MTT 2004 Annual Winter School

Durban, 10th August 2004

Mitigating the Impacts of HIV/AIDS
on Education Systems

Development Impacts
of HIV/AIDS
M. J. Kelly, Lusaka, Zambia
mjkelly@zamnet.zm
 The Impacts of HIV/AIDS on
People and Societies
 In all of our countries, HIV/AIDS is
 Reversing decades of health, economic and social
progress
 Reducing life expectancy
 Slowing economic growth
 Deepening poverty
 Contributing to and exacerbating food shortages
 Creating a growing human capacity crisis
 Enhancing gender inequities by affecting women and
girls more than men and boys
 Are the Impacts Due to AIDS?
 Fairly clear that illness and death may be due to AIDS
(though AIDS may not be acknowledged as the cause)
 The same with orphanhood
 But in many cases it may be very difficult to separate
out what is due to other factors and what is due to
HIV/AIDS
 AIDS impacts entangled with those of poverty, female
disadvantage, poor economies, climate, public
corruption, unbalanced North-South relationships
 But HIV/AIDS increases the scale of almost
every existing problem, making it more difficult
to deal with —just as HIV makes it difficult
for the body to deal with infections it would
otherwise be able to manage
 What We are Up Against in
HIV/AIDS
 HIV/AIDS confronts us with two situations:
The disease: the medical conditions of
HIV infection and/or AIDS in
individuals
The social and developmental
problem: the social and developmental
conditions and impacts that follow on
from the disease, especially when it
becomes widespread with infected
individuals being found throughout a
community and eventually across a
country or region
 Global Emphasis on Medical and
Behavioural Approaches
 Current dominant global models focus on HIV/AIDS
 EITHER as a medical issue that requires a biomedical
response;
 OR as a condition resulting from human behaviour
practices and hence requiring a response that focuses
on aspects of human behaviour
 Both points of view are valid but whether taken
separately or together they deal with only part of the
AIDS problem
 This limitation has contributed to global failure to
respond adequately to the epidemic
 Behavioural Approaches to Prevention
 The majority of current approaches are based essentially
on the modification of individual behaviour
 They address the obvious risks of sex and injecting drug
use, and factors that increase personal vulnerability (e.g.,
ignorance or peer pressure)
 They follow a logical pattern, as if HIV risk-reducing
decisions were always rational and seldom emotional
 They take almost no account of non-western world views
—their uniform context is that of the homogenised,
individual, western cultural world
 They deal only marginally with the underlying issues &
contextual features of joblessness, helpless economies,
female disadvantage, responding to youth needs, facing
up to poverty, grassroots voicelessness
 Taking a Holistic Approach
 An adequate conceptual framework for the developmental
impacts of HIV/AIDS (and for responding to them) must take
due account of the economic, social, cultural, environmental
and political factors that render individuals and communities
vulnerable
 This implies going beyond the symptoms of infection, sickness
and behaviours that contribute to these and looking to the
factors that underlie the infection, sickness and behaviours
 It means asking about the roots of the problem
 Instead of focussing narrowly on HIV/AIDS as a stand-alone
issue, there is need to see it as arising within the complexities
of poverty, gender inequalities, cultural determinants, religious
understandings, environmental questions
 HIV/AIDS Impacts on Various
Aspects of Society

ECONOMY HIV/AIDS spreads EDUCATION

into the general
LABOUR population GOVERNANCE
=
Epidemic, with a CULTURE,
MANAGEMENT VALUES,
variety of impacts BELIEFS
AGRICULTURE
SOCIAL
DEVELOPMENT
-
ENVIRONMENT HEALTH
-
 Development
• Initially, attention focused on economic development—the
movement (at individual or national levels) from a low economic
status to one that was higher
• But although very important, economic development is only one
aspect of development
• Today, development is seen more in terms of increasing choices and
enlarging freedoms
• Development means advancing human freedoms by
increasing the capabilities and opportunities for
individuals to lead a life they have reason to value
(based on Amartya Sen)
• Because HIV/AIDS limits & does not advance human freedoms, it
works against development
 Human Development
 Human development is about creating an environment in
which people can develop their full potential and lead
productive, creative lives in accord with their values, needs
and interests
 The most basic capabilities for human development are to
 Lead long and healthy lives
 Be knowledgeable
 Have access to the resources needed to maintain a decent
standard of living
 Be able to participate in the life of the community
 HIV/AIDS undermines each of these
 A Long and Healthy Life
 Where HIV/AIDS is prevalent, there is little prospect that people will
be able to lead a long and healthy life
 Life expectancy falls to dramatically low levels (see next slide)
 Child mortality rates remain alarmingly high
 AIDS enlarges the impact of other threats to health such as TB or
malaria
 Coping with AIDS issues overwhelms health services
 AIDS claims the lives of numerous medical service personnel
 Applying anti-retroviral therapy makes extensive demands on the small
number of doctors, nurses and health-care workers in all of our
countries
 Donor-funded ART programmes may bleed away health practitioners
from providing the services that the non-HIV infected public needs
Life Expectancy at Birth (Years),
2001 and 2002
2001 2002 2001 2002
Botswana 39 41 Swaziland 42 36
Ethiopia 44 46 Tanzania 51 44
Kenya 50 45 Uganda 45 46
Malawi 40 38 Zambia 42 33
Namibia 45 45 Zimbabwe 43 34
S. Africa 50 49

