PLA Notes 37 February 2000

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More talk, less sex: AIDS prevention through schools

Noerine Kaleeba, Joyce Kadowe, Daniel Kalinaki and Glen Williams

completing primary school (Bagarukayo et · Background al. 1993). This pattern of sexual activity was clearly exposing many young people in to a high risk of unplanned "Why is it that someone can at times have pregnancy, Sexually Transmitted Diseases an erection even when he doesn't want it?" (STDs) and HIV/AIDS. "Is someone likely to get AIDS by kissing In the early 1990s, the District of Soroti, in an infected person?" eastern Uganda, was struggling to emerge from several years of civil war. Many "Can HIV be contracted after only one schools had been looted and damaged single sexual intercourse with an infected during fighting between dissidents and person?" government forces and large numbers of children were attending classes in the open These are just a few of the frank questions air. Although about 90% of children were about sex and HIV/AIDS which primary reported to be starting primary school, school pupils in , Uganda (which has covers the range of 6–20 years are putting into their 'health letter boxes'. of age) only 40-50% were actually The health letter boxes are part of an completing the full seven-year course. innovative School Health and AIDS Many children were in their late teens by Prevention Programme, which has helped the time they left primary school. to dramatically reduce sexual activity among primary school pupils. The letters Health education, including AIDS are read out to the children during morning prevention, was already part of the assemblies and answered on the spot by primary school curriculum in Uganda at specially trained teachers. As in many this time. However, teachers generally other countries, sex in Uganda has long lacked the training and the skills needed to been regarded as a taboo subject, which talk explicitly about human reproduction causes feelings of embarrassment or even and sexual health, and to encourage their shame when discussed in public. Yet this pupils to discuss intimate sexual matters. has not prevented large numbers of young Ugandans from becoming sexually active. A national survey in 1995 found that on · Programme strategy average, girls became sexually active at the age of 16, and that 30% of girls had In 1993 the African Medical and Research engaged in sexual intercourse by the age Foundation (AMREF), together with the of 151. In some parts of Uganda, Soroti District Administration, started a up to 62% of boys and 38% of girls were School Health and AIDS Prevention involved in unprotected sex before Project in 95 primary schools, with an enrolment of about 120,000 children, in

1 two rural counties and Soroti town. A Statistics Department, Demographic and baseline survey of primary school pupils Health Survey, Ministry of Finance and aged 13-14 in the project area in 1994 Economic Planning, Entebbe, 1995. found that 42.9% were sexually active. Boys were more likely than girls to be

50 PLA Notes 37 February 2000 sexually experienced: 61.2% of boys and Science teachers attended four-day claimed to have had sex, compared with health education training courses to 23.6% of girls (Shuey et al., 1999). improve their knowledge and health education skills. Looking towards the The project aimed to encourage safer longer-term future, the project helped local sexual behaviour, particularly abstinence, teacher training colleges to introduce amongst primary school pupils, through a school health, AIDS prevention and Child- three-pronged operational strategy: to-Child health learning techniques into · improved access to information about their training courses. healthy sexual behaviour and decision- making; When the project entered primary schools, · improved adolescent-to-adolescent teachers initially encountered some interaction regarding information and reluctance on the part of pupils to discuss decision-making relating to AIDS, sexual matters and AIDS in a frank and sexuality and health; and, open manner in the classroom. However, · improved quality of the existing these inhibitions were soon overcome, and district education system in the pupils responded positively to the more implementation of the school health open approach (i.e. being frank and curriculum and in counselling/advice- specific) to teaching about human giving to school pupils. reproduction, sexual health and AIDS.

