This paper is a response to a growing vision of schools as sites of care and support for vulnerable children in the context of HIV and AIDS. The paper is based on a desk review of projects working in schools on HIV and AIDS and document review of a project in a province of South Africa. The authors outline education policies in South Africa related to the care and support of vulnerable children in the context of HIV and AIDS. The misalignment between the policies around schools and vulnerable children, the resourcing of these policies, and their contexts of implementation is brought into relief, as well as the implications for thinking about expanded roles for schools and teachers. The paper offers possible ways forward in considering the role of schools in the context of HIV and AIDS. These include new ways of thinking about resourcing, proper monitoring and evaluation of projects, and a focus on quality teaching and learning.
Equity and HIV/AIDS
Children contract HIV infection largely through vertical transmission and are vulnerable to AIDS illness due to an immature immune system. In South Africa, hospitals are often overburdened and thus children with HIV may be directed to the community for care. As a result, non-professional caregivers are a predominant source of care for children living with HIV. Various authors, including the Department of Health, have stipulated the importance of establishing the knowledge and needs of non-professional caregivers of children with HIV. Our research has investigated the extent of non-professional caregivers' knowledge and needs, specifically those within the Potchefstroom district of the North-West Province. The objectives included formulating guidelines for a training programme that can enhance relevant knowledge and skills among these caregivers. Quantitative data were gathered using a questionnaire, which was developed following a literature study. The 109 non-professional caregivers who responded to the questionnaire displayed some knowledge and skills concerning specifically the care of children with HIV or AIDS, although gaps existed concerning their knowledge of community-based referral, caring needs specific to children, and precautionary measures to prevent HIV transmission. Recommendations are made with specific reference to a training programme. We surmise that non-professional caregivers play a pivotal role in the care of children with HIV in the Potchefstroom district — a service that is sometimes rendered in perilous conditions. This study improves our understanding of the support and training needed for non-professional caregivers in their pursuit to care for children with HIV in resource-limited communities, and thus it contributes to the field of nursing science. The findings may generate ideas for future research on this important topic.
This study explores the social representations of HIV and AIDS that circulate among white women teachers in South Africa, a group whose personal risk of the disease is low but who have a major role to play in shaping attitudes to HIV/AIDS among children and young people. The study examines how white women talk about the origin and causes of the spread of HIV in South Africa and their personal and community risk. This was explored through 25 semi-structured interviews and two focus groups with white female teachers in Johannesburg. A thematic analysis of the in-depth interviews revealed a shared private understanding of the disease, wherein the women distanced themselves by anchoring it in the context of racist cultural stereotypes of black sexuality and vulnerability. In contrast, the focus group discussions revealed a type of public talk in which HIV/AIDS is anchored in the contemporary cultural images of the new South Africa and the spirit of ubuntu or togetherness. These contradictory views reflect the racial tensions and social contexts of South Africa and which shape HIV/AIDS discourses. The findings suggest that more needs to be done to create a genuine understanding of HIV and AIDS within contemporary South African contexts.
This paper explores the nature of HIV/AIDS education and information networks in Malawi, with a focus on Dedza district. We consider the role of institutional and personal actors involved in Malawi's recently instated and decentralised behaviour-change intervention strategy, as well as the form and function of interpersonal social networks that mediate this information. The research reveals that the organisational capacity of actors and the conflicting messages regarding promotion of condom use may prevent Malawi from achieving a coordinated and effective decentralised response to the HIV epidemic. The research shows that individuals draw on complex interpersonal social networks, often processing mixed messages regarding HIV prevention strategies and receiving negative messages regarding condom use. The paper discusses the implications of such inconsistencies and conflicts with actors, interpersonal social networks and the nature of the messages themselves for HIV/AIDS education in Malawi.
This narrative review evaluates: 1) viral factors, in particular the aggregation of subtype-C HIV infections in Southern sub-Saharan Africa; 2) host factors, including unique behaviour patterns, concomitant high prevalence of sexually transmitted diseases, circumcision patterns, average age at first marriage and immunogenetic determinants; and, 3) transmission and societal factors, including levels of poverty, degrees of literacy, migrations of people, extent of political corruption, and the usage of contaminated injecting needles in community settings. HIV prevalence data and published indices on wealth, fertility, and governmental corruption were correlated using statistical software. The high prevalence of HIV in Southern sub-Saharan Africa is not explained by the unusual prevalence of subtype-C HIV infection. Many host factors contribute to HIV prevalence, including frequency of genital ulcerating sexually transmitted infections, absence of circumcision and immunogenetic loci, but no factor alone explains the high prevalence of HIV in the region. Among transmission and societal factors, the wealthiest, most literate and most educated, but also the most income-disparate, nations of sub-Saharan Africa show the highest HIV prevalence. HIV prevalence is also highest within societies experiencing significant migration and conflict as well as in those with government systems experiencing a high degree of corruption. The interactions between poverty and HIV transmission are complex. Epidemiologic studies currently do not suggest a strong role for the community usage of contaminated injecting needles. Areas meriting additional study include clade type, host immunogenetic determinants, the complex interrelationship of HIV with poverty, and the community usage of contaminated injecting needles.
Attitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived ‘positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.
This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. The 286 trainee teachers largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.
This report looks at the armies of Botswana, Swaziland, Tanzania, Zambia and Zimbabwe in the context of the HIV and AIDS epidemic. These armies report HIV rates between 20 to 40 percent, with some sections having a rate between 50 to 60 percent. The report explores approaches to reduce HIV rates among soldiers and recognises that the inherent structure and discipline of armies and their ability to follow set regimes, means that they can become change agents in their societies in the fight against HIV and AIDS.
HIV/AIDS and water-borne diseases account for a substantial degree of morbidity and mortality in different age groups across the globe, but their ripple effects are more devastating in developing countries. Estimates of the HIV/AIDS epidemic in South Africa vary but attest to a mature and generalised epidemic. In rural areas, devoid of electricity and potable water, the impact is more profound because of the role of water in cooking, drinking, consumption of anti-retrovirals and in the preparation of milk supplements for infants. Improving water quality will lead to a decline in child and adult mortality as well as diarrhoeal diseases in people living with HIV and AIDS. The cross-paths between HIV/AIDS and water have long-term implications for effective water resource management and the provision of wholesome water to communities. Such implications include faltering payment for water supply because HIV and AIDS are financially dis-empowering, erosion of social capital and waning productivity. Mainstreaming of HIV and AIDS in the water sector is of utmost importance, including development of work-place policies, adaptation and reorganisation of workload, development of strategies for reserve staff, adjustment of performance appraisal systems, pro-poor financing with a focus on water for health and economic benefit and integration of HIV and AIDS into training activities.
Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.