Education is the key prevention tool

December 12, 2012 — Joško Miše, Journal of Global Health

While discussing HIV prevention methods and sexuality education for young people with a youth officer working in one of the top UN agencies involved with fighting the HIV epidemic, I was told, "Yes, what you say is true—education for young people is very important. But you can’t measure early enough the impact of sexual education on HIV. If we start with the sexuality education programmes, we can measure their impact only after 5–10 years."

This made me wonder about how it seems much more convenient to count the billions invested in treatment while hoping that everyone will be provided with treatment, rather than to count how many people who are educated about sexuality, sexual and reproductive health rights, and HIV/AIDS, changed their behavior as a result, and how this affected the HIV epidemic. But is this appropriate?

In many high-income countries, a high percentage of people living with HIV are currently undergoing treatment, which is readily available. However, does putting everyone on treatment mean we can say that we have won the fight against the epidemic? New data shows that in countries where treatment is highly available, certain groups of the population have shown an increase in the number of HIV infections. An increasing amount of people seem to have the mindset that even if one contracts HIV, the treatment is easily accessible and therefore one can achieve normal life expectancy simply by taking one pill a day. This increase in the number of new HIV infections results in an increased need for the production of medication, which in turn increases the need for people investing in these treatments. And the circle is closed. However, will this solution work in the long run? Can we continue to simply invest in treatment for years to come, and claim that victory is ours? In my opinion, this is not a solution and that as important as treatment is, we also need more prevention. The only effective way to eliminate HIV is to also focus on incorporating prevention measures.

When we talk about HIV prevention, not everything is clear-cut. Most people immediately link prevention with condoms, and the general consensus is that if we provide everyone with condoms, we immediately eliminate the risk of HIV transmission. Again, this misconception is because of emphasis on numbers—it is easy to count how many condoms we produce and distribute to at-risk populations. However, my experience in community activism tells me otherwise. It is dangerous to assume that everyone who has access to condoms actually uses them. Even in my immediate surroundings, there are many people who know the potential threats of HIV/STIs yet do not use condoms. The fact that people who have, at the least, basic knowledge about the importance of condoms, rarely or never us them, leads me to wonder about what young people in countries like sub-Saharan Africa would do when provided with condoms from organizations and NGOs without access to education and information.

Thinking about why that is the case brings up two questions that people who provide condoms might be overlooking: how to use a condom and why to use a condom? I asked myself the same questions not that long time ago when I was a teenager. In the first case people might be informed and motivated to use condoms but not know how to do it. In the second case of why, people might have the proper knowledge about condom use but might miss strong emotional or intellectual reasons as to why they would want to practice such behavior of using condoms.

Education is a key prevention tool. This does not just include educating people on how to use a condom, but providing comprehensive education addressing, values, attitudes, gender equality, maternal health and even family planning. I believe it is the only effective way to achieve behavioral change and adopting safer sexual practices, which will lead to a significant and much faster decrease in the number of people newly infected with HIV. This type of comprehensive sexuality education is needed. But we see very small efforts being made in respond to that need.

Many countries currently don’t have comprehensive sexuality education as a part of their curricula nor do they support youth-led voluntary organizations that in some countries are the only ones leading sexuality education programmes. There could be several reasons for that – societies that cherish family and Church values; governments and ministries that fail to respond to the needs of young people; and UN agencies who do recognize the need and importance for sexuality education but fail to provide proper support in advocating for the inclusion of sexual education programmes in schools, in acknowledging the power of youth led organizations who are providing education to their peers on a voluntarily base. These are the reasons that contribute to why young people age 16–24 are disproportionately affected by HIV leading to 3000 young people becoming infected with HIV daily.

Recently Hillary Clinton said that we could achieve the first AIDS free generation—I believe it can happen, but it could have happened much earlier if young people were given proper education about HIV/AIDS, sexuality and sexual and reproductive health rights.

At this point in the epidemic, it is time to support prevention methods more than ever. Is it by re-allocating the money invested in AIDS to support the prevention methods that prove to be effective on a long-term plan? Perhaps it is. But one thing is clear—it is time to acknowledge the importance of comprehensive sexuality education and to empower young people in becoming the center of the HIV prevention.

Joško Miše is the Director on Reproductive Health including AIDS 2011/2012 for the International Federation of Medical Students’ Associations.

(article taken from www.ghjournal.org)