HIV/AIDS AND EDUCATION IN UGANDA: WINDOW OF OPPORTUNITY?
Karin A. L. Hyde Andrew Ekatan Paul Kiage Catherine Barasa
Funded by the Rockefeller Foundation
Contact: [email protected] or [email protected]
HIV/AIDS AND EDUCATION IN UGANDA: WINDOW OF OPPORTUNITY?
Table of Contents LIST OF FIGURES ...... III LIST OF TABLES...... III EXECUTIVE SUMMARY...... VI 1. INTRODUCTION ...... 1 1.1 THE AIDS CRISIS AND EDUCATION ...... 1 1.2 THE KNOWLEDGE BASE...... 1 1.3 STUDY OBJECTIVES ...... 4 1.4 REPORT STRUCTURE...... 4 1.5 TEAM MEMBERS...... 5 1.6 ACKNOWLEDGEMENTS...... 5 2. OVERVIEW AND CONTEXT...... 6 2.1 THE EDUCATION SYSTEM ...... 6 2.2 GOVERNMENT EDUCATION POLICY ...... 7 2.3 NGOS REACHING OUT TO YOUTH IN SCHOOLS...... 9 3. HIV/AIDS—THE CHALLENGE AND THE RESPONSE.... 14 3.1 THE EXPERIENCE OF HIV/AIDS IN UGANDA...... 14 3.2 FIGHTING AIDS—THE MESSAGE ...... 22 3.3 THE CONDOM DEBATE...... 23 3.4 CONTINUING CHALLENGES ...... 24 4. METHODOLOGY...... 26 4.1 INTRODUCTION ...... 26 4.2 SCHOOL SURVEY ...... 27 4.3 STAKEHOLDER INTERVIEWS...... 28 4.4 MODELLING ...... 29 4.5 LESSONS LEARNED...... 29 5. PREVENTING HIV INFECTION AMONG STUDENTS..... 31 5.1 HIV/AIDS EDUCATION IN SCHOOLS ...... 31 5.2 FORMAL CURRICULUM ...... 32 5.3 STUDENT KNOWLEDGE ...... 33 5.4 GUIDANCE AND COUNSELLING ...... 36 5.5 EXTRA-CURRICULAR ACTIVITIES ...... 37 5.6 STUDENT ATTITUDES AND BEHAVIOUR ...... 38 5.7 SEXUAL HARASSMENT...... 38 6. IMPACT ON STUDENTS ...... 42 6.1 CHARACTERISTICS OF STUDY SCHOOLS...... 42 6.2 REPETITION, ABSENTEEISM AND SCHOOL INTERRUPTION...... 43 6.3 ORPHANS ...... 45 6.4 HIV POSITIVE STUDENTS ...... 49 6.5 STUDENTS LOOKING AFTER SICK FAMILY MEMBERS...... 50 6.6 ADDRESSING THE PROBLEMS ...... 51 7. IMPACT ON TEACHING STAFF ...... 53
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7.1 INTRODUCTION ...... 53 7.2 IMPACT OF HIV/AIDS ...... 55 7.3 PROJECTIONS ...... 64 8. GOVERNMENT OF UGANDA RESPONSE ...... 68 8.1 PLANNED GOVERNMENT INITIATIVES ...... 69 8.2 COMMENT ON INITIATIVES...... 71 9. HIV PREVENTION...... 73 9.1 INTRODUCTION ...... 73 9.2 ENHANCING HIV/AIDS CONTENT ...... 73 9.3 CAPACITY BUILDING FOR TEACHERS ...... 75 9.4 ENHANCING GUIDANCE AND COUNSELLING ...... 75 9.5 SEXUAL HARASSMENT...... 76 10. MITIGATION OF IMPACT ON STUDENTS...... 77 10.1 PRIMARY EDUCATION ...... 77 11. TEACHING STAFF--MITIGATION...... 79
12. CONCLUSION AND RECOMMENDATIONS ...... 83 12.1 PREVENTION ...... 83 12.2 IMPACT ON STUDENTS ...... 83 12.3 TEACHERS AND OTHER STAFF ...... 83 12.4 RESEARCH AND MONITORING...... 84 APPENDIX 1: FOCUS GROUP STATEMENTS ...... 92
APPENDIX 2: STAKEHOLDERS INTERVIEWED ...... 94
APPENDIX 3: MODELLING STRATEGY AND PROCEDURES ...... 97
APPENDIX 4: EDUCATIONAL DATA FROM STUDY SCHOOLS..... 102
APPENDIX 5: EDUCATIONAL STATISTICS, UGANDA...... 124
APPENDIX 6: RESPONDENT RECOMMENDATIONS ...... 134
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LIST OF FIGURES Figure 1: Impact of HIV/AIDS on Education……………………………………..………….3 Figure 2: Infection Rates at ANC Sentinel Sites……………………………………..……...14 Figure 3: Trends in HIV Rates Among Female First Time Testers………………………….15 Figure 4: Trends in HIV Rates Among Male First Time Testers……………………….……16 Figure 5: HIV Seroprevalence by Education Level………………………………………….16 Figure 6: Number of Orphans in Primary Schools, 1995- 98……………………………..….46 Figure 7: AIDS Mortality (%) – Primary Teachers, 1997 – 2013.………………………..…63 Figure 8: AIDS Mortality (%) --- Secondary Teachers, 1995 – 2013……………….………63
