African Universities Responding to the Challenge of HIV and AIDS

1. African Universities Responding to the Challenge of HIV and AIDS Uganda Martyrs’ University 18th February 2009 mjkelly@jesuits.org.zm

2. Severity of the AIDS Crisis • HIV and AIDS have been with us for over 100 years, today’s epidemic for nearly 30 years • Since the early 1980s they have continued to expand at an ever-faster rate in every continent • Prevalence has risen to heights that once were thought impossible – for example, in Lesotho, about 40% of those aged 35 to 40 are infected with HIV • Prevention programmes have brought some but only limited success • Anti-retroviral therapy is bringing huge benefits to about 4 million people (the Lazarus effect), but faces massive problems in reaching all who are in need

3. Global HIV Dynamics, 2007 New HIV infections 2.7 million PLWHA 33.0 million AIDS-related deaths 2.0 million PLWHA = Persons Living with HIV or AIDS

4. Some HIV Estimates for Uganda • Adult HIV prevalence rate: 6.3% (women 7.3%, men 5.2%) • Prevalence rate among 15-24 year-olds: 4.3% in women, 1.1% in men • 43% of new infections come from ‘low-risk’ discordant couples • 44% of new infections come from those who have multiple sex partners • Sexually active persons reporting multiple partners: women 3.7%, men 28.5% • Receiving ART: 115,000 out of 350,000 in need (33%) 4

5. Why Did the Global EpidemicGet Out of Hand? • Insufficient leadership, vision, sense of urgency, commitment at all levels, coupled with epidemic-enhancing global structures • The silent epidemic – unnoticed, denied • Attention focused on the immediate causes and manifestations but failed to address the contexts of income inequalities, gender & human rights abuse • Insufficient attention to youth needs • Lack of sensitivity to and conflict with cultural and religious perceptions and values • Pervasive stigma and offensive discrimination

6. Our Responsibility • As educators we have a responsibility to the present and future generations to put a permanent end to this disease and its numerous negative consequences • We do that by taking steps to ensure • Sustained education • More education • Better education • Education content and systems that are responsive to the epidemic

7. The Mandate of a University • The heart of a university’s business is knowledge • “Intellectual imagination, energy and experience are a university’s stock-in-trade; these are our biggest business assets and we are determined to focus these assets on the concerns of the world around us” (ACU) • Society expectsa universityto • expand and generate knowledge through research • develop, elaborate and evaluate it through study • transmit it through teaching and training • disseminate it through publications and conferences • promote its utilization through engagement with those inside and outside the university world

8. Why Every Higher Education Institution Must Respond • No institution is immune – above all those that engage a large number of persons, many of them young • The long lead-time between becoming HIV infected and manifesting what we call AIDS affects students and staff differently (mostly, AIDS tends to manifest itself in students after graduation, in staff while they are in service) • This can affect institutional functioning and the attainment of institutional objectives. It can also have an impact on costs, especially for training • Personal and family concerns arising from HIV or AIDS can interfere with teaching and learning activities and inhibit quality performance

9. Why Every Higher Education Institution Must Respond (2) • The AIDS-affected Ugandan society needs the special kind of help that only its universities can give • A university has a special responsibility for the development of professional human resources • A university should be a key agent of change and provider of leadership within Ugandan society • It should be the dynamic source for new intellectual, cultural, philosophical, theological, linguistic, scientificunderstandings of the disease • It has the multidisciplinary intellectual capacity to consider in depth the complex human rights, legal, and ethical issues raised by AIDS • The epidemic and its impacts will be part of the social scene in Uganda for generations to come

10. Critical Response Elements • Need to recognize that HIV and AIDS are vital university matters that demand a coordinated university response • Two aspects to the response: • Protect the university’s own functioning as an AIDS-affected institution (put on its own oxygen mask) • Serve the needs of a Ugandathat is very seriously affected by HIV and AIDS (help others to put on their oxygen masks)

11. What the AIDS-affected Ugandan Society Might Say to a University • Protect your staff, your students, and your institutional self against infection, and counteract the negative institutional impacts of the epidemic – otherwise you will be less well able to help others • Provide the trained and skilled personnel needed across society, in the numbers and areas that are needed, and with an understanding of the epidemic and a commitment to defeating it