Source: The State of the World’s Children, 2003 & 2004 (UNICEF)
 Be Knowledgeable
 The negative impacts of HIV/AIDS on educators, learners
and the overall learning environment suggest that the
epidemic adversely affects the ability of individuals to
become knowledgeable
 It also removes a major incentive to becoming
knowledgeable—why bother, if life will be too short to use
the knowledge, or if the process of acquiring knowledge
(usually through schools) means that young people are not
available during large parts of the day to help the family or
community cope with AIDS impacts, or if the knowledge
will not lead to employment, or even if it is believed that
the knowledge will increase vulnerability to HIV infection?
 HIV/AIDS and Human Capacity

 HIV/AIDS affects human capacity in different ways:

 It robs sectors, enterprises and undertakings of
qualified and experienced personnel
 It creates the need for additional personnel (e.g. in
nursing care)
 It creates the need for persons with new
understandings and skills
 Because of the way it removes young and
productive adults, it has negative effects on the
transfer of skills
 Have Access to the Resources Needed to
Maintain a Decent Standard of Living
 Poverty is widespread and is closely related to HIV/AIDS
 However, AIDS is not a disease of poor countries
 Neither is it a disease of poor people, but
 the poor are at higher risk of HIV infection
 the poor are more vulnerable to HIV infection
 the disease makes the poor poorer
 HIV/AIDS leads to the impoverishment of households and even to
their disappearance as units of society
 Productivity declines, jobs are lost, and incomes fall
 Expenses increase, for medical care and eventually for funerals
 Productive assets are sold off to cater for income loss and increased
outlays
How Poverty and HIV/AIDS Relate
to Each Other
H IV /A ID S a n d P o ve rty

P o o r a t h ig h P o o r m o re P o o r b e c o m in g
ri s k o f vu l n e ra b l e to p o o re r
H IV i n f e c ti o n H IV i n f e c ti o n b e c a u s e o f H IV i n f e c ti o n

o n h e a lth o n s o c i o -e c o n o m i c b e c a u s e o f w h a t c o s ts in c o m e s re s o u rc e s
g ro u n d s g ro u n d s it m e a n s i n c re a s e a n d re s o u rc e s a re s p e n t
to b e p o o r d e c re a s e o n H IV /A ID S
Impacts on Households and their Economies
• Two-thirds of families where the fathers die from AIDS
experience an 80% drop in income (Zambia)
• In Cote d’Ivoire the household income of AIDS-affected
families is about half of the average household income
• In Zimbabwe, two-thirds of households that had lost an
adult woman ceased to exist; the members dispersed and
the households disintegrated
• In Botswana, AIDS will lead to a decline of 13% in per
capita household income for the poorest quarter of
households, while every income earner in this category can
expect to take responsibility for four or more dependants
 HIV/AIDS Increases Costs
 Costs of goods and services increase as enterprises raise
costs to offset those arising from HIV/AIDS:
 lower productivity
 smaller markets
 increased medical costs
 high funeral costs
 early payment of terminal benefits
 higher insurance costs

 in-house HIV/AIDS education programmes

 Goods which are in scarce supply because of HIV/AIDS
increase in cost
 HIV/AIDS Reduces Incomes and
Resources
 Jobs lost (sickness; death; firms collapsing)
 Farm production reduced
 Smaller volumes of sales
 Loans not being repaid
 Capital assets being disposed of
 Savings drawn down
 Lower levels of production in households headed by the elderly or
children
 Firms losing profitability and paying less
 Reduced ability to transact business or manage affairs efficiently
(reduced social capital)
 HIV/AIDS Diverts National and
Institutional Resources
 Additional national resources absorbed by
AIDS care and responses, at the cost of
important medical and other needs
 Medical, personnel, agency and NGO
resources diverted to AIDS issues
 Already limited and over-stretched public
capacity is further extended with AIDS
concerns
 HIV/AIDS Diverts Personal and
Household Resources
 Household resources consumed by medical costs,
cleaning, transport, funerals, mourning
 Limited resources spread more thinly over larger
numbers
 amalgamated families
 orphan care
 increased dependency ratio