Perhaps even more influential were the Beyond embarrassment weekly ‘guidance and counselling’ sessions run by the SWTs and SMTs for The new approach was not without risks. pupils in years five, six and seven (aged Objections were to be expected from between 11-14, but pupils can often be traditionally minded parents, as well as older). These sessions, often held in small cultural and religious leaders. The project groups sitting under a tree, gave pupils the made meticulous preparations, therefore, chance to interact with one another to minimise the likelihood of informally, with guidance and support misunderstandings, social tensions and from teachers whenever necessary. They outright opposition. A District level took the form of teacher facilitated group Steering Committee was appointed to discussions, with the use of drawings and oversee the activities of the project. This posters to support them. Particularly consisted of officials from the useful to the guidance and counselling Departments of Education and Health, sessions were copies of the newspapers local government personnel, religious Young Talk and Straight Talk supplied free to schools by the Straight Talk leaders, representatives of parents, youth 3 and women's affairs, and staff from Foundation . These provided accurate, AMREF-Uganda. Headmasters and local factual information about sex, human leaders (politicians, government officials, reproduction and HIV/AIDS, and also religious and local opinion leaders) were stimulated discussions amongst pupils, and sensitised about the aims of the project between pupils and teachers. Many pupils through a series of one-day workshops. also wrote to one or other of these The project also organised meetings to discuss health and sex education with local give guidance and counselling to pupils, alongside their normal teaching duties. parents, community leaders and teachers at 3 each school and in each administrative The Straight Talk Foundation is an organisation whose aims are: to increase zone. Teachers were also thoroughly understanding of adolescence, sexuality and prepared: Senior Women Teachers 2 reproductive health; and to promote safer sex, (SWTs), Senior Men Teachers (SMTs) life skills and child/adolescent rights. It publishes two monthly newspapers – Young Talk and Straight Talk, which reach over 1 2 Senior Women and Men Teachers are million young adolescents and youth, mainly experienced teachers designated by schools to through primary and secondary schools.

51 PLA Notes 37 February 2000 newspapers to seek advice or express their survey was made of the sexual behaviour opinions. of a sample of pupils in year seven of primary school in the project area. An Pupils began using ‘health letter boxes’ at identical survey was also carried out in a school to ask questions about HIV/AIDS, 'control' group of schools in a STDs and other intimate matters related to neighbouring county, where the project sexual and reproductive health. In was not operating. The survey found that, addition, pupils went to teachers for in the schools involved in the project, the individual counselling, advice or practical percentage of pupils claiming to be help. “Girls come to me,” says Christine sexually active had fallen dramatically: Oluka, Deputy Head of Soroti from 42.9% to 11.1%. Boys were still Demonstration School, “for advice about more likely than girls to be sexually their relationships with their boyfriends, active: 15.8% compared with 6.4%. By or to complain about a boy who is contrast, no significant changes in sexual pestering them. They also ask about their behaviour were recorded among pupils in periods. Sometimes they get their period the ‘control’ group of schools (Shuey et at school but they haven’t brought a al., 1999). sanitary towel, so we can help them deal with that.” The survey also explored the reasons for this 74% decline in reported sexual In every school involved in the project, activity among young people. It groups of pupils also started extra- concluded that the main reason was curricula school health clubs, whose greater social interaction between pupils members came together to share and teachers, and among pupils knowledge and experiences, and to themselves. This high degree of social support one another in following a healthy interaction was not accidental, but was lifestyle. They also composed songs, carefully fostered by the project. It was staged skits and plays, and wrote poems effectively reinforced by the thrice-yearly and essays about HIV/AIDS, pregnancy visits paid to schools by officials from the and other health-related issues. The District Education Service to monitor condom issue had to be handled very activities and provide supportive carefully, since many parents feared that supervision to teachers. teaching young people about condoms would encourage them to become sexually The channels of communication that have active. Most teachers confined been opened up between the project and themselves, therefore, to providing local families and communities have also information about the condom, without contributed to the success of the project. showing samples or demonstrating how it Community leaders and parents were should be used. Some teachers, however, sensitised about the aims and activities of brought condoms to school and the project, and also offered the demonstrated, albeit discreetly, their use to opportunity to express their views at local senior pupils, especially to those who are meetings. These efforts have helped local already sexually active4. parents and community leaders understand and accept the aims and strategies of the Increase in abstinence project. While some parents have complained that the project has led to their In 1996, after the project had been fully children experimenting with condoms, operational for two years, a follow-up most would probably agree with Salome Abuko, a small kiosk owner and mother of

4 two primary school children in Soroti AMREF also sells condoms and contraceptive town, who says: pills to the general public. However, this project is separate from the School Health and AIDS Prevention Project. “It's good that the children are being taught about AIDS and sex at school. The teachers aren't spoiling them but are

