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Education and HIV/AIDS

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1 Education and HIV/AIDS
“Global success in combating HIV/AIDS must be measured by its impact on our children and young people. Are they getting the information they need to protect themselves from HIV? Are girls being empowered to take charge of their sexuality? Are infants safe from the disease, and are children orphaned by AIDS being raised in loving, supportive environments? These are the hard questions we need to be asking. These are the yardsticks for measuring our leaders. We cannot let another generation be devastated by AIDS.” - Carol Bellamy, UNICEF Executive Director Educating young people about HIV, and teaching them skills in negotiation, conflict resolution, critical thinking, decision-making, and communication, improves their self-confidence and ability to make informed choices, such as postponing sex until they are mature enough to protect themselves from HIV, other STIs and unwanted pregnancies. It is important to reach young people with HIV/AIDS prevention education as early as possible. Therefore, children can be introduced to age-appropriate information and skill-building exercises well before adolescence. A major challenge is to reach both in school and out of school youth.

2 11.8 million Young People (15-24) Living with HIV/AIDS
7.3 million young women million young men 38% 62% South Asia 1.1 million Industrialized Countries 240,000 67% 33% Middle East & North Africa 160,000 59% 41% Central and Eastern Europe 430,000 35% 65% 49% 51% East Asia & Pacific 740,000 31% 69% Latin America & Caribbean 560,000 Sub-Saharan Africa 8.6 million The pie charts indicate the percent of females and males infected with the virus in each region. Young people in sub-Saharan Africa are bearing the brunt of the epidemic but large numbers of young people in South Asia, East Asia and the Pacific, and the Caribbean are now living with HIV/AIDS. In some regions, young males still have higher rates of infection than females – primarily because the epidemics in these regions are driven by IDU and MSM. In Africa, the Caribbean and South Asia, however, year-old girls are becoming infected at a much higher rate than young men. In some countries the ratio is up to 6:1, girls to boys infected with the virus. Source: UNAIDS/UNICEF, 2000

3 Number of Young People age 15-24 years old, 2005 estimate
Europe 100 million North America 50 million Asia 700 million Caribbean & Latin America 100 million Africa 180 million By 2005, it is estimated that there will be a total of 1.2 billion young people between age 15 and 24 years old. This means that life skills-based education programmes - both formal and non-formal education strategies - need to reach over 1 billion young people. UNICEF Division of Policy and Planning, Strategic Information Unit Oceania 5 million Total: 1.2 billion Young People that need to be reached with LIFE SKILLS

4 Most Adolescents Know Little about HIV Prevention
% of young women (15-19) who have heard of AIDS and % who know the three primary ways of avoiding infection* 26 41 54 57 58 59 67 69 73 77 84 85 88 90 91 93 94 95 97 99 1 11 23 5 9 24 15 22 14 33 27 19 29 16 38 20 30 56 46 25 50 75 100 Somalia Guinea Bissau Madagascar Azerbaijan Uzbekistan Sierra Leone Senegal Niger Chad Bolivia Gambia Vietnam Comoros Kenya Cameroon Yugoslavia (FR) Côte d'Ivoire Botswana Moldova U. R. Tanzania Bosnia and Herzegovina Dominican Republic Ukraine Cuba Heard of AIDS Know the 3 main ways of protection % New studies from across the globe have established that while many young people have heard of HIV/AIDS, the vast majority of young people are not well informed about how it is transmitted or how to protect themselves from the disease. In Cameroon, although 90% of girls have heard of AIDS, only a third of them can identify the three primary ways to prevent HIV infection. In Somalia, only 26% of girls have heard of AIDS; only 1% know how to avoid infection. In Ukraine, 99% of girls have heard of AIDS, but only 9% can correctly identity the three primary ways of avoiding infection. *three primary ways (ABC): Abstinence; Be faithful; Consistent condom use Source: UNICEF/MICS, DHS

5 Most Adolescents have Misconceptions about HIV/AIDS
% of young women (aged 15-19) who have at least one major misconception about HIV/AIDS or have never heard of AIDS Misconceptions about HIV/AIDS are widespread among young people. They vary from one culture to another, and particular rumours gain currency in some populations both on how HIV is spread (for example, by mosquito bites or witchcraft) and on how it can be avoided (by eating a certain fish, for example, or having sex with a virgin). Surveys from 40 countries indicate that more than 50% of young people aged 15 to 24 harbour serious misconceptions about how HIV/AIDS is transmitted. Interventions need to ensure that young people know the facts about HIV, but also that misconceptions are dispelled because this can affect their motivation to protect themselves (e.g. if they believe they can be infected with a mosquito bite, they may think it useless to use a condom) Misconceptions (%) East Asia & the Pacific Latin America & Caribbean Eastern & Southern Africa West & Central Africa Middle East & North Africa CEE/CIS and Baltic States Source: UNICEF/MICS, Measure DHS, Misconceptions: HIV can be transmitted through witchcraft; mosquito bites; or believe a healthy-looking person cannot have AIDS virus.

