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HIV/AIDS Education - Why & How
Why HIV/AIDS education?
Who needs to be educated?
What form should AIDS education take?
AIDS education in school - when should it start?
Learning from the past
Turning knowledge into action
What form should AIDS education take?
The difference between AIDS education and AIDS
prevention
Each year there are more and more new HIV
infections, which shows that people either aren't learning the
message about the dangers of HIV, or are unable or unwilling to act
on it. Many people are dangerously ignorant about the virus - a
survey in the UK found recently that a third of teens thought there
was a 'cure' for AIDS. Education is an important component of
preventing the spread of HIV.
Even if education were completely successful, it
would still have to be an ongoing process - each generation a new
generation of people become adult and need to know how to protect
themselves from infection. The older generations, who have hopefully
already been educated, may need the message reinforced, and need to
be kept informed, so that they are able to protect themselves and
inform the younger.
There are three main reasons for AIDS
education, the first of which is to prevent new infections
from taking place. This can be seen as consisting of two processes:
• Giving people information about HIV - what HIV and
AIDS are, how they are transmitted, and how people can protect
themselves from infection.
• Teaching people how to put this information to use
and act on it practically - how to get and use condoms, how to
suggest and practice safer sex, how to prevent infection in a
medical environment or when injecting drugs.
A second reason that AIDS education is needed
is to improve quality of life for HIV positive people. Too often,
AIDS education is seen as being something which should be targeted
only at people who are not infected with HIV in order to prevent
them from becoming infected. When AIDS education with HIV positive
people is considered at all it is frequently seen only in terms of
preventing new infections by teaching HIV+ people about the
importance of not passing on the virus. An important and
commonly-neglected aspect of AIDS education with HIV positive people
is enabling and empowering them to improve their quality of life.
HIV positive people have varying educational needs, but among them
are the need to be able to access medical services and drug
provision and the need to be able to find appropriate emotional and
practical support and help
The third reason people need AIDS education
is to reduce stigma and discrimination. In many countries there is a
great deal of fear and stigmatisation of people who are HIV
positive. This fear is too often accompanied by ignorance,
resentment and ultimately, anger. Sometimes the results of prejudice
and fear can be extreme, with HIV positive people being burned to
death in India, and many families being forced to leave their homes
across the United States when neighbours discover a family-member's
positive status. Discrimination against positive people can help the
AIDS epidemic to spread - if people are fearful of being tested for
HIV, then they are more likely to pass the infection to someone else
without knowing.
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Anyone who is vulnerable to AIDS, and almost
everyone is vulnerable, unless they know how to protect themselves.
It's not only young people, injecting drug users or gay men who
become infected - the virus has affected a cross-section of society.
This means that education ought to be aimed at all parts of society,
not only those groups who are seen as being particularly high-risk.
It is all very well to educate young people but it's usually adults
who become infected, and in the UK, for example, in recent years
there has been very little AIDS education targeted at adults. The
people who are most urgently in need of HIV education are those who
think they're not at risk.
In 1987 in the UK, a leaflet about AIDS was
delivered to every household, and the government also launched a
major advertising campaign with the slogan "AIDS: Don't Die of
Ignorance" This is an example of non-targeted education, or rather,
education with a very broad target, intended to blanket the whole
population. To plan an effective AIDS education strategy with
smaller sections of the population, it helps to know the
characteristics of the group who are to be educated. It is possible
to identify four distinct groups of people who require targeted
education:
• People who have not yet been educated and may be
at risk of becoming infected. This usually means young people, who
need to know the risks involved in unsafe sex and drug use before
they are old enough to find out for themselves.
• People who have already been educated for whom the
education was not effective. If AIDS education were completely
effective, there wouldn't be nearly so many new infections. These
infections do not only occur amongst young people - many people who
have already experienced AIDS education continue to become infected
with HIV.
