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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


    


 

AFRICA AT THE CROSSROADS:  AIDS

Paper presented to the Convention of African School Leaders

St Stithians College

23rd August 2000.

 

When I was given the title for this talk - I was not sure how I would address it and wondered about another one, but in the end I decided to keep it and to modify it somewhat - to Education at the Crossroads - its impact on HIV/AIDS in Africa. I do this somewhat deliberately for a feature of this epidemic for as long as we have been aware of it, its spread and its devastation has been the understanding that the one way we have had to stop its phenomenal spread was through the education system.  It's become one of the many AIDS clichés to say that with young people we have a 'window of opportunity' and the possibility to 'secure the future'.

In this the education sector as a whole has failed and failed dismally. The failures are numerous - the national department has failed to place AIDS firmly within the curriculum. Teacher unions and associations have failed to address AIDS as a serious subject for inclusion in their practice. Parents have failed in demanding that the schools fulfil their most basic function - to prepare our children for the future. Many of the non state schools have failed for they have on the whole (erroneously) believed that AIDS would not affect them as their children are 'not like that' and have an 'innocence' which needs to be preserved.

But we have failed in another way and that is because when we did try to do AIDS education we did not think carefully enough how it should be done. We did not try to get children to understand what we were about . Wke did not try to look beyond the conventional categories of thought and wisdom that placed AIDS education in the field of lifeskills and guidance - underpinned by heavy moral and indeed even religious overtones. What was not paramount in our thought was how we save lives, what was paramount in our thoughts was how we maintain our dignity, push our value system and our ideologies.

In acting in this way we became part of the problem - we exacerbated the situation, fed into the denial, the apathy and helped to create the paradox that we have the fastest growing epidemic in the world, whilst we have one of the most aware populations.

AIDS took the form of a shocking novelty when it first reached public consciousness in the mid 1980s. But soon it became apparent that in the absence of affordable treatment the majority of people infected with HIV would die of AIDS. Some people called for massive prevention efforts. Others claimed that religion, national character, monogamy and fidelity would protect against infection.

Preventing HIV has proved to be particularly difficult - it mean among other things forging new links between sex illness and death and encouraging the belief that solidarity, compassion and understanding are more appropriate to HIV disease than discrimination and ostracisation.

 


We are now all too familiar with the figures, but they bear brief repeating - sub -Saharan Africa accounts for the overwhelming majority of new infections and AIDS cases. Out of a total of 34.3 million people living with HIV at the end of 1999, 24.5 million are in sub Saharan Africa. One in ten adults between the ages of 15-49 is already living with HIV.

In South Africa the facts of AIDS are well known. South Africa has been identified as having the fastest growing epidemic in the world - having more infections each day than Australia has in a year. With close on 1700 new infections per day, and over 4 million people currently living with HIV and a significant number ill with AIDS, the rate of infection shows little sign of slowing. There is little evidence to show that any of the interventions are working and we are set firmly on a course that is likely to take us to the highest levels of infections that have been predicted.

KwaZulu Natal remains the peak of infection (32.5%) and the Western Cape lowest (5.2%) with the other provinces ranged in-between. With the population concentrated below the age of 40 and with the peak of infection currently in young women between the ages of 15 and 26 and in young men slightly older - the prospects for south and southern Africa and for the rapid changes we need to see in development, housing, education, unemployment and social upliftment look bleak.

AIDS has the potential to undermine all the gains we have made and to render impossible the government commitment to growth and development.

Nearly two decades into our infection we are still puzzling about how we should intervene to curb the rate of infection and care for the ill and dying and educate the uninfected to remain so. Our early responses fed into all the categories of marginalisation and social rejection at which as South Africans we excel. It was a disease of white gay men, of drug users and of prostitutes. After that it was a disease of poor (black) people and foreigners.  It was not and could not be a disease of the (white) heterosexual population nor a disease that could affect their children.

In all meetings and in educational and social gatherings AIDS is discussed - but always at one remove - rather in the same ways that we talked about Apartheid - it was part of us but we were not part of it.

