Opportunity for HIV Prevention that Works. 11/3/11
South Africa is making progress, but we need to maintain the status of those that are HIV negative
OPINION: South Africa’s HIV/AIDS National Strategic Plan for health has two objectives – reducing the incidence of new HIV infections by half and placing 80% of those in need onto anti-retroviral treatment. As a country, we are making some progress in scaling up our national HIV treatment programmes, but concurrently we need to maintain the status of those that are HIV negative. By Joanne Brink.
Over 95% of grade 8 to 12 learners are HIV negative. Although not preventative, testing for HIV in secondary schools presents a significant opportunity for establishing a culture of knowing your status, allowing for the enforcement of a healthy lifestyle. Yes, there are many concerns, but let us focus on addressing the concerns by involving learners and their parents in the design and implementation of any school health and HIV testing programme, rather than lose this opportunity. By instilling healthy habits and regular HIV testing amongst our teens of today and at an early age, we have a better chance of reducing new HIV infections amongst our adults of the future.
And make no mistake, many of our teens are having sex and are very much at risk of contracting HIV. A recent study conducted in Tshwane Municipality by The Foundation for Professional Development (FPD), a private institute of higher education, found that 40% of grade 8 to 12 learners are engaging in sexual activity, half of them with more than one sexual partner. However only 22% of these sexually active teens had been tested for HIV or thought they were at risk of contracting the disease. Yet, the vast majority reported that HIV was a topic discussed in their school at least once a month. This suggests that our current classroom model of delivering HIV prevention programmes to our learners is excelling on a theoretical manner, while the reactive behaviour that should stem from such knowledge is not evident.
Focus groups conducted through FPD’s HIV management courses for schools, have provided some insight into the reasons that HIV prevention is not working in our schools and how to improve on the current approach. Discussions in the grade 8 to 12 learner focus groups confirmed an extensive factual knowledge of HIV – learners were able to quote statistics and recite the majority of HIV transmission and prevention methods. Yet they did not see themselves at risk of contracting HIV, even though the majority reported to be sexually active.
The critical insight here is that learners are not able to relate to or internalise the meaning behind these “HIV facts” that they are being taught at school. According to them, the current HIV prevention messages are delivered through didactic classroom lectures - often emphasising abstinence - whereas they would prefer to engage in the open and have direct conversations about the reality of their lifestyles and sexual health, as young adults, rather than focusing on HIV only. They advised that we should not be “coming in saying HIV HIV”, but make the campaign part of a wider focus about looking after their overall health. “Talk to us about what has been happening in our lives and [then] compare it to HIV and AIDS – helping us to differentiate between the lives that we are living and the lives that we need to lead” – female Grade 12 learner.
A school based health screening and HIV testing campaign will give learners a chance to engage with counsellors and health workers, whether they choose to test for HIV or not. For many, this will be their first open conversation with an adult about sexual health and lifestyle choices. Broadening the school based HCT campaign from an exclusively HIV screening focus to an integrated health programme, as proposed by the departments of health and education, will help to make HIV testing routine amongst our teens. The pre- and post-test counselling experience will provide learners with the opportunity to ask direct questions and reflect on their own lifestyle and behavioural choices.
Furthermore, learners shared that their most trusted and valued source of information was their parents or caregivers. Yet their parents were unwilling and uncomfortable discussing sexual health matters or HIV with their children. The majority of parents believed that their role would be fulfilled once the “birds and bees” had been discussed once, whereas their teens craved regular conversations starting at a much younger age. Parents were however accused by their kids of being relatively uninformed about HIV and its effects. “They only know to tell us to use condoms to prevent HIV and that’s it. It would be nice to have parents who are informed about HIV. And if we could do something to inform our parents”- male Grade 12 learner. Although talking about sex to their parents would initially be awkward, learners yearned to do so and wanted to find a way to make the conversation easier for their parents.
A school health and HIV screening campaign is an opportunity for parents to become better informed and thereby help to open the conversation between parents and their teens. Parents should be encouraged to accompany their children for health and HIV screening at the school, not only for their own wellbeing, but so that they can better understand the emotions and questions that their children will face during an HIV test and can better provide ongoing support and compassion post-testing.
Grade 8 to 12 learners were born after the years when South Africa started responding to HIV and have grown up knowing about HIV and anti-retroviral treatment. This implying, that the messages to this group should be different to those of other generations.
School based HIV counselling and testing, integrated with a general health screening programme, is a chance for us to get HIV prevention right amongst our adults of the future. What is clear is that our teens have a lot of good advice to offer about how to improve HIV programmes that target youth. Involving them in the design of any school based health and HIV screening programme is critical to ensuring its success.
Joanne Brink works for Foundation for Professional Development (FPD) - The Foundation for Professional Development’s (FPD) vision is to build a better society through education and development, and the best place to start is with the foundation of society – our teachers – developing their ability to manage classrooms and inspiring them with the latest international teaching methodologies.