Why education is a powerful tool for HIV prevention
HIV is sexist. According to an Education For All report, 60% of young people living with the disease are women; in sub Saharan Africa the figure rises to 71%.
Simultaneously, the health benefits of educating girls becomes more and more obvious. As Secretary General of the United Nations, Kofi A. Annan, says, “Study after study has taught us that there is no tool for development more effective than the education of girls. No other policy is as likely to raise economic productivity, lower infant and maternal mortality, or improve nutrition and promote health — including the prevention of HIV/AIDS.”
The impact of an education:
A report by UNICEF offers a few examples of this. In Ethiopia, over 80% of women with a secondary-level education know that a healthy looking person can submit HIV, compared to less than 60% with a primary level education, and around 25% with no education at all. In Zambia, the percentage of women aged 15–24 who knew where to be tested for HIV grew by almost 40% among those with a secondary-level education.
The report also provides multiple examples of how education inspires a change in sexual behavior: In Zambia, almost 60% of educated women have either never had sex, not had sex within a 12 month period, or have only had sex with one partner and used a condom; Only 30% of uneducated women fall into these categories.
Jan-Walter De Neve is a Doctoral student in Global Health at Harvard University, on the Health Systems track. Medically trained in Belgium, he was shocked to see the devastation caused by the HIV epidemic during a clinical/international elective in South Africa and has dedicated his career to this line of work.
In collaboration with colleagues at Boston University School of Public Health and the Botswana Harvard Partnership in Gaborone, he carried out research focusing on the impact of secondary-level formal education on HIV in Botswana.
The results are clear. “Each additional year of secondary schooling decreased the probability of being HIV positive by 8 percentage points, from about 25% to 17% infected, about a decade after completing secondary school.”
“We also found that additional schooling affected age at sexual debut, fertility preferences (e.g., women had less children, postponed their first birth), condom use, HIV testing, attitudes towards HIV, discussion of HIV with others, labor market participation, wages, and literacy rates.”
He explains that these results may represent a maturing epidemic. Though initial studies showed that more educated people contracted HIV, it now seems that education is a powerful tool for HIV prevention.
“One reason could be that, as information about HIV prevention has become more widespread, the more educated might have better access to knowledge or have the cognitive skills to avoid HIV infection.”
Women are disproportionately affected by the HIV epidemic. Almost one in three girls was HIV positive in the study sample, increasing to about one in two among those with less than higher secondary education.
De Neve sees at least three potential reasons for this. “For instance, there could be biological reasons. It has been suggested that women are somewhat more vulnerable to infection by HIV during vaginal intercourse compared to men. Adolescent girls, whose reproductive systems are not fully developed, may be especially vulnerable to becoming infected during sex. Second, there could be behavioral reasons, such as age at sexual debut, fertility preferences, or age of partner, or attitudes towards HIV. Third, broad social and structural reasons, such as gender inequities and lack of access to quality health services, formal schooling, and job opportunities.”
However, the impact of formal education on female opportunity is protective. He says that education encourages women to pursue a career and earn their own money, potentially giving them more leverage in their relationships. It also gives more choice over family planning or essential cognitive skills that allow someone to “navigate a complex web of risk factors.”
A more personal perspective:
In Uganda, 17 year old Elizabeth Nalukwago has experienced the devastating impact of HIV first hand. Born in the Rakai district of Uganda, her district experienced one of the first epidemics in Sub-Saharan Africa. “I nursed my parents and I saw how much they suffered. I saw them dying [of AIDS]. My Dad died first and after 4 months my Mam followed.”
She and her four younger siblings now live in Nserester Orphanage — founded and run by Reverend Dr Isaac Nsereko. She is proud of the work her school is doing to combat HIV, and the open-ness with which it is discussed. “Revd Dr Isaac makes sure we visit hospitals to see those suffering. He encourages staff to be free with the students in straight talk, and he brings visitors in every Saturday to talk to us.”
From Nalukwago’s experience, the benefits of HIV education are more practical. “Women live longer with HIV than men. If they are educated they are able to take care of the children. In a family where there is a sick person, girls care the most. If they are not educated, they may fail to read instructions on the medicine.”
As well as more measurable outcomes like increased condom use, Nalukwago believes that, “Education opens a person’s brain. Culture in Africa means a girl must say yes to whatever a man says. This has killed many people. With Education, a girls gets to know what to do — read books and the news, know where to report, learns her rights.” She adds that learning how to live positively with HIV/AIDS and the importance of family planning is especially important.
The power of a teacher:
At Ndururumo High School in Kenya, Jane Kamau is an integral part of this movement. In her school of just under 1000 students, Kamau is Deputy Principal in charge of girls. As a teacher and passionate advocate for women’s education, she sees the strong cultural benefits of education on the HIV epidemic.
“We have some cultures that do not favor girls. When girls are educated they will say no to forced marriages/female genital mutilation. Education gives girls economic empowerment and therefore they do not have to undergo the oppression involved. I believe that when educated, girls will be able to avoid risky situations that would lead to cases of rape.”
Kamau believes that it is also important to educate those who are not directly impacted by the disease to reduce stigma.“HIV and AIDS is prevalent among the uneducated due to ignorance. There are some people who think that if you are HIV positive and you had sex with a young virgin girl you will be cured! To you and I this is crazy.”
To highlight the impact that stigma can have, she tells the story of the only HIV positive girl in her care. “She does not want anyone else to know about it. She is on medication and nobody knows about it apart from the nurse, the principal, the class teacher and I … She is full of fear that other people would know about her status.”
This girl is 15 year old Lucy Wambui, who has never spoken publicly about being HIV positive before. Though shy, she has a clear intention to remain in control. “HIV is just like any other disease that other people suffer from. All that you need to do is to accept yourself and follow doctor instruction.”
Her reasoning for keeping her status quiet is simple. “Since I realized my status I have never been stigmatized — because only my mum, my teachers and we know about it.” She goes on to say that there are no specific programs at her school related to HIV, so her inspiration and support comes from her deputy principal.
Kamau sees her role in Lucy’s life as one of inclusion. “We allow her to interact with the others freely. We allow her to take her drugs in her own privacy because that is her wish. We most importantly befriend her so that she can feel loved. Away from that we generally impress on our students to understand and accept one another even where they are different.”
Wambui hopes to utilize her personal experience, and is currently working to achieve an A grade in her KCSE exam so she can become a doctor. For other HIV positive students, her message is clear. “Take the doctors advice seriously and you will succeed in life. You should also accept yourself the way you are.”
Kamau highlights the importance of awareness by saying, “We have millions of girls round the world who will not even know that there is a World Aids Day on 1st December.”
“Education generally empowers on causes and living positively. Education will make a woman know that being positive does not mean death. Education gives hope with facts.”
