In 1986 Dan was a six-grader in a public school in Jerusalem, Israel. I was then a "Flower Project" volunteer, teaching him and his fellow classmates a general course in health education. During one of the weekly sessions, Dan astonished me with two simple, straightforward questions: "Why is everyone now talking about this new disease – ‘ADIDAS'?" "Could I die of it if my sports shoes are of a different brand?"

"AIDES", "AYDAS", "ADIDAS" – in the mid-1980s, kids and many of their parents did not even know how to pronounce the correct name of what has now become a well-known epidemic. Today, Dan is 28 years old. Fully aware of HIV/AIDS, he can tell you how HIV is spread, its origins, and how it affects the individual, families and orphans. He could advise you on voluntary counselling and testing (VCT) and how to put on a condom; he can show you how to create your own Red Ribbon and discuss with you the need to care for and protect the rights of persons infected with HIV. Dan was educated in a school system that provides education on HIV/AIDS from grade six, with repeated cycles throughout high school and compulsory military service.

But if you ask Dan discretely, he will admit that when he had sex with his new girlfriend last week, he did not use a condom, did not ask her about her previous sexual experiences or partners, or suggest mutual HIV testing. "It will never happen to me!" he would say. So have we failed Dan and his peers? Do we continue to fail them?

Many examples from around the world demonstrate how orchestrated policies, legislation, programmes and funds enable pupils, as well as teachers and managers of education systems, to protect themselves and others from being infected and to play an active role in prevention, care and anti-discrimination. Several of these efforts are reported in this issue of the Sexual Health Exchange.

How do we define success?

Success stories in HIV prevention education are published more often now than ever before. However, it is still difficult to define best practices in this area, mainly because there is not much consensus on what "success in HIV prevention education" means. Is it the inclusion of all politically correct items? Is it being blunt about sexuality? Or is it maybe just being able to demonstrate that we are reaching out to thousands of youth with some prevention messages?

Education is a long process, involving many participants and many variables to consider when we seriously evaluate its long-term effects, especially on risk-taking behaviours. The attempt to define best practices in education for HIV prevention is directly linked to reductions in HIV infection and it is therefore complicated.

The AIDS educator as a central figure

The International Bureau of Education, a Geneva-based UNESCO institute, and the International Academy of Education have published 10 principles for effective education on HIV prevention in schools by focusing on the teachers' role:¹

1. Become an effective AIDS educator by acquiring the appropriate skills and teaching methods.
2. Develop partnerships within your school and with the community.
3. Use participatory methods that encourage active learning.
4. Encourage discussion on controversial and sensitive issues, including gender inequalities, sexual violence, premarital sexual behaviour and condom use.
5. Provide multiple sessions through multiple media.
6. Adapt teaching methods to both male and female students.
7. Be culturally sensitive to diversity in your community.
8. Reinforce local values and attitudes about unprotected sexual behaviour and introduce peer education.
9. Teach life skills as a component of HIV prevention.
10. Evaluate and monitor your progress and that of your students.

When discussing how the education system can impact the HIV/AIDS epidemic, we also need to look at the other side of the coin and recognize that the epidemic has a tremendous impact on education systems. Even in less affected areas, the need to address HIV/AIDS and develop appropriate responses means that education systems must create new curricular units, make changes in their resource allocations, and develop new training and materials.

Education systems in countries that are seriously affected by HIV/AIDS are in danger of being weakened and disrupted. The epidemic greatly increases the scale of existing educational problems, including the possibility that the system will not be able to deliver its mandated services. Five domains most affected by HIV/AIDS are demand, supply, content, planning and the quality of education.

Education demand – As the epidemic advances, fewer families are able to financially support their children's education. There are greater numbers of sick children. Many children, especially girls, are taken out of school to care for sick relatives or to take over household tasks. Hence, HIV/AIDS has especially adverse effects on girls' education.

Education supply – There is a huge loss of human resources to AIDS. Teachers and school administrators fall ill and die, or they are psychologically traumatized by family and community deaths due to AIDS, becoming unable to work. In almost all cases, HIV-positive educators remain on the payroll, draining funds that might otherwise have been used to employ substitute or replacement staff.

Education content – The content of current curricula must be reformed to reflect learning needs such as health and sex education messages, coping with illness and death in the family, non-discrimination towards people living with HIV/AIDS, gender roles and issues, and life skills. Teachers also face new demands posed by the behavioural, emotional and psychological problems brought into the classroom by infected and affected learners. The issue of sexual abuse of girls by teachers, male pupils and "sugar daddies" needs to be addressed as well. To most parents schools are a safe place for kids to be in. This may well not be the case in many countries where teachers and other adults are sexually abusing young girls in schools or on the way to and back from school.

Education planning – HIV/AIDS affects the planning and management of an education system at all levels: ministries, departments, agencies, and policy-makers responsible for proper planning and allocation of education resources and services.

Education quality – When the education sector cannot support AIDS-affected teachers or supply adequate replacements for those who fall ill or die, the overall morale of people working in the sector, and consequently the quality of the system, is lowered. If curricula do not provide the knowledge and skills that young people need in an AIDS-affected society, the quality of education provided to them will also decrease. In addition, among teachers in high-prevalence countries, the frequent experience of death and serious sickness in their families, communities and schools is tending to undermine their morale.²

It is important that we monitor the effects of the HIV/AIDS epidemic and its impact on education systems in the above domains. This will allow us to better understand the epidemic's societal implications and how to devise remedies for them. Monitoring and evaluation are no less important in investigating the effectiveness of HIV prevention education interventions. Only such studies can teach us why we fail in educating Dan and other youngsters around the world about HIV prevention and how we can improve our strategies and programmes.

1. Schenker, I. and Nyrenda, J. Preventing HIV/AIDS in Schools. Educational Practice Series, International Academy of Education and IBE, 2002.

2. Kelly, M.J. and Bain, B. Education and HIV/AIDS in the Caribbean. IIEP, Paris, 2003.