"A few months after we started having unprotected
sex, I fell gravely ill. . . I recovered slowly but . . . I guess
the warning signs have been there since I fell sick earlier this
year, I'm educated on HIV and some of my symptoms literally had the
warning bells ringing inside my head. Still, the shock of
discovering my status is something I will never wish on my worst
enemy." TK, a South African woman
• Everyone needs to learn how and why not to
discriminate against positive people. People who are not HIV
positive must learn about how the virus is transmitted in order that
they are able to protect themselves from infection. At the same
time, they must also learn how the virus is not transmitted. People
need to know that they cannot become infected from such things as
sharing food, towels or toilets. This will help to reduce
discrimination against positive people by reducing ignorance and
fear.
• People who are already infected also require
education. Initially, this must involve an element of counselling
and support, and must teach them how about living well with HIV, the
tests they may need to have and the medications they may need to
take. They must also learn about HIV transmission and safer sex, for
two reasons - they need to know how to live positively without
passing the virus on to anyone else, and they need to know how to
avoid coming into contact with a strain of the virus which differs
from the one they are already have.
• The only people who do not fall into one of these
groups are those who have received AIDS education, have taken it in,
and have the resources to turn knowledge into action. One group who
should hopefully fall into this category are AIDS educators. This
may seem obvious, but in many cases, teachers may require teaching
themselves. They may be called upon to act as AIDS educators when
they themselves have little experience or knowledge of the subject.
Peer educators must also receive training, even if they themselves
are HIV+. Information for teachers and HIV educators can be found
here.
If AIDS education that had been done up until now
had been fully effective, then there wouldn't have been five million
new infections in 2002. It is clear that the campaigns carried out
so far have failed to prevent the spread of the virus, so the
message needs to be repeated, in different forms, until people
appreciate it, or until, hopefully, education is no longer needed.
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AIDS education doesn't always take place in a
classroom. It can be presented in many ways and put across by many
forms of media, which should be selected with the target group in
mind. Some people can be best reached via newspapers and magazines,
whilst other people might be more used to street theatre as a form
of media. AIDS education needs to embrace culturally appropriate and
relevant media.
These might include radio, television, billboard
advertising, street theatre, comic strips, etc. Sometimes AIDS
education is about giving people information which they will
remember on a long term basis, about how to protect themselves, the
difference between HIV and AIDS, and helping to reduce
discrimination. On other occasions, an education strategy might
intend to have a more immediate effect and target people when they
are most likely to take part in risky behaviour - in nightclubs or
holiday resorts, for example.
There is no set or prescribed form that AIDS
education should take, but when considering an education campaign,
the following points are relevant:
• What age are the people to be educated?
• Where and when will the target group be most
receptive?
• Are there cultural issues to be considered - e.g.
attitudes to sexuality, laws against portrayal of explicit images or
language, etc.
• Are the people to be educated already sexually
aware?
• Have the people been exposed to AIDS education
before?
• Are the people literate?
• What language do they speak?
• Is the education program targeted at a specific
risk-group - e.g. injecting drug users? What is the best way to
reach the group being targeted?
• Is it better to tell people how they should behave
or inform them of the dangers and let them decide?
• Are people able to do what you're suggesting they
do? There's no point in advising people to use condoms if none are
available to them, or to use clean needles if needle exchanges are
illegal.
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There is no set age at which AIDS education should
start, and different countries have different regulations and
recommendations. In some areas this is a very sensitive subject, and
some groups regard teaching young people how to protect themselves
as a form of abuse. It seems obvious, however, that people should
know how to protect themselves before they begin having sex, rather
than after.
"At school, my sex ed was pretty poor. It started in
year 8 when we are about 12-13, which is kind of 2 late really.
Quite a few of my friends had already had heterosexual sex and had
not protected themselves at all." Laura
Especially when educating young people, AIDS
education often shares territory with sex education. Education which
teaches about sex and sexuality can also teach about preventing
pregnancy and STI infection.
