may not. Those schools that do may want to check that they have covered the main priorities. You can use the following template as a guide to develop an HIV and AIDS policy. Template of an HIV and AIDS school policy HIV and AIDS Policy of ____________________________ Date: ___________________________________________ Written by: _______________________________________ Signature: _______________________________________ Priority 1: Prevention of HIV infections What are the issues? In the end your HIV prevention policy should be fairly detailed and should include issues such as: providing correct information to teachers and learners about HIV transmission; promoting safe sex practices for both teachers and learners; Priority 1: Prevention What our school believes about preventing the spread of HIV and what it aims to do. setting up peer education programmes; speaking out against sex between young girls and older men; providing effective life skills training; What our school believes about protecting the quality of education and what it aims to do. making schools safe places to prevent bullying, abuse or stigmatization; promoting universal precautions.
Type of structure Priority 2: Protecting the quality of education Type of structure Priority 3: Providing care and support for learners Type of structure Priority 4: Providing care and support for teachers Type of structure Priority 5: Managing an effective response at school level Type of structure What our school believes about providing care and support for teachers and what it aims to do. What our school believes about providing care and support for learners
Priority 2: Protecting the quality of education What are the issues? Managing absenteeism, illness and trauma among learners and staff. Protecting the human resources (teachers) that are lost. Providing for the training needs of teachers. Finding the money to fund short-term help.
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Priority 3: Care and support for learners What are the issues? Try to be specific about the way you plan to respond to learners needs. This makes your policy a useful and effective document. Some of the issues you would need to think about are: creating a caring, supportive school environment and identifying vulnerable children; creating a safe school where learners are protected against stigma and discrimination; creating a healthy school where the physical and emotional health of all learners and staff is important; creating a caring classroom which becomes a safe and nurturing place for learners; Priority 1: Prevention What our school believes about preventing the spread of HIV and what it aims to do. encouraging peer support both inside and outside the classroom. Priority 4: Care and support for teachers What are the issues? What our school believes about protecting the quality of education and what it aims to do. Creating an open school that promotes human rights, disclosure and confidentiality. Creating a school that does not allow discrimination or unfair dismissal. Being aware of the physical, medical, emotional and social needs of the sick teacher. Dealing with death and sorrow in the school in an open and caring way. What our school believes about providing care and support for learners Dealing with teacher stress by finding ways to manage stress better. Promoting mutual support in the school amongst teachers and other staff. Developing supportive leadership that recognizes and acknowledges the role of teachers. Priority 5: Managing an effective response at school level What are the issues? Developing a vision for the school that withstands the HIV epidemic. Developing an HIV and AIDS policy if the school doesnt have one already Understanding what it takes to make a policy work in a school. Type of structure Finding out about other examples of successful policy implementation. Ensuring that there is a clear action plan to implement the policy. Monitoring and reviewing the policy regularly.
HIV and AIDS Policy of ____________________________ Date: ___________________________________________ Written by: _______________________________________ Signature: _______________________________________
Type of structure Priority 2: Protecting the quality of education
Type of structure Priority 3: Providing care and support for learners Type of structure Priority 4: Providing care and support for teachers Type of structure Priority 5: Managing an effective response at school level What our school believes about providing care and support for teachers and what it aims to do.
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Structures to implement policy

A good policy will briefly outline what structures are needed. It will show how the policy should be implemented in an ongoing way. Schools should not feel that they have to set up a number of new structures. Sometimes too many teams and committees are a burden and can end up duplicating one anothers work. What you put in place will depend on what structures already exist. Remember that you could expand the role of existing structures (e.g. the fundraising committee or school safety committee) to meet your needs.
Activity 16
Think about what structures you have and what you still need. Look at the examples of structures below. How could you adapt existing structures to include the tasks that are outlined in these examples? Think about the kind of structure(s) you would need if these structures do not exist. School-based support team (SBST) Who could be involved? Members of the SGB, SMT, life orientation staff, teachers, learners, someone from the department of social services. What could it do? The SBST could be an umbrella body for the other committees. It could drive your HIV and AIDS policy, make sure that actions happen, respond to crises and make financial decisions. Teacher support team Who could be involved? Members of the SMT, union representatives, teachers, people living with HIV. What could it do? Deal with Priority 3 - Care and support of teachers. - Support teachers personally so that they cope emotionally with the difficulties of colleagues and learners living with HIV and AIDS. - Refer teachers for counselling and support. - Identify teacher needs regarding workplace policies, leave and professional development. Life skills and HIV prevention team (This may be part of the staff development committee in some schools.) Who could be involved? Life-skills and other teachers, members of SGB, learners. What could it do? Deal with Priority 1 Prevention of HIV infection.
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- Drive life-skills and HIV-prevention programmes, e.g. awareness campaigns. - Network with HIV and AIDS organizations and service providers. - Involve community and youth. Health and safety team Who could be involved? Teachers, a local health care worker, learners and PLWH. What could it do? Deal with Priority 1 Prevention of HIV infection. - Create and maintain a healthy school. - Deal with nutritional issues, hygiene and cleanliness of the school. Make sure that the sick bay and the first-aid kit are properly maintained and create awareness around universal precautions. - Advise the SGB on all health matters. Youth peer health team Who could be involved? Youth, teachers, social workers, PLWH, nurses, doctors and other professionals. What could it do? Deal with Priority 2 Care and support of learners. Provide paraprofessional training for youth to support fellow learners. Go back to the HIV and AIDS policy template in Activity 15. Fill in the kind of structure(s) that you already have. Write down any new structures that you think are necessary.
Developing a school policy on HIV and AIDS is an important first step. The policy gives guidelines on the way forward. Guidelines, however, are not enough. You still have to plan practical actions that will help to make the policy a living document. An action is not an action until it gets done! Many policies and action plans are useless because people talk about their intentions, but never actually do the work. A policy will only become a practical document when actions are carried out. Before you draw up an action plan, you need to decide: what action to take; what activities will be involved; who will be responsible; what the timeframes will be; what budget there is.
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Activity 17
Use the following template to implement a policy and plan action. HIV and AIDS ACTION PLAN OF ____________________ for YEAR Priority:____________________________ Date: Participants: Action? Activities? Who is responsible? By when? Budget?
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Summary remarks
All over the world control of HIV has been best when the local response has been strongest. The same can be expected from the Education Sector, where the response to HIV needs to be led by schools. It is at schools where young people spend many hours every day, it is the place where educators, the biggest number of all civil servants, need support. At the very least schools need to ensure they maintain their basic function and purpose, which is to educate learners. Added to this they need to ensure that learners and educators are kept safe from HIV, and that nothing in the school environment contributes to the spread of the epidemic. Schools have another task in preparing young people for sexual activity, and having the time and staff in place to provide good Life Skills facilitation as part of the school curriculum. But the responsibility of schools also extends to supporting vulnerable children. These children are present everywhere, but their numbers increase dramatically when the HIV epidemic is severe. Schools have an important role, not necessarily in the provision of care, which is not their main function, but in ensuring that children receive the care they deserve. In many countries HIV is just one of many developmental issues that schools face. It is important to consider HIV issues in other initiatives, just as it is important to consider gender issues, poverty reduction and general development in HIV programmes. Hopefully the materials that are contained in this module will be useful in supporting an HIV response at a school level. But this is only a start. Please send back comments and feedback, so that the next version can be stronger and build on your experience.
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Lessons learned
This module has focused on a school level response to HIV and AIDS. Any response must be based on five critical priorities: 1. Prevention of the spread of HIV. 2. Working together to continue to protect the quality of education. 3. Providing care and support for learners affected by HIV and AIDS. 4. Providing care and support for teachers affected by HIV and AIDS. 5. Managing and leading a response at school level. The module has covered each of these priorities in some detail. Where HIV and AIDS is a national emergency, every school should have an HIV and AIDS policy as well as an action plan to implement the policy. The critical priorities must be included in the policy. The action plan should set out clearly how the priorities will be achieved, by whom and by when. Hopefully this module will help schools to see that the response begins at school and shows ways in which schools can respond effectively to HIV and AIDS.
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Activity 1 There is no right or wrong answer for this activity. The answers will depend on the specific school situation. Activity 2 Same as in activity 1. However, it is important to think as broadly as possible, and focus on all the possible ways that HIV is affecting or could affect your school. Remember that HIV will make existing problems worse in many situations. Activity 3 There is considerable research showing how silence about HIV, stigma, unequal relationships between men and women and women, alcohol and drug abuse and sexual violence contribute to the spread of HIV. Alternatively, acting to remove some these factors is often critical the responding to the HIV epidemic. Activity 4 Risk factors in this case could have been: Activity 5 Depending on how many questions you answered yes to, you can work out whether you have assessed your schools capacity to respond. For example: good = 6-8; fair = 4-7; poor = 1-3. The adequacy of a response should be looked at considering the priorities that you established in activity 2. For example, if sexual harassment is a problem, then the school should definitely have a code of conduct that is monitored and enforced. Activity 6 Many of these things are not HIV specific, but HIV can make these worse. Use this exercise the get an idea of where your school is stronger and weaker in maintaining quality education. Note where you dont have enough information to answer a question. Is this important to you? Then you need to find a way to get the answers you need The death of her mother Poverty Young girls having sex with older men in exchange for gifts Lack of knowledge about contraception and safe sex practices.
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Activity 7 The answer will depend on the specific school situation. However, try and think creatively of ways to respond to situation in your school. Activity 8 Again, the answers here will depend on the specific school situation. Activity 9 One issue you may have to deal with here is confidentiality. The class teacher may not be the best person to identify children in need. Other methods, for example using an anonymous letters or notes in a box, may be better in your situation. However, the fact is that it is impossible to provide support to children if there is no way of telling which ones need help. Activity 10 There may be different groups in the community that could conduct household visits. These could include social workers, NGOs etc. However, there is a particular power to teachers getting involved in supporting families affected by HIV and AIDS, and this does have an additional impact on fighting stigma. Activity 11 The answer will depend on the specific school situation. Do you have this information? You may need to find ways to collect this information, and check with a wide range of stakeholders to accurately asses the needs of children. Activity 12 UNAIDS and the UNDP have a lot of resource material looking at issues of HIV and human rights. Discrimination against a person on the basis is considered a violation of human rights, and is illegal in most countries. See www.unaids.org and www.hrw.org. Activity 13 The answer will depend on the specific school situation. However, see the ideas that are given below this activity.
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Activity 14 Use this activity to consider what structures support teachers in the education sector, but also what is available in the community. After all, schools cant do everything. Has the school made contact with the local clinic or hospital? What about NGOs or CBOs that offer support or counselling services? Think carefully of groups or even individuals that can assist the school. Maybe there are parents who have some support skills. Activities 15-17 These activities involve designing a school policy and plan, and putting in place structures to support this. This response is most appropriate in countries and communities with a high HIV burden, such as in most of Southern Africa. In areas with a lower HIV burden it may be more valuable to use this planning process to highlight other important development challenges for your school, or issues such as school safety, which is important both as an HIV response and as a broader development issue.
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Department of Education. 2003. Develop an HIV and AIDS plan for your school. A guide for school governing bodies and management teams. (www.doe.gov.za). Additional resource material Circles of Support. 2004. Training material. Produced by Health and Development Africa for the SADC Health Sector Coordinating Unit HIV/AIDS Project.
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Module
M. Crewe C. Nzioka
The higher education response to HIV/AIDS
4.6
About the authors

Mary Crewe has extensive experience in education and management and is currently the Director at the Centre for the Study of AIDS based at the University of Pretoria. She was chair of the National Department of Education and Health Committee for HIV/AIDS education in schools, and helped establish and manage the Greater Johannesburg AIDS Program, one of the largest HIV/AIDS centres in Africa, which provides education and awareness programmes for young people in the inner city. Charles Nzioka is a Programme Specialist at the International Institute for Educational Planning where he works on the impact of HIV and AIDS on educational planning and management and has published extensively on the impact of HIV and AIDS in higher education and teacher training institutions. He has also worked as a consultant for organizations such as UNICEF, World Health Organization, Family Health International, World Bank and the African Policy and Health Research Centre.
Module 4.6
THE HIGHER EDUCATION RESPONSE TO HIV/AIDS
Table of contents
Questions for reflection Introductory remarks Why should tertiary and higher education institutions be concerned with HIV and AIDS? 2. What makes tertiary and higher education institutions or higher education institutions able to contribute effective responses to HIV and AIDS? 3. Mainstreaming HIV prevention and management of AIDS 4. Gender mainstreaming 5. Developing institutional leadership on HIV and AIDS 6. Developing an institutional HIV and AIDS policy Institutional HIV and AIDS Policy vs. Workplace HIV and AIDS Policy 7. Integrating HIV and AIDS into academic and non-academic programmes Teaching HIV and AIDS as separate subject Integrating HIV and AIDS into existing subject Infusing HIV and AIDS across the curriculum Integrating HIV and AIDS into extra-curricular activities Combination of different approaches 8. Research 9. Financial resources 10. Community outreach programmes 11. Monitoring and evaluation 1. Summary remarks Lessons learned Answers to activities
MODULE 4.6: The higher education response to HIV and AIDS
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Aims
The aim of the module is to:
enable you to understand the role that higher education can play in addressing HIV and AIDS; present the ways in which tertiary and higher institutions can act to address HIV and AIDS within the institutions, in the surrounding communities and in the wider society.
Objectives
At the end of this module you should be able to:
recognize the ways in which tertiary and higher institutions can operate to support staff and students dealing with HIV and AIDS both personally and professionally; understand the role of staff and students in programmes and curricula that address HIV and AIDS; develop an institutional HIV and AIDS policy for your tertiary or higher education institution, that takes into account the managerial and workplace issues that tertiary and higher institutions face under the increasing burdens of HIV and AIDS; design and develop appropriate responses to HIV and AIDS within the structures of higher education and its many complex social, economic and political issues; initiate monitoring and evaluation (M&E) systems to measure programme and project progress.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the space provided. As you work through the module see how your ideas and observations compare with those of the author. Should tertiary and higher education institutions provide leadership in response to HIV and AIDS? Why or why not?
Identify some possible impacts of HIV and AIDS on the functions and operations of tertiary and higher institutions.
Why is an HIV and AIDS policy necessary in a tertiary or higher education institution?
What leadership can tertiary and higher education institutions provide in addressing the challenges of HIV and AIDS in the education sector and the wider community?
What are some of the workplace issues that tertiary and higher education institutions will need to address when dealing with HIV and AIDS?
What opportunities for transformation do HIV and AIDS represent for institutions of higher education?
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Module 4.6
THE HIGHER EDUCATION RESPONSE TO HIV/AIDS
Tertiary or higher education institutions are those that have theory-based programmes intended to provide sufficient qualifications for gaining entry to advanced research programmes and professions with high skill requirements. They also have programmes devoted to advanced study and original research, and thus lead to the award of advanced research qualifications (UNESCO, 2005: 397). Tertiary level or higher education institutions could include universities, polytechnics, teacher training colleges and/or other specialized colleges of further education and training. In the context of this module, the term tertiary institutions will be used interchangeably with the terms institutions of higher learning or higher education institutions. These institutions are for the greater part preoccupied with the following roles: Transmitting the accumulated body of global knowledge relevant to the development of society through teaching (UNESCO, 2006). Creating new knowledge and extending boundaries of knowledge through research (Crewe, 2000). Preserving knowledge on national and international values of culture, history, art and science through technology, publications and library acquisitions. Providing advisory, extension and consultancy services on issues that are relevant to the socio-economic advancement of society (Otaala, 2000)
Tertiary and higher institutions must be aware of how HIV and AIDS are affecting their functioning and operation, especially in countries where the virus is endemic. HIV and AIDS can reduce student enrolments through deaths, illness, financial constraints, and demand for home care of sick relatives and friends. HIV and AIDS also increase the cost of training academic and support staff due to attrition, premature deaths, and employee benefits given in case of illness or after death. Moreover, these impacts can adversely affect the quality of education within the institution because sick, depressed, unmotivated or demoralized staff cannot be expected to teach effectively, nor can infected and affected students be expected to fully comprehend educational instructions or assume all the course workloads. Accurate data on HIV prevalence levels among staff and students may be lacking in some higher and tertiary education institutions, but there is anecdotal evidence that HIV- and AIDS-related illnesses and deaths among both staff and students in these institutions are on the increase. Student absences and deaths are, however, less conspicuous owing to rapid growth in student populations in these institutions and also due to the fact that many students with HIV- and AIDS-related illnesses withdraw from their studies and subsequently there is little way of tracking where they go and what
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happens to them. It is possible that HIV-related absenteeism, the loss of skills, and the overall costs and impacts due to HIV and AIDS are seriously undermining the capacities of tertiary institutions to achieve their defined educational and research goals (Abebe, 2004; Anarfi, 2000; ACU, 2002; Crewe, 2000). This module examines how tertiary and higher education institutions can develop effective policies and strategies for dealing with the impact of HIV and AIDS. It shows how members of these institutions can be equipped with the knowledge, information and skills to address HIV and AIDS as a workplace issue as well as its potential impact on the process of teaching, research, learning, staff recruitments and retention. The module will also show how higher education institutions can provide intellectual leadership in HIV and AIDS education, prevention, care and research to the wider society.
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1.
Why should tertiary and higher education institutions be concerned with HIV and AIDS?
Tertiary or higher education institutions have an ethical and intellectual responsibility to set an example by openly debating the issues surrounding HIV and AIDS and finding creative responses to this epidemic. These institutions constitute one of the essential components in developing a united and effective country response to the pandemic for the following reasons: These institutions cater for sexually-active young people, mostly in the 18-30 year old category. Global data shows that more than a third of all people living with HIV are under the age of 25 (UNAIDS, 2004). Certain aspects of social life place members of tertiary and higher education institutions at risk of contracting HIV. Enhanced personal freedom coupled with the attractions and pressures of life in tertiary and higher education institutions is a recipe for sexual activity and experimentation. Casual sex and multiple sexual partnerships are common. Instances of offering sex in return for favours like promotions or good grades which are euphemistically termed as sexually transmitted degrees and diplomas exist in some of these institutions. Commercial sex may not be uncommon as poor students seek to earn money to pay for their fees or for personal upkeep. Campuses are places where the safety of all students and staff, especially women must be guaranteed. Nevertheless, some university residences have earned a reputation as being places where rape, sexual violence and harassment of women are commonplace and where unprotected sex is perhaps the norm. These institutions have a responsibility to ensure that all trained graduates have the capacity to deal with HIV and AIDS at their own individual and professional levels. These institutions have an obligation to cater for the welfare of their members by creating an environment that reduces the likelihood of HIV transmission. HIV and AIDS can seriously impair and undermine the operation and functioning of tertiary and higher education institutions. Often, it takes particular talents, resources and a lot of time to produce specializations in particular academic disciplines. Subject specialists in tertiary level institutions cannot be interchanged easily, as may be the case in other school levels. Even where skilled manpower exists, the process of staff recruitment to replace other staff lost to HIV and AIDS is expensive both in terms of time and resources. Higher education institutions have a responsibility to promote gender sensitization and awareness of the situation of women with respect to the epidemic and the larger society.
Tertiary and higher education institutions can contribute to more effective, expanded and sustained responses to HIV and AIDS. These institutions can assist
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the wider society in developing knowledge-based solutions to the problem of HIV and AIDS, such as through vaccines and other forms of social and behavioural research. As centres of excellence in research and knowledge building, tertiary institutions have an institutional responsibility to society.
Activity 1
Identify some of the ways in which you think HIV and AIDS will have an impact on the institution in which you work is this likely to be on staff, students, teachers, the management processes or the quality of teaching?
How would you act to reduce this impact, and what steps would you put in place to ensure that your institution is HIV and AIDS literate?
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2.
What makes tertiary and higher education institutions or higher education institutions able to contribute effective responses to HIV and AIDS?
Tertiary and higher education institutions occupy an advantageous position that allows them to easily influence and shape debate, action and policy with regard to HIV and AIDS, both at institutional and societal level.
These institutions: are responsible for the preparation of a large segment of the professional and skilled personnel that society needs. are crucial agents of change and can influence how society responds to issues such as HIV and AIDS; can offer leadership in terms of critical debate, policy development and research; are capable, through medical and social research, of generating new knowledge that can have enormous benefits to both the public and private sectors in dealing effectively with HIV and AIDS; due to weak surveillance systems, many higher education institutions lack accurate data on the magnitude of the HIV epidemic and the health problems of staff and students within the institution (Nzioka, 2006). a culture of silence surrounds the disease at the institutional, academic and personal levels (Kelly, 2001); initiatives to address HIV and AIDS in most institutions are ad hoc, fragmented, not embedded within an institutional framework, and lacking a holistic approach, making it difficult to evaluate their effectiveness; many responses to HIV and AIDS are often driven by individuals and small groups with little impact; some tertiary and higher education institutions do not have an HIV and AIDS policy in place; most HIV and AIDS strategies and programmes in tertiary and higher education institutions focus on prevention and are not sufficiently comprehensive; in most instances, the context in which tertiary and higher education institutions must respond to the epidemic is constrained by the absence of a national policy or guidelines specific to tertiary and higher education institutions. There are no incentives for top institutional leadership, staff, or even students to make HIV prevention and management an institutional priority. Since most students in tertiary or higher education institutions are adults, there is always an assumption that these students are already equipped with adequate HIV and AIDS education from their secondary schooling.
Yet, in spite of this advantage:
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3.
Mainstreaming HIV prevention and management of AIDS

There is a need to mainstream HIV and AIDS into the core functions and operations of tertiary or higher education institutions and to increase the overall relevance of the epidemic into all such institutions. Mainstreaming can be defined as the process of analyzing how HIV and AIDS impacts on all sectors now and in the future, both internally and externally, to determine how each sector should respond based on its comparative advantage (Elsey and Kutengule, 2003). In the context of a higher education institution, it may mean looking at how the epidemic is likely to affect the departments goals, objectives and programmes and whether the department has a comparative advantage to respond to and limit the spread of HIV, and also to mitigate the impact of the epidemic. There is certainly no standard approach or universal recipe to mainstreaming HIV and AIDS into the life of any institution. In the case of tertiary institutions, mainstreaming can involve integrating HIV and AIDS into core operations, functions and curricula. For example, HIV and AIDS is now part of professional studies at Kaliro National Teacher Training College in Uganda and at Migori Teacher Training College in Kenya. HIV and AIDS could also be integrated into non-curricular activities such as sports and creative art or debates. Mainstreaming entails: examining how the institution is influencing the spread of HIV within the university and the surrounding communities. putting in place policies and practices that protect institutional staff and students from HIV infection while also supporting the infected to live with HIV and AIDS and its impact; ensuring that training and recruitment takes into consideration possible future staff depletion rates and disruption that are likely to be caused by increased morbidity and mortality due to HIV and AIDS; refocusing the work of the organization so as to ensure that the infected and the affected are still able to be optimally productive; ensuring that the institutions activities do not increase the vulnerability of the communities working with or around the institution;
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Box 1

Key features in mainstreaming HIV and AIDS

Sustained, committed, creative and dynamic leadership. Identification of institutional constraints (such as lack of skills and finances) for effecting desirable changes. Re-ordering priorities so that essential resources are shifted to HIV and AIDS concerns and activities. Strengthening staff and student capacities to understand HIV and AIDS and build responses into programmes. Establishment of clear indicators of success in the mainstreaming itself, in prevention, in care and support, and in the mitigation of the impacts of HIV and AIDS.
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4.
Gender mainstreaming
Gender mainstreaming is the process of assessing the implications of any planned HIV and AIDS action, policy and programme on both women and men. It is a strategy for making women's as well as men's concerns and experiences an integral dimension of the design, implementation, monitoring and evaluation of institutional HIV and AIDS policies and programmes so that everyone benefits equally. The ultimate goal of gender mainstreaming is to achieve gender equality. Since in the case of higher education institutions, it is well known that women are considered at higher risk of transmitting the virus, gender mainstreaming in the context of tertiary and higher education institutions requires the following: 1. Collection, analysis and use of sex-disaggregated data on HIV and AIDS in all faculties, and departments. 2. That the right of all women, including girls, to protection from exposure to the possible risk of HIV infection is explicitly recognized. 3. Protection of the legal, civil and human rights of women/girls affected and infected, and giving women access to treatment, counselling and support on an equal footing with men. 4. Monitoring the impact of HIV and AIDS on both men and women in these institutions. Students in the tertiary and higher education institutions are increasingly under pressure to pay higher fees, and this pressure is perhaps much more acute on female students, who are now being pressured into commercial sex work or sexual liaisons with older men to secure these extra finances to bridge their fee gaps (Ochanda, Njima and Schneegans, 2006;). Recent studies in Uganda, Kenya, Ethiopia and Zambia appear to suggest that women in the age cohort attending tertiary and higher education institutions such as teacher colleges and universities are more vulnerable to HIV infection (Ashebir, 2007; Katahoire and Kirumira, 2007; Nzioka, 2006; Ramos, 2006). There are probably now many more female students in tertiary and higher education institutions that are infected with HIV than their male counterparts. Gender mainstreaming may lead to reduced HIV transmission among women and girls through safer sexual practices, such as increased use of male and female condoms, faithfulness to one uninfected partner, and abstinence.
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Activity 2
How would you go about mainstreaming HIV and AIDS into the core functions of your own institution? What about gender mainstreaming?
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5.
Developing institutional leadership on HIV and AIDS

