HIV and AIDS knowledge for behaviour transformation in the biology curriculum

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A LUTA CONTINUA: THE BATTLE AGAINST HIV AND AIDS

“Four hundred thousand South Africans are dying every year of AIDS. This makes the war in Iraq look like a birthday party” – Jeremy Cronin7

 Introduction

Jeremy Cronin‘s quote paints a dire picture of the battle between South Africans and HIV and AIDS. He indicates that battles fought through the physical arsenal are far easier to fight than the battle against an enemy within one‘s own blood; a battle where the soldier is either not fighting (i.e. not infected), or almost certain to lose. The researcher therefore explores HIV and AIDS using Cronin‘s analogy of a battle in order to signify the urgency to develop strategies that will yield positive results.
It has been more than three decades since the venom of HIV first stung through the first victim. Since then millions of people have died. On the front line are children, women and men, who on a daily basis battle the virus, with the hope that one day in their lifetime the battle will be won. Hope also resonates in the minds and hearts of thousands of medical practitioners, teachers and researchers who have made it their mandate to battle this unrelenting enemy. With tears of hope, they roar like lionesses defending their cubs; they cry out, ―A luta continua8.‖ In the middle of the battle, the researcher paused and reflected: will these weapons yield desired results?
In this explorative chapter the researcher enters into discourse with researchers in search of a response to the question, why do HIV and AIDS remain elusive? In this discourse a comprehensive look at the cost of having HIV and AIDS in the current generation is provided, together with a glimpse at what the future holds. In this regard the researcher explores the impact of HIV and AIDS on the education system. The researcher then surveys literature to determine the effectiveness of current educational mechanisms used to derail the spread of HIV. Here strategies that are currently used to limit the spread of HIV and AIDS are compared with factors that influence the spread of HIV and AIDS. Thereafter the researcher examines literature on other health-related issues, particularly health education. This is done in order to understand why health education would fail to produce the desired outcomes. Such an understanding could provide lessons for HIV and AIDS education. In the end the researcher argues that some strategies used to battle HIV and AIDS, are probably not effective enough to address the urgent and most effective reasons responsible for the spread of HIV and AIDS, such as behaviour transformation. Given this, a question is asked: can the school Life Sciences curriculum provide an effective solution?

The educational cost of HIV and AIDS

The impact of HIV and AIDS in society cannot be ignored. However that does not mean it should be watered down either. In this regard the researcher argues that the cost is too high for solutions to yield average or even below average results. For example since the 1980s, the number of people infected with HIV has been increasing drastically. As stated in Chapter 1, about 33 million people from six continents of the world are infected with HIV and AIDS (UNAIDS, 2010; UNAIDS, 2006). By the year 2009 5.6 million South Africans were infected with HIV and about 1400 new infections occurred every day (UNAIDS, 2010). According to Dorrington et al. (2006), in South Africa alone the virus was most prevalent (that is, 33%) among women aged between 25 and 29 years. This in turn had caused over 1.5 million children under the age of 18 to become orphans. Furthermore in 2006 alone, it is estimated that there were 950 AIDS related deaths every day (Dorrington et al., 2006). In this regard 71% in deaths of the age group 15 to 49 were AIDS related.
Because of the HIV and AIDS pandemic, since 1990, the life expectancy in South Africa has dropped dramatically from 62 to 46 years. Dorrington et al. (2006) report that there is a 56% chance that a South African 15-year old will die before the age of 60. Anderson and Beutel (2007) cite a report that suggests that in 2005 10.3% of the youth aged 15 to 24 in South Africa were HIV positive. With this prevalence in the youth, Bennet et al. (2006) believe that by the year 2020, over 29 million people in the Sub-Saharan region will be infected with HIV and 10 million deaths would have occurred.
Given the high number of HIV infections, it is clear that sectors such as the education sector are the most affected (Bunnell, 2003; Grassly, Desai, Pegurri, Sikazwe, Malambo, Siamatowe Bundy, 2002). Besides loss of life within schools, reports of psychological distress and socio-economical distresses have been widely reported (Manase, Nkuna, & Ngorima, 2009; Ssewamala, Ismayilova, McKay, Sperber, Bannon & Alicea, 2009; Ssewamala, Alicea, Bannon & Ismayilova, 2008; Cluver, Gardner & Operario, 2007; Lachaud, 2007; Grassly, Desai, Pegurri, Sikazwe, Malambo, Siamatowe, & Bundy, 2003; Bennell, Hyde & Swainson, 2002; Hyde, Ekatan, Kiage & Barasa, 2002; Kadzamira, Swainson, Maluwa Banda & Kamlongera, 2001). Because of the psychological and socio-economical distress both the supply and demand of education are affected (Coombe, 2000). For example Bunnell (2003) reports that in the near future, student intake will be lower starting with primary schools through to tertiary education. Bunnell (2003) suggests that this low student intake is because of high infant and adult mortality as well as increased poverty among HIV and AIDS affected households. Scholars (Bunnell, 2003; UNICEF, 2000) also suggest that within the next two decades, there might be a high mortality rate among teaching staff which will in turn affect the schooling system. Besides deaths, researchers also indicate that the rates of teacher absenteeism due to prolonged and regular illness is expected to increase (Bunnell, 2003; Grassly et al., 2002). In addition reports suggest that HIV and AIDS orphans and other HIV and AIDS affected students are expected to suffer an increased emotional instability (Cluver, Gardner & Operario, 2007).
Due to psychological and socio-economical distresses reports also suggest that students‘ vulnerability to HIV and AIDS could increase (Bhargava, 2005; Atwine, Cantor-Graae & Bajunirwe, 2005). For instance studies have shown that when in deep financial and emotional distress, some students may rely on unsafe sexual activities and drugs both for financial gain and emotional comfort (Bhargava, 2005).
The above conversation indicates that the impact of HIV and AIDS in society is immense. An apparent question is, given the length of time that HIV has been known to human kind, why has humanity failed to stop HIV and AIDS? In search of an answer to this question, the researcher explored some educational strategies that are currently used to counteract the spread of HIV and AIDS.

