MTT 2004 Annual Winter SchoolDurban, 10th August 2004

Mitigating the Impacts of HIV/AIDS on Education Systems

Development Development Impacts of Impacts of HIV/AIDSHIV/AIDS

M. J. Kelly, Lusaka, Zambiamjkelly@zamnet.zm

The Impacts of HIV/AIDS on The Impacts of HIV/AIDS on People and SocietiesPeople and Societies

In all of our countries, HIV/AIDS isReversing decades of health, economic and social

progressReducing life expectancySlowing economic growthDeepening povertyContributing to and exacerbating food shortagesCreating a growing human capacity crisisEnhancing gender inequities by affecting women and

girls more than men and boys

Are the Impacts Due to AIDS?Are the Impacts Due to AIDS? Fairly clear that illness and death may be due to AIDS

(though AIDS may not be acknowledged as the cause) The same with orphanhood But in many cases it may be very difficult to separate

out what is due to other factors and what is due to HIV/AIDS

AIDS impacts entangled with those of poverty, female disadvantage, poor economies, climate, public corruption, unbalanced North-South relationships

But HIV/AIDS increases the scale of almost every existing problem, making it more difficult to deal with —just as HIV makes it difficult for the body to deal with infections it would otherwise be able to manage

What We are Up Against in What We are Up Against in HIV/AIDSHIV/AIDS

HIV/AIDS confronts us with two situations:The disease: the medical conditions of

HIV infection and/or AIDS in individuals

The social and developmental problem: the social and developmental conditions and impacts that follow on from the disease, especially when it becomes widespread with infected individuals being found throughout a community and eventually across a country or region

Global Emphasis on Medical and Global Emphasis on Medical and Behavioural ApproachesBehavioural Approaches

Current dominant global models focus on HIV/AIDS EITHER as a medical issue that requires a

biomedical response;OR as a condition resulting from human behaviour

practices and hence requiring a response that focuses on aspects of human behaviour

Both points of view are valid but whether taken separately or together they deal with only part of the AIDS problem

This limitation has contributed to global failure to respond adequately to the epidemic

Behavioural Approaches to PreventionBehavioural Approaches to Prevention The majority of current approaches are based essentially

on the modification of individual behaviour They address the obvious risks of sex and injecting drug

use, and factors that increase personal vulnerability (e.g., ignorance or peer pressure)

They follow a logical pattern, as if HIV risk-reducing decisions were always rational and seldom emotional

They take almost no account of non-western world views—their uniform context is that of the homogenised, individual, western cultural world

They deal only marginally with the underlying issues & contextual features of joblessness, helpless economies, female disadvantage, responding to youth needs, facing up to poverty, grassroots voicelessness

Taking a Holistic ApproachTaking a Holistic Approach An adequate conceptual framework for the developmental

impacts of HIV/AIDS (and for responding to them) must take due account of the economic, social, cultural, environmental and political factors that render individuals and communities vulnerable

This implies going beyond the symptoms of infection, sickness and behaviours that contribute to these and looking to the factors that underlie the infection, sickness and behaviours

It means asking about the roots of the problem Instead of focussing narrowly on HIV/AIDS as a stand-alone

issue, there is need to see it as arising within the complexities of poverty, gender inequalities, cultural determinants, religious understandings, environmental questions

HIV/AIDSHIV/AIDS Impacts on Various Impacts on Various Aspects of SocietyAspects of Society

HIV/AIDS spreads into the general

population =

Epidemic, with a variety of impacts

ECONOMY

LABOUR

AGRICULTURE

MANAGEMENT

GOVERNANCE

CULTURE, VALUES, BELIEFS

SOCIALDEVELOPMENT

EDUCATION

----------------------

HEALTHENVIRONMENT

DevelopmentDevelopment• Initially, attention focused on economic development—the

movement (at individual or national levels) from a low economic status to one that was higher

• But although very important, economic development is only one aspect of development

• Today, development is seen more in terms of increasing choices and enlarging freedoms

• Development means advancing human freedoms by increasing the capabilities and opportunities for individuals to lead a life they have reason to value (based on Amartya Sen)

• Because HIV/AIDS limits & does not advance human freedoms, it works against development

Human DevelopmentHuman Development Human development is about creating an environment in

which people can develop their full potential and lead productive, creative lives in accord with their values, needs and interests

