[procaare] Re: Pre-6th HCC: Children - Infected or Affected by HIV/AIDS (13)

["World Bank Report" <procaare@healthnet.org>]

Re: Pre-6th HCC: Children - Infected or Affected by HIV/AIDS (13)

Lessons Learned About School-Based Approaches to Reducing HIV/AIDS Related 
Risk
World Bank report 2003
******************

[Moderators?s note: This is an excerpt of the ?Education and HIV/AIDS: a 
sourcebook of HIV/AIDS prevention programs? edited by the World Bank in 
2003. Since there are many references to schooling we have considered very 
adequate for the children discussion.  To get the whole report: 
http://www.schoolsandhealth.org/Sourcebook/sourcebook%20intro.htm ]

Please note that these reviews are derived from experience in both 
developing and more developed nations. ?Quality? programming is essential to 
realizing the potential of HIV/AIDS prevention education.

The following principles are central to maximizing program outcomes.

QUALITY OF LEARNER

Recognizing the Child

Recognize what the learner already knows, feels, and can do in relation to 
healthy development
and HIV/AIDS-related risk prevention. Individuals and communities often have 
established mechanisms and practices for supporting children and young 
people to learn and develop, and these should be embraced. Encouraging 
learning from each other ? peer to peer, teacher, family, and community ? 
can integrate the unique and valuable knowledge and experience of learners 
that can make school programs more relevant and effective. Some learners 
will be more affected by HIV/AIDS than others ? they may be orphans 
themselves, or they may be already caring for others who are sick, or caring 
for siblings. The starting point for effective teaching and learning is 
working toward ensuring that all learners are healthy, well nourished, ready 
to learn, and supported by their family and community in gaining access to 
education.

Relevance

Focus on the risks most likely to occur among the learners, as well as those 
that cause the most harm to the individual and society. Some issues attract 
media attention and public concern, but these may not be the most prevalent 
or most harmful. The program objectives, teaching methods, and materials 
need to be appropriate to the age, sexual experience, and culture of 
children and young people and the communities in which they live. Both 
direct and indirect factors need to be considered, for example, 
understanding gender and power relations and preventing violence should be 
integrated into programs, along with other factors where they are evident in 
the lives of learners. Well-targeted research, including listening to what 
young people believe and already know, can help to address motivation for 
behavior and ensure an acceptable and appropriate program.


QUALITY OF CONTENT

Theoretical Underpinnings

Use social learning theories as the foundation of the program.1 Some common 
elements exist across these theories, including the importance of 
personalizing information and risk, increasing motivation for change and 
action, understanding and influencing social norms, enhancing personal 
ability to act, and developing enabling environments.

More Than Information

Make decisions about the information, attitudes, and skills to include in 
the program content on the basis of relevance to preventing HIV/AIDS risk, 
developing protective behaviors, and related attitudes. Programs that 
address a balance of knowledge, attitudes, and skills, such as 
communication, negotiation, and refusal skills, have been most successful in 
changing behavior.
Examples of risk factors for HIV/AIDS include ignorance, discriminatory 
attitudes toward those affected by HIV/AIDS, or lack of access to or use of 
condoms. Examples of protective factors include obtaining accurate 
information, developing positive personal values and peer groups that 
support safe behavior, identifying a trusted adult for support, using health 
services, and using condoms if sexually active.

Interrelationship

Ensure an understanding of HIV/AIDS, characteristics of individuals, the 
social context, and the interrelationship of these factors within program 
content. Programs that address just one of these components may neglect 
other significant influences, which can limit success. Information is 
necessary, but not sufficient, to prevent HIV/AIDS. The values, attitudes, 
and behaviors of the community, as well as of the individual, need to be 
addressed along with the basic facts.
Responsible decisions by learners are more likely when peer and community 
groups demonstrate responsible attitudes and safe behavior.3 Therefore, 
reinforcing clear values against risky behavior and strengthening individual 
values and group norms are central to HIV/AIDS prevention programs.


QUALITY OF PROCESSES

Evidence

Build programs based on research, effective teaching and learning practice, 
and identified learner needs. Unilateral or single-strategy approaches ? 
such as testimonials alone, or information alone ? have failed in many cases 
because they ignore local needs and tend to be based on unevaluated 
assumptions. Analysis of learner needs and broader situation assessment 
should be an important source of information for shaping programs.

Preparation and Training

Deliver programs through trained and supported personnel within or attached 
to the school. The classroom teacher is in some cases the optimal person to 
deliver the program. In other cases, other trained facilitators or peer 
educators are needed. However, in cases where teachers do not deliver the 
program, they should be involved and activities should be reinforced in the 
broader school environment. Training and support at both preservice and 
in-service levels are required.

Teaching and Learning Methods

Use a range of teaching and learning methods with proven effects on relevant 
knowledge, attitudes, and risk behavior. Although there is a place for 
teacher-centered delivery of information or lecture, interactive or 
participatory methods have been proven more effective in changing key 
HIV/AIDS-related risk behaviors, such as delaying sex, increasing confidence 
or using condoms, and reducing number of sexual partners. Programs with a 
heavy emphasis on (biological) information can improve some knowledge, but 
are generally not effective6 in enhancing attitudes and skills or changing 
actual risk behavior.