52 PLA Notes 37 February 2000 helping to save their lives. In fact they are helping us to do our jobs of teaching our "As a teacher, I am now much more open children”. with my pupils. I don't hide any facts when I am teaching about sex or AIDS in the classroom. In the past, I could feel · Feedback from project uneasy when talking about such things. participants But now, even if my own child is in the class, I talk quite openly. The children sometimes have problems being open. At The following section provides some first they are shy and afraid to use the feedback from a selection of the project’s language to describe sexual matters. I just participants, both students and teachers encourage them not to be afraid and to alike, in which they share some benefits, speak out. We also talk about AIDS at outcomes and learnings that have been a school functions, like Parents' Day and direct result of the project thus far. Open Day, where the pupils sing songs depicting AIDS and other social problems. Jesca Harriet Acao: class 7 pupil "Not everyone agrees with what we are doing. Some parents bounce the problem Fourteen year-old Jesca is in class 7 at back to us, and say we are trying to teach Katine Tiriri Primary School, about 20 their children irrelevant things, and kilometres north of Soroti. causing them to be interested in sex at too early an age. But the Project recently ran "The greatest worry in my life is AIDS. It a peer group seminar on AIDS and sexual has killed four of my sisters and brothers. issues for school pupils, and afterwards My surviving sisters at home tell me how I some of the pupils went and explained it could get AIDS and they advise me to all to their parents. I also talk to people in behave myself so that I can stay safe. We my community about AIDS. The death talk about AIDS in our free time here at rate from AIDS seems to be decreasing, school, and we also read the Young Talk but the problem is that the people at the newspaper which comes to the school. I grassroots, who don't have radio or also borrow Straight Talk from the television, still lack information. But we teachers. I also listen to 'Capital Doctor' shouldn't try to hide anything about AIDS. on Capital Radio on Tuesdays, and I have The problem is already with us so we learned a lot about AIDS from that. We cannot hide from it”. have learned about AIDS in class - how we can get it, prevention, taking care of yourself, and teaching other people back Grace Ebunyo: senior woman home in the village so they do not get it teacher also. As the Senior Woman Teacher at Soroti "My parents feel happy that I am learning Demonstration Primary School, Grace is about AIDS and sex at school, because responsible for the weekly guidance and whatever they teach us here I pass on to counselling sessions for pupils in the top them. They tell me I will have a better life three classes of the school. She is 39 years in future because of what we are learning old, married, with five children. Her life at school. has been deeply marked by the HIV epidemic. Joseph Julius Omio: science teacher "AIDS has affected me a lot. In 1995 I lost my brother, who was teaching in Teso Joseph is a Science teacher at Katine College - he had just finished his Tirere Primary School. He was trained by university degree. I also lost my other the AMREF School Health and AIDS brother just after his training, and my Prevention Project:

53 PLA Notes 37 February 2000 sister died when she was in her last year in with their parents. I have a friend who teacher training college. I spent a lot of divorced her husband 16 years back. They money helping my brothers and sister get were planning to reconcile but her a good education, but they all died so daughter, who was in Primary 6 at the young! I'm really worried about my own time, said 'Mum, you've been away from children. Whenever I lose a close relative each other for such a long time. We are to AIDS, I take them there to see, and I not sure whether father is free from even tell them the cause of death, but still HIV/AIDS.' My friend thought seriously I'm worried for their sake. As a teacher, about what her daughter said, and in the I'm worried about my pupils. Today's end she declined his proposal." children learn many bad things from TV and from one another”. Caroline Imalingat: class 7 pupil Grace is strongly in favour of teaching about sex, human reproduction and AIDS Fifteen year-old Caroline is in class 7, her in primary schools: final year at Soroti Demonstration Primary School. When her teacher first started "AIDS is covered in the school curriculum, talking about sex in class, she was but only from Primary 5 to 7. But with uncomfortable: UPE5, we are now getting big boys and girls, even 15 year-olds, in Primary 1. So "I used to feel so embarrassed when the the curriculum should cover AIDS right teacher was talking about sexual matters from P1. in class. I felt that such things were not supposed to be talked about in class like "We try to emphasise abstinence from sex that. Now I don't feel embarrassed at all, as the best method of AIDS prevention, but because I know that such things are children cannot easily avoid temptation. important and should be discussed. But We have to tell children about condoms. I some of my fellow pupils still say it's bad even show condoms to the big ones. My to discuss such things openly. I also brother is a doctor and he has condoms in discuss sexual matters with the Senior his clinic, so I can easily get them. The Woman Teacher, and with my mother, and parents are generally very positive about they advise me about what to do. I think the teaching of AIDS prevention in school. sex is very dangerous because you can get Many have lost their children to AIDS, so diseases which cannot be treated. It can they support of what the school is trying to also cause you to get married early do. because you become pregnant. Some parents can even chase you from home. "People in the community are much better Sex is only good when you have finished informed about AIDS, and they are much your studies and got a job and want to more supportive towards people with have children. AIDS. In the past they were afraid to touch the sick, or even to carry the body of "I have learned about AIDS here at someone who had died of AIDS to be school, and through reading. I read buried. But now they know that touching Young Talk and Straight Talk at school. someone with AIDS is not risky, so they My friends and I, we talk about AIDS nurse and care for the sick. And they no during lessons and in our free time. We longer waste time analysing how someone have agreed to stay safe so that we do not got AIDS, which was the case in the past. get infected, because AIDS cannot be "There are some school children who cured. I tell my parents what I am share their knowledge of HIV and AIDS learning about AIDS at school. They are happy about it. They say that the teachers 5 Universal Primary Education – a government are helping them. programme which began in 1998 and which "I have good friends who are boys. I think aims to enable each family to have four it is possible to be a close friend with a children educated to complete primary school.