 Labour resources going to AIDS care and away

from productive work
 HIV/AIDS Impacts at the Household
Level: Some Issues
 Impacts are almost always very severe emotionally—distress, shock, anger, denial, grief,
stigma, isolation
 The disease has severe implications for household well-being:
 Income reduction (job loss; reduced ability of infected person to work and produce;
time spent on patient care is time taken from productive activities)
 Increased health-related expenditures (medicines, special foodstuffs, soap and cleaning
materials, clinic-related use of resources & time—patient transport, getting medicines)
 Some households disappear
 Impacts may be masked by complex extended family and other relationships between
households
 Ripple effects—more demands on other households, or less to give to households that had
previously been getting assistance
 Vulnerability of female-headed and child-headed households
 HIV/AIDS and Food Security
 Remote fields left fallow; poor timing of essential farming operations;
lack of resources to purchase agricultural inputs; abandonment of soil
conservation measures; dominant need to give priority to immediate
survival
 Switch from labour-intensive crops to ones that are less demanding, often
less nutritious; crop variety declining
 Livestock and other farm assets sold to pay the medical costs of AIDS or
are used for funeral expenses
 Credit for agricultural production diverted for the medical care of sick
relatives, funeral expenses, food
 Illness and deaths among agricultural extension staff
 Result: less food security and increased malnutrition (and hence vicious
cycle of increased vulnerability to HIV/AIDS)
 Girls, Young Women and
HIV/AIDS

H I V /A I D S h a s a d is p r o p o r t io n a t e im p a c t o n g ir ls a n d y o u n g w o m e n

T h e y a re a t T h e y a re T h e y a re
h ig h e r r is k m o r e v u ln e r a b le t o m o r e e x t e n s iv e ly a f fe c t e d
o f H IV in fe c t io n H IV in fe c t io n w h e n H IV /A ID S is p r e s e n t

o n p h y s io lo g ic a l o n s o c ia l o n e c o n o m ic G ir ls a r e t a k e n o u t o f s c h o o l
a n d h e a lt h g ro u n d s g ro u n d s W o m e n 's b u r d e n o f c a r e
g ro u n d s M u s t w o r k e v e n if in fe c t e d
D o n o t h a v e a c c e s s to A R V s
 Impacts on the Exercise of
Human Rights
 HIV/AIDS attacks basic human rights:
 Free and equal (female/male; rural/urban, poor/wealthy)
 Recognition as a person (PLWHA; orphans)
 Life and health (knowledge, supplies, infrastructure)
 Marriage (freely entered into; early/forced?)
 Property (inheritance rights of widows, orphans?)
 Social security (economic, social and cultural rights
indispensable for human dignity and personal development)
 Rest and leisure (women, child labour)
 Education (girls; orphans; poor)
 Environmental Impacts
 Degradation of forest and soil reserves that are nearest to
the home
 Less soil conservation and maintenance of contour ridges
 Boreholes and wells not maintained
 Water pollution
 Concentration on easy-to-grow crops and reduction in
crop varieties
 Less transmission of knowledge and skills leading to
harmful environmental practices (fishing, bee-keeping,
grazing, tillage)
 Impact on the Future
• What kind of adults will orphaned children be?
• How will they function as parents when they have never
known normal childhood?
• Who will look after the next generation of orphans when the
present generation of grandparents have died?
• Who will communicate traditional skills and skills for life to
OVCs?
• Will society be very different because a large part of the next
generation will not have experienced normal nurturing and
affection in a family setting?
• Will there be special security problems because so many
children are growing up without the supervision of
responsible parents or relatives?
 Role of Education
• What role does the formal education system play in
mitigating these multiple developmental impacts of
HIV/AIDS?
• Do educators ever think about or plan for these
issues?
• Are they preparing young people for the world of
the future, with HIV/AIDS and its many
consequences?
• Or are they locked in the past, preparing learners for
the world as it was twenty and more years ago?
• Apart from issues relating to HIV prevention,
education should also play a role in orientating
young people to the likely world of the future,
opening their minds to what could possibly be, and
preparing them for life in a world with AIDS
 The Interaction between
HIV/AIDS and Development:
Exercise
• To what extent has HIV/AIDS become an issue in
the governance of your country?
• Does your country show signs that the epidemic has
slowed or reversed social progress?
• In what ways has it deepened poverty?
• Is there evidence in your country that the epidemic is
leading to a growing human capacity crisis?
• Has the epidemic had any impact on the exercise of
human rights in your country?
 Education, HIV/AIDS and
Development: Exercise
• What role could the education sector play in
offsetting the negative impacts HIV/AIDS
has in such development areas as
 Poverty reduction
 Better living conditions
 Improved agricultural production
 Expanding each person’s range of
choices?