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 44188 times)
M_Mbilima
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« Reply #30 on: October 08, 2010, 01:54:09 pm »

The Association of African Universities (AAU) have ongoing HIV & AIDS Core Programme "African Universities Responding to HIV and AIDS". One of the strategic objectives is, "Strengthened HIV and AIDS Prevention, Treatment and Care among AAU members." AAU have as well produced publications on the Higher Education's Response to HIV and AIDS in Africa, which may be accessed through links provided below:


An HIV/AIDS toolkit for Higher Education Institutions in Africa
http://www.aau.org/?q=aur2hiv/african-universities-responding-hivaids

Higher Education Institutions in Africa Responding to HIV/AIDS
http://www.aau.org/sites/default/files/Responding_to_HIV_Aids.pdf

HIV and AIDS and Higher Education in Africa: A Review of Best Practice Models and Trends
http://www.aau.org/sites/default/files/AAUBP-report.pdf
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Manilee
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« Reply #31 on: October 08, 2010, 05:33:53 pm »

Please see below a post e-mailed to us from Alice Ochanda, at UNESCO Office in Nairobi which provides a good example of HIV service program at a University in Uganda and a workshop experince in Rwanda. 

In Uganda Nkumba University is a pioneer in the field of HIV and higher education having formulated an institutional HIV/AIDS Policy in 2002. The policy was formulated based on research that demonstrated the following challenges:  
•   Lack of knowledge about HIV and AIDS among students and staff
•   High prevalence of unexpressed psycho-social problems
•   Adverse peer influence
•   False assumptions about University community
•   Semi-urban location
•   Lack of parental guidance – institutionalised education
•   Growing student population
•   High proportion of non-resident students

The intervention outcomes included:
•   The development of courses on HIV/AIDS and Development,
•   HIV/AIDS Education and Management (run jointly with TASO),
•   Guidance and Counselling;
•   Appointment of a University Counsellor;
•   Rolling out peer counselling initiatives, both in the university and in the surrounding community (including at primary and secondary schools);
•    The establishment of the Nkumba Women’s Health Centre, providing a community outreach programme, which incorporates reproductive health, nursery & day care and micro-finance.  

Rwanda: in a regional workshop on HIV stigma and discrimination for universities in Sub-Saharan Africa hosted by UNESCO in Rwanda in April this year, the participants shared their experiences of providing services in their respective universities and proposed the following recommendations: 
•   All HIV interventions should be evidence-based
•   The Counselling Centre should not be set apart from other services provided by the University
•   It should be named ‘Psychological Guidance and Counselling’ and should be staffed by professional counsellors

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kusiluka
VCT


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« Reply #32 on: October 09, 2010, 11:24:15 am »

The Open University of Tanzania (OUT) has a HIV/AIDS Policy and Technical HIV/AIDS Committee, comprising members of the Management and medical professionals to oversee the implementation of the policy. The creation of awareness and prevention of transmission of HIV/AIDS is promulgated in University's Rolling Strategic Plan (RSP) and there are specific targets for addressing the problem, starting with intensification of the awareness campaigns. This is very critical for OUT because, as an Open and Distance Learning (ODL) Insitution, it has Regional Centres distributed throughout the country. After every six months, the university holds a review workshop of the RSP and updates on the development concern HIV/AIDS are presented and discussed. In this way, we have tried to keep our staff and students regularly updated on the developments in the area. During the quartely staff meetings, we invite various external experts to provide recent advances and share experiences on cross-cutting issues including HIV/AIDS.

The major challenge, however, is to reach all the staff and students scattered all over the country with the right information on Services for HIV treatment, care and support on time. The University Management has trained peer educators, among staff and students, who serve as focal points for dissemination of HIV/AIDS related information. We have also exploited the power of ICT in information dissemination across the institution such that staff and students that are based in very distant regions like Kigoma, Mtwara and Kagera access information at the same time as those based in Dar es Salaam. This has proved quite helpful in information dissemination in a situation where staff and students are such spatially distributed. Universities should embrace the use of ICT in information dissemination.

