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 44184 times)
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« Reply #15 on: October 06, 2010, 04:28:01 pm »

Regarding Nepal, there is an interesting study published by UNESCO Kathmandu Office in 2009, "Review On: The Education Sector Response to HIV & AIDS in Nepal" which appears to confirm this, and which also suggests some recommendations. It is available online at: http://unesdoc.unesco.org/images/0018/001850/185007e.pdf
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YF_Liu
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« Reply #16 on: October 06, 2010, 05:16:49 pm »

I came across the following information about "Scholarships for Students Living with HIV/AIDS" (http://www.collegescholarships.org/health/aids-hiv.htm):

* San Francisco State University (SFSU): SFSU offers the Robert Westwood Scholarship to assist a student who has been diagnosed with HIV (documentation of the diagnosis is required) and who has plans for working with others affected by HIV/AIDS. $2,000 in funding will be awarded to an applicant pursuing any major who has attained a minimum GPA of 3.0.

* Ohio State University: The Harold A. McIntosh Scholarship, offered by Ohio State University, provides two scholarships in the amount of $1,200 each. One will be awarded to a student who is living with HIV/AIDS and one will be made available to a candidate with a history of service and leadership to the community in regard to the affliction.

* University of Colorado at Boulder: Full-time University of Colorado at Boulder (CUB) students who have been affected by HIV/AIDS are eligible to apply for a $1,500 scholarship from the Positive Futures Scholarship program, administered by the GBLT Resource Center at CUB. Full-time students who are either U.S. citizens or permanent residents are eligible to apply. A minimum GPA of 3.0 is also required.

I would be interested to know if there would be similar initiatives in other countries, and what would have been their outcomes and impact.
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pdennis
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« Reply #17 on: October 06, 2010, 05:37:50 pm »

I was listening to a radio program this morning about girls here as young as twelve and thirteen, selling themselves for a few cents (USD) and having unprotected sex. It pains my heart, yet motivates me to 'do something about it'! I know most of us agree that mobilization into the communities surrounding our HEI's are just as important as having programs on our campuses. The risk of contracting the disease is all around us. Access to transportation to reach these communities, trained workers to educate, and preventive tools are essential.

To Manilee: To respond to your questions?  The majority of our HEI's are clustered in and around our capital city of Monrovia. I have not seen an active HIV/Aids awareness program at any of them so far. I do not see a conscious effort to address the whole population about the dangers associated with and prevention of the same. I am doing some research to see why, but an educated guess is that funding plays a big role.
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Dhianaraj Chetty
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« Reply #18 on: October 06, 2010, 05:54:10 pm »

Its great to see that institutions in the developed world are making specific efforts to support students living with HIV and AIDS. We need to see more of that. Most of our knowledge base at the moment is focused on interventions in the developing world - particularly Africa. We need a better global picture of the HIV response in higher education, so it would be interesting to hear more about the responses developed in Latin America, North America, Western and Central Europe and Central Asia.
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Dulce Pereira
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« Reply #19 on: October 07, 2010, 04:17:04 am »

First, I would like to share my 'litter experience' in HIV/AIDS (Mozambique)

As a student I realise that EDUCATION can bring a social change in Mozambique in the context of HIV/AIDS. (Without start reading Father Michel Kellys, years before I start reading a powerful manual like: Planning for education in the context of HIV/ AIDS, and I realise the relevance of join education and HIV at same Umbrella).
As a professional at my HEI from my owen initiative with Dean university support I start coordinate (focal point) the HIV/AIDS actions at the university, and the name of the group is NASUP. From 2006 until now we have done the followings activities:
1. PREVENTION among students, lectures, and university staff;
2. PREVENTION, all friday with the NASUP activist we put the condoms at lectures and students toilets, at students toilets the condoms disappeared  in 5 minutes.
3. PREVENTION, at student day in november, at AIDS day, and all festival in university we are doing activities with student. So from where i work since 2004 (2006 as HIV activist) its all around PREVENTION and research. But Mozambique has 31 HEI, and we can't generalise my 'owen' tales from the field of my university. The HEI where I belong is a Pedagogic University, which means we are train the secondary and university teacher's in the 'whole' country (coz among the 11 province in the country you can find the university), but the questions can be: are we aware of our role among the future teachers HIV/AIDS related in Mozambique?
There is a STRONGER need of treatment, care e support at HEI in my country, but how to managed it, or how to face it? when all we have done is around PREVENTION!

As a mention before there's many and many HEI in Mozambique, and within they good lesson, e.g, I know that Catholic University have a specific curricula chair with is : HIV/AIDS; Polytechnic University has interventions, University Eduardo Mondlane also, Pedagogic University also.

I'll be here to share, listen and learn from others experiences.

