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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:

  1. Expose girls to HIV and AIDS education, which helps prevent HIV.
  2. Provide psychosocial benefits for young women, helping them to build their self-esteem and capacity to act on HIV prevention messages.
  3. Lead to better economic prospects, which in turn lead to lifestyle changes that can influence HIV vulnerability.
  4. Influence the level of power within sexual relationships.
  5. 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.

AfricaFocus Bulletin can be reached at africafocus@igc.org. Please write to this address to subscribe or unsubscribe to the bulletin, or to suggest material for inclusion. For more information about reposted material, please contact directly the original source mentioned. For a full archive and other resources, see http://www.africafocus.org


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