Evidence shows that an effective response to HIV and AIDS requires a strong and visionary leadership. Strong and committed leadership can inspire action, mobilize resources, establish policies and set up responsive organizational structures (see also Kelly and Bain, 2005). In instances where institutional leaders have made HIV and AIDS a priority, the response has been immediate, effective and visible. In higher education institutions leadership that comes from vice chancellors or a designated senior manager sends a strong message within the institution and to the wider community that HIV and AIDS management is a priority. A recent study on the response of teacher training colleges (TTCs) to HIV and AIDS demonstrated that when institutional heads provide leadership in HIV and AIDS, college communities are likely to take such activities more seriously (Nzioka, 2006). One example is the University of Durban, now known as the University of KwaZulu-Natal, where strong response began in the late 1990s under the leadership of the Vice-Chancellor. One outcome was the establishment of what is now the internationally renowned Health Economics and AIDS Research Division (HEARD) under the leadership of Professor Alan Whiteside. In institutions like this, decision-making and programme management structures have been established, networks have been created, resources have been found and the climate of silence and denial about AIDS has been broken. The creation of the position of Chair in HIV and AIDS Education at the University of the West Indies, Barbados, in October 2004 is yet another good example of how tertiary institutions can develop institutional leadership in response to HIV and AIDS. This Chair was created by the Commonwealth Secretariat, in partnership with the United Nations Educational Scientific and Cultural Organization (UNESCO) with the aim of providing institutional leadership on HIV and AIDS through education in the Caribbean. This was the first time an internationally supported Chair in the area of HIV/AIDS and Education was created in a higher education institution to highlight the critical role that higher education institutions can play in the response to HIV and AIDS (Morrissey, 2005). Strong and focused leadership is necessary to break the highly observable culture of silence on HIV and AIDS and to help to acknowledge the threat to institutional functions and operations. Effective responses to HIV and AIDS by top institutional leadership in tertiary institutions should: acknowledge that HIV and AIDS may have an impact on the institutions functions and operations; recognize that HIV and AIDS could undermine the quality and quantity of the training and educational services offered; prioritize a careful and well co-ordinated response to HIV and AIDS; integrate HIV and AIDS into the institutional mission, while ensuring that HIVand AIDS- related stigma and discrimination is addressed;. target all members of the institutional community including students, teachers/lecturers and non-teaching staff; establish interventions that are both inward-looking (protecting the institutions own functioning) and outward-looking (serving the needs of the wider society).
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Leadership in the response to HIV and AIDS should not, however, be limited to only the top levels of institutional management. In tertiary institutions, leadership could also come from deans, heads of departments and professors. Leadership could also come from student anti-AIDS clubs, professional student associations, peer-group networks and possibly from people living with HIV (UNESCO, 2006). The University of Nairobi has a very strong association known as Medical Students Against AIDS (MSAA), which serves not only university students but also offers peer counselling to secondary school students and other forms of assistance to many urban communities in Nairobi. Similar organizations can also be found in other public universities in Kenya, such as in Kenyatta University (Ochanda, Njima and Schneegans, 2006). For more information on leadership and HIV and AIDS management, see Module 1.5, Leadership against HIV/AIDS in education.
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6.
Developing an institutional HIV and AIDS policy

A policy is a statement of intent. An institutional HIV and AIDS policy is necessary at the institutional level because it seeks to answer the following questions: What should be done? Why? By whom? How? The existence of a policy is not a guarantee of action, but the existence of a written policy implies a tacit admission that the institution perceives HIV and AIDS as an institutional priority that must be addressed. Policies in themselves do not however provide solutions to the challenges posed by HIV and AIDS in tertiary institutions. Rather, the presence of an institutional HIV and AIDS policy will provide a broad framework upon which institutional action can be premised. Policies can then be translated into action by an institutional structure such as an action committee, which is mandated with such responsibility and is accorded resources for this purpose. On the other hand, the absence of a written policy does not always mean the absence of a framework of action against HIV and AIDS. Some institutions have evolved and developed certain practices and programmes in response to HIV and AIDS that do not derive from any written policies. Some institutions also take the view that programmes can be launched and delivered successfully without a fully developed policy framework, and can then be formalized into policies if necessary. Where such practices, activities and programmes have evolved, they have become part of an institutional culture that continues to drive action against HIV and AIDS in the institutions. Nevertheless, a written institutional HIV and AIDS policy is necessary because it can assist a tertiary institution in: defining the institutions position with regard to HIV and AIDS and in setting clear guidelines on how the epidemic can be managed within the institution; defining the rights, obligations and responsibilities of all the stakeholders in an institution, including affected and infected persons and their partners; setting the behavioural standards to be expected of each institutional member; setting institutional standards for communication about HIV and AIDS; identifying the human, material and financial resources to be used for HIVand AIDS-related activities; legitimizing institutional actions on HIV and AIDS and aligning the institutional responses to the broader national policy framework; providing guidance to institutional managers and other players and providing an overall framework for action; indicating commitment to deal with and control HIV and AIDS; ensuring consistency with national and international practices.
Institutional HIV and AIDS Policy vs. Workplace HIV and AIDS Policy
The wider institutional HIV and AIDS policy needs to recognize the specific needs of both staff and students but should remain separate from an HIV and AIDS workplace policy. Students are not employees of institutions of higher learning, and may not be adequately covered under an HIV and AIDS workplace policy. Nevertheless, they are part and parcel of the work environment and there is evidence that students and staff
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in these institutions interact in a variety of ways which permit the spread of HIV and AIDS within both groups. Therefore, an institutional HIV and AIDS policy should be broad enough to cover students and staff. For example, an institutional HIV and AIDS policy may need to provide for adjustable academic programmes so as to accommodate the needs of students who need time out of their studies for reasons of ill health or dealing with the impact of HIV and AIDS in their families or communities. The institutions may also need to think of ways of developing expanded support services for infected and affected staff and students. One consideration may be to train staff and students as educators and counsellors to support and help their peers and colleagues. Universities such as Nkumba University in Uganda, the University of Zambia, the University of Kwazulu-Natal in South Africa and a whole host of universities and tertiary institutions in sub-Saharan Africa have developed institutional HIV and AIDS policies. Reading through these policies shows that they are broad enough to take account of both staff and students needs. Thus, it appears that these institutional HIV and AIDS policies are more comprehensive than a workplace HIV and AIDS policy. Normally, a workplace policy consists of a detailed document on HIV and AIDS within all aspects of the workplace and its staff, setting out prevention programmes, treatment and care for staff living with and affected by HIV and AIDS. It could also be part of or found within the institutional policy or agreement on safety, health and working conditions, or just a short statement of principle. (For more information on workplace policies, see Module 2.3, HIV/AIDS workplace policies and programmes).
Activity 3
1. Identify the major challenges and obstacles that are likely to come in the way of developing and subsequently implementing your HIV and AIDS policies and programmes in your institution.
2. How can your institution overcome these challenges and obstacles?
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7.
Integrating HIV and AIDS into academic and non-academic programmes

One main outcome of HIV and AIDS policies in a tertiary or higher education institution should be the mainstreaming of HIV and AIDS into the formal and non-formal curricula. HIV and AIDS education needs to be incorporated into the curriculum of all faculties. Students and staff need to be HIV-aware, HIV-competent and HIV-safe (Coombe, 2003). To do this, they need to fully grasp, understand and internalize pertinent facts and practices relating to HIV and AIDS. This might however, only come about if these institutions have competent and credible systems for delivering HIV and AIDS education. In seeking to provide HIV and AIDS education, tertiary and higher education institutions may need to explore adopting the use of a variety of approaches.
Teaching HIV and AIDS as separate subject

HIV and AIDS can be taught as a compulsory subject or topic across all degrees or diploma courses in the institution. This teaching could entail providing information on basic epidemiological facts about HIV and AIDS, the impact of HIV and AIDS on society, and desirable protective behaviour vis--vis HIV and AIDS, such as safer sex practices and life skills. To ensure students take the teaching seriously, compulsory questions should be included in their examinations to assess their competence in understanding the critical issues.
Integrating HIV and AIDS into existing subject

HIV and AIDS education can be integrated into an existing subject to which the epidemic may be relevant, such as civics, religious education, social ethics, social studies, or health education. The advantage of this approach is that the carrier subject teachers are likely to see the relation between HIV and the other aspects of the subject. These teachers are also likely to have a greater grasp of the subject and be able to find appropriate examples and issues owing to their experience in teaching the subject. The training of lecturers on how to integrate HIV and AIDS into their subject areas of competence is also likely to be easier, faster, and cheaper than through infusion or creating a separate course.
Infusing HIV and AIDS across the curriculum

Another option is infusing HIV and AIDS into the curriculum. For example, the Africa University in Zimbabwe and the University of Botswana have taken steps to mainstream HIV and AIDS education into many of their training programmes. Infusion would give students a greater understanding of how to mitigate the impact of HIV and AIDS in their area of expertise such as in Chemistry, Engineering, or law. This will require that students be taught to understand the epidemic and its ramifications on the society including such issues as: what has caused the epidemic to unfold in the way that it has? How has the response of the state helped or hindered the response? What is the role of the private and public sector in addressing HIV and AIDS? How will an effective workplace programme be developed in the sectors in which the students are employed?
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Infusing of the HIV and AIDS into the curriculum requires that there are sufficiently trained and motivated staff to offer the course, to teach well and to evaluate the students. This could potentially pose a huge burden on staff, particularly if they themselves are not trained in the teaching HIV and AIDS and might already be overburdened. This approach also assumes that the institution is ready to shoulder the additional financial cost of preparing the staff and providing the course materials, and that students are willing to participate in such a compulsory programme. Ideally, students and staff should somehow be involved in the decision to make it compulsory and in appreciating the relevance of learning about HIV and AIDS to their courses, lives and future careers.
Integrating HIV and AIDS into extra-curricular activities

Tertiary and higher education institutions might also wish to consider integrating HIV and AIDS into non-curricula activities such as sports, or creative arts like drama and music subjects, going to see plays and concerts, and debates. Box 2 Integrating HIV and AIDS into extra-curricular activities
The Office of the Associate Vice-President for Research and Graduate Programs at the University of Addis Ababa has introduced a new interactive play entitled Walkers of Life. Walkers of Life focuses on the campus life of students and the risky sexual behaviors, examining the knowledge, attitudes and practices, in this case of the audience (i.e. students) and has intervals at which a moderator asks the audience for an opinion or challenges them on some controversial issues such as peer pressure, faithfulness to sexual partnerships, the desire to experiment new experiences, pressure to have unprotected sex in different contexts, and living away from immediate parental guidance. The play is part of the Modeling and Reinforcement to Combat HIV/AIDS (MARCH) project at Addis Ababa University. The MARCH project seeks to promote behaviors that reduce the risk of HIV infection through providing role models. The project also includes reinforcement activities in which these positive behaviors are discussed and assimilated in a peer group setting and sustained via community support. MARCH targets the Addis Ababa University students, academicians and administrative staff, promoting abstinence, mutual fidelity and other preventive behavior. The organizers hope that such an interactive play will create an environment conducive to free interaction among the audience on the issues raised in the play. The play, which was produced by the Universitys School of Theatrical Arts, targets the 30,000 students plus 3,000 academic staff in the 12 campuses of the University of Addis Ababa, together with other students from all over Ethiopia. Source: http://www.aau.edu.et/march/index.php
Combination of different approaches

Given the diverse nature of institutions of higher learning particularly universities, it is possible that many of the approaches outlined above might be appropriate for use across the different sections, and departments in the institution. Tertiary and higher education institutions might also wish to try using a combination of these techniques. Any approach assumes that the institution is ready to shoulder the additional financial cost of preparing the staff and providing the course materials, and that students are willing to participate in such a compulsory programme. Ideally, students and staff should somehow be involved in the decision to make it compulsory and in appreciating the relevance of learning about HIV and AIDS to their courses, lives and future careers.
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8.
Research
Integrating HIV and AIDS into the professional and intellectual work of staff and students in tertiary institutions is a form of mainstreaming or institutionalizing HIV and AIDS. Universities and other tertiary institutions exist in society to provide intellectual guidance and to cater to the need for knowledge and expertise in particular demarcated areas of specialization within the society. The dense concentration of intellectual expertise in tertiary and higher education institutions places them in the forefront of the global search for an improved biomedical, epidemiological, scientific, social and economic understanding of HIV and AIDS. With no known cure for the virus and its related illnesses, the potential role of universities and other tertiary and higher institutions in biomedical research that seeks to address this critical issue is even more urgent (UNGASS, 2001). Tertiary and higher education institutions can make their own unique contribution to the various areas of prevention, care, treatment and impact management, and can contribute to technical advancement, new products, improved diagnosis and treatment, new understandings, improved economic growth, accelerated industrial and agricultural growth, and an improvement in the quality of life. A good research base ensures a good understanding of social and scientific issues as well as offering the institution the opportunity to develop a database and better knowledge of how to address the many issues related to this epidemic. All faculties and departments need to be encouraged to develop an HIV and AIDS research profile and encourage students to use HIV and AIDS as the basis of their research. There is a need to develop simulation models on the possible future impacts of HIV and AIDS, calculate the potential cost under different conditions, and use that data when planning interventions to counter the adverse effects of HIV and AIDS. HIV and AIDS research in tertiary institutions could also be externally oriented focusing on the knowledge, understanding and information needs of society. However, there is also need for research that is directed towards the information needs of the university itself. Under the auspices of the International AIDS Vaccine Initiative (IAVI), the University of Nairobi in Kenya has been working in conjunction with Oxford University in the United Kingdom on the development of an AIDS vaccine, while a similar partnership has developed between the University of Cape Town, South Africas Medical Research Council and the National Institute of Virology and a North Carolina-based biotechnology firm (Kelly, 2003). This is an example of externally oriented research. Finally, tertiary and higher education institutions could be involved in theoretical and applied research, both of which could contribute to an intellectual understanding of the epidemic as well as giving policy and intervention direction. Research should also offer a critique of existing programmes and policies, as well as a critical examination of donor agendas and the ways in which these shape national responses.
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Activity 4
When you consider the ways in which your institution is structured, how would you best integrate HIV and AIDS into student activities and the overall learning environment?
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9.
Financial resources
The ways in which HIV and AIDS will affect the finances of the institution are many and varied. Campus health services will face considerable financial strain if they have to provide HIV testing, counselling, treatment for opportunistic infections and sexually transmitted infections and anti-retroviral treatment (when this is not provided by the state). A further direct cost for the health services of an institution will be increased expenditures on disposable materials such as gloves and other equipment to protect health workers and researchers. Funeral benefits need to be considered, as well as replacement costs of staff who leave or who die and skills training for new members of staff. Other costs would include temporary replacement of staff. The benefit packages for staff members can also be affected as the demand for payout of these packages can occur sooner than expected. Some of the indirect costs include staff absenteeism due to illness or family responsibilities, caring for others and attending funerals. The HIV epidemic is also threatening the funding sources of tertiary and higher education institutions. Money previously budgeted for other services may have to be channelled towards HIV- and AIDS-related expenditures implying the need to raise more money. HIV- and AIDS-related costs may also mean less money available for bursaries and scholarships and may affect the ability of students to pay for their tuition and books and other requirements.
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10. Community outreach programmes

Institutions of higher learning can play an important role in the development of community outreach projects for HIV and AIDS prevention, care, and counselling of the infected and affected. These could include impact-mitigation projects for orphans and vulnerable children, and people living with HIV or suffering from AIDS. Students could be encouraged to participate in the development and implementation of awareness campaigns and peer-education activities within the university community as well as the surrounding ones. They could also assist local communities by offering skilled/professional services free of charge, which could also serve as opportunities for the students to gain professional experience. For example, in some countries, university students from different faculties would visit a slum settlement within the vicinity of the university and offer public education and free medical services to the inhabitants. Such outreach programmes were also observed in teacher colleges in Kenya, where teacher trainees visit schools on the weekends to do their teaching practice and educate the local communities on the risks of HIV and AIDS (Nzioka, 2006).
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11. Monitoring and evaluation

Programmes must also be created for tertiary and higher education institutions to monitor and evaluate their policies and programmes. Monitoring involves tracking the inputs, processes, outputs and quality of a programme over time. It also involves assessing whether the ways in which a programme is being implemented is consistent with its initial design and implementation plan. Institutions of higher learning can develop both quantitative and qualitative monitoring indicators. Quantitative indicators would include items that are easily measured or counted, for example: number of student programmes and activities; number of participants per activity; number of counsellors available; number of counselling sessions held; number of times a promotional radio spot was aired; number of posters distributed; condom uptake; other programme elements carried out their frequency.
Quantitative monitoring involves record-keeping and numerical counts. Activities in the project/programme timeline of activities should be closely examined to see what kinds of monitoring activities might be used to assess progress. The method for monitoring and its associated activities should be designed from the start of the programme and integrated into the project timeline. Higher education institutions can also develop qualitative monitoring indicators. Such indicators can provide information on how well the elements are being carried out. Qualitative issues concern items that are harder to get at and more difficult to measure. This kind of information could be obtained through in-depth interviews and focus group discussions. Qualitative questions for a project may include: how are staff and student attitudes on stigma and discrimination changing as a result of a training or course? how are programme activities influencing behaviour change?
Evaluation entails assessing programme outcomes, what such outcomes mean and whether such outcomes make a difference. Sustained monitoring and evaluation is an essential activity of any HIV and AIDS programme, and the findings need to be relayed to the staff and students who are involved in the programme. Part of the monitoring and evaluation process is to ensure that all tertiary and higher education institutions have the capacity to: develop; implement; finance sustain; and evaluate programmes and projects
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Strengthening the HIV and AIDS monitoring and evaluation process also allows staff to build their capacity for ensuring identification of programme and project weaknesses to enhance programme effectiveness.
Activity 5
What are the major obstacles to monitoring and evaluating a programmes activities in your institution? How can these obstacles be overcome?
In what ways can you ensure effective monitoring and evaluation of HIV and AIDS programmes in your institution?
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Summary remarks
Tertiary and higher education institutions have a crucial role to play in developing responses that will ensure that all staff and students have access to education, prevention and care in an environment in which their rights are protected. Tertiary institutions are uniquely placed to develop innovative and effective responses to HIV and AIDS. This is because as institutions of higher education, they are concerned with the generation and development of new ideas and their key role is to push the boundaries of knowledge and to give intellectual leadership and vision. At the same time, tertiary or higher education institutions are more vulnerable to HIV and AIDS than other formal institutions of learning because they cater mainly for students who fall within the ages of 18-25 an age group with a high HIV prevalence, which is largely as a result of unprotected sexual relations. Understanding this dichotomy can help higher education institutions to develop policies that address the issues of risk and prevention within universities. Tertiary and higher education institutions remain committed to: developing new sources of knowledge and understanding; challenging the status quo and developing new explanatory frameworks; critical research that will lead to new social formations and new ways of coping with complex social, economic and political issues; influencing policy-makers in both the public and the private sector to develop programmes and implement policies that will ensure that issues such as HIV and AIDS are not merely pushed into the existing policies and programmes; ensuring that research findings are channelled to appropriate audiences; ensuring that HIV and AIDS become core concerns of the institution.
Tertiary and higher education institutions could develop and design policies and responses to HIV and AIDS that take into account all of these commitments as well as the different ramifications of the epidemic. Understanding how societies live through epidemics is a crucial aspect of tertiary based work. Academics have a key role to play in fostering new social movements and a new social consciousness as well as developing a critical engagement with the wider social, political and development issues of the epidemic and understanding the role of the tertiary sector in globalization and development. Tertiary and higher education institutions have at their disposal a wide and well trained skills base and they need to ensure that they are able to retain this. The time and resources devoted to training academics and support staff needs to be offset against the costs of antiretroviral treatment and other support services for staff and students living with HIV and AIDS. Through active research and community participation, tertiary and higher education institutions can act as role models for other institutions. On the whole, tertiary and higher education institutions are able to support countries to develop comprehensive responses to HIV and AIDS that are based on research, intellectual activity, models of understanding and engagement vis--vis the epidemic as well as offering practical solutions and policy and programme implementation.
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Lessons learned
Lesson One
HIV and AIDS have a crippling effect on the functioning and operation of tertiary and higher education institutions, particularly in highly-impacted countries. At the same time, tertiary institutions occupy an advantageous position in society and play a key role in developing strategies for the prevention and control of HIV and AIDS within and outside the institution.
Lesson Two
Strong and visionary leadership is essential in the development of institutional responses to HIV and AIDS in tertiary and higher education institutions.
Lesson Three
For tertiary and higher education institutions to respond effectively to HIV and AIDS, they need to develop institutional policies on HIV and AIDS that establish appropriate internal programmes for mainstreaming HIV and AIDS into institutional life.
Lesson Four
As part of the mainstreaming process, HIV and AIDS need to be integrated into the curriculum so that every student can become AIDS competent.
Lesson Five
Tertiary and higher education institutions should dedicate part of their research mandate to issues relating to HIV and AIDS.
Lesson Six
Tertiary and higher education institutions should encourage both staff and students to engage with the external community on issues of HIV and AIDS.
Lesson Seven
An effective monitoring and evaluation system is required in each tertiary institution in order to track institutional progress in response to HIV and AIDS.
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Activity 1
HIV and AIDS can impact on your institution by reducing demand, supply and quality of education directly or indirectly through increased staff, students, parents and relatives morbidity and mortality. This can therefore affect the operations and functions of your institution in a number of negative ways, including loss of skills, and absenteeism, leading to low quality teaching and reduced institutional revenue. You can also think of other indirect ways in which HIV and AIDS can affect your institutions, such as in loss of reputation. Some of the ways of reducing this impact could include provision of preventive education to staff and students and enhancing access to treatment, care and support to the infected and affected.
Activity 2
Mainstreaming entails integrating HIV and AIDS into the key functions and operations of an institution. In the case of tertiary institutions, mainstreaming implies ensuring that HIV and AIDS is taken into account in the institutional planning and budgeting process, in research activities, and is also infused or integrated into formal curricula and other extra-curricular activities. You could mainstream HIV and AIDS into your organization through: developing an institutional policy on HIV and AIDS; creating HIV and AIDS management structures; creating projects and programmes on HIV and AIDS; widening the levels of institutional participation in HIV and AIDS activities; identifying human and financial resources for HIV and AIDS activities;
For gender mainstreaming, you would need to evaluate the problems as to how they affect men and women differently, and then address these differences in the actions listed above. For example, when infusing HIV and AIDS information into courses, the gender aspects of the problem could also be explored and discussed as to how it contributes to the problems of HIV transmission.
Activity 3
Major challenges in the development of an effective response to HIV and AIDS include lack of strong and committed leadership, lack of financial resources and skilled human resources. These obstacles can be averted through accelerated HIV and AIDS awareness within institutional membership, planning for HIV and AIDS, identifying and allocating resources to HIV- and AIDS-activities, and building the capacities of the institutional membership to deal with HIV and AIDS through training.
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Activity 4
Integrating HIV and AIDS into students activities and overall learning environment requires: ensuring that students can seen the possible implications of HIV and AIDS and relate it to their day-to-day lives; developing a clear perception of the linkage between HIV and AIDS, the teaching and learning environment, exams, staff and students wellbeing, the structure of degrees/diplomas; creating a climate of intellectual engagement with HIV and AIDS, supporting pertinent research and developing ways of understanding how students are able to cope with the impact of HIV and AIDS; demonstrating how HIV and AIDS will affect the financial resources of the institution as well as the financial position of students.
Activity 5
Some of the major obstacles to proper monitoring and evaluation (M&E) Lack of baseline information Lack of clear indicators Lack of well kept data a checklist of critical issues to be dealt with during M & E; develop clear and measurable indicators; develop appropriate evaluation methodologies; develop an understanding of how to gather different data sets using these methodologies and how to use the different data sets; develop appropriate questions.
Your institution may need, among other things, to develop:
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Documents
Abebe, G. 2004. African universities' response to HIV/AIDS in the Global AIDS Initiative countries: A synthesis of country reports. Accra: Association of African Universities. Anarfi, J.K. 2000. Universities and HIV and AIDS in Sub-Saharan Africa A Case Study of the University of Ghana. Study commissioned by the ADEA Working Group on Higher Education. Accra, Ghana. Ashebir, D. 2007. Mitigating the impact of HIV/AIDS in teacher training institutions: Analyzing the response in Ethiopia. Paris: IIEP-UNESCO. ACU. 2002. Commonwealth Universities in the Age of HIV and AIDS: Guidelines towards a Strategic Response and Good Practice. London: Association of Commonwealth Universities. Coombe, C. 2003. HIV and AIDS and teacher education: a synopsis of observations and principal conclusions. Pretoria: InWEnt. www.harare.unesco.org/hivaids/webfiles/Electronic%20Versions/draft%20report%20i nwent.doc Crewe, M. 2000. HIV and AIDS and tertiary education: New possibilities, new hope. SAfAIDS News, 8(2). Chetty, D. 2000. Institutionalizing the response to HIV and AIDS in the South African university sector: A SAUVCA analysis. SAUVCA occasional paper N 2. Pretoria: South African Universities Vice-Chancellors Association. Elsey, H.; Kutengule, P. 2003. HIV/AIDS mainstreaming: A definition, some experiences and strategies. Durban: University of KwaZulu-Natal. www.sarpn.org.za/documents/d0000271/P263_HIV_Report.pdf Katahoire, A.; Kirumira, E. 2007. The impact of HIV/AIDS on higher education institutions in Uganda and their responses to the pandemic: a case study of a university and a teacher training college. Paris: UNESCO-IIEP. Kelly, M.J. 2001. Challenging the challenger: understanding and expanding the response of universities in Africa to HIV and AIDS. Washington, DC: World Bank. Kelly, M.J. 2003. The significance of HIV/AIDS for universities in Africa to HIV and AIDS. In: Journal of Higher Education in Africa, 1(1), 1-23. Kelly, M.J.; Bain, B. 2005. Education and HIV/AIDS in the Caribbean. Paris: IIEP-UNESCO. Morrissey, M. 2005. Response of the education sector in the Commonwealth Caribbean to the HIV/AIDS epidemic: A preliminary overview. Geneva: ILO. www.ilo.org/public/english/dialogue/sector/papers/education/sn-educat1.pdf ADEA. Nzioka, C. 2001. The impact of HIV/AIDS on the University of Nairobi. Paris:
Nzioka, C. 2006. Kenya: strengthening teacher education in HIV and AIDS. In: IIEP Newsletter, 24(4), 9-10. Ochanda, A; Njima, R.; Schneegans, S. 2006. Students choose life in Kenya. In: A World of Science, 4(4), 19-23.
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Otaala, B. 2000. Impact of HIV and AIDS on the University of Namibia and the universitys response. Windhoek: Printech. Ramos, L. 2006. Analyzing the response of a teacher training institution to HIV and AIDS: A case study from Zambia. Paris: UNESCO. UNFPA. 2004. At the crossroads: Accelerating youth access to HIV/AIDS interventions. New York: UNFPA. www.unfpa.org/upload/lib_pub_file/316_filename_UNFPA_Crossroads.pdf UNESCO. 2005. EFA Global Monitoring Report 2005. Paris: UNESCO. UNESCO. 2006. Expanding the field of inquiry: a cross-country study of higher education institutions responses to HIV and AIDS. Paris: UNESCO. UNGASS. 2001. Declaration of commitment on HIV/AIDS. United Nations General Assembly, 26th Special Session. New York: United Nations. www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html
Additional reading materials AIDS Policy Formulation Project. 2002. Nkumba University HIV and AIDS Policy. Entebbe, Uganda: Nkumba University. Crewe, M.; Maritz, J. 2005. UNESCO review of higher education institutions responses to HIV and AIDS: the case of the University of the West Indies. Kingston: UNESCO. HIV and AIDS Committee. 2003. Highridge Teachers College HIV and AIDS Policy. Nairobi, Kenya: Highridge Teachers College.
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Useful links
Web sites:
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Population Services International Youth AIDS: http://projects.psi.org/site/PageServer?pagename=home_homepageindex The Policy Project www.policyproject.com The United States Presidents Emergency Plan for AIDS Relief: www.pepfar.gov/c22629.htm UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org UNESCO EFA Background documents and information: www.unesco.org/education/efa/ed_for_all/background/background_documents.s html www.unesco.org/education/efa/know_sharing/flagship_initiatives/hiv_education.s html www.unesco.org/education/efa/index.shtml UNESCO Institute of Statistics website: www.uis.unesco.org United Nations Millennium Development Goals: www.un.org/millenniumgoals UNICEF United Nations Childrens Fund: www.unicef.org UNICEF Life skills: www.unicef.org/lifeskills UNAIDS Joint United Nations Program on HIV/AIDS: www.unaids.org United States Agency for International Development: USAID: www.usaid.gov/ School Health: www.schoolsandhealth.org/HIV-AIDS&Education.htm
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World Bank Multi-Country HIV/AIDS Program for Africa (MAP): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRHE ANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001234 ~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html World Economic Forum: www.weforum.org/globalhealth World Health Organization: www.who.int/en/
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by L. Teasdale
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High-risk behaviour: Activities that put individuals at greater risk of exposing themselves to a particular infection. In association with HIV transmission, high-risk activities include unprotected sexual intercourse and sharing of needles and syringes. Highly active antiretroviral therapy (HAART): A combination of three or more antiretroviral drugs that most effectively inhibit HIV replication, allowing the immune system to recover its ability to produce white blood cells to respond to opportunistic infections. HIV: Human Immunodeficiency Virus, the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. HIV testing: Any laboratory procedure such as blood or saliva testing done on an individual to determine the presence or absence of HIV antibodies. An HIV positive result means that the HIV antibodies have been found in the blood test and that the person has been exposed to HIV and is presumably infected with the virus. Homosexual: A person sexually attracted to or practising sex with persons of the same sex. Immune system: The bodys defence system that prevents and fights off infections. Incidence (HIV): The number of new cases occurring in a given population over a certain period of time. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new. Incubation period: The period of time between entry of the infecting pathogen, or antigen (in the case of HIV and AIDS, this is HIV) into the body and the first symptoms of the disease (or AIDS). Informed consent: The voluntary agreement of a person to undergo or be subjected to a procedure based on full information, whether such permission is written, or expressed indirectly. Life skills: Refers to a large group of psycho-social and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Log frame or logical framework: A matrix that provides a summary of what a project aims to achieve and how, and what its main assumptions are. It brings together in one place a statement of all the key components of a project. It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic of how the project is expected to work. It provides a basis for monitoring an evaluation by identifying indicators of success, and means of assessment. Maternal antibodies: In an infant, these are antibodies that have been passively acquired from the mother during the pregnancy. Because maternal antibodies to HIV continue to circulate in the infants blood up to the age of 15-18 months, it is difficult to determine whether the infant is infected. Mother-to-Child Transmission (MTCT): Process by which a pregnant woman can pass HIV to her child. This occurs in three ways, 1) during pregnancy 2) during childbirth 3) through breast milk. The chances of HIV being passed in any of these ways if the mother is in good health or taking HIV treatment is quite low.
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The series
1.1 1.2 1.3 1.4 1.5
2.1 2.2 2.3
3.1 3.2 3.3 3.4
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4.1 4.2 4.3 4.4 4.5 4.6
5.1 5.2 5.3 5.4
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Volume
Costing, Monitoring and Managing
Foreword

