Sound of Silence: Difficulties in Communicating on HIV/AIDS in Schools

Published by Action Aid in March 2003, this report studies the linkages between and importance of connecting education and HIV/AIDS.

Executive Summary

Formal education is often assumed to have significant influence on how people make informed decisions about their health - including very important areas such as sexual behaviour. With estimates of 11.8 million young people aged 15 to 24 living with HIV/AIDS (UNAIDS, 2002) it is now vital to understand better how educators are, and should be, responding to the challenges posed by the epidemic.

The educational response to the HIV/AIDS epidemic is an important aspect of ActionAid's work. Our underlying belief that every person has the right to information on HIV has led to concern that barriers or silences in communication around HIV/AIDS are impeding efforts inthe classroom. This assertion is based upon anecdotal evidence from some of our community partners, and twenty years of experience in participatory empowerment and learning approaches which encourage communication of difficult or "silent" issues. An unchallenged culture of silence can only serve to exacerbate the AIDS epidemic and increase confusion, denial and stigmatisation.

This report attempts to elucidate how HIV/AIDS education is implemented and received by schools in India and Kenya - two countries chosen partly for their differences, but also a similarity: the existence in each of the chosen regions (Nyanza, Kenya and Tamil Nadu, India) of a state-sponsored HIV curriculum. Through a mixture of quantitative and qualitative approaches, the research catalogues the reported attitudes of 3,706 teachers, pupils, parents and other key stakeholders in the educational community. In doing so, the report aims to answer the following four questions:

1. What is the parental and community demand for school-based HIV/AIDS education?
2. What role does the school have in teaching young people about HIV?
3. How is HIV/AIDS education being taught in the classroom?
4. What difficulties exist in successfully delivering school-based HIV/AIDS education?

The research indicates that in both Kenya and India teachers and schools play a pivotal role in teaching young people about HIV and AIDS. On the whole, parents appear to support schools in this endeavour, partly as it relieves their own responsibilities for discussing HIV/AIDS. However, perceptions of risk of HIV appear not to be "personalised" with an underlying attitude that HIV only happens to "them" and not "us". Unfortunately, attempts to deliver HIV/AIDS education in schools are severely constrained by a wider crisis in education, and more specifically by social and cultural restraints in discussing HIV/AIDS, sexual relations and power inequalities. These constraints manifest themselves in the practice of "selective teaching" in which messages on HIV/AIDS are either not communicated at all, or restricted to overly-scientific discussions without direct reference to sex or sexual relationships.

Key findings

1. Parental and community demand for HIV/AIDS education

The research suggests that in both countries young people and their families perceive HIV to be a serious threat, and there is a strong belief that education can act to mitigate that threat. As a consequence, there is a strong demand for young people to be taught about HIV.

Key findings include:

• 68% of Kenyan parents reported knowing their child was being taught about HIV in school, compared to12% of Indian parents.
• Teachers perceive parental support for school-based HIV/AIDS education to be lower than it is.
• The majority of young people, parents and teachers in both countries view HIV to be a very big problem nationally. However, in Tamil Nadu, HIV was seen as less of a problem in the local area or school, whilst most Kenyan respondents viewed HIV to be a big problem locally.
• Striking differences exist between countries on perceived frequency of risk behaviour in schools.74% of Indian parents reported that casual sexual relationships between students never happened, compared to 15% of their Kenyan counterparts.

2. The role of the school in HIV/AIDS education

The research suggests that a number of social factors influence young people's perceptions about HIV, including religious influence, the media, family and peers. Parents often feel uncomfortable talking about sensitive issues with their children and, particularly in India, the media is perceived as giving out harmful messages. Consequently, the school is viewed by the community as a trusted and important place for young people to learn about HIV. Within this context, teachers were perceived as paramount in teaching young people about HIV/AIDS.

Key findings include:

• 87% of Indian teachers and 90% of Kenyan teachers viewed their profession as having responsibility for teaching young people about HIV and AIDS.
• In Kenya, teachers viewed responsibility for teaching young people about HIV as being diffused throughout the community - including parents (88%) and religious leaders (85%).
• Respondents in both countries thought that young people learn about HIV from a number of sources. Teachers and television were among the top three most commonly cited sources across all respondent groups and in both countries.
• Parents (particularly mothers) and religious leaders appear to play a far greater role in teaching young people about HIV in Kenya than India: 42% of Kenyan parents reported often talking to their children about sex and HIV. In comparison, 63% of Indian parents reported never talking about sex or HIV to their children.

