Effects of HIV/AIDS and Interventions to Mitigate the Epidemic at Public Primary and Secondary Schools in Addis Ababa, Ethiopia

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Addis Ababa University


Background Globally, HIV/AIDS is one of the most profound developmental challenges faced in the human history. Despite the fact that the epidemic is affecting almost all development sectors, it is widely asserted that the education sector has been profoundly affected. The effects of the epidemic on the education sector are complex. In its current disposition, education remains the most human intensive public sector in Ethiopia. Cumulatively, the sector has a total of 17,413,176 students, 314,524 teachers and more than 80,000 non-teaching staff (constituting a total of more than 24% of the country’s population). Mitigating the effects of HIV/AIDS on the education sector is especially important, since this sector trains all public servants. Moreover, it is crucial to provide all concerned at different levels with some research based and up-dated data on the effects of HIV/AIDS on the education sector and interventions to mitigate the epidemic for evidence based prevention, control, and care and support programs. Objective of the study: To assess the effects of HIV/AIDS and interventions against the epidemic with particular emphasis on the public primary and secondary schools in Addis Ababa, Ethiopia Methodology: This study consisted of community and school based longitudinal, cross-sectional and quasi experimental study designs which were conducted among teachers and students at public primary and secondary schools in Addis Ababa in the year 2012/13. The selection of schools was conducted in three phases: 103 primary and secondary schools in phase I, 30 secondary schools in phase II and 4 secondary schools in phase III. The selections were done randomly in Phase I and II and purposively in Phase III. Furthermore, triangulations of various methods of data collection were used to increase the validity of the study. For the specific objective I or assessing the trend of mortality among teachers in the era of HIV /AIDS a longitudinal study with a verbal autopsy approach was used. But for the specific objectives II, III and IV or examining the proportion of students who lost one or both parents due to HIV/AIDS related causes, investigating factors associated with HIV Counselling and Testing /HCT/ among xiii secondary school students, and assessing factors associated with HCT up-take and its correlations with risky sexual practices among primary and secondary school teachers in Addis Ababa a cross- sectional study design was used. In addition, for the specific objective V or examining the effects of school- based HIV prevention interventions on sexual behaviours of students at secondary schools a quasi-experimental study design was used. Sampling techniques and sample sizes varied as per the five different, but practically interrelated specific objectives in order to address each of them effectively and adequately. Data collections were conducted by 12 diploma graduate nurses under the supervision of 2 senior health professionals and the principal investigator. Data were entered first into Epi-Info software, version 3.5.4 for cleaning and were transported to SPSS software version 20.0 for analysis. Various statistical methods, including descriptive statistics, Chi squared test and multiple logistic regressions were used to show the magnitudes of the problems and the relation-ships of different factors with the effects of HIV /AIDS and the interventions to mitigate the epidemic by controlling various confounders at the same time. Results As the verbal autopsy data of deceased teachers demonstrated the proportionate mortality ratio between the total and HIV/AIDS related mortality declined from 0.33 to 0.18 during the first two years (Nov.2005-Oct.2007) and the last two years (Nov.2012-Oct.2013) of the study period, respectively. The decline in the HIV/AIDS related mortality was statistically significant with Mantel Haenszel Chi-square=7.04(P<0.01) (Paper I). The overall prevalence of parental death among secondary school students was 347(17.8 %) 95% CI (16.2%, 19.6%) and the HIV/AIDS proportionate mortality ratio was 28% (97/347) A multivariable binary logistic regression analysis demonstrated that high HIV/AIDS related knowledge (AOR= 0.39 ; 95% CI, 0.18-0.84), positive attitude towards HIV prevention methods (AOR=0.48 ; 95% CI, 0.23-0.97) , being tested for HIV (AOR= 0.52 ; 95% CI, 0.31-0.87) and chewing Khat (AOR= 2.59 ; 95% CI,1.28-5.26)] were significantly associated with having xiv multiple sexual partners among both orphaned