Community Health Development Coalition (N. West)
Comment on the draft national policy on HIV Aids, for learners and educators in public schools, and students and educators in further education and training institutions
Response to Government Gazette No. 19603 February 1999
Phineas Ngale, (chair), David Hirsch, Mapula Kekana, Stephan Le Roux, Vusi wa Moyakhe (ex-officio) Tshilidzi Tuwani
Summary
The realities of HIV/AIDS prevention in secondary schools are not recognised
To accord with these realities, the policy should:
Extend school hours to reduce teenage sexual activity
Secondary schools should work a much longer school day and have much shorter holidays. This will allow more time for lessons, including sexuality-education, homework, sport and extramural activities and reduce teaching days lost to registration and school events. Teenagers will have much less time, inclination, energy and opportunity for sexual activity.
Use young people from the community for effective sexuality education
A young person from the community, employed full-time at a school (but not permanently), deployed by an NGO or CBO and managed by the guidance teacher, is the most effective and preferable sex educator.
Use community health workers led by a nurse for school visits
Sexually active pupils need active but largely routine support of their sexual health. Community health workers led by a nurse do routine consultation and contraception for large numbers of pupils during regular, frequent school visits. Arising from this will be small numbers pupils referred to clinics for STDs, pregnancy and beginning contraception. Thus the clinics only deal with pupils who require their resources, the community health workers do most mundane tasks, and the nurse applies professional judgement and procedures where needed and follows up STD contacts.
Measure teenage pregnancy as a proxy of HIV prevention
Teenage pregnancy is a serious problem in its own right, easily and non-controversially reported and a good measure of the success of sexuality education in a school. All schools should report it monthly so that schools can be targeted for assistance.
Use (and fund) civil society in schools
Formal, age-segregated schooling isolates pupils from opportunities to learn self-reliance, solidarity and competence informally from people of all ages. A long school day and term will exacerbate this problem, unless organisations and individuals participate in a fuller school life.
Proposed Amendments
2.3 Replace "…Indications that young people are sexually active mean that increasing numbers of learners attending primary and secondary schools and students attending institutions might be infected…"
With "…Indications that many young people are sexually active means that the main risk of HIV infection to learners attending primary and secondary schools and students attending institutions arises from their own sexual activity…"
2.8.2 Replace "…while in secondary grades, the guidance counsellor would ideally be the appropriate educator .."
With "…while in secondary grades, a young community worker managed by the guidance counsellor, would ideally be the appropriate educator .."
2.9 Renumber as 2.10
New 2.9 Insert "In the secondary grades, schools should not close in the early afternoon. The afternoon can include lessons, including sexuality-education, homework, sport and extramural activities. Pupils should be meaningfully occupied for most of the day. Educators and pupils should not be able to absent themselves during the day without good cause.
Education departments should also seek to reduce the length of school holidays that engender boredom and sexual experimentation. Public funds should be available to school governing boards to assist the participation of civil society in school activities so that pupils learn self reliance and solidarity from a diversity of people from the community."
Add 6.4 Insert "Teenage pregnancy should be measured as a proxy of HIV prevention. Teenage pregnancy is a serious problem in its own right, easily and non-controversially reported and a good measure of the success of sexuality education in a school. All schools should report it monthly to the education department so that schools can be targeted for assistance."
13 Replace "HEALTH ADVISORY COMMITTEE "
With " HEALTH ADVISORY COMMITTEE AND SCHOOL HEALTH VISITS "
Add 13.3 "Where community resources make this possible, school districts and education districts should liase with NGO’s and secondary schools to create and make use of a district school health team.
13.3.1 Sexually active pupils need active but largely routine support of their sexual health. Community health workers led by a nurse should do routine consultation and contraception for large numbers of pupils during regular, frequent school visits.
The community health workers should do most mundane tasks and the nurse should apply professional judgement and procedures where needed and follow up STD contacts
13.3.2 Arising from this will be small numbers pupils referred to clinics for STDs, pregnancy and beginning contraception. Thus the clinics will need to deal only with pupils who require their resources."
Discussion
A failing sexuality education system is not being remedied and providing sexual health care at schools is not even proposed.
