HIV
HIV/AIDS AND THE EDUCATION SECTOR:
THE FOUNDATIONS OF A CONTROL AND MANAGEMENT STRATEGY IN SOUTH AFRICA

Abridged by Speakout site managers 30 June, 2000

CAROL COOMBE
PRETORIA
June 2000

The UN Economic Commission for Africa has asked for details about what is being done in South Africa to control and manage HIV/AIDS in the education sector, and to mitigate its consequences.

THE SPREAD OF HIV/AIDS IN SOUTH AFRICA

South Africa has the fastest growing HIV/AIDS epidemic in the world, with more people infected than in any other country. By June 2000, it was estimated that at least 20% of the population is infected. Rates are highest among youth, with an alarming increase observed among teenage girls. The highest rates are found in KwaZulu-Natal, Mpumalanga and Free State Provinces.

Table 1: Provincial Antenatal Clinic HIV Prevalence (%)

The country will be in the most devastating throes of the AIDS epidemic by the year 2005, when, the Metropolitan Life Group estimates, more than six million South Africans will be infected, and about 2.5 million people will have died of AIDS or an AIDS-related illness.

HIV/AIDS should be viewed as a 'slow onset disaster' - that is, a serious disruption of the functioning of society which causes widespread human, material or environmental losses.

SEXUALITY, HIV/AIDS AND CHILDREN

A survey among youth 16-20 years old in urban townships found that 40% of young women and 60% of young men had more than one sexual partner in the previous six months; condom use was low. Failure to practice safe sex was related to pressure to engage in early and unprotected intercourse, coercion, pressure to have a child, lack of access to user-friendly health services, negative perceptions about condoms, and low perceptions about personal risk, in addition to lack of privacy and time.

In rural KwaZulu-Natal, 76% of girls and 90% of boys are reported to be sexually experienced by the time they are 15-16. Boys start sexual intercourse earlier than girls (13.43 years versus 14.86 years), have more partners and nearly twice as often have an STD history. In Free State, teenagers reported they were sexually active at around 12 years old, due to experimentation or peer pressure, and relatively few practised safe sex.

Violence is common and even considered the norm in sexual relationships. A qualitative study among Xhosa-speaking pregnant adolescent women revealed that violent and coercive male behaviour, combined with young women's limited understanding of their bodies and of the mechanics of sexual intercourse, directly affected their capacity to protect themselves against STDs, pregnancy and unwanted sexual intercourse. Communication between partners on sexual issues was non-existent, and conditions and timing of sex were defined by male partners, giving young women little or no opportunity to discuss or practice safer sex.

In some places, particularly where there is political violence and high crime levels, HIV has come to be accepted as a new and inevitable part of growing up. Young people who suspect they are infected with HIV may avoid a definite diagnosis, but at the same time seek to spread the infection as widely as possible.

The NPPHCN survey found that it is boys who determine when and how sex occurs, and that girls commonly experience rape, violence and assault, including within relationships. Another survey of urban youth found that 28% of the women aged 16-20 had been forced to have sex against their will. Adolescent women felt unable to refuse sex or to discuss safe sex, including contraception or condom use, for fear of violence. Some young men in the NPPHCN survey justified rape because of the perception that young girls have sex with older men for material gain. Research with pregnant and non-pregnant teenagers in one township found that all the girls (mean age 16.4 years) had had sexual intercourse and at least one boyfriend. A third described their first sexual experience as rape or forced sex, and two-thirds of both pregnant and non-pregnant teenagers had experienced sex against their wishes. Reasons given for not refusing sex included fear of abandonment or violence.

THE IMPACT OF HIV/AIDS

At least 20% of South Africans (15-49) are likely infected with HIV/AIDS. Half of South Africa's children who are 15 years old will probably die of HIV/AIDS. On the basis of modelled trends HIV/AIDS will result in lower population growth rates due to increased infant, child and adult mortality, and lower fertility rates due to the death of potential mothers age 15-45. Infant, child and adult mortality rates are expected to double by 2010, and life expectancy will drop by 20 years, from 68 to 48 by 2010.

Orphanhood rates will increase by a factor of five: by 2005, South Africa will support nearly one million children without parents.

Economic Impact: Declining Productivity
It is anticipated that productivity will decline in all sectors due to illness on the job, absenteeism due to personal or family illness, and funeral attendance. Old Mutual Actuaries and Consultants forecast that the annual death rate in the workforce will rise from 5 to 30 per 1,000 workers. Hardest hit are the mineworkers, some 45% of whom are already HIV+ (late 1999). Educators constitute the largest cadre of workers in South Africa: at least 12% are HIV+.