"I know by the time I was taught about sex it was
too late, I had already made my mistake." Safiyyah
AIDS education should start at about seven or eight
years of age. When working with very young people, this type of
education does not necessarily need to involve learning about sexual
activities or drugs, but should at least teach children that 'AIDS'
is not a pejorative term of abuse. Playground name-calling, to some
extent, reflects attitudes in general society, but it can also grow
up to become discrimination.
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The first major government education campaign in the
UK came in 1986 when the government launched a leaflet campaign,
targeting every household in the UK with the 'AIDS - Don't Die of
Ignorance' slogan. Around this time, the media covered stories about
gay men and drug users becoming HIV positive, whilst portraying
people who had become infected through contaminated blood
transfusions as the innocent victims of a disease spread by the
immorality of others. Tabloid newspapers carried scare-stories about
people being attacked with dirty needles - much more memorable than
the government's leaflet. This is a formula which is still, to some
extent, true today.
In these early years, much attention was given to
the fact that the virus seemed to be especially prevalent amongst
such groups as gay men and people who shared needles. Targeted
education programs aimed at harm reduction amongst these groups may
have been effective to some extent but, when disseminated by the
mass-media, this message also reached people who were not in the
target group. This seems to have had the effect of giving people the
impression that, if they are not in these high-risk groups, then
they are not at risk at all.
Government campaigns often do not have the impact
that they need in order to change people's behaviour, and the media
disseminates the idea that HIV affects minority groups. These two
sources of information need to be able to coordinate and inform
people in an effective, appealing manner.
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Many people are now aware of the dangers of HIV, and
yet the number of infections continues to climb. This suggests that,
although people are being told the necessary information, they are
not listening or are either unwilling or unable to act. It is
clearly not enough to simply dispense information to people if they
cannot or will not turn this knowledge into action.
In order for people to be able to use the
information that AIDS education gives them they often need more than
simply the facts about HIV transmission. AIDS education will fail to
help people to protect themselves if it gives no more than the
biological facts. Some other identifiable needs are:
• Motivation is a very important initial
need. People need to know that what they are learning about the
epidemic is personally relevant to them. They need to know that they
can be themselves affected by HIV if they do not take steps to
protect themselves. Sometimes this motivation comes only when people
see their friends dying, and it would be preferable if education
could persuade people to act before they are frightened into doing
so.
• Empowerment is also crucial to people's
ability to protect themselves. They must be in a position where they
are able to take control of their sexual behaviour or methods of
drug use. In many parts of the world, women have limited control of
when and with whom they have sex, and less control of whether
condoms are used. This may be because they are sex workers, because
they are in abusive relationships, or simply that such a situation
is endemic to the society they live in. AIDS education needs to help
people to take control of their sexual and drug-using behaviour, and
to help both men and women to act responsibly and evolve strategies
to avoid risky situations and to say no to sexual encounters which
are risky or unwelcome.
• Condoms should be available. There is
little point in teaching people about the need to practise safer sex
if they are unable to access condoms. Ideally, condoms should be
freely available, and should be accessible to young people,
regardless of whether they are over the age of consent or not.
• Needles and injecting equipment need to be
made available in the same way, regardless of legislation
prohibiting drug use. In some parts of the world, a person found by
the police in possession of drug injecting equipment can be
prosecuted, which tends to encourage injecting drug users to share
equipment. This is clearly unsatisfactory, and people need not only
to be taught how to inject without risking the transmission of HIV,
but to have access to the equipment they need to do so, without fear
of prosecution.
• Medical supplies are also crucial to
putting AIDS education into action. Medical personnel can be taught
how to prevent HIV transmission during their work, but actually do
this they need sterile needles and surgical equipment, non-infected
blood-products and latex gloves. Nurses and doctors need to have the
facilities enabling them to protect both themselves and their
patients.
• Testing facilities are also a priority.