We all know that in South Africa, almost 25% of pregnant women are testing positive. We know that over 60% of all African women who are infected are infected by their husbands and we now have the sobering evidence from Zimbabwe and KwaZulu/Natal that the highest risk activity for young men is marriage.

 The latest UNAIDS report suggests that 50% of the current 15 year olds in South Africa, Namibia, Zimbabwe and Botswana will not live to their 50th year. Life expectancy which had risen to over 60 years in South Africa is expected to fall to just 40years by the year 2010. In 1990 a mere 10 years ago the infection rate in South Africa and Thailand was under 1%, nine years later it was close to 25% here but less than 5% in Thailand.

This leaves us with a situation that can only have devastating implications. Already we are preparing for and experiencing age shifts in the population with high death rates in young, productive people leaving behind elderly and very young people to care for and socialise one another.

 We talk dispassionately about AIDS orphans and child headed households as if these were the norm in our society. We talk with romantic nostalgia about how the great extended families of Africa will with love and compassion absorb the orphans while we refuse to accept that the reality is that these are already over extended families and unlikely to survive through this epidemic.

We accept that taking children into already stretched homes will damage the life chances of both the orphans and the children of the previously intact households but argue that this is preferable to finding other solutions.

There is no doubt that AIDS will have dramatic and unimaginable repercussions on education and the education system in South Africa and the rest of the continent. These lie in the obvious areas of the loss of skilled teachers to infection, the changing patterns of enrolments, high absenteeism and the consequences of the disintegration of families. And there are other repercussions. These lie in the toll of human pain and suffering that an epidemic like this will extract. It lies in the general decline in the family life of the children who come to our schools and the withdrawal of children and communities from the education process. Both education provision and quality will be affected - through the illness and death of the teachers and in the inability of families to support their children in schools. In a world increasingly reliant on technology a significantly illiterate or badly schooled workforce will be a huge financial drain.

And finally before moving to the specifics about HIV/AIDS and education, as social and political stability is threatened by this epidemic, so too will be the attempts to bring down the levels of crime and social corruption. The tenuous hold that we have on social cohesion will seriously wobble. We are beginning to see the effects of AIDS on social cohesion in Zimbabwe and Sierra Leone

It is easy to say that we were warned - that there is not a single school which could claim that they were unaware of the potential threat which HIV/AIDS poses both to their existence and the society. It is easy to blame the education sector for their slow reaction and failure to give leadership and take decisive action.

Such blame and finger pointing is easy and unhelpful. What we need now is a look at how HIV/AIDS will impact on education and the multiple ways in which we can still act to turn the epidemic around and in doing so transform our society.

The first shift is that while we must look at what AIDS will do to the schooling system and at how we are to prepare young people to be able to live in a fundamentally changed world - we must recognise the liberating potential that HIV/AIDS has for us. Unless we see what good can come from this epidemic we are doomed to be dragged down by it. We have to see that AIDS opens all kinds of new exciting economic and social possibilities and we can prepare our pupils to grasp these and have a future that will be rewarding, exciting and challenging.

The second shift is to throw away what does not work - if our best planned prevention programmes are not working it does not help to rewrite them in different language and increase the spending - they have not worked, it is likely that they never will work.

The third shift is that we have to prepare our selves and our pupils for a radically different world from the one that we know and the one that they have known so far. All our cherished notions of family, community, society will change and we have to be flexible in how we understand this. We cannot cling to the security of the past and the 'good old attic' values to see us through.

And we have to decide now which road we take at these crossroads.

We hear that each month 4 teaches are dying in Zambia, in South Africa the figures vary wildly with the National Department suggesting 14% infection rate amongst teachers and SADTU going much higher. Whilst we cannot be sure, it is unlikely that the teachers' infection rates would be very different from the national average . We know we are looking at an infection rate of well over 10% and that once one has reached 10% one is facing disaster.

We are also fairly certain that tertiary institutions where the teachers are trained have an infection rate on around 12%. This has two important considerations - it means not only that 12% of new teachers will enter the workforce already living with HIV, but also that there will be an incremental increase in the numbers of teachers who are dying in the early years of their careers. Whilst this has the potential to seriously disrupt the process of teaching it also has serious consequences for the continuity of teaching - as these young teachers are those whom traditionally we expect to become the older teachers, the mentors, the skilled practitioners.