Poverty levels will rise even further as parents who are sick and no longer bring in an income from employment die, and the number of child-headed households increases.

Social Consequences: Poverty, HIV/AIDS and Children
The first South African supplementary report on the UN Convention on the Rights of the Child (May 1999) described South Africa as a 'racially divided, traumatised, dehumanised and child welfare negligent society'.

One fifth of all children do not live with their mothers. About 39% of households are headed by women and the poverty rate in these households is double the rate in male-headed households. It was estimated in 1994 that 500,000 female children were victimised sexually each year.

It is projected that HIV/AIDS will account for a 100% increase in child mortality - from an anticipated 48.5 per 100,000 births without HIV/AIDS to almost 100 per 100,000 births in the year 2010. In 1999, at one hospital in KwaZulu-Natal, 81% of all deaths in the paediatric ward were proven HIV/AIDS related deaths, or 90% for children under 3 years.

South Africa, according to the 1999 Progress of Nations Report, is one of seven countries where the number of children orphaned by HIV/AIDS between 1994 and 1997 increased by more than 400%. In the same period, of children under 15, about 110 per 10,000 lost either their mother or both parents to HIV/AIDS. In KwaZulu-Natal, it is estimated that this year there will be between 197,000 and 278,000 HIV/AIDS orphans - that is, 5.8-8.8% of all children. By 2015, when the epidemic is expected to peak, orphans will constitute between nine and 12% of the total population of South Africa - or about 3.6-4.8 million children.

In this context, the South African Institute for Security Studies anticipates that 'age and AIDS will be significant contributors to an increase in the rate of crime over the next ten to twenty years. In a decade's time, every fourth South African will be aged between 15 and 24. It is at this age where people's propensity to commit crime is at its highest. At about the same time, there will be a boom in South Africa's orphan population as the AIDS epidemic takes its toll. Growing up without parents, and badly supervised by relatives and welfare organisations, this growing pool of orphans will be at greater than average risk to engage in criminal activity….As a result of an increase in the number of juveniles, especially orphaned juveniles, as a proportion of the general population, South Africa is likely to experience an increase in crime levels in the short- to medium-term (five to 20 years).'

Table 2: The Consequences of the Pandemic: Projections to 2010

THE IMPACT OF HIV/AIDS ON THE EDUCATION SECTOR

In 1998, there were 12.3 million learners in primary and secondary education, taught by about 370,000 educators, and supported by approximately 5,000 inspectors and subject advisers. In addition, 68,000 officials, managers and support personnel staffed the bureaucracy.

The education budget constitutes about one-fifth of the national budget;
Educators are the largest cadre of workers in the country;
Their salaries consume about 85% of the education budget.

Enrolments: Declining and Changing Demand for Education
In other SADC seriously affected by the AIDS pandemic, it is probable that by 2010, 30-35% of children will have lost one or both parents. The ability of relatives of such children to keep them in school will become a critical issue. In the context of widespread and deepening poverty, enrolment rates will decline, and drop-out rates will rise. In some cases, there will be a negative school population 'growth'. UNDP's 1998 Human Development Report, Namibia suggests that by 2010 combined primary and secondary enrolments are likely to be eight per cent lower than total enrolment in 1998.

The UNDP 1998 Human Development Report, South Africa calculated that there were perhaps more than 258,000 HIV+ learners over 18 in the system in that year. The entry-level cohort was already in decline: an average five per cent per annum shrinkage was observed over the previous three years.

Drop-out rates due to poverty, illness, lack of motivation and trauma will ncrease. Absenteeism among children who are care-givers or heads of households, those who help to supplement family income, and those who are ill, is bound to rise.

Educators: Reducing Supply and Quality of Education
In SADC countries, skilled workers seem more vulnerable to the disease. The incidence of HIV infection among teachers is likely to be above that for the population as a whole. Rates as high as 40% have been reported from parts of Malawi and Uganda.

South Africa has an educator cadre of approximately 443,000. Assuming, very crudely, an infection rate of 20-30%, and that, on average, a person who is HIV+ dies within seven years of infection, by 2010 at least 88,000-133,000 educators will have died. There will be in addition, uncountable others who are ill, absent, and dying, or pre-occupied and busy with family crises. As professionals, teachers will often be required to take on responsibility for orphans within the extended family.

Swaziland's recent impact assessment suggested that teachers will leave the profession because they are attracted to better jobs in other sectors where skilled personnel are laid low by HIV/AIDS. A recent assessment by JTK Associates for the Swaziland Ministry of Education estimated that, for every teacher lost, 2.6 more would have to be trained to keep up with demand. And even then, teacher:pupil ratios were expected to decline to 1:50 by 2005.

