1. Socio Economic Burden
of HIV & AIDS in
Developing Countries:
Education Sector
Response
By
Prof. Obioma Nwaorgu

2. Presentation Outline
Background
Overview of HIV and AIDS Situation:
Globally and in Sub-Saharan Africa
Factors that contribute to the
progression of the epidemic in Sub-
Saharan Africa

3. Presentation Outline
(Cont’d)
Impact on Social and
Economic Development
Orphans and other special at risk
population
Impact on Education
Response of the Education sector
Challenges
Recommendations and Conclusion

4. Background
Human Immunodeficiency Virus and Acquired
Immune Deficiency Syndrome (HIV &AIDS)
continues its course.
HIV and AIDS are reversing decades of
development gains, increasing poverty
especially among the poor countries and
undermining the very foundations of progress
and security.
The pandemic demands a response that
confronts the infection in every sector, but
education has a particularly important role to
play.

5. Overview of HIV/AIDS Situation
There were about 33.3 million people living with
HIV at the end of 2009 (UNAIDS,2010)
compared with 26.2 million in 1999.
In 2009 an estimated 2.6 million people became
newly infected
In 2009 about 1.8 million died from HIV and
AIDS.
Also it is estimated that 2.5 million children are
living with HIV in 2009.

6. Global HIV Trends, 1990 to 2009

7. Globally Prevalence of HIV, 2009

8. Sub-Saharan Africa (SSA)
SSA, bears the global burden and remains the worst-
affected region, with the highest prevalence in Southern
African (between 15–35%)
• At the end of 2009, 68% of all people living with HIV, or
22.5 million individuals, lived in sub-Saharan Africa.
• In 2009, an estimated 1.8 million people in the region
became newly infected with HIV and 1.3 million adults
and children died of AIDS
In 2009, 14.8 million children in the region have lost one
or more parents to AIDS. Almost 90% of the total
number of children living with HIV live in sub-Saharan
Africa and fewer than one in ten of these children are
being reached by basic support services.

9. Prevalence in Sub Saharan Africa

10. Factors that aid the progression of the
Epidemic in Sub-Saharan Africa
Physiological factors
Poverty
Lack of information/ ignorance ,
Discrimination and stigmatization, denial
There is increasingly awareness of the female
face of the AIDS epidemic (Feminization of HIV
and AIDS)
Women are more vulnerable to HIV infection on
social and economic grounds which are clearly
related to gender, cultural norms, expectations
and harmful traditional practices eg wife
inheritance, FGC etc

11. Social Economic Impact of HIV and
AIDS
Household and individuals
Agriculture
Health
Orphans and other special at risk
population
Education

12. Impact on household & individuals
Increase in number of female headed
households, exuberating poverty
South Africa
Study in South Africa showed affected
households have less monthly income than non
affected households and funeral costs were four
times the monthly income of households.
The purchasing power of the market is affected
because there is lower income to rising prices.

13. Household & individuals (cont’d)
Nigeria
In Benue state Nigeria, affected
households took an advance on future
earnings by reducing their investment in
farming (19% reduced expenses on hired
labour), 12% stopped the payment of
school fees while 8% started working as
casual labourers at the expense of their
own farms or sold their land ( Hilhorst et
al, 2006)

14. Impact on Agriculture
Reduction in Agricultural labour force : It is estimated
that by 2020 the pandemic will have claimed 26%
lives in Namibia, 23% in Botswana and Zimbabwe,
20% in Mozambique and South Africa, and 17% in
Kenya.
Decrease in range of crops being cultivated and output
by 50% (FAO).A study in Thailand showed a shift
away from labor-demanding crops like rice and chili to
crops that need less labor.
85% of the women farmers interviewed in a study at
Enugu , Nigeria stated that HIV and AIDS caused
reduction in their family income.

15. Agriculture Cont
Effects of HIV/AIDS on Major Agricultural Output(100kg bags grains) in Benue
State Nigeria (Duru and Mernan, 2011)

16. Impact on the Health Sector
Reduction in health care work force eg in Botswana
17% died between 1999 to 2005
Increased infrastructure modifications, spending and
cost on government.
More demand for services and care due to long
hospitalization.
A significant increase in time spent by all household
members in caring for the ill. Women spent on
average of 14 hours per week, men 12 hours, and
boys and girls 10 and 11 hours per week respectively .

