HIV/AIDS is the global issue of new era of science and technology and we should know that the problem of widespread AIDS is challenge for human survival. Children and young people need to be equipped with the knowledge, attitudes, values and skills that will help them face these challenges and assist them in making healthy life-style choices as they grow. Education delivered through schools is one of the ways through which children can be helped to face these challenges and make such choices.
Providing information about HIV (transmission, risk factors, how to avoid infection) is necessary, but not sufficient, to lead to healthy behavioral change. Programs that provide accurate information, to counteract the myths and misinformation, frequently report improvements in knowledge and attitudes, but this is poorly correlated with behavioral change related to risk taking and desirable behavioral outcomes. Education can be effective in the more difficult task of achieving and sustaining behavior change about HIV/AIDS. The schools can either be a place that practices discrimination, prejudice and undue fear or one that demonstrates societys commitment to equity.School policies need to ensure that every child and adolescent has the right to life education; particularly when that education is necessary for survival and avoidance of HIV infection.
HIV infection is one of the major problems facing school-age children today. They face fear if they are ignorant, discrimination if they or a family member or friend is infected, and suffering and death if they are not able to protect themselves from this preventable disease.
It is estimated that 40 million people, worldwide, are living with HIV or have AIDS, at least a third of these are young people aged 15-24. In 1998 more than 3 million young people worldwide became infected including 590,000 children under 15. More than 8,500 children and young people become infected with HIV each day . In many countries over 50% of all infections are among 15-24 years old, who will likely develop AIDS in a period ranging from several months to more than 10 years.
Studies have shown the enormous impact HIV and AIDS have on the education sector and the quality of education provided, particularly in certain regions of the world such as Sub Saharan Africa. Consequences of the AIDS epidemic include a probable decrease in the demand for education, coupled with absenteeism and an increase in the number of orphans and school drop out, especially among girls. Girls are socially and economically more vulnerable to conditions that force people to accept risk of HIV infection in order to survive. A decrease in education for girls will have serious negative effects on progress made over the past decade toward providing an adequate education for girls and women. Reduced numbers of classes or schools, a shortage of teachers and other personnel, and shrinking resources for educat ional systems all impair the prospects for education.
Effective HIV/AIDS education and prevention is needed in all schools for all children so that no one is left ignorant. Yet in many places schools are apprehensive about providing sex education or discussions of sexuality because of cultural demands to protect adolescents from sexual experience. Women often lack skills needed to communicate their concerns with their sexual partners and to practice behaviors that reduce their risk of infection, such as condom use, which is often controlled by men.
The school can either be a place that practices discrimination, prejudice and undue fear or one that demonstrates societys commitment to equity. School policies need to ensure that every child and adolescent has the right to HIV/AIDS education; particularly when that education is necessary for survival and avoidance of HIV infection.
A UNAIDS review (1997) of 53 studies which assessed the effectiveness of prog rams to prevent HIV infection and related health problems among young people concluded that sex education programs do not lead to earlier or increased sexual activity among young people, in fact the opposite seems to be true. 22 reported that HIV and/or sexual health education either delayed the onset of sexual activity, reduced the number of sexual partners or reduced unplanned pregnancies and STD rates. 27 studies reported that HIV/AIDS and sexual health neither increased nor decreased sexual activity, pregnancy or STD.
The review concluded that school based interventions are an effective way to reduce risk behaviors associated with HIV/AIDS/STD among children and adolescents.
There are three main objectives for this paper to integrate the education effectively with the HIV/AIDS preventions and other health aspects related with it.
These are as follows:
Objectives:
1) Health education focusing on HIV/AIDS prevention.
2) Raising awa reness about HIV/AIDS among educators and learners.
3) Stimulate peer support and HIV/AIDS counseling in schools.
The main focus of the paper is to give the importance to the HIV/AIDS precaution with the health education raising the awareness about it among all the students as well as their teachers also and provide the supportive environment for the HIV/AIDS education for all.