This final volume in the series focuses on costing and funding the response, monitoring its evolution and staying on target. The management checklist at the end provides you with a comprehensive framework to advocate, guide and inform the planning and management of your HIV and AIDS response.
Learners guide List of abbreviations MODULE 5.1: COSTING THE IMPLICATIONS OF HIV/AIDS IN EDUCATION Aims Objectives Questions for reflection 1. 2. 3. 4. 5. Introductory remarks Understanding the impacts of HIV in the education sector Zero-budget Planning Major reasons why HIV places an increased demand on education-sector budgets. Types of costs and resources How to develop a budget for HIV strategic and/or implementation plan Summary remarks Lessons learned Answers to activities Bibliographical references MODULE 5.2: FUNDING THE RESPONSE TO HIV/AIDS IN EDUCATION Aims Objectives Questions for reflection 1. 2. Introductory remarks Regarding the national context: creating the national agenda Developing proposals: steps involved Summary remarks Lessons learned Answers to activities 5 9 15 16 16 17 18 20 24 26 29 31 45 46 48 56 59 60 60 61 62 64 67 73 74 75
Appendix Bibliographical references and additional resource materials MODULE 5.3: PROJECT DESIGN AND MONITORING Aims Objectives Questions for reflection 1. 2. 3. 4. 5. 6. Introductory remarks Designing a sound project Preparatory steps Writing the proposal section by section Rationale for sound monitoring and evaluation Steps for developing a practical M&E plan Reporting Summary remarks Lessons learned Appendix Answers to Activities Bibliographical references and additional resource materials MODULE 5.4: MITIGATING THE HIV/AIDS IMPACT ON EDUCATION: A MANAGEMENT CHECKLIST Aims Objectives Questions for reflection 1. 2. 3. 4. Introductory remarks Developing a strategic response framework Phase One: understanding impact Phase Two: planning mitigation Phase Three: implementation monitoring and review Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials Useful links HIV and AIDS glossary The series
76 81 85 87 87 88 89 90 97 99 107 109 119 120 121 123 126 133 137 138 138 139 141 142 147 149 151 153 155 156 157 158 162 168
Learners guide
by B. Tournier
Background


The volumes
The modules
Each module has the same internal structure, comprising the following sections: Introductory remarks: Each author begins the module by stating the aims and objectives of the module and making general introductory remarks. These are designed to give you an idea of the content of the module and how you might use it for training. Questions for reflection: This section is to get you thinking about what you know on the topic before launching into the module. As you read, the answers to these questions will become apparent. Some space is provided for you to write your answers, but use as much additional paper as necessary. We recommend that you take time to reflect on these questions before you begin. Activities and Answers to activities: The activities are an integral part of the modules and have been designed to test what you know as well as the new knowledge you have acquired. It is important that you actually do the exercises. Each activity is there for a specific reason and is an important part of the learning process. In each activity, space has been provided for you to write your answers and ideas, although you may prefer to make a note of your answers in another notebook. You will find the answers to the activities at the end of the module you are working on. However, in some cases, the activities and questions may require countryspecific information and do not have a right or wrong answer (e.g. Explain how your ministry advocates for the prevention of HIV). As much as possible, sources are suggested where you could find this information. Summary remarks/Lessons learned: This section brings together the main ideas of the module and then summarizes the most important aspects that were presented and discussed.

Your feedback
Enjoy your work!
Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Involvement of People living with or Affected by HIV and AIDS Highly active antiretroviral therapy HIV and AIDS Management Unit Home-based care Health and Development Networks Health and family life education Highly indebted poor countries Human Immunodeficiency Virus Human resources International Bureau of Education International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa International Council of AIDS Service Organizations Injecting drug user Information, Education, and Communication International Finance Corporation International Institute for Educational Planning International Labour Organization In-service education and training International Planned Parenthood Federation Knowledge, attitudes, practices and behaviour Monitoring and evaluation Multi-Country AIDS Program (World Bank) Millennium Development Goals Management information system Medium-to-large-scale project Ministry of Basic Education, Sport and Culture Ministry of education Ministry of Education and Sports Ministry of Higher Education, Training and Employment Creation Men who have sex with men Medium-term expenditure framework Mother-to-child transmission Mobile Task Team (MTT) on the Impact of HIV and AIDS on Education
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Module
M. Grgens
Costing the implications of HIV/AIDS in education
5.1
About the author

Marelize Grgens is an independent consultant and specializes in project management, system design, implementation, research and database development, with a particular interest in monitoring and evaluation systems within the public and private sectors. She is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Module 5.1
COSTING THE IMPLICATIONS OF HIV/AIDS IN EDUCATION
Table of contents
Questions for reflection Introductory remarks 1. Understanding the impacts of HIV in the education sector 2. Zero-budget Planning 3. Major reasons why HIV places an increased demand on education sector budgets. HIV impacts on the cost of education The education system responses to mitigate the impact of HIV on education 4. Types of costs and resources 5. How to develop a budget for HIV strategic and/or implementation plan Activity-based budgeting Process for developing an HIV budget Important aspects to take into account during the above process Prioritizing and choosing between different budget options Appropriate software to use for the development of costings Linkage to national education-sector budgets Accessing additional resources Summary remarks Lessons learned Bibliographical references
MODULE 5.1: Costing the implications of HIV/AIDS in education
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Aims
The aim of this module is to enable you to develop a cost estimation for an HIV strategic and/or implementation plan in the education sector.
Objectives
At the end of this module, you should be able to: calculate the cost and resource implications of an HIV strategic and/or implementation plan; identify where cost savings could be incurred in the government's education sector budget as a result of implementing the government's new HIV strategic and/or implementation plan; identify the types of costs associated with an HIV strategic and/or implementation plan for the education sector; develop a budget, with different implementation and costing options, for a national and district HIV strategic and/or implementation plan; make informed choices about implementation and costing options so as to improve the affordability of the HIV strategic and/or implementation plan; include the budget for HIV in the ministry of education's annual budget and the government's medium-term expenditure frameworks.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. Do ministries of education need a separate budget for HIV? If so, why?
How high are the costs of HIV in the education sector?
What are the main costs associated with HIV in the education sector?
What are the best options for intervention from a cost and cost-effectiveness point of view?
Where would the funding for your ministry's HIV policy and strategy come from?
Does your ministry have a specific budget for HIV? If so, how is this budget converted into actual expenditure?
These questions for reflection remind us that most ministries of education either do not have a specific budget for HIV or they have a specific budget for HIV but it is not used in terms of actual expenditure. It also reminds us of and makes us think about the cost implications of HIV for the ministry. Whilst many officials in the ministry may feel that 'nothing can be done without a budget, this is not necessarily true. HIV impacts on the education system as a whole and affects all departments within a ministry of education, but there are a number of things that these departments can do without incurring additional costs.
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Module 5.1
COSTING THE IMPLICATIONS OF HIV/AIDS IN EDUCATION
When there is a new area requiring attention, such as the incorporation of HIV in a ministry of education's policies and strategic and/or implementation plans, those responsible for developing the policies and plans are aware of the fact that there is 'no such thing as a free lunch', that is to say that these policies and strategic and/or implementation plans will most probably cost money. This means that there is a need to develop a budget for the implementation of an HIV policy in a ministry of education. However, such a budget cannot and should not be developed on its own. The ministry must follow a proper development process (see Figure 1). Figure 1: Steps for developing a budget for the implementation of an HIV policy in a ministry of education
Understand the impacts of HIV in the education sector
Plan a prioritized response by developing: (a) an HIV policy (b) an HIV implementation plan
Implement the response by: (a) developing an HIV budget (b) securing resources as per budget (c) implementing the activities
As Box 1 shows, developing a budget is one of the key steps that a ministry of education needs to take in order to tackle HIV within the education sector. It can also be explained like this:
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Imagine you want to travel from point A (a ministry without an HIV policy) to point B (a ministry with an HIV policy), then: the education sector's HIV policy and strategy would be considered the design specification of the car; the unit or structure dedicated to implementing the policy would be the driver of the car; the strategic and/or implementation plan that converts the policy into practical actions would be the roadmap indicating the route that the car would need to follow to reach its destination; the finances and resources would be the fuel to put in the tank. Unless you already have experience in developing an HIV strategic and/or implementation plan for the education sector, it is strongly recommended that you work through Module 2.1, Developing and implementing HIV/AIDS policy in education, and Module 3.1, Analyzing the impact of HIV/AIDS in the education sector.
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1.
Understanding the impacts of HIV in the education sector

Education is one of the main strategic resources for poverty reduction and socioeconomic development in most developing countries. Education systems have been affected by HIV, and the pandemic presents a new challenge to ministries of education. These issues are explained in Module 1.2, The HIV/AIDS challenge to education and can be summarized in the following points: Demand for education Supply of education Availability of resources for education Potential clientele for education Process of education Content of education Role of education Organization of schools Planning and management of the education system Donor support for education Further research with ministries of education in countries with a generalized epidemic (over 3 per cent) has shown that the impact of HIV on education can include the following consequences (see below). Table 1 will also help you identify the associated costs and resource implications.
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Table 1 How HIV impacts on education. Demand for education Quantity and type in the education system Fewer learners More orphans New roles due to the impact of HIV Education system needs to: Provide HIV prevention education for learners and educators Provide increased numbers of relief teachers due to increased absenteeism Look after the special needs of HIVpositive learners Manage the additional number of OVC* by: -providing psychosocial care; -managing the potential for increased abuse; -devising mechanisms to deal with orphans that cannot pay school fees; -devising incentives to keep orphans in schools. New roles impact on available resources and create demand for additional resources Less money is available for school fees Direct cost: fewer skilled staff are due to an increased number of orphans available. Indirect cost: loss in quality of and reduced household income. education Education systems need to budget for: -change in pension funds; -increased teacher medical care; -additional teacher training; -increased number of relief teachers; -funding to fulfil the new role of the education system. Orphans are more vulnerable. Learners need to work to generate household income. Less money for school fees Carers at home
* OVC orphans and vulnerable children
Supply of education
More teachers infected Fewer teachers in education system
However, the different impacts of HIV on education illustrated above are not a standard 'laundry list' of impacts; in other words, the impacts will not be the same in all ministries of education or in all countries.
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Activity 1
1. Will HIV affect all ministries of education in the same way? Why/why not?
2.
Describe the ways in which HIV can impact on your ministry in the table hereunder. Next to each impact that you listed, indicate whether or not this impact will have financial implications.
Will this impact have negative financial implications? (Answer YES or NO, and describe with an example)
Impact of HIV on your ministry of education
1. 2. 3. 4.
3.
Is it possible that some of the impacts of HIV could lead to cost savings?
4.
Think, for example, about the fact that HIV tends to reduce the number of children in the education system. How will this affect the costs of education?
As you probably discovered in Activity 1, HIV will not affect all ministries of education in the same way. The type of effect that HIV will have on the ministry of education in your country will depend on a number of factors: The HIV prevalence in the 24-49 age-group in your country. The current strength of the education system in your country.
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Other factors that would adversely affect the number of teachers, students or orphans in the country. The strength of the economy and how severely HIV will affect household income. The current student-to-teacher ratio in the primary, secondary and higher education system. You will also have discovered in Activity 1 that there are different types of costs associated with the impact of HIV on the education system. Despite the fact that in an increasing number of countries there are no more fees at primary education level (at least in government/state schools), families and/or communities may be asked to contribute to the school budget. The hidden costs of education also have to be considered. Even if there are no school fees, learners still need uniforms (particularly in English-speaking countries), as well as textbooks, stationery, etc., all of which cost money. The different costs of HIV on education are discussed later in this module. This section of the module has shown that HIV impacts on education, that these impacts are not the same for all ministries of education, and that mitigating these impacts could have cost or resource implications. However, the fact that a ministry's response to the impact of HIV could cost money should not lead to decision paralysis or a feeling that 'nothing can be done without money'. There are various small or zero-budget options (see below).
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2.
Zero-budget Planning
Because of the different ways in which HIV impacts on education systems, it is important that a ministry of education does not begin its HIV budgeting process until it understands all the impacts of HIV on its own education system. It is also important for a ministry to recognize that it is possible to mitigate and manage some of the impacts of HIV on education without any additional cost implications for the ministry.
Activity 2
1. From the list of impacts that you identified in question 2 of Activity 1, describe how you can mitigate this impact if you had a zero budget.
Activity 2 shows that it is possible to plan and implement HIV interventions whilst executing activities that are part of the management of the education system. One could, for example, discuss HIV as part of the monthly school management team meetings. Not all HIV interventions are necessarily costly or require additional funding; not all activities to mitigate the impact of HIV on the education sector will require additional funding or place an additional strain on resources that are already limited. These activities may cost something in terms of the time that they will take to implement, but they have virtually no financial implications. There are several valuable interventions that can be made without changing strategic plans, without placing additional pressure on a ministry of education's budget, or without the need to apply for external funding. There are actions that can be put into practice on a zero-budget basis. Zero-budget planning consists essentially of a brainstorming session within a ministry, one of its sections or one of its institutions, in order to identify worthwhile actions that can be taken on a professional or personal basis. Further examples of zero-budget activities that the ministry of education could implement that would cost virtually nothing have been listed below. However, it is up to education officials to determine for themselves those interventions that could be of importance.
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Include HIV messages in school assemblies, staff meetings, meetings with parents, meetings of school governors, etc. Have HIV messages printed on educational stationery (exercise books, folders, etc.). Display posters and information about HIV. Hold debates, essay-writing and other competitions on HIV topics, offering red-ribbon awards. Invite entertainers, sports personalities and individuals respected by students to talk about HIV. Invite persons living with HIV to address school gatherings. Provide for the inclusion of HIV issues in co-curricular activities. Use school drama sessions, school magazines and school open days to communicate the HIV message. Establish HIV committees at both school and ministry levels. Organize individual or class project work with an HIV focus.
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3.
Major reasons why HIV places an increased demand on education-sector budgets.

As we can see from our discussion above, HIV will be a systematic drain on delivery and quality over the short to medium term. It is also clear that these impacts will require some additional funding. There are some important factors to take into account when considering the cost and resource implications of the mitigation of the HIV impact in the education sector (Kinghorn et al., 2003). The amount of additional funding that is required will depend on the nature of the epidemic in a particular country, as well as the types of activities that will be implemented by the ministry to mitigate the impacts of HIV on the education system. HIV is not expected to be the main determinant of delivery, costs or ability to achieve staffing and other policy targets in the education sector. Low average levels of impact can still hide a significant number of schools and classes where impacts on quality and access are much more severe. HIV highlights limitations in human resource planning and management in education, and adds to other stresses and challenges to the achievement of targets regarding coverage and quality of education. Despite limitations of data to assess the costs of HIV for education, it is possible to predict that these costs will be small compared to the other costs involved in achieving universal primary education (UPE) and Education for All (EFA) goals. What are the types of costs that education officials will need to consider? Fundamentally, demands for increased funding and resources due to HIV are discussed below.
HIV impacts on the cost of education

In addition to decreased enrolment and a reduced teaching workforce, HIV also impacts on the cost of education, i.e. HIV makes it more expensive for ministries of education to manage their education systems. The major costs of HIV to education systems arise from impacts on staff. These can manifest themselves as financial costs, or alternatively as indirect costs of reduced education quality and efficiency. Specific direct costs of HIV on education can include the following: Increased teacher pension fund payouts. Increased medical costs and medical aid contributions for teachers. Increased teacher training costs: additional teacher training due to higher teacher attrition. Increased payroll: increased absenteeism leading to the need for more staff and relief teachers. Again, it should be noted that the extent of these cost implications will differ dramatically from ministry to ministry, and it is not possible to apply one standard
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recipe or fixed budgets to quantify the above impact of HIV on the cost of education. A study looking into the impact of HIV on the education sector in Namibia revealed that the epidemic has the following cost implications. Estimates of the cost implications of the epidemic on staff are summarized in the table below and they suggest several important conclusions. Pension-fund costs are reported by the Government Institutions Pension Fund to be unlikely to increase substantially due to HIV. Medical-aid costs are likely to be the single largest HIV-related cost. Projections of antiretrovirals (ARVs) are a potentially affordable strategy for the education system. Costs of extra teacher training to replace staff who die of AIDS need to be refined. The direct costs of replacing lost educators would be high. Direct costs in the absence of ARVs would be lower than ARV costs but of a similar overall magnitude and with other potential indirect benefits. Absenteeism costs will often be hidden and manifest themselves through declining education quality. However, costs of well-managed relief/substitute teacher systems targeted at AIDS illness and the schools in greatest need seem potentially affordable. Other costs, such as transfers and delays in deploying replacement staff, are likely to be lower than for illness-related absenteeism. However, with reported average delays of three months in the appointment of replacement staff, this could add a further 50 per cent to estimates of the costs of absenteeism due to illness. Table 2 Summary of key cost implications of HIV among employees
Pension fund Medical aid (ARVs) Extra teacher training Absenteeism/relief teachers Neutral N$ 146m to 2010 2% of school costs by 2010 N$ 35m (ARV) N$ (no ARV) to 2010 </=1.7% of payroll
The education system responses to mitigate the impact of HIV on education

We have discussed extensively the fact that HIV impacts on education in a number of ways, including the cost impacts listed above. This set of modules advocates that a ministry of education, in response to these HIV impacts on its education system and in order to mitigate the impacts, needs to develop an HIV policy and an HIV strategic and/or implementation plan for the education sector. Such a policy and strategic and/or implementation plan would cost money to implement. This is the second main type of cost of HIV on education: the cost of implementing all of the activities in its HIV strategic and/or implementation plan.
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In the next section we will look at how to calculate the cost and resource implications of an HIV strategic and/or implementation plan. We will not focus on how to calculate the cost impacts of HIV on the education system, since these are based on projection tools and estimations which fall outside the scope of this module. Specific technical resources are available to assist in making these predictions.
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4.
Types of costs and resources

By now we have determined that a ministry of education would respond to the impact of HIV on education by developing an HIV policy and strategic and/or implementation plan. Let us therefore now consider the typical cost components of such an HIV strategic and/or implementation plan. One of the significant costs of the epidemic that needs to be included is funeral costs. This is a sensitive subject as it is draining resources in all countries, but it is difficult for a ministry to decide how to include it in the budget. The Malawian Ministry of Education, for example, has allocated a specific allowance per person for transport to funerals of immediate family; these costs have been included in the district's budget. One cost that needs to be considered, i.e. the training of additional teachers due to the premature death of existing teachers, is an important and controversial issue. It is difficult to determine the exact number of additional teachers that need to be trained, as the number of teachers required in an education system is dependent on the number of students that are enrolled. In a high-prevalence setting, it has been shown that learner enrolment drops due to lower birth rates and the fact that there are more orphans and vulnerable children (particularly girls) that are taken out of school and kept at home to help with domestic duties; caring for the sick, food production and income generation. It is necessary to estimate the number of additional teachers that are required and this can only be done through the simulation exercise described earlier in this series of modules (see Module 3.4, Projecting education supply and demand in an HIV/AIDS context).
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Table 3 Typical cost components for an HIV strategic and/or implementation plan
Main cost category Personnel costs Cost sub-categories Public service staff salaries Local consultants External consultants Transport Recurrent costs/consumables Equipment Workshops and training Curriculum Ground transport Air travel Telephone Office materials Office equipment Vehicles Workshops Training Development of HIV curriculum Printing & distribution of curriculum materials Training of teachers in new curriculum Printing, publication and media Printed materials Photocopy materials Other materials Distribution cost School and district level activities Distribution to districts Allowances for clubs Distribution to schools Supervision/monitoring allowance Funeral costs Support for vulnerable children Transport costs Allowance per staff member Nutrition Psychosocial support Medical & financial support Care & support for infected teachers Medical support - ARVs and medical care for opportunistic infections Psychosocial support Involvement of people living with HIV Training of teachers Travel & expenses Training of additional teachers
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5.
How to develop a budget for HIV strategic and/or implementation plan

