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Africa: Girl Power
AfricaFocus Bulletin
Sep 23, 2006 (060923)
(Reposted from sources cited below)
Editor's Note
"Girls who complete secondary school are up to five time less
likely to contract HIV than girls with no education," according to
a new ActionAid review of over 600 research studies. But in Africa,
an estimated 22 million girls have never been to primary school.
The contribution of girls' education to development is widely
acknowledged by international agencies and researchers, the report
notes. But obstacles such as school fees, as well as armed
conflicts, poverty, and other factors still hinder rapid expansion
of girls' education. Expanding secondary as well as primary
education is critical to combatting HIV/AIDS, this new report
stresses.
This AfricaFocus Bulletin contains the press release and executive
summary from the ActionAid report on Girl's Education, Sexual
Behabiour and AIDS in Africa. The full report is available on the
ActionAid UK website (see
http://www.actionaid.org.uk/100520/press_release.html).
A wide variety of reports and data on girls' education is available
at the website of the United Nations Girls' Education Initiative
(http://www.ungei.org), including announcement of a CD-ROM with
more than 100 recent resources on girls' education and HIV
prevention (http://www.ungei.org/infobycountry/247_950.html).
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Girl Power: Girls' Education, Sexual Behaviour and AIDS in Africa
ActionAid
http://www.actionaid.org.uk/100520/press_release.html
14 August 2006
Girls educated to secondary and tertiary levels are more likely to
wait before having sex, are much more likely to use condoms when
they do have sex, and are therefore at much less risk of
contracting HIV, according to a new report released on 15 August.
One of the latest trends in the development of AIDS in Africa is
its increasing feminisation. In Africa, 6.3 million young people
aged 15-24 are living with HIV & AIDS, and 74% of those are young
women and girls.
In a systematic review of over 600 pieces of research on girls'
education, sexual behaviour and HIV, ActionAid has shown that
secondary education provides African girls with the power to make
sexual choices that prevent HIV infection.
The research shows that before 1995, educated girls were more
vulnerable to AIDS. Post 1995, as sex education improved and a
greater understanding of HIV prevention developed, more educated
girls became less likely to contract HIV.
Report author, Tania Boler said: "Young women receiving higher
levels of education are likely to wait longer before having sex for
the first time, and are less likely to be coerced into sex.
Strikingly, girls with more education are far more likely to use
condoms and they are less likely to contract HIV."
The report's findings challenge the increasingly vocal lobby which
claims it is inappropriate to promote condoms widely in the fight
against HIV.
"This report demonstrates the value of promoting condoms to a broad
population including young people, and not only to high risk groups
such as sex workers," said Tania Boler.
ActionAid finds that education gives girls power, reduces
vulnerability and helps them make more independent, confident
choices about their sexual behaviour.
The report shows that:
- Schools and teachers are the most trusted source for young people
to learn about HIV, and that school attendance ensures greater
understanding of prevention messages. It also strengthens girls'
control, confidence and negotiating abilities to decide if to have
sex, and when they do, whether to use a condom.
- Peer group solidarity within school strengthens girls' social
networks and creates more responsible attitudes to sexual
behaviour, safer sex and HIV.
- Conversely, girls who drop out of school are more likely to enter
into adult sexual networks, where older partners with more
experience and power dictate the 'rules' of sexual engagement.
- Poverty and vulnerability to HIV are closely linked. More
educated women have better economic and social prospects and
consequently have more choices.
Despite the role of education in protecting girls from HIV
infection, 110 million children worldwide do not receive an
education. In Africa, 22 million girls have never been to primary
school. Children still have to pay to go to primary school in 92
countries.
ActionAid recommends the abolition of school user fees in
developing countries to achieve maximum access to education,
broadening the curriculum to include sex education, encouraging
teenage mothers back into education and that condoms should be more
widely available for young people.
The Impact of Girls' Education on HIV and Sexual Behaviour
ActionAid
http://www.actionaid.org.uk/100520/press_release.html
August 2006
This year marks the 25th anniversary of the first diagnosis of
AIDS. This year, over one hundred countries pledged to ensure
universal access to AIDS prevention, treatment and care by 2010.
However, despite these grand promises, countries and donors are
failing to launch the type of large-scale prevention efforts that
are needed to reverse the spread of HIV.
The AIDS epidemic continues to evolve, staying one step ahead of
our attempts to prevent it. There are 13,500 new HIV infections
every day. One of the latest facets of this dynamic disease is the
increasing feminisation of AIDS: in Africa, where the HIV and AIDS
epidemic has hit hardest, 74% of young people living with HIV are
women.
HIV prevention campaigns often fail to address the increased
vulnerability of young women because they fail to deal with the
simple fact that many women lack the power to determine who to have
sex with, or when and how to have sex. The new challenge is how to
empower young women to assert their sexual and reproductive rights.