Need of HIV/AIDS education:
In area such as HIV/AIDS prevention individual behavior, social and peer pressure, cultural norms and abusive relationships may all contribute to the health and lifestyle problems of children and adolescents. There is now increasing evidence that in tackling these issues and health problems, a healthy approach to HIV/AIDS and sex education works, and is more effective than teaching knowledge alone. T
here are numerous studies indicating that providing information about issues such as sex, STDs (Sexually Transmitted Diseases) and HIV (trans mission, risk factors, how to avoid infection) is necessary, but not sufficient, to lead to healthy behavioral change (Hubley, 2000). Programs that provide accurate information, to counteract the myths and misinformation, frequently report improvements in knowledge and attitudes, but this is poorly correlated with behavioral change related to risk taking and desirable behavioral outcomes (Gatawa 1995, UNAIDS 1997a). HIV/AIDS with health education can be effective in the more difficult task of achieving and sustaining behavior change.
Health education with HIV/AIDS is widely applicable:
This problems largely affecting men and women as well as older children and adolescents, both this age group and younger children also face a wider range of health problems where education can play a vital role in sustainable prevention and management. Health education with HIV/AIDS programs plays a vital role in preventing infections. This is done through promoting knowledge of areas such as symptoms, transmission, and behaviors that are specifically relevant to many infection in each community; attitudes such as responsibility for personal, family and community health, confidence to change unhealthy habits; skills such as avoiding behaviors that are likely to cause infection, encourage others to change unhealthy habits, communicate messages about infection to families, peers and members of the community (WHO, 1996).
This kind of health education with HIV/AIDS prevention focuses upon the development of Knowledge, Attitudes, Values, and Skills (including life skills such as inter-personal skills, critical and creative thinking, decision making and self awareness) needed to make and act on the most appropriate and positive health-related decisions. Health in this context extends beyond physical health to include psycho-social and environmental health issues.
This approach utilizes student centered and participatory methodologies, giving participants the opportunity to explore and acquire health promoting knowledge, attitudes and values and to practice the skills they need to avoid risky and unhealthy situations and adopt and sustain healthier life styles.
HIV/AIDS a critical need for health education:
HIV/AIDS is an area where the scale and impact of the problem is such that the urgency of implementing preventative measures, including health education, is critical. Health education programs are being increasingly adopted as means of reaching children and young people to help halt the spread of this crippling epidemic. Studies from African countries show that children between the ages of 5 and 14 have the lowest prevalence of HIV infection. Below the age of 5 they are susceptible to mother to child transmission and after they become sexually active, the rate of infection increases rapidly especially for girls (K elly, 2000). Children aged 5-14 need to be reached at this critical stage in their lives and offer the window of hope in stopping the spread of HIV/AIDS.
Health Education with HIV/AIDS prevention Does Change Behavior:
There is now strong evidence from an increasing number of studies that health education HIV/AIDS prevention applied in an appropriate context, changes behavior including behavior in sensitive and difficult areas where knowledge based health education has failed.
For example: Sexuality and HIV education USA:
This study was implemented in 4 schools in New York City with 9th and 11th grade students (867 students), in intervention (AIDS prevention program) and control classes (no AIDS prevention program). The program focused on correcting facts about AIDS, teaching cognitive skills to appraise risk of transmission, increasing knowledge of AIDS-prevention resources, changing perceptions of risk-taking behavior, clarifying personal values , understanding external influences and teaching skills to delay intercourse and/or consistently use condoms. An evaluation carried out three months after the end of the program found that the intervention group showed the following positive behavioral outcomes when compared with the control group: decrease in intercourse with high risk partners, increase in monogamous relationships and an increase in consistent condom use. (Walter & Vaughan, 1993).
HIV/AIDS prevention-Nigeria:
Health education programs are being implemented in many schools in Nigeria to increase levels of knowledge, influence attitudes and encourage safe sexual practices among secondary school students. A study to evaluate one such program was conducted comparing 223 students who received comprehensive sexual health education with 217 controls. Students in the intervention group received 6 weekly sessions lasting 2-6 hours, with activities including lectures, film shows, role-play stories, songs, debates, essays and a demonstration of the correct use of condoms. Following the intervention, students in the intervention group showed a greater knowledge and increased tolerance of people with AIDS compared to the control. The mean number of sexual partners also decreased in the intervention group, while the control group showed a slight increase. The program was also successful in increasing condom use (Fawole et al., 1999) Above mentioned studies shows that health education with HIV/AIDS prevention does change the behavior of students especially adolescents.
Method for implementing Health Education with HIV/AIDS prevention:
Although there is strong evidence that HIV/AIDS prevention is effective when properly applied and supported, implementing this approach and achieving this success on a larger, countrywide scale is one of the greatest challenges to be faced.
