Students Access In Relation To HIV And Aids Essay
HIV and AIDS Human Immuno Deficiency virus and Acquired Immuno deficiency syndrome respectively is one of the most devastating worldwide public health problem in recent history. The United States Centers for Disease Control and Prevention (CDC) estimated that in 2006, 942,000 people in the United States had been diagnosed with Aids since the disease was identified in 1981. Ijezie, (2012) stated that HIV and AIDS are called pandemic instead of epidemic because no country has escaped. It is not known where it started. It poses a great danger to the full realization of the potentials of all humankind.Students Access In Relation To HIV And Aids Essay It affects our religious, social, cultural, economic and political development and a threat to global peace, security and order. World Health Organization, (WHO) (2016) stated that the Human Immuno Deficiency Virus (HIV) infects cells of the immune system destroying or impairing their function. Infection with the virus results to progressive deterioration of the immune system, leading to “Immune deficiency”. The immune system is considered deficient when it can no longer fulfill its roles of fighting infection and diseases. Infection associated with severe immune deficiency is known as “opportunistic infection”, because they take advantage of weekend immune system. Acquired Immuno Deficiency Syndrome (AIDS) is a term which applies to the most advanced stage of HIV infection. Christian, (2017) stated thus, AIDS (Acquired Immuno Deficiency Syndrome) is a syndrome caused by a virus HIV (Human Immuno Deficiency Virus).The diseases i.e. HIV alters the immune system making people more vulnerable to infection and diseases. This susceptibility worsens as the syndrome progresses. HIV is found throughout all the tissue of body fluid (semen, vaginal fluid, blood and breast milk) of an effected person.Students Access In Relation To HIV And Aids Essay
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We report results from a randomized evaluation comparing three school-based HIV/AIDS
interventions in Kenya: 1) training teachers in the Kenyan Government’s HIV/AIDS-education
curriculum; 2) encouraging students to debate the role of condoms and write essays on how they
can protect themselves against HIV/AIDS; and 3) reducing the cost of education. Our primary
measure of the effectiveness of these interventions is teenage childbearing, which is associated
with unprotected sex. We also collected measures of knowledge, attitudes, and behavior
regarding HIV/AIDS. After two years, teacher training increased students’ tolerance toward
people with HIV/AIDS. Girls exposed to the program were more likely to be married to the
fathers of their children. The program had little other impact on students’ knowledge, attitudes,
and behavior, or on the incidence of teen childbearing. The condom debates and essays increased
practical knowledge and self-reported use of condoms without increasing self-reported sexual
activity. Reducing the cost of education by paying for school uniforms reduced dropout rates,
teen marriage, and childbearing.
Key words: HIV/AIDS prevention; school; Africa; Kenya; Youth; developing countries Students Access In Relation To HIV And Aids Essay
∗
Department of Economics and Poverty Action Lab, MIT.
∗∗ Paris-Jourdan Science Economiques.
∗∗∗ Department of Economics, Harvard University; Brookings Institution; NBER; Poverty Action Lab,
MIT.
∗∗∗∗ Jomo Kenyatta University of Agriculture and Technology, Kenya.
The authors thank ICS Africa, the Kenya National AIDS Control Council, and the Kenya Ministry of
Education for their cooperation in all stages of the project, and would especially like to acknowledge the
contributions of Chip Bury, Robert Namunyu, Laban Benaya, Carol Nekesa, Grace Makana and her staff,
Willa Friedman, Jessica Leino, Jessica Morgan, Ian Tomb and Paul Wang, without whom the project
would not have been possible. Gratitude is also extended to the teachers and school children of Bungoma,
Butere-Mumias and Busia districts for participating in the study. Mutsa Chironga provided excellent
research assistance. We are grateful for financial support from the Partnership for Child Development and
the World Bank. All errors are our own.
