THE ROLE OF EDUCATION

Every country seems to recognize the importance of education in the response to HIV/AIDS.  But most countries have been slow in organizing their education systems to work in the threefold area of HIV prevention, care and support for infected and affected persons, and mitigation of the impacts of the disease on the education sector itself.  Namibia and Zambia have had a head-start in this, but even these countries still have a long way to go.

When countries think of responding to HIV/AIDS through education, the first thing they usually think of is putting some form of AIDS education into the curriculum.  This is only natural, because Ministries of Education feel comfortable when they are dealing with curriculum and teaching matters.  But in fact the impact of education on HIV seems to have very little to do with teaching about HIV/AIDS.

EMPIRICAL EVIDENCE

In a rural area in Uganda, HIV testing was conducted annually over a period of more than ten years.  What was found was that for those with secondary education HIV prevalence fell steadily from 12% in 1991 to less than 2% in 2001; for those with primary education it fell from 12% to 6%; and for those with no education it did not fall, but fluctuated around 12%.  This occurred at a time when the education being provided in schools was not very good and when HIV/AIDS did not receive very much attention in the school curriculum.

This shows that the more education the less HIV.  It seems that it was the fact of being through school that made the difference, and not education about HIV or AIDS as such.  Something similar has been found in Zambia: a girl who dropped out of school was three times more likely to be HIV positive than her age-mate who remained in school.  What seems to be happening is that school education somehow opens a person up to taking in and acting on information from other sources, including information about the disease and how to protect oneself against it.

But the beneficial effects of education are now being seen more widely.  In Zambia, the percentage of people who know that a healthy-looking person can have HIV rises steadily with level of education.  So also does the percentage of those who know more than one way of protecting themselves against HIV infection, the percentage who know where to go for an HIV test, and the percentage who have actually had an HIV test.

On every measure that has been taken, those with primary education come out better than those with no education, those with secondary better than those with primary, and those with tertiary   better   than  those with secondary.  Clearly education counts, and the difference is more than in knowledge, since being educated is linked with going for HIV testing, something that requires action.

AIDS AND SEXUALITY EDUCATION

It was remarkable to hear people in Phnom Penh, Jakarta, Bangkok, Almaty, Nairobi, Kingston, Windhoek and elsewhere expressing the same fears and doubts about AIDS and sexuality education that were being expressed in Malawi and Zambia.  In any of these places you could close your eyes and think you were at a workshop in Mangochi or Kafue!

Seven principal issues kept coming up everywhere:

1.      Teachers are not comfortable with this area and hence they try to avoid having to teach it.

2.      Such teaching as there may be is confined to the biological and examinable aspects, but avoids dealing with issues of behaviour.

3.      Very few teachers are prepared to deal with sexuality, relationships and the formation of attitudes.

4.      There is no comprehensive training or preparation of teachers for work in this area.

5.      There is a great shortage of suitable books and teaching materials.

6.      Teachers fear that if they go into any detail in this area they will be accused by parents of wanting to seduce some of the children or lead them into bad practices.

7.      Parents and community leaders fear that teaching children about sexuality and safer sex may promote promiscuity.

On the last point, it is worth noting that there is abundant evidence, from Africa as well as from other parts of the world, that teaching about sexuality and safer sex -- even very explicit teaching -- does not lead to promiscuity.  On the contrary it is associated with the deferment of sexual activity, more extended periods of abstinence, greater partner stability, and fewer unwanted pregnancies.

TREATMENT

Every country seemed to want more antiretroviral (ARV) treatment for people infected with HIV.  But those dealing with the situation were not always aware of some of the limitations and constraints of ARV treatment.  HIV infection cannot be cured, not even by the best form of ARV treatment.  The treatment suppresses the activity of the virus in the body, but never eliminates it.  Hence, the treatment, once started, must be continued for the remainder of one’s life.  Many people did not seem to know this.

Currently about 7,000 people are receiving free ARV treatment in Zambia.  The plans are to extend this eventually to 100,000, while in Malawi there are plans to provide treatment to 50,000 people.  But as Zambia’s Minister of Health, Brian Chituwo, has pointed out, these plans will succeed only if greater emphasis is placed on planning and preparation; information, education and communication; training; extending laboratory capacity; getting the drugs in good condition to the people who need them when they need them; and ongoing medical monitoring of those who are taking the drugs.  There did not seem to be much international attention to these vital details.  Instead, many people seemed to think of ARVs almost as they would of panadol, as something that can be dispensed simply and easily, without much prior planning or subsequent monitoring.