Dulce Maria Passades Pereira, from my everyday life and knowledge in the field.
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Thanh Loan
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« Reply #20 on: October 07, 2010, 09:42:21 am »

In response to the question on specific recommendations for improving the access and quality of the HIV services provided by HEIs, I would like to share my views as below:

Some universities in Thailand and Vietnam, where I had a chance to  visit, have their health clinics where students and staff can get initiate medical assistances (not specific for HIV services alone) when needed. However, services of some of these clinics are either underused or of poor quality.
 
If I could, I would suggest the following actions to be done at university level
1) Improving the quality of current available medical services, if necessary: 
- Clinic facilities: Ensuring that the space arrangement is designed in a way which communications between a patient and doctor/nurse cannot be heard from a third party.
-  Medical staff:  (doctors, nurses, and cleaners): additional training or re-fresh courses focusing on communication skills for dealing with patients and patients’ relatives.
-  Rules/Instructions for medical staff listed in proper places and can be seen, read and understood by patients (so patients would feel confidence to speak about their health problems)

2)  Providing a simple information package for free distribution at all clinics and campus (such as a print pocket-size guide on common public health problems and where to contact (not only HIV, as some people who visit the clinic may think that HIV is not their problem so they don’t read)

3) Making it as a well-known University’s policy that the University does their best to promote/support healthy living and better understanding among staffs and students about their rights related to health. University could encourage, for example, each Faculty/Division takes turn to support Student Union or Student Associations to organize relevant health-promoting activities as that of culture fairs, food fairs, and book fairs.

Thank you. NTL
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« Reply #21 on: October 07, 2010, 09:48:43 am »

Received from Ethiopia

In Ethiopia, all Higher Education Instituions (Public and Private) are gathered together and established a sub-forum of HEIs against HIV/AIDS so as to support governement and other stakeholders' efforts (Private, Donors, ..) in preventing and controlling HIV&AIDS in the HEIs especially University students,  staff and and surrounding community. We have drafted MOU and HIV/AIDS Policy and Strategy framework , the forum is answerable to federal Governement Minsitry of Education, Federal HIV/AIDS Prevention and Control Office, and technically assited by UNESCO, Higher Education Relevance and Quality Assurance Agency,... This is really a good enabling environment where HIV/AIDS prevention, care, treatment, support, research, curricular integration and best practices of contextually designed mainstreaming efforts can be shared among each Universities and colleges in Ethiopia. Indeed , there are many ways we need to go agressively but harminization and alignment to educations sector and national HIV/AIDS Polcies and Strategies with the efforts of HEIs can significantly add values and brign terrific changes very soon as Ethiopia is is in a right and best track of achieving MDGs (Goal 6 and others) due to such agressive mainstreaming efforts.  This is just to share what is currently going on at national level and where my orgainization is part as one of instituions with best practice and plays secretary role at the sub-forum level....   Philipos Petros, Lecturer and Head of HIV/AIDS Management Unit  phili_development@yahoo.co.uk For any comments and inquiries...
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Mas
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« Reply #22 on: October 07, 2010, 10:12:32 am »

The issue of Stigma and Discrimination though is a problem in some places, it is becoming non-issue in most of the developing countries. I have reached to such a thought after looking at some researches on attitudes and practices of people towards HIV/AIDS and witnessing my job experience.

Previously people were curious to know HIV status of another person whom they know. But these days, every one shows his/her concern to help PLWHAs on how/where to acces the treatment. Let me qoate from one University student while expressing her opinion towards the Pandemic, she said 'HIV/AIDS is becoming 'Normal' among youth. The issue of HIV has been normalized as if people are talking about one social issue'. Though it may not represent the whole, this statement clearly tells us that the world's attention has been diverted from the 'old fasion' to the new one, Right to access to Treatment and care.

Regarding the HIV/AIDS policy in HEI, here in Ethiopia there wasn't an HIV/AIDS  Policy specifically for HEIs. But recently it is expected to be endorced officially. The prevailing reason that enforced the Gov't to formulate a policy for HEIs is that ones up on a time in the past there was a research conducted to see trends of the rates of Positivity in HEIs. The results found from all the HEIs was so shocking. The positivity rates in some of the Universities was up to 42%. The then Officials were so panic and started to prepare the policy.

This Policy is believed to consider all the leading risk factors (Environmental, Personal, Social etc..) that predispose students and staff to HIV/AIDS. And also it considers the friendliness of all kinds of SRH services in the clinics.