17. Orphans and other special at risk
populations
Largest impact of the AIDS pandemic, with an estimated 15
million children who have lost one or both parents to AIDS
Due to death of parents or to take care of other family
needs, OVC withdraw from schooling .
Initially estimated at 2% but has now risen to as high as 15
to 20 percent in some African countries.
Children orphaned by AIDS often exhibit cognitive deficits
when compared with their uninfected peers (Martin et al
2006).These deficits can adversely affect learning and
earning ability later in life.

18. Orphans in selected sub-Saharan
African Countries (UNAIDS, 2004)
Orphans as share of young Average Dependency Ratio of
population 2003 1 ratio2 orphan to
non orphan
children
attending
school
All Orphans AIDS Orphans Households with Households with
Orphans children not
orphans
Botswana 15.1 10.6 1.4 1.7 0.99
Cote d’Ivorie 13.3 6.2 1.4 1.5 0.83
Ethiopia 13.2 3.4 1.5 1.6 0.60
Malawi 17.5 8.7 1.5 2.0 0.93
South Africa 10.3 4.5 1.4 1.7 0.95
Uganda 14.6 7.5 1.7 2.3 0.95
Zimbabwe 17.6 13.5 1.4 2.2 0.85

19. Impact on Education
This can be analyzed at different levels:
1. Access to Education - Children may be denied
access to school due to fears and
stigmatization in the community
2. Demand for education – decline in the number
seeking education
3. Supply of education – reduced number of
teachers
4. Quality and management – decreased human
and material resources.

20. Impact on Education (Cont’d)
The impact and devastating effect of HIV/AIDS to the
education system has not been calculated or determined
in SSA.
Deaths of children born with HIV and the removal of AIDS
orphans and other children affected by the epidemic from
school, result in smaller numbers of children needing
education. In Swaziland, it is projected that by 2016, there
will be a 30% reduction in the size of the primary school
population for each grade.
In South Africa, 21% of teachers aged 25 – 34 and 13 %
of those aged 35- 44 are estimated to be infected; even
with decline in teacher’s resources, there are reports that
the number of teachers being trained is not enough to fill
the gaps.

21. Impact on Education (Cont’d)
In Zambia, 60% of teachers are absent in schools
because of personal illness or taking care of family
members. Also a survey carried out among teachers
found a five percent increase in a teacher’s rate of
absence, there by reduced students’ average gains in
learning by four to eight percent per year.
Tanzania estimated that 45,000 additional teachers are
needed to make up for those who have died or left the
system because of AIDS.
The average age, and therefore the level of training of
teachers, is also expected to fall, which will mean that
teachers may be less experienced.

22. Why does education matter?
‘Education is the most powerful weapon you can use to
change the world’ (Nelson Mandela, Global Campaign
for Education (GCE), 2004), and ‘is a basic instrument
for eradicating poverty’
HIV/AIDS has significantly reduced average years of
schooling or enrolment rates.
Investment in education is vital: It promotes achievement
of six of the eight MDGs
Better educated women are more likely, in comparison
with their peers to adopt and sustain behaviours that will
reduce the spread of the virus

23. Why education? (Cont’d)
Data in the late 1980s and early 1990s, mostly showed a
positive correlation between level of education and rates of
infection. E.g. a study in Zambia found a marked decline in
HIV prevalence rates in 15- to 19-year-old boys and girls
with a medium to higher level education, but an increase
among those with lower educational levels (Kelly, 2000c).
Countries’ education sectors have a strong potential to
make a difference in the response against HIV/AIDS. In
terms of monetary impact, HIV/AIDS is estimated to add
between US $450 million and $550 million per year (US
dollar values for 2000) to the cost of achieving the mandate
set out in ‘Education For All’ (UNESCO, ) in 33 African
countries.