When faced with the task of developing a budget for an HIV strategic and/or implementation plan, one needs to be clear on whether the purpose is to determine the impact of HIV on the cost of education, or whether there is a need to develop a budget for an HIV strategic and/or implementation plan. As stated earlier, this module focuses on the second task, i.e. developing a budget for an HIV strategic and/or implementation plan. The first important aspect to recognize is that one cannot develop a budget for HIV in isolation. Before the budget can be developed one would, ideally, want the ministry of education to have (a) developed its HIV policy for the education sector, and (b) developed an HIV/ AIDS strategic and/or implementation plan based on the HIV policy. Only when these steps have been taken can funding and resource implications be considered.
Activity-based budgeting
The basic premise of developing this budget is that activity-based costing will be used; i.e. for every objective in the HIV policy, a number of activities will be defined. These activities may differ from year to year. Costs and resources will be quantified for each of the activities. This process is illustrated below.
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Figure 2 Activity-based budgeting
HIV Strategic Objective 1
HIV Strategic Objective 2
HIV Policy
Objective 1: Activity 1
2 HIV Strategic Plan
Cost Implications Activity 4 Activity 3 Activity 2 Activity 1
Resource Requirements
3
HIV Budget
Process for developing an HIV budget

Within the context of this broad concept of activity-based costing, the following process should be followed to develop a budget for the ministry's HIV implementation plan.
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Box 1
Process for developing an HIV budget
Step 1: Assemble a team of persons who will be involved in the budgeting process. Step 2: Obtain a copy of the ministry's HIV strategic and implementation plans, and provide each member of the team with a copy of these documents. Ask team members to study the documents. Step 3: Develop a budget matrix (usually a spreadsheet, using the appropriate software) that defines, for every objective listed in the HIV policy, the specific activities that will be implemented, as well as the timeline for these activities. The list of activities for this matrix may be obtained from an existing HIV implementation plan. Step 4: For every activity and for every year of implementation, identify the cost elements for that activity. You may wish to use categories of cost, such as the cost categories discussed in Section 7 of this module. Describe the costs in detail, for example: "In year 1, four two-day workshops of 30 participants each". Step 5: Identify whether there are any costs that are common, i.e. costs that appear across more than one activity. For example, there may be a need for workshops to be undertaken in more than one activity. Now develop (a) a UNIT COST TABLE that contains a standard costing for these common costs, and (b) standard prices for road transport, venue hire, poster printing, etc. Step 6: Based on the estimates that the team developed in Step 4 and Step 5, now develop a detailed budget for the entire lifespan of the HIV implementation plan. For each budget item, list the potential funding source for that budget item (this could be government or other external funding sources, such as development agencies).
Important aspects to take into account during the above process

A. Multi-year budgeting or medium-term expenditure framework. Typically, an HIV strategic or implementation plan will not be implemented in one year, but will cover a number of years. In addition, many governments function on a mediumterm expenditure framework (MTEF), which means that the government develops its budget for more than one year (although annual adjustments are allowed). Since this HIV budget will be partly funded through government, this budget would also need to take cognisance of and be developed within the auspices of the government's budgeting guidelines. B. The effect of inflation. Every year, inflation causes an increase in the prices of goods and services. Since the HIV budget will more than likely be developed over a number of years, your team needs to take into account the effect of inflation when developing the HIV budget. This can be done by estimating the annual inflation rate (the country's national Statistics Bureau or Reserve Bank should be able to provide annual estimates), and by multiplying the annual costs, using the unit costs that you have used in the budget, by this annual inflationary multiplier. C. The government's financial year: Since a part of your budget will be funded by your government, it is essential that the budget that you develop follow the same timeframes as the government's fiscal or financial year. This means that if your government's budget runs from July of one year to June of the following year, then the implementation plan timeframes and the annual budget need to be divided in the same way.
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Example of an HIV development budget Overleaf is an example that shows, step by step, how the spreadsheet was developed and finally how the budget was determined. Please note that in this example, it has been assumed that Step 1 (Assemble a team) and Step 2 (Obtain and distribute copies of the HIV policy and strategic plans to the team members) have already been completed.
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Step 3: Develop a matrix
Objective 1: To promote development and implementation of policy guidelines and legal provisions relevant to HIV in the education and sports sectors Strategy 1.1: Initiate and foster policy guidelines and legal provision relevant to HIV in the education sector Activity description Establish an HIV Policy Review Task Team for the education and sports sectors Sub-activity Define TOR, schedule meetings, accountability, co-ordination + resource needs Start date Jul-04 End date Jun-05
1.1.1
1.1.2 1.1.3
Define policy areas that need to be covered in audit None and TOR for review process. Present review findings and hold biannual None consultative meetings with all relevant stakeholders
Jul-04 Jul-04
Jun-07 Jun-07
Strategy 1.2: Popularize policies, legal provisions and regulatory provisions relevant to HIV Activity description 1.2.1 Sub-activity Start date Jul-04 End date Dec-04
Reproduce and distribute approved policies Define distribution strategy (national, regional, district, country & schools) + cost implications + responsibilities + monitoring mechanism Develop a resource plan and partnership agreements for all activities in policies
Jul-04 Jul-04
Jun-05 Jun-07
1.2.2
Sensitize the stakeholders to the approved Public communications strategy (electronic policies, guidelines and legal provisions media, print media, advocacy meetings, etc.) +
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Step 4: Define costs for each activity in the matrix
Objective 1: To promote development and implementation of policy guidelines and legal provisions relevant to HIV in the education and sports sectors
Strategy 1.1: Initiate and foster guidelines and legal provision relevant to HIV in the education sector Activity description 1.1.1 Establish an HIV Policy Review Task Team for the education and sports sectors Sub-activity Define TOR, schedule meetings, accountability, co-ordination & resource needs Start date Jul-04 Cost description End date Jun-05 July 2004 June July 2005 2005 June 2006 No extra cost Not implemented July 2006 June 2007 Not implemented
1.1.2
Define policy areas that None need to be covered in audit and TOR for review process. Present review findings and hold biannual consultative meetings with all relevant stakeholders None
Jul-04
Jun-07
10 days' technical assistance (intl. consultants) and 5 days local
10 days' technical assistance (international consultants)
No extra cost
1.1.3
Jul-04
Jun-07
1 national two- 2 one-day day workshop for meetings for 100 people 50 people
2 one-day meetings for 50 people
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Strategy 1.2: Popularize policies, legal provisions and regulatory provisions relevant to HIV Activity description 1.2.1 Reproduce and distribute approved policies Sub-activity Define distribution strategy (national, regional, district, country, schools) + cost implications + responsibilities + monitoring mechanism Develop a resource plan and partnership agreements for all activities in policies Start date Jul-04 Cost description End date Dec-04 July 2004 June 2005 Production + printing of 25,000 copies of 8 policy documents of Technical assistance (5 days local consultants) July 2005 July 2006 June 2006 June 2007 None None
Jul-04
Jun-05
Not Not implemented implemented
1.2.2
Sensitize the stakeholders to the approved policies, guidelines and legal provisions
Public communications strategy (electronic media, print media, advocacy meetings, etc) + relationship to advocacy strategy
Jul-04
Jun-07
32 radio spots 32 radio and 16 spots and 16 newspaper ads newspaper ads
32 radio spots and 16 newspaper ads
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Step 5: Identify common costs and develop a unit cost table
UNIT COST TABLE
Annual inflation rate estimation - 6% Cost of one newspaper advertisement - $1,000 per spot Cost of one radio spot - $400 per spot One-day meeting unit cost - $245 per person per meeting per day One day meeting unit cost Workshop unit cost
Local consultancy rate - $1,000 per day International consultancy rate - $2,000 per day Printing of one report on 100 pages - 50 per report Workshop unit cost - $418 per person per workshop per day
CALCULATION OF ONE-DAY MEETING UNIT COST

Units Venue hire Lunch per person Per diem cost per person Accommodation (for one night for 20% of persons who come out of town) Transport (only 20% of persons for out of travel) TOTAL Room Per person Per person per day Per person night Per person per Unit cost 500 75 100 200 1 50 50 20% of 50 person = 10 persons 20% of 50 person = 10 persons # of units Sub-total $500 $3,750 $5,000 $2,000
100
$1,000 $12,250
Total cost of meeting divided by number of persons 12,250 50 = 245
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CALCULATION OF WORKSHOP UNIT COST FOR A THREE-DAY WORKSHOP FOR 50 PERSONS

Units Venue hire Lunch per person Per diem cost per person Accommodation (for duration of workshop for all participants) Transport (for all participants) TOTAL Total cost of workshop divided by the number of persons and by number of days 62,750 3 = 418 Room Per person Per person per day Per person per night Per person Unit cost 500 75 100 200 100 3 50 persons x 3 days = 150 50 persons x 3 days/person= 150 50 persons x 3 nights/person=150 50 # of units Sub-total $500 $3,750 $5,000 $2,000 $1,000 $12,250
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Step 6(a): Develop a detailed budget
Objective 1: To promote development and implementation of policy guidelines and legal provisions relevant to HIV in the education and sports sector
Strategy 1.1 Initiate and foster guidelines and legal provision relevant to HIV in the education sector
BUDGET # 1.1.1 ACTIVITY DESCRIPTION SUB-ACTIVITY July 2004 Funding July 2005 Funding July 2006 Funding - June source - June source - June source 0 Not 0 Not 0 Not applicable applicable applicable
Establish an HIV Policy Review Define TOR, schedule Task Team for the education and meetings, accountability, cosports sectors ordination & resource needs Define policy areas that need to be covered in audit and TOR for review process. Present review findings and hold biannual consultative meetings with all relevant stakeholders None
1.1.2
25,000
21,200
Not applicable
1.1.3
None
83,600
25,970
27,528
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Step 6(b): Assign potential funding sources to each budget Strategy 1.2: Popularize policies, legal provisions and regulatory provisions relevant to HIV
BUDGET # ACTIVITY DESCRIPTION SUB-ACTIVITY Define distribution strategy (national, regional, district, country, schools) + cost implications + responsibilities + monitoring mechanism Develop a resource plan and partnership agreements for all activities in policies 1.2.2 Sensitize the stakeholders to the approved policies, guidelines and legal provisions Public communications strategy (electronic media, print media, advocacy meetings, etc) + relationship to advocacy strategy July 2004 June 2005 1,000,000 Funding source Global Fund July 2005 - Funding June 2006 source 0 Not applicable July 2006 - Funding June 2007 source 0 Not applicable
1.2.1 Reproduce and distribute approved policies
10,000
Government
Not applicable
Not applicable
28,800
DFID
30,528
USAID
32,360
USAID
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Activity 3
Developing an annual budget The table below contains an extract of an HIV implementation plan, with cost descriptions that have already been completed. A unit cost table has also been supplied. For this HIV budget matrix, please develop the annual budget for three consecutive years of implementation. You may want to use a calculator.
Activity
Start Date
End Date
Cost Description July 2004 June 2005 25,000 booklets and 3,000 brochures printed and distributed 100 two-day workshops of 40 persons each July 2005 June 2006 July 2006 June 2007 July 2004 June 2005
Budget July 2005 June 2006 July 2006 June 2007
1. Print education materials
Jul-04
Dec-04
None
None
Calculate
Calculate
Calculate
2. Run prevention workshops
Jul-04
Jun-06
200 threeday workshops of 60 persons each
Calculate
Calculate
Calculate
UNIT COST TABLE Annual inflation rate estimate Cost to print one booklet Cost to print one brochure Cost to distribute booklet and brochures Local consultancy rate Workshop unit cost 7% per annum $2 per booklet $3 per brochure $5 per brochure or booklet $1,000 per day $100 per person per workshop per day
Prioritizing and choosing between different budget options

It is almost always necessary for education officials to prioritize or make choices in the areas of both objectives and actions. There may be many directions that promise good progress, but it is not always possible to embark on all of them simultaneously. Moreover, changing external circumstances may mean either the impossibility of doing all that was planned or the possibility of doing more than was
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expected. A clear sense of priorities will enable managers to respond to such circumstances and make the necessary choices. General criteria for priority areas are the following: Areas where the need is greater. Areas where the impact is likely to be greater. Areas where there is likely to be a multiplier effect. More specifically, the answers to the following questions can guide prioritization: Where would the activity reach the biggest number? Where would the activity promise to make the maximum impact on a specific aspect of the problem being considered? Does the activity address the most urgent challenge (for instance, by targeting the most vulnerable children)? Does the activity promise the maximum leverage, making the biggest impact for the smallest effort? Does the activity promise quick and visible positive results? Is the activity proposed in an area that nobody else is addressing? If implementation is straightforward because the activity will use existing processes and infrastructure. Is the activity independent and can it be executed without conditionalities or other prerequisite activities? If the activity is prerequisite to other important interventions, but these cannot be launched until the activity has been put in place. If the activity being considered is not controversial, but will easily get the necessary political, professional and administrative commitment. Will the activity use locally available resources that facilitate immediate implementation?
Appropriate software to use for the development of costings

In the previous section we looked at the process of how to develop a budget for HIV in the education sector. In this section, we have referred to a number of tables and calculations that needed to be done. These calculations can either be done manually or by using the appropriate software. We would like to recommend that your ministry consider the use of spreadsheet software to develop its HIV budget. This allows for a flexible process where many different iterations can be made.
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Linkage to national education-sector budgets

Typically, the HIV budget that has been developed will not stand on its own and will need to fit into the government's budget. Most governments of developing nations that receive substantial funding from development agencies have two main categories in their budget: (a) recurrent expenditure budget to cover all operational costs (such as salaries, transport, vehicles, stationery, etc.) incurred by ministries; and (b) a development budget that is used for all development projects, i.e. where all contributions from development partners are accounted for and budgeted as part of the government's annual budgeting process. You need to recognize that not all of the costs described in the above budget will be funded through your own ministry. Once you have completed the budgeting process, ensure that you have followed the government's MTEF expenditure guidelines.
Accessing additional resources

It is more than likely that HIV strategic and/or implementation plans, even with some zero-budget activities, will have a cost implication for your ministry. It will not always be possible for your ministry to carry this additional cost burden on its own or within its own budget. There are a number of ways in which your ministry can access additional resources, including access to specific funds that have been set up internationally to fund HIV activities. The next module in this series, Module 5.2 on Funding the response to HIV/AIDS in education, will provide you with the information and skills to access these additional resources.
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Summary remarks
People do not always like to talk or think about the financial implications of a new initiative. Yet, it is essential that we cost and budget for any new interventions. Developing a budget brings us back to a place of reality and ensures that we are able to do what we planned, i.e. that which is contained within the HIV policy. It should be noted that not all activities will require additional funding. Furthermore, there are external funding sources that could be accessed to fund any additional funding and resource requirements. A lack of funding cannot and should not paralyze and prevent us from taking action to tackle HIV. With proper planning and practical skills, it is possible to mitigate, manage and minimize the effects of HIV on the education sector.
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Lessons learned
Lesson One
HIV impacts on education systems.

Lesson Two
The nature and type of impact differ and vary and are dependent on a number of variables.
Lesson Three
The nature and extent of HIV impacts in a ministry of education will determine the nature and extent of the ministry's response to mitigate this impact on the education system.
Lesson Four
HIV will have an effect on the available resources in a ministry of education. These effects can be either good (reduction in resource demand and reduced costs) or bad (increase in resource demand and increased costs).
Lesson Five
Not all activities in the HIV strategic and/or implementation plan cost money or imply the need for additional resources. There are things that you can do that will not cost any money (zero-budget planning).
Lesson Six
There are different types of costs that need to be considered.

Lesson Seven
An HIV budget cannot be developed in isolation or before the ministry has developed its HIV policy and strategy documents.
Lesson Eight
When developing an HIV budget there is a specific process that can be followed that will make the budgeting process easier. This includes the development of a budget matrix, the estimation of unit costs and the annual budgeting linked to your government's MTEF.
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Lesson Nine
It is important that the effect of inflation is taken into account when developing a budget.
Lesson Ten
The budget should be developed for all the years of implementation of the HIV strategy, and should be grouped in such a way that it can link with the government's budgeting process.
Lesson Eleven
It may sometimes be necessary to prioritize and choose between different budget and implementation options.
Lesson Twelve
There are external resources available for HIV funding (see Module 5.2 on Funding the response to HIV/AIDS in education).
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Activity 1 1. No. Not all MoEs are faced with the HIV epidemic to the same extent. In countries and MoEs where HIV prevalence is high, there are more people infected with HIV. This will lead to a greater impact, as more people will die prematurely. 2. Describe the ways in which HIV can impact on your ministry in the table hereunder. Next to each impact that you list, indicate whether or not this impact will have financial implications.
Impact of HIV on your ministry of education 1. Reduced number of students 2. Greater absenteeism amongst teachers 3. More sick leave for teachers 4. Reduced quality of education Will this impact have negative financial implications? (Answer YES or NO, and describe with an example) YES YES YES NO
3. Yes 4. A reduced number of students will mean that the ministry has to build fewer schools and purchase fewer textbooks. There are HIV impacts that could reduce costs within the ministry of education. The most visible example is that of learner enrolment. High HIV prevalence leads to a reduction in learner enrolment that reduces the number of children in school and thus the amount of money that needs to be spent on textbooks, etc. Activity 2 Think for a few minutes about the list of possible implications and impacts of HIV in your ministry, as we discussed earlier. Can you identify at least one HIV intervention that your ministry can do to mitigate a potential impact of HIV on education that will not lead to additional cost or resource implications?
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EXAMPLES On a weekly basis, during quarterly meetings with principals, district offices could ensure that school principals are briefed in HIV and that practical means of including it in their schools are prepared. Include something about HIV in school assemblies, staff meetings, meetings with parents, meetings of school governors, etc. Have HIV messages printed on education stationery (exercise books, folders, etc.). Display posters and information about HIV. Hold debates, essay-writing and other competitions on HIV topics, with red-ribbon awards. Invite entertainers, sports personalities and individuals respected by students to talk about HIV. Invite people living with HIV to address school gatherings. Provide for the inclusion of HIV issues in co-curricular activities. Use school drama, school magazines and school open days to communicate HIV messages. Establish HIV committees at both school and ministry levels. Organize individual or class project work with an HIV focus. Activity 3 The table overleaf contains an extract of an HIV implementation plan, with cost descriptions that have already been completed. A unit cost table has also been supplied. For this HIV budget matrix, please develop the annual budget for three consecutive years of implementation.
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Half-completed matrix
Activity Start Date End Date July 2004 June 2005 25000 booklets and 3000 brochures printed and distributed 100 twoday workshops of 40 persons each Cost Description July 2005 - June 2006 July 2006 June 2007 July 2004 June 2005 Budget July 2005 June 2006 July 2006 June 2007
Jul04
Dec04
None
None
Calculation A
Calculation C
Calculation E
Jul04
Jun06
Calculation B
Calculation D
Calculation F
UNIT COST TABLE FOR 2004/2005 Annual inflation rate estimate Cost to print one booklet Cost to print one brochure Cost to distribute booklet and brochures Local consultancy rate Workshop unit cost 7% per annum $2 per booklet $3 per brochure $5 per brochure or booklet $1,000 per day $100 per person per workshop per day
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Step 1: First calculate the costs for Year 1 (July 2004June 2005)
The formula for doing this is: Cost = TOTAL NUMBER X UNIT COST
Calculation A Printing: 25,000 booklets and 3,000 brochures Distribution: 25,000 booklets and 3,000 brochures PRINTING COST = 25,000 booklets x $2/booklet (see unit cost table) + 3,000 brochures x $3 per brochure (see unit cost table) = $50,000 + $9,000 = $59,000 DISTRIBUTION COST = 25,000 booklets x $5/booklet (see unit cost table) + 3,000 brochures x $5 per brochure (see unit cost table) = $125,000 + $15,000 = $140,000 TOTAL COST = Printing cost + distribution cost = $59,000+ $140,000 = $239,000 Calculation B Calculate cost of 100 2-workshops of 40 persons each TOTAL COST = 100 workshops x 40 persons per workshop x 2 days per workshop x unit cost per person per day of workshop = 100 x 40 x2x $100 (see unit cost table) = $800,000
Step 2: Now calculate the costs for Year 2 (July 2005June 2006)
Calculation C Calculation D No activity planned so no costs! TOTAL COST = $0 Calculate the cost of 200 three-day workshops of 30 persons each First, we need to adapt the unit cost table to take into account the effect of one year of inflation. Since the inflation rate has been estimated at 7% (see unit cost table), this means that we must INCREASE the unit costs by 7% to take into account the effect of inflation. NEW UNIT COST = $100 per person per workshop day x 1.07 (7% from unit cost table) = $107 TOTAL COST = 200 workshops x 60 persons per workshop x 3 days per workshop x NEW unit cost per person per day of workshop
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Inflation is usually defined as "a sustained increase in the general price level. We measure it as the annual percentage increase in prices. It can be measured as a monthly change, but the most often quoted figure is the annual change. We need to add the effect of inflation because prices increase on an annual basis. This means that every year we can buy less for the same amount of money. Thus, we need to increase the unit costs if we want to be able to buy the SAME things year after year.
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Step 3: Now calculate the costs for Year 2 (July 2005 June 2006)
Calculation E No activity planned so no costs! TOTAL COST = $0 Calculation F Calculate the cost of 200 3-day workshops of 30 persons each First, we need to adapt the unit cost table to take into account the effect of two years of inflation. Since the inflation rate has been estimated at 7% (see unit cost table), this means that we must INCREASE the unit cost for Year 2 by 7% to take into account the effect of inflation. NEW UNIT COST = $107 per person per workshop day (see Calculation D) X 1.07 (7% from unit cost table) = $114.49 TOTAL COST = 200 workshops x 60 persons per workshop x 3 days per workshop x NEW unit cost per person per day of workshop = 200 x 60 x 3 x $114.49 (see calculation above) = $4 121 640
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Step 4: Capture the answers from Step 1 in the matrix

Activity Start Date End Date Cost Description July 2004 June 2005 25,000 booklets and 3,000 brochures printed and distributed 100 twoday workshops of 40 persons each July 2005 - June 2006 July 2006 - June 2007 July 2004 June 2005 Calculation A= None None $239,000 Budget July 2005 June 2006 Calculation C= $0 July 2006 June 2007 Calculation E= $0
Jul-04
Dec-04
Jul-04
Jun-06
Calculation B= $800,000
Calculation D= $3,852,000
Calculation F= $4,121,640
See how the costs of running 200 three-day workshops for 60 participants each have increased from Year 2 (Calculation D) to Year 3 (Calculation F), in spite of the fact that exactly the same output (200 three-day workshops of 60 participants each) is achieved. This is due to inflation.
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Step 5: Now calculate the annual cash flow

Activity Start Date End Date Cost Description July 2004 June 2005 25,000 booklets and 3,000 brochures printed and distributed 100 twoday workshops of 40 persons each July 2005 - June 2006 July 2006 - June 2007 July 2004 June 2005 Calculation A= None None $239,000 Budget July 2005 June 2006 Calculation C= $0 July 2006 June 2007 Calculation E= $0
Jul-04
Dec04
Jul-04
Jun-06
Calculation B= $800,000
Calculation D= $3,852,000
Calculation F= $4,121,640
ANNUAL CASH FLOW REQUIREMENTS
$1,039,000
$3,852,000
$4,121,640
These annual cash flow requirements can now be included in the ministry's medium-term expenditure framework.
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International AIDS Alliance. 2002. Raising funds and mobilizing resources for HIV/AIDS work A toolkit to support NGOs/CBOs. Brighton, UK: International HIV/AIDS Alliance. www.aidsalliance.org/graphics/NGO/documents/english/415a_Alliance_ mobilising_resources.pdf Kinghorn, A.; Kgosidintsi, B.N.; Schierhout, G.; Gatete, F.; Bwandinga, G.; Rugeiyamu, J. 2003. Assessment of the impact of AIDS on the education sector in Rwanda. Johannesburg: CfBT/Stoas. Telyukov, A.; Stuer, F.; Krasovec, K. 2000. Design and application of a costing framework to improve planning and management of HIV programs. Special Initiatives Report No. 29. Maryland, USA: Abt Associates. www.abtassociates.com/reports/sir29fin.pdf World Bank. 2003. Training guide for project planning and implementation. Washington, DC: World Bank.
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Module
P. Mukwashi
Funding the response to HIV/AIDS in education
5.2
About the author

