More than 100 pupils in yellow uniforms sit in a primary school class. The teacher is talking about HIV today. She asks if anyone can tell her what “HIV” stands for. Several hands are raised, and one girl answers confidently that it’s Human Immunodeficiency Virus.
The teacher continues to lecture about the disease for 15 minutes. She asks if there are any questions. The room is silent.
A need for change
The above scenario shows that teaching facts about HIV has become tiresome and not enough to guide today’s youth.
“We need to check how we are reaching the youth if we want the message to sink in,” said Musa Bugundu, Country Director of UNAIDS. “Even though treatment is part of prevention, we need more focus on the educational aspect… Young people need more guidance.”
Nearly 10 million students attend primary and secondary schools, government and private. 56 per cent of Uganda’s population is below the age of 19, meaning the majority of the people are within school going age.
This is both a challenge and opportunity for guiding young people in making healthy life choices.
“Sex and HIV education is one of the essential things students need, because many young people who don’t have sexuality education don’t even finish their schooling,” said Lewis Bukenya Denis, training manager at Naguru Teenage Information and Health Centre.
12 years later...
School interventions have been rolled out, mainly the Presidential Initiative for Aids Strategy Communication to the Youth (PIASCY) in 2002, but today, schools face challenges that weren’t there when the programme was developed.
For starters, more than 400,000 students, teachers, and school staff were reported as HIV positive in 2012, making up nearly a quarter of all HIV positive people in Uganda.
Another challenge is overcrowded schools—the total study body increased by approximately 19.7 per cent since 2002. Young people are more sexually active today, giving reason as to why 25 per cent of annual births are to women under the age of 18.
Not to mention only 39 per cent of young people aged 15 to 24 know all the necessary facts about how to prevent HIV, suggesting a lack of sex education, according to the 2011 Aids Indicator Survey.
“The fact that young people are unaware is a major factor of the prevalence rates,” professor Vinand Nantulya of Uganda Aids Commission. “Education is most needed.”
Improving lessons on HIV
Presidential Initiative for Aids Strategy Communication to the Youth (PIASCY), started as a tool for schools to assist children in staying safe and helping prevent HIV/Aids.
It was started in 2002, and added to secondary schools in 2005.
“PIASCY is a holistic approach where everyone—students, teachers, communities—work together,” said Dr Yusuf Nsubuga, director for basic and secondary education and HIV/Aids sector coordinator.
The materials—texts for students and teachers, and posters for school messaging—are given to more than 20,000 public and private schools. They cover topics from life skills to reproductive health, and HIV transmission and prevention.
The appropriateness of materials is grouped by class level. The programme encourages schools to hold assemblies every two weeks that focus on a message, such as saying no to sex for gifts.
Head teachers are trained to incorporate messages within class curriculum. Now 12 years later, representatives from the Ministry of Education and Ministry of Health say that the programme has been losing steam.
“The most critical factor to me is complacency,” Dr Nsubuga said. “Complacency because we have had [HIV] for more then two decades. There is a general burn out, by health workers, teachers, by everybody.”
The lack of monitoring and assessment and changing priorities in the national response are some of the reasons there are signs of PIASCY fading, explained Sam Enginyu, senior health educationist for the Ministry of Health. “This is working, but it needs modifications,” Enginyu said. “When the document came out, there wasn’t the issue of ARVs. Now we have the challenge of our children being given ARVS and the issues around stigma need to be addressed…we need to review the document and incorporate those areas.”
Dr Paul Kagwa, Assistant Commissioner in Health Promotion and Education at Ministry of Health, also advised that the PIASCY be reviewed for new strategies in the larger national response.
“We’ve had so many players and so many cooks in the kitchen, as a country we had ended up with uncoordinated movements in HIV,” “We expect teachers to do a lot with little strategy.”Dr Kagwa said.
Mary Mulgai, head teacher of Muyenga High School, remembers attending a PIASCY workshop last year.
“We had training on how to train our teachers, but to me I don’t think it is very effective because head teachers are always so busy running the school,” Mulgai said.
Time is one of the biggest challenges for teachers trying to balance academic curriculum with PIASCY.
“[PIASCY] has no time allocation on the time table,” Jesse Waiswa, social studies teacher at Wabulungu Primary School said. “It is awakened sometimes, and then we sometimes forget. When it is talked about daily, that is when it is effective.”
Teachers said they often act as parents to their students because they lack guidance at home, and they counsel about a range of concerns from sexual health to discipline.
This does not mean all teachers are prepared to take on such a role. Denis Lewis Bukenya, training manager from Naguru Teenage Information and Health Centre, remembers training a group of teachers who were embarrassed to name parts of the body.
