This article is based on the synthesis report of studies of the impact of HIV/AIDS on elementary and secondary education in Botswana, Uganda and Malawi, conducted by the University of Sussex. The Executive Summary, Chapter One and part of Chapters Two and Nine were selected for publication in order to provide interested readers with basic information about the design and conduct of the studies and chapter summaries which dealt with a wide range of findings. The complete report can be obtained by contacting Dr. Nicola Swainson and/or Dr. Paul Bennell at the e-mail address: <swainson@bennell.u-net.com>  The studies and synthesis report were directed by Paul Bennell, Nicola Swainson and Karin Hyde for the Centre for International Education of the University of Sussex. Support was provided by the Rockefeller Foundation, the Department for International Development of the United Kingdom and by the United States Agency for International Development.
 
 
 
 

EXECUTIVE SUMMARY
 

This report presents the main findings and recommendations of an international research project, which has focused on assessing the impact of the HIV/AIDS epidemic on primary and secondary schooling in three countries, namely Botswana, Malawi and Uganda. Adult HIV prevalence rates were estimated to be 36% in Botswana, 21% in Malawi and 8% in Uganda in 1999. The report explores the following three areas: student prevention and the impacts on students and teachers.

It is widely accepted that the HIV/AIDS epidemic will seriously affect the education sector in Sub-Saharan Africa. However, little systematic empirical research has been undertaken, particularly in the high prevalence countries (HPCs) that seeks to assess the actual and likely future impacts on the supply of and demand for educational services.

Given the very limited amount of school-based research that has been undertaken on the impact of epidemic on the education sector, Chapter 2 discusses in some detail the common methodology that was developed for the country studies. A range of qualitative and quantitative methods was employed. A total of 41 schools across the three countries were surveyed and extensive interviews were conducted with education managers and teachers as well as other key stakeholders, including other ministries, NGOs, and donor organisations.
 

Chapter 3 assesses the effectiveness of school-based HIV/AIDS prevention programmes at other activities in BMU. Despite the mounting concern about the vulnerability of young people in SSA, there is still not sufficient information available to be able to make a comprehensive and robust assessment of the extent to which adolescents have changed their sexual behaviour in response to the AIDS threat. The study did not attempt to survey directly the sexual behaviour of primary and secondary school children. It appears though that young people in Uganda have made important changes to their sexual behaviour, which makes them less vulnerable to HIV infection. Some indicators suggest that more limited changes towards safer sexual behaviour are occurring in Botswana as well. HIV prevalence among the 15-19 age group has fallen markedly in Uganda, but continues to rise in Botswana. In Malawi, prevalence rates for this age group appear to have declined in urban areas, but continue to increase in some rural areas.

The main conclusion of the three country studies is that there is little hard evidence to show that school-based HIV/AIDS education and, more generally, sexual reproductive health and life skills education has had a major impact on sexual behaviour. Generally speaking, students at the survey schools were well informed about the causes and consequences of HIV/AIDS. It is translating this knowledge into behaviour change that remains the major hurdle. Economic and social/cultural pressures that fuel unsafe sex among adolescents remain as high as ever, and in the poorest communities, are probably increasing. There is growing concern about the risk of female students contracting HIV from teachers and other older men. Condom use remains highly controversial, particularly in Malawi.

Curriculum design and delivery of HIV/AIDS and SRH education remain seriously problematic. It is clear that the ‘integration and infusion’ approach where HIV/AIDS topics are included in carrier subjects is not effective. Teachers themselves lack both the competence and commitment to teach these topics in an already over-crowded and examination-driven curriculum. Little or no training has been provided. Guidance and counselling services and peer education are also seriously inadequate.

The report makes a number of recommendations about how schools can play a more effective role in the prevention of HIV. In particular, it argues that urgent efforts are needed to develop a professional cadre of full-time SRH/life skills teachers in both primary and secondary schools and that there should be regular time-tabled lessons for this subject for all children right from the start of the primary education cycle. This should be combined with the continued integration and infusion of HIV/AIDS in the curriculum. While HIV/AIDS education in schools should focus on sexual abstinence, the role of condoms in preventing infection cannot be ignored.

