Approaches to estimating the impact of HIV/AIDS on teachers

Published by ActionAid and Save the Children, this 12-page paper describes approaches to examining the impact of HIV/AIDS on teachers. It summarises discussions from the first meeting of the UK Working Group on Education and HIV/AIDS, which was held in July 2003. Consisting primarily of UK-based researchers, practitioners, and policy-makers, the group provides an opportunity to discuss and build on research that explores the interfaces between education and HIV/AIDS. This first report in the Policy and Research series was based on discussions evoked by presentations from Paul Bennell, Roy Carr-Hill, Anthony Kinghorn, and Alan Whiteside.

The Working Group opens the report by explaining its objectives and scope: "This paper does not attempt to assess what the actual and likely impact of the epidemic is on teachers. Instead, it attempts to draw together the different approaches to understanding the impact on teachers: highlighting the key methodological issues and consequent gaps and recommendations". To begin, the report indicates that the clearest quantifiable impact of HIV/AIDS on teachers is the level of in-service mortality. The Working Group describes research related to several strategies for assessing past or actual impact, and offers these recommendations:

1. Education personnel records and Education Management and Information Systems (EMIS): "Well-functioning personnel systems and EMIS offer consistent, sustainable and simple ways to examine teacher mortality. These systems need to be strengthened in a number of resource-poor countries, not merely to further our understanding of the impact of HIV/AIDS, but more crucially to improve the capacity to monitor and respond to changes in the education sector. From a wider management perspective, EMIS human resource-related data could be integrated with personnel systems such as payroll, to allow for a more rigorous assessment of quality and completeness of data".
2. School-based surveys: "In attempting to quantify the impact of HIV/AIDS on teacher mortality, it is paramount to bear in mind that the impact will differ between districts, and even between schools and years. Teachers are not a homogenous group and data should therefore be disaggregated as much as possible. It follows that impact management must, at the very least, be country specific, and target different sub-groups of teachers in different ways. The utility of school-based surveys would be increased if they fed into a wider attempt to improve the underlying educational management system, both at the local and national level."
3. Estimating HIV prevalence: "Large scale and representative seroprevalence studies are an important way to quantify the actual and likely impact of HIV/AIDS on teachers. This type of study should be encouraged in the school-place and testing should ideally also include a CD4 count so that virus progression can be monitored. Although testing is anonymous, it is vital that Voluntary Counselling and Testing (VCT) services are available for teachers and that testing should, more broadly, be part of an initiative to respond to the needs of infected staff."

This report indicates that approaches to future impact assessment are crucial, since most HIV-related morbidity and mortality occurs approximately 8 years after incidence (at least in a non-antiretroviral (ARV) scenario). The Working Group suggests drawing on the skills of experienced modellers who are able to contextualise projections. In addition, the group suggests that these projections be frequently validated and revised based on epidemiological, demographic, and risk behaviour data.

The Working Group also emphasises the importance of qualitative research focused on questions such as the following:

1. What drives HIV in schools?
2. How much teacher attrition is due to the epidemic?
3. Does stigma and discrimination in the school mask the true impact of HIV/AIDS?
4. How does AIDS-related absenteeism affect the quality of education?
5. What other challenges has the epidemic created for teachers?
6. What role do positive living and availability of ARVs play in mitigating the impact?

In the report's discussion section, the Working Group explains why precise information about the impact of HIV/AIDS on teachers is important. Underestimating the impact may induce complacency; overestimates could lead to incorrect and costly decisions or engender advocacy-related problems: "in order to reduce the risk of fatalism, it is important to avoid the highly inaccurate estimates that appear in the media, and differentiate these from the more appropriate advocacy messages." In conclusion, the Working Group states that "while it seems plausible that the levels of teacher mortality are lower than suggested by many commentators, further work needs to be done to establish more rigorously on a country-by-country basis what the impacts are, how to interpret projections and empirical data, and whether new estimates make a substantial difference to policy and planning decisions. The improvement in quality of data will allow for more accurate projections, thus improving educational planning."

Click here to access the full report in PDF format. Contact Tania Boler (tboler@actionaid.org.uk) to request a hard copy of the report.

Click here to access the AIDS Consortium website, where it is possible to download several of the July 2003 presentations in PowerPoint format.

Click here for further details about the working group.