The university is now exploring the feasibility of conducting six-monthly medical screening of our staff for various diseases, including HIV/AIDS. This move is intended to promote a culture of regular health screening.
We believe that these strategies will form a firm base for our subsequent plans for on addressing HIV/AIDS pandemic.

We would like to get more ideas that will assist us in reaching out our staff and students more effectively and efficiently.
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« Reply #33 on: October 12, 2010, 09:46:48 am »

The following was received by email from Mary Crewe, Centre for the Study of AIDS, Pretoria, South Africa.

On the question of services: Well, I suppose the answer to this lies in to what extent Universities are responsible for the health care of their staff and students - should this kind of care for HIV and AIDS differ from that for TB or cancer or alcoholism etc. Most South African university staff would have medical aids and should have an HIV clause in their medical aid contracts – I’m not sure that the University has any responsibility to provide primary health care for staff. Exceptions may be for staff on low wages for whom medical aid is not part of their employment contract for whatever reason.

I think that all Universities should have at the very least a student health centre where students can get basic primary health care and a good referral system to more complicated health systems if need be.  Some of the students would be covered by their parents' medical aid and so the service should essentially be for those who aren't - and it needs to be good.

Most campus health clinics would have some form of sexual and reproductive health service. This may be just through the provision of condoms and advice but may also be more geared to family planning, contraception, the morning after pill, STIs etc. I think this should be the minimum service. However, it is also the case that the staff at the clinics tend to be very judgmental about the sexual behaviour of students - particularly women students and so it’s essential for a good sexual and reproductive health service that the staff are well trained and are not judgmental about students' sexual behaviour and practices and - as important - about sexual preference. Gay students generally receive a hostile reception at campus health centres and need as much sexual and reproductive support as heterosexual students do. The problem with sexual and reproductive health is that it’s generally about prohibition and the unhelpful ABC messaging rather than about the education of desire and sexual integrity.

HIV and AIDS testing, treatment support and care are fraught areas. I do not think that Universities should get into the testing circuses - these kinds of testing campaigns are in my view entirely counter-productive and unless there is a very good follow up service for students they are expedient. I do think that the University of Pretoria model is a good one. Here the campus clinic is an accredited ARV rollout site linked to the Steve Biko Academic Hospital. After initial testing and counselling and medical support, students are eased into the services at Steve Biko. This means that when they leave the University they are already in the national roll out. It also means that the University shares the costs of treatment and it avoids the problem that students have a break in treatments when they leave.

All students should have easy access to testing. This must be done without peer pressure or coercion. Some universities may be able to budget for this, others will need to form a partnership with a local service, but the partnership must be worked at and high standards of  couselling maintained. We need to counter the trend to do less counselling. Universities should ensure excellent counselling services for HIV and a range of associated issues. Also, once a student is tested the University must make sure that there is enough institutional support for positive students - ongoing counselling, support in disclosure, understanding about respite care and about the need to restructure some courses. Without a campus wide reduction in stigma and prejudice we should be very vigilant in our pushes for testing and the somewhat trite claims that testing will normalise the disease and reduce stigma - there is very little firm evidence for this. There needs to be counselling available for students testing negative as well because the research shows that a negative test has very little impact on behaviour.

It is essential that the staff in any testing treatment or care programme are very well trained and well supported by the institution.
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« Reply #34 on: October 12, 2010, 09:52:49 am »

The following was received by email from Mary Crewe, Centre for the Study of AIDS, Pretoria, South Africa.

In response to the question about ‘special needs of girls, women, young people and people infected and affected by HIV and AIDS’: 

This is the whole institution!! Universities need to ensure 'safe campuses'. This means that they have to recognise how the institutional culture of the institution creates patterns of patriarchy and oppression and allows for women students to be particularly vulnerable. If we do not address the traditionally male-dominated cultures at universities and the sexual behaviour and practices of male staff and students then we are only addressing part of the picture. There needs to be a strongly debated and enforced code of sexual conduct and a strong stand on sexual harassment across the campus. This means understanding sexual networks, staff student sexual behaviour, how young masculinities play out and how men students have been socialised into their ways of behaving. The same goes for young women - how have they been socialised and how do they collude with or oppose the dominant sexual cultures and networks and who supports them in this. This means that Universities have to take a far stronger stand on the ways in which residences are managed and recognise the sexual abuse that can happen there and also need to ensure that equality and equity permeate through all of the University operations.