LIST OF TABLES TABLE 1: COMPARISON OF POPULATION BASED KABP FINDINGS, 1995 AND 1998...... 15 TABLE 2: DISTRIBUTION OF INSTRUMENTS AND RESPONDENTS...... 28 TABLE 3: STUDENT KNOWLEDGE OF HIV/AIDS, PERCENTAGE WRONG BY CLASS AND GENDER ...... 34 TABLE 4: STUDENT KNOWLEDGE OF HIV/AIDS, PERCENTAGE WRONG BY LOCATION ...... 34 TABLE 5: MOST USEFUL SOURCE OF INFORMATION ABOUT HIV/AIDS ...... 35 TABLE 6: STATEMENT RESPONSES, STUDENT QUESTIONNAIRE—HIV/AIDS TEACHING...... 36 TABLE 7: INDIVIDUAL IN SCHOOL WITH WHOM PROBLEMS ARE DISCUSSED, BY LEVEL ...... 37 TABLE 8: PRIMARY TEACHERS STATEMENT RATINGS (QUESTIONNAIRE)—SEXUAL HARASSMENT ...... 38 TABLE 9: SECONDARY TEACHERS- QUESTIONNAIRE STATEMENT RATINGS ...... 39 TABLE 10: STATEMENT RESPONSES FROM STUDENT QUESTIONNAIRE ...... 39 TABLE 11: STUDENT STATEMENTS FROM FOCUS GROUPS ...... 40 TABLE 12: TEACHER STATEMENTS FROM FOCUS GROUPS...... 41 TABLE 13: REPETITION, SCHOOL INTERRUPTION AND ABSENCE BY PARENTAL PRESENCE ... 43 TABLE 14: ABSENCE AND REASONS FOR ABSENCE BY LEVEL, GENDER AND LOCATION...... 44 TABLE 15: ABSENTEEISM BY PRESENCE OF PARENTS ...... 45 TABLE 16: REPETITION, SCHOOL INTERRUPTION AND ABSENTEEISM BY LIVING ARRANGEMENT ...... 45 TABLE 17: NUMBER OF ORPHANS AND PERCENTAGE OF ENROLMENT BY YEAR, STUDY SCHOOLS, SCHOOL RECORDS...... 47 TABLE 18: STATEMENT RESPONSES FROM STUDENT QUESTIONNAIRE–ORPHANS ...... 48 TABLE 19: STUDENT STATEMENTS FROM FOCUS GROUPS—ORPHANS...... 48 TABLE 20: STATEMENT RATINGS FROM STUDENT QUESTIONNAIRE—HIV AFFECTED STUDENTS ...... 50 TABLE 21: STUDENT STATEMENTS FROM FOCUS GROUPS—STUDENTS AFFECTED BY HIV... 50 TABLE 22: AGE PROFILE OF TEACHERS IN STUDY AND 1998 NATIONAL SAMPLE ...... 53 TABLE 23: ACADEMIC QUALIFICATIONS, TEACHERS IN STUDY SAMPLE ..ERROR! BOOKMARK NOT DEFINED. TABLE 24: YEARS OF EXPERIENCE, TEACHERS IN STUDY SAMPLE AND 1998 NATIONAL SAMPLE...... 54 TABLE 25: MORTALITY AMONG ALL TEACHERS IN UGANDA...... 56
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TABLE 26: NUMBER OF DAYS ABSENT THIS TERM, STUDY SAMPLE SELF-REPORT ...... 57 TABLE 27: ABSENTEEISM THIS TERM, SCHOOL RECORDS ...... 58 TABLE 28: REASONS FOR ABSENCE, % OF TEACHERS INDICATING REASON ...... 58 TABLE 29: PRIMARY TEACHERS STATEMENT RATINGS—ABSENTEEISM...... 58 TABLE 30: SECONDARY TEACHERS STATEMENT RATINGS—ABSENTEEISM ...... 59 TABLE 31: TYPE OF TEACHER COVER PROVIDED, PRIMARY...... 59 TABLE 32: TYPE OF TEACHING COVER PROVIDED, SECONDARY ...... 59 TABLE 33: PRIMARY TEACHERS STATEMENT RATINGS—DISCRIMINATION ...... 61 TABLE 34: SECONDARY TEACHERS STATEMENT RATINGS—DISCRIMINATION ...... 61 TABLE 35: PRIMARY TEACHERS STATEMENT RATINGS–TEACHER MORALE ...... 63 TABLE 36: SECONDARY TEACHERS STATEMENT RATINGS—TEACHER MORALE ...... 63 TABLE 37: PRIMARY STUDENT AND TEACHER PROJECTIONS...... 67 TABLE 38: PRIMARY STUDENT AND TEACHER PROJECTIONS...... 67 TABLE 39: SECONDARY STUDENT AND TEACHER PROJECTIONS ...... 68
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ABBREVIATIONS
