In Tamil Nadu, lessons on HIV/AIDS have been included in the syllabi for Tamil, English, botany, zoology and science. The lessons are scientific in nature, with an emphasis on issues such as the structure of the virus or disease progression. In addition, these lessons are only available to science students after Standard 10. More recently, the Total Health Programme, funded by UNICEF, has been introduced; it is much wider in scope and also includes discussion of HIV through a life skills approach.

Researchers investigated the attitudes of 3,706 teachers, pupils, parents and other key stakeholders about HIV/AIDS instruction. They found that teachers and schools play a key role in teaching young people about HIV/AIDS. Young people and their parents view the school as a trusted place to learn about HIV, believing it to be a serious problem. A large majority (87%) of teachers feel that their profession has a responsibility to teach young people about HIV/AIDS.

Nevertheless, sensitivities surrounding HIV/AIDS create gaps in communication, and in many cases, "selective teaching" takes place. This is manifested in three ways: a) entire lessons from the syllabus are not taught at all; b) HIV/AIDS lessons make no direct reference to sexual relationships; and c) communication on HIV and sexual relationships relies solely on messages regarding abstinence. For example, 95% of teachers claimed that the HIV component of the Total Health Programme was being taught, compared to only 53% of students. A male student said: "Though we have one period per week, they never teach about health or AIDS, but use it to teach other lessons. They teach us about AIDS only when someone comes for inspection."

Gaps in communication

It appears that teachers choose which messages to give, often relying on an overly scientific approach and avoiding any discussion about sex. Of the 92% of students who claimed that they had received HIV education, about one-third reported never having been taught about sex. Silence about the issue of condom use or messages other than abstinence arises from tension between two societal assumptions: one assumption that young people should not, and will not, have pre-marital sex, and another that it is necessary to discuss condom use since young people do have pre-marital sex. Clearly these viewpoints are contradictory; a paradox concerning safer sex arises because both assumptions are thrust upon the educational agenda, the first by the HIV/AIDS curriculum and the second by deeply entrenched societal pressures.

The problems with such teaching are manifold. Discussion of HIV without direct reference to sex, or advocating abstinence without mentioning safer sex, cannot work. On the contrary, it binds notions of HIV to immorality, and leads to a "them, not us" attitude. This, in turn, leads to further discrimination of people living with HIV/AIDS. It also makes it less likely that already sexually active young people will seek advice or personalise their risk of becoming HIV positive.

Gender segregation in mixed-gender schools

The research also revealed a high level of gender segregation in the schools: male and female students in Tamil Nadu's mixed-gender schools are not only told to sit in separate parts of the classroom, but are forbidden to talk to each other. Such gender segregation distorts human relations between boys and girls. Once young people enter sexual relationships, this type of segregation hampers communication about HIV and sex. Indeed, the less interaction there is between boys and girls in other spheres of life, the more difficult it may be for both to handle sensitive issues when they do come together in a relationship.

The implication is that young people need more than knowledge – they also need the skills to apply that knowledge to everyday situations that are far removed from the classroom. In addition to skills, people need the power to leverage their sexual health rights. One critical element of ActionAid's work in both the fields of education and HIV has been to challenge ingrained gender and power relations which contribute to the rapid spread of the HIV/AIDS epidemic.

Examining gender inequality and its effect on communication in sexual relationships is essential in any educational approach that truly aims to change sexual behaviour. The challenge is to find constructive ways to work with men as well as women, and boys as well as girls, to address the wider gender and power issues that affect communication within (sexual) relationships.

Tackling the culture of silence

Apart from the social and cultural constraints that exist in teaching about HIV/AIDS, there are a number of obstacles faced by teachers that are symptomatic of a wider crisis in education. Efforts in the classroom are severely hampered by oversized classes, overstretched curricula – 52% of teachers said that they did not have enough time to teach about HIV/AIDS – and a lack of training opportunities and learning materials. For example, 54% of teachers report never having been on a training course. A female teacher complained: "We do not have enough time to teach about HIV/AIDS as we are already burdened with enough workload. We are always in a rush to complete the syllabus."

There are also many positive features in the educational system in Tamil Nadu, and these should be drawn upon when considering improvements. Advantage should be taken of pre-existing systems of knowledge transfer such as encouraging religious leaders to take a more positive role – all sectors of society should be involved to ensure that communication on HIV/AIDS is accurate, open and positive.

Teachers should also be given the confidence that parents support school-based HIV/AIDS education. Many teachers (36%) believe that parents would not approve of HIV/AIDS education in schools, while in reality only 4% of parents do not approve. A large majority of parents, 87%, said that they wanted their children to be taught about HIV/AIDS in schools. Increased communication between parents and teachers also has the benefit of allowing an increased flow of information between the school and community, expanding the range of education.

Furthermore, HIV/AIDS education should be locally relevant so that the risks related to HIV/AIDS can be personalised. This can be achieved if HIV/AIDS education moves away from its scientific focus. Learning materials should stimulate children to understand the human side of HIV so they can connect the issue to real life. Innovative and participatory forms of learning are important to achieve this – and efforts are needed to ensure that exam-focussed systems allow sufficient space and give recognition to such approaches.

If the educational system is to be an effective vehicle to prevent the further spread of HIV/AIDS, improving the basic functioning of the system is a prerequisite. A massive injection of resources is needed in order to support teachers – not just for teaching about HIV/AIDS, but to ensure some degree of quality education for all.

It takes special skills to talk about sex and a life-threatening disease, especially in countries where sex and HIV are linked to immorality. These obstacles can be overcome but not by assuming teachers can gain these talents from a book: it will take a very different type of training and learning process for them to acquire the necessary skills. More than anything, it is about communication. On this foundation, the culture of silence can begin to be tackled in schools.