Advancing Education
Increasing girls' access to education is critical to combating the AIDS pandemic. "There is a well-established protective effect of schooling on HIV risk" (Pettifor et al., 2008a; Hargreaves et al., 2008a; Jukes et al., 2008 cited in Pettifor et al., 2012a: 1). Education of girls is associated with delayed marriage and childbearing, lower fertility, healthier babies, and increased earning potential. Analysis by the Global Campaign for Education estimates that seven million HIV infections in young people could be averted in a decade, if all children completed primary school (Global Campaign for Education, 2004 cited in UNAIDS et al., 2004b). In 2009, 56% of the world's children who are at primary school age live in countries that have achieved gender parity at the primary level but this drops to 29% at the secondary level and to 15% at the upper secondary level (UNESCO, 2012a).
The 2009 report of the Millennium Development Goals (UN, 2009) shows that in the developing world, enrollment coverage was 88 percent in 2007, up from 83 percent in 2000, but still not on track to reach the MDG Goal 2 of achieving universal primary education. Many regions have reached gender parity where males and females are equally likely to attend primary school education, although girls remain disadvantaged in some countries in Africa and Asia, such as Afghanistan, Cote d'Ivoire, Pakistan, Mali, Benin, Lesotho, India, and Tanzania. Furthermore, there can be significant disparities by region or within countries. In India, for example, in some states, one-third to nearly one-half of school age female children are not in school (UN, 2009). In most countries, girls and boys are equally likely to transition to secondary school. However, once girls get to secondary education, they do not stay in school at the same rate as boys due to the fact that young women are significantly more likely to be married as child, have sex before the age of 15 and become pregnant (UNICEF, 2011a). Secondary school attendance and completion are strongly influenced by poverty, location and gender. Young people aged 23 to 27 in Cambodia from the wealthiest 20 per cent of households have secondary completion rates of 28 per cent, compared with 0.2 per cent for the same age group from the poorest households (UNESCO, 2012b: 54). In 2007, only 53 of the 171 countries with data had achieved the target of gender parity in education. An estimated "72 million children worldwide were denied the right to education in 2007. Almost half of these children live in sub-Saharan Africa, followed by Southern Asia, home to 18 million out-of-school children" (UN, 2009). It is estimated that half or more of those children might never have any schooling. A recently released report from UNESCO found that "girls and women remain deprived of full and equal opportunities for education" (Bokova, 2012: 1).
In addition, recent data from the International Men and Gender Equality Survey (IMAGES) finds that boys' education may also be a key to HIV and gender equality. Across middle- and low-income countries where the household survey was carried out, men with some secondary education consistently showed less use of violence against women, more gender-equitable norms and were more involved in caregiving/domestic activities in their households. This suggests that while we must work to reduce gender disparity gaps in education and to promote girls' education, the education of boys also brings multiple benefits for women and men (Contreras et al., 2012)
Education: The "Window of Hope" in HIV Prevention
The effectiveness of education as an HIV prevention strategy, which the World Bank calls the "window of hope," rests upon two key components: (1) greater access to schooling and (2) using schools as a natural place to reach young people with AIDS education and life skills training -- practical tools that help them stay safe (World Bank, 2002). "Data compared across countries and regions and disaggregated by education levels show that young women and men with higher levels of education are more likely to have increased knowledge about HIV/AIDS, a better understanding of ways to avoid infection, and an increased likelihood of changing behaviour that puts them at risk of contracting the disease. Thus, it is clear that ensuring quality education for all children is one of the best ways to protect both the rights and the lives of young people threatened by HIV/AIDS" (UNICEF, 2004a). Comprehensive sex education, covered in Prevention and Services for Adolescents and Young People, is also an important component of HIV prevention planning.
DHS surveys from 11 countries found that women with some schooling were nearly five times as likely as uneducated women to have used a condom the last time they had sexual intercourse (Global Campaign for Education, 2004). Literate women are three times more likely than illiterate women to know that a healthy-looking person can be HIV-positive and four times more likely to know preventive behaviors (Vanandemoortele and Delamonica, 2000 cited in Global Campaign for Education, 2004). While universal primary education is not a substitute for HIV/AIDS treatment and prevention, young people with little or no education may 2.2 times more likely to become HIV-positive as those who have completed primary education (De Walque, 2004 cited in Global Campaign for Education, 2004). Even controlling for income, education's impact on HIV/AIDS is robust. In the five years before the publication, better-educated young people have increased condom use and reduced the number of casual partners at a much steeper rate than those with little or no education (Hargreaves and Glynn, 2002; World Bank, 2002 cited in Global Campaign for Education, 2004).
"I think we should not tease a student with AIDS." --Girl in grade 4, Thailand, who received education on how HIV is transmitted (Ishikawa et al., 2011a: 242)Yet girls face barriers to staying in school. A study of primary school in Uganda in 2001 found that 51 percent of girls dropped out of primary school due to money needed for school funds, uniforms, textbooks and supplies, among other items, including uniforms and shoes. Some girls receive pressure from their parents to marry (Kasente, 2003). Other barriers can include the need to provide income for the family, long distances to school, safety issues traveling to school, sanitary facilities for girls at school, and the preference to send boys, among other barriers. One study found that since 2003 when school fees were abolished in Kenya, girls in schools with free uniforms had a 10 percent decrease in childbearing and a 12 percent decrease in teen marriage (Duflo et al., 2007). Furthermore, "lack of sanitary facilities means that girls and female teachers cannot attend school during menstruation" (Adams et al., 2009: iii). An estimated 1 in 10 African girls of school age do not attend school during menstruation or drop out at puberty due to lack of appropriate sanitation facilities in schools (UNICEF, 2005). Further interventions are needed to eliminate these barriers and enable girls to stay in school, for example "school fee abolition strategies to be embedded within country-wide poverty alleviation and growth strategies" (World Bank and UNICEF, 2009: 11), or improving sanitary facilities so girls can attend school when they are menstruating (Adams et al., 2009).
Schools Can Be a Source of Support for Children Affected by HIV
With significant numbers of the world's HIV-positive youth living longer, even in resource-poor settings, more schools will be attended by students living with HIV. Schools can be a source of support and protection for children affected by HIV/AIDS. Education beginning in primary school for all children about routes of HIV transmission is important to reduce HIV stigma against the students living with HIV (Ishikawa et al., 2011a). [See also Prevention and Services for Adolescents and Young People and Reducing Stigma and Discrimination] Programs on behavior change and gender norms can also be conducted in schools. See ippf.org/resources/publications/healthy-happy-hot, prepared by IPPF in 2010.