6 Adolescents in Latin America & the Caribbean “Regarding AIDS, I feel…
Very informed = 4 Moderately informed = 3 Not very informed = 2 Not at all informed = 1 This bar chart provides examples from Latin America of how adolescents rate their own level of knowledge and information on HIV/AIDS and Sex Education. The adolescents shown here do not feel very informed about HIV/AIDS or sex education. Voices of children and adolescents in Latin America and the Caribbean. Regional Survey. UNICEF, 2000.

7 Few Have Sufficient Knowledge to Protect Themselves
% of young women (aged 15–24) who have heard of AIDS and have sufficient knowledge to protect themselves 94 27 91 4 97 14 37 33 93 13 3 96 17 93 16 43 2 90 99 23 70 5 81 18 84 15 59 72 26 The majority of women that have heard of HIV/AIDS do not have sufficient knowledge to protect themselves. “Sufficient knowledge” to protect one’s self from HIV/AIDS is defined as knowing three major ways to help prevent transmission (Abstain from sex, Use a condom every time, Have one faithful uninfected partner), and knowing the facts behind three major misconceptions (AIDS is not transmitted by supernatural means, AIDS is not transmitted by mosquito bites, A healthy looking person can be infected). Young people and HIV/AIDS, Opportunity in Crisis. UNICEF, UNAIDS, WHO, 2002. Multiple Indicator Cluster Survey, UNICEF. Demographic and Health Survey, Macro Int. Have heard of AIDS Have sufficient knowledge to protect themselves Source: UNICEF/MICS & Measure DHS,

8 Education Makes a Difference % of youth (aged 15-19) in Cameroon who know that a healthy looking person can have HIV, 1998 Know Don’t Know Young people cannot protect themselves if they do not know the facts about HIV/AIDS. Adolescents must learn the facts before they become sexually active, and the information needs to be regularly reinforced through schools, communities and the media. It is necessary to maintain continued HIV/AIDS education in order to reach each new cohort of adolescents and to build upon the existing knowledge of all young people. Boys Girls 91% Never in school 83% Young people cannot protect themselves if they do not know the facts about HIV/AIDS. Adolescents must learn the facts before they become sexually active, and the information needs to be regularly reinforced through schools, communities and the media. The pie chart illustrates an example in Cameroon where adolescents who have not attended school have higher levels of misconception about HIV+ healthy looking people. It is necessary to maintain continued HIV/AIDS education in order to reach each new cohort of adolescents and to build upon the existing knowledge of all young people. No longer in school 52% 45% Still in school 32% 26% Source: DHS, 1998.

9 Condom Use & Educational Attainment
% of unmarried adolescents (aged 15-19) in Côte d’Ivoire reporting condom use during sexual intercourse by educational status, 1998 100 80 60 As seen in Cote d’Ivoire, there is a positive correlation between educational attainment and condom use. The proportion of unmarried adolescents reporting condom use during last sexual intercourse increased with each level of education. Cote d’Ivoire 1998. Percentage using condoms during last sexual intercourse Boys 45 Girls 40 40 28 26 20 20 19 No education Primary Education Secondary and higher education Source: Enquete de surveillance de comportements relatifs aux MST/SIDA en Côte d'Ivoire. BSS, ENSEA,FHI/IMPACT, IRESCO.

