UNESCO HIV and AIDS Education Clearinghouse forum UNESCO HIV and AIDS Education Clearinghouse forum
E-forum on Treatment, Care and Support for HIV and AIDS in Higher Education Institutions. This forum is held at the request of the United Nations Inter-Agency Task Team on Education Working Group on Higher Education (WGHE). It aims to share experiences and good practices on the management of HIV and AIDS within higher education institutions, particularly universities as centres of treatment, care and support.

The forum will be open from 4 to 15 October 2010.

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Author Topic: Services for HIV treatment, care and support: Questions for discussion  (Read 44183 times)
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« on: September 16, 2010, 10:34:25 am »

Week 1: Services for HIV treatment, care and support in higher education institutions: current practice, prospects and challenges

1. What services do educators, learners and other personnel in the higher education institution need for
a. Primary health care
b. Sexual and reproductive health
c. Treatment, care and support for HIV and AIDS?

2. What, if any, are the special needs of girls, women, young people and people infected and affected by HIV and AIDS in the higher education institution for
a. Primary health care
b. Sexual and reproductive health
c. Treatment, care and support for HIV and AIDS?

3. In your opinion, what is the minimum package of sexual and reproductive health and HIV and AIDS care, support and treatment that should be provided by/in the higher education institution?

4. What is the current practice of service programmes in your higher education institution?
a. What services are currently provided by/in your higher education institutions, in terms of 1) primary health care; 2) sexual and reproductive health; and 3) treatment, care and support for HIV and AIDS?
b. How the fees of the services are recovered? Do students, teachers and other clients have to pay for any of the services? Are there financial support schemes for people infected or affected by HIV and AIDS to access to care, support and treatment?
c. What do you think about the scope, coverage, accessibility and quality of these services provided? Are confidentiality and privacy ensured for sexual and reproductive and HIV-related services?
d. What are, or should be, the links between the programmes for primary health care, sexual and reproductive health and treatment, care and support for HIV and AIDS?
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J_Sass
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« Reply #1 on: October 04, 2010, 05:37:03 am »

In 2006 I supported a review of the institutional response to HIV in 12 countries - at varying stages of the epidemic, in differing social and cultural contexts, and different regions of the world.

This report, Expanding the field of inquiry: a cross-country study of higher education institutions' responses to HIV and AIDS, found that most institutions included in the study focused predominently on preventive education - at the expense of more holistic efforts to address stigma and discrimination, to establish protective workplace policies and programmes for staff and students, and to provide treatment, care and support services - or referrals to appropriate services.

Where services were available, they were accessible primarily to students, with little options for academic and non-academic staff. Counselling services for HIV testing were inadequate, with professionals being grossly unprepared to deliver these services. 

Two universities included in the study stood out at that time - University of Brasilia and the University of the West Indies - as providing a wider range of care and services for students (including STI diagnosis and treatment, voluntary counselling and testing, free anti-retroviral treatment and treatment for opportunistic infections.)

I hope to hear over the course of these dicussions that things are changing and that higher education institutions are engaging more deeply and more systematically with the AIDS epidemic.

To repeat the words of Father Michael Kelly, who authored the foreword to this report, "without such inquiry and action, universities cannot be true to their mission in a world with AIDS- and even worse, without such inquiry and action, the struggle against the disease will be never-ending."

Justine Sass
Regional HIV and AIDS Adviser for Asia and the Pacific
Chief, HIV Coordination, Adolescent Reproductive and School Health (HARSH) Unit
UNESCO Bangkok
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Manilee
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« Reply #2 on: October 04, 2010, 10:06:46 am »

Thanks - for information this publication, Expanding the field of inquiry: a cross-country study of higher education institutions' responses to HIV and AIDS, is included in the list of recommended readings section of the forum.
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YF_Liu
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« Reply #3 on: October 04, 2010, 02:59:12 pm »

In countries where the HIV prevalence is low, the need for HIV treatment, care and support in higher education institutions may not be so visible.