Patience Mukwashi is an independent consultant and specializes in monitoring and evaluation, transmission dynamics and evidence-based youth and workplace HIV and AIDS programmes, with a particular interest in differentiated HIV and AIDS responses. She is also a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education.
Acknowledgements
IIEP and ESART would like to thank Alexandra Draxler who has assisted in the development, updating and completion of this document.
Module 5.2
FUNDING THE RESPONSE TO HIV/AIDS IN EDUCATION
Table of contents
Questions for reflection Introductory remarks 1. Regarding the national context: creating the national agenda 2. Developing proposals: steps involved Consultations Resource mapping Designing the project Writing the proposal Incorporating monitoring and evaluation Summary remarks Lessons learned Answers to activities Appendix Bibliographical references and additional resource materials
MODULE 5.2: Funding the response to HIV/AIDS in education
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Aims
The aims of this module are to: help you to identify and analyze the resources available to your ministry for funding and programme implementation; enable you to position your funding strategy within existing relevant national and international sector plans and strategies; help you to understand the current donor funding landscape and where you can access materials.
Objectives
At the end of this module you should be able to: define your goals for resource mobilization; prioritize your funding actions according to national and international sector plans and strategies; implement the steps required to mobilize resources effectively.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What are the goals and objectives of your group and work with respect to HIV prevention and management?
What programmes do you plan to carry out over the next two to four years to meet these goals?
Define resources: What are they at ministry level? At school level? Within your organization?
Name some activities or steps to be undertaken to raise funds or mobilize resources to respond to HIV/AIDS in the education sector.
Name the resources you will need to mobilize to carry out activities you have just listed.
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Module 5.2
FUNDING THE RESPONSE TO HIV/AIDS IN EDUCATION
International commitment to HIV and AIDS responses has grown rapidly in recent years, stimulated by the leadership of the United Nations Joint Program on HIV/AIDS (UNAIDS) with its ten UN agency cosponsors, and the 2001 United Nations General Assembly Special Session on HIV/AIDS (UNGASS). These are complemented by, among others, the World Banks Multi-Country AIDS Program (MAP), set up in 2000; the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM or Global Fund), established in 2002; and the largest bilateral programme on AIDS the United States President's Emergency Plan for AIDS Relief (PEPFAR), created in 2003. Each of the cosponsors of UNAIDS has a specific HIV and AIDS programme in its areas of expertise. For the education sector, AIDS is included as an element of other international efforts, such as those of Education for All (EFA) and the Millennium Development Goals (MDGs). Private initiatives have come to join the commitments with impressive funding. A number of foundations have initiated programmes in the area of HIV and AIDS or have been created specifically for that purpose. As these have grown in number and size, the available funding through private sources is a very large proportion of total resources devoted to HIV and AIDS prevention and relief. Businesses have seen the need and the benefit of devoting resources to prevention, treatment and care. Global HIV and AIDS spending has grown very significantly over recent years. Based on UNAIDS data, a Kaiser Family Foundation report estimates that resources made available from all funding streams rose from approximately $1.6 billion available in 2001 to $6.1 billion in 2004, and $8.3 billion in 2005 (Kates and Lief, 2006). Spending still does not meet the estimated needs, however. UNAIDS estimates indicate global resource requirements amounting to US$15 billion in 2006, US$18 billion in 2007 and US$22 billion in 2008 for prevention, treatment and care, support for orphans and vulnerable children (OVC), as well as programme and human resource costs. Funders are increasingly calling for co-ordination among donors and avoidance of duplication of effort, particularly in planning and scaling up strategies. The Paris commitment on enhanced aid effectiveness1 in 2005, the specific commitments
1www1.worldbank.org/harmonization/Paris/ReviewofProgressChallengesOpportunities.
pdf%20 Figures taken from www.aidsmedia.org to be printed in a forthcoming report by UNAIDS secretariat.
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on the Three Ones to harmonize national strategies, and the Global Task Team on Improving AIDS Coordination Among Multilateral Institutions and international donors are all pushing national authorities to map out priorities, partners and projects to optimize resources and results. Many educational organizations still find it difficult to identify funding and support sources and are somewhat unsure of the procedures and protocol for attracting funds. This module aims to help you build a plan for funding the response to HIV and AIDS programmes in the country and in the education sector. The module begins by looking at the importance of clearly designed response plans that take into account national sector plans and priorities as well as international declarations and agendas. It is designed to enable users to analyze all possible resources in their own environments and prioritize projects and goals in order to find funders and align all available resources. This module should be approached after having gone through some of the programmatic modules that are part of these training materials, for example Module 5.3, Project design and monitoring. The annex gives pointers on how to find information about major donors.
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1.
Regarding the national context: creating the national agenda

Today, HIV and AIDS funding tends increasingly to focus on treatment of AIDS and improving health care provision to people living with HIV, with much of that funding going to ministries of health and to the health sector. In spite of the unanimous agreement that education plays a primary role in preventing HIV transmission, many funding mechanisms look to where their input will have the most immediate impact, that is to say, support, treatment and care for those affected by HIV and AIDS. However, there is also a growing push by international bodies to strengthen comprehensive national AIDS responses that are led by the countries themselves. This is seen to be the most efficient way to avoid duplication of work and to build collaboration between sectors. This broadens opportunities for the education sector to raise funds and mobilize resources for needs within the sector, within national AIDS policies and strategies. In order to promote this, UNAIDS and other international agencies and their partners have agreed on three principles, or Three Ones, to be used for developing plans to efficiently use resources and funding: One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. One National AIDS Coordinating multisectoral mandate. Authority, with a broad-based
One agreed country-level monitoring and evaluation system. By applying the Three Ones and presenting a unified country response, countries can actually garner greater support and raise more funds to achieve their overall goals. When beginning to raise funds, or mobilize resources, it is necessary to consider what existing strategies and documents influence country strategies. It is important to understand what you are going to focus on, what resources you will mobilize. Resources include not only money, but also people, physical facilities and equipment, political support, access to information, networks and partnerships. It is intended that the most important mechanism at country level for co-ordination be the United Nations Development Group mechanism, called the Theme Group. This group typically brings together the cosponsoring UN agencies of UNAIDS. It often becomes an expanded group, including government representatives, bilateral donors, international and national NGOs. The Theme Group works well in most countries, and is the forum where policy collaboration and co-ordination is decided and where noteworthy decisions about UNAIDS funding are made. HIV and AIDS national policies and sector policies exist in most countries seriously affected by the epidemic. National Poverty Reduction Strategy Papers (PRSP) can also include elements of HIV and AIDS responses. PRSPs are participatory plans developed by governments with local and international partners, that entitle
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countries to debt alleviation and these are often a condition for countries to receive other internationally funded sector-wide programmes. Funding the HIV response within the education sector demands clear understanding of the national HIV project landscape, the major stakeholders or partners working in the field, and the donors that are involved in funding HIV and AIDS response programmes in education.
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Activity 1
List the principal resources in the education sector that could be mobilized towards an HIV and AIDS programme that we describe as resources in the education sector.
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2.
Developing proposals: steps involved

In this section, we will discuss briefly the process of developing a proposal. You can also learn more about developing proposals in Module 5.3, Project design and monitoring. Developing a proposal requires the following steps. 1. Consultations 2. Resource mapping 3. Designing the project 4. Writing the proposal 5. Incorporating monitoring and evaluation
Consultations
The first step in funding the response or preparing to mobilize resources is to develop an overview of what is being done at all levels within the country by all sectors. Such an overview is essential for understanding the needs, for ensuring collaboration and avoiding overlap, and for making pertinent requests for resources. Consultations with key persons within your organization and among your partners, the related sectors and where possible the beneficiaries, is important for a clear understanding of the actual situation with respect to HIV and AIDS actions and programmes. This activity gives you a lay of the land, and allows you to take stock of what responses may be implemented or planned by your partners and colleagues, and how the Ministry of Education or your organization might fit in to such existing programmes, or find the gaps. Such consultations could be done with everyone at one time, or separately according to stakeholder groups and specific external partners. The advantages to holding such meetings include: a clearer understanding is gained of who is doing what; relationships are established with your potential partners; partnerships are used to increase efficiency and resources; HIV and AIDS prevention and care are advocated within all sectors; stakeholder buy-in and support for your project and activities are increased; agreement over the mobilization and subsequent use of resources is assured; overlap of similar projects with partners is reduced.
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Activity 1
List the consultations and background documents necessary for mapping and defining goals.
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Resource mapping
The second preparatory step to preparing an overview is to go through a resource mapping exercise. Simply put, this exercise will enable you to identify all possible internal, external, national and international resources, either monetary or otherwise. Specific activities of resource mapping include: Brainstorming: Before doing anything, take time, as a group, to think about and write down what might be needed or what is a priority when implementing HIV prevention programmes. Things you could discuss: Who should you speak to? To whom should you address your project? Who needs to be trained (teachers, school heads, other personnel)? What materials are needed (public information, lesson plans, textbooks)? Are special needs taken into account in existing sector policies or through specific measures (orphans needs, workplace policies, treatment protocols and confidentiality)? Box 1 Checklist for consultations and resource mapping
1. Bodies and organizations UNAIDS office UNDG Theme Group on HIV and AIDS National AIDS council or group Education ministry HIV and AIDS office or group Most active international NGOs National civil society groups, including people living with HIV and faith-based groups 2. Commitments and strategies Legislation National, district and local budgets Donor strategies Sector reviews
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Meeting with the major AIDS agencies in your local area (or district or country): Meet with the National AIDS Council (usually located in the Prime Ministers or Presidents Office, or within a government ministry such as the Ministry of Health), and then the HIV/AIDS Units within the ministries of health, finance and education. Afterwards, it is good to meet with NGO consortiums, United Nations theme groups, major donors and any possible supporters/partners in the private sector. Reviewing HIV and AIDS research, literature, bulletins and newsletters in order to track possible resources and activities: If you can access Internet, be on the lookout for newsletters and websites that specialize in HIV and AIDS research or programmatic work. Examining budget documents: The difference between plans, policies and actual resources available can be striking. Both at government level and within possible funding sources, it is useful to consult carefully the actual resources announced and disbursed for AIDS programmes. Using all the above methods should result in a clearer understanding of the external environment in which you will conduct your efforts to obtain funding and to mobilize resources. It cannot be emphasized enough that taking into account the wider sector and national goals, as well as other framework policies, will go a long way to helping you be successful in securing resources and carrying out programmes.
Designing the project

Once you have successfully developed your programme priorities and overall strategy, you are then ready to begin writing a proposal to raise funds and mobilize more resources. Before you begin to write a proposal, you must have a clear programme design in mind. The following steps show the necessary levels of establishing programmes to effectively monitor the programme. The steps below are a brief summary taken from the module entitled, Module 5.3, Project design and monitoring. As you will see, steps for resource mapping, fund raising and mobilization can overlap with the steps of project design, development and proposal writing. Stakeholder consultation to determine project goals and objectives, resource needs and identify intended proposal recipient: This is generally conducted through resource mapping, as well as through conducting needs assessments to determine the way things are and they way they should be, and to determine the utility of the envisioned project. Identify a proposal writer or group of writers: Often one person will write the proposal and then others will critique it to help focus the work and provide a unanimous final product for the donors. Identify proposal recipients funding requirements and guidelines: Know your audience: Different funders have different timelines for proposals and different guidelines for the submission of proposals that you need to be aware of. This information can be found easily during the consultations and through contact with the donors.
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Collect baseline data and any additional information: A good proposal will carefully present its case, and will also provide data to support it. This data can be taken from existing programme data or from the needs assessment. Develop a conceptual framework: You must provide a clear articulation of what you hope to achieve with your project. Develop a log frame: This is a theoretical overview of the project you wish to implement, detailing outputs, inputs, outcomes and impacts. Make sure you check with the funder, as many institutions have their own versions of log frames. Once you have completed these steps, you can write the proposal. Below is a summary of the steps needed in order to prepare a proposal (with a budget) once the project design is in place.
Writing the proposal

Your proposal will typically comprise the following chapters: 1. Cover page and table of contents 2. Executive summary: summarizes the whole proposal and tells donors the main points of the project. 3. Introduction: This is a justification for the activities being proposed. 4. Goals and objectives: These are often taken from the log frame. 5. Activities: This section presents outputs and services to be delivered as a result of donor funds. 6. Monitoring and evaluation: Tells donors how the projects success and progress will be measured. 7. Cross-cutting ethical issues: Be sure to include these important cross-cutting HIV and AIDS issues: gender equity, stigma and discrimination, good governance, and others that might be particular to your environment. 8. Key personnel: Outline numbers and positions of staff that are to be implicated in the project. This section should be in line with the budget. 9. Strengths and innovation: Be sure to mention the skilled staff you may have for a project, or the best practices upon which you base activities. Be sure to mention strong collaborative partners. 10. Sustainability: This refers to how the project will continue once the funding from the donor is gone. It must be addressed at the beginning of the project.
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11. Budget: Ideally, this should be presented in a table, and be sure to follow the donors format. 12. Additional annexes: Here you can add the frameworks or a work plan.
Incorporating monitoring and evaluation

The importance of monitoring and evaluation of projects is crucial to raising funds for a project. Monitoring is the routine assessment of ongoing project activities. Evaluation is the assessment of overall project achievements. As you design the project, think about how you will monitor the daily work of the project and how you will measure success. Think about the indicators you can use for each output and outcome. By following the conceptual framework and the log framework, you can develop indicators that measure each step in the process of the project. Good data collection from the onset of project leads to good assessment. Furthermore, this data can then be accessed when you wish to write more proposals to secure more funds or to attract other donors. Good monitoring and evaluation enables us to answer the following questions: are we doing the right thing (that is, are we evidence-based)?; are we doing it right (that is, are we doing it in accordance with what the evidence says is needed for effect)?; and are we doing it on a large enough scale to make a difference (that is, coverage)? As donor recipients, we must be able to document the relevance, quantity and quality of our services and the integrity of our financial management.
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Summary remarks
The changing face of global health spending puts the education sector in a unique position. The education sector has the ability to reach youth, a highly vulnerable group in itself, particularly in HIV/AIDS high prevalence regions, as well as education sector staff who, are often the biggest section in the public sector. It is important that we recognize this and actively develop and implement evidencebased interventions. It is therefore also important that we develop the skills and knowledge needed to source resources. The difficulty is not necessarily a lack of resources (much as some of us would like to think!), as globally, resources for HIV/AIDS interventions are relatively plentiful. The difficulty is with developing effective programmes and knowing where and how to source funds. You need to do your research: what donors are out there?; what are their interests?; does your project fit in with the donors vision?; can you convince donors, your organization and the intended beneficiaries that the project deserves to be funded? Following the steps highlighted in this module should help you to successfully answer these questions, but it is important for you to keep current with funding mechanisms and the inevitable shifts in donor spending.
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Lessons learned
Lesson One Resources are more than just money or even people: resources are skills, experience, ideas, facilities, equipment, partnerships, and good will. We need to broaden our outlook in the education sector and be more creative in implementing our activities so as to maximize the value of the resources that are available. Lesson Two It is important that the education sector increase stakeholder buy-in into project and activities. We need to move from top-down approaches where decisions are made almost unilaterally at higher levels, to truly participatory decision-making at all levels. Stakeholder buy-in goes a long way to convincing donors that our projects will be effective and are worthwhile. Lesson Three The education sector often seems isolated from other sectors in many countries, and is seen to lag behind others when it comes to mobilizing resources for health interventions. We need to gain confidence in our own skills and recognize that we play an integral part in the fight against HIV/AIDS. We also need to start collaborating with members of other sectors and ministries (such as health and finance).
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Activity 1 These data will be country specific, but some examples can include people, teachers, materials, schools, staff, etc. Activity 2 Again, answers will vary, but the documents necessary would be policy documents, international or UN declarations such as EFA, any existing national or education sector policies, as well as any HIV-related studies, reports or materials that may have been produced by UN partners, donor agencies and other sectors of government.
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Appendix
Organizations to target
Naturally, each country has its own landscape of principal funders, main coordinating bodies, and influential organizations. The list below is only indicative. Try to make local contacts within these organizations to stay abreast of the priorities of donors and other funding organisms. Where possible you should meet with these organizations at country level frequently. National AIDS councils (NACs) National AIDS councils (NACs) are increasingly prominent players in the HIV and AIDS field. Most country NACs have grants for education sector activities conducted by ministries of education and NGOs. Some NACs have domestic resources, such as Zimbabwes which is funded by a 3 per cent payroll tax, while others have funds from the bilateral and multilateral donors. Most NACs have an operational manual which specifies how ministries of education and NGOs can prepare and submit proposals and include application forms. A strategic way of resource mobilization is to acquire these operational manuals, study them carefully, meet with the NAC, education sector or NGO officers, and build a rapport with the NAC. This allows us to better understand NAC funding requirements and will assist us in preparing the proposal. As with other funding sources, most NAC councils require timely financial reports. Recipients who have problems delivering these reports can find that disbursements cease after the first financial quarter. It is important to carefully consider during the proposal and project design phases what staff, skills and systems you will need in order to report systematically and punctually. It is important to ensure that these systems are put in place. Meeting with the NAC on a regular basis will enable you to understand both financial and programme reporting requirements. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) The Global Fund to Fight AIDS, Tuberculosis and Malaria (GTAFM) was created to both increase and direct resources to geographic regions at elevated vulnerability to the worlds three worst diseases. Its priorities are regions or countries with the highest disease burdens and fewest resources. It also supports countries with emerging epidemics, such as the Ukraine. All grants include prevention interventions (especially targeting youth) and most grants include some component on treatment. The Global Fund works as a partnership between communities, civil society, private sector and government. The Global Fund does not implement programmes directly and sees its role as a financial instrument sourcing, managing and distributing resources.
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Country proposals are generally developed by the Country Coordinating Mechanism (CCM), which is a very inclusive body encompassing government, civil society, private sector, and major donors. Countries must identify the principal recipient, who receives and is responsible for funds from the GFATM and makes subsequent grants to other sub-contractors or partners to implement certain aspects of the work. principal recipient are typically ministries of health or NACs. Sub-recipients may be ministries of education or education sector NGOs. The Global Fund has very specific application procedures which put great emphasis on results-based disbursement and thus monitoring and evaluation. It is vital to have clear, measurable goals and a strong monitoring and evaluation system to access Global Fund money. It is very important for ministries of education and major education NGOs to be represented on the Country Coordinating Mechanism. There is great scope for the education sector to become more involved in the Global Fund. Detailed information is available at the Global Fund website: www.theglobalfund.org, A toolkit for applicants and recipients can be found at: www.theglobalfund.org/en/links_resources/applicants_recipients/toolkit/ World Banks Multi-Country HIV/AIDS Program for Africa (MAP) At its inception in 2000, the World Banks MAP was the largest single HIV and AIDS initiative ever. Over US$500 million was approved by the executive directors in September 2000 and US$1 billion was committed for interventions in over 24 African countries. Each recipient country typically receives US$20-50 million. The money is primarily given to the country NAC, which then acts as an on-grant mechanism to the national response. MAPs are implemented by the NACs in accordance with a fairly accessible operational manual and guidelines. The MAPs are very flexible and iterative and they do not tell countries how to spend the money - they only set up structures for the response. A typical MAP has four components: Strengthening national co-ordination Support to the health sector Support to other ministries or public agencies Support to civil society Those working in the education sector can seek funding from the other ministries component if they are ministries of education, and from the civil society component if they are NGOs. It is important to fully understand the procedures found in the World Bank operational manual and guidelines if you are to successfully mobilize funds from this source. Most MAPs are under-spent and require good proposals and implementation capabilities. More detail on the World Banks MAP can be found at the following website: World Bank MAP Program
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United Nations Agencies UNAIDS - UNAIDS have Program Acceleration Funds (PAFs) earmarked for specific priorities, including some HIV and AIDS interventions in the education sector. They are also an important source of technical assistance. www.unaids.org UNESCO UNESCO provide both technical support and resources in several countries, for example the Southern Africa Teacher Training College AIDS programme. www.unesco.org UNICEF UNICEFs major focus is on rights-based youth programming, including HIV and AIDS prevention and life skills education, as well as orphans and vulnerable children. They are an important source of both technical assistance and resources. www.unicef.org/aids/ www.unicef.org/about/structure/index_worldcontact.html The United States Government The US Government has committed a total of US$14 billion over five years through PEPFAR and US Government-presence countries, with a further US$1 billion committed to the Global Fund. PEPFAR was started in 2003 and has a strong emphasis on treatment, and this constitutes 66 per cent of the budget. Regarding prevention, approximately a third of the budget is earmarked for abstinence/partner reduction, which is a major aim for many ministries of education and youth NGOs. This makes PEPFAR an important potential source of funds for the education sector. There is also a strong emphasis on faith-based organizations, so religious organizations working with youth have important opportunities. PEPFAR is based on country plans, each co-ordinated by the US Government Ambassador to the country and implemented mainly by the Centers for Disease Control and Prevention (CDC), USAID and major co-operating agencies (CAs) such as Catholic Relief Services (CRS), World Vision, Family Health Internationa (FHI), and Population Services International (PSI). Funds are often disbursed through CAs, so it is important to identify and understand CAs and their reporting requirements, and how to prepare proposals and access money. More information on the United States Presidents Emergency Plan for AIDS Relief: www.pepfar.gov/c22629.htm
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More information on PEPFAR partners can be found at: Catholic Relief Services: www.crs.org/ Family Health International: www.fhi.org Family Health International: Youth Area: www.fhi.org/en/Youth/YouthNet/ProgramsAreas/Peer+Education.htm Population Services International Youth AIDS: http://projects.psi.org/site/PageServer?pagename=home_homepageindex World Vision www.worldvision.org/ DFID The Department for International Development (DfID) of the British Government is a major international donor with increasing resources. It is philosophically committed to working primarily through multilateral agencies, such as the United Nations, and provides budget support to ministries of finance. Some funds are earmarked directly for the education sector, as in Zambia, Malawi and Ghana. It is important to understand how to access these funds and to dialogue with DfID so that multilateral and Ministry of Finance budget support ensures provision for education/youth AIDS responses. More information on DFIDs support can be accessed at their website: www.dfid.gov.uk OECD and other major development partners The German Agency for Technical Co-operation, Deutsche Gesellschaft fr Technische Zusammenarbeit (GTZ) GmbH, is an important source of technical support and also funding. GTZ is one of the worlds largest consultancy organizations for development co-operation. It works in many African countries, including Central and West African countries. Other very good sources of technical support and funding can be accessed from the Canadian, Irish, Netherlands, Nordic, and UK governments. They are an important source of support to many NACs, providing funds which the NAC then distributes to other organisations or associations participating in the national response. Most of the DAC countries provide assistance to the health sector, which may help to strengthen youth-friendly facilities and services relevant to the education sector. Information on GTZ can be found at: www.gtz.de/en/ More information on bilateral donors can be found at the OECD website on development co-operation: www.oecd.org/linklist/0,3435,en_2649_33721_1797105_1_1_1_1,00.html.
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Private Sector Support The private sector is an important source of funds in many countries, for example in South Africa and Kenya. Oil companies are sources in Angola and Nigeria. In South Africa, Soul City, a youth television drama is supported by Mobil, Old Mutual and other private sector partners. Foundations Foundations and other private sources of funding are becoming increasingly important globally. Each foundation has its specific focus and rules. A module of this kind cannot guide you through these, but a careful reading of their published requirements, combined with the general principles you have learned here, can lay the groundwork for useful dialogue with the ones most interested in your needs.
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Documents Eldis. HIV and AIDS Resource Guide. Retrieved on 7 June 2007 from www.eldis.org/hivaids. FHI. 2004. Strategies for an Expanded and Comprehensive Response (ECR) to a National HIV/ AIDS Epidemic. Arlington: Family Health International (FHI). http://www.fhi.org/NR/rdonlyres/elwuussewhozpizshiomzjg6sh33t57krclh uil5mudazpqfxrhbsxhwbogfquvsgmtvlfxrel5pkn/ECRenglish1.pdf International AIDS Alliance. 2002. Raising funds and mobilizing resources for HIV/AIDS work A toolkit to support NGOs/CBOs. Brighton, UK: International HIV/AIDS Alliance. http://www.aidsalliance.org/graphics/NGO/documents/english/415a_Alli ance_mobilising_resources.pdf Kates, J.; Lief, E. 2006. International Assistance for HIV/AIDS in the Developing World: Taking Stock of the G8, Other Donor Governments and the European Commission. USA: Kaiser Family Foundation. Retrieved 5 June 2007 from www.kff.org/hivaids/upload/7347-02.pdf Kates, J.; Lief E.; Izazola, J. 2006. Financing the response to AIDS in low- and middle-income countries: International assistance from the G8, European Commission and other donor Governments. USA: Kaiser Family Foundation. Retrieved on 7 June 2007 from www.kff.org/hivaids/upload/7347_03.pdf UNAIDS. 1998. Guide to the Strategic Planning Process for a National Response to HIV/ AIDS. Geneva: Joint United Nations Programme on HIV/ AIDS (UNAIDS). http://old.developmentgateway.org/download/84424/test.pdf UNAIDS. 2004. Consultation on Harmonization of International AIDS Funding. Retrieved on 5 June 2007 from http://data.unaids.org/UNA-docs/ThreeOnes_Agreement_en.pdf UNAIDS. 2004. Three Ones key principles. Retrieved on 5 June 2007 from http://data.unaids.org/UNA-docs/Three-Ones_KeyPrinciples_en.pdf UNAIDS. 2004. Coordination of National Responses to HIV/AIDS - Guiding principles for national authorities and their partners. Retrieved on 5 June 2007 from http://data.unaids.org/UNA-docs/coordination_national_responses_en.pdf
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Module
P. Mukwashi
Project design and monitoring
5.3
About the author

Patience Mukwashi is a member of the EduSector AIDS Response Trust network and was a member of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. She is an independent consultant and specializes in monitoring and evaluation, transmission dynamics and evidence-based youth and workplace HIV and AIDS programmes, with a particular interest in differentiated HIV and AIDS responses.
Module 5.3
PROJECT DESIGN AND MONITORING
Table of contents
Questions for reflection Introductory remarks 1. Designing a sound project Conducting a needs assessment Developing a conceptual framework Developing a logical framework (logframe) 2. Preparatory steps 3. Writing the proposal section by section Cover page and table of contents Executive summary Introduction Goal and objectives Activities Monitoring and evaluation plan Cross-cutting ethical issues Key personnel Strengths and innovation Sustainability Budget The annexes 4. Rationale for sound monitoring and evaluation 5. Steps for developing a practical M&E plan Outputs Monitoring and evaluation logframe: input level Monitoring and evaluation logframe: output level Monitoring and evaluation logframe: outcome level Monitoring and evaluation logframe: impacts level 6. Reporting Summary remarks Lessons learned Appendix Answers to activities Bibliographical references and additional resource materials 88 89 90 90 92 94 97 99 99 100 100 101 102 102 103 104 104 105 106 107 109 115 116 117 118 119 120 121 123 126 133
MODULE 5.3: Project design and management
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Aims
The aims of this module are to: set out the basic and practical steps needed to develop and submit sound proposals to resource partners; set out the steps needed to develop sound project monitoring and evaluation.
Objectives
By the end of this module you should be able to: identify why proposal-writing is important; strengthen proposals by designing sound projects using needs assessments and conceptual and logical frameworks; write a strong proposal by following basic preparatory steps and utilizing standard chapter formats; identify the rationale for sound monitoring and evaluation; design and develop a monitoring and evaluation plan for your own projects.
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Before you begin