Close on 25% of the children coming to our schools will be coming from homes or communities where HIV and AIDS are already prevalent. In the more affluent and elitist areas the extent of this may still be muted, but at the very least children will be aware of HIV and AIDS if not through the illness and death of their families and communities - through the illness and death of domestic workers and he employees in their parents business concerns.

We have traditionally not trained teachers to cope with death and dying in their training programmes. We have not trained them in what it means to be teaching a quarter of their pupils who are in stress, terrified about their security and future and whilst at school anxious about what is happening at home. We have not trained them to cope with pupils who attend school erratically because they are involved in home based care, nor how to deal with children who through no fault of their own cannot conform to the norms and expectations of the school. We have not equipped them to deal with the multiple complexities of race and culture and how these fuel the epidemic.

 We have not trained our teachers in the creative art of teaching that will allow them to see their teaching as one of the fundamental ways in which this epidemic can be challenged.

Such training can and should be offered by schools as a crucial part of inservice training. It should be the case that when new teachers apply for jobs that if they are not AIDS literate and fully skilled in AIDS in the work-place and teaching AIDS we should not consider their appointment.

 


And yet our teachers should have had some of this training - for our education system and those in other African countries have always been vulnerable to political, economic and social instability. It already has high attrition, repetition and drop out rates and in redressing the past has high over age enrolments. We already have large numbers of traumatised, malnourished and stunted children whom we are trying to deal with through mainstream conventional education.

In addition to this we now are likely to have fewer children who will enrol in school because mothers with HIV die young and HIV affects fertility.  Children giving care or themselves ill will be out of school. Qualified teachers and educational officials will fall ill and die, and as the epidemic bites into the private sector teachers will be increasingly poached away from schools into industry and management.

Fewer students will reach secondary school and this will affect the enrollment into teacher training - and the quality of teacher training will be affected by the loss of training staff. School and official departmental management will be affected as the administrative staff fall ill and die. Teachers traditionally have generous sick leave packages and benefits and so will hold down jobs, whilst being unable to teach - but the conditions of service will be affected as the death and disability claims soar.

As the epidemic bites into the provision of welfare and health services, the available pool of money for education will fall making it expensive beyond the reach of most families. It is likely that legislation may be passed that affects the relative autonomy of private schools as they will be expected to provide education for certain sectors of the school going population.

So where does this leave us?

Clearly the first step is planning. As we have done at the University of Pretoria HIV/AIDS has to be 'mainstreamed' throughout all of the activities of the school.

 Two imperatives must drive this -

·        The economic imperative              and

·        The moral imperative

The economic imperative is that schools will need to look at how they are able to survive this epidemic - what will the effects be on their traditional pool of pupils and staff as well as the costs of benefits and hiring of temporary staff and of boarding and illness packages. It must also address the economic costs of high teacher turnover and the increasing inability of a percentage of parents to pay full or part fees and to let their children take part in school activities, as well as their ability to survive in an increasingly depressed society with new educational demands. 

The second economic imperative is what the epidemic is likely to be doing to the country - in terms of developmental growth. What does this mean in terms of what the school curricula teaches and how we prepare our youth for a world of AIDS. How do we ensure that they understand what the epidemic is likely to do and how it will affect their future livelihoods

The moral imperative is the way in which we deal with HIV and AIDS in the school community and in society. We have an obligation to the pupils to ensure that we given them the means to remain uninfected and that we are able to deal with compassion and understanding towards teachers, parents and students who may themselves be infected and affected. This must be reflected in the conditions of service as well as in the bold steps that we take to educate staff and students about HIV and AIDS and how it is likely to affect them.

The second moral imperative is that how society deals with the epidemic largely depends on how we socialise the students in schools. We are now well into the second decade of this epidemic and the levels of stigma and prejudice remain high. This means schools are failing to instil in their students the understanding and commitment to the epidemic that allows them to treat people with HIV and AIDS with the respect and dignity we all deserve.

In part this stems from the attitudes of teachers and their ability to deal with their own sexuality, fears and anxieties as well as their ability to deal with the sexuality, fears and anxieties of the students they teach.