Nevertheless, there is some evidence that young people in higher education institutions need sexual and reproductive health services.  In a survey covering 81960 students from 57 universities or colleges from 7 provincial capital cities in China (Wang Xueyi, 2009), 12.22% unmarried undergraduate students and 24.57% unmarried graduate students reported having sexual experience.  29.45% of the former and 20.32 of the latter had unwanted pregnancies, and most ended with abortion. This survey also reported that the most favored sources of contraceptives were 1) pharmacies, 2) vending machines, 3) supermarkets, and 3) free supplies by concerned institutions. This preference might imply that students need to ensure their confidentiality and privacy.

Another survey (Ma Chengpeng, 2007) assessed the attitude and skills of 234 health workers in 10 universities and colleges in Yunnan, a province most impacted by HIV and AIDS in China. Two thirds respondents reported supporting providing sexual health services to college students, but three quarters reported lack of necessary knowledge and skills, and one fifth found it embarrassing for themselves to provide sexual and reproductive health services to students.
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pdennis
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« Reply #4 on: October 04, 2010, 06:26:32 pm »

Thank you for the information. I concur that we need to start to tackle the mindset and stigma attached to HIV and AIDS, especially in parts of Africa where this type of education is not prevalent. Unless our people can see and believe that it does not have to be a 'death sentence' and that prevention and treatment are key, we will get nowhere in attacking HIV/AIDS.  We need to have more 'train the trainers' programs to get more of our people out into the whole countryside, educating, testing, supporting and providing options on this all important topic.
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Managa
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« Reply #5 on: October 04, 2010, 10:33:36 pm »

We have in place a very progressive and comprehensive strategy here in South Africa - the programme beingdeisgned on the premise that higher education institutions have a critical role to play both ITO service provision and also to contribute to the country strategy - this speaks to research capabilities, as well as producing graduates that not only have competenciesin their chosen professions, but also personal and professional competencies in relation to HIV and AIDS.

As such in the development of a policy framework to guide HIV policy development and implementation at our 23 public HEIs - the framework went beyond the scope of service delivery, but looked further at leadership, curriculum and research related issues.

In costing HIV programmes for HEIs - the Programme undertook the exercise of developing norms and standards for services. This looked at both a minimum and comprehesive package of services,which supports that view that HEI should provide services on-site and or have referral networks in place.
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Mas
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« Reply #6 on: October 05, 2010, 07:38:50 am »

As it was pointed above, Higher Education Institutions are the most targeted sites for HIV/AIDS treatment, care and support. It is not possible to think of HIV Programmes with out linking it to the Primary Health Care services.
Hawassa University, the second preferred University by students next to Addis Ababa University, students clinic is providing a comprhensive health service to students. Among the services: disease diagnosis and treatment, FP, Emergency Contraception, Condom promotion, TT Vaccination, PAC and the like are the major ones. The clinic in collaboration with the University's HAPCO, has all the services like HCT, ART, TB/HIV, Care and supports to PLHA. The clinic is providing these service with a referral linkage with the University' Referral Hospital.

Students will get all the services with no charge for all SRH and HIV/AIDS services. They will be only charged for those treatments otherthan the above mentioned. The goverment subsidizes the costs of all the services for students since students may not get money to buy drugs and so on.

The Government has funds every year to care and support in HEI so as to help students in care and support activities

Since the University's Health care providers are trained on Youth Friendly Service (YFS), they give due care for students Confidentiality and privacy. Though there are shortage of rooms in the clinic to maintain privacy, they try to keep all these issues critically.

The major challenge in HEI here in Ethiopia is that SRH services are not being given in a friendly way as per the national standard. SRH problems like Unwanted pregnancies, STI/HIV and Unsafe abortions are very rampant. Students awareness towards Sexuallity is full of myths and misconceptions. In order to avert this trend it will be necessary to integrate SRH/HIV/AIDS services into a Primary Health Care Program.
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Manilee
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« Reply #7 on: October 05, 2010, 02:18:41 pm »

Here are some comments/Questions on your posts from the moderators:

For pdennis

You make an important remark about the interlocking and interdependency nature of Prevention Education and the availability of treatment, care and support services. You also highlight the challenge of the lack of service availability in some parts of Africa.