There also seemed to be a fairly widespread lack of awareness that ARV treatment may not keep a person in good health indefinitely.  Most people seemed to overlook the possibility that over time the virus might become resistant to the particular ARV drug being taken by an individual.  This is because as it replicates within the body, HIV does not have the ability to make sure that each one of the billions of new copies that it produces every day is an exact replica of  the original.  The variations to which this leads result in a large number of departures from the original.  Some of these may be immune to the ARV drug being used and in a classic example of the “survival of the fittest” may go on to multiply in the body, until eventually the drug no longer has the effect of suppressing the activity of the virus.

          The grave lesson from international experience, therefore, is that there should be much more realism in ARV expectations.  The drugs can work wonders and where possible should be administered (under good medical supervision) to those whose medical condition shows that they need them.  But they are not the silver bullet that will solve the whole problem.  At best they are only one part of the answer to HIV/AIDS.

IMPORTANCE OF NUTRITION

          Nutrition is integral to a complete response to HIV/AIDS.  Improved nutrition can protect against becoming infected with HIV and extend the number of years between HIV infection and the development of AIDS.  Moreover, enhancing nutritional status is necessary before treatment with ARVs can start -- if the individual’s nutritional status is poor, the ARVs might do more harm than good.

          There seemed to be fairly widespread understanding of the importance of nutrition in itself, but efforts to link it to the control of HIV and AIDS were quite limited.  There seemed to be very little appreciation that effective teaching of nutrition, including ways of achieving it (through the involvement of agricultural advisors, better use of school gardens, and community participation), was something that could be of extraordinary value to school learners when they left school, and was also something that the majority of parents and communities would support wholeheartedly.

          If most people seemed to place the relevance of nutrition to HIV/AIDS control on their back burners, this was even more true regarding the role played by a balanced intake of micronutrients.  Educators seemed to have very little knowledge on this, preferring to leave the matter in the hands of public health specialists.

THE NEED FOR A BALANCED APPROACH

          The relevance of both of these areas in the response to HIV/AIDS seems to have been overwhelmed by an approach to HIV control that places almost all the emphasis on the management of sexual behaviour.  The narrow focus on the acknowledged link between sexual behaviour and HIV transmission has had several unfortunate effects.  It has fuelled moralisation and stigma.  It has diverted attention from the importance of nutrition and an adequate supply of micronutrients.  It has not paid adequate attention to the role played by the disempowerment of women, widespread personal poverty, and the structural poverty in many societies.  In all these ways the focus on sexual activity has been somewhat superficial and, as a result, largely ineffective in stemming HIV transmission.  Too much attention has been paid to the symptoms and the superficial causes, but not nearly enough to underlying factors and causes.  (Part IV on the Role of Organised Religion continues below)

Michael J. Kelly, S.J.
Luwisha House
Lusaka

 

HIV/AIDS: REFLECTIONS ON THE ROLE OF RELIGION (PART IV) THE ROLE OF ORGANIZED RELIGION

          It was encouraging to see increasing recognition in so many different parts of the world of the positive role that organized religion plays in responding to HIV/AIDS.  The Christian Churches and Islam are seen as being of major importance in Africa, while in South-East Asia the Buddhist communities and monasteries work strenuously with many Catholic and Protestant bodies in the struggle against the epidemic.

          The Catholic Church is recognized as being the world’s largest provider of AIDS care, accounting for more than 25% of the global support and care for those infected or affected.  Universally there is praise and appreciation for the work the Church and its members do in caring for the sick, especially through home-based care, and in responding to the needs of orphans and vulnerable children.

          The position on condom use is almost always a sticking point, for both Catholics and Muslims.  Some Catholic spokespersons do not show much familiarity with traditional moral principles of the Church and hence they are very forthright in saying that condom use is immoral. The media seize on these statements and often caricature the whole Catholic involvement with HIV/AIDS as opposition to condom use.  This in turn makes the Catholic media and many bishops even more sensitive and anxious, and so the problem grows larger.

          For instance, in November 2003, the editor of a Catholic newspaper in Trinidad censored a reference made in a draft article by one of its staff reporters to a statement from the Bishops of Chad, because the Bishops acknowledged that it might be lawful for a married couple, one of whom was HIV positive, to use condoms.

          The tragedy is that while the debate over the morality of condom use absorbs the energy, resources  and  wider concerns of many on both sides, recognition is growing in secular circles of the importance of promoting abstinence and fidelity as successful ways of preventing HIV transmission.  In Uganda, condom use certainly played some role in reducing HIV transmission.  But the Ugandan success was essentially due to staying faithful to one partner.  Next came abstinence, showing itself in a delay in sexual activity by young people.  With only 8% of Ugandans saying that they use condoms consistently, it seems that although it played a role, condom use was not highly significant in the Ugandan achievement.