24. HIV &AIDS and education: The
consequences of inaction

25. Why Education sector Response
The largely uninfected age group (0-14) is found in the sector and
represents a window of hope for prevention of new infections
Schools not only offer an organized and efficient way to reach
large numbers of school-age youth but the students are particularly
receptive to learning new information.
Schools provide a base for reaching out to the wider community
The sector provides tools for behaviour change and provides
comparative advantage with an existing framework – the
curriculum.
Education sector is now unanimously recognized as having a key
role to play in HIV prevention and mitigation of the impact of
AIDS; not only in its capacity to reach large numbers of the most
at risk group (the youth) but also in its ability to change the
negative attitudes, behaviours and practices that put staff and
learners at all tiers at risk.

26. Response (cont’d)
The Dakar Framework for Action during the
World Education Forum drew attention to the
urgent need to combat HIV/AIDS, if Education
for All (EFA) goals is to be achieved. It called on
governments to ensure that by 2015 all children,
particularly girls, children in difficult
circumstances and ethnic minorities have
access to complete free and compulsory primary
education of good quality.

27. Response (cont’d)
Millennium Development Goals for Education
which seeks to “ensure that by 2015, children
everywhere, boys and girls alike, will be able to
complete a full course of primary schooling”,
cannot be achieved without urgent attention to
HIV/AIDS.
UN GASS targets and the MDG for HIV/AIDS,
malaria and other diseases cannot be achieved
without the active contribution of the education
sector.

28. Response of Sub- Saharan African
Countries
At national level, some countries in SSA have
taken steps to address the impact of HIV and
AIDS on the education sector and to adapt
systems to respond to the epidemic.
Mass media campaigns have been conducted,
but many have not been formally evaluated.
Life skills programmes have been introduced
within the education sector as part of the school
curriculum.

29. Response Africa (cont’d)
Less attention to teachers’ programmes
on HIV and AIDS.
Comprehensive programmes on OVC
only available in 29% of countries
Implementation tends to be weak, with
geographical disparity within countries; it is
mostly focused on schoolchildren and is
only just beginning to focus on teachers.

30. Response Nigeria
Faced with controlling HIV&AIDS in its 36 states and the
Federal Capital Territory (FCT), Nigeria’s response until
1999 was coordinated by the Federal Ministry of Health
Stages in response to the epidemic included: an initial
period of denial; a largely medical response; a public
health response; and now a multi-sectoral response that
focuses on prevention, treatment and impact mitigation
interventions.
In 2000, National Action Committee on AIDS (NACA)
was inaugurated and a 3-year HIV strategic plan,
HIV/AIDS Emergency Action Plan was formulated in
2001 (HEAP 2001- 2004)

31. Response Nigeria (Cont’d)
In 2001 provision of subsidized ART was announced by
the President through the Abuja Declaration.
In 2003 the first national workshop on accelerating the
education sector response to HIV&AIDS organized by
the FME, supported by the UNAIDS and other
development partners, helped set the stage.
In 2004 National Policy on HIV&AIDS for the
Education Sector was developed and finalized in
2005. This helped to inform the National
Education Sector HIV&AIDS Strategic Plan
(NESP) 2006-2010.

32. Nigeria cont’d
Acceleration of education sector response is in
four main areas namely:
Policy and Strategies with five main strategic
areas for response
Planning and mitigation
Prevention
Orphans and Vulnerable Children

33. Response Nigeria cont’
26 out of the 36 states and the FCT had
developed state level strategic plans based on
NESP, with technical support from development
partners. This led to following responses:
o Increased capacity for programme
management, leading to establishment of critical
mass within FME, States and mobilisation of
funds
o Development of culturally appropriate national
HIV prevention curriculum - Family Life and HIV
Education (FLHE) between 2003 and 2004

34. Response Nigeria
In 2006, 26 states reported that they had initiated
teachers training on FLHE. In 13 states, the FLHE
was already being taught in secondary schools, while
nine states reported teaching the FLHE in primary
schools .
E-learning methods for delivering the FLHE were
also being piloted in three states.

