Effective Interventions to Address the Impact of HIV on School-Age Girls

With the progression of HIV/AIDS/AIDS, the education sector has emerged as an important arena for preventing new infections and maintaining the HIV-free status of young people.Beasley, M, Valerio, A and Bundy, D (2008, p.ix) Education and HIV AIDS: A Sourcebook of HIV/AIDS Prevention Program Vol 2 Education-Sector-Wide Approaches. Washington DC: The World Bank. http://siteresources.worldbank.org/EDUCATION/Resources/278200-1099079877269/547664-1099080042112/SourcebookofHIVAIDSvolume2.pdf (Accessed 17 July 2012) Therefore school-based programs and solutions to mitigate the impact of HIV on girls and prevent new infections among girls hinge on keeping them in school.UNAIDS Inter-Agency Task Team (IATT) on Education (2008) Girls Education and HIV Prevention: http://unesdoc.unesco.org/images/0015/001586/158670e.pdf (Accessed 17 July 2012) Intervention efforts that have had measurable impact have focused directly on girls and their everyday realities.

Elimination of all costs associated with schooling

Background on primary school fees in Sub-Saharan Africa

During the 1980s and 1990s, international financial institutions like the World Bank engaged in cost-sharing, where they met parts of the education costs for children in Sub-Saharan Africa.Riddell, A (2003, p2) The Introduction of Free Primary Education in Sub-Saharan Africa. Background Paper Prepared for the Education for All Global Monitoring Report 2003/4 Gender and Education for All: The Leap to Equality. http://unesdoc.unesco.org/images/0014/001469/146914e.pdf (Accessed 24 July 2012) This was particularly important for primary-school age girls given that: (1) by the end of the 1980s the net enrolment rate for girls in Sub-Saharan Africa was 51 per cent and (2) per capita income decreases due to slow economic growth.Reimers, F (1997, p6-8) Education and Structural Adjustment: Unmet Needs and Missed Opportunities. http://isites.harvard.edu/fs/docs/icb.topic648757.files/EducationAndStructuralAdjustment_Reimers1997pp3-18.pdf (Accessed 24 July 2012) The latter condition increased the ratio of household income that families had to put towards meeting school-going cost associated with tuition, notebooks, uniforms and transportation.

Primary school fees as a barrier to girls’ education

Eliminating all costs associated with schooling reduces the economic burden on poor families to send children to school. This is particularly important where parents have previously had to choose between their children: girls will more likely have the opportunity to go to school.Morgan, C., Petrosino, A., Fronius, T (2012) A systematic review of the evidence of the impact of eliminating school user fees in low-income developing countries. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. http://www.dfid.gov.uk/r4d/pdf/outputs/systematicreviews/SchoolFees2012MorganReport.pdf (Accessed 19 July 2012) A randomised controlled experiment in primary schools in Western Kenya found fewer dropouts and a lower rate of early marriage and teenage childbearing.Duflo E., et al (2007, p.4) Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya. Background Paper to the 2007 World Development Report. http://poverty-action.org/sites/default/files/Duflo%20et%20al.%2006.06_1.pdf (Accessed 18 July 2012)

Provision of Information Relevant to Lived Experience

HIV prevention messaging should be applicable to the recipients’ lives; general information is less likely to effect change in behavior, attitudes, or self efficacy. Further, HIV education and prevention information should be gender sensitive and shared in an enabling and safe environment. For example, United NationsICEF’s HIV programming in Eastern and Southern Africa (ESA) during 2009 and 2010 explicitly included gender and focused on life skills and peer education.UNICEF Preventing Infections Among Adolescents and Young People (Online). http://www.unicef.org/esaro/factsonchildren_5802.html (Accessed 24 July 2012) In Western Kenya, providing girls with HIV prevalence information disaggregated by age and sex caused girls to reduce their risk of contracting HIV by avoiding sexual relationships with older men.Duflo E., et al (2007, p.4) Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya. Background Paper to the 2007 World Development Report. http://poverty-action.org/sites/default/files/Duflo%20et%20al.%2006.06_1.pdf (Accessed 18 July 2012)

Multifaceted Approaches for HIV and AIDS Prevention

Cooperation Across Sectors

National multi-sectoral efforts and cooperation to ensure girls attend school in an environment where they are comfortable and secure allows them to thrive and accrue maximum benefits from schooling. For example provision of school supplies should also be accompanied by the installment and maintenance of adequate water and sanitation systems.UNAIDS Inter-Agency Task Team (IATT) on Education (2008) Girls Education and HIV Prevention: http://unesdoc.unesco.org/images/0015/001586/158670e.pdf (Accessed 17 July 2012), UNICEF (2010) Water Sanitation and Hygiene: WASH in Schools and Gender Equality. http://www.unicef.org/media/media_45481.html (Accessed 18 July 2012)

Integrated Approaches to HIV Prevention

United NationsFPA promotes the prevention of HIV/AIDS among adolescents through integrated communication programming.UNFPA Preventing HIV/AIDS Among Adolescents Through Integrated Communication Programming (p4-11). http://www.unfpa.org/upload/lib_pub_file/224_filename_hiv_adolescents02.pdf (Accessed 24 July 2012) Such programming is rooted in a rights based approach and emphasizes and capitalizes on the synergy between three prevention modalities:

• Advocacy: promotes changes in social norms, policy, programming, and legal frameworks.
• Behaviour change communication: enables individuals to understand their personal circumstances and encourages the individuals to modify their actions and in doing so improve their quality of life.
• Education: refers to the acquisition of attitudes, values, and skills with affect individual and social life in the areas of population and development, reproductive health, adolescent reproductive health, HIV/AIDS and gender.

These three interconnect to ensure that young people have accurate, appropriate, and practical information to enable them to make decisions that reduce their vulnerability to HIV infection.

HIV Prevention Programs Information Sharing

Programs and approaches to address the impact of HIV in the education sector vary according to context but may sometimes be generalisable. Different countries and entities have designed and implemented HIV prevention programs for school-age children, and in response to calls for mutual learning and information sharing, the World Bank created a resource book cataloging approaches being employed in the education sector globally.Beasley, M, Valerio, A and Bundy, D (2008) Education and HIV AIDS: A Sourcebook of HIV/AIDS Prevention Program Vol 2 Education-Sector-Wide Approaches. Washington DC: The World Bank.

References

Further Reading

• Gallanta, M and Maticka-Tyndale, E (2004) School-based HIV Prevention Programmes for African Youth. http://web2.uwindsor.ca/courses/sociology/maticka/psabh/published_papers/ss%26m.pdf
• Innovations for Poverty Action (2012) Teacher Training and Free Uniforms for HIV Prevention in Primary Schools in Kenya. http://www.poverty-action.org/project/0409
• Abrahams, N., Mathews, S., and Ramela P. (2006) Intersections of ‘sanitation, sexual coercion and safety in schools’. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2006.01600.x/full
• Rotheram-Borus M J et al (2009) Common Principles Embedded in Effective Adolescent HIV Program. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883464/