and non-orphaned secondary school youths (Paper II) . In addition, the proportion of secondary school students who were never tested for HIV was 761/1948 (39.1%), with 95% CI (36.3 -41.8 %). Of those who were never tested, 820 (69.4%) with 95%CI, (66.3%- 72.5%) reported their willingness to go for HCT within two months after the survey (Paper III). A multivariable binary logistic regression analysis showed that age being >18 (AOR= 2.64 ; 95% CI, 1.46-4.77) and having multiple sexual partners in the previous year (AOR= 2.08 ; 95% CI, 1.21-3.57 were positively associated with being ever tested for HIV (paper III). As the comparative cross sectional study /Paper IV/ indicated, the proportion of teachers who had ever been tested for HIV was 739/1034 (71.5%) with 95% CI (69.1% -74.2 %). Multivariable binary logistic regression analyses showed that male teachers (AOR=0.63 ; 95% CI, 0.44-0.90) had lower chance of being ever tested for HIV compared with female teachers. Married teachers (AOR=0.30;95% CI,0.19-0.47) also had lower chance of being ever tested for HIV compared with unmarried teachers. Age being >45 (AOR= 4.05 ; 95% CI, 1.82-9.03) , high HCT related knowledge (AOR=3.56;95% CI,1.73-7.32) and perceived risk of HIV AOR=1.43; 95% CI,1.04-1.96) were positively associated with determinants of HCT. Regarding factors associated with HIV Counseling and Testing, teachers who never had HCT were more likely to have multiple sexual partners than their counterparts (AOR=1.85; 95% CI, 1.08-3.15). In contrast, those teachers ever tested for HIV were less likely to use condoms consistently compared to those who were never tested (AOR=0.55; 95% CI, 0.32-0.96 (Paper IV). The quasi-experimental study (Paper V) showed that students in the peer education intervention group were more empowered compared to the control group. Comprehensive knowledge of HIV xv (P-Values =0.004) and willingness to go for HIV counseling and testing (P-value= 0.01) demonstrated significant differences among intervention group during post intervention period. Students in the intervention group were more likely to use condoms during post intervention period compared to students in the control group [AOR=4.73 (95% CI (1.40-16.0)] (Paper V) Conclusions  The findings of this study have demonstrated a statistically significant decline in the total and HIV/AIDS related mortality between November 2005 and October 2013 among teachers at public primary and secondary schools in Addis Ababa.  Significant proportion of secondary school youths lost at least one parent due to various causes including HIV/AIDS. High knowledge of HIV/AIDS, positive attitude towards ‘ABC’ rules for HIV prevention, being tested for HIV and chewing khat were more likely to be factors associated with multiple sexual partnership among secondary school students in Addis Ababa.  The observed proportion of HCT among secondary school students was low. Of the selected predictors, age, grade level, having sexual intercourse and practicing sex with multiple sexual partners in previous year were associated with ever having HCT as well as showing willingness to go for it in the near future.  Gender, age, marital status, knowledge of HCT, and perceived risk were found to be factors associated with HCT uptake among primary and secondary school teachers. Being faithful to a partner and inconsistent use of condom were observed correlates of HCT among teachers.  Despite the short follow up period, students in the peer education intervention group demonstrated positive changes in HIV related comprehensive knowledge and showed xvi better interest to go for HIV testing in the near future. In addition, positive changes on risky sexual behaviors were reported from the intervention group. Recommendations:  The Ministry of Education and its collaborators should inject more resources to improve the quality of teaching and learning of HIV / AIDS Program for the School Community  HIV/AIDS related interventions in the education sector should also be strengthened with practical strategies of controlling health risk habits such as chewing Khat and drinking alcohol, besides sexual risky behaviors.  Since the present study has focused on schools in Addis Ababa only, there is a need for large scale or nationwide studies with more representative sample size to consolidate much needed empirical evidence on HIV/AIDS effects among the school community. Keywords: Education Sector, Primary and Secondary schools, Teachers, Students, HIV/AIDS , Risky Sexual Behavior, Orphans, Mortality, Peer Education, Factors associated, and HIV Counseling and Testing



Education Sector, Primary and Secondary schools, Teachers, HIV/AIDS, Risky Sexual Behavior