Can you share with us the specific situation of your country? For example, can you tell us if the higher education institutions are clustered in urban spaces?  Is it the lack of HIV services on the sites that make it difficult for a larger population to have access to them or is it the exclusive nature of these services?

For Managa and other participants from South Africa

It would appear the higher education sector in South Africa is very active in terms of its HIV and AIDS programnes both at the policy and service levels.

It would be interesting to hear from HEAIDS more information about the policy process next week.

Would any of the participants from the HEIs share with us some more details about the provisions of their services this week?

To MAS

You provided an example of a good practice namely, the University of Hawassa for providing services to students. Do they provide HIV services to the institutes’ staff and/or the surrounding community members? How about the immediate family of the students? If yes, can you tell us more about how they reached this achievement, and, if not can you identify some of the challenges they face?


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Mas
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« Reply #8 on: October 05, 2010, 02:53:05 pm »

Just to respond to some of the the questions raised by Manilee, from among the HIV/AIDS services are being rendered in the University are HIV testing and counseling, ART, OI treatment, Care and Support are the major ones. Both preventive and curative services are provided to students in a tailored manner.

The clinic is also open to the University community/staff to undergo HIV testing and other services. However, since the University is located out side the Provincial Capital, the surrounding community can access other public institutions for any kinds of services.
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« Reply #9 on: October 05, 2010, 03:03:39 pm »

A message received by email from Cameroon.

- What is the current practice of service programmes in your higher education institution?

There are good service programmes put in place but the practice of these services is the major problem.

- What services are currently provided by/in your higher education institutions, in terms of 1) primary health care; 2) sexual and reproductive health; and 3) treatment, care and support for HIV and AIDS?

In Cameroon, to enroll into the University, you have to do medical tests including HIV/AIDS tests but usually not all the tests are being done. Personal experience when I was enrolling in the University HIV/AIDS test was not conducted on me because of the too much population and the very few medical staffs.

Sexual and reproductive health care programmes are still very ineffective. Promoted by the fact that there are even no specialized courses for this in schools.
Treatments are provided when students are tested positive but this needs a lot of protocol and since the level of sensitization or sex education in the school is too small or almost not existing in most Cameroonian Universities, it makes it difficult for positive people to understand that they can go and get drugs. Treatments are not free as such as patience have to pay 3,000 fcfa a month after having gone through a lot of protocol which make some people to be discouraged as they also fear they will be identified during the protocol process. Not everybody can even afford to have this money.

To the best of my knowledge, there is no special center for HIV/AIDS positive patients in the HEI in Cameroon. Some still exist only on papers.
 
- How the fees of the services are recovered? Do students, teachers and other clients have to pay for any of the services? Are there financial support schemes for people infected or affected by HIV and AIDS to access to care, support and treatment?

Yes students and teachers have to pay but a small amount of about 3000 fca but other clients for  example when they have to go to the University teaching hospital have to pay more than teachers and students. And this money is being paid in cash. Financial support exist but mostly to those who make public declarations or don’t hide their status but the problem here is that the money may not be given on time and you may be discourage on the way. This had turn to make most people to stay and hide their status.

- What do you think about the scope, coverage, accessibility and quality of these services provided? Are confidentiality and privacy ensured for sexual and reproductive and HIV-related services?

Normally there is confidentiality and privacy but people are being exposed due to protocol when they have to fight for services, financial aids etc.

-  What are, or should be, the links between the programmes for primary health care, sexual and reproductive health and treatment, care and support for HIV and AIDS?