For all people at the University, they need to be treated with dignity and respect. Young people need a good primary health service that addresses the particular issues young people face - and particularly those with very limited incomes - all university people need to be part of a process to understand and respect sexual and reproductive rights, sexual diversity and sexual practices and behaviours that are not part of the norm. The institutional culture is often a reflection of the social culture and Universities should be - though they often aren’t - at the forefront for social and cultural change and for creating new knowledge, explanations and patterns of understanding from which society can start to take a lead. It is not acceptable for universities merely to reproduce the status quo.

Universities in high prevalence countries (indeed everywhere) need to open up the debates about sexual rights and identity, about practices and conditions that make people more at risk, more vulnerable, and ensure that the institutional culture is openly supportive of people   with HIV and AIDS and of young people navigating and negotiating their way through their sexual identities and through developing their adult identities and developing a sense of social and personal and sexual honesty and integrity.
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« Reply #35 on: October 12, 2010, 10:01:47 am »

Received by email from Mary Crewe, Centre for the Study of AIDS, Pretoria, South Africa in response to questions on the 'minimum package' and 'institutional response'.

On the question of the minimum package:
The minimum would be a good well functioning and non judgmental campus health service - the decision about testing and treatments depends on budgets and here there need to be negotiations for a partnership with the national roll out and clinic accreditation. All students need access to good and supportive counselling, to support groups and to a range of information about HIV and AIDS which is wider than just sexual practice and allows for debate and discussion. The ABC campaigns in my opinion have no place in a good sexual and reproductive health programme.

On the programmes in my institution:
The University of Pretoria (UP) has a good campus clinic which has been accredited as part of the national roll-out of testing and treatments. There is a well trained and very good team of student counsellors who do the initial counselling of students – pre-test counselling in private and detailed - should a student wish to take the test, a staff nurse does the test and the same student gives the result. Negative students are given extensive counselling and encouraged to keep in contact with their counsellor. Positive students are referred to the doctors, dieticians and nutritionists at the clinic. These are people who volunteer their time and they do all of the follow up tests. Should the doctor and the student decide that treatment is an option, the student is referred to the Steve Biko Academic Hospital and will likely see the same doctor at the hospital and be supported by student counsellors. These students who go on treatment are mentors and supported by the Centre for the Study of AIDS in collaboration with Campus Health and Student Support. Condoms are freely available for all students through the CSA and campus health, and the STI and family planning services are working well. Gay students are supported by the CSA and the local Gay and Lesbian Association. There is also a strong link between the University and the city clinics.

The CSA runs an extensive series of student training and outreach.

Campus health is free and this was one of the rationales for getting the clinic accredited - students can get free or reduced-cost services at the Academic Hospital. There are no financial support schemes yet for off-campus care support and treatments.

At UP we need to reach far more students - the VCT service is very well used and at the moment all students who request counselling, support, testing and then treatment and care are able to access it.  The University is looking at ways to expand the service. Confidentiality, counselling and privacy are absolutely guaranteed.
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Haruna Ibn Hassan Agbevenu
teachers


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« Reply #36 on: October 14, 2010, 04:57:23 pm »

Ghana as a country has a National HIV and AIDS Policy. The policy has a provision of all persons; irrespective of status to be provided with HIV Prevention Education, CT Services, Treatment, Care and Support.
In accordance with this policy,Ministry of Education as a sector Ministry responsible for education development at all levels of education in Ghana, had set up an HIV secretariat to coordinate all activities relating to HIV Prevention, Treatment, Care and Support at all these levels of education development in the country.
The secretariat have been involved so much in awareness creation on prevalence rate and prevention.
In partnership with donor support, the secretariat initiated a project called the "TAD Project". This project trained almost teachers at the basic level of education to acquire knowledge and skills in HIV and sensitize learners. HIV was therefore to be taught at these levels as an integrated at all the stages.
The the Higher Education level, it is taught as a subject but non-examinable.
Tertiary institutions in Ghana are semi-autonomous so therefore have their own plan of action in HIV Prevention, CT services, Treatment, Care and Support.
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