35. Response Nigeria (Cont’d)
Co-curricular methods ( peer education, anti-
AIDS clubs, Drama, Music comic books, posters
etc) were widely promoted in all states.
UNICEF supported Co-curriculum programme for
NYSC members in schools
Support to orphans and vulnerable children: In
2007 The FME proposed holistic scholarship
support to OVC children working with the
Federal Ministry of Women Affairs to identify and
respond to the educational needs of these children

36. Trend in HIV prevalence in Nigeria
from 1991 - 2005

37. Case Study States

38. FLHE Implementation
States were asked to implement under
culturally acceptable standards
Global Health Awareness Research
Foundation (GHARF) a non-governmental,
non- profit making and humanitarian
organization based in Enugu State, south East
Nigeria facilitated the process in the state

39. FLHE Implementation
GHARF facilitated the integration of Family Life and
HIV Education into the curriculum of all the 286
Public Junior secondary schools in Enugu State with
support from the John T. and Catherine D MacArthur
Foundation
Integration was in two subjects Social Studies and
Integrated Science
FLHE was implemented in three phases :
Phase 1: PRE IMPLEMENTATION
Phase 2: IMPLEMENTATION
Phase 3: POST IMPLEMENTATION

40. Pre-implementation Phase
The following activities were carried out:
Advocacy visits to Enugu State Government which led to
the signing of Memorandum of Understanding (MOU)
between GHARF and Enugu State Government in 2004
Formation of Think- Tank Committee (Staff of Ministries
of Education: Health, Gender Affairs & Social
Development, Human Resources & Poverty Alleviation,
Post Primary School Management Board (PPSMB), State
Universal Basic Education Board (SUBEB) and State
Technical Science and Vocational Schools Management
Board (STSVSMB) and chaired by the Commissioner for
Education

41. Pre-implementation Phase (Cont’d)
Selection and training of Master Trainers (3
GHARF staff & 2 from MoE)
Baseline survey in selected schools and
communities to ascertain the KAP of students,
community members and leaders using both
qualitative and quantitative methods

42. Implementation Phase
The following activities were carried out:
Sensitization of stakeholders (Traditional rulers,
FBOs leaders, PTA, CSPs, Media, Principals)
Capacity building of implementers (Teachers of
Social Studies & Integrated Science now Basic
Science)
Capacity building of GHARF staff, PPSMB, Zonal
supervisors (ZIE) & State Supervisors (AIE) for
monitoring of FLHE implementation in schools.

43. Implementation Phase (Cont’d)
Teaching of FLHE in classroom
Monitoring of FLHE implementation – Two types of
monitoring visits were conducted
-Baseline monitoring: To ascertain the availability of
the curriculum, scheme of work and number of
teachers trained
-Classroom monitoring: To determine the extent and
quality of teaching.
Checklist of indicators was developed for the
monitoring in schools

44. Summary of Results
483 teachers trained by end of 2007
252 schools monitored
3, 615 students reached
Results of Mid term evaluation showed
student’s performance levels in knowledge,
skills and attitudes were high
Comfort level on sexual and RH issues of
teachers improved

45. Post implementation Phase
The following activities were carried out:
Monitoring of FLHE
Evaluation of FLHE implementation
Consensus building meeting with major
stakeholder
Scale up of FLHE to other subjects Home
Economics, Physical and Health Education,
Social Studies and Integrated Science

46. Participant’s group work presentation

47. During the teaching practice

48. Evaluation Results
Increase in knowledge score compared to
baseline especially among females (from 24%
to 82.4%)
Decrease in sexual activities among
intervention group
Reduction in number of sexual partners
Increase in number of individuals using
condom for protection against unwanted
preganancy and STDs

49. Evaluation continues
Decrease in incidence of unwanted pregnancy
among the intervention groups. Only 2.0%
indicated that they have been pregnant or made
some one pregnant compared with control that
reported 4.9%

