useful overview of school-based HIV and AIDS education in the Asia

While the majority of country or region-specifi c material considered for this review concerns sub-Saharan Africa, a
useful overview of school-based HIV and AIDS education in the Asia-Pacifi c region was conducted by Smith and
Kippax et al. (2003). While all the countries surveyed appeared to have sexual and reproductive health education
at some stage in the school career, the content tended to focus on the biology of reproduction within an overall
context of married life and there was notable reluctance to discuss sexual and drug-related HIV transmission. In
Asia, HIV and AIDS and sexual relationships are rarely discussed at primary school level, with the notable exceptions
of Papua New Guinea and Cambodia, where discussion of condoms was included. This was despite the fact
that, in some countries, the majority of children would not progress to secondary school. The authors also note that
when cross-ministerial policy support exists for primary education on HIV and AIDS, and where this is implemented
alongside community-based education of adults (generating local support for school-based education), primary curricula
can be introduced successfully. They conclude that there is a need to reassess the age at which education on
sexual and reproductive health is provided to students and the content of that education together with the mode
of its delivery.
Negative outcomes associated with sexual behaviour are the result of risk (at the personal level) and vulnerability
(the socio-economic and cultural factors that put people at risk in the fi rst place). While sex education can reduce
risk, broader action is required over the longer term to tackle underlying issues of vulnerability.
Approaches to sex, relationships and HIV education can be conceptualised as a continuum from risk reduction to
risk elimination and vulnerability reduction. At one end of the continuum is ‘abstinence-only’, which seek to eliminate
risk through promotion of sexual abstinence until marriage, often within an explicit framework of religious or
ideological values and beliefs.
At the other end of the continuum are approaches that seek to reduce vulnerability through broader changes at the
whole school or community level. Between these two ends of the continuum lie the majority of approaches best
described as ‘risk reduction’, which focus on reducing risk to HIV prevention and other STIs through, for example,
consistent and correct use of condoms. Throughout the continuum, sex, relationships and HIV education can range
from didactic learning methodologies (provision of relevant information) through to participatory approaches (exploration
of values and attitudes) and acquisition of skills through skills-based approaches.
In terms of the specifi c content included within these different approaches, there may be considerable overlap; the key
differences being in relation to emphasis and intended outcomes. Thus, skills acquisition could be an important element
of an abstinence-only programme, but within this approach the emphasis would be narrow and focus on learning how
to refuse sex. In broader programmes that seek to reduce risk, skills-based programmes might be included with a view
to learning the skills to negotiate non-penetrative sex or how to use a condom or challenging sexual harassment.
Programmes draw from a range of social science theories.19 These theories focus on individuals and the assumption
that, with support, individuals have the ability to adopt safer behaviours. However, this is contrasted with theories
that believe individual change is not possible without affecting broader socio-economic, cultural and political
factors. Moreover, these behaviour change approaches have mostly been developed by social scientists in developed
countries and do not appear to have been empirically tested in other settings.20 Researchers who have done
this in the contexts of South Africa and Tanzania have highlighted the importance of traditional belief systems rather
than simply the knowledge acquired through formal schooling.21
Other researchers22 draw attention to the need for sex, relationships and HIV education to be grounded in a clear
appreciation of the different (and sometimes confl icting) ways in which sex and sexuality are discussed and understood
within a given community or society, together with awareness of the differences between these ‘discourses’
of sex and the realities of sex as it is lived in everyday life.