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Educational weaponry against HIV and AIDS

The purpose of this section is to provide a picture of educational strategies that are used to counter the spread of HIV and AIDS, and also to determine the effectiveness of such strategies. Such a look will inform the assessment of HIV and AIDS education in Life Sciences in response to the research questions of the study.
HIV and AIDS education is a complex, multidisciplinary subject. Scholars have partitioned HIV and AIDS education into specific areas with specific goals, in order to improve effectiveness in minimizing the impact of HIV and AIDS. For example HIV and AIDS education can be taught within formal school curricula or outside of formal curriculum. These educational strategies are used to present scholar academic, social efficiency, student-centred and social reconstruction knowledge. In the previous chapter the researcher engaged the complexity of curriculum ideologies in relation to behaviour transformation. Therefore, as implied in Chapter 2, basing HIV and AIDS education for behaviour transformation on any one ideology would require a clear curriculum framework.
Within the scope of HIV and AIDS education, the idea of curricular versus non-curricular strategies presents yet another dimension. Both these strategies have their own complexities, advantages and disadvantages, making it difficult to decide which method is more effective for leading to behaviour transformation than another. The complexities are compounded by the fact that there are numerous factors that affect the spread of HIV, such as behaviour, gender, stigma and discrimination and human rights. Based on the views presented in Chapter 2, the researcher believes that both strategies would be more effective in fostering behaviour transformation if they are able to integrate knowledge into the social context. Curricular strategies would however require a meticulous integration strategy in order to be able to address socialization as well as behaviour transformation. To substantiate these views, the researcher will first discuss curricular-based HIV and AIDS education. Thereafter non-curricula strategies will also be discussed.