To be effective, HIV/AIDS prevention programs must address the following areas:
Reassure stakeholders that these messages are beneficial:
Talking and teaching about reproductive health and HIV/AIDS issues does not result in earlier initiation of sex or promiscuity. The evidence suggests that well implemented skills-based programs, conducted in an atmosphere of free discussion of all the issues, is likely to lead to young people delaying the initiation of intercourse and reducing the frequency of intercourse and number of sexual partners (Kirby et al. 1994, UNAIDS 1997a).
Provide support to teachers: The lack of support for implementation of new programs is one of the most important factors affecting success. For most teachers both the content and methods of HIV/AIDS prevention programs are new and perhaps sensitive, and yet the approach has great potential to assist teachers both in their work and also their personal lives since HIV/AIDS is, of course, also affecting teachers. Sufficient support, training, practice and time needs to b e available to teachers, in both pre- and in-service training sessions and workshops, to facilitate reflection and development of their own attitudes, and to motivate them to apply their new knowledge and skills, rather than continue with the more didactic, traditional teaching methods, which are often focused on information alone (Gatawa 1995, Gachuhi 1999). In addition, sufficient time and an appropriate place must also be given in the curriculum so that all students have access to HIV/AIDS prevention.
Start early: As well as targeting adolescents, programs need to be targeted at children at an early age, with developmentally appropriate messages, before they leave school (Gachuhi 1999, Partnership for Child Development 1998). Because younger children are generally not sexually active, these programs will address the building blocks for healthy living and avoiding risk, rather than the very specific issues related to sexual relationships and HIV/AIDS which are progr essively introduced to programs for older ages. However, the large number and diverse age range of children within primary schools is an enduring challenge, especially when addressing sensitive issues. Active and self-directed learning methods which are commonly used in education can be helpful in overcoming these classroom management issues to some extent.
Provide a supportive environment: Schools need to have strong policies and a healthy supportive environment in terms of behavior of students towards each other, teachers and school personnel. Sexual abuse can occur in schools, with both boys and girls reporting abuse by school staff (Kinsman et al. 1999, Lowensen et al. 1996). Programs need to address this potential problem by training and supporting teachers, so that they can become role models rather than neutral or adverse figures in relation to sexual behavior.
Respond to local needs: Many of the models for HIV/AIDS prevention have been developed in west ern, developed countries. The available evidence from developing countries, although more limited in scope than the studies from non-developing countries, supports skills-based health education for HIV/AIDS and reproductive health (Hubley, 2000). The main issue is that wherever programs are to be implemented they must be shaped to meet the local socio-cultural norms, values and religious beliefs, and need to include ongoing monitoring (Kirby et al 1994, UNAIDS 1999, Kinsman et al.1999).
Elements of a Health Education for HIV/AIDS prevention:
Reviews of school-based HIV/AIDS prevention programs (23 studies in the USA (Kirby et al. 1994), 37 other countries (reported in UNAIDS 1999) and 53 studies in USA, Europe and elsewhere (UNAIDS 1997a) have identified the following common characteristics of successful programs:
1.Focus on a few specific behavioral goals, (such as delaying initiation of intercourse or using protection), which requires knowledge, attitu de and skill objectives.
2.Provision of basic, accurate information that is relevant to behavior change, especially the risks of unprotected intercourse and methods of avoiding unprotected intercourse. 3.Reinforcement of clear and appropriate values to strengthen individual values and group norms against unprotected sex.
4.Modeling and practice in communication and negotiation skills particularly, as well as other related life skills.
5.Use of Social Learning theories as a foundation for program development.
6.Addressing social influences on sexual behaviors, including the important role of media and peers.
7.Use of participatory activities (games, role playing, group discussions etc.) to achieve the objectives of personalizing information, exploring attitudes and values, and practicing skills.
8.Extensive training for teachers/implementers to allow them to master the basic information about HIV/AIDS and to practice and become confid ent with life skills training methods.
9.Support for reproductive health and HIV/STD prevention programs by school authorities, decision and policy makers, as well as the wider community.
10.Evaluation (e.g. of outcomes, design, implementation, sustainability, school, student and community support) so that programs can be improved and successful practices encouraged.
