opening doors, closing wounds
AIDS in school

Fernando Seffner

School is a place for information. All areas of knowledge are to be found there, presented in a particular order constituting a "curriculums", a path to be followed by the student. In Western society, the transmission of humanity's cultural heritage is an essential task of education and may be seen as the student's "introduction" to a specific cultural tradition. School is, in this respect, an institution that contributes to the construction of the individual's historical and social identity.

School is a set of social and human relationships. The path followed by individuals while at school has to do with the links they establishes, the "tribes" they identify with, social relationships built up over the years, falling in love, fighting, confrontations and alliances with colleagues and teachers, and the moral values they come into contact with. In this way, schools collaborate in shaping the individual's identity.

In addition to classical and traditional knowledge, schools are besieged by other forms of knowledge which also need to be taught. New subjects and problems emerge every day, and schools are under constant pressure to address them. Violence is one of the most serious problems in this day and age, and it is therefore suggested that the topic should be discussed and tackled at school. Is traffic causing deaths? This, then, is another issue that schools should include in their curriculum. Is adolescent sexuality explosive, and are families having a difficult time dealing with it? Nothing better than delegating this task to the school by creating the subject "sex education". Human rights are not being respected? Let's create a "cross-cutting subject" to address this issue in the school curriculum.

These demands are unending and, in our opinion, schools must be open to them, sharing the responsibility with other institutions and social stakeholders whenever possible. It is not enough to transmit knowledge on these subject, as today, information "ages" very quickly. Although it is true that "information is power", unfortunately students are buried by tons of information that does not help them to understand the world or to move in it in an intelligent way. In general, schools pass on a lot of information, but do not teach students how to think. Students "know" but "don't know how to formulate opinions", which amounts to the same as not knowing.

The problem of AIDS is one of these emerging issues waiting outside the school doors, asking to be let in and discussed. This provokes fear in many teachers because the subject of AIDS is usually accompanied by a whole series of polemical and embarrassing issues: sex, drugs, homosexuality, promiscuity, death, disease, agony, sin, discrimination. And even if the subject were to be taken up by schools, a whole series of questions would then arise: Should AIDS be addressed as a new "subject" within the curriculum? Would it be enough to deal with it as an item within another subject's program? Or, does AIDS have still broader implications for the human and social relationships taking place in school?

In order to be efficient, educational work in HIV prevention should draw on knowledge from many different perspectives, representations and assessments of AIDS in the country and among adolescents. Educational practice should respect socio-economic, cultural and religious diversity, taking into account the particularities of understanding and relating to HIV. We should take as our starting point the questions and knowledge about AIDS which already exist in the school context.

AIDS, adolescence and vulnerability

AIDS statistics increasingly show a clear trend towards more cases at a younger age. Between 1983 and 1985, the mean age of individuals infected by HIV was 46. Between 1994 and 1997, this average dropped to 34. Bearing in mind that the average lapse between infection and the final clinical stage, characterised by the appearance of AIDS, is between 8 and 10 years, the moment of infection may have occurred at the end of adolescence.

In the case of Rio Grande do Sul, approximately 30% of those infected, both male and female, come from the 20-29 age group, indicating that infection took place during the preceding stage, adolescence. This situation is clearly related to sexual activity, the most important form of HIV transmission.

Therefore, adolescence appears to be an important, vulnerable time. At the same time, there is evidence that the pattern of sexual transmission also changed among adolescents, in line with the trends in other age groups. Until 1986, the totality of sexually transmitted cases occurred among homosexual or bisexual men. From 1991 onwards, cases associated with heterosexual transmission were the most common.

Progress in the number of cases notified, the struggle by non-governmental organisations, increased research and other factors all pointed to a new fact: anyone could be infected by HIV -all it took was risk behaviour. That is, if condoms were not used during sexual intercourse, anyone could be infected by HIV, regardless of their sexual orientation, gender, colour, economic or cultural situation, or their membership of a particular social group.

From the model of at risk groups, the approach shifted to the model of risk behaviour, which summarises the whole issue as an individual concern: either I take care of myself or I don't. This approach does not take into account life stories, variables relating to gender, social and economic class, access to cultural goods and information. If someone is infected by HIV it is exclusively his/her fault, for adopting risk behaviour. Poor and rich, adults and adolescents, literate and illiterate people, men and women, all are equal in the face of the disease.

At present the attitude towards AIDS adopted by most of the population involves a combination of the two models. For example, a married man has sexual intercourse with a women outside marriage. He does not use a condom because he knows she is also married and therefore does not belong to an at risk group, so he is not particularly concerned to adopt non-risk behaviour. This same man, if he resorts to the services of a prostitute will use a condom because the prostitute belongs to a high risk group. This is how most people go through life, adopting methods of prevention or not, and judging each case with criteria that vary enormously. Various research reports, news items, comments in the mass media and health services have shown that adults who have sexual relations with adolescents do not regard it as necessary to use a condom, given that adolescents are not seen as potentially dangerous.

Over the past years, the concept of vulnerability has become an important category to measure the exposure of each person and each group to AIDS. A person's vulnerability is determined by a series of factors that can be classified in three categories:

1. Those factors that depend directly on individual action, shaping the behaviour of persons, on the basis of the degree of awareness that they show.
2. Those factors relating to the actions taken by public authorities, private initiatives and civil society institutions, in terms of reducing the chances that harm may occur.
3. A set of social factors which reflect the structures in place, allowing access to information, funding, services, cultural goods, freedom of expression, etc.