Take a few minutes to think about the questions below. You may find it helpful to make a note of your ideas in the spaces provided. As you work through the module, see how your ideas and observations compare with those of the author. What information do we need to have when designing a project?
Before actually writing a good proposal, what a) information is necessary and b) what structures should be in place (for example, what types and number of people will we need to write and comment on the proposal, and what financial resources will we need)?
What are the most basic thematic sections of a good proposal (for example - an introduction chapter or a chapter on proposed activities)?
What type of information should be provided in each of the proposal's thematic sections that you have identified?
Practically, how would you define monitoring and evaluation?
What information can monitoring and evaluation provide us with? Why is this important in both project design and project implementation?
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Module 5.3
PROJECT DESIGN AND MONITORING
The increasing burden of disease makes it necessary to more effectively source funding and support. Sourcing funds locally is becoming difficult and it is therefore important that we develop skills to sell our project concepts to international donors. We often know very little about these donors and they often have higher standards for approving funding than smaller local donors. The two questions that will most likely interest you are: 1. How best can we design an effective project? 2. How can we convince a donor that our project is worthwhile to fund? A well written proposal allows us to articulate our project design to funding sources. A good proposal will convince these sources that funding our project will contribute to the education sectors capacity to better prevent and mitigate the impact of HIV. Through using the previous modules in this series, we already have a better idea of the first challenge: designing an effective results-oriented project which has sound monitoring and evaluation and is based on proven approaches. We will go through the main components in designing a good project here, but it is recommended that we also familiarize ourselves with other complementary modules, especially Module 4.4, HIV/AIDS care, support and treatment for education staff, and Module 5.4, Mitigating the HIV/AIDS impact on education: a management checklist. This module focuses primarily on integrating the development of a good project design into meeting the second challenge: making our project appealing to donors. Please note that sections of the module draw heavily on the seminal work of IPPF, Alice Reid, the World Bank and UNAIDS.
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1.
Designing a sound project

Conducting a needs assessment
A needs assessment allows us to focus on the needs of our intended beneficiaries and to understand specific problems. Well designed needs assessments are useful in providing baseline information (a set of critical observations or data used for comparison or a control) on our target populations. This information enables us to assess change and the impact of our project providing we episodically measure specified indicators during and after the project. Ideally, therefore, a needs assessment should be conducted before the beginning of project activities. A needs assessment is a systematic exploration of the way things are and the way they should be. Exploring the way things are and determining what needs to be done to improve the situation gives justification to our proposed activities. The findings from a needs assessment allow us to answer the all important question: is what we are proposing to do going to be useful? The needs assessment is linked to proposal-writing in two very important ways: By briefly discussing the methodology used (and these can be either quantitative as in surveys or project reports and evaluations or qualitative as in key informant interviews and material or document meta-analysis , or a combination of both quantitative and qualitative) and discussing the findings, we are better able to identify the major problems or issues and provide justification for our proposed project activities. These important findings should be briefly discussed in the introductory section of the proposal. If a needs assessment is going to be conducted as part of the project activities after successful receipt of funding, the description and methodologies to be used should be discussed in the Activities, Monitoring and Evaluation and Budget sections of the proposal.
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Activity 1
Conducting a detailed needs assessment This is useful exercise if you are unable to conduct a detailed needs assessment at the moment. Ideally, this exercise should be conducted in a group with key informants drawn from the beneficiary community, researchers and knowledgeable staff within your department or ministry, although you can complete the activity on your own. These questions can also form the basis of a more comprehensive needs assessment. 1. What exactly is the problem that you want to address? Clearly describe the problem.
2. How are you planning to address this problem? Give a simple definition of your project goal(s).
3. What specific activities do you propose to do? How will these activities contribute towards solving the problem? Describe what you will do and how this will help solve the problem.
4. What is the environment? Include factors that may affect your project, such as the political situation, cultural sensitivities and relationships with other ministries and/or implementing partners.
5. What, if anything, have you or other people already done, or are currently doing, to address this problem? This allows you to make sure that you are not replicating existing services. It also allows you to identify potential collaborative partners. Finally, identifying what else is being done allows you to make sure that you are complementing existing activities instead of competing with them.
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Developing a conceptual framework

Developing a conceptual framework (or model) for your project requires a clear articulation of what we theoretically hope to achieve as a result of our proposed activities. Using monitoring and evaluation (M&E) terminology, this means identifying the intended outcomes and impacts that theoretically occur as a result of our outputs and proposed inputs. This step is often neglected, which is unfortunate as a sound conceptual model of our design ensures that the design is logical, consistent and based on proven theory. Conceptual models vary. It is important to note though, that we are not saying that we need to have expert knowledge of the scientific models. In many cases, we may actually decide to develop a conceptual model of our own. What should be clear is how the proposed activities will theoretically result in intermediate outcomes which should in turn lead to attaining the major goal or impact. Box 1 What is a conceptual framework?
Why develop a conceptual framework? A theoretical discussion of our project model can be a very useful tool. Not only do we have a clearer understanding of what our overall objectives and goals are and how we intend to achieve them, but we are now able to more clearly articulate this to potential donors. How do we develop a conceptual framework? Review findings from the needs assessment. Define your project goals. Review the theories relating to your project area. Determine whether your project is related to any of the theories. Determine whether you need to develop your own theoretical model showing the relationship between your activities and achieving the project goal(s). Illustrate the relationship between your project activities, intermediate results and project goals (see Activity 2). Suggested reading IPPF. 2002. Guide for designing results-orientated projects and writing successful proposals. IPPF.
It is obviously not compulsory to develop conceptual models in great detail. Great benefit can be obtained from simply asking ourselves the questions in the following activity (see below).
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Activity 2
Developing a conceptual framework Based on either the findings of a completed needs assessment or your responses to Activity 1, complete the table below. Please complete the diagram in the order shown. This will represent a basic conceptual framework that will allow you to ensure that your project design is logical and consistent. An example is provided in the Appendix.
Complete 1st What is your projects longterm goal?
Complete 2nd What needs to change for your projects long-term goal to be achieved?
Complete 4th Will your projects activities detailed in Step 3 lead directly to the changes detailed in Step 2? If not, what is the logical step in between? (1)
Complete 3rd What activities will your project undertake in order to make the changes in Step 2 happen?
(1)
(1)
(2)
(2)
(2)
(3)
(3)
(3)
(4)
(4)
(4)
(5)
(5)
(5)
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Developing a logical framework (logframe)

While the conceptual framework gives us a theoretical overview of the project, logframes allow us to represent graphically: things our project or programme should be doing; resources that are required; measures of attainment given for our activities; how we will both set and measure the impact of our programme.
Many international development agencies such as USAID, the World Bank and various UN agencies have their own logframe formats. It is therefore vital that we know what our potential donors own format is before writing the proposal. Below is an example of a typical logframe format with definitions of the main sections. The logframe should be attached to the proposal in the Annexes section. A logframe typically has four levels: inputs, outputs, outcomes and impacts. The basic premise of a logframe is that each level should logically lead into the next. Thus, inputs should lead to outputs, which should lead to outcomes, which should ultimately lead to impacts. Inputs are simply the people, training, equipment and resources that we put into an activity, project or programme in order to achieve outputs. Outputs are the activities we conduct or services we deliver, including HIV-prevention, care and support services, in order to achieve outcomes. The processes associated with service delivery are important. The key processes include quality, unit costs, access and coverage. Through quality, economical, accessible, widespread services, key outcomes should occur. Outcomes are changes in behaviours or skills, such as safer HIV-prevention practices and increased ability to cope with HIV. They are also changes in attitudes and knowledge. These outcomes are intended to lead to major health impacts. Impacts refer to measurable health impacts, particularly reduced transmition of sexually transmitted infections (STIs) and/or HIV, and reduced HIV impact.
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Table 1 Example of a logframe template

Narrative Description Defines the intervention logic of each level. Verifiable Indicator An objectively verifiable standard against which we measure performance. Means of Verification The data source or method used to determine whether the indicators have been attained or not. Assumptions That which is assumed to be in place for the intervention to work and whose absence would entail potential risk.
Inputs The resources & materials we put into a project. Outputs The services we deliver as a result of the inputs. Outcomes The major behavioural, knowledge, attitudinal & skills changes that occur in our target population as a result of our outputs. Impacts The major health or social changes that occur in our target population as a result of the outcomes.
At each level, we need to give a clear description or definition of what it is we will be doing and ultimately measuring. This is the narrative description. The narrative description defines the intervention logic of each level. There is usually more than one item in each level, particularly at input and output level. We also need to provide clear, reliable and valid indicators. Very simply, a verifiable indicator is an objectively verifiable standard against which we measure performance. A good indicator should be:
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simple is it simple to collect and to understand? relevant is it directly related to our targets? measurable can we set measurable levels? significant does the indicator provide useful, important information? accessible is it collected, where possible, from existing data sources? When we have provided clear, reliable and valid indicators for each item in each logframe level, we need to identify the means of verification or how we will actually measure our indicators or what tools we will use to measure our indicators. The means of verification is therefore the data source or method used to determine whether the indicators have been attained or not. Finally, we need to try and identify key assumptions that need to hold true if we are to accomplish what we set out to do and whose absence would entail potential risk. More information on the development of logframes is given in the section Monitoring and evaluation.
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2.
Preparatory steps
We should now have a clearer understanding of the major steps required when designing a project, specifically: conducting a needs assessment, developing a conceptual framework and developing a logframe. Let us now look at the preparatory steps needed before actually beginning to write the proposal. The first step to good proposal-writing it to make sure that we understand who we are writing the proposal for and what we hope to gain. We could be writing a proposal for a completely new activity and intend to submit it to as wide a net of possible donors or sponsors as possible in the hope of obtaining financial and material support. Or perhaps we are submitting a proposal to a specific donor to continue an activity and we require funding for the next phase. Whatever the reason, it is important to make sure that we ourselves understand what exactly we hope to achieve with our activities, the steps we are going to take in order to achieve the desired outcomes and the resources we will need (financial, material, staff, and technical assistance). The person or group of people writing the proposal should have this level of understanding, and it is advisable to hold regular stakeholder consultations during the process of writing. We will discuss in greater detail the choice of proposal-writer(s) in a following section. However, it is advisable to identify the writer or group of writers either before or during the initial stakeholder consultation. This constitutes the second step (although, of course, it can be interchangeable with Step 1). The third step is to have a clear understanding of the intended proposal recipients requirements. We need to ask ourselves what guidelines have been given, especially those relating to the donors expectations on programme activities including cross-cutting issues such as programme impact analysis by gender, environmental impact of the programme, and good governance. What additional reference documents could be useful and where can we get them? Has the donor provided content and formatting guidelines for the proposal? Once we are sure that we know exactly what activities we wish to conduct and what our donors expect, we should then proceed to the fourth step, which is to collect any data or additional information that we will need to make reference to in the proposal. In many cases, a needs assessment or baseline survey needs to be conducted and results used as a means of comparison when measuring programme impact at a later stage. It is at this stage that we need to develop our conceptual framework (fifth step) and logical frameworks (sixth step). Finally, we need to understand how what we propose to do links with what has already been done by ourselves and others.
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Table 2 Preparatory steps checklist

1 2 3 4 5 6 Stakeholder consultation to determine project goals and objectives, resource needs and identify intended proposal recipient Identify proposal-writer or group of writers Identify proposal recipients funding requirements and guidelines Collect baseline data and any additional information Develop conceptual framework Develop logframe
One of the most important things we do at the beginning of the preparatory stage is identify who will write the proposal. A good proposal-writer should have a clear understanding of the organization as a whole and the projects goals and objectives. Obviously, the writer should have strong writing skills, be a good communicator and ideally be technically skilled in the type of intervention being proposed. The choice of recruiting a writer from either within your ministry/department or externally can be difficult. While internal proposal-writers often have a fuller understanding of community needs, the projects approaches, and what proposed activities are practical and able to be implemented, on the other hand, external writers often have additional technical expertise, insight into other approaches, and a fresh perspective and objectivity. There is no rule of thumb, but we need to make sure we balance the above considerations as far as possible. Ensuring regular consultative meetings between the writer and key personnel within the organization and with beneficiaries allows us to identify any potential problems sooner rather than later, increases stakeholder buy-in, and ensures that we reflect the needs of all or most stakeholders.
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3.
Writing the proposal section by section

Now we have completed the six main preparatory steps, it is time to start writing the proposal. Different donors have different formatting requirements, so it is important to follow these closely. The format presented here is generic and can be used when there is no specified format. It can also be used to understand what might be needed in individual sections. Unless otherwise stated by the donor, a proposal for a medium-to-large-scale project (MLP) should be a maximum of 20-25 pages, not including annexes. A smaller project (SP) should be a maximum of 15 pages, not including annexes. It is often useful not to bind the proposal many donors prefer it to be printed on clean white paper and simply stapled allowing for greater ease in photocopying and handling. This section looks at the following 12 typical sections that make up a proposal: 1. Cover page and table of contents 2. Executive summary 3. Introduction 4. Goal and objectives 5. Activities 6. Monitoring and evaluation 7. Cross-cutting ethical issues 8. Key personnel 9. Strengths and innovation 10. Sustainability 11. Budget 12. Additional annexes
Cover page and table of contents

The key word here is 'professional'. The cover page and table of contents should be neat, have no spelling mistakes and look as professional as possible. The cover page of the proposal should include the following information: The organizations name and logo if available The projects name and logo if available The proposed duration of the project The organizations contact details specifying a contact persons full name and position within the organization, telephone and fax number, e-mail and physical address) The date of submission to the donor The potential donors name and logo if available
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If the proposal is longer than eight pages, it is recommended that it have a table of contents. This will provide the reader with details of what to expect and could point them to specific content areas that they might be more interested in. It is often easier to develop the table of contents first before writing the rest of the proposal as this will guide the writing process in a logical manner. The table of contents lists all the proposal sections and highlights the page number on which each section begins. Ensure that the page numbers given in the table of contents are accurate. The cover page and table of contents should each take up only one page.
Executive summary
An executive summary is a tool to grab a donors attention in the first few minutes of reading by giving an overview of what is to follow. Donors receive a large number of proposals, and many donors sometimes only delve deeper into the meat of the proposal if their interest has been piqued by a well written and comprehensive summary at the beginning. A good summary also shows evidence of preparation and knowledge of subject matter. An executive summary summarizes the whole proposal and provides details on: who we are, i.e. the name of the organization and project; why we are asking for support and what kind of support we require; what we are currently doing, what our goals and objectives are, what we propose to do, and why we are proposing these activities, i.e. the justification; what impact we expect to have; how long we expect the project to last; what our project budget is and what we are asking for from the donor; whether we have any other funding sources who and approximately how much; issues of sustainability, i.e. what we intend to do once the proposed funding ends. The executive summary is placed immediately after the table of contents. At most it should be two pages in length for larger projects and one page for smaller projects. Finally, the executive summary should be written last, and should be given as much attention as the rest of the proposal.
Introduction
The introduction of the proposal serves as a justification for the activities to be conducted in order to address a specific health or social problem. It also serves as a justification for the choice of our organization to receive support from the donor. When describing the problem, the following questions should be addressed. What exactly is the health or social problem and why should the donor regard it as important? What information is available regarding the problem? Here, we will need to cite recent research findings and discuss results from our needs
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assessment and baseline survey if conducted. Any statistics we use should be clearly referenced and should be as up-to-date as possible. What has already been done by our organization or other groups regarding the problem? Specifically, what interventions were put in place? What were the successes, failures, strengths and challenges? What needs to be done to build on or complement what has already been done? How is the problem related to national or international donors priorities? For example, gender equity, human rights, treatment and care, or womens reproductive rights. Based on the above considerations, what type of project is needed to address the problem? Briefly, what is our project intending to do? Who will our beneficiaries be? What results will we be expecting? To what extent are our intended beneficiaries involved in the project design and proposal write-up? Here we can mention the regular stakeholder meetings held during both phases and any other relevant activities. Finally, what are the geographic and demographic characteristics of our coverage area? Providing a small map of the coverage site relative to a larger area such as the province or country it is in is often useful. When describing the organization, the following questions should be addressed. Why is the problem we have described above so important to our organization? Who originally formed our organization? Fro what purpose? What is its overall mission and goal? What experience and skills does our organization have that makes it a good candidate for funding? We need to be able to convince the donor that our organization has what it takes to successfully achieve the projects goal. Who else will be working with us on the project and how will we work together? Many donors are particularly keen to fund collaborative initiatives as there is often greater chance of success due to an increased pool of experience and skills to draw from. Working collaboratively with other government departments, ministries and NGOs benefits not only our project but others as well. Useful and constructive collaboration also allows us to align with, rather than work against, country development priorities such as our Country Poverty Reduction Strategy Paper, and existing national and global plans. What previous collaborative experiences does our organization have? The Introduction section of the proposal should be up to three pages in length for MLPs and up to one-and-a-half pages SPs.
Goal and objectives

This section is quite simple, especially if you have already completed a logframe as described in the Designing a sound project section of this module. All that is
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needed in the Goal and objectives section is to list the overall goal and the objectives. It is recommended that we number the objectives in a logical manner, for example Objective 1, Objective 2 and so on. This allows for easier reference in later sections of the proposal. Objectives should also refer to the project timeframe, intended beneficiaries and coverage area. An example of a well written objective at impact level: To stabilize or reduce HIV infection, STIs and pregnancy among young people in school aged 15-19 in Province X through a three-year intensive peer education programme. The Goal and objectives section of the proposal should be up to two pages in length for MLPs and up to one page for SPs.
Activities
This section describes in detail our proposed outputs or services that will be delivered as a result of the donors inputs. The outputs should logically lead to changes in behaviours, skills or knowledge levels of the beneficiaries and ultimately to the projects goals or impacts. Be as descriptive as possible when writing this section. We should also keep in mind the skills base of our organization and any collaborating partners, as well as results from the needs assessment or baseline survey. It is important that the activities we detail in this section can be implemented. When describing each of the projects activities, the following questions should be addressed. Why did we choose that particular activity? How will the activity be carried out and who will do it? What is the timeframe for the activity, i.e. when will it start and when will it end? Does it run throughout the duration of the project? What inputs do we need to carry out the activity? Who are the intended beneficiaries of the activity? To what extent will the intended beneficiaries be involved in designing, implementing and evaluating the activity? To what extent will there be collaboration with other organizations and groups? The Activities section of the proposal should be up to six pages in length for MLPs and up to two-and-a-half pages for SPs.
Monitoring and evaluation plan

Increasingly, this section is becoming a vital component of any proposal and therefore will be given special attention later in this module. Suffice it to say here that it allows the donor to understand how the projects attainments will be measured. It also allows us to observe how the project is functioning, allowing us to detect any problems early on and improve on our activities.
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The M&E section of the proposal should address the following questions in narrative form. What verifiable indicators will be measured? What are the means of verification? Who is responsible for collecting what information? When, how and how often will data be collected? Who is responsible for compiling and disseminating reports (to the organization, the beneficiaries, and the donor)? When, how and how often will reports be compiled and disseminated? The M&E plan should be consistent with the budget and there should be budget lines to cover M&E personnel, activities, and materials needed. The M&E section of the proposal should be up to three pages in length for MLPs and up to one page for SPs.
Cross-cutting ethical issues

This section refers to ethical issues such as gender equity, steps to address stigma and discrimination amongst vulnerable groups such as sex workers, injecting drug users (IDUs) and people living with HIV, and issues of good governance. Projects should try to meet national and international gender and development markers. Possible questions for consideration regarding gender issues are the following. Does our project promote gender equity? If so, how? Will we incorporate gender-sensitive consultation in our activities? Do we have strategies to ensure participation in our project by both men and women? Does our M&E plan have gender-sensitive indicators? What percentage of our budget is devoted to activities promoting gender equality? Projects should also ensure that they do not increase stigma and discrimination towards vulnerable groups through their activities. Projects should strive to reduce stigma and discrimination. Possible questions for consideration regarding prevention of stigma and discrimination towards vulnerable groups such as sex workers, injecting drug users and people living with HIV are: Does our project promote the human rights of vulnerable groups? Have we fully thought through the possible law enforcement consequences of our project on vulnerable groups such as sex workers and IDUs? What steps have we taken to prevent negative consequences of law enforcement activities for vulnerable groups participating in our project activities? Have we fully thought through the consequences of community responses to our project on vulnerable groups? What steps have we taken to prevent negative community reactions towards vulnerable groups participating in our project activities?
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How our project will contribute to issues of good governance at national and local government and organizational levels is also an important consideration to include in our proposal. Good governance can be described as how competently a government or programme manages its resources and activities in an open and transparent manner that is responsive to its peoples needs. Issues of good governance should not be restricted to central government, but should include all government service delivery levels, local government, civil society and NGOs. Possible questions to ask ourselves are: Do we have an independent board or management body? Do we have professional and skilled staff? Do we have clear and professional management and decision-making structures? Do we have a proven track record of financial accountability and will we have regular audits? Do we display proven community responsiveness? The Cross-cutting ethical issues section of the proposal should be up to two pages in length for MLPs and up to one page for SPs.
Key personnel
We need to convince the donor that we have the staff resources necessary to be successful in meeting our goals. In this section of the proposal, we need to describe the following: How many people will be working on the project? What are the key positions and what will be the roles and responsibilities for each position? What proportion of key personnels time will be used in the project? What qualifications do key personnel hold? Will we have volunteers? If so, what will be their qualifications? Will we need to hire a consultant? If so, what qualifications will the consultant have? This section on key personnel must be congruent with the budget. In addition, if we will have other key staff involved with the project that will not be funded by the specific donor receiving the proposal, we should profile these staff as counterpart funding. The Key personnel section of the proposal should be up to one page in length for MLPs and up to half a page for SPs.
Strengths and innovation

We need to emphasize the strengths of our project (such as having experienced and skilled staff, our activities being based on proven best practices or having strong collaborative partners) in this section. Potential donors need to be confident that a project will meet its targets and goals and that risks are minimized. We need to ask ourselves:
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What are our strengths? What are our partners strengths? What are the strengths of the communities we will be working with? Are our proposed activities based on best practice or an evidence-based conceptual model? What are we doing to minimize risk? Many donors want to fund innovative or pilot projects that try something new. This could be through the use of different methodologies to better address a health or social problem, or new technology, or even focusing on a target group that has been ignored or not effectively reached before. We should ask ourselves what makes our project unique. Of course, not all of our projects will be innovative and this should not necessarily be seen as a negative we should be focusing on our strengths in service delivery and not on trying to re-invent the wheel! The Strengths and innovation section of the proposal should be up to one page in length for MLPs and up to half a page for SPs.
Sustainability
Sustainability is a critical component in project and proposal design. It refers to our ability to continue with the project when the funding we are requesting from a particular donor has stopped. In other words, sustainability asks "What happens when the donor is gone?" This is very important because we have an obligation towards our beneficiaries and the communities we will be working in we need to ensure that they will continue to be served. In addition, writing a good sustainability section in our proposal shows the potential donor that we have planned wisely for the future and that their investment will not be lost. Good planning at the beginning of the project goes a long way towards ensuring future sustainability of the project. Strategies that we could use to ensure sustainability: Actively seek other donors Ensure stakeholder collaboration at community and beneficiary level during planning, implementation and evaluation Improve efficiency and cost-reduction mechanisms Integrate the project activities into our overall organization budget. The project itself may not need to continue at the end of funding. What we then need to show is how lessons learned and how certain aspects of the project will be incorporated into the rest of your organizations activities. The Sustainability section of the proposal should be up to one page in length for MLPs and up to half a page for SPs.
Budget
This section should detail the inputs required for the project. (More comprehensive information on budgeting and costing can be found in the reference documents
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given at the end of this module). The budget is often the most important section for donors and great care should be taken when developing it. It is important that we follow the specific donors format. However, many aspects are fairly generic. For example: The budget should be presented clearly in a table, accompanied by budgetary notes on a separate page. Budget notes are narrative summaries clearly explaining what is in each budget line. The organizations name, project title, and proposed funding period should be clearly seen at the top of the page. The budget items should be congruent with other sections of the proposal (for example the M&E activities and key personnel should be reflected accurately). The budget sent to the donor should be a one-to-two-page summary of the full budget that we will be using for programmatic purposes. Multi-year projects should display costs for each year in a separate column. Salary costs should be displayed by monthly rates and the proportion of time dedicated to the project should also be clearly shown. Plan for future cost rises, for example, due to inflation and currency fluctuations. An example of a real-life youth peer educator sexual health programme is attached to this module (in the Appendix). The Budget section of the proposal should be up to two pages in length for MLPs and up to one page for SPs.
The annexes
We will need to attach several annexes to the end of our proposal. The most typical and basic annexes are: Annex 1: Conceptual model although this is in most cases optional Annex 2: Logical framework (logframe) Annex 3: Workplan detailing key activities, the key personnel responsible for each activity and the timeframe See the appendix for a summary of the sections in a typical proposal.
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4.
Rationale for sound monitoring and evaluation