11.Age-appropriateness, targeting students in different age groups and developmental stages with appropriate messages that are relevant to young people. For example one goal of targeting younger students, who are not yet sexually active, might be to delay the initiation of intercourse, whereas for sexually active students the emphasis might be to reduce the number of sexual partners and use condoms.
12.Gender sensitive, for both boys and girls.
Conclusions:
Health Education with HIV/AIDS prevention offers an effective approach to equipping children and young people with the knowledge, attitudes and skills that they need to help them avoid risk taking behavior and adopt healthier life styles. The scope of health education means that it can be applied to a wide range of areas, especially STDs and HIV/AIDS prevention, but also including violence, substance abuse, unwanted situations such as early pregnancy and all areas where knowledge and attitudes play a critical role in promoting a healthy lifestyle for children and young people growing up in the 21st century. We can sum it in following points- The constitutional rights of learners and educators must be protected equally.
There should not be compulsory disclosure of HIV/AIDS status.
No HIV positive learner or educator may be discriminated against.
Learners must receive education about HIV/AIDS and abstinence in the context of life- skills education as part of the integrated curriculum.
Educational institutions should ensure that learners acquire age and context a ppropriate knowledge and skills to enable them to behave in ways that will protect them from infection.
Educators need more knowledge of, and skills to deal with HIV/AIDS and should be trained to give guidance on HIV/AIDS.
Suggestions for implications for policies and programmes:
Male and female condom promotion efforts need to recognize, identify and address gender issues including sexual and other forms of violence, that inhibit condom use.
HIV/AIDS, peer education, and sex education programmes for adolescents that incorporate gender equality issues into their framework should be fostered. Such programmes should enable a better understanding of how norms related to masculinity and femininity may increase risky sexual behaviour, and help young people begin thinking about how to work towards equal and responsible relationships.
Voluntary Counselling and Testing (VCT) services should take into account the risk of violence and other adverse c onsequences when evaluating different approaches to disclosure. For example, patients can be given the choice of counsellor-mediated disclosure if that would help minimise adverse consequences.
Both men and women should be involved in Prevention of Mother to Child Transmission (PMtCT) programmes. Antenatal services can educate men about sexuality, fertility and HIV prevalence to raise their awareness and sense of responsibility. This would avoid reinforcing the belief that women alone are responsible for pregnancy and for HIV transmission to the infant.
Community Home Based Care (CBBC) approaches need to include a special effort to promote the role of men as care-givers in the family and community, and to provide adequate support and guidance to enable male participation. At the very least, such programmes should acknowledge that reliance on home care is, at present, largely reliance on womens care.
References:
1.Fawole, I.O., Asuzu, M.C., Oduntan , S.O., Brieger, W.R. (1999). A school-based AIDS education program for secondary school students in Nigeria: a review of effectiveness. Health Education Research Theory & Practice, 14: 675-683.
2.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 Programs.
3.Gatawa, B.G. (1995). Zimbabwe: AIDS Education for schools. Case Study. UNICEF Harare Zimbabwe.
4.Hubley, J. (2000). Interventions targeted at youth aimed at influencing sexual behavior and AIDS/STDs. Leeds Health Education Database, April 2000.
5.Kelly, M.J. (2000). Standing education on its head: Aspects of schooling in a world with HIV/AIDS. Current Issues in Comparative Education. 3(1).
6.Kinsman, J., Harrison, S., Kengeya-Kayondo, J., Kanyesigye, E., Musoke, S. & Whitworth, J. (1999). Implementation of a comprehensive AIDS education program for schools in M asaka District, Uganda. AIDS CARE, 11(5): 591-601.
7.Kirby, D., Short, L., Collins, J., Rugg, D. et al. (1994). School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Reports, 109(3): 339-361.
8.Lowensen, R., Edwards, L. & Ndlovu-Hove, P. (1996). Reproductive health rights in Zimbabwe. Training and Research Support Centre (TARSC).
9.UNAIDS (1997a). Impact of HIV and sexual health education on the sexual behavior of young people: a review update.
10.UNAIDS (1997b). Learning and teaching about AIDS at school. UNAIDS technical update, October 1997.
11.Walter, H. & Vaughan, R. (1993). AIDS risk reduction among a multiethnic sample of urban high school students. JAMA, 270(6): 725-730.
12.WHO (1996). Preventing HIV/AIDS/STI and related discrimination: an important responsibility of health promoting schools. WHO series on school health, document six.
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