The most basic capabilities for human development are toLead long and healthy livesBe knowledgeableHave access to the resources needed to maintain a decent

standard of livingBe able to participate in the life of the community

HIV/AIDS undermines each of these

A Long and Healthy LifeA Long and Healthy Life Where HIV/AIDS is prevalent, there is little prospect that people will be

able to lead a long and healthy life Life expectancy falls to dramatically low levels (see next slide) Child mortality rates remain alarmingly high AIDS enlarges the impact of other threats to health such as TB or

malaria Coping with AIDS issues overwhelms health services AIDS claims the lives of numerous medical service personnel Applying anti-retroviral therapy makes extensive demands on the small

number of doctors, nurses and health-care workers in all of our countries Donor-funded ART programmes may bleed away health practitioners

from providing the services that the non-HIV infected public needs

Life Expectancy at Birth (Years), Life Expectancy at Birth (Years), 2001 and 20022001 and 2002

2001 2002 2001 2002

Botswana 39 41 Swaziland 42 36

Ethiopia 44 46 Tanzania 51 44

Kenya 50 45 Uganda 45 46

Malawi 40 38 Zambia 42 33

Namibia 45 45 Zimbabwe 43 34

S. Africa 50 49

Source: The State of the World’s Children, 2003 & 2004 (UNICEF)

Be KnowledgeableBe Knowledgeable The negative impacts of HIV/AIDS on educators, learners

and the overall learning environment suggest that the epidemic adversely affects the ability of individuals to become knowledgeable

It also removes a major incentive to becoming knowledgeable—why bother, if life will be too short to use the knowledge, or if the process of acquiring knowledge (usually through schools) means that young people are not available during large parts of the day to help the family or community cope with AIDS impacts, or if the knowledge will not lead to employment, or even if it is believed that the knowledge will increase vulnerability to HIV infection?

HIV/AIDS and Human CapacityHIV/AIDS and Human Capacity

HIV/AIDS affects human capacity in different ways: It robs sectors, enterprises and undertakings of

qualified and experienced personnel It creates the need for additional personnel (e.g. in

nursing care) It creates the need for persons with new

understandings and skillsBecause of the way it removes young and

productive adults, it has negative effects on the transfer of skills

Have Access to the Resources Needed to Have Access to the Resources Needed to Maintain a Decent Standard of LivingMaintain a Decent Standard of Living

Poverty is widespread and is closely related to HIV/AIDS However, AIDS is not a disease of poor countries Neither is it a disease of poor people, but

the poor are at higher risk of HIV infection the poor are more vulnerable to HIV infection the disease makes the poor poorer

HIV/AIDS leads to the impoverishment of households and even to their disappearance as units of society

Productivity declines, jobs are lost, and incomes fall Expenses increase, for medical care and eventually for funerals Productive assets are sold off to cater for income loss and

increased outlays

How Poverty and HIV/AIDS Relate How Poverty and HIV/AIDS Relate to Each Otherto Each Other

P oor a t h ig hrisk o f

H IV in fec tion

on h ea lthg rou n d s

on soc io -econ om icg rou n d s

b ecau se o f w h a tit m ean s

to b e p oor

P oor m orevu ln erab le toH IV in fec tion

cos tsin c rease

in com esan d resou rces

d ec rease

resou rcesare sp en t

on H IV /A ID S

P oor b ecom in gp oorer

b ecau se o f H IV in fec tion

H IV /A ID S an d P overty

Impacts on Households and their EconomiesImpacts on Households and their Economies

• Two-thirds of families where the fathers die from AIDS experience an 80% drop in income (Zambia)

• In Cote d’Ivoire the household income of AIDS-affected families is about half of the average household income

• In Zimbabwe, two-thirds of households that had lost an adult woman ceased to exist; the members dispersed and the households disintegrated

• In Botswana, AIDS will lead to a decline of 13% in per capita household income for the poorest quarter of households, while every income earner in this category can expect to take responsibility for four or more dependants

HIV/AIDS Increases CostsHIV/AIDS Increases Costs Costs of goods and services increase as enterprises raise

costs to offset those arising from HIV/AIDS: lower productivity smaller markets increased medical costshigh funeral costsearly payment of terminal benefitshigher insurance costs in-house HIV/AIDS education programmes

Goods which are in scarce supply because of HIV/AIDS increase in cost

HIV/AIDS Reduces Incomes and HIV/AIDS Reduces Incomes and ResourcesResources

Jobs lost (sickness; death; firms collapsing) Farm production reduced Smaller volumes of sales Loans not being repaid Capital assets being disposed of Savings drawn down Lower levels of production in households headed by the elderly or

children Firms losing profitability and paying less Reduced ability to transact business or manage affairs efficiently

(reduced social capital)

HIV/AIDS Diverts National and HIV/AIDS Diverts National and Institutional ResourcesInstitutional Resources

Additional national resources absorbed by AIDS care and responses, at the cost of important medical and other needs

Medical, personnel, agency and NGO resources diverted to AIDS issues

Already limited and over-stretched public capacity is further extended with AIDS concerns

HIV/AIDS Diverts Personal and HIV/AIDS Diverts Personal and Household ResourcesHousehold Resources