Of the possible solutions, giving girls an education is widely
recognised as the best way to provide this girl power.
However, in the rush to tackle the AIDS crisis, our response has
forged ahead of the evidence, especially as some of the research on
girls' education and vulnerability to HIV has yielded mixed
results. The most rigorous way to make sense of the different
pieces of evidence is to conduct a systematic review examining all
possible evidence according to a predetermined set of criteria. To
date, there has only been one such review, which was conducted four
years ago a long time in the context of a rapidly evolving AIDS
epidemic.
Given the importance of basing our response to HIV on solid
evidence, ActionAid collaborated with the researcher from the
original review James Hargreaves and conducted a systematic review
of all the research published between 1990 and 2006 in eastern,
southern and central Africa to address the following research
questions:
1 What is the impact of girls' education on sexual behaviour and
HIV?
2 What difference does primary or secondary education make to
women's vulnerability to HIV?
3 What are some of the possible mechanisms underlying the
relationship between HIV and girls' education?
The results show strong evidence that, early in the epidemic
(before 1995), more highly educated women were more vulnerable to
HIV than women who were less well educated. The most likely reason
is that more highly educated people had better economic prospects,
which influenced their lifestyle choices such as mobility and
number of sexual partners. They were also more likely to live in
urban areas where HIV prevalence rates were highest. At that stage,
there was also a general information vacuum about HIV and AIDS in
Africa.
However, as the epidemic has evolved, the relationship between
girls' education and HIV has also changed. Now, more highly
educated girls and women are better able to negotiate safer sex and
reduce HIV rates. The more education the better. Across all the
countries reviewed, girls who had completed secondary education had
a lower risk of HIV infection and practised safer sex than girls
who had only finished primary education. Put simply, education is
key to building "girl power"! There are also inter-generational
benefits of education, with more highly educated adults having a
positive bearing on young women's condom use. Moreover, more
education empowers boys and men to practise safer sex, thus
reducing their own, and their partners', risk of infection.
Despite the power of girls' education and numerous international
commitments to education, the reality is that the vast majority of
girls in Africa will not complete primary education, let alone
manage to get to secondary school. A key obstacle is the rising
cost of education. Most children in Africa have to pay to go to
primary school, paying increasing amounts as they rise through the
grades, particularly if they enter secondary school. This leads to
the exclusion of many children from education, especially girls.
If we are to see the real benefits of educating girls, then fees
need to be removed and governments and donors need to be urged to
invest more in primary and secondary education. Any increase in
funding to education should not be seen as an alternative to the
universal goals of HIV prevention, care and treatment but rather as
a complementary response that lays a solid foundation for our HIV
prevention efforts.
The gap between the epidemic and the response is - in some
countries - narrowing. This report shows that it is possible to
stay ahead of the virus but only when individuals (particularly
women and girls) have the power to choose who they have sex with,
and when and how they do so. Educating girls and women is one huge
step towards turning around the AIDS epidemic in Africa.
Summary of results
Formal education can influence vulnerability to HIV in five
different ways:
-
Expose girls to HIV and AIDS education, which helps prevent HIV.
-
Provide psychosocial benefits for young women, helping them to
build their self-esteem and capacity to act on HIV prevention
messages.
-
Lead to better economic prospects, which in turn lead to
lifestyle changes that can influence HIV vulnerability.
-
Influence the level of power within sexual relationships.
-
Affect the social and sexual networks of girls.
Impact of girls' education on HIV rates
In total, over 600 articles were identified for the review, of
which only 45 met the review criteria. Of these, 22 articles
examined the impact of education on HIV rates and revealed the
following findings:
- Before 1995, 10 out of 13 articles showed girls' education had a
negative impact on HIV infection rates (more education, more HIV).
However,
- After 1995, none of the research showed more highly educated
women to have higher rates of HIV infection. Half of the articles
reviewed showed no association between HIV and education, and the
other half showed girls' education to have a positive impact on HIV
vulnerability (more education, less HIV).
- An additional five studies examined HIV rates over time and found
HIV vulnerability to be decreasing in the most educated groups and
increasing or remaining stable in the least educated groups.
These findings suggest that the impact of girls' education on HIV
is changing as the epidemic evolves. The evidence shows that, as
the epidemic matures, the impact of girls' education reverses and
starts having a positive impact. This changing relationship between
education and HIV rates is strongly supported by studies taken over
time in four countries. A change is occurring in which more highly
educated women are becoming less vulnerable to HIV and at the same
time, less well educated women are becoming more vulnerable.