54 PLA Notes 37 February 2000 boy without playing sex. I do not have a boyfriend and have never had one. A boy · Noerine Kaleeba, UNAIDS, 21 via can make you neglect your studies because Appia, 1211 Geneva, Switzerland. you are thinking about him all the time”. Email: [email protected], Joyce Kadowe, Uganda AIDS Commission, P.O. Box 10779, , Uganda. Email: [email protected], · Expansion and sustainability Daniel Kalinaki, Department of Mass Communication, Makerere University, In late 1998 the project expanded to cover Kampala, Uganda. Email: [email protected], and Glen all 213 primary schools in Soroti District Williams, Strategies for Hope, 93 and 154 schools in the neighbouring Divinity Road, Oxford, OX4 1LN, UK. District of - a total of 367 schools Email: [email protected] with a total enrolment of 192,000 children. REFERENCES The project employs only one full-time health educator, who is scheduled to leave Shuey, D.A., Babishangire, B.B., Omiat, the project in March 2000. The prospects S., Bagarukayo, H. Increased for the longer-term sustainability of the sexual abstinence among in- benefits of the project, however, are good. school adolescents as a result of Firstly, the project is based on the existing school health education in Soroti health education curriculum. It is district, Uganda, Health Education implemented on a day-to-day basis by Research, Oxford University Press, Vol. 14 (3), 1999, pages local teachers and officials from the Soroti 411-419. District Education Department, and pays Bagarukayo, H., Shuey, D., Johnson, K., no allowances to staff outside of normal and Babishangire, B., An government policy (i.e. for travel expenses operational study relating to and to cover the costs of attendance at sexuality and AIDS prevention workshops etc.). among primary school students in Kabale district of Uganda. Poster Moreover, the social interaction approach presentation at VIIIth International adopted by the project has been Conference on AIDS in Africa, Marrakesh, 1993. incorporated into the curriculum of the two teacher training colleges, which NOTES supply most new teachers for the two local Districts covered by the project. There is This article is an abridged version of a every prospect, therefore, that the new chapter from book no 15 in the Strategies approach will become institutionalised, for Hope series entitled, ‘Open Secret: and that future generations of primary Facing up to HIV and AIDS in Uganda’. school pupils will also be equipped with ActionAid, London 2000. the knowledge and skills they need to postpone sexual activity until they are It is available from TALC, P.O. Box 49, St. Albans, Herts, AL1 5TX, U.K. Email: physically, socially and emotionally [email protected] mature For further information on the Straight Talk Foundation, please contact Kathy Watson or Ann Akia at Straight Talk Foundation, PO Box 22366, Kampala, Uganda. Email: [email protected]

To find out more about materials in the Strategies for Hope Series, please visit our website,: www.stratshope.org

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