The fundamental mistake we may have made is to have targeted education at personal behaviour and risk taking. Given our failure to have effective sexuality education in the past and our failure in the smoking and alcohol campaigns it is extraordinary that we tackled HIV/AIDS education in this way.

Certainly it’s the wrong way to educate teachers - they do not attend training college and inservice training primarily t be trained in safe sex and 101 ways to use a condom. We have done personal education badly and we have not addressed at all the professional aspects of teaching in a world of AIDS.

Young people do need guidance into the world of sexual exploration, and in the kind of world that they will be doing such exploration. We have premised too much of our HIV/AIDS education in the context of right and wrong doing - rather than on the overriding moral imperative to save lives.

We have allowed our religious beliefs, moral value system and ideology to stand in the way of frank and open sexuality education. The joy and pleasure that young people experience with their sexual awakening is masked in the blanket of denial that would have us believe that all young sex is coercive or wilful, or that its due only to peer pressure. We treat the pupils an 'innocent victims' in a world of dangerous and exciting sexual possibility and I suspect that we do this with a mixture of judgement and envy!

Part of our failure to deal with this epidemic is that even as teachers we do not know how to ask the right questions. In most of our work we ask status quo questions which must give status quo answers. Status quo answers will not help us fight this epidemic and most school based HIV/AIDS education is premised on status quo questions and answers.

 The challenge lies in oppositional questions which give oppositional answers and allow both staff and students to recognise their own particular vulnerability to infection and the ways in which they can address this. It should also allow for new categories of meaning and explanation - new forms of understanding, a new language and new solutions.

Clearly if parents or teachers cannot speak to their children or students about HIV/AIDS and related sexual issues, then at a very fundamental level they are saying that their embarrassment, morality, pride is in the long run more important to them than their child's or their student's life.

If traditional HIV/AIDS education has failed then we must seek new ways to achieve what we want. My experience from the lifeskills committee as well as through the work we are doing at UP has convinced me that HIV/AIDS cannot be a separate area of study - it cannot be a component of life skills or guidance and hope to succeed.

What we need is to challenge our existing curricula and integrate it through all the subjects we are teaching - from the principles of coffin making in design and technology education to the obvious ways in which it fits into all subject disciplines.

HIV/AIDS is far too fascinating a subject in terms of its history what it tells us about society, about culture, racism and ourselves and its effects on our present and future to be relegated to the easy options. It also places an undue burden on those teachers.

All teachers need essential training in the legal and ethical issues that the epidemic poses for their careers - their rights, duties and obligations in a world of AIDS, counselling skills and social empathy and understanding. Many teachers have this already, but they will need greater skills as society comes to realise that it is teachers who are at the interface of this epidemic far more than nurses and doctors.

It is teachers who will carry the burden of care for young people whose lives are shattered by disintegrating families, it is teachers who have to cope with the fear and horror that parents confront, as they know they will predecease their children. Teachers will have to cope with the illness and death of their colleagues and their families.

But is because teachers are this interface that schools play the pivotal role in ensuring that as a society we can cope with the epidemic as it unfolds. That we can teach our students about new forms of community, family, belonging and relationships. How do we teach them to confront a world in which people of 40 are the ones who are dying and how do they cope in a world of the very young and very old?

Schools will need to recognise the need for some kind of institutional care for the students - but not institutions as we now know them but institutions as we have never thought of before. School must become the places of open debate and understanding - where the current prejudice and stigma is challenged and understood and where the fears of AIDS are allayed. This is a terrible period in our history and we must give young people a secure and honest road they can travel - to get through it and survive.

That is the choice as we stand at the crossroads. What is our greater morality - to fundamentally change how we think and teach about and act on this epidemic so that we can find the liberation and new exciting challenges it offers;  - or to take the road that we know - the road that is secure to us in our beliefs and prejudices, but the one that will ultimately lead many students to their death.

If we make the wrong choice now - we are in danger of reaching the point of no return - the cul de sac of the worst case scenario.

Its an act of faith and an act of courage and requires great leadership and vision. But it is the only road to take - or the effect of education on HIV in Africa will be decisive and catastrophic.