Chapter 4 focuses on school children who are most affected by the AIDS epidemic, in particular orphans, children who are looking after sick family members, and the small numbers of children who have AIDS-related illnesses. It is important to point out that among the estimated 8.2 million AIDS orphans in SSA in 1999 (3.6% of the under 15 population), less than one-third were AIDS-orphans.  Information on the numbers of children most directly affected by the epidemic is very limited in most SSA countries. While schools in Uganda keep reasonably accurate records on orphaned students, this is not the case in Botswana and Malawi.
 

The country studies highlight the complexity of the living arrangements of school children in most of SSA. Even before the AIDS epidemic, relatively large numbers of children were living in single parent (usually female-headed) households and with other relatives. The extended family supports the large majority of double orphans. In Malawi and Uganda, orphan guardians are under considerable strain and many households do not have enough resources to absorb extra children.

The educational impact of the epidemic on the most affected children is complex and multi-faceted. The analysis of conventional education performance indicators highlights the difficulty of making broad generalisations about impact across countries. Although time series data on student absenteeism could not be collected because school records were so poor, current levels of student absenteeism, repetition and dropout in the survey schools were assessed.

Absenteeism rates in Botswana are relatively low and, in primary schools, orphans had better attendance records than non-orphans. An important reason for this is the strong schooling culture and already very low dropout rates in both primary and secondary school. Government has also introduced a comprehensive programme of material support for disadvantaged orphans. In Malawi and Uganda absenteeism is very high among all primary school children. The main causes are mainly poverty-related. While student absenteeism tended to be higher among orphans than non-orphans, the differences were much lower than expected. Illness in the family was not a major reason for absence, except for maternal and double orphans in Uganda. Generally it is the poorest orphans who have the most problems at school.

Although orphans are subject to insensitivity at school on the part of teachers and management, instances of deliberate discrimination were rare.

Nearly all governments in SSA have been slow to respond to the orphan crisis. Unlike Botswana, Malawi and Uganda have few resources to tackle the orphan problem. In Uganda, government is focusing more on encouraging family-based income generation rather than targeted assistance to individual orphans. Although NGO and CBO support for orphans expanded rapidly during the 1990s, (particularly in Malawi and Uganda), assistance remains localised and concentrated in urban and peri-urban areas.

Schools themselves offered very little targeted support for children most directly affected by HIV/AIDS. The following reasons for the limited school response are discussed: MoE policy and leadership, the perceptions and attitudes of school managers and teachers, the acute lack of resources (especially in Malawi and Uganda), identification and needs assessment, other children in especially difficult circumstances, the school environment, and discrimination and stigmatisation.
 

Chapter 5 considers how many children are likely to be directly affected by the epidemic during the next 10-15 years. Total AIDS cases will rise drastically in the next decade and, without appropriate levels of support for adult carers, many more children will be caring for the sick. In the HPCs, 30-40% of all children are projected to be orphans by 2010. It then considers what policy interventions are needed at both the national and school-levels to prevent and mitigate the likely adverse impacts on the education sector. A key point is that the impact of the epidemic on the education sector will, to a large extent, depend on the overall level and effectiveness of assistance given to these children and their carers. The design and implementation of effective national HIV/AIDS strategies based on multi-sectoral community mobilisation is fundamentally important.  In addition, well-resourced national poverty reduction programmes should support the most basic livelihood needs of all children, including those affected by the AIDS epidemic. As a general rule, therefore, orphans and especially AIDS orphans should not be targeted. The provision of home-based care programmes will do much to relieve the burden of care for children in AIDS-affected households.

The report discusses a number of important measures that can be realistically introduced in schools that will significantly improve the level and effectiveness of school-based support. Six priority areas are identified: identification, referral and monitoring, school feeding, pastoral care and counselling, financial assistance with fees and school-related expenses (especially at the secondary level), involvement of guardians and carers, and children living with AIDS.