I think effective sensitization, will make people to go for primary health care, SRHT  and HIV/AIDS support. For three days now, I have tried to ask some University students on HIV/AIDS programmes and services two out of ten told me they have an idea of such services in the university and amongst the two just one had tried to visit the center and gave a discouraging responds.
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« Reply #10 on: October 05, 2010, 04:00:35 pm »

Sent in from PP_Gile Ethiopian Civil Service College

Higher Education Institutions' Community (students&staff) need all these services. However, making these all services accessable  to them is challenge because of traditional approaches of focusing on education or teaching learning and lack of adequate planing for such services as most of the affected , afflicted community memebrs do not disclose their status due to fear of stigma, though currently  such stigma and discrimination are somehow being postively changed. The other challenge is people from higher social or occupational status and profile are not as such visible and not vividly disclosing their status (that is their right  indeed). In addition, resource particularly well trained and HIV/AIDS Programmes Management comptent faculty and staff members not available (the ones who commit themselves and exert extraordinary effort  are those who just developed passion and personal commitment that specifically trained in this particular field , challenging field work. Indeed top m anagement commitment is in place in instituions like Civil Service and nowadays federal HIV/AIDS Prevention and control office is willing to work and collaborate though care and support projects are offten out of thir focus..continued negotiation and action learning ongoing.  Yes indeed in our case, we are readily providing these services, some services like primary  health care, sexual and reproductive  services, treatment (ART, opportunitstic infection, STI management,..are being provided through our student clinics while  those services beyond clinic level are delivered though referral and with our partner hospitals and and some humanitarian service organizations. These are our service packages and practices since our efforts of Mainstreaming HIV&AIDS management Programmes (curicular and co-curricular, since 2002) How ever, scopes, intervention areas, etc still need to be strenghtened and expanded but we need more collaborators, more partners and more support. Infact we are  working with federal HIV/AIDS Prevention and Contol Office here in Addis Ababa to know how HIV/AIDS is really a challenge for Higher Learning Instituions?..In this regard we have been conducting macro-level assessment (hope the final output will be available for all concerned bodies locally and internationally). There is also big research project(macro)..undergoing on public and civil service sectors in the country as a whole, the reserch is commissioned by Federal HIV/AIDS Prevention and Control Office (we found this is very intesting initiative and best practice  so as to contribute to  achive MDGs and national efforts of controlling and mitigating HIV&AIDS related problems in Ethiopian and best practice to other nations as well. .
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lynne
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« Reply #11 on: October 06, 2010, 11:07:38 am »

There has been some recent interesting research conducted in Namibia amongst students living in university hostels which indicates an 'alarming' risk of infection and which highlight the need for treatment, care and support services to be available in universties. The study found that 83% of institutions had no HIV and AIDS hostel policies and recommends that stakeholders be made more aware of sexual relational HIV risk inherent in hostel life. More details are available online at:
http://www.newera.com.na/article.php?articleid=13370

I wondered what other countries' experiences on this are?
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Managa
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« Reply #12 on: October 06, 2010, 11:53:29 am »

I find the input from Namibia interesting in light of what we found in South Africa. As part of the HEAIDS inititiative, we invested extensive resources to ascertain prevalence amongst students.

In light of them being a transient population, countryprevalence figures amonst this age cohortand the residence culturelead to the presumption that prevalence would in fact be quite high.

The prevalence study- which sampled both staff and students (res students included)interestingly found very fairly prevalence among students and in fact high prevalence among staff - service staff in partucular. The findings seemed to mirror country data - showing then geographical trends, high prevalence among women.

It was however clear though that in spite of these numbers, there was an expectation that services be made accessible.

As a follow-up study,I guess a longitutional tracking will be useful to acsertain infection rates whilst at uni. We did also find that education was a protective factor

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P_Dhungana
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« Reply #13 on: October 06, 2010, 03:05:48 pm »

I am thankful to know about the practices, reflection and views from different parts of the world. I am from Nepal. The practices are different in Nepal. There are no institutionalized support (like services, treatment, care ) in Nepal. The  curriculum (besides the core interest area curriculum)do not address the issue. Some Non Government Organizations work for awareness but motives are different. Some teachers voluntary add the contents beside the formal design and deliver the information. This is a salutary job from teachers. But concerned with the services, no services are provided.
One of the greatest challenge associated with it is the culture. People do not communicate the pains; as it considered social inferiority. Despite any sorts of challenges, disease, poverty, starvation, education etc... rarely the people open.