3. Silences in communicating on HIV/AIDS

Given the sensitivities that surround sex and HIV, teachers reported finding it difficult to discuss HIV/AIDS with their students. Our findings suggest that ‘selective teaching' often takes place. Teachers appear to be selecting which messages to give or else choosing not to teach HIV at all. An overly-scientific emphasis during lessons leads to discussions of HIV without any direct reference to sexual relationships. In other cases sex is discussed, but only within the "acceptable" boundaries of abstinence.

The occurrence of selective teaching is alarming. Discussion of HIV without direct reference to sex, or advocating abstinence without mentioning safe sex, cannot work. On the contrary, it bonds notions of HIV to immorality, and leads to a "them, not us" attitude. This, in turn, leads to even further discrimination. It also fails to help the many young people who are sexually active, making it less likely that they will seek advice or personalise their risk of becoming HIV positive.

Silences in communication over the issue of condoms, or messages other than abstinence arise out of a paradox of safer sex. In the context of young people, the paradox or tension can occur between two assumptions: a societal assumption that young people do not, and will not, have pre-marital sex, and the necessary assumption needed to discuss condoms: that young people do have pre-marital sex.

Key findings include:

• It appears that selective teaching is taking place in both Kenya and India with both students and teachers (to a lesser extent) claiming that lessons are not being taught. For example, 95% of teachers inTamil Nadu claimed that the HIV component of the Total Health Programme was being taught compared to only 53% of students. In both countries selective teaching appears to be more common in rural areas than urban areas.
• Selective teaching is also manifested in HIV/AIDS education which does not directly refer to sex. This appears to be more common in Tamil Nadu than Nyanza: 35% of the Indian students reported having been taught about HIV and never having been taught about sex (compared to 7% of Kenyan students).
• In Kenya, selective teaching of HIV appears to be linked to negative stances towards condoms and safe sex. Surprisingly, Indian respondents, particularly students, appeared to have less negative attitudes towards condoms than their Kenyan counterparts(28% of Indian students were against students having access to condoms compared to 57% of Kenyan students).

4. Obstacles to teaching HIV/AIDS -a wider crisis in education

Apart from the social and cultural constraints that exist in teaching HIV/AIDS, there are, in addition, a number of obstacles faced by teachers which are symptomatic of a wider crisis in education. Efforts in the classroom ares everely hampered by oversized classes, overstretched curricula, and a dearth of training opportunities and learning materials. Moreover, the large numbers of children who are out of school do not have any access to school-based HIV/AIDS education.

Key findings include:

• 45% of Kenyan teachers said they did not have enough knowledge to teach about HIV/AIDS, compared to 20% of Indian teachers.
• The majority of teachers in both countries reported never having been on a training course on HIV/AIDS(70% in India, 54% in Kenya).
• About half of the teachers in both countries said they did not have enough time to teach HIV/AIDS (52% in India, 54% in Kenya).
• Interviews and focus group discussion in both countries suggest that the cultural barriers included both the "paradox of safe sex" (discussed above) and gender specific issues in which teachers (particularly female teachers) felt unconfident teaching students of the opposite sex.
• 24% of Kenyan students stated that teachers did not set good role models when it comes to sexual behaviour, compared to 12% of students in India.

Key recommendations

Extending beyond the classroom

If HIV/AIDS education is to succeed, it must target all sectors of society including religious leaders, the media and families. Pre-existing systems of knowledge transfer should be taken advantage of: parents and the extended family should be targeted for adult learning programmes that encourage them to communicate openly, positively and accurately onHIV/AIDS.

Locally relevant HIV/AIDS education

There needs to be a move away from an overly scientific approach to HIV/AIDS education. Learning materials should stimulate children to understand the human side of HIV so they can connect the issue to real life. Learning resources on HIV/AIDS should be locally driven - drawing upon local statistics of prevalence and local case studies.

Challenging social and power inequalities

Education that leads to positive behaviour or social change needs to look beyond skills and, in this particular context, challenge social, gender and power inequalities. HIV/AIDS education should focus on power and communication issues in wider human relationships, and in this way some of the power issues involved in sexual relationships can be addressed.

Prioritisation and resource mobilisation for education

If the education system is to be an effective vehicle to prevent the further spread of HIV/AIDS, then improving the basic functioning of the system is a prerequisite. A massive injection of financial resources is needed at every level; internationally, nationally, in communities and in schools themselves to provide good quality education. Only on this foundation can HIV/AIDS adequately be addressed in schools.