Background HIV in the Caribbean The University of the West Indies

1. HIV and Caribbean Education:HIV education in the second most severely affected region on earthDavid PlummerCommonwealth / UNESCO Chair in Education (HIV/AIDS)School of Education The University of the West Indies Trinidad and Tobago

3. Background • HIV in the Caribbean • The University of the West Indies

4. Why target young children, given that AIDS is largely a disease of sexually active adults?

5. Figure 1.Cumulative HIV infections in the Bahamas by age and sex to end 2005 (UNGASS 2006d)

6. Sexual debut before the age of 15 • one quarter of 15–29 year-old women in Barbados • just over 30% of young men and around 12% of young women in Guyana • 63% of young men and over 37% of young women in SVG • 28% of young men and 12% of young women in Haiti • (Source: UNAIDS/WHO, 2005; UNGASS 2006)

7. Are widespread protective behaviours realistic, given that sexuality is so deep seated?

8. Figure 2.The number of new cases of HIV per year in Australia (1980-1993) (Plummer & Irwin 2006)

9. Does sex education work, or will it simply worsen the situation?

10. Table 1.Number of studies reporting effects on different sexual behaviours and outcomes by study setting (Kirby, Laris & Rolleri 2006)

11. Gender • ‘Feminisation’ of the epidemic • Is poverty an adequate explanation? • Is ‘disempowerment’ an adequate explanation?

12. Gender • Who is missing? • Masculine obligation & taboo • Hard masculinities • Educational outcomes for boys

13. The resilience of risk • Gaps between awareness, accurate knowledge and behaviour • Risk as a resilient socially-embedded phenomenon

14. Embedding risk • Gender roles • Peer group policing • Stigma and discrimination • Economic factors • Mixed messages • ABC and the missing ‘D’ • Role of the health sector?

15. Re-visioning HIV • Reject the pervasive bleak and blinkered visions of HIV • Rediscover our common ground • Cultivate visions of a better world that have been crafted not in spite of AIDS, but because of it

16. Deepening our understanding • in order to deepen our response • Prevention • Stigma & discrimination • Gender • Impact & implementation

17. The tertiary education sector • Proactive leadership • Reconnect the academy with society • Comprehensive engagement with the epidemic

18. Recent Caribbean initiatives • Joint initiative between UNESCO, WB and UWI to deepen the regional educational response • CARICOM COHSoD ‘Port of Spain Declaration’ on the Education Sector’s Response to HIV and AIDS • Professionalisation of HIV & health and human relationships in the education sector • Teacher training: regional Masters in Education (Health Promotion) • ILO / UNESCO workplace strategy

19. Acknowledgements People with HIV, people at risk & people working with HIV The University of the West Indies UNESCO Paris & Kingston, Jamaica The Commonwealth

20. Thank you

21. Points for action • Review sex education programs elsewhere to identify best practice and reasons for negative outcomes • A deadline is needed for universal coverage of sex education • Curricula should be revisited and adjusted to ensure adequate HIV focus • Additional HIV content should be added to school curricula outside of HFLE • Additional attention should be directed to extra-mural, informal and peer-based education settings • Social dimensions that serve to entrench HIV (e.g. peer group dynamics, gender roles, stigma and discrimination) should be addressed • Constant reinforcement will be required • HFLE needs professionalising and solid academic foundations

22. Summary: 5 key recommendations • Strengthen HFLE and set a timetable for universal coverage • Develop an HIV education strategy which goes beyond HFLE • Develop an HIV education strategy beyond the school walls • Professionalise HIV/HFLE/School Health Promotion • Build the academic foundations for School Health Promotion

23. Feminisation of HIV • HIV infection was found to be six times higher among 15–19 year-old females than among males of the same age in Trinidad and Tobago • women under 24 years were almost twice as likely to be HIV positive than among males of the same age in the Dominican Republic • teenage girls were found to be two-and-a-half times more likely to be HIV-infected, compared to their male counterparts in Jamaica • Survey data on the age of sexual debut • and HIV risk in Caribbean countries • (Source: UNAIDS/WHO, 2005; UNGASS 2006)

24. gender Sex before 15 2005 (age 15-24) M F Barbados 35.9 25.6 Dominican Republic 18.0 13.0 Saint Vincent and the Grenadines 63.0 37.0 Median age at first sex Jamaica 19.5 20.5 Non-marital, non-cohabiting sexual partner in recent 12 months (age 15-24) Barbados 26.6 15.9 Dominican Republic 83.0 29.0 Jamaica 89.0 77.7

25. gender Comprehensive HIV knowledge (age 15-24) M F Both Cuba 40.2 56.2 Dominican Republic 33.0 23.0 Haiti 24.0 8.0 Trinidad and Tobago 33.0 Guyana 35.2 36.4 Suriname 21.0 6.8 Jamaica 22.8 46.7 Condom the last time they had sex with a non-regular partner (age 15-24) Barbados 77.8 33.3 Dominican Republic 48.0 12.0 (2003) Dominican Republic 52.0 29.0 (DHS) Haiti 30.0 19.0 (2003) Jamaica 38.0 (2003) Jamaica 74.4 62.7 (2005)

26. Basic considerations • The paradoxes of gender and education in the Caribbean • The resilience of risk • Setting a research agenda for HIV in education • Re-visioning HIV • The tertiary education sector • Caribbean initiatives

27. Masculine obligation and taboo Obligations are identity related and peer policed and provide a constant pressure to engage in risk Taboos have their origins in homophobia and proscribe a range of activities, including many related to health and safety Obligations and taboos is concert underwrite: a range of risk taking activities boys educational achievement sexual praxis gender relations peer, clique and gang codes hypermasculinity and criminal engagement