1. Introduction
The future course of the AIDS epidemic in Africa depends in large part on the
behavior of the next generation. Children between the ages of 5 and 14 have been
referred to as a ‘window of hope’ because they have low infection rates and have not yet
established patterns of sexual behavior (Kelly 2000, Bundy 2002). The majority of
children in Africa attend at least some primary school, and schools offer an opportunity
to reach these children. There is, however, considerable debate on whether scalable
school-based HIV/AIDS education programs can be effective in limiting the spread of
HIV/AIDS among youth. Will teachers actually teach these curricula? If the curricula are
taught, can they affect knowledge, attitudes, or behavior? Even if these programs have an
impact, are these programs an effective use of resources relative to other alternatives, in
particular simply subsidizing school attendance? There is also intense debate over the
content of these programs. Will discussion of condoms spur increased use of condoms?
Will it spur increased sexual activity?Students Access In Relation To HIV And Aids Essay
Although many countries have incorporated HIV/AIDS education in their school
curriculum, there is limited rigorous evidence from controlled trials on these questions.1
Gallant and Maticka-Tyndale (2004) review 11 school-based HIV/AIDS risk reduction
programs in Africa and report only one randomized controlled trial. Stanton et al. (1998)
found that AIDS education in Namibia reduced some self-reported HIV risk behaviors—
such as sex with multiple partners in the last month and sex without a condom—among
sexually inexperienced 15 to 18 year olds, but that reductions were not significant for all
1
Kinsman et al. 2001, UNAIDS 1997, Kirby et al. 1985, 1994, 1995, Kirby and Coyle 1997, Klepp et al.
1997, Aplasca et al. 1995.
2
program participants. Stanton et al (1998) like most existing studies of the effectiveness
of HIV education programs, rely on self-reported information about knowledge and
behavior.2
However, self-reported data on behavior may suffer from social desirability
bias if subjects report what they think the interviewer wants to hear (Aral et al. 1996,
Mellanby et al. 1995).
To our knowledge, there is only one randomized trial of sexual health education
in Africa that looks at biological outcomes. Results from this study became available
subsequent to the Gallant and Maticka-Tyndale (2004) review. MEMA Kwa Vijana,
conducted in 10 communities of rural Tanzania, included in-school education, youthfriendly health services, and community-based condom promotion and distribution. Ten
other communities served as a comparison group. The program led to improved
knowledge, reported attitudes and reported behaviors, but an evaluation found no
consistent impact on biological indicators of HIV, other STIs, or pregnancy (DFID,Students Access In Relation To HIV And Aids Essay
2004). However, since the incidence of these events is low among adolescents, the
sample size of 10 treatment and 10 comparison communities did not provide enough
statistical power to detect changes smaller than 50% (Hayes et al, 2005). Since programs
would be cost effective even at much lower efficacy levels, it is difficult to draw firm
conclusions.
This paper reports results from a randomized evaluation of three different schoolbased interventions in Kenya: 1) training teachers in the HIV/AIDS-education curriculum
designed for primary schools by the Kenyan Government; 2) encouraging students to
debate the role of condoms, as suggested in the Kenyan Governments’ Facilitator’s
2
See Gallant and Maticka-Tyndale [2004] for a review.
3
Handbook, and to write essays about how they can protect themselves from HIV/AIDS;
and 3) reducing the cost of education to keep children in school longer. To shed light on
the role of risk reduction, we also compare our results to those of Dupas (2005) who
conducted, in the same schools, a randomized evaluation of the impact of informing
teenagers about variation in HIV rates by age and sex.
The study involved 70,000 students from 328 primary schools. Our primary
measure of the effectiveness of these interventions is teenage childbearing, which is
associated with unprotected sex, the main driver of HIV/AIDS in this population. We
also collected measures of knowledge, attitude, and behavior regarding HIV/AIDS. We
find that after two years the teacher training program had little impact on students’
knowledge and self-reported sexual activity and condom use, or on teen childbearing.Students Access In Relation To HIV And Aids Essay
However, it increased students’ tolerance toward people with HIV/AIDS and girls
exposed to the program were more likely to be married to the fathers of their children.