Confusion between monitoring and evaluation is common. There is a simple distinction between monitoring and evaluation that you may find helpful. Monitoring is the routine, daily assessment of ongoing activities and progress. In contrast, evaluation is the episodic assessment of overall achievements. Monitoring asks: "What are we doing?" Evaluation asks: "What have we achieved?" or "What impact have we had?" Table 3 Distinction between monitoring and evaluation
Monitoring Routine, daily assessment of ongoing activities and progress - Done daily - Part of normal programme activities - Done at all programme levels Evaluation Episodic assessment of overall achievements - Done episodically - Part of normal programme activities - Done at higher programme levels
Activity 3
Why do we need good M&E? Brainstorm the reasons why M&E is important not only to your own individual programmes/institutions, but to the education sector as a whole. Write down your responses in the table below.
Importance of M&E for individual programmes
Importance of M&E for education sector as a whole
The increase in international funding for HIV and public health interventions has been accompanied by a growing concern to account more effectively for public
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funding and document activities and impact. This has led to increased efforts to introduce and/or strengthen M&E systems. M&E makes our programmes and activities more accountable to donors, to our stakeholders, and to us, both financially and programmatically. Financial accountability relates not just to basic book-keeping, but also to transparent procurement of goods and services. In addition to providing accountability, good M&E allows us to learn lessons from our own activities and those of other organizations, regions and governments; good M&E can allow us to understand why and how some initiatives work and others do not. Good M&E, (which includes bio-surveillance, behavioural surveillance and research) also provides us with increased epidemiological knowledge, allowing us greater insight into the transmission patterns of disease and providing evidence of disease impact on the education sector. M&E tells us what methods or initiatives work under ideal, typically research conditions. This is called efficacy. For example, research may tell us that a certain type of in-school reproductive health curriculum when combined with certain broader community initiatives targeting parents is efficacious in stabilizing or reducing pregnancy and incidences of sexually transmitted infection (STI) among high-school students in a particular community. Once we know what works under ideal conditions, good M&E provides us with information on efficiency, i.e. what works in actual 'real life' conditions. M&E tells us how well we are implementing and executing our basic services, as well as giving us insight into how to best economically scale-up our activities so as to achieve as wide a coverage as possible without adversely compromising our service delivery. It is unfortunate that many of us are involved in very worth-while and effective interventions which are in effect 'boutique-style' small and limited in scale and reach. Sound M&E can therefore serve as a powerful management and planning tool: an M&E system enables us to set clear milestones and goals (strengthened by the use of needs assessments and baseline studies), and to analyze how things are done within the organization. M&E therefore allows us to improve planning, management and administration. Table 4 Summary of rational for sound M&E
1 2 3 4 Lesson Learning - Are we doing the right things? Accountability and performance assessment - Are we doing the right things right? Coverage - Are we doing the right things right and on a big enough scale? Organizational development - What can we do to make sure we do the right things right on a big enough scale?
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5.
Steps for developing a practical M&E plan

Table 5 Steps for developing a practical M&E plan
Step 1 Step 2 Step 3 Step 4 Step 5 Identify project goals and objectives Examine past evaluation studies and existing data Identify M&E system components Design data flow chart and (ideally) central data repository Articulate data dissemination process
For many of us, the real difficulty with developing and implementing an M&E plan is knowing where to begin. The first step and surprisingly one of the most overlooked is to make sure we know exactly what our project goals and objectives are and can articulate them clearly. What is the aim of our project? What exactly do we hope to achieve, and how, with whom, and over what time period? Are our project goals and objectives realistic and, importantly, useful? Once we have clearly articulated our project goals and objectives, the second step is to examine past evaluation studies and existing data. What behavioural data is available for example, what do we know about in-school youths' median age of sexual debut? What is the rate of partner change among in-school youths? Are there geographical or cultural differences in sexual behaviours among in-school youths? What biological data is available for example, what is the HIV prevalence among young people aged 15-19 and 20-24 in the regions we wish to work in? And what are the pregnancy rates among in-school youths? What other projects are in place and how will our own project fit into existing initiatives? Do we have data on teacher attrition rates due to death? What do we know about HIV rates among teachers? After examining past evaluation studies and existing data, the third step is to identify the major components in our M&E system. A comprehensive M&E system for the education sector has the following components: Programme activity monitoring Financial monitoring Biological surveillance Behavioural surveillance Education facility surveillance Research It is important to stress that your project does not need to have all of these components. You need to assess your organization's internal and external M&E capabilities to determine what can be achieved. You also need to ensure that you are only collecting data that is vital, not additional data that is just 'nice to know'. For a small community- or school-based project it is often enough to focus only on conducting robust project activity and financial monitoring. National level M&E should have most, if not all, of the above components. As an organization or
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project, you should not expect to be involved in the collection of data at all levels of the M&E plan. You must concentrate on your own competencies and skills. For example, most biological or behavioural surveillance data will most likely be collected externally to the ministry of education, probably by the ministry of health or a contracted research group such as MEASURE or the Family Health Organization (FHI) with expertise in that particular area. You need to clearly identify what data you have the capacity to directly collect and research and what data would be better collected from other bodies. The fourth step is to design an integrated data flowchart and database which ensures that the M&E data collected flows to a single electronic and/or physical database. The integrated data flowchart should highlight major timeframes and processes and identify the key internal and/or external players involved in the collection, verification, analysis and dissemination of the data. Finally, the fifth step is to clearly articulate how, when and to whom analyzed data should be communicated, disseminated and discussed. A simple and helpful way of coherently summarizing details of our M&E plan components and the relationship between them and our project goals and activities is through the use of logframes, which are widely seen as the cement and bricks with which good M&E is built. However, logframes are not necessarily the beall and end-all of M&E. There are alternatives to displaying the results framework, most notably USAIDs Results Package which details an overall strategic goal and intermediate results. However, logframes are still the most widely used tool, most notably popular with international development agencies such as the European Union, the World Bank, Scandinavia and the Netherlands, and international NGOs such as Population Services International (PSI). In terms of M&E, logframes can tell us in a logical and clear way what the measures of attainment for our activities are, and how we will both set and measure our programme impact. Let us now go through each of the four levels (inputs-outputs-outcomes-impacts) in greater depth using illustrative examples. We will then go through an exercise utilizing your own work experiences and activities to develop an M&E logframe. Inputs are the resources and materials that we put into an activity, project or programme. These are typically financial, material and human resources. Below is an illustrative example of the narrative description, verifiable indicators, means of verification and assumptions for the input level of a logframe for an education sector in-school youth HIV-prevention and care programme in four major provinces.
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Table 6 Example of inputs for an education sector M&E logframe

Narrative description Funds (delivered into project bank account) Verifiable indicator Funds USD XXXX over a period of 5 years Means of verification Project management information system (specifically, financial records) Project management information system (specifically, human resource and payroll records) Project management information system (specifically, fixed asset inventories and stock records) Assumptions
Personnel (in place)
Personnel One director, two programme officers, one clerk
Inputs provided are relevant and sufficient to achieve results
Inputs Equipment (in place)
Equipment office, stationery, computer equipment, vehicle, information, education, and communication (IEC) materials
Outputs
Outputs are the services or activities that we deliver as a result of the inputs that we put into the programme. Examples of indicators (or measures of attainment) for education sector sexual health programme outputs are: number of AIDS-prevention and care teachers trained; number of one-day advocacy seminars held; number of AIDS orphans receiving care and support services through the Education Sector HIV Fund; number of school-community liaison groups established (to strengthen partnerships between communities and schools). Examples of indicators for the processes associated with outputs, specifically coverage, quality and economy for education sector programmes are: percentage of schools with teachers who have been trained in life-skillsbased HIV education and who taught it during the last academic year; proportion of AIDS services with improved quality; unit cost per beneficiary reached.
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Below is an illustrative example of the narrative description, verifiable indicators, means of verification and assumptions for part of the output level of a logframe for an education sector in-school youth HIV-prevention and care programme in four major provinces.
Table 7 Outputs for an education sector M&E logframe

Narrative description To implement efficient, effective in-school youth HIV-prevention and care programmes in four major provinces Verifiable indicator 100 HIV-prevention and care teachers trained in each of four major provinces over a period of 5 years (a total of 400 teachers trained) Means of verification Assumption s
Outputs
Two one-day advocacy seminars held annually in each of four major provinces over period of 5 years (a total of 40 advocacy seminars) A total of 3,000 orphans receiving care and support services through the Education Sector HIV Fund by end of 5 year period
Project monitoring forms
Project monitoring form reports are accurate and timely
75% of AIDS services show improved quality in service delivery by end of five-year period
Outcomes are changes in behaviours or skills that occur as a result of our services. Examples of indicators (or measures of success) for education sector sexual health programme outcomes are: proportion of learners with non-regular partner during last year; percentage of young people aged 15-24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission;
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ratio of current school attendance among orphans to that of non-orphans aged 10-14; median age at first sexual encounter of boys and girls; proportion of young women less than 18 years of age having sex with men more than 30 years of age during the last year. Below is an illustrative example of the narrative description, verifiable indicators, means of verification and assumptions for part of the outcome level of a logframe for an education sector in-school youth HIV-prevention and care programme in four major provinces. Table 8 Example of outcomes for an education sector M&E logframe
Narrative description Verifiable indicator Means of verification Assumptions
To increase safer sexual practices amongst in-school youth in four major provinces
Decreased percentage of inschool youth reporting sex with a nonregular partner during last year Increased percentage of young people aged 15-24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission. Increased age of reported sexual debut amongst in-school youth Decreased percentage of young women less than 18 years of age having sex with men more than 30 years of age during last year
Outcomes
Behavioural surveillance surveys
Behavioural surveillance data are based on representativ e samples and accurate responses
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Impacts
Outputs lead to measurable health impacts. Examples of indicators (or measures of success) for education sector sexual health programme impacts are: the percentage of young people aged 15-24 who are HIV-infected; the percentage of in-school girls reported pregnant during last year. Impacts or goals usually refer to major health or social problems, refer to a specific target population or geographic site, and must be clear and easily understood. Below is an illustrative example of the narrative description, verifiable indicators, means of verification and assumptions for part of the IMPACT level of a logframe for an education sector in-school youth HIV-prevention and care programme in four major provinces. Table 9 Example of impacts for an education sector M&E logframe
Narrative description To improve sexual health among inschool youth in four major provinces Verifiable indicator Means of verification Assumptions
Reduced antenatal HIV prevalence in 1519 and 20-24 age groups Reduced percentage of inschool girls reported pregnant during last year Health centre HIV and pregnancy records
Sexual intercourse is the primary mode of HIV transmission
Impacts
Pregnant girls seek medical support from the health centre
Overleaf is an activity to develop your own M&E logframe (or logic model).
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Activity 4
Developing a participant-specific M&E logframe Individually or as a group made up of people within the same organization/project, develop an M&E logic model for an actual activity or project that you are currently involved in or planning. Four templates are provided for each level of the logframe. Use the templates to complete your M&E logic model. It is often easier to start at impact level and then work back to the inputs. Taken together, all four levels will make up a basic M&E logic model for your own specific activity or project. Monitoring and evaluation logframe: input level
Organization Project goal or objective Narrative summary Verifiable indicator Means of verification Assumptions
Inputs
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Monitoring and evaluation logframe: output level

Outputs
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Monitoring and evaluation logframe: outcome level

Outcomes
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Monitoring and evaluation logframe: impacts level

Impacts
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6.
Reporting
Reporting of analyzed M&E data should take place at both a local and a national level. Recipients of reports (obviously depending on the nature of the programme) should include community members, programme staff and management, donors and the national co-ordinating bodies such as the National AIDS Councils. It should be clearly shown that decisions on the future direction of programmes and activities are directly informed by these reports. Reporting of M&E data should also be as simple as possible and appropriate for the intended recipients of the reports. Some programmes might find, for example, that it is better to compile two reports a comprehensive 'technical' one for their donors and management, and a simpler, shorter and more descriptive one for the communities they are working with. Data must also be presented in a clear and easily digestible form. This could be done by prioritizing the data that is to be included in the report and putting detailed data into separate reports or annexes, and by using visual tools such as graphs, pictures, maps and charts. It is important to report data in comparison to earlier results. This provides a clearer picture to readers of the programme's achievements and areas for possible revision. Finally, as we mentioned earlier when talking about the proposal, presentation of the report is important. It should look as professional as possible and should have gone through an editing process to correct spelling and grammar and should be typed on clean paper.
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Summary remarks
When designing a project, it is helpful to conduct a needs assessment to provide information on intended beneficiaries and to better understand their specific concerns. Developing a conceptual framework is useful in understanding and better articulating project goals and objectives and determining how you intend to achieve the goals and objectives through activities. Designing a logical framework or logframe is a good, practical way of concisely stating what resources you will use (or intend to use), what activities you will be conducting and what outcomes and impacts are expected to occur as a result of the activities. Logical frameworks are an important tool in M&E in that they are a simple way of indicating how to both set and measure attainment of goals and objectives for inputs, outputs, outcomes, and impacts. The project proposal should be as detailed and professionally laid out as possible. Choosing the appropriate writer(s) is therefore key. It is important to stress that the proposal, whilst sound and perhaps even innovative, should be grounded in reality, etc. there is little point in promising what we cannot realistically deliver simply to obtain funds! At the same time, the proposal should not sell the project short; it should highlight the strengths of the project's design, the strengths of the organization and its staff, and indicate how the activities will benefit the intended recipients of the project activities as well as the donors. Good project design should have sound M&E built into the project right from its conception. M&E provides us with useful information on context, on the efficacy of the proposed project's design, on the efficiency of the project, and provides us with accountability to the beneficiaries, ourselves, our donors, and the wider community. By following the steps and guidelines given in this module, you should now be better equipped to develop logical, consistent and evidence-based projects and to 'sell' your vision to donors through a good project proposal.
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Lessons learned
Lesson One Successful project design and proposal-writing require that: the project design be logical, based on best practice or and/or a coherent conceptual model, and must address the problems identified in the needs assessment; the proposal benefit from collaboration with relevant stakeholders during the preparatory and writing process; great effort be put into writing the proposal, making sure it reflects the needs of the intended beneficiaries, the vision of the potential donors and the capacity of your own organization to undertake the activities. Lesson Two Information about impacts and outcomes is generally gathered through national data collection systems, such as nationally representative surveys and the national sentinel surveillance system, whereas information about outputs and inputs is generally derived from monitoring forms used at the programme level. Therefore, evaluation (which we defined as the episodic assessment of overall achievements), takes place when we measure at outcome and impact level, and monitoring (which we defined as the routine, daily assessment of ongoing activities) takes place when we measure at input and outcome level. Lesson Three The higher the results cycle, the fewer the organizations, projects and studies involved all partners collect complete input and output data, many partners collect some process data, far fewer partners assess outcomes, even fewer partners assess impact. Lesson Four M&E must be as simple as possible. Programmes often collect far more data than they use. The more complex an M&E system, the more likely it is to fail. Lesson Five M&E must be built into programme design at the outset, not added later. All too often, M&E is seen as an extra component of a project plan and is not seen as being integral to development of the project itself.
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Lesson Six M&E will fail without widespread stakeholder 'buy-in'. All levels in data collection must be actively involved in development and refining of the M&E system. There must also be a rigorous feedback system.
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Appendix
1. Summary of proposal sections
Section Cover page Summary of contents Organizations name and logo if available Projects name and logo if available Proposed duration of the project Organizations contact details (specifying a contact persons full name and position within the organization, telephone and fax number, e-mail and physical address Date of submission to the donor Potential donors name and logo if available Table of contents Executive summary Lists all the proposal sections Highlights the page number on which each section begins. Gives overview of proposal and highlight key information from each section Written LAST after completion of the other proposal chapters Introduction Presents statistics and results from needs assessment, baseline and meta-analysis Provides justification for activities Provides justification for the choice of organization to receive funding Goal and objectives Activities Lists the overall goal and objectives Details the proposed OUTPUTS or services that will be delivered as a result of the donors inputs Details responsibilities and timeframes Monitoring and evaluation Refers to the logframe Details the verifiable indicators, the means of verification and the key assumptions Details key M&E responsibilities and timeframes 3 MLP 1 SP 1 1 N of pages
2 MLP 1 SP
3 MLP 1.5 SP
2 MLP 1 SP 6 MLP 2.5 SP
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Cross-cutting ethical issues
Discusses the extent to which the project: meets national and development markers; international gender and 2 MLP 1 SP its
reduces stigma and discrimination against vulnerable groups; addresses the environmental impact of its activities; addresses issues organization; Key personnel Strengths & innovation of good governance within
Description of staff and skills Description of organization strengths Description of what makes the proposed activities unique. Narrative description of strategies to be used to ensure continuation of the project after end of proposed funding cycle Submit a one- to two-page budget summary to the donor Prepare a more detailed budget for programmatic use (not necessarily included in the proposal)
1 MLP 0.5 SP 1 MLP 0.5 SP
Sustainability
1 MLP 0.5 SP
Budget
2 MLP 1 (SP)
Annexes
Typically: Annex 1: Conceptual model Annex 2: Logical framework Annex 3: Workplan (which details the key activities, the key personnel responsible for each activity and the timeframe) Projectspecific
Budget example youth peer educator project The estimated first year project budget is presented below. First year implementation costs will be met by the ministry of education. Thereafter, the second year implementation costs will be raised from private sector sources in the region and elsewhere. Condoms will be provided by the department of health. Training, technical support and research costs will be met by the NGO.
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First year budget

Categories and line items Co-ordinator Seconded by ministry of education Sub-total Peer educators Allowances: R200 monthly x 12 monthly x 31 peer educators Uniforms. R250 annually for uniform set x 31 peer educators Sub-total Training Co-ordinator's training met by NGO Peer educators' annual training met by NGO Peer educators' weekly training R600 weekly transport and refreshments x 50 weeks Sub-total Transport Co-ordinator's transport R500 monthly x 12 months Sub-total Youth STI care Supplementary youth diagnosis and treatment R2, 500 monthly x 12 months Sub-total Evaluation Behavioural and biomedical surveys met by NGO Sub-total Administration Communication (post/phone/fax/e-mail) R200 monthly x 12 months Stationery R50 monthly x 12 months Sub-total Contingency Contingency Sub-total TOTAL 23,850 23,850 175,000 600 3,000 2,400 00 00 30,000 30,000 6,000 6,000 30,000 30,000 00 00 7,750 82,150 74,400 00 Amount 00
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Answers to Activities
Obviously the answers given below are just examples, but they should be useful in providing guidance for your own specific real-life responses. Activity 1 1. What exactly is the problem that you want to address? For example, the problem may be High numbers of female students dropping out of secondary schools in Province X due to pregnancy. 2. How are you planning to address this problem? The project goal may be Reduced incidence of pregnancy among female students in Province XXX. 3. What specific activities do you propose to do? How will these activities contribute towards solving the problem? i) To set up and train in-school sexual health peer education groups in all secondary schools in Province X ii) Develop and train teachers in a sexual and reproductive health curriculum for use by teachers with secondary school students iii) Distribute contraceptives in secondary schools in Province X 4. What is the environment? Include factors that may affect your project, such as the political situation, cultural sensitivities and relationships with other ministries and/or implementing partners. 5. What, if anything, have you or other people already done to address this problem? What, if anything, are you or other people currently doing to address this problem? This allows you to make sure that you are not replicating existing services. It also allows you to identify potential collaborative partners. Finally, identifying what else is being done allows you to make e sure that you are complementing existing activities instead of competing with them.
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Activity 2 Using the example of reduced incidence of pregnancy among students in province X, see suggested answers below.
1 (complete first) What is your projects long-term goal? 2 (complete second) What needs to change for your projects longterm goal to be achieved? 4 (complete last) Will your projects activities detailed in Step 3 lead directly to the changes detailed in Step 2? If not, what is the logical step in between? 1. Female secondary school students aware of the benefits of abstinence or delay of sexual debut until completion of school 2. Female secondary school students know about contraceptives and that they are available, and are confident about using them. 3. Secondary school teachers more confident about teaching reproductive health issues to female students 3 (complete third) What activities will your project undertake in order to make the changes in Step 2 happen?
Reduced incidence of pregnancy among female students in Province X
1. More female secondary school students abstain from sex
1. Set up and train in-school sexual health peer education groups
2. Sexually active female secondary school students use contraceptives.
2. Distribute contraceptives
3. Secondary school teachers teach reproductive health issues to female students.
3. Develop and train teachers in a sexual and reproductive health curriculum for use by teachers with secondary school students
Activity 3 Importance of M & E for individual programmes 1. M&E provides us with accountability to our beneficiaries, ourselves, our donors and the wider community. 'Accountability' refers to financial accountability, procurement and programme activity monitoring. 2. M&E gives us information on context or the environment that we are proposing to work in. 3. M&E tells us what project methods or initiatives work under ideal conditions. 4. M&E tells us whether we have effectively moved from efficacy to efficiency, i.e. from what works under ideal conditions to what works in the real world.
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5. M&E is a good management and administrative tool in that it provides us with information that allows us to constantly improve and potentially redesign our project. Importance of M&E for the education sector as a whole M&E tells us what project initiatives and methods are being used in the sector (and who is doing what). M&E provides us with an understanding of the broad impact of these initiatives and methods. M&E provides us with information to shape policy and the allocation of resources. Importantly, M&E allows us to constantly reflect on and often modify assumptions in the education sector. For example, in Africa, is the correlation between level of education and HIV incidence positive or negative?
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Activity 4 Monitoring and evaluation logframe: input level

Organization Project goal or objective Teman Saya Community Action Group To improve sexual health among in-school youth in Satu Province, Dua Province, Tiga Province and Entam Province
Narrative summary Funds (delivered into project bank account)
Verifiable indicator Funds USD XXXX over a period of 5 years
Means of verification Project management information system (specifically, financial records)
Assumptions Inputs provided are relevant and sufficient to achieve results.
Personnel (in place) Inputs
Personnel one director, two programme officers, one clerk
Project management information system (specifically, human resource and payroll records)
Inputs provided are relevant and sufficient to achieve results.
Equipment (in place)
Equipment office, stationery, computer equipment, vehicle, IEC materials
Project management information system (specifically, fixed asset inventories and stock records)
Inputs provided are relevant and sufficient to achieve results.
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Monitoring and evaluation logframe: output level

Narrative summary To implement efficient, effective inschool youth HIV-prevention and care programmes in 4 major provinces
Verifiable indicator 100 HIVprevention and care teachers trained in each of 4 major provinces over period of 5 years (a total of 400 teachers trained) Two one-day advocacy seminars held annually in each of 4 major provinces over period of 5 years (a total of 40 advocacy seminars) A total of 3,000 orphans receiving care and support services through the Education Sector HIV Fund by end of fiveyear period 75% of AIDS services show improved quality in service delivery by end of fiveyear period.
Means of verification Project monitoring forms
Assumptions Project monitoring form reports are accurate and timely.
Project monitoring form reports are accurate and timely.
Outputs
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Monitoring and evaluation logframe: outcome level

Organization Project goal or objective Teman Saya Community Action Group To improve sexual health among in-school youth in Satu Province, Dua Province, Tiga Province and Entam Province Narrative summary To increase safer sexual practices amongst inschool youth in 4 major provinces Verifiable indicator Decreased percentage of in-school youth reporting sex with a nonregular partner during last year Increased percentage of young people aged 15-24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission Increased age of reported sexual debut amongst inschool youth Means of verification Behavioural surveillance surveys Assumptions Behavioural surveillance data are based on representative samples and accurate responses Behavioural surveillance data are based on representative samples and accurate responses
Outcomes
Behavioural surveillance data are based on representative samples and accurate responses Behavioural surveillance data are based on representative samples and accurate responses
Decreased percentage of young women less than 18 years of age having sex with men more than 30 years of age during last year
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Monitoring and evaluation logframe Impact level

Narrative summary To improve sexual health among inschool youth in four major provinces
Verifiable indicator Reduced antenatal HIV prevalence in 15-19 and 2024 age groups
Means of verification Health centre HIV and pregnancy records
Assumptions Sexual intercourse is the primary mode of HIV transmission.
Impacts
Reduced percentage of in-school girls reported pregnant during last year
Health centre HIV and pregnancy records
Pregnant girls seek medical support from the health centre.
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Documents IPPF. 2002. Guide for designing results-oriented projects and writing successful proposals. New York: IPPF. www.ippfwhr.org/publications/download/monographs/proposal_guide_e.pd f Global AIDS Programme. 2003. Monitoring and evaluation capacity building for programme improvement field guide, Version 1. Atlanta, USA: US Centre for Disease Control and Prevention. Reid, A.N.T. A practical guide for writing proposals. UNAIDS. 1998. Guide to the strategic planning process for a national response to HIV/AIDS. Geneva: UNAIDS. http://old.developmentgateway.org/download/84424/test.pdf UNAIDS; World Bank. 2002. National AIDS Councils (NACs) Monitoring and Evaluation Operations Manual. Geneva: UNAIDS; World Bank. www1.worldbank.org/hiv_aids/docs/M&EManual.pdf Additional source materials Milstein, B.; Kreuter, M. 2000. A summary of logic models: What are they and what can they do for planning and evaluation? CDC Evaluation Working Group. Atlanta: National Centre for Disease Prevention and Health Promotion, CDC. UNAIDS. 2003. Monitoring and evaluation modules. Geneva: http://data.unaids.org/Topics/M-E/me-modules-a4_en.pdf UNAIDS.
USAID. 2002. Handbook of indicators for HIV/STI programmes. Washington, DC: USAID. www.synergyaids.com/APDIME/mod_3_design/ext_doc/1570_entiredoc.pdf
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Module
P. Badcock-Walters
Mitigating the HIV/AIDS impact on education: a management checklist
5.4
About the author

