HIV and Caribbean Education: HIV education in the second most severely affected region on earth David Plummer Commonwealth / UNESCO Chair in Education (HIV/AIDS) School of Education The University of the West Indies Trinidad and Tobago

Background HIV in the Caribbean The University of the West Indies

Why target young children, given that AIDS is largely a disease of sexually active adults?

Figure 1. Cumulative HIV infections in the Bahamas by age and sex to end 2005 (UNGASS 2006d)

Sexual debut before the age of 15 one quarter of 15–29 year-old women in Barbados just over 30% of young men and around 12% of young women in Guyana 63% of young men and over 37% of young women in SVG 28% of young men and 12% of young women in Haiti (Source: UNAIDS/WHO, 2005; UNGASS 2006)

Are widespread protective behaviours realistic, given that sexuality is so deep seated?

Figure 2. The number of new cases of HIV per year in Australia ( ) (Plummer & Irwin 2006)

Does sex education work, or will it simply worsen the situation?

Developing country (n=18) All studies (n=83) Outcome Number of studies Negative outcome Positive outcome Negative outcome Positive outcome Delayed sexual debut Reduced frequency of sex Reduced partner numbers Reduced sexual risk taking Increased condom use Increased contraceptive use Reduced pregnancy (self report)90012 Reduced pregnancy (lab report)40101 Reduced STI (self report)50010 Reduced STI (lab report)51012 Table 1. Number of studies reporting effects on different sexual behaviours and outcomes by study setting (Kirby, Laris & Rolleri 2006)

Gender ‘Feminisation’ of the epidemic Is poverty an adequate explanation? Is ‘disempowerment’ an adequate explanation?

Gender Who is missing? Masculine obligation & taboo Hard masculinities Educational outcomes for boys

The resilience of risk Gaps between awareness, accurate knowledge and behaviour Risk as a resilient socially-embedded phenomenon

Embedding risk Gender roles Peer group policing Stigma and discrimination Economic factors Mixed messages ABC and the missing ‘D’ Role of the health sector?

Re-visioning HIV Reject the pervasive bleak and blinkered visions of HIV Rediscover our common ground Cultivate visions of a better world that have been crafted not in spite of AIDS, but because of it

Deepening our understanding in order to deepen our response Prevention Stigma & discrimination Gender Impact & implementation

The tertiary education sector Proactive leadership Reconnect the academy with society Comprehensive engagement with the epidemic

Recent Caribbean initiatives Joint initiative between UNESCO, WB and UWI to deepen the regional educational response CARICOM COHSoD ‘Port of Spain Declaration’ on the Education Sector’s Response to HIV and AIDS Professionalisation of HIV & health and human relationships in the education sector Teacher training: regional Masters in Education (Health Promotion) ILO / UNESCO workplace strategy

Acknowledgements People with HIV, people at risk & people working with HIV The University of the West Indies UNESCO Paris & Kingston, Jamaica The Commonwealth

Thank you

Points for action  Review sex education programs elsewhere to identify best practice and reasons for negative outcomes  A deadline is needed for universal coverage of sex education  Curricula should be revisited and adjusted to ensure adequate HIV focus  Additional HIV content should be added to school curricula outside of HFLE  Additional attention should be directed to extra-mural, informal and peer-based education settings  Social dimensions that serve to entrench HIV (e.g. peer group dynamics, gender roles, stigma and discrimination) should be addressed  Constant reinforcement will be required  HFLE needs professionalising and solid academic foundations

Summary: 5 key recommendations  Strengthen HFLE and set a timetable for universal coverage  Develop an HIV education strategy which goes beyond HFLE  Develop an HIV education strategy beyond the school walls  Professionalise HIV/HFLE/School Health Promotion  Build the academic foundations for School Health Promotion

Feminisation of HIV HIV infection was found to be six times higher among 15–19 year-old females than among males of the same age in Trinidad and Tobago women under 24 years were almost twice as likely to be HIV positive than among males of the same age in the Dominican Republic teenage girls were found to be two-and-a-half times more likely to be HIV-infected, compared to their male counterparts in Jamaica Survey data on the age of sexual debut and HIV risk in Caribbean countries (Source: UNAIDS/WHO, 2005; UNGASS 2006)

gender Sex before (age 15-24)MF Barbados Dominican Republic Saint Vincent and the Grenadines Median age at first sex Jamaica Non-marital, non-cohabiting sexual partner in recent 12 months (age 15-24) Barbados Dominican Republic Jamaica

gender Comprehensive HIV knowledge (age 15-24)MFBoth Cuba Dominican Republic Haiti Trinidad and Tobago 33.0 Guyana Suriname Jamaica Condom the last time they had sex with a non-regular partner (age 15-24) Barbados Dominican Republic (2003) Dominican Republic (DHS) Haiti (2003) Jamaica 38.0(2003) Jamaica (2005)

Basic considerations The paradoxes of gender and education in the Caribbean The resilience of risk Setting a research agenda for HIV in education Re-visioning HIV The tertiary education sector Caribbean initiatives

Masculine obligation and taboo Obligations are identity related and peer policed and provide a constant pressure to engage in risk Taboos have their origins in homophobia and proscribe a range of activities, including many related to health and safety Obligations and taboos is concert underwrite: a range of risk taking activities boys educational achievement sexual praxis gender relations peer, clique and gang codes hypermasculinity and criminal engagement