Chapter 6 focuses on the impact of the epidemic on teachers and other staff in the three case study countries. Surprisingly, hardly any the other impact studies that have been undertaken to date have actually assessed trends in morbidity and mortality among teaching staff. The demographic projections that are the centrepiece of these assessments are based on the assumption that teachers will be affected in the same way as the adult population as a whole. The empirical evidence from Botswana, Malawi, and Uganda indicates that this assumption is not likely to be valid in most countries.

It is widely asserted that teachers are a high-risk behaviour group and that therefore HIV prevalence among the teaching profession is higher than the adult population. No supporting evidence for this assertion is found in the three country studies or any other country in SSA. Teacher mortality in Botswana, for example, was less than half than that projected for the overall adult population in the late 1990s. Mortality rates vary also widely among teachers according to type of school (primary and secondary), gender, location and marital status. In general, mortality rates are much higher among primary school teachers and male teachers. More research is urgently needed to establish the key factors underlying what appear to be very large mortality rate differentials among different groups of teachers.

Trends in mortality rates have also been investigated. In Uganda, mortality for both primary and secondary school teachers peaked at less than one percent during 1995-97. Probably around half of this mortality was AIDS-related. Both in absolute terms and in relation to high rates of attrition from other causes (resignations, retirements, etc), this level of mortality has not posed a serious threat to the development of the education sector in Uganda. Primary school enrolments expanded over threefold with the introduction of UPE in 1994 and there is currently an excess supply of secondary teachers. The overall mortality rate among teachers in Botswana was around 0.8 percent in 1999/2000. Although demographic projections indicate that AIDS-related adult mortality will rise to 3-4 percent by 2010, the mortality rate among Ministry of Education staff actually fell during 1999/2000. The reasons for this are not entirely clear, but there was over a threefold increase in the number of staff taking anti-retroviral drugs during this period. In Malawi, mortality rates among female and male primary school teachers were over two percent in 2000, but less than one percent for secondary teachers. Mortality rates among secondary school teachers had also fallen steadily since 1997.

The remainder of the chapter reviews the evidence collected on teacher morbidity and absenteeism, motivation and morale and discrimination and finally assesses the reasons for the limited response of Ministries of Education to the threat posed by the epidemic with respect to staffing.

Chapter 7 assesses the likely impact of the AIDS epidemic on teaching staff over the next 10-15 years. The main conclusion here is that unless morbidity and mortality projections are based on detailed and accurate information of HIV prevalence among teachers and other staff, they are likely to be of little or no value for planning purposes. For SSA as a whole, the report estimates that, on average, one school in nine will lose a teacher to HIV/AIDS each year over the next decade. The worst affected country will be Botswana where annual AIDS-related mortality will average one teacher per school during this period.

It is widely believed that teacher recruitment will have to expand rapidly in order to make up for much higher levels of AIDS-related attrition. However, this is only likely to be the true for a minority of HPCs because, with lower than expected school-age populations, fewer teachers will be required to educate these children.

Chapter 8 outlines the main activities that need to be incorporated in a comprehensive AIDS in the workplace strategy for teachers and other staff in the education sector. These include: robust prevalence and risk assessments, intensive education and prevention programmes, active promotion of HIV testing, establishment of work-based counselling and support groups, careful monitoring of teacher deployment and transfers, extra teaching cover for schools with sick teachers, new regulations and procedures to deal with sickness and absenteeism, and medical support and the provision of anti-retroviral drugs.  Urgent steps also need to be taken to stamp out sexual misconduct by school managers and teachers.

The report recommends the adoption of a comprehensive implementation strategy for AIDS in the workplace programmes. In the worst affected countries, the AIW Programme should be managed by full-time personnel with have the expertise, authority, and resources to ensure rapid and effective implementation. At the school-level, there should be a cadre of full-time AIDS counsellors who can make regular visits to schools to meet with staff both individually and in groups.

