Today, 12 August, the world is celebrating International Youth Day with the theme “transforming education”. This implies the desire to make education more relevant and equitable to all for social transformation. Currently, HIV/AIDS is a major health and development issue and evidence shows that the youth bear the largest burden of new HIV infections in Sub-Saharan Africa (SSA). Now more than ever, in the fight against HIV in Kenya, the focus needs to shift to adolescents and young people who bear the brunt of the scourge. Youth aged between 15 and 24 years now account for 40% of all new HIV infections in the country each year (Kenya HIV estimates report, 2018). This burden is higher among young women than men with adolescent girls and young women (15-24 years) accounting for 24% of annual new infections compared to 10% among their male counterparts in Kenya (Kenya HIV estimates report, 2018).
Vulnerability of adolescents and young people to HIV
Adolescence and early adulthood is a critical transition period physically and emotionally. Individuals’ also experience changes in terms of autonomy and responsibility for their health. It is a time when adolescents and young people explore and navigate peer relationships, gender norms, sexuality and economic responsibilities. Early sexual debut, use of alcohol and substance abuse, transactional sex and sexual violence among others; may all contribute to unsafe sex and hence increase the risk of HIV infection. For vulnerable youth living in informal settlements, the risk is even higher as it is compounded by poverty, fragmented social networks, and limited access to social services including health and education. Being in school has been shown to mitigate against some of these exposures and by extension, the risk of acquiring HIV. It is for this reason that keeping girls in school is now a recognized and evidence-based intervention for HIV prevention.
The promise of education in the fight against HIV/AIDS in Kenya
Evidence has demonstrated that provision of information and building skills on human sexuality and relationships helps avert health problems and creates more mature and responsible attitudes. Adequate information may help to delay sexual debut which may serve to significantly protect adolescents and young people from HIV infection as well as prevent unintended pregnancies or unsafe abortions. Inclusion of HIV prevention education in the curriculum driven by the Education Sector Policy on HIV and AIDS is a big milestone in improving HIV prevention awareness among adolescents and young people. Indeed, in Kenya, age-appropriate Comprehensive Sexuality Education (CSE) has been proposed by various stakeholders as a best bet, especially for those in school, in empowering adolescent and youth to overcome sexual and reproductive health issues, including HIV and STI infections, unintended pregnancies and unsafe abortions.
The effective implementation of CSE however, is not devoid of challenges. The policy environment, exposure to education by learners and insufficient content are some of the barriers to actualizing CSE implementation in schools. Differential access to education among adolescents and youth in rural and urban areas may be a factor hindering access to sexuality education. For instance, in rural areas, cultural practices such as early marriages might hinder adolescent girls from going to school thus presenting a missed opportunity for sexuality education. On the other hand, poverty in urban slums may be a barrier to school attendance and a promoter of transactional sex which increases HIV risk. The quality of education provided to adolescents and young people also has a bearing on the expected outcomes observed. Messages are mostly conservative and focused on abstinence leaving out important topics such as gender equity and rights which might minimize the effects on educational, sexual and reproductive health outcomes. Pre-service and in-service training of teachers on sexuality education should also be enhanced to promote the quality provided to adolescents and young people.
DREAMS: Education as an intervention to reduce HIV risk among adolescents and youth
The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women (DREAMS) initiative is a great example of a program that incorporates education as an intervention to reduce HIV risk among adolescents and youth. The program employs a multi-component package of HIV prevention interventions aimed at reducing HIV incidence among the most vulnerable adolescent girls and young women (AGYW) aged 10-24 years in 15 SSA countries. In Kenya, the intervention package is delivered in two urban informal settlements with a high HIV burden in Kisumu and Nairobi. Education is among the key evidence-based interventions implemented to empower AGYW and mobilize and strengthen their community for change to ultimately reduce their HIV risk. These educational interventions include: school and community-based HIV prevention education for boys and girls; provision of education subsidies to AGYW to keep them in school; provision of financial literacy training; and empowerment of their caregivers and community members to change norms and promote AGYW empowerment.
The AGYW participating in DREAMS have indicated knowledge on HIV risk reduction as a major source of empowerment from the educational interventions. The program demonstrates the feasibility of safe spaces both in schools and communities as an avenue for the provision of comprehensive sexuality education and HIV prevention messages. In addition, empowering communities with education may have a beneficial and protective effect on adolescents and young people. Some of the challenges encountered include the selection of beneficiaries for education subsidies whereby poor and deserving adolescents may miss out thereby hindering school enrollment. There is also the obvious question of the sustainability of the DREAMS interventions beyond the program as the educational interventions are not integrated into the school curriculum, which presents a call to action to policy-makers to integrate age-specific CSE in the school curriculum.
Conclusion
While education is critical to human capital development, it is also a proven preventive intervention for one of the most devastating epidemics in SSA. Education is not only critical for the attainment of SDG 4 but also SDG 3 in as far as ending the AIDS epidemic is concerned. The message this International Youth Day is to call on all actors, including government and civil society organizations to take an active role in ensuring provision of relevant, practical and equitable education for adolescents and young people, especially the socially most vulnerable.
Happy International Youth Day.