Debates among peers on the role of condoms and an associated essay competition on
ways students could protect themselves against AIDS increased self-reported use of
condoms, without increasing self-reported sexual activity. (The condom debate and essay
competition took place too recently for us to be able to detect any possible reduction in
childbearing.) Dupas (2005) reports that informing girls about variation in HIV rates by
age and sex led girls to avoid cross-generational partnerships, which are particularly
risky. Reducing the cost of education by paying for school uniforms reduced dropout
rates and the incidence of teen childbearing.
The remainder of the paper proceeds as follows. Section 2 provides background
information on the Kenyan context. Section 3 describes the programs. Section 4
4
discusses the data and the estimation strategy. Section 5 presents the empirical results.
The final section concludes.
2. Background on HIV/AIDS in Kenya
a. HIV Prevalence Students Access In Relation To HIV And Aids Essay
Until recently AIDS prevalence in Kenya was estimated to be around 15%, based
on data from antenatal clinics. The 2003 Kenya Demographic and Health Survey
(KDHS), which included HIV testing of survey respondents, estimated that 7% of
Kenyan adults are infected with HIV. (Attrition might be a concern, however, since 14%
of the KDHS respondents refused to get tested, and 13% were not available at the time of
the survey.) Measured prevalence levels among young women rise quickly with age (3%
are infected in the 15-19 age group and 9% are in the 20-24 age group). Among men,
prevalence reaches its peak (8.8%) in the 40-44 age group (Central Bureau of Statistics,
Kenya 2004).
b. HIV/AIDS Awareness
A number of institutions are currently implementing HIV/AIDS prevention
programs in Kenya. These programs involve schools, health clinics, and the media. The
Government of Kenya created the National AIDS Control Council (NACC) in 1997 to
coordinate all HIV/AIDS activities in the country. Voluntary Counseling and Testing
(VCT) services are available in each district. Radio programs on HIV/AIDS can be heard
daily. Population Services International conducts social marketing of “Trust” condoms at
the very low cost of 3 condoms for 12 US cents. Large wall-painted advertisements for
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Trust Condoms are present everywhere from large towns to rural villages. A number of
NGOs are implementing HIV/AIDS prevention programs in schools, in churches and for
specific target groups.
c. Government Policy on HIV/AIDS education
The great majority of Kenyan children attend at least some primary school, which covers
grades 1-8, but most do not attend secondary school. In 1999, the Kenyan government
established a national curriculum on HIV/AIDS education to reach children in primary
school. The national curriculum was developed with the assistance of UNICEF, and was
the outcome of an extensive consultation process within Kenyan society that included
many stakeholders, including religious groups. The Ministry has sent books covering the
curriculum to all schools.Students Access In Relation To HIV And Aids Essay
The primary school HIV/AIDS curriculum teaches basic medical facts about
AIDS, HIV transmission, prevention, and care for people living with AIDS. It stresses
abstinence as the most effective way to prevent pregnancies and infection with sexually
transmitted diseases. Teachers are not taught to promote condom use. However, teachers
have a fair amount of discretion in answering students’ questions on condoms and the
official Facilitator’s Handbook recommends that teachers organize a debate among
students on whether condom use should be taught to primary school students.
Individual schools and teachers effectively have a lot of discretion about whether
to teach about HIV/AIDS, because specific times are not set aside on the timetable for
HIV/AIDS education and because Kenyan schools tend to be focused on the exams
students take at the end of primary school and HIV/AIDS is not examined as a separate
subject (although questions on HIV/AIDS are included in exams on other subjects). Students Access In Relation To HIV And Aids Essay
upper primary teachers have been trained to teach particular subject matter, such as math,
and see this as their primary responsibility. Moreover, many do not feel competent to
teach about HIV/AIDS. In many cases no teachers have been assigned specific
responsibility for teaching the subject. Thus HIV/AIDS is often not covered very well in
practice, despite the development of the national curriculum. In response, the Kenya
Ministry of Education, Science and Technology (MOEST) has trained trainers to provide
in-service courses for teachers on HIV/AIDS education.