10 Teaching Children about HIV/AIDS Prevention
% of women (age 15-49) who have heard of AIDS and who think that children age should be taught how to use condoms to avoid AIDS, by educational status, selected countries 2000 52% 38% 45% 55% 80% 48% 56% 65% 87% 0% 20% 40% 60% 100% Malawi Gabon Haiti Cambodia There is also a positive correlation between women’s educational attainment and the belief that children age should be taught how to use condoms to protect themselves from HIV/AIDS. As women become more educated, a greater percentage of women believe that children should be taught to use a condom to prevent HIV. “Young people need adult assistance to deal with the thoughts, feelings and experiences that accompany physical maturity….Evidence from around the world has clearly shown that providing information and building skills on human sexuality and human relationships help to avert health problems and create more mature and responsible attitudes.” - Dr. Gro Harlem Brundtland, Director-General, World Health Organization No education Primary school Secondary+

11 Knowledge of HIV Testing Facilities Increases with Education
% of young women who know where to get an HIV test by education level Suriname, 2000 Young women’s knowledge of HIV testing facilities has been shown to increase with education. Suriname, 2000. Voluntary and confidential HIV counselling and testing (VCT) is an important tool for preventing HIV. Despite the importance of VCT, in many countries fewer than 50 percent of young people know where they can be tested for HIV. VCT allows adolescents and young people to evaluate their behaviour and its consequences. A negative test result offers a key opportunity to reinforce the importance of safety and risk-reduction behaviours. Young people who test HIV positive must receive referrals for care and opportunities to talk to knowledgeable people who can help them understand what their HIV status means and the responsibilities they have to themselves and others as a result. Post-test support services should serve as a safety net to help them continue to meet their health, psychosocial and financial needs. Young people and HIV/AIDS, Opportunity in Crisis. UNICEF, UNAIDS, WHO, 2002. Know test place (%) N=1675 Source: Surinam-MICS/UNICEF, 2000

12 Adult Knowledge of HIV Testing Facilities
Increases with Educational Attainment When examining the correlation between knowledge of HIV testing facilities and educational levels for all men and women of reproductive age, it is apparent that knowledge increases with educational level. Malawi, Tanzania, 1999. Know test place (%) Source: Malawi 2000 DHS, Tanzania 1999 DHS.

13 Countries Need HIV/AIDS Training for Secondary School Health Personnel
CHINA, N=573 Knowledge of AIDS 99% Willing to conduct AIDS prevention 89% education Willing/No objection to provide direct 86% services/help for HIV-positive students HIV/AIDS prevention education for young people can only be successful if quality information and facts are provided together with activities that help youth to develop the necessary skills to protect themselves. It is necessary to have properly informed educators, therefore countries must invest in the training of teachers, peer educators, health personnel, and community leaders. Not sure if AID is curable 31% Transmitted through Mosquitoes 41% Transmitted through Toilets 19% 0% 20% 40% 60% 80% 100% Source: AIDS Prevention Knowledge, Attitudes and Education Practice of Secondary School Health Personnel in China. Jinqi Chen; Decai Zhao; Michael P. Dunne. December th International Congress on AIDS in Asia and the Pacific, 5-10 October 2001, Melbourne, Australia. Abstract Book, page 29.

14 Reach All Adolescents with AIDS Education
% of 14 year olds in primary school, secondary school or out of school, 2000 36% 48% 16% Lesotho, Boys & Girls 72% 8% 20% Guinea Bissau, Boys & Girls 46% 10% 1% 53% Senegal, Boys 37% 9% 4% 50% Senegal, Girls 24% 3% 65% Cameroon, Urban Boys & Girls Cameroon, Rural Boys & Girls 62% 15% 23% In many sub-Saharan African countries, adolescents become sexually active by age 15. HIV/AIDS education, therefore, must reach all young people before they become sexually active because it is easier to instil safer sex practices early than to change established risky behaviour. Interventions must account for differences between young people living in rural and urban areas, in school and out of school, younger and older adolescents, boys and girls. A basic education of good quality for all children and young people (both in and out of school) offering sound knowledge about sexuality and HIV is essential. In many sub-Saharan African countries, adolescents become sexually active by age 15. HIV/AIDS education, therefore, must reach all young people before they become sexually active because it is easier to instil safer sex practices early than to change established risky behaviour. Interventions must account for differences between young people living in rural and urban areas, in school and out of school, younger and older adolescents, boys and girls. Non-standard education Primary school Secondary school Out-of-school Source: UNICEF, MICS, 2000

15 School is a Protective Factor
% of girls who were not yet sexually active at various ages, by schooling status, Kenya 1993 and 1998 In school According to the data from Kenya, young women who are out of school engage in sexual activity at an earlier age than those who attend school. Young girls are at a very high risk of getting infected with HIV for a number of reasons including early marriage, biological immaturity, “age mixing” (older men having sex with young girls), and transactional sex. School is a protective factor. Keeping girls in school allows them a greater chance to mature and develop the knowledge and skills necessary to protect themselves from HIV/IDS. Out of school Source: DHS