The classical definition of these three components, made by health professionals with respect to AIDS, covers the following elements:
"At the individual level, the assessment of vulnerability is basically concerned with behaviour that creates the opportunity for infection and/or illness. But behaviour linked to greater vulnerability cannot be understood as an immediate consequence of people's wills, but rather is related to the degree of awareness that people have of the damage that such behaviour can produce and the effective power of transformation of their behaviour on the basis of this awareness."

"The programmatic level refers to the existence of institutional action specifically targeting the AIDS issue, and here vulnerability is understood to be linked to aspects such as: a) the degree of commitment by local authorities to tackling the problem; b) the measures effectively proposed by these authorities; c) inter-institutional and inter-sectorial coordination (health, education, social welfare, labour, etc.) on specific measures; d) planning of measures; e) management of these measures; f) response capacity of the institutions involved; g) adequate and stable funding of the proposed programmes; h) continuity of the programmes; i) assessment of and feedback from these programmes."

"At the social level, vulnerability is being measured through aspects such as: a) access to information; b) amount of resources assigned to health care by local authorities and legislation; c) access to and quality of health services; b) trends in epidemiological indicators, such as infant mortality rate; e) socio-political and cultural aspects, such as the situation of women (lower salaries, absence of specific legislation protecting them, exposure to violence, restrictions in their exercise of citizenship); f) degree of freedom of thought and expression, vulnerability being greater where there is less possibility of these subjects making themselves heard in different decision-making spheres; g) degree of political (and hence, economic) priority afforded to health; h) social welfare conditions, such as housing, schooling, access to consumer goods, inter alia." (1)

Dialogue and research

Research has enabled us to reach some conclusions regarding promotion of AIDS prevention among adolescents at the La Salle Educational Centre (2):

1. Adequate knowledge does not necessarily generate permanent attitudes of prevention, making it necessary to construct an interactive environment, where adolescents may have discussions on the subject, translating this knowledge into an attitude of care for themselves and their partners.
2. Permanent, follow-up research is required in order to analyse the socio-cultural and sexual behaviour of the adolescent population.
3. Exchange of experience with other institutions and professionals working on this subject in the country will provide a basis for data collection and the development of research.
4. Research results cannot be generalised to all adolescents immediately and simply, and only serve to reveal a specific situation. However, they can contribute to the construction of better situational indicators.

(1) Ayres, José R. "AIDS, vulnerabilidade e prevençâo". Rio de Janeiro, II Seminário Saúde Reprodutiva em Tempos de Aids, 1997.
(2) Research project with adolescents at the La Salle Educational Centre, a 1st and 2nd grade school in Canoas, Brazil.

Fernando Seffner is professor at the Faculty of Education, Federal University of Rio Grande do Sul, Brazil.

This article was compiled by Lilián Abracinskas, from the author's paper published in: "Cuadernos Educaçâo Básica Nº4, Salud y Sexualidad en la Escuela", Dagmar E. Estermann Meyer, organiser, Porto Alegre, 2000.

Translated from Spanish to English by Victoria Swabrick

What isn't mentioned

This research was being carried out at the La Salle Educational Centre, a 1st and 2nd grade school in Canoas, Brazil. The project was launched in 1996 and its objective is to identify factors of vulnerability in adolescents with respect to AIDS, focussing on issues such as sexuality, drugs and pregnancy. At the start, emphasis was placed on a quantitative approach, in order to obtain a general overview of the situation. Following this, qualitative research carried out with voluntary informants.
An anonymous, self-applied survey was prepared, with questions divided into 5 sections:
1. Characteristics of the student (age, sex, housing, allowance, work, some habits and tastes, places frequented, cultural life, relations with home, family and school).
2. Sexuality (characteristics of sexual life, sexual preference, sexual behaviour, virginity).
3. Pregnancy (knowledge of biological aspects, fears, care)
4. Drugs (knowledge, use and opinions)
5. AIDS (biological knowledge, preconceptions and prejudices, methods of prevention, recognition of other sexually transmitted diseases, social characteristics of the epidemic).

The questionnaire was completed by 814 respondents, 314 boys and 500 girls aged between 15 and 17. Almost all (98%) live with their families and almost 40% receive an allowance from their parents. Only 12% declared that they work.
20% reported that they had smoked marihuana, while the remaining 80% who had not done so, added "not yet", or "I have not had the opportunity to do so", "no but I will certainly smoke it". Regarding intravenous drugs, 99% responded that they did not use them, their replies being "they must not be used", "it is wrong", "of course not", "never".
Regarding issues of sexuality, although a percentage did not reply, 45% stated that they were sexually active (40% of girls and 60% of boys) against 55% who were still virgins.
Regarding AIDS, the students had a considerable degree of information on the origin, methods of transmission, preventive measures and treatment. When asked how many had used a condom the last time they had had sexual intercourse, a total of 44% declared that they had not used one, while 56% stated that they had. But when asked about the last 5 times they had had sexual intercourse, only 36% stated they had used a condom on every occasion.
And, when asked with whom they talked about the subject, most responded that they did not discuss it with anyone.

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