3. Program Description
Four interventions took place in the same area: 1) training teachers in the HIV/AIDSeducation curriculum designed for primary schools by the Kenyan Government; 2)
encouraging students to debate the role of condoms and to write essays about how they
can protect themselves from HIV/AIDS; 3) informing teenagers about variation in HIV
rates by age and gender; 4) reducing the cost of education by providing free uniforms,
with the aim of keeping children in school longer.
a. Teacher Training on HIV/AIDS curriculum
The Kenyan government cannot implement the teacher training program on HIV/AIDS
education everywhere simultaneously due to insufficient trainers and other resources.Students Access In Relation To HIV And Aids Essay
The training is thus being phased in over several years, as funds are made available. This
creates a unique opportunity to rigorously evaluate the impact of the program using a
randomized design. With the assistance of International Child Support (ICS), a nongovernmental organization working in Western Kenya, and funding from the Partnership
7
for Child Development (PCD), the MOEST trained teachers in three districts of Western
Province between September 2002 and June 2003. All the schools that were selected to
participate in the study agreed to participate. Each chose three upper primary teachers to
participate in the 5-day training program.Students Access In Relation To HIV And Aids Essay
3
Attendance at the trainings was high (93%).
The training sessions were conducted jointly by one facilitator from the AIDS
Control Unit of the Ministry of Education (ACU-MOEST), two facilitators from the
Kenya Institute of Education (KIE), and one trained staff member from ICS. The teacher
training covered a wide range of topics, including basic facts on HIV/AIDS, condom
demonstration, information on Voluntary Counseling and Testing, and AIDS education
methodology. The participants reviewed material in the HIV/AIDS Facilitator’s
Handbook, learned both how to discuss HIV/AIDS issues as part of classes devoted to
other topics and how to devote full-period lessons to HIV/AIDS activities, and prepared
lesson plans under facilitator supervision. At the end of the training, teachers were asked
to prepare an “action plan” for AIDS education in their school, including how they would
reach out to the other teachers in the school and integrate HIV/AIDS into the timetable.
In addition to delivering the classroom-based activities, trained teachers were
advised to set up health clubs to encourage HIV avoidance through active learning
activities such as role plays. Health clubs were monitored through school visits. A year
after the training, 86% of the schools whose teachers had been trained had established a
health club. Trained teachers who had maintained an active health club were given a tshirt with a red ribbon and the message: “PAMOJA TUANGAMIZE UKIMWI”
(Together, let’s crush AIDS). Students who were members of the health club received red Students Access In Relation To HIV And Aids Essay
3
There are 14 teachers per school on average, so the training affected 21% of teachers in program schools
8
ribbon pins to put on their school uniforms. Small grants of up to US$50 were provided
for health clubs that submitted a proposal to organize HIV/AIDS awareness activities for
youth in and out of school. In the first year, 67% of the schools submitted a proposal that
was approved.
Overall the teacher training and health club follow-up cost $550 per school4
.
While the Kenyan government’s HIV/AIDS teacher training program does not
necessarily represent an ideal program, it is financially, politically, and culturally feasible
to scale, and thus seems worth evaluating.
.
b. Debates on condoms, essay competition
Half the schools that had received teacher training reinforcement were encouraged to
organize a debate in 2005. The motion of the debate was: “School children should be
taught how to use condoms”, a motion suggested in the official Facilitator’s Handbook
(KIE, 1999). All upper class students attended the debate. The debate was followed by an
essay competition for students in Grade 7 and 8. The essay question was: “Discuss ways
in which you can protect yourself from HIV infection now and at later ages in your life”.