Finally, Chapter 9 considers the kind of organisational and management arrangements that should be put in place by MoEs in order to tackle the actual and potential impacts of the epidemic on both students and staff. For the HPCs in particular, current arrangements including HIV/AIDS co-ordinators and focal points are inadequate for a variety of reasons. The report argues that nothing short of a Ministry-wide mobilisation is required in order to deal with the crisis. HIV/AIDS management programmes should be established as soon as possible, which should be headed by a Director and other managers responsible for student and staff prevention and mitigation at both the national and regional levels.
 

CHAPTER 1   INTRODUCTION
 
 

1.1   STUDY RATIONALE AND OBJECTIVES

It is generally accepted that the HIV/AIDS epidemic will seriously affect the education sector in sub-Saharan Africa and, in particular, the high prevalence countries (HPCs) in Eastern and Southern Africa. The high profile UNICEF publication, The Progress of Nations, states that ‘although HIV affects all sectors, its most profound effects are concentrated in the education sector’ (UNICEF, 2000:10). More generally, ‘HIV/AIDS appears to be in the ascendancy and to have virtually overcome education, swamping it with a wide range of problems’ (Kelly, 2000:24).

However, even at this relatively late stage of the epidemic, our understanding of how HIV/AIDS is affecting educational provision in sub-Saharan Africa is generally poor.  Without an adequate knowledge base, Ministries of Education (MoE) cannot develop well-conceived strategic responses to the epidemic, which will make a real difference in schools and other educational institutions.  To date, interventions by MoEs to help prevent HIV infection and support students and staff directly affected by AIDS have remained very limited. This is mainly because national AIDS strategies have focused on HIV/AIDS education through community-based initiatives.  While these programmes have achieved significant results in some countries, the opportunity within the education system to make a lasting impression on children before they become sexually active has not been fully exploited.  The same is also true with regard to mitigating the impact on both teachers and students who are directly affected by the epidemic.

Very little systematic empirical research has been undertaken that specifically addresses the actual and likely impacts of the epidemic on the education sector in Eastern and Southern Africa.  Country impact assessments have relied heavily on demographic models to make projections of student enrolments and teacher requirements.  While a number of more qualitative factors have been identified that are likely to affect the supply and demand for schooling, these have not been analysed in detail with adequate supporting evidence. In particular, little or no research has been undertaken in schools themselves. The lack of hard evidence about what is actually happening in schools has resulted in anecdotalism and broad generalisations about the impact of the epidemic on the education sector, which although largely unsubstantiated, have already been widely accepted as received wisdom.

In an attempt to obtain a more in-depth understanding of the impact of the epidemic on the education sector, country impact assessments were undertaken in three countries, namely Botswana, Malawi and Uganda. This report presents the main findings and recommendations of these country studies. Where appropriate, evidence from other impact assessments and relevant research is also included.

Each country study has focused on the following questions:

? What has been the impact of HIV/AIDS to date on educational provision in primary and secondary schools?
? What are Ministries of Education and other organisations doing in order to prevent further HIV infection among students and teaching staff?
? What support is being given to students and staff who are directly affected by the scourge?
? Given current and projected rates of HIV prevalence, what are the likely impacts on education supply and demand over the next 10-15 years?
? What should schools do to minimise the spread of HIV among schoolchildren in the future?
? What should the MoE and schools do to support both students and teaching staff who are directly affected by the epidemic?
 

1.2   HOW HIV/AIDS AFFECTS THE EDUCATION SECTOR

There are four main 'institutional arenas' that collectively determine how the AIDS epidemic will affect the supply of and demand for education, namely the household, community, school, and government. The epidemic could lower the demand for schooling in three main ways:

? Smaller student intakes: Lower fertility levels will lead to smaller than expected cohorts of six year olds over the next few decades. In the worst affected countries, it is anticipated that the school-aged populations will actually contract.
? Impact on students: As the numbers of orphans, caregivers and children with AIDS related illnesses increase, the educational performance of these children is likely to deteriorate. More specifically, intake rates could fall and repetition and dropout rates increase.
? Level of poverty: Parents and guardians will be poorer because of the macro-economic impacts of HIV. They will less able therefore to support their children’s schooling through the payment of fees, purchase of supplies, etc.