12. Further Words from Ugandan Society to a University • Learn to know the disease better, to understand it in all its dimensions, and bring that knowledge to bear on the development of solutions, interventions and programmes that will generate hope • Share your knowledge, your understanding, your time, and your expertise with those who do not belong to the institutional community, and learn from them, so as to identify jointly with them what has to be done to control and roll back HIV and AIDS

13. Universities Responding to HIV and AIDS

14. The Global Response of Universities to HIV and AIDS • UNESCO survey of universities in Africa, Asia, South America and the Caribbean • Discouraging findings: • Institutions know little about how HIV is affecting them • Institutionalising an HIV response appears as something quite new, poorly understood, and not happening in an effective sustainable way • HIV and AIDS initiatives mostly sporadic, uncoordinated and dependent on the initiatives of a few dedicated staff and students • HIV and AIDS seen to be relevant to only a few professional areas, but not to the future professional, personal and community life of every student

15. How HE Institutions in Africa Have Responded to the Epidemic • Various indicators show considerable impacts on Higher Education institutions – loss of staff and students, reduced productivity, direct and indirect costs, strain on facilities and services, and ultimately on quality of services • Reports from more than 80 universities in 12 countries show • Between countries, institutions are at different stages in terms of their response to the epidemic • There are pronounced differences in institutional responses even within the same country • There is an absence within the institutions of systematic studies to assess impacts and risks

16. Positive Developments • Increasing stimulation from supra-institutional bodies: AWSE, AAU, ACU, ADEA, UNESCO, UNDP, Vice-Chancellors’ Associations, etc. • Growing number of institutions have HIV policies • Capacity building efforts, such as AAU’s training programme for senior university managers (SUMA); UNESCO and AWSE workshops; UNDP TOT and mainstreaming programmes • Policy in some universities requires inclusion of HIV and AIDS in core teaching, research and service activities, though curriculum integration remains weakest element • Considerable amount of research, though often uncoordinated and not yet according to a locally conceived agenda • Increase in provision of prevention services, partnerships (local and international) and outreach programmes

17. Slowness of the Higher Education Response to HIV and AIDS • Higher education responses to the AIDS pandemic leave much to be desired • Many institutions are doing practically nothing in terms of tangible responses • Little obvious realization among staff that their institutions should be at the forefront of the response • Institutional responses are reactive rather than proactive, ad hoc rather than systematic • Few institutions accord a high level of priority to responding institutionally to HIV and AIDS

18. University Teaching, Research and Outreach • Core programmes have not adequately integrated HIV and AIDS • Integration into curricula has largely been the domain of health science or medical faculties, or dependent on the personal commitment of individuals • HIV and AIDS research is accidental rather than systemic, individual rather than institutional, externally induced rather than internally initiated • AIDS-related community and outreach programmes are not being vigorously embarked upon • Universities are not willing to sell themselves or are seen as being too costly, and are not prominent in work with governments or other external agencies

19. Focus of HIV and AIDS Initiatives within Universities • The involvement of staff (particularly academic staff) in HIV and AIDS response initiatives is very small • Students appear more strongly at the centre of whatever little activity there is • Academic staff have not sufficiently felt the urgency of responding within their programmes • Capacity building programmes have been supply-driven and resource-constrained • An HIV or AIDS intervention is considered as an added activity but is not well mainstreamed within a university’s life

20. Components of the University of Zimbabwe Policy • The rights and responsibilities of students and staff infected oraffected by HIV/AIDS • The integration of HIV/AIDS into teaching, research and serviceactivities of all University Faculties and Institutes • Provision of prevention care and support services on the Universitycampus including appropriate referrals • Implementation, monitoring and review of the Policy • Creation and maintenance of an enabling environment within theUniversity that supports positive behaviour change regarding HIVprevention, care, and support including stigma reduction

21. Components of the University of Zambia Policy • Obligations of the University Council • Responsibility of university senior administration • Rights of members of staff • Rights of students • Responsibilities of members of staff and students • Teaching and research • Information, education and communication • Counselling and supportive care • Community engagement

22. The Challenge to Uganda Martyrs’ University

23. Questions for Uganda Martyrs’ University • Does Uganda Martyrs’ University take deliberate steps to protect (a) its staff and (b) its students against HIV infection? • Have HIV and AIDS been adequately integrated into core teaching programmes? • To what extent is this left to individual lecturers, and to what extent is it a matter of institutional policy? • Are activities mostly student-driven and student-orientated? • Do academic and other staff recognize that they must act as a matter of urgency, to protect the institution, one another and themselves?