16 Prevention programmes must target all adolescents, including those out-of-school
Rural areas Urban areas Age N=8,950 % out-of-school % in secondary school % in primary school Young adolescence 10-14 year olds Official primary school age Where are they? % out-of-school AIDS education needs to start early: before adolescents become sexually active and while they are still in school. In India, 42 % of boys and 59 % of girls aged 15 to 17 are not in school, yet HIV/AIDS education is often introduced in schools only for children aged 15 and older. Education for HIV prevention should be timely, age-appropriate, and relevant to the situations and culture of young people and their families. More than 120 million children of primary school age are not in school; 53 % of them are girls, and the gender gap widens further in secondary school. Efforts to reach out-of-school youth are essential. Urban/Rural consideration must be taken into account. % in secondary school % in primary school % in pre-school Young adolescence Source: Cameroon-MICS/UNICEF, 2000

17 Impact of Parents’ Death on Schooling
% of youth (aged 10-14) in school according to whether their parents are alive Selected countries, 100 living with one or both parents both parents dead 90 80 70 60 Children whose parents have died are less likely to attend school than those who have not lost a parent. Children may drop out of school due to the inability to pay school fees, to care for parents infected with HIV or for younger siblings, or to work to support the family. Orphans also leave school because of discrimination and emotional distress. Children who leave school are less likely to develop the skills necessary to abstain from sex or practice safe sex; they are economically vulnerable, and open to sexual exploitation and HIV infection. Proportion of children in school (%) 50 40 30 20 10 Benin Cameroon Chad Mali Niger Togo Peru Tanzania Haiti Bolivia Côte d'Ivoire Guatemala Source: Demographic and Health Surveys, Macro International, USA, and UNICEF, 2000

18 Kenya Zambia Impact of HIV/AIDS on Teachers 1995 1999 1996 1998
Number of deaths of teachers between 1995 and 1999, Kenya and Zambia 1600 Kenya Zambia 1400 1200 1000 As the epidemic progresses, HIV/AIDS begins to have a devastating effect on the educational system. In many of the most affected countries, teachers are dying from AIDS at an alarming rate, leaving the countries with a deficit of trained educators. Number of deaths 800 600 400 200 1995 1999 1996 1998 Source: Adapted from World Bank, Education and HIV/AIDS: A Window of Hope, 2002

19 Children are Adversely Affected by the Loss of Teachers to AIDS
Children are adversely affected by the loss of their teachers to AIDS deaths. A viscous cycle: The HIV/AIDS epidemic spreads and becomes generalised in the population, affecting all sectors of society. Teachers die of AIDS and leave a shortage of trained educators. Young people are unable to receive good quality education which includes knowledge and skill development to protect themselves from HIV/AIDS. Greater numbers of uninformed young people become infected. The epidemic continues to grow. To make a read and lasting difference, the commitment and resources of all sectors must be mobilised, coordinated and channelled to families and communities to protect young people from HIV/AIDS. There must be a commitment to bring people together at every level - community, nation, region, world-wide - to invest in young people.

20 Education is a Major Component of the 10 Step Strategy to Prevent HIV/AIDS
1. End the silence, stigma and shame. 2. Provide young people with knowledge and information. 3. Equip young people with life skills to put knowledge into practice. 4. Provide youth-friendly health services. 5. Promote voluntary and confidential HIV counselling and testing. 6. Work with young people, promote their participation. 7. Engage young people who are living with HIV/AIDS. 8. Create safe and supportive environments. 9. Reach out to young people most at risk. 10. Strengthen partnerships, monitor progress. Young people and HIV/AIDS, Opportunity in Crisis. UNICEF, UNAIDS, WHO, 2002. Young people are at the centre of the global HIV/AIDS pandemic. They also are the world’s greatest hope in the struggle against this fatal disease. Educating young people about HIV, and teaching them skills in negotiation, conflict resolution, critical thinking, decision-making, and communication, improves their self-confidence and ability to make informed choices to protect themselves from HIV/AIDS. Part of an AIDS education and awareness project, girls sit on the floor around a large poster, drawing lines to connect groups at risk of contracting HIV/AIDS, at the Pang Lao School, in the northern city of Chiang Rai. Thailand.


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