The supply of educational services could be affected by changes in:

? Teacher requirements: The number of teachers who will die of AIDS-related illnesses is expected to increase rapidly in high-prevalence countries during the next 10-15 years. At the same time, however, lower than expected student enrolments will reduce the demand for new teachers.
? Teacher productivity: There will be increased levels of absenteeism and morbidity among teachers, which will result in a reduction in the number teacher-hours available.

In addition, there are factors, which have potentially sizeable resource implications for the education sector. These include:

? HIV/AIDS education in schools: It has become necessary to either institute or enhance sexual and reproductive health education in schools.  This will require substantial investment in materials and personnel.
? External support for education: The degree to which international donors and NGOs respond to the need for increased levels of assistance.

? Internal support for education: The extent to which governments, communities, local authorities and organisations can marshal additional funding for education.
 

1.3   STUDY DESIGN

The three countries selected for this study are among the worst affected by the AIDS epidemic in sub-Saharan Africa. However, they differ in a number of important respects. The AIDS epidemic has already peaked in Uganda and adult HIV prevalence had fallen to around 8% in 1999.  In marked contrast, HIV prevalence rates are much higher and rising in Botswana and Malawi.  In Malawi, prevalence was reported at between 17-30% and in Botswana higher still at 30-40% during 1999-2000 (ADF, 2000).

The research project was co-ordinated by Paul Bennell, Karin Hyde and Nicola Swainson who each had primary responsibility for one country study.  The main focus was on assessing the impacts of the epidemic on primary and secondary schooling in each country. However, a supplementary study of the impact of HIV/AIDS at the University of Botswana was also completed. In Botswana and Malawi, Ministry of Education staff were full members of each study team.
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To maximise the benefits of cross-country comparison, a common methodology was devised. The country teams met in Uganda in February and October 2000 for initial and final workshops.  At the initial workshop, a common research strategy was developed, which included the core qualitative and quantitative information to be collected and the main groups of respondents to be interviewed. A number of survey instruments were developed and pre-tested for use in representative samples of schools. The final workshop was used for reviewing country findings and identifying lessons learned for inclusion in the final country reports.
 

1.4   DISSEMINATION

The main findings and recommendations were disseminated at one-day workshops in each of the three countries.  In Botswana, the workshop for the school study was held in November 2000 and a second one for the university study in January 2001.  In Malawi, two workshops were held in April 2001; for MoE staff, major donors and NGOs in Lilongwe and in Blantyre for district education officers, teaching staff and NGOs. In September 2001 a further workshop was held in Blantyre for schools which had participated in the research and NGOs. In Uganda, one workshop was held in November 2000 in Kampala, primarily for Ministry of Education officials.

Copies of the country reports have been distributed to respondents and informants in all countries and are available on request.  Follow-up dissemination activities are planned for all three countries using a range of media and strategies to make the findings available to a wide range of audiences.  These will include condensations, posters, pamphlets and dramatisations.
 
 

1.5   STUDY TEAM MEMBERS

Botswana

? Dr. Paul Bennell -Independent Consultant and Team Leader
? Dr. Bagele Chilisa-Senior Lecturer, Faculty of Education, University of Botswana
? Dr. Karin Hyde-Independent Consultant
? Mr Archie Makgothi-Head, Division of Planning, Statistics and Research, MOE, Gaborone.
? Mrs Enni Molobe--Education Officer, Division of Planning, Statistics and Research, MOE, Gaborone.
? Mrs Limpet Mpotokwane-Senior Education Officer, Department of Curriculum Development and Evaluation, MOE.
 
 
 

Malawi

? Ms. Esme Kadzamira-National Team Leader, Research Fellow, Centre for Educational Research and Training, University of Malawi
? Dr Augustin Kamlongera-Principal Planning Officer, Planning Unit, Ministry of Education, Science and Technology, Lilongwe
? Dr. Dixie Maluwa-Banda-Head, Department of Educational Foundations, Faculty of Education, University of Malawi
? Dr Nicola Swainson, Study Co-ordinator, Centre for International Education, University of Sussex.
 

