10 More Talk, Less Sex: AIDS Prevention Through Schools
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PLA Notes 37 February 2000 10 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 Uganda 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 Soroti District, 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