Peter Badcock-Walters is Director of the EduSector AIDS Response Trust and was the founding Director of the Mobile Task Team (MTT) on the impact of HIV/AIDS on education. He specializes in strategic planning, policy development, implementation design and research, with a particular interest in systemic response, information-based decision support systems, process facilitation and training.
Module 5.4
MITIGATING THE HIV/AIDS IMPACT ON EDUCATION: A MANAGEMENT CHECKLIST
Table of contents
Questions for reflection Introductory remarks 1. Developing a strategic response framework Three phases Planning and management checklist 2. Phase One: understanding impact Step One - HIV and AIDS situation analysis, response review and impact assessment Step Two - Management information and research review Step Three - Education sector HIV and AIDS policy and regulation audit Step Four - Education sector capacity audit 3. Phase Two: planning mitigation Step Five - Establish an HIV and AIDS Management Unit (HAMU) Step Six - Education sector HIV and AIDS policy development Step Seven - National HIV and AIDS policy implementation planning Step Eight - Decentralized HIV and AIDS policy implementation planning Step Nine - Implementation budgeting and resource development 4. Phase Three: implementation monitoring and review Step Ten - Monitoring and evaluation (M&E) Step Eleven Reporting Step Twelve - Policy implementation review Summary remarks Lessons learned Answers to activities Bibliographical references and additional resource materials 139 141 142 143 145 147 147 147 147 147 149 149 149 149 149 150 151 151 151 151 153 155 156 157
MODULE 5.4: Mitigating the HIV/AIDS impact on education: a management checklist
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Aims
The aim of this module is to provide a comprehensive framework for a strategic response and a checklist of steps and activities that can be used within ministries of education (MoEs) to advocate, guide and inform the planning and management of a HIV and AIDS response.
Objectives
On completion of this module, you should be able to: recognize the key issues involved in managing and mitigating the impact of HIV and AIDS on education systems; identify the three phases of activity required to guide an effective response; use the planning and management checklist to benchmark the progress of your own MoE/education sector in relation to these issues; help initiate a systemic response to the impact of HIV and AIDS in your own MoE/education sector.
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Before you begin

Take a few moments to think about the questions below and make a note of your answers and ideas in the spaces provided. As you work through the module, see how your responses compare to those put forward by the author. Does your MoE/education sector have a comprehensive response to the impact of HIV and AIDS?
Does your MoE/education sector have a strategic management plan to mitigate the impact of HIV and AIDS?
Has an evaluation of impact and response taken place recently or been presented to senior decision-makers?
Does your MoE have structures, personnel and resources in place to manage, monitor and report on impact and response?
How would you use a checklist of recommended activities within the MoE/education sector, and what effect do you think this might have?
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Module 5.4
MITIGATING THE HIV/AIDS IMPACT ON EDUCATION: A MANAGEMENT CHECKLIST
There is growing acknowledgement that HIV and AIDS is a systemic management problem for education and that responses must: be located within the system at every level; and address questions of prevention, treatment, care and support, and mitigation including workplace issues and response management. The primary impact of HIV and AIDS is that it increases the scale of existing systemic and management problems in education; education systems have always had problems of supply, demand, quality and output HIV and AIDS simply add to these problems and increase their scale. Lack of reliable data makes it difficult to know where routine system problems stop and systemic erosion starts. These routine problems include staff attrition, service ratios, student enrolment, drop-out and transition rates, quality, output and budgeting, all of which will be adversely affected. HIV and AIDS should not be seen as an external factor. The nature of its impact on the system affecting every function of demand, supply, quality and output makes it integral to the function of education management, and highlights an important message to HIV and AIDS planners and managers: What is good for the efficiency and reform of the education system is good for HIV and AIDS mitigation, and vice versa. Many MoEs have initiated a significant level of response, but this is often limited to prevention and even treatment, care and support, without adequate attention to sector policy, workplace issues or comprehensive planning and management. There is a need for a flexible framework for strategic responses to guide the development of policy and action plans that provides a checklist of issues requiring attention. This checklist can be used for advocacy or strategic planning purposes and to confirm the comparative progress of the MoE in relation to recommended steps. This module should be studied in conjunction with Module 1.2, The HIV/AIDS challenge to education; Module 2.1, Developing and implementing HIV/AIDS policy in education; Module 2.2, HIV/AIDS management structures in education; and Module 4.3, An education policy framework for orphans and vulnerable children.
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1.
Developing a strategic response framework

There is growing understanding that any comprehensive response must address four key themes: prevention; treatment, care and support; workplace issues; management of the response. MoEs must recognize that any HIV and AIDS response must be sustainable over the long term and must be within the means of the recurrent education budget, irrespective of short-term donor or other funding. Increasing erosion of the system and management problems associated with HIV and AIDS will compromise the ability of the MoE/education sector to meet Education for All (EFA), UNGASS and other international goals. Systemic impact requires systemic response: a comprehensive, prioritized plan of action, from assessment and sector policy development, to decentralized planning and implementation within a flexible framework for strategic response. Effective response within such a framework must therefore be based on dependable data and regular monitoring, evaluation, review and reporting. To be effective, the strategic response framework must cover key phases, which include: understanding impact (assessing, benchmarking and measuring impact); planning mitigation (action planning and costing prioritized activities required to mitigate impact); implementation, monitoring and review (initiating and implementing planned activity, monitoring progress and reporting outcomes and response). Finally, in every aspect of planning and management, it should be remembered that while HIV and AIDS are a long-term human and development catastrophe, it is also a unique opportunity to address any number of long-standing problems in the structure and function of education. For example, the increased demand for new teachers driven to a large extent by increasing mortality may mean that the length of pre-service training may have to be shortened. This represents a major management problem, but it is also an opportunity to reconsider how, why and for what we train teachers. It may allow us to address long-standing difficulties that could not ordinarily be resolved. Therefore, at every step of the mitigation response we should be asking ourselves what opportunities this action provides for concomitant system improvement or reform.
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Three phases
A strategic response framework (SRF) is required to provide the big picture within which a comprehensive checklist of action phases and steps can be located. It allows MoEs to recognize achievements as well as missing or incomplete activities to date, and plan rationally for the future. The checklist of steps or activities within this framework can be customized to MoE requirements to prioritize strategically important issues and need not be sequential. The framework and steps/activities should be tailored to fit country circumstances and may be informed by an impact assessment or rapid sector review that is designed to benchmark the extent of the impact and the state of readiness to manage this impact. The resultant framework and checklist of steps should describe the key actions required for a comprehensive and sustainable programme of response and mitigation. The framework and checklist should also address the requirement from donors for a movement towards prioritized and achievable plans, and fully costed national and decentralized implementation, monitoring, evaluation and reporting. The strategic response framework consists of three distinct phases, which together comprise a continuum of activity designed to address the needs described above and which are laid out in the box below.
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Box 1
The three phases of a response framework
Phase 1: Understanding impact No comprehensive response is possible until sector decision-makers fully understand the nature and extent of the problem. Twenty years into the pandemic, many senior officials in the education sector still assume HIV and AIDS to be a public health issue and have not grasped the erosive effect of the disease on every function of supply, demand, quality and output in education. Every education sector manager must therefore be helped to understand, through a structured advocacy process, that HIV and AIDS are now, and for the foreseeable future, a systemic management problem of direct and personal concern. Phase 2: Planning mitigation Once there is consensus within the sector on the nature and scale of the problem, it is possible to move into a planning phase to ensure that mitigation becomes a routine function of the system and sector. This planning phase requires the development of clear and unambiguous steps to ensure that the necessary data and information are in the hands of planners and decisionmakers; that management structures exist with relevant training and support; that a policy for the sector is available; that national and decentralized planning for implementation has been consultatively developed; that this activity has been costed and initiated at all levels; and that the necessary recurrent resources exist to sustain it over time. Phase 3: Monitoring and review of implementation If the implementation of responses is to be systemic and sustainable, its initiation must be benchmarked (a standard or point of reference) and its progress monitored against a set of simple indicators to provide evidence of mitigation of HIV and AIDS. This monitoring process must therefore be reported if the sector response is to be transparent, and all stakeholders and interest groups must be kept informed and engaged. Finally, given the dynamics of the pandemic and the education sectors vulnerability to it, it is of the greatest importance that the entire process be reviewed on a regular basis. This is critical both to the well-being of the country and the future of education, and to the continuing interest and commitment of the donor agencies which remain central to the resourcing of mitigation and education development.
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Activity 1
What is the impact of HIV and AIDS?
What is the key feature of planning mitigation?
Why is it important to monitor and review?
Planning and management checklist

Within each of the three phases of this framework, there are steps and activities that should ideally be undertaken if the MoE/education sector concerned is to build a sustainable defence against the erosive affects of HIV and AIDS. The list describes a sequence of steps and activities that should be undertaken, but the list cannot take account of country or education sector circumstances that may make these steps difficult or even impossible. The checklist cannot anticipate political or budgetary constraints for example, or personnel, structural or other limitations. But what it can do is list all of the actions that could and should be contemplated, as a basis for advocacy the persuasion of senior decision-makers to respond more comprehensively and effectively and for future planning. The checklist also provides a big picture of the activities that should comprise a holistic and sustainable national response. It allows planners and managers to review where their own systems stand in relation to this activity checklist. It may provide a sense of achievement for those countries which have already successfully progressed through one or more of the framework phases and have initiated activity in a number of critical strategic steps. Equally, the checklist may give pause for thought to those managers whose systems have not yet moved beyond the early stages of response, and provide a set of targets and goals on which they can focus. The checklist should not be seen as a vertically sequential set of instructions or a blueprint. Any given country or education system may find that they have begun planning mitigation without having reached sectoral consensus on policy, or achieved a universal understanding of the implications of HIV and AIDS impact. What is important is that they move forward aware of the big picture and its implications. This is precisely why the strategic response framework is a flexible construct within which countries can confirm progress to date and prioritize steps or activities which seem more or less strategically important to them at this point in the development of their own response. The checklist therefore allows them to flag issues for
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follow-up and to which they may return once a particular priority has been addressed. Twelve steps or activity clusters are offered for adoption, revision or reorganization within the three key phases of this flexible strategic response framework.
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2.
Phase One: understanding impact

Step One - HIV and AIDS situation analysis, response review and impact assessment
Identify and agree on key HIV and AIDS impact and vulnerability indicators. Develop objectives and terms of reference for impact assessment/activity review. Commission independent sector impact assessment/activity review; or Undertake interactive rapid sector appraisal/activity review. Consider findings and establish impact and activity benchmarks.
Step Two - Management information and research review

Review MoE data history, quality and reliability. Review and audit data systems/capacity, including collection, access to HIV and AIDS impact indicators, and support systems for analysis and decision making. Review other sector data/information sources. Review education sector research agendas inside and outside MoE. Aggregate all available data/information to provide a single consolidated source and develop preliminary proposals for system reform and extension. Develop a national, prioritized research agenda.
Step Three - Education sector HIV and AIDS policy and regulation audit
Review national HIV and AIDS policy framework and implications for the development of education sector policy. Review education sector HIV and AIDS policy where it exists, and check coverage of prevention, treatment, care and support and mitigation. Review/audit relevant MoE legal procedures and regulations and identify shortcomings and issues for policy review. Advocate to create champions for the development and dissemination of education sector HIV and AIDS policy.
Step Four - Education sector capacity audit

Review national and sub-national MoE systems and human resources capacity at all levels to respond to and manage HIV and AIDS impact. Review capacity and programme coverage for the education sector, and co-operation agreements and protocols with national and international development partners.
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Identify and estimate availability of financial resources to support HIV and AIDS response and agree on access and other protocols. Integrate information and data from the audit of capacity, appraisal of the impact assessment, and audit of policy to provide a strategic overview for decision-making.
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3.
Phase Two: planning mitigation

Step Five - Establish an HIV and AIDS Management Unit (HAMU)
Identify education sector needs for a full-time co-ordination structure (HAMU) through policy development and a strategic planning process. Develop sectoral agreement on the form, function, structure and commitment of a permanent/dedicated national and sub-national HAMU. Establish HAMU with appropriately high levels of access and reporting. Commit to adequate capital and recurrent resources to equip and sustain HAMU in the long term. Ensure commitment and access to appropriate, regular training and support for HAMU personnel.
Step Six - Education sector HIV and AIDS policy development

Agree on guiding principles, goals and objectives for adaptive education sector HIV and AIDS policy. Develop a draft education sector HIV and AIDS policy in accordance with agreed principles and national/international policy frameworks and guidelines. Address key policy themes of prevention, treatment, care and support and mitigation, with special attention to workplace issues and managing the response. Agree and entrench a process for regular policy review and adaptation based on implementation experience at national and decentralized levels.
Step Seven - National HIV and AIDS policy implementation planning

Develop a prioritized framework for planning the implementation of an HIV and AIDS policy by goal and objective. Segment the plan by policy theme to cover prevention, treatment, care and support, and mitigation. Address legal issues and the development of enforceable regulations to give effect to policy implementation. Ensure that planning framework includes: capacity-building for an effective HIV and AIDS response at all levels of the system; system review and reform to improve functional efficiency.
Step Eight - Decentralized HIV and AIDS policy implementation planning

Locate sub-national planning within national planning principles and framework, for implementation.
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Develop specific, measurable, achievable, realistic, time-bound plans for sub-national levels reflecting regional variance, needs and priorities. Address regional/district constraints and difficulties and factor these in planning. Consolidate decentralized plans to update and strengthen national education sector framework.
Step Nine - Implementation budgeting and resource development

Cost national/sub-national implementation plans over five years, with defensible assumptions. Analyze the availability of MoE capital and recurrent budget and confirm access protocols. Confirm the availability of external/donor resource. Develop a partnership and programme delivery database to support co-ordination and identify available country technical assistance capacity. Hold a donor conference to present comprehensive, costed education sector HIV and AIDS policy implementation plan to mobilize external resources.
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4.
Phase Three: implementation monitoring and review

Step Ten - Monitoring and evaluation (M&E)
Monitor quantitative implementation of policy at all levels, against agreed target dates and outputs. Monitor HIV and AIDS impact indicators via the capture and analysis of national data. Monitor system and sector capacity in relation to observed management and delivery. Establish and evaluate qualitative indicators of policy implementation success against agreed targets and outputs. Design and introduce M&E and supplementary data capture systems to support the monitoring and evaluation.
Step Eleven Reporting

Report the progress/outcomes of the implementation of education sector HIV and AIDS policy at agreed intervals to all national and international constituencies, stakeholders and development partners.
Step Twelve - Policy implementation review

Convene an inclusive annual HIV and AIDS policy and implementation strategy review to report progress, performance and vulnerability assessment. Revise/adapt national and sub-national strategies and implementation activities, based on impact indicators, implementation monitoring, evaluation and reporting. Develop/publish revised implementation plans for the following year, based on review/adaptation of revised targets, priorities and goals. Assure education stakeholders/development partners of effective M&E and implementation planning.
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Activity 2
Checklist review 1. Use the Checklist to review what you think your MoE has accomplished to date. Against each item on the checklist, put a tick () if you feel that the step has been comprehensively dealt with and is complete. If not, place an estimate of achievement against each item in percentage terms in other words, if you feel that your MoE is half-way to completing this step, put 50% in the column. See example below. Step One: HIV and AIDS Situation Analysis, Response Review and Impact Assessment Identify and agree on key HIV and AIDS impact and vulnerability indicators Develop objectives and TOR for impact assessment/activity review Commission an independent sector impact assessment/activity review Undertake an interactive rapid sector appraisal/activity review Consider findings and establish impact and activity benchmarks 50%
2. When you have finished reviewing the checklist, consider how you would use it within your MoE to alert decision-makers to the need for a comprehensive approach and identify those issues which are yet to be tackled. Also consider what affect the information might have and how you might capitalize on this to advance the mitigation agenda. Develop a five point plan for the strategic use of the checklist and its likely impact on decision-makers in MoEs.
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Summary remarks
It is apparent that no MoEs on the African continent or anywhere else have completed every one of these steps. This is not surprising, though many have advanced a long way in the development of awareness, materials and training of teachers in prevention and even care and support, for example. Indeed, a few MoEs have made great strides in policy development and implementation planning, and serve as international examples of good practice. That not all MoEs have addressed all these complex issues does not signal a failing, rather it recognizes that a comprehensive HIV and AIDS response at every level of the education sector requires political and institutional commitment, time and considerable resources commodities often in short supply in over-burdened systems. The task is to recognize what could and should be done in an optimal situation and to prioritize these activities to suit local conditions and resource constraints. No MoE can be expected to do more without means at its disposal, but the availability of this big picture of comprehensive response may do three important things: 1. Help to guide thinking and planning within the MoE and facilitate a process of informed prioritization. 2. Confirm that the MoE is committed to a broad mitigation plan which will assist in achieving EFA and other internationally supported goals the attainment of which cannot otherwise be assured in the AIDS era. 3. Mobilize donor/development agency support based on the MoEs evident commitment to, and understanding and prioritization of, these issues. These phases, steps and activities are intensive and complex and require management, co-ordination and reporting. These are very real responsibilities that must be allocated to identified structures and individuals if they are to be effectively operationalized. This implies that MoEs committed to action must move beyond part-time or ad hoc committees and establish full-time, well-resourced coordinating and management structures whose sole responsibility is the roll-out and monitoring of these and other HIV and AIDS mitigation plans. You will note that Step Five in Phase Two of the strategic response framework is the establishment of an HIV and AIDS Management Unit (HAMU) for this very purpose. However, it is important to note that such a unit could be established at any point in the framework continuum; this is an example of the fact that the steps in this framework do not have to be sequential, and that local circumstances can change this sequence at any point. Finally, it should also be noted that even if the MoE is able to initiate and complete all of these steps and activities, the concept of regular monitoring and review means that the response will never be complete. The process of monitoring and review will throw up new challenges, new data and information and help identify shortcomings in the activity already completed. In other words, in the AIDS era, the management of mitigation must be considered a full-time, continuous task for a
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dedicated co-ordination unit, and a routine part of the day-to-day activity of every manager within the system.
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Lessons learned
Lesson One HIV and AIDS mitigation must be comprehensive addressing all the theme areas of prevention, treatment, care and support, workplace issues and management of the response. Lesson Two Every country and its education sector have taken some steps to mitigate HIV and AIDS impact, and these steps should be noted and recorded in relation to the checklist to establish what has been done and what remains to be done. Lesson Three The steps described in the strategic response framework do not have to be sequential and may be rearranged depending on what has already been done, and on local circumstances and priorities. Lesson Four Tools, models and templates exist to assist in this process and these can speed response and make available comparative country experience. Lesson Five Improved capture systems for HIV- and AIDS-sensitive data and the development of supplementary monthly management and monitoring systems will provide early warning of both system failure and HIV and AIDS impact. Lesson Six HIV and AIDS mitigation is synonymous with good management; effective management at every level of the system will help mitigate HIV and AIDS impact, provide better support information to guide response and help anticipate system stress in the areas of demand, supply, quality and output. Lesson Seven HIV and AIDS will be a routine feature of the education process for the foreseeable future, certainly for the next 20-30 years. As such, its impact on every aspect of system function and output must be seen as a routine part of management at every level, and must be factored in every budget and development plan.
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Activity 1 What is the impact of HIV and AIDS? The primary impact of HIV and AIDS is that they increase the scale of existing systemic and management problems in education; education systems have always had problems of supply, demand, quality and output HIV and AIDS simply add to these problems and increase their scale. Routine or existing problems that may be made worse by HIV and AIDS might include staff attrition, service ratios, student enrolment, drop-out and transition rates, quality, output and budgeting. This increasing erosion of the system and management problems associated with HIV and AIDS will also compromise the ability of the education sector to meet EFA, UNGASS and other international goals. Please refer to Module 1.2, The HIV/AIDS challenge to education, for a detailed account of the impacts of HIV and AIDS on the education sector. What is the key feature of planning mitigation? The key feature of planning mitigation is consensus within the sector on the nature and scale of the problem. Once this is achieved, it is possible to move into a planning phase to ensure that mitigation becomes a routine function of the system and that comprehensive action planning and costing of prioritized activities can be carried out. Why is it important to monitor and review? If the implementation of responses is to be systemic and sustainable, its initiation must be benchmarked and its progress monitored against a set of simple indicators to provide evidence of mitigation of HIV and AIDS. In addition, given the dynamics of the pandemic, it is of the greatest importance that the entire process be reviewed on a regular basis to provide insight to the process for all the constituencies involved. Activity 2 Answers are country-specific.
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Documents Kelly, M.J. 2000. Planning for education in the context of HIV and AIDS. Fundamentals of Educational Planning, No. 66. Paris: IIEP-UNESCO. UNAIDS Inter Agency Task Team on Education (IATT). 2002. HIV and AIDS and education: a strategic approach. Paris: IIEP-UNESCO. UNAIDS. 2005. AIDS in Africa: Three scenarios to 2025. Geneva: UNAIDS. www.unaids.org/unaids_resources/images/AIDSScenarios/AIDS-scenarios2025_report_en.pdf UNESCO. 2004. EFA Global Monitoring Report, Gender and education for all The leap to equality. Paris: UNESCO. http://portal.unesco.org/education/en/ev.phpURL_ID=23023&URL_DO=DO_TOPIC&URL_SECTION=201.html Tools and resources A number of intervention tools and resources have been developed to support this three-phase strategic response framework and the steps checklisted. Available for download on the MTT website: www.mttaids.com/site/awdep.asp?dealer=5562&depnum=8525 They include: Education Sector Strategic Assessment Framework Survey questions - assess HIV impact on education employees How to evaluate HIV policies and strategies Options for establishment of HIV Management Unit Description of Strategic Planning process Tips to help MOEs prioritise activities Tips to help prioritise activities & zero budgeting Strategic Planning Workshop Budget Template for HIV and AIDS Implementation Plan HIV and AIDS Implementation Plan - Activity Matrix Workshop Evaluation Form Zero budgeting Monitoring and Evaluation Framework HIVAIDS Partnership Directory for MOEs
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Useful links
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World Bank Multi-Country HIV/AIDS Program for Africa (MAP): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAFRHE ANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001234 ~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html World Economic Forum: www.weforum.org/globalhealth World Health Organization: www.who.int/en/ World Vision www.worldvision.org/
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by L. Teasdale
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High-risk behaviour: Activities that put individuals at greater risk of exposing themselves to a particular infection. In association with HIV transmission, high-risk activities include unprotected sexual intercourse and sharing of needles and syringes. Highly active antiretroviral therapy (HAART): A combination of three or more antiretroviral drugs that most effectively inhibit HIV replication, allowing the immune system to recover its ability to produce white blood cells to respond to opportunistic infections. HIV: Human Immunodeficiency Virus, the virus that causes AIDS, this virus weakens the bodys immune system and which if untreated may result in AIDS. HIV testing: Any laboratory procedure such as blood or saliva testing done on an individual to determine the presence or absence of HIV antibodies. An HIV positive result means that the HIV antibodies have been found in the blood test and that the person has been exposed to HIV and is presumably infected with the virus. Homosexual: A person sexually attracted to or practising sex with persons of the same sex. Immune system: The bodys defence system that prevents and fights off infections. Incidence (HIV): The number of new cases occurring in a given population over a certain period of time. The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new. Incubation period: The period of time between entry of the infecting pathogen, or antigen (in the case of HIV and AIDS, this is HIV) into the body and the first symptoms of the disease (or AIDS). Informed consent: The voluntary agreement of a person to undergo or be subjected to a procedure based on full information, whether such permission is written, or expressed indirectly. Life skills: Refers to a large group of psycho-social and interpersonal skills which can help people make informed decisions, communicate effectively, and develop coping and self-management skills that may help them lead a healthy and productive life. Log frame or logical framework: A matrix that provides a summary of what a project aims to achieve and how, and what its main assumptions are. It brings together in one place a statement of all the key components of a project. It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic of how the project is expected to work. It provides a basis for monitoring an evaluation by identifying indicators of success, and means of assessment. Maternal antibodies: In an infant, these are antibodies that have been passively acquired from the mother during pregnancy. Because maternal antibodies to HIV continue to circulate in the infants blood up to the age of 15-18 months, it is difficult to determine whether the infant is infected. Mother-to-Child Transmission (MTCT): Process by which a pregnant woman can pass HIV to her child. This occurs in three ways, 1) during pregnancy 2) during childbirth 3) through breast milk. The chances of HIV being passed in any of these ways if the mother is in good health or taking HIV treatment is quite low.
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The series
1.1 1.2 1.3 1.4 1.5
2.1 2.2 2.3
3.1 3.2 3.3 3.4
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4.1 4.2 4.3 4.4 4.5 4.6
5.1 5.2 5.3 5.4
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Educational planning and management in a world with AIDS

Setting the Scene

UNESCO-IIEPEduSector AIDS Response Trust (ESART) 2007

Franoise Caillods Deputy-Director IIEP

Peter Badcock-Walters Director EduSector AIDS Response Trust

Volume 1: Setting the Scene

53 54 54 55 56 58 60 62 71 73 75 77 78 81 82 82 83 84 86 88 97 99 103 110 111 112 113

185 189 195 200 204

Each situation is different

Structure of the series

Teaching the series: using the modules in training courses

Enjoy your work!

UNICEF UP UPE USAID VCCT VCT VIPP WCSDG WHO WV

HIV and AIDS knowledge test

The impacts of HIV/AIDS on development

About the authors

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

Before you begin

Are HIV and AIDS linked to poverty? If so, in what ways?

Does AIDS have an impact on economic growth?

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

The challenges posed by HIV and AIDS

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

Source: UNAIDS, 2005.

MODULE 1.1: The impacts of HIV/AIDS on development

Peer and social pressure

Low health and nutritional status

War and conflict

MODULE 1.1: The impacts of HIV/AIDS on development

HIV, gender and culture

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

HIV/AIDS and poverty

AIDS and poverty

Poor are at high risk of HIV infection.

Poor are vulnerable to HIV infection.

Poor become poorer because of HIV and AIDS.

Because of what it means to be poor

Incomes and resources decrease.

Resources are spent on HIV and AIDS.

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

AIDS, development and economic growth

MODULE 1.1: The impacts of HIV/AIDS on development

The private sector

MODULE 1.1: The impacts of HIV/AIDS on development

The public sector

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

Implications for the education sector

Supply and demand

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development

MODULE 1.1: The impacts of HIV/AIDS on development