“We have to support teachers to become comfortable with these topics that are often considered vulgar,” Lewis said. “It can’t be just one teacher. The whole school environment must work to it.”
Prossy Namugomya, 22, remembers one message about HIV from her time in primary and seconday school: “Aids kills.”
As an HIV positive student, she feared telling her teachers or peers.
“I felt very alone in secondary school,” she said. “I feared that students may suspect my status and discriminate me.”
Her counsellor helped her overcome stigma, but she did not feel comfortable going to her schoolteachers for help. Most students, like Namugomya, fear opening up to teachers.
“Teachers are not equipped enough,” Prossy said. “They still need more information… schools really need professional counsellors.”
Students and young people said that counsellors are needed to help both HIV positive and negative students live healthily.
“I think 99 per cent of schools don’t have counsellors, even private schools,” said Kenneth Wenani, guild president of Uganda National Students Association (UNSA) at Uganda Christian University. “These are emotional, psychological issues we are handling. Young people need a lot of care and need a lot of attention, which teachers are not specialised or able because they are overloaded with class work.”
Some community groups, such as Community Concerns Uganda, step in to help schools with health education and counselling, but programmes are too few and far between to make a lasting impact.
1Revisiting PIASCY messages and implementation in schools was a must for both teachers and young people, but youth stressed the need for programmes developed by young people, for young people.
“If are you to handle youth, you need youth to handle it,” said Emmanuel Ekima, member of UNSA.
Just as fatigue has set in for teachers and decision-makers, young people are tired of the same messages and approaches.
2The need for counsellors in schools prevailed among both teachers and youth. Teachers did not feel equipped enough to address all the challenges young people face, yet young people need guidance outside of the home in addition to PIASCY messages.
“The programmes are there, but they have limited resources,” Ivan Kizza, social sciences student at Makerere University said. “A lot has been done for the theoretical side of HIV education, but we need more practical ways to help students.”
3The missing link for teachers is support from parents. Most of what students struggle with come from their homes. PIASCY set out to bring teachers, parents and students together, but lack of involvement on the parents’ part hinders teachers’ ability to help students.
Labson Kisakye, head teacher of St. Barnabas Primary School, recalled parents refusing to come to counseling sessions.
“The government should tactfully target parents, and show them it is not shameful to talk to children about sexuality,” Kisakye said. “Let’s tell parents that if your child has contracted HIV, where were you before it got to this level?”
Jacquelyne Alesi: Helping Youth through her story
The first time Jacquelyne Alesi said publicly that she’s positive, was while giving an HIV lesson to hundreds at a school, and she has never looked back.
“I will never forget that day,” Alesi said. “I felt relieved.”
Ever since that day in 2008, Alesi said she has been “preaching the gospel” of living positively and is a role model for both HIV positive and negative youth alike. She is the director of programmes for Uganda Network for Young People Living With HIV/Aids (UNYPA).
Alesi was 17 years old and pregnant when she first tested for HIV. Fearful of the results, she left before knowing her status. Less than a year later, her child died and she began to fall ill. Her parents encouraged her to test again, and she learned she was positive in 2003.
“It was really not easy for me,” she said. “I almost failed my exams in Senior Four. It even became worse in Senior Five and Six because I did not accept that this was me.” Alesi said she overcame much to finish her schooling and received a bachelor’s degree in social sciences and a diploma in guidance and counselling. Many people in her situation do not make it this far.
“Some [HIV positive] students fail to go back to school because of the stigma and discrimination that occurs in school,” she explained.
Alesi remembers counselling a HIV positive 14-year-old girl who was forcibly disclosed. When the truck from her clinic came to get her from school one day, the teacher shouted in front of the class that she needed to leave for treatment.
“This traumatised the girl for more than six months and she was afraid to go back to school,” she explained. Alesi has since counselled her and she has returned to school.
Alesi is working to form support groups to sensitise teachers and students, but many schools say they already have clubs.
“Clubs talk about what is HIV and what is Aids. This is good information, but that is not what information is needed right now… One of the things that young people don’t know is that they can be born with HIV and live. They think sex is the only mode of transmission.”
At UNYPA, Alesi is working to involve youth and positive people in the national HIV response. Having young people revise the PIASCY programme is one way she believes youth can influence the response effort for the better.
“I believe in young people,” she said. “The problem is that decision-makers don’t believe in us. We believe that when youth are used meaningfully, we can help with the HIV response in the world.”
Alesi is married and has two children.
Because of antenatal treatments and ARVs, as well as regular testing, her family is negative and healthy. And that is in part because of a promise she made to herself: “I promised myself long ago that my HIV ends with me.”