Household resources consumed by medical costs, cleaning, transport, funerals, mourning

Limited resources spread more thinly over larger numbersamalgamated familiesorphan care increased dependency ratio

Labour resources going to AIDS care and away from productive work

HIV/AIDS Impacts at the Household HIV/AIDS Impacts at the Household Level: Some IssuesLevel: Some Issues

Impacts are almost always very severe emotionally—distress, shock, anger, denial, grief, stigma, isolation

The disease has severe implications for household well-being: Income reduction (job loss; reduced ability of infected person to work and produce;

time spent on patient care is time taken from productive activities) Increased health-related expenditures (medicines, special foodstuffs, soap and cleaning

materials, clinic-related use of resources & time—patient transport, getting medicines) Some households disappear Impacts may be masked by complex extended family and other relationships between

households Ripple effects—more demands on other households, or less to give to households that had

previously been getting assistance Vulnerability of female-headed and child-headed households

HIV/AIDS and Food SecurityHIV/AIDS and Food Security Remote fields left fallow; poor timing of essential farming operations;

lack of resources to purchase agricultural inputs; abandonment of soil conservation measures; dominant need to give priority to immediate survival

Switch from labour-intensive crops to ones that are less demanding, often less nutritious; crop variety declining

Livestock and other farm assets sold to pay the medical costs of AIDS or are used for funeral expenses

Credit for agricultural production diverted for the medical care of sick relatives, funeral expenses, food

Illness and deaths among agricultural extension staff Result: less food security and increased malnutrition (and hence

vicious cycle of increased vulnerability to HIV/AIDS)

Girls, Young Girls, Young Women and Women and HIV/AIDSHIV/AIDS

on phys io logic a l

and hea lth

grounds

T hey are a t

higher ris k

of H IV infec tion

on s oc ia l

grounds

on ec onomic

grounds

T hey are

more vulnerable to

H IV infec tion

G irls are tak en out o f s c hoo l

Women's burden o f c are

M us t w ork even if infec ted

Do not have ac c es s to A R V s

T hey are

more ex tens ive ly aff ec ted

w hen H IV /A IDS is pres ent

H IV /A IDS has a disproportionate impac t on girls and young w omen

Impacts on the Exercise of Impacts on the Exercise of Human RightsHuman Rights

HIV/AIDS attacks basic human rights: Free and equal (female/male; rural/urban, poor/wealthy) Recognition as a person (PLWHA; orphans) Life and health (knowledge, supplies, infrastructure) Marriage (freely entered into; early/forced?) Property (inheritance rights of widows, orphans?) Social security (economic, social and cultural rights

indispensable for human dignity and personal development) Rest and leisure (women, child labour) Education (girls; orphans; poor)

Environmental ImpactsEnvironmental Impacts Degradation of forest and soil reserves that are nearest to

the home Less soil conservation and maintenance of contour

ridges Boreholes and wells not maintained Water pollution Concentration on easy-to-grow crops and reduction in

crop varieties Less transmission of knowledge and skills leading to

harmful environmental practices (fishing, bee-keeping, grazing, tillage)

Impact on the FutureImpact on the Future• What kind of adults will orphaned children be?• How will they function as parents when they have never

known normal childhood?• Who will look after the next generation of orphans when the

present generation of grandparents have died?• Who will communicate traditional skills and skills for life

to OVCs?• Will society be very different because a large part of the

next generation will not have experienced normal nurturing and affection in a family setting?

• Will there be special security problems because so many children are growing up without the supervision of responsible parents or relatives?

Role of EducationRole of Education• What role does the formal education system play

in mitigating these multiple developmental impacts of HIV/AIDS?

• Do educators ever think about or plan for these issues?

• Are they preparing young people for the world of the future, with HIV/AIDS and its many consequences?

• Or are they locked in the past, preparing learners for the world as it was twenty and more years ago?

• Apart from issues relating to HIV prevention, education should also play a role in orientating young people to the likely world of the future, opening their minds to what could possibly be, and preparing them for life in a world with AIDS

The Interaction between The Interaction between HIV/AIDS and Development: HIV/AIDS and Development:

ExerciseExercise • To what extent has HIV/AIDS become an issue in

the governance of your country?• Does your country show signs that the epidemic has

slowed or reversed social progress?• In what ways has it deepened poverty? • Is there evidence in your country that the epidemic

is leading to a growing human capacity crisis?• Has the epidemic had any impact on the exercise of

human rights in your country?

Education, HIV/AIDS and Education, HIV/AIDS and Development: ExerciseDevelopment: Exercise

• What role could the education sector play in offsetting the negative impacts HIV/AIDS has in such development areas asPoverty reductionBetter living conditionsImproved agricultural productionExpanding each person’s range of

choices?