50. Knowledge of Reproductive Health Issues among Respondents
by some Demographic Characteristics and Evaluation

51. Distribution of Respondents by Sexual Experience (Ever
had sex) by some Demographic Characteristics

52. No. of Sex Partners of the Sexually Active Respondents by Arm
and Evaluation Period

53. Effort made to Prevent Reproductive Health Hazards by
Sexually Active Respondents, Study Arm and Evaluation

54. Frequency of use of Protective Devices against
Reproductive Health Hazards among Sexually
Active Respondents

55. Distribution of Respondents by Pregnancy
Experience, Study Arm and Evaluation

56. Scale up of FLHE to other subjects
Through The Global Fund Round 9 grants
strengthen of FLHE implementation in 4 subjects
in Nigeria was initiated.
This took off in the 20 states in Nigeria including
Enugu in 2010.
GHARF is also involved as one of the Master
Trainers
FLHE has been integrated into four subjects:
Social Studies, Basic Science, Home Economics
and Health & Physical Education

57. Summary of Results
14 batches of training conducted in the 6
educational zones
560 teachers trained
16, 000 students reached using 3 strategies in
line with the Minimum Prevention Package of
the National Prevention Plan

58. Achievements: Enugu State
In Enugu, the training of trainers was cascaded down to
most of the estimated 282 public junior secondary
schools teachers between 2005 and 2006, with funding
from the Ford Foundation and MacArthur Foundation
(FME & AHI 2006).
During that year, additional teachers were trained by the
state government to bring the total to 600 (approx. 2
teachers per school) . At the same time, 30 school
inspectors were trained on monitoring and
evaluating the FLHE curriculum. FLHE was taught in
social studies and integrated science in 88% of junior
secondary schools.

59. Assessment of the response
The steady decrease in the prevalence
rate obtained from the sentinel surveys is
encouraging (6. 00 in 2001, 5.3 in 2003,
4.3 in 2005, 4.6 in 2008 and 4.1 in 2010).
This has given us some rays of hope that
our preventions/interventions are
effective.

60. Lessons Learnt
The programme in general has won support of parents,
community and religious leaders, there by has helped to
remove policy barriers and change service provider’s
prejudices.
Other lessons learned indicate the need to enlist children
and young people in programme design and delivery,
inform young people specifically what they need to do,
and help them to acquire interpersonal skills to avoid
risks.
Finally, it is crucial to link information and advice with
services, offer role models that make safe behaviour
attractive and invest enough-for long enough- to make a
difference.

61. Challenges
Some of the challenges faced by the education sector were
due to the country’s diverse demography, variations in
HIV prevalence and technical capacity for response
across states, and the availability of resources. These
include:
• Inadequate funding (provided by the state government):
• Monitoring and evaluation is inadequate.
• Poor networking within the sector and between States
Non inclusion of out-of-school youth
Non acceptance of condoms despite evidence for risk
reduction
• Lack of incentives for staff of the Education ministry to
implement HIV and AIDS activities.

62. Challenges Cont’d
Misconception on the content of the
curriculum in some schools
Some of the school Principals did not allow
FLHE teachers to teach FLHE topics in such
schools due to lack of knowledge
The division of schools into junior and senior
secondary schools Trained teachers were
unable to step down the training to other
teachers in their schools

63. Challenges (cont’d)
Constant and frequent transfer of FLHE teachers
without replacement in some schools
Constant change of scheme of work by the Ministry
of Education. This has led to schools using different
schemes of work most of which do not have
comprehensive FLHE topics.
Frequent transfer of policy makers in the SMOE by
the state government

64. Recommendations
Implementation of the national education sector HIV
policy (Work place policy), particularly at the state
level should be accelerated for improved result.
Improving the coordination, monitoring and
evaluation of programmes especially at the state
levels at all stages of implementation.
Increasing the provision of education incentives for
OVC
Improving Information data bank on HIV and AIDS
in this sector (Unavailability of data also made it
difficult to assess the impact of the supportive
schemes and to improve its management )

65. Recommendation Cont’d
Continuous monitoring of classroom teaching of
FLHE
Scale up implementation to the senior secondary
classes.
Conduct interactive sessions for FLHE teachers for
experience sharing and best practices
Conduct trainings /re-trainings for teachers
Establish/strengthen peer education programme in
schools and for out of school youth
State government should provide budgetary
allocation for FLHE for sustainability purposes

66. Conclusion
Our children represents our future and window
of hope.
No stone should be left unturned towards
ensuring that a HIV free generation is achieved
In view of the above, their education remains
the best place to start