Teacher recruitment targets may be lower than at present if enrolments decline as expected.

Classrooms: Trauma for Learners and Teachers
At any one time, 30-40% of teachers who are HIV+ will have developed full-blown AIDS. Their work as teachers will be seriously compromised by prolonged periods of illness. Once teachers know they are HIV+, they are likely to lose interest in continuing professional development. And, even among teachers who believe they are not infected (or, most probably, simply do not want to be tested), morale is likely to fall significantly.

SOUTH AFRICA'S NATIONAL HIV/AIDS STRATEGY

The Minister of Health has announced (June 2000) the launch of a new HIV/AIDS/STD Strategic Plan for South Africa, 2000-2005, for funding purposes. The document is intended to be a broad national strategic plan to guide the country's response as a whole to the pandemic. There is nothing in the document which speaks about the potential social, economic and infrastructural impact of the pandemic on vital national sectors like labour, education, agriculture, the public service, or business. It is concerned with learning about the predisposing factors of the epidemic, preventing or finding a cure for HIV/AIDS, and monitoring health interventions. It is perhaps a step backwards.

Forty per cent of government's 1999/2000 HIV/AIDS budget was unspent. Funding for community organisations was cut by 43% in the current budget, although the total HIV/AIDS budget increased by 73%.

Lack of political commitment. Political leaders wear the HIV/AIDS red ribbon. But too often they have not been committed personally to fight the pandemic, to master the technical, social and ethical details of the struggle, and to stand and deliver. Education Minister Kader Asmal is one exception to this rule.

EFFORTS TO MANAGE THE IMPACT OF HIV/AIDS ON THE EDUCATION SECTOR

Preventing. Children, their parents and communities need comprehensive health education aimed at preventing and controlling the spread of the disease among young people in and out of school.

Responding. The education sector needs to devise and put in place strategies for reducing, managing and controlling the impact of the pandemic on the education sector; and to predict and respond to the impact of the pandemic in a variety of ways.

Two HIV/AIDS contract posts are being made available to each provincial education department for three years. Although these posts are generally meant to be for HIV/AIDS-in-education coordination, they are most closely linked to implementation of the Life Skills curriculum in schools.

Directorates and individual personnel lack clear mandates, perhaps because the parameters of the task are not yet appreciated.

In June 2000, the resourcing scene was chaotic: business plans were not ready at national or provincial level; funds expected from agencies had not been secured; and procedural requirements for accessing funds were time-consuming and complicated. Where budgets were ready, funding delays disrupted planning and action.

Gauteng Department of Education. The Department has launched the Life Skills programme. Its Deputy Director-General outlined the Department's attempts to control violence in schools on which the pandemic thrives. GDE now has in draft a training module to help principals and other educators to deal with sexual violence and harassment, and create appropriate guidelines for policy and practice in school. District officials are being trained, with support from DoH, to provide assistance to teachers on HIV/AIDS, Life Skills curriculum, sexual and substance abuse, teaching learners to say NO to drugs and violence, and developing greater assertiveness among young women. The Victim Empowerment Programme focuses on informal settlements in the Vaal area of the province, to empower women who are particularly vulnerable to male abuse. The Department's employee assistance programme is designed to assist education staff to deal with sexual harassment in the workplace.

The HIV/AIDS Emergency Guidelines for Educators. DoE's guidance notes for teachers in all South Africa schools are being distributed through provincial structures. The guidelines establish HIV/AIDS as a national emergency which will affect every learner and educator.

The booklet targets male educators especially:

Male educators have a special responsibility. There must be an end to the practice of male teachers demanding sex with schoolgirls or female teachers. It shows selfish disrespect for the rights and dignity of women and young girls. Having sex with learners betrays the trust of the community. It is also against the law. It is a disciplinary offence.

Working on Education Sector Impact Issues: Understanding and Responding
It is not enough to confine resources and energies to controlling the spread of HIV/AIDS. It is necessary at the same time to learn to live with the virus. Information is needed on illness and death, duration of illness, and age distributions. This will provide the basis for education sector projections which take account of the pandemic.

CONCLUSION

Will DoE flesh out the social and economic impact side of its Call to Action?

It is now time to take a hard look at the health of the system itself, and its ability to withstand the pandemic's onslaught on teachers, managers and children, the education sector's organisational structures and systems, its management capacity, its leadership and, ultimately the quality of education it provides.

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