THE HIV/AIDS threat to society and the economy demands changes in many sectors - not least secondary schools, where a cultural change is needed so that the behaviour of the next generation will create substantial immunity to HIV infection. (25% of teenage girls are now estimated to be HIV+).
This is far from the case at present, where the level of sexual activity is high at many secondary schools. Although most pupils are not promiscuous, there are a small number of girls who have sexual relations with older men. This is the conduit for all sexually transmitted diseases (STDs) into the school population, the presence of which accelerates the transmission of HIV. Teenage pregnancy is a major problem in its own right.
The deadline of the request period for comments on the draft national education policy on HIV/AIDS in schools and tertiary education institutions has now passed. It seems appropriate to look at its strengths and weaknesses.
The policy does not make practical proposals on the most important issues - the school day, sexuality education and sexual health care at secondary schools.
First, the policy does not declare that the high level of teenage sexual activity is the overwhelming HIV risk to teenagers. Not coincidentally, many secondary schools close at 1.30pm. Schools should remain open until the late afternoon and include a broad range of activities that ideally also involve a diversity of people from the community.
Educators should put in a full eight hours of work every day in these schools and school holidays should be reduced. These changes are likely to reduce the level of sexual activity and the associated risk of HIV, other sexually transmitted diseases and teenage pregnancy.
Second, the policy does not recognise that the guidance counsellor, normally a teacher with a conventional teaching load of exam subjects, is often not a good choice for sex educator. She or he usually has the dignity and reticence of a teacher, is usually middle class, older and lives in another area.
sexuality education should not be regarded as a conventional pedagogical topic. It should involve the pupils committing themselves to open and honest debate so that they comprehend and apply the knowledge to their choices.
This is an ideal opportunity for them to realise themselves as responsible and self-reliant individuals who have obligations to themselves, their fellows, their families, their school and their community.
A young person from the community, employed full-time at schools (but not permanently), deployed by a non-governmental organisation or community-based organisation and guided by teachers, is the most effective and preferable sex educator.
Third, the policy does not envision a yardstick to measure the effectiveness of sexuality education at each school. If there is no measurement, there is no means to identify and replicate excellence and direct attention to poor performance. There is such a yardstick available - teenage pregnancy. More than half the girls in SA have a baby in their teenage years. The prospects for the mother and the baby are poor.
If the incidence of teenage pregnancy was largely reduced, nearly half the fertility reduction necessary for long-term population stabilisation would be achieved. All secondary schools should be required monthly to report teenage pregnancies to the provincial education department, which should use the information as a management tool for HIV/AIDS and pregnancy prevention.
Fourth, the policy does not embody a realisation that secondary schools where high levels of sexual activity are prevalent represent large gatherings of young people who need active, albeit largely routine, support of their sexual health. Most of it can be done at the school, just as sexuality education is best delivered at school.
Otherwise, the reservoir of STDs will tend to increase and multiply the rate of HIV transmission. Tracing of STD contacts will be more difficult. There will be more abortions, unwanted children and schoolgirl mothers.
Community health workers, led by a nurse, can do routine consultation and contraception for large numbers of pupils during regular school visits. Arising from this will be small numbers of pupils referred to clinics for STDs, pregnancy and contraception.
Thus the clinics will deal only with pupils who require their resources. The community health workers will do more mundane tasks.
Last, the policy does not acknowledge the pivotal role that lay people can play. At present, non-governmental organisations all too often have a core of officials surrounded by "volunteers" who are given partial responsibility, part-time work and derisory payment. They depend on their families who themselves live in poverty. Eventually, many give up in despair.
The nurse, teacher and social worker have failed because HIV/AIDS requires a cultural response - not trained expertise. It would be a great pity if the pandemic resulted in more certified and licensed officials.
What is needed is a steady spread of work, knowledge, skills and solidarity among many ordinary people paid living wages under the aegis of non-governmental and community-based organisations.
It is an ideal focus for funding arising from the job summit. Co-ordination could be provided by small secretariats, and resources by organisations such as education and health systems, tertiary education institutions, research institutes, mining houses and commercial firms.