Uganda

? Dr. Karin Hyde-Independent Consultant and Team Leader
? Ms. Catherine Barasa-Independent Consultant
? Dr. Andrew Ekatan-Independent Consultant
? Ms. Eunice Kyomugisha-Independent Consultant
 

1.6   FUNDING

The Rockefeller Foundation generously provided core funding for the Malawi and Uganda country studies and the preparation of this synthesis report. The UK Department for International Development funded the two Botswana studies.  The Ministry of Education in Botswana provided logistical support for the school survey. USAID also supplemented the budget for the school survey in Malawi.
 
 
 
 

CHAPTER 2  STUDY METHODOLOGY
 
 
 

2.1   OVERALL APPROACH

Each country study adopted a three-pronged approach.  The first was a school survey in 10-20 schools in two districts in each country; the second was the interviewing of key informants in the education, health, social work, financial and population sectors.  And thirdly, secondary data was collected on the education system, and HIV prevalence and mortality.

School Survey

The survey schools were randomly selected in two urban and rural administrative districts, which were among those in each country with the highest recorded levels of HIV infection. A team member visited or communicated with each school before fieldwork to brief the head-teacher about the school survey.

The team spent a day in each survey school in Botswana and Uganda and two days in Malawi.  Semi-structured interviews were held with the head-teacher and with members of the school management team to obtain their views of the impact of HIV/AIDS on their school, trends in numbers of orphans, levels of teacher deaths and sickness, sexual harassment, etc.  These interviews were conducted in English.

Teachers were interviewed in several ways.  All teachers were given a questionnaire that asked for basic background information and their views on a range of issues related to HIV/AIDS and education through a five-point rating of a series of statements.  Up to 10 teachers were also randomly selected for interview.  Then 4-12 teachers (depending on the number of teachers available after the interviews) were randomly selected for participation in semi-structured focus group discussion.  Interviews and discussions with the teachers were conducted either in English or local languages.

Forty students (selected from the last two years of primary and each year of the main secondary cycle) were randomly selected for a group-administered questionnaire.  A sub-group of 12-16 students from the same classes were selected for a focus group discussion.  Both groups of respondents were gender balanced.  The student instruments were usually administered either in the local language or by a local language speaker.
 

For the focus group discussions with both students and teachers, the facilitator utilised sets of statements, each printed on a separate sheet, that participants were asked to put in the following categories:  ‘agree’, ‘disagree’ or ‘not sure’.  All the statements portrayed negative situations, for example “HIV/AIDS is a big problem in this school” or “Boys in this school are fearful and anxious about their safety”.  The criterion was how true the statement was for their school (see appendix 1 for statements).  Participants were asked to further categorise the statements they ‘agreed’ with as: ‘not bothered’, ‘dislike a little’ or ‘dislike a lot’.  The second level of classification was a way of indicating strength of feeling.  The categorisations were done as a group (either one or two depending on the number of participants) and the group was required to adopt a consensus position.  The discussion then centred on the reasons for the classifications and the reasons for differences between groups. Statements were translated into local languages for primary school students.

A small number of focus group interviews were held with orphans in Malawi and Uganda. The original plan was to interview an orphan group in each school surveyed.  However, in Botswana, orphan interviews were considered too sensitive and were not part of the research protocol.  The orphan interviews were conducted both in schools and under the auspices of NGOs that were service-providers.
 

CHAPTER 9 DEALING WITH THE AIDS THREAT
 

As has already been discussed in some detail, the response of most MoEs in Africa to the AIDS threat has been quite limited. This concluding chapter briefly considers the kind of organisation and management arrangements that should be put in place if MoEs are to effectively tackle the actual and potential impacts of the epidemic on both students and staff.
 

9.1   ORGANISATION AND MANAGEMENT

Current arrangements

Most MoEs have appointed an official to act as the HIV/AIDS Focal Point for the Ministry.  Ministry-wide HIV/AIDS committees have also be established in many countries. However, to date, officials appointed as the HIV/AIDS Focal Point have usually been relatively junior and they have therefore lacked the power and authority to ensure that all departments and units properly mainstream HIV/AIDS with respect to both policy and practice. Furthermore, most are expected to take on the responsibility for HIV/AIDS issues over and above their normal duties. HIV/AIDS Committees tend to meet irregularly and most senior officials have neither the time nor the expertise to design and implement the comprehensive strategy that is required.