Above all, every strategy shouldn't solely consider HIV/AIDS services without other SRH services. Investing on 1/3 of world's popullation, Adolescents and Youth, would save the generation. Investing on Adolescents SRH would help dry the source of the problem

Let me wrap up my piece in saying Complex problems have simple solutions.
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S_Feddal
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« Reply #23 on: October 07, 2010, 12:03:27 pm »

I would like to draw our attention to the specific needs of women and girls, by sharing the following website: http://www.whatworksforwomen.org/

Thank you.
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YF_Liu
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« Reply #24 on: October 07, 2010, 12:29:51 pm »

Thanks to Mas for sharing your thought and experience. It's encouraging to see the positive change taking place in people's attitude to those living with HIV. Things do change, and we should keep up with these changes to avoid frustrating ourselves with hypothetic challenges.

However, I would also agree that HIV-related stigma and discrimination remains prevalent and a major barrier against access to treatment, care and support. Earlier this year (June 2010), the United Nations Working Group on Young People (UNAIDS, UNICEF, UNESCO, UNFPA and WHO) conducted an online survey to collect voices from young people across the countries and regions on a variety of issues such as comprehensive sexuality education, condoms and HIV counseling and testing. It was found that the pervasive stigma and fear associated with living with HIV keeps people from testing for HIV.

Quoted from the respondents:

"The fear! After the horror stories people are fed about the HIV infected as well as the stuff our parents tell us when growing up-sigh-it’s no wonder we are terrified. People believe it’s a death sentence." (Male, 21, Kenya)

"Most of the young girls fear to be damped, rejected and discriminated especially by those that cared about them and gave them any sort of support to them, i.e. financial support, emotional support, parental support. They also fear to be rejected by their peers and friends because most of our societies, even though they understand the situation, they associate HIV Positive status to immorality. So, they prefer remaining ignorant about their status to avoid all these strings attached." (Female, 24, Uganda)


 
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J_Cornell
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« Reply #25 on: October 07, 2010, 01:40:10 pm »

Mas makes an important point about youth friendly services and the importance of providing HIV services in the context of broader sexual and reproductive health services.  We should also be looking at sources of information - in the survey quoted by Yongfeng Liu, many young people raised concerns about the way they had been educated - or not educated! - about sexuality.

For example:
Trinidad and Tobago' 'Most HIV awareness events on campus are put on by students.  The initiative seldom comes from the campus administration.  They seem very passive in distributing information.  Instead of administration reaching out to students, they wait for students to come to them: often this may be too late, if ever at all.'

Brazil: 'I believe the biggest problem is to access youth-friendly information.  That means for me a comfortable and non-judgemental way, that creates a good environment in which young people can really ask their questions instead of just listening to the informations.'

Netherlands: 'Besides the classes in high school, information is freely accessible through the internet and all young people use internet.  A reason for young people to not look up this information could be the idea of 'those things do not happen to me'.  This idea is encouraged by the sexuality education that talks about HIV as some biological information on a far away disease.'

Bhutan: 'Sources of information are limited...  HIV is not talked freely in the family and we don't feel it important to know about it which makes us to believe we are not at risk of getting HIV.  Poor community support in sharing and informing the youth about HIV.  Lastly but the most importantly, we have no sexuality education in formal educational institutions in whatsoever form.'

Nigeria: 'Sexuality education I believe if introduced into the Nigeria primary and secondary school curriculum and not leaving out the tertiary level will contribute a great deal to decreasing the spread of the disease among Nigerian youths'

Canada: 'Poorly trained teachers.  Teacher discomfort with the topic (e.g. if homosexuality comes up, they squirm)'

Philippines: 'Lack of proper training on the teachers in handling questions related on HIV.  They seem to get this weird notion that any student who asks things about HIV and STIs is already sexually active.'

Lebanon: 'There is absence of youth friendly spaces where young people can speak openly and in a safe space about their sexuality.'

Pakistan: 'Most adults are not used to talk openly about sex, and they feel uncomfortable about it.  Teachers are not an exception....  Many teachers prefer to think that they do not need to talk about this at all, leaving this important task to parents.  But many parents feel equally shy to talk about sex with their children and they may assume that the teachers will do it.  As you can see, an information and knowledge vacuum is easily created.'

It's interesting to see such similarities in experience across such very different regions.

We've heard a lot about school teachers' role in HIV preventive education - as well as in care and support in some highly affected countries - but what about teaching staff at tertiary level in colleges and universities?  What training is available for them, in order to equip them to deal with these issues?  And what support is there from the management of the HEIs? 