When a person has a positive HIV test, they can be educated how to
protect their partners from infection and how to live well with HIV.
This is not possible in a situation where there are insufficient
testing facilities.
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There are a number of different methods which can be
used to educate the public about the dangers of HIV.
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Peer education is, quite simply, a social form of
education without classrooms or notebooks, where people are educated
outside a 'school' environment but still have the opportunity to ask
questions. Sometimes the 'peer educators' will be from the group
that is to be educated - a group of workmates might pick someone
from amongst them to become the educator. On other occasions the
educator may be someone who has a similar social background, age and
gender to the target audience, sometimes a person who is HIV+. Most
peer education focuses on providing information about HIV
transmission, answering questions and handing out condoms to people.
The sessions take place wherever is convenient - sometimes in the
workplace, or perhaps in a bar, or where a group of women gather to
wash clothes.
Peer education should be an ongoing thing, and most
peer educators make contact with their target audience at least
weekly and their sessions will usually be in the context of informal
discussions with individual people or groups. This gives people the
opportunity to ask questions outside an academic environment, and
with someone who isn't an authority figure, and isn't going to test
them or expect them to perform activities such as might be expected
in the context of a classroom-based lesson. This form of education
also has the advantage of avoiding the possibility of embarrassment,
which might make people feel unable to ask questions of a teacher of
person they find more difficult to relate to.
Peer education tends to be used mostly with adults,
who can not be reached through the school system, although it has
also been found to be effective with young people. It has been found
to be an effective method of reaching groups who might not listen to
a teacher or someone from a different background to themselves - it
has been found to work well in prisons, for example, and with risk
groups such as prostitutes. The peer educators provide a credible
link between the target audience and the education project, by whom
the educator is trained.
Peer education is often effective when targeted
specifically at a particular group, as people seem more willing to
listen to someone who understands their social background. It also
does not have the effect, as is risked by a media-based campaign, of
making the target audience appear to the public as a whole to be a
danger.
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In order to understand 'active' learning, it is
first necessary to understand 'passive' learning. Passive learning
occurs when a learner is given a set of facts, often in a classroom
environment, and is the type of learning that has been traditionally
favoured by academic institutions.
AIDS education in Congo, where there is a shortage
medical personnel and AIDS educators.
More recently, however, educators have realised that
people are more likely to both remember information and to relate it
to themselves if they are given an opportunity to put it to use as
they learn.
An example might be a chemistry lesson in school -
who is more likely to remember the information - the child who sits
in silence and records the nature of the chemicals in a textbook? Or
the child who performs an experiment to discover the information for
themselves.
Active learning can sometimes link into peer
education, especially when AIDS education is aimed at young people,
as one of the best methods of learning something oneself is to teach
it to others.
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This is a general message aimed at the population as
a whole. In many countries, the general population is seen as being
at a fairly low risk of HIV infection, and blanket education usually
aims to inform the population about which behaviours are risky and
to give them support in changing these behaviours. This gives the
opportunity for people who are already infected with the virus to
avoid transmitting it to others, and for people who have not been
infected to protect themselves.
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This type of strategy is usually used to speak to
social groups who are perceived as being at a high risk of HIV
infection - injecting drug users, for example. This type of
education usually tends to focus on risky activities particular to
the specific target group - in this case, the risky behaviour is
injecting drugs. Blanket education is inappropriate when wishing to
communicate with specific risk groups, as it can incite
discrimination in the general population towards the group, and can
tend to promote 'somebody else's problem' thinking.
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Education is an important part of AIDS prevention,
but it is only one part. AIDS prevention work being done around the
world covers such diverse topics as the search for a vaccine,
distribution of condoms, research into microbicides, lobbying
governmental organisations, and testing people to monitor the trends
of the epidemic. Education, however, is a crucial factor in
preventing the spread of HIV, and, given the huge numbers of deaths
that might still be prevented, the importance of effective education
cannot be overestimated.
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