AIC AIDS Information Centre AMREF African Medical Research Foundation ANC Antenatal Clinic DFID Department for International Development DISH Delivery of Improved Services for Health ESIP Education Sector Investment Plan FGD Focus group discussion FP Family Planning JCRC Joint Clinical Research Centre KABP Knowledge, Attitudes, Behaviour and Practices LC Local Council MOES Ministry of Education and Sports MOH Ministry of Health NCDC National Curriculum Development Centre NGO Non-governmental organisation NRM National Resistance Movement PLWA Person Living with AIDS PTC Post-Test Club PTR Pupil Teacher Ratio SHEP School Health Education Programme SMT/SWT Senior Man Teacher/Senior Woman Teacher STD/STI Sexually Transmitted Disease/Sexually Transmitted Infection TASO The AIDS Support Organisation UAC Uganda AIDS Commission UPE Universal Primary Education USH Uganda shillings UWESO Uganda Women’s Effort to Save Orphans VCT Voluntary Counselling and Testing WHO World Health Organisation
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Executive Summary HIV prevalence has been falling steadily in Uganda since 1992 and is now approximately 8%. This decline has been most noticeable in the 15-29 age groups and has been achieved through an aggressive public health campaign spearheaded by the Ministry of Health, with support and encouragement from President Museveni. The anti-AIDS activities have been co-ordinated by the National Uganda AIDS Commission. The main strategy has been to disseminate a message that emphasizes empathy and support for AIDS victims, abstinence, faithfulness in sexual relationships and the use of condoms during sexual intercourse. It has been a joint effort with national and international NGOs and religious organizations playing significant roles.
Behaviour changes have also been documented, for example: A two-year delay in the onset of sexual intercourse among youth aged 15-24 years A sharp increase in condom use from 15.4% to 55.2% among men and from 5.8% to 38.7% among women A drop of nearly 50% in the proportion of men and women exchanging sex for money Decrease in the proportion having sex with casual partners Increase in the proportion using condoms with non-regular partners.
However, challenges remain and a national AIDS control strategic plan is being re-launched with substantial funding from the World Bank. The Ministry of Health is negotiating with drug companies to reduce the cost of AIDS therapies. The Ministry of Education and Sports is also currently developing a strategic plan to fight AIDS and HIV infection in the education sector.
This study of the impact of HIV/AIDS on the education sector was part of a three country study (Uganda, Malawi and Botswana) and had three broad aims: To assess the strategies being used to educate students about HIV/AIDS in schools To assess the impact on students as orphans, caregivers and those infected with HIV. To assess the impact on teachers as educators and employees.
Carried out by a four-person team in Uganda, the study took a multi-pronged approach to the assessment: Interviews with stakeholders (government, NGOs and international agencies) Developing projections of teacher and student numbers using national demographic and educational statistics Survey in 10 schools (6 primary and 4 secondary) in two districts (Masaka and Jinja) Interviews with orphans
The study’s findings and recommendations are summarised below under the three broad areas of interest.
HIV/AIDS Education Findings There is very little reference to HIV/AIDS in the formal curriculum; only the last year of primary has any significant content
Final Draft, 20-09-02 vi HIV/AIDS AND EDUCATION IN UGANDA: WINDOW OF OPPORTUNITY?