Impact of girls' education on sexual behaviour
The studies looked at a wide range of sexual behaviour outcomes and
the results can be summarised as follows:
- Six out of eight articles showed that girls who had received more
education were more likely to start having sex at a later age. None
of the articles showed a link between more education and earlier
sexual activity or sexual debut.
- 10 out of 13 articles showed that higher levels of girls'
education were related to higher levels of condom use. Again, none
of the articles suggested that more education might lead to less
condom use.
- Education was also related to levels of coercive sex,
transactional sex, age difference between partners, and
relationships with commercial sex workers. However, the number of
studies are too small to find any trends.
The most striking finding is that more highly 5 educated women are
more likely to use condoms during sex. The finding on earlier
sexual activity is slightly more difficult to interpret as it is
also likely that the relationship actually works the other way:
earlier sexual activity impacts negatively on education. Put
simply, young women who are sexually active are more likely to get
pregnant and therefore drop out of school.
Boys' or girls' education?
Is the impact of education on HIV vulnerability different for young
women and men? Our analysis shows no striking gender differences.
The fact that education helps to protect against HIV holds true as
much for boys as for girls. Although the focus of this report is on
young women, empowering young men through education is as much a
part of the solution to the HIV epidemic as targeting young women.
However, focusing on girls' education remains important as girls
tend to have less access to education and are therefore more
vulnerable to HIV and AIDS.
Primary or secondary education?
There were six studies that compared the results for primary and
secondary education. In all of these studies, completion of
secondary education was related to lower HIV risk, more condom use
and fewer sexual partners compared with completion of primary
education. These results tentatively suggest that more education is
linked to better protection against HIV. The relative importance of
investing more resources in primary or secondary education is less
clear but self-evidently, no girl will be able to access secondary
school unless she has been to primary school. Tens of millions of
girls are still excluded even from the first grade at school.
Of course, it should be noted that even when they have completed
secondary education, women are still vulnerable to HIV infection.
In other words, education helps protect women but many other
measures are also needed.
Mechanisms
Very few of the studies reviewed attempted to look at the
underlying mechanisms through which girls' education might impact
on HIV vulnerability. The scant evidence that does exist suggests
that increased condom use is likely to be a factor. Economic status
is clearly also a factor, although it is hard to separate this from
education. Eight studies tried to show the relative strengths of
education and economic status and their bearing on HIV
vulnerability:
- One study shows education is more important than economic status.
- Two studies show economic status is more important than
education.
- Five studies show it is impossible to separate education and
economic status.
Recommendations
1 Prevention messages need to address gender and power dynamics
within sexual relationships, so that both girls and boys can become
confident enough to overcome negative stereotyping and peer
pressure.
2 The education sector response to HIV and AIDS needs to be
prioritised and all schools should provide comprehensive sexual
health education with a special focus on HIV and family planning.
Promoting condoms is a message that is working and should be
encouraged.
3 Schools should foster gender equality, promote positive role
models and challenge negative gender stereotyping. Zero tolerance
should be shown towards sexual violence and towards teachers having
sexual relationships with students.
4 Schools need to respond to the problem of teenage pregnancy by
providing comprehensive sex education to reduce pregnancy and
improve sexual health. Part of the response should include policies
on how to encourage teenage mothers to return to education.
5 In order to expand girls' education, all forms of school fees in
primary education should be abolished. This policy must be
accompanied by adequate planning and resources to cover the loss in
funding from the fees and also to meet the increased demand when
education becomes free. The quality of education provision must not
suffer and governments should resist the practise of hiring
non-professional teachers.
6 Expansion of the Fast Track Initiative (FTI) a pledge made by the
international community to make sure that all countries have enough
resources to provide basic education should be encouraged. Donors
need to prioritise filling the immediate resource gap in FTI ($510
million) and the long-term gap of $10 billion.
7 Macroeconomic constraints that prevent governments from expanding
their spending on girls' education need to be removed. To get all
girls into school and to keep them there requires the recruitment
of millions of new professional teachers. This means lifting public
sector wage bill caps imposed by the International Monetary Fund
(IMF) and generating open public debate about the trade-offs
between driving towards low inflation targets and ensuring adequate
spending on education and HIV and AIDS.
8 More focus needs to be placed on removing the bottlenecks between
completion of primary school and access to secondary school,
particularly for girls. This will require significant expansion of
secondary schooling in many countries and specific interventions to
remove the obstacles faced by girls wishing to continue their
education.
9 More research on young people, HIV vulnerability and teenage
pregnancy is desperately needed. All data should be separated by
gender. More longitudinal studies are also needed to understand the
reasons why education might protect against HIV, as well as
research comparing the impact of primary and secondary education on
HIV vulnerability. Finally, systematic reviews of existing
literature should be encouraged in order to build upon the research
that already exists, rather than reinventing the wheel.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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