Participation
Develop mechanisms to allow involvement of students, parents, and the wider 
community in all stages of the program. A collaborative approach can 
reinforce desired behavior through providing a supportive environment for 
school programs. The participation of learners and others in HIV/AIDS 
prevention education can help to ensure their specific needs and concerns 
are being met in a culturally and socially appropriate way. It can also 
foster commitment to or ownership of the program, which can enhance 
sustainability.

Timing and Duration

Ensure sequence, progression, and continuity in programs over time, 
throughout schooling. Messages about HIV/AIDS need to start early, be 
regular and timely, and come from a credible source. The age and stage of 
the learner needs to be taken into account, moving from simple to complex 
concepts, with later lessons reinforcing and building on earlier learning.

Placement in the Curriculum

Place HIV/AIDS prevention education in the context of other related health 
and social issues, such as sexual and reproductive health and population, 
that are relevant to children, young people, and the community in which they 
live. For example, ?carrier subjects? such as health education or civic 
education can accommodate the necessary balance of knowledge, attitudes, and 
skills together. Over time, programs that are ?integrated? or ?infused? 
thinly throughout a curriculum without a discrete, intensive module have 
been generally disappointing. Programs that are part of the national 
curricula and officially timetabled can have the advantage of greater 
coverage as well as greater likelihood of training, support, and actual 
delivery. Where nonformal approaches are utilized, they should be clearly 
linked to other school-based activities.
Whether formal or nonformal approaches are employed, isolated or one-off 
programs should be avoided, as they tend to be unable to address the 
complexity and interrelationship of the full range of relevant issues.

Going to Scale

For a vision of national program coverage of high quality, establish early 
partnerships with key ministries. Without such a vision and political 
commitment, activities will not move beyond pilot program status. Political 
investment of ministries of education and health are often central to 
establishing large-scale school-based programs. Encouraging links with other 
ministries particular to the setting, nonformal mechanisms, and the 
community will augment scope and capacity to reach all learners.


QUALITY OF ENVIRONMENTS

Garnering Commitment

To influence key national leadership and mobilize the community to overcome 
the key barriers, use intense advocacy from the earliest planning stages. In 
too many cases, policymakers are not aware of key information such as the 
extent of HIV infection, sexually transmitted infections, teen pregnancies, 
and other sexual health problems among young people. Advocating with 
accurate and timely data can convince both communities and national leaders 
of the importance of prevention from an early age. It can also help ensure 
that programs focus on the real health needs, experience, motivation, and 
strengths of the target population, rather than on problems as perceived by 
others. Communicating the evidence, listening and responding to community 
concerns, and valuing community opinions can help garner commitment, and 
effective resource mobilization will underscore the effectiveness of such 
efforts.
More than Education Alone

Over time, coordinate education programs with other consistent strategies, 
such as policies, health services, condom promotion, community development, 
and media approaches. Education programs work best in the context of other 
consistent strategies over time. Because the determinants of behavior are 
varied and complex, and the reach of any one program (e.g., schools) will be 
limited, a narrow focus on prevention education alone is unlikely to yield 
sustained behavior change in the long term.

Consistency

Ensure that HIV/AIDS prevention messages are consistent and coherent across 
the school environment. Finding ways to encourage open communication among 
learners, teachers, families, and the broader community is essential to 
recognizing and clarifying the many myths and misunderstandings that exist 
in relation to HIV/AIDS. School policies and practices that reinforce the 
program objectives maximize the potential for success.


QUALITY OF OUTCOMES

The Goal

Focus on prevention and reduction of HIV/AIDS-related risks as the overall 
goal. Program objectives should concentrate on key behaviors that are linked 
to achieving the goal, such as avoiding unprotected sex and unsafe drug use, 
including abstinence and avoidance of intravenous drugs.

Realizing Outcomes

Consider the full range of available strategies known to contribute to the 
program objectives. Some strategies are marginalized because of lack of 
understanding or political, religious, or cultural issues (e.g., condom use 
or needle exchange programs). Gathering all the available evidence from 
credible sources is important to choosing the most effective and acceptable 
strategies, and to adapting them wherever possible. Some strategies are used 
because they are popular, fun, or interesting, but unless they are also 
linked to the achievement of the objectives, the value of such approaches 
for achieving the intended outcome is questionable.

Long-Term View

Select programs, activities, materials, and resources on the basis of an 
ability to contribute to long-term positive outcomes among learners and in 
the school environment. Some approaches may attract media and public 
attention in the short term, but these may not be the most effective, 
especially where they are not coordinated with existing strategies. A 
coordinated series of short-term programs linked with longer-term outcomes 
should be given priority over superficially attractive stand alone, one-off, 
or quick-fix alternatives.

Research, Monitoring, and Evaluation

Evaluate program objectives, processes, and outcomes using realistic 
indicators, and allow enough time for results to be observed.
At the outset, an evaluation plan and monitoring mechanisms should set the 
stage for measuring the degree to which progress is made toward the 
objectives over time. Setting objectives that are too ambitious, and 
indicators that are too difficult to collect or do not accurately reflect 
what the program is attempting to change, are common problems. In general, 
much more process evaluation than outcome evaluation information is 
collected, and probably only a fraction of that is reported. Accurately 
assessing and reporting the extent to which the program was implemented as 
planned is equally important as the ultimate outcome -- changes among 
learners.

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