An HIV/AIDS Management Programme
 

MoEs in the high prevalence countries must make the HIV/AIDS crisis a top priority for at least the next ten years. Nothing short of a ministry-wide mobilisation is required in each country in order to deal with this crisis. It is essential therefore that an HIV/AIDS Management Programme (HAMP) is established as soon as possible. Figure 9.1 presents the main features of the organisation and management structure of such a programme, which was recommended by both the Botswana and Malawi country study.

HIV/AIDS National Management Team: Since HIV/AIDS is a ministry-wide problem, no one department should be given overall responsibility for the planning and management of this process. The National HIV/AIDS Management Team should not therefore, be formally attached to any one department, but should instead be a free standing ‘project team’.  In most HPCs, this team should comprise of least four managers. The national director should have overall management responsibility for the entire programme and related strategy. It is essential that this person has the power and authority to ensure that each department within the Ministry fulfils the specific objectives of the overall strategy and annual action plans. Ideally, therefore, the Director should have the rank of a Deputy Permanent Secretary and report directly to the Permanent Secretary. The other three members of the team should each be responsible for the management of three separate sub-programmes, namely student HIV prevention, student support, and staff prevention and support.
 
 

MoEs do not currently employ staff with the expertise and experience that is needed for the planning and managing a large and complex HIV/AIDS management programme of this kind. In most countries, therefore, the National Director and some of the National Programme Co-ordinators will have to be external appointments.

Long bureaucratic delays in getting the HAMP operational must be avoided at all costs. However, it is extremely difficult to create new posts, especially at senior levels in most civil services.  So that national teams can be appointed as quickly as possible, each HAMP will probably need to be established as a separate project.

HIV/AIDS Regional Management Teams: The implementation of the HAMP should be the responsibility of regional teams. Each team should have a Regional Programme Manager and at least three other professional staff. Between them they should have overall responsibility for the implementation of the HAMP all schools and other education and training institutions in each region.

The proposed HAMP for Botswana has 20 full-time professional staff. While this is a major commitment of personnel and resources, such a critical mass of professional expertise is essential.

School and Departmental HIV/AIDS Management Teams: At the school and departmental level, implementation of the HAMP should be the responsibility of School and Departmental HIV/AIDS Management Teams, which should be chaired by head teacher and heads of departments respectively. Key resource people at the school and regional level are Guidance and Counselling teachers and AIDS Counsellors.

MoE committee structure: Every MoE should have a single, high-powered HIV/AIDS Committee, which advises the Minister and senior management and supervises the work of the HAMP.  All heads of department should be members of this Committee, which should be normally chaired by the Minister of Education.  Specialist committees should also be set up for each of the three sub-programmes. Their memberships should be drawn from the relevant MoE departments as well as other relevant government ministries and NGOs. Finally, each Education Region should have its own Regional HIV/AIDS Management Programme Committee.
 

9.2   INFORMATION AND RESEARCH
 

Given the gravity of the AIDS crisis in many countries, there is an understandable urgency to convince politicians and policymakers about the need to take decisive action to prevent and mitigate the impacts of the pandemic. However, advocacy-without-facts is not a sound basis for the development of well-conceived prevention and mitigation strategies. Instead, it tends to encourage an excessively negative and simplistic assessment of the impacts of the pandemic, which, in some ways, is as serious in its consequences as the denial about the epidemic, which it seeks to counter. The widespread assertion that teachers are a high-risk group is perhaps the most notable example of the emergence of a received wisdom about the impact of the epidemic on the education sector, which is based on fragmentary, anecdotal evidence coupled with a general lack of analytical rigour. Consequently, the analysis of the AIDS impact on the education sector must be based on detailed, robust and on-going empirical research in each affected country.
 

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