What's your understanding of the situation in your country?
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J_Cornell
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« Reply #26 on: October 07, 2010, 01:56:49 pm »

Interesting article in today's Guardian Online on sex education: on higher education, it says:

'Is there any chance that Egyptian students will get some formal sex education further down the schooling road? Apparently, none. Medical students I have spoken to have told me that even the country's leading medical school at Cairo University does not teach sex education. Ain Shams University medical school students have a "sexology" class – the "anatomical and biological aspects of sex ed, not the social and psychological ones," one explained.'

http://www.guardian.co.uk/commentisfree/2010/oct/07/egypt-sex-education


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lynne
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« Reply #27 on: October 07, 2010, 02:27:49 pm »

I am writing as someone who is not an expert on this subject, but through the UNESCO Clearinghouse see a lot of information passing. I came across a few years back (around 2008) an initiative being undertaken by a firm called Initiative Conseil International in Burkina Faso who with support from WHO were looking to do an inventory of HIV and AIDS related training programmes and courses  in francophone universities in Africa. My understanding is that this included also training related to treatment, care and support. I am not sure how far the projected was implemented and wondered if anyone knew of this initiative?

I also know that organisations such as AAU and ADEA did much important work at the beginning of 2000 on HIV in universities in Africa both Anglophone and francophone, including impact studies and policy processes. I feel that this forum is an important step into updating this work with all the contributions received so far.

On a separate issue, perhaps related to the debate on cultural issues, I have also come across a publication from the World Council of Churches, looking at mainstreaming HIV and AIDS in theological education (http://www.oikoumene.org/fileadmin/files/wcc-main/documents/p4/ehaia/Mainstreaming_HIV_and_AIDS_in_Theological_Education.pdf) which I think is a significant publication and may be a useful resource for participants.

In response to the post on Egypt above see also work undertaken on higher education by the UNESCO Office in Beirut
http://unesdoc.unesco.org/images/0018/001841/184160e.pdf
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Manilee
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« Reply #28 on: October 07, 2010, 03:48:58 pm »

For Dulce Pereira from Mozambique:

As discussed during the last past three days, providing prevention solely, does not seem to neither answer the needs in responding to HIV and AIDS, nor does it meet it’s own goals fully. You have made a similar point here about a less debate it issue of how to go from prevention to treatment, care and support. We might be able to discuss this in more depth during the next week while discussing other policy relevant issues.

However, here are some issues that we might think about and discuss in the  context of policy framework:
•   How, if at all, should we go from viewing prevention education as not a separate issue to treatment, care and support?
•   What are the policy implications of an approach where all four matters are dealt with equally rather than separately and in hierarchical manner?
•    What are some of the policy arguments concerning the necessity of addressing each question separately and/or keeping flexibility concerning the priority of each issue?

For this week discussion you make an important contribution to the recommendations list which is the essential role that the HEIs managers play in working closely with the students to bring about a strong response to HIV and AIDS. You shared with us your interesting work which you done with the support of your dean, such efforts could maybe extended to include care and support. For example, in your institution is there a network of students living with HIV?  

PP_Gile from the Ethiopian Civil Service College

Thank you for sharing this important information on the incentive that has encouraged policy makers in your country to formulate a comprehensive HIV and AIDS response. The importance of conducting HIV impact analysis on HEIs was also mentioned during the last past three days by different participants.

Concerning the current HIV services practices it would be interesting to obtain your ideas and the other participants on two interrelated issues:
 
1)   At the practice level what are the implications of having ongoing research on the impact of HIV within the HEIs. For example, should the HIV/health service centers be mainly responsible for information on staff and student HIV related morbidity and morality. Could this perhaps answer partially the challenge of HIV confidentially?

2)   At the policy level (which we will come back to during the next week): Does the impact analysis need to exist prior to formulation of policy framework? Why, if at all, should there be such an analysis in order to provide HIV related services, especially in places where health centers addressing other health issues are established in HEIs sites? In another words,  why is there a need for extra incentive for policy makers to react to the AIDS pandemic in a stronger fashion?  
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M_Licata
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« Reply #29 on: October 08, 2010, 12:11:40 pm »

Provision of health services is not a core business of Schools, considered as workplaces however, inside and outside services can be considered.
In the workplace, access to treatment, care and support can be provided through on-site services, referrals to public or private health facilities or agreements with a separate HIV and AIDS programme.

A minimum package is not just an end-result, but is a process, by which higher educations set a minimum standard according to their needs, and then they refine it periodically. It is important to consider the package not as a fix set of measures but a flexible one, that can be re-assessed on a regular basis.

According to the IIEP module on HIV/AIDS care, support and treatment
for education staff, a minimum package can be established at the level of the Ministry of education and include:

- lifestyle education and harm reduction (targeted at all staff);
- established referral networks and partnerships for nutritional advice and support, treatment of minor ailments, treatment of STIs, reproductive health services for women, surveillance for and prevention and treatment of opportunistic infections and family support;
- benefits to cover HAART, or a cost-sharing arrangement;
- psychosocial support from a trained counsellor – possibly within a broad-based employee assistance programme;
- on-site or community-based support group activities.

Margherita (ILO)
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