Cultural settings of every place have some pros and cons. For this issue it becomes a challenge in Nepal. Some monetary incentive linked for identification and services would help the people living with HIV. Still it would ripple other challenges. And the needy with strong cultural setting still gets deprived. Though it requires patience, social awareness, mass media communication, the key communications to diseases to people would change the mindset.
It is a general phenomenon that culture influences policy. These will be reflected in rules action and attitudes. Change is essential. So that we can reach for services and do something for the humanity. Otherwise the present  set of ongoing rituals would keep prevailing and more will suffer.

This seems to be anti-direction discussion, but I am sorry it is a fact. I had a hard time (last year) to convince the principal to get approval for key information dissemination  related to HIV infections in higher secondary class (age 16-18 years students).

My personal opinion; for a country like Nepal, may be similar with some of the other developing countries (especially south Asia, where cultural ties are very strong) two approach should work together. Not only in HIV but different other issues also could be addressed by this modality. Work parallel; Top to bottom (lobbying, advocating, counseling, communicating the consequences/challenges, predicting) and bottom to top (awareness, reasoning, challenges, participation...).


 
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« Reply #14 on: October 06, 2010, 03:08:42 pm »

Comments/questions on your posts

For Gile from Ethiopian Civil Service College:

You mentioned that one of the main challenges in establishing and providing HIV services within HEIs is the absence of disclosure by people living with HIV. As you correctly noted disclosure is an individual right and an important human rights issue to be respected. However, the fact that most individuals are scared to disclose their HIV status due to the discrimination and stigma attached becomes a wider issue.

A same issue was highlighted by Dr. Michell Besser who is the founder of Mother2Mother (www.m2m.org) in South Africa on TED, an online program to spread ideas. (You may listen to this speech online by accessing this website www.ted.com).

Dr. Besser emphasized that the main challenge in halting HIV is the stigma attached which refrains people from disclosure, and from seeking out treatment, care and support. He goes further more showing that the lack of professional resources in providing HIV support, treatment and care are practical issues that partially can be answered when more people with HIV disclose their status and are empowered through employment, and activism.
 
The Mother2Mother organization for example is fully is staffed by mothers living with HIV. Currently, the organization members make up of 20% of mothers living with HIV worldwide.

This inspiring initiative makes us realize even more the importance of HIV services on HEIs sites.  The minimum package of support services and referral can make a huge difference in ending the culture of HIV stigma. Moreover, tapping the resources of the HEIs will take away huge burden from the external health centers.

What would be interesting to debate today are also the financial aspects of establishing centers on HEIs. In recent years we have seen a lack of trust from donors, be it individual or institutional, to HIV projects. In particular, questions have been raised about misuse of money by organizations which claim to provide treatment, care and support.
 
We would like to hear from you and the other participants if HEIs have a special role in gaining back the public trust by providing transparent and free of charge HIV services? And if you know of any successful programs that are run by HEIs in your country?

For Managa from South Africa and others who might want to debate the differences in the current practices of HIV services by HEIs in women and men lives. The example of the prevalence study - which sampled both staff and students (res students included) provided by you found high HIV prevalence among staff, especially among women, as similar to that of the national trends. (HIV prevalence and related factors - higher education sector study, South Africa, 2008-2009, listed in the useful resources section of the forum).

This takes us back to an issue that was raised earlier on by a participant writing on China. That perhaps there are differences between the reactions of HEIs in high and low HIV prevalence countries. While this seems at the first glance a fair response, would you and the other participants think that the HEIs given their socio-cultural role as lead thinkers should set an example by providing a minimum HIV and sexual package despite the national HIV prevalence?
  
Ending this note with an inspiring note from Dr. Besser we can find simple solutions to complex challenges.
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