24. Further Questions about the UMU Response to HIV and AIDS • Where there is teaching about the epidemic, is the focus on facts and scientific knowledge or is it on engaging the whole person? • Have there been systematic programmes to build the capacity of staff (a) to teach in this area, (b) to create an institutional climate that will work against further HIV transmission? • Where there is research, is it individual or is it rooted in Departments and Faculties? Do the Departments proactively initiate research or do they mostly respond to proposals from outside?

25. Capacity Building • Are there programmes to build the capacity of staff to • Know more about HIV and AIDS? • Deal with the epidemic personally in their own lives? • Help them develop a professional understanding of the epidemic in their area of expertise? • Are capacity building programmes planned and delivered systematically, or are they mostly supply-driven and resource-constrained?

26. UMU as a Source of Professional Expertise • One of this University’s major responsibilities is to prepare the professional and skilled personnel that society and the economy in Uganda need • HIV and AIDS constrain ability to do so • in the numbers needed • with the necessary quality • The epidemic may make it necessary • to increase numbers in certain areas (teaching, social sciences, social work, demography, …) • to prepare professional and skilled personnel in new areas (bereavement counselling, the science and management of HIV and AIDS, early childhood issues, …)

27. AIDS-Competent Graduates • To meet society’s needs in a Uganda that is still heavily infected with HIV, graduates from every Faculty in the University need to be competent to deal with the disease and its impacts, personally in their own lives and professionally in their area of expertise • Graduates should be AIDS-competent • AIDS-competence means that the graduate has a theoretical and practical understanding of the epidemic, appropriate to the programme of study being undertaken, and its implications for his or her future career

28. Conclusion

29. Promoting a Comprehensive UMU Response to HIV/AIDS • Absolute need for sustained, committed top level leadership that manifests itself in • a strategic planning and policy development approach • the commitment of resources • the establishment of the necessary implementation structures within an appropriate institutional framework • agreement on realistic targets and the development of monitoring and evaluation procedures • meaningful efforts to eradicate all forms of HIV denial, stigma and discrimination, and to induce openness • Important that there be university-wide ownership of all policies, with involvement of all sectors of university community

30. Fundamental Principles for Every Institutional Response to HIV and AIDS • Openness and acceptance that breaks the silence that surrounds HIV and AIDS • Promotion of gender equity and empowerment • Adoption of a strong human rights approach • Inclusion at all levels of PLAs • Fits well within the framework of national policies and strategies

31. Lessons Learned from Other Countries • Leadership is vital: where Vice-Chancellors, Deans and other academic leaders make AIDS a priority, there are immediate and visible results • Sustained advocacy from well placed committed champions can quickly transform the situation • Involvement of academic staff is crucial • Student involvement enhances effectiveness • Institutionalising an effective AIDS-response in and through higher education requires long-term commitment and sustained efforts

32. The Addis Ababa Consensus on Leadership • Success in overcoming HIV and AIDS demands an exceptional personal, moral, political and social commitment on the part of every African • Leadership in the family, the community, the workplace, schools, civil society, government & at an international level is needed to halt the preventable spread of HIV and AIDS & to provide a decent life for all the citizens of Africa • Each and every one of the leadership acts necessary to prevent HIV/AIDS, and to help those living with HIV, without exception, are things we want anyway for a better, more developed Africa, and must be implemented in full and without delay

33. Leadership is Central • The first pre-requisite for a successful response to HIV and AIDS is dynamic, sustained, publicly manifested, resource-backed and action-backed leadership • In the absence of such leadership, the success and sustainability of the response will be less certain • This leadership must be at all levels, from the grassroots up to the highest political level • “This leadership needs to be the boldest, most persistent, most insightful, compassionate, forceful, cooperative and imaginative we have ever had” • “It must be leadership not only to do what is right in education, in health care, in economic support, but to do what is right on the proper scale” (ADF, 2000)

34. Thank you