Integration of HIV/AIDS knowledge into curricula: current trends

In an attempt to address HIV and AIDS in South Africa, the Department of Health (2000) instituted an HIV and AIDS/STD strategic plan. This plan led to the development of an HIV and AIDS policy which makes HIV and AIDS education a component of the curricula of all secondary schools. The policy also suggests that schools be made places where youth can access friendly and supportive counselling services related to HIV and AIDS. Previous research also supports the implementation of HIV and AIDS education at secondary school level (Anderson & Beutel, 2007; Fawole et al., 1999). Page et al. (2006) also support this view as schools have the largest number of adolescents who are sexually active.
While suggesting that students be educated concerning HIV and AIDS, the South African government has not given any clear indication of how this should be done (Page et al., 2006). Some researchers argue that students‘ preferences and experiences should inform HIV and AIDS curriculum design (Page et al., 2006; Griessel-Roux, Ebersöhn, Smith & Eloff, 2005). This is in line with Anderson and Beutel‘s (2007) suggestion that HIV and AIDS education might be more effective if tailored to specific groups, which have been found to have different views and experiences with HIV and AIDS.
Although some researchers recommend HIV and AIDS education for secondary schools only, Van Laren (2008) suggests an integrating HIV and AIDS education throughout the functioning of education. Van Laren (2008) also points out that there is a need for interdisciplinary collaboration in teaching about HIV and AIDS. However she cautions that interdisciplinary collaboration will be complicated by curriculum reform. For example adding new content may mean recurriculating as well as redistribution of teachers and resources.
To prevent costly curricular reform, UNESCO (2006) suggests an integration of HIV and AIDS knowledge into an already existing subject, such as Life Sciences. In this regard HIV and AIDS knowledge is added as extra content knowledge into the curriculum. This method is cost-effective in that the same group of teachers of the mother subject are the ones who teach HIV and AIDS content. However the danger here is that HIV and AIDS knowledge could be taught from a particular curriculum ideology which may jeopardize the intended HIV and AIDS outcomes. For example teaching HIV and AIDS content from a scholar academic ideology could limit behaviour transformation as an outcome. Another problem with integrating HIV and AIDS into an existing curriculum is that there may not be enough time (and other resources) to give information on HIV and AIDS because of the need to address other topics as well. Furthermore some teachers may be hesitant to deal with HIV and AIDS information (and sexuality education) due to cultural and religious beliefs.

Abstract 
Declaration
Dedication 
Acknowledgements 
List of Tables
List of Figures
1. CHAPTER 1: PRELUDE TO THE STUDY
1.1 Challenges for HIV and AIDS education in South Africa: A problem statement
1.2 The research context: conceptualization
1.3 Rationale for the study
1.4 Assumptions about knowledge and behaviour
1.5 Locating the discourse of the study in the literature
1.6 Aims of the study
1.7 Research question and subquestions
1.8 Theoretical approach of the study: a conceptual framework
1.9 The researcher as a research instrument
1.10 Conclusion and implications of the study to the body of knowledge.
2. CHAPTER 2: EXPLORING THE CURRICULUM-BEHAVIOUR TRANSFORMATION RELATIONSHIP 
2.1 Introduction .
2.2 Curriculum challenges can be resolved
2.3 Curriculum challenges
2.4 Selection of content knowledge
2.5 Resolving the curriculum-behaviour transformation dilemma
2.6 Implications for the current study
3. CHAPTER 3: A LUTA CONTINUA: THE BATTLE AGAINST HIV AND AIDS 
3.1 Introduction
3.2 The educational cost of HIV and AIDS .
3.3 Educational weaponry against HIV and AIDS
3.4 The enemy redefined: factors affecting the spread of HIV
3.5 Why does health education fail? Lessons for HIV and AIDS education
3.6 Implications for the study
4. CHAPTER 4: METHODOLOGICAL APPROACH TO THE STUDY 
4.1 Introduction
4.2 Justification of methodological and metatheoretical paradigms
4.3 Methodology for research subquestion 1
4.4 Methodology for research subquestions 2 and 3.
4.5 Conclusion
5. CHAPTER 5: HIV AND AIDS KNOWLEDGE FOR BEHAVIOUR TRANSFORMATION IN THE BIOLOGY CURRICULUM
5.1 Introduction
5.2 Results
5.3 Making sense of the results: reflecting on literature
5.4 Conclusion
6. CHAPTER 6: HIV AND AIDS KNOWLEDGE AND BEHAVIOURAL PREFERENCES OF STUDENTS
6.1 Introduction
6.2 Results
6.3 Making sense of the results: reflecting on literature
6.4 Conclusion.
7. CHAPTER 7: IMPLICATIONS OF THE STUDY FINDINGS: AN EPILOGUE
7.1 Introduction
7.2 Revisiting the research subquestions with the major findings
7.3 Recommendations for further research
7.4 Recommendations for Life Sciences curriculum development and HIV and AIDS education
7.5 Conclusion: there is a need for social reconstruction
REFERENCES 
APPENDICES

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