The debates were not graded by teachers from the school, but by outside teachers hired
by ICS during school break. A school bag was given as a prize for the best essays by a
boy and by a girl in each school’s 7th and 8th grade class.
on average. Schools were encouraged to send at least one female teacher to the training; headmasters were
encouraged to attend themselves or to send their deputy. 4
The costs included: full board accommodation of trainees and trainers for 5 nights; fare refund to and
from the training venue for trainees and trainers); facilitation fee paid to trainers; cost of trainees’ time; a
set of 4 textbooks per trainee (Facilitator’s handbook + 3 students textbooks); handouts and stationery;
issuance of training certificates for trainees; anti-AIDS T-shirts for trainees; anti-AIDS badges for health
club members at school; mini-grants for health clubs who submit a proposal.Students Access In Relation To HIV And Aids Essay
9
Both debates and essay writing are established practices in Kenyan schools, and
teachers agreed to organize these activities in 95% of sampled schools.
c. Informing students about the profile of HIV prevalence by age and sex (Dupas,
2005)
Cross-generational sex is associated with a higher risk of HIV infection for adolescent
girls than sex with same-age partners, but many adolescent girls seem unaware of this.
Information on the distribution of HIV infections by age and gender is typically not given
to adolescents by their teachers because it is not covered by the HIV curriculum and was
not included in the teacher training.
Dupas (2005) evaluates an intervention conducted in the fall 2004, in which
students in Grade 8 were provided statistics on the prevalence of HIV, by age and gender.
The intervention also included the screening of a 10 minute video, “Sarah: The Trap”.
This intervention was implemented both in schools where teachers had been trained and
in schools where teachers had not been trained.
d. Reducing the cost of education
For HIV/AIDS education programs to be justified, they must not only be effective, but
also more effective than alternative uses of the necessary resources. One natural
alternative use for these resources is helping students stay in school longer. Since girls
who become pregnant typically face strong social pressure to leave school (although
legally they are entitled to attend), reducing the cost of education raises the cost of
pregnancy and thus of unprotected sex.
10
Since school fees were abolished in Kenya in 2002, school uniforms are the main
direct financial barrier to access to education at the primary level. A uniform costs about
$6, a substantial expense for parents in a country where the GDP per capital is $360
(World Bank, 2002).
Between February and July 2003, ICS distributed a free school uniform to all
students who were enrolled in grade 6 in January 2003 (students enrolled in grade 6 are
on average 14 years old). In total, about 10,000 uniforms were distributed. In order to
avoid creating incentives for students to transfer between schools, ICS field officers
visited all the schools to collect baseline enrollment data before announcing the
program—only children enrolled at the time of the baseline were eligible for the uniform
program. In the fall of 2004, ICS distributed a second uniform to the same students if
they were still enrolled in the same school. It was announced at the onset of the program
that students still enrolled in school would be eligible for a second uniform.
e. Selection of Schools and Program Design
The program took place in two rural districts of Western Kenya, Bungoma and ButereMumias. The study is based on a sample of 328 schools. Among them, 163 were
randomly chosen for the teacher training. The randomization was done by the generation
of a random number, after stratifying by the geographical division of the school, average
performance of the school at the Kenya Certificate of Primary Education exam of 2001,
and the gender ratio among upper primary students.
11
In addition, 163 schools were randomly selected to receive uniforms, after Students Access In Relation To HIV And Aids Essay
stratifying by whether or not the school was receiving training reinforcement on HIV
education and by geographical location, school achievement and gender ratio.
In 71 schools, teenagers were given information on HIV prevalence by sex and
age. Among these 71 schools, 36 schools were randomly chosen among schools that did
not receive the teacher training reinforcement and 35 schools were randomly chosen
among schools where the teacher training reinforcement was provided (Dupas, 2005).