INCREASING PUBLIC RECOGNITION

          A further development is the way international conferences have changed in recent years in the provision they make for religious perspectives on HIV/AIDS.  Before the formal opening of the 13th ICASA held in Nairobi in September 2003, time was allocated for special presentations on behalf of the Catholic, Anglican and Muslim faiths, while the main programme made provision on a couple of occasions for discussions on faith-based initiatives.  Previous conferences had never done anything like this.  The Catholic presence at the Nairobi ICASA was also highlighted by a special Mass for delegates, celebrated by the Archbishop of Nairobi, and followed by a reception.

          Another example of the increasing recognition of the major role that organized religion plays in the struggle with HIV/AIDS is the way international statements and resolutions are increasingly calling on religious leaders to spearhead aspects of the campaign.  Thus, a high level meeting on the orphans challenge, convened in 2002 by Nelson Mandela, called on religious organizations to make even better use of their potential for breaking the silence, stopping the stigma, and mobilising action to prevent HIV and promote care for orphans, vulnerable children and families affected by HIV/AIDS.

INTER-FAITH DIALOGUE AND COOPERATION

          Responding to HIV/AIDS has been significant for the faith communities themselves in the way it has stimulated them to work together.  The epidemic has promoted ecumenical and inter-faith dialogue, with Christian communities of all faiths collaborating with one another and with their Muslim, Jewish, Buddhist and other counterparts in work aimed at HIV prevention, the care and support of the infected and affected, and the mitigation of the impacts of the epidemic.

          As an example, with leadership from the Muslim community, women from all faiths in Uganda -- Catholic, Protestant, Pentecostal and Muslim -- meet regularly as groups for fellowship and to develop their self-respect as women.

          In addition to this dialogue of action, the epidemic has fostered the dialogue of theological exchange where the faith communities endeavour to appreciate better the religious and social approaches of other religious heritages.  Some of this is being achieved through the World Conference of Religions for Peace (WCRP), a partnership involving major religious bodies and communities (including several Catholic religious congregations) that seeks to mobilize the moral and social resources of religious people to address their shared problems.  Among other things, WCRP has helped launch the Hope for African Children Initiative (HACI), a programme for the millions of children affected by HIV/AIDS in Africa.

EXPECTATIONS FROM THE WORLD

          Clearly, then, the international community is coming to recognize that, as the largest and best-organized set of civil institutions in the world today, religious communities are uniquely well equipped to meet the challenges of responding to HIV/AIDS.

          Increasing expectations accompany this growth in recognition.  These expectations would like to see the Churches and other faith communities:

·         Providing more public and coordinated leadership, within countries and regions, in the struggle against the epidemic.

·         Coming out loud and clear in every possible way about HIV/AIDS, and overcoming silence or denial, among their own personnel, in their members and in their teaching.

·         Adamantly rejecting every utterance, pronouncement or practice that carries any connotation of stigma or discrimination, and working hard to ensure that stigma and discrimination never find a home in any member of their faith communities.

·         Pouring their enormous human resources into the major tasks of eliminating poverty and ending the subjugation of women (recognizing the sea-change this will mean for many of their internal structures and practices).

·         Recognizing the dimensions of the orphans challenge and mobilizing their communities for a massive response to it in humane and practical ways.

·         Galvanizing their members into even further action for the reduction of HIV transmission, the provision of care and support for those infected or affected, and the mitigation of the impacts of the disease and epidemic.

·         Working in cooperation and harmony with one another, the representatives of local cultures, civic personnel, and local, national and international leaders.

·         Maintaining a multi-dimensional response to HIV/AIDS at the top of their agenda and as an integral element in their seminary and other training programmes.

          It is significant and encouraging to note that the message issued by the Symposium of Episcopal Conferences of Africa and Madagascar (SECAM) for World AIDS Day, 1^st December 2003, responded to many of these expectations. What remains now is to see the establishment of the Africa-wide HIV/AIDS service that SECAM intends to set up for the implementation of its plan of action.

HELP US TO HOPE

          Finally, we could say that what the world looks for perhaps more than anything else, and what those living with HIV/AIDS need above all, is hope.  This should be real hope, costly perhaps for the infected and affected, but costly also for the healthy and wealthy.  The deepest roots of this hope lie in the death and resurrection of Jesus Christ.  As the Irish theologian, Father Enda McDonagh, has said, “this hope cost the all-powerful and privileged God the life of his only-begotten Son”.  But it also saw God confirm the Son’s complete self-emptying by raising him up -- as he likewise will raise every person living with HIV/AIDS.

If it is to provide this hope, and to experience it within itself, the Church cannot stand apart.  It can no longer see HIV/AIDS as infecting and affecting people “out there”.  It must identify and acknowledge that it too is infected.  It must proclaim in word and deed that the Body of Christ has AIDS -- for in Father McDonagh’s words, “only a Church with AIDS can speak effectively and provide hope in a world with AIDS”.

Michael J. Kelly, S.J.
Luwisha House
Lusaka