Among the 163 schools selected for teacher training, 82 were randomly selected
for the condom debate on and essay contest after stratifying by whether or not the school
was receiving uniforms.Students Access In Relation To HIV And Aids Essay
HIV, or Human Immunodeficiency Virus, weakens your immune system by destroying important cells that fight disease and infection. Over time, HIV can destroy so many of your T-cells or CD4 cells, a key part of your immune system, that your body can’t fight infections and disease anymore. When this happens, HIV infection can lead to AIDS.
AIDS, or Acquired Immunodeficiency Syndrome, is a complex illness with a wide range of complications and symptoms. AIDS is the final stage of HIV. When individuals reach this stage, they are at high risk for opportunistic infections due to their badly damaged immune system.Students Access In Relation To HIV And Aids Essay
For more information, visit HIV.gov.
HIV is found in specific human body fluids. You can be infected with HIV if any of the following fluids enter your body:
According to HIV.gov, other body fluids and waste products—like feces, nasal fluids, saliva, sweat, tears, urine, or vomit—don’t contain enough HIV to infect you, unless they have blood mixed in them and you have significant and direct contact with them.
There are very specific ways that HIV can be transmitted through body fluids.Students Access In Relation To HIV And Aids Essay
Many people who are HIV positive do not have symptoms of HIV infection. The virus can sometimes cause people to feel sick, but most of the severe symptoms and illnesses of HIV come from the opportunistic infections that attack the damaged immune system. It is also important to recognize that some symptoms of HIV are similar to common illnesses, such as the flu or respiratory infections.
Signs and symptoms commonly seen in the early stages of HIV include:
Infected individuals can have the virus for up to 10 years—sometimes longer—without showing signs or symptoms.
Reducing your sexual risk is one way to prevent the transmission of HIV. You can reduce your risk by:
For more information on HIV prevention, visit HIV.gov.
All individuals should get tested for HIV at least once a year. Below are options for local testing sites:
The most common HIV tests look for HIV antibodies. Enzyme immunoassay (EIA) tests use blood, oral fluid, or urine to detect HIV antibodies and can take up to two weeks. Rapid HIV antibody tests use blood, oral fluid, or urine to detect antibodies and take 10–20 minutes to receive results. If you test positive for HIV after taking an EIA or rapid antibody test, you will need to take another test, called Western blot test, to confirm that result. It can take up to two weeks to confirm a positive result.Students Access In Relation To HIV And Aids Essay
The FDA has approved one home testing kit. Home Access HIV-1 Test System is not an HIV testing kit, but allows you to collect samples of your blood to send for laboratory testing. For more information, read Testing Yourself for HIV-1, the Virus that Causes AIDS.
If you test positive for HIV, the CDC recommends that you be in the care of a licensed health care provider. Your health care provider can assist you with treatment information and guidance. Getting treatment quickly is important because it can help you keep your immune system healthy, which can slow the progression to AIDS. Your medical provider will also discuss how to stay healthy and how you can keep from transmitting HIV to others.Students Access In Relation To HIV And Aids Essay
All HIV-positive test results must be reported to your state health department for data tracking. This information is often reported to the CDC, but no personal information is ever shared when data are reported.
More than 1.1 million people are living with HIV in the United States. Due to advances in treatment, people with HIV are living longer and their quality of life has improved. AIDS.gov suggests utilizing the Newly Diagnosed Checklist to manage an HIV diagnosis. If you are HIV positive, it is important that you make choices that keep you and others healthy. The CDC provides suggestions on how individuals with HIV can live a healthy and safe life.Students Access In Relation To HIV And Aids Essay
Every December, IUP students honor World Aids Day and HIV/AIDs AWAREness week, a campaign designed to offer support for those living with the disease, education for those trying to prevent transmission of the disease, and remembrance for those who have lost their battle to HIV and/or AIDS. Students Access In Relation To HIV And Aids Essay