world are sexually acquired. Effective prevention of HIV

In some countries, the education system itself is a source of risk, particularly for girls. For example, harassment of
girls on their way to and from school, especially where travelling distances are long, may lead to parents withdrawing
girls from school. Girls may also be sexually abused and coerced by boys or older men (including teachers) in
exchange for educational advancement or other favours.
A recent study9 in four sub-Saharan countries concludes that, at any given age, girls are more likely than boys to
drop out before completing primary school. Those girls who do complete primary school are less likely than boys to
progress to secondary education. Typically, pregnancy leads to girls leaving school, whereas the educational careers
of boys are less likely to be compromised by fatherhood. The study draws attention to the need to coordinate HIV
prevention activities with those that address the poor economic conditions and unequal gender norms that encourage
boys and girls to engage in risky sexual relationships. This includes, for girls, relationships with older men in
which sex is exchanged for money or gifts. The researchers argue for continued investment in young women to
increase educational attainment, improve fi nancial opportunities and expand legal rights, which will in turn lead to
benefi ts in terms of the sexual and reproductive health of young women and their male partners.10
Misunderstanding of the nature and purpose of sex education on the part of local communities can generate
opposition that impedes the delivery of sex education. When the views of local communities and their leaders are
solicited at the outset of a programme’s design, for example, by working with Parent-Teacher Associations (PTAs),
fears and concerns can be addressed and support galvanised. Opposition on the part of religious leaders can also
be common.
There are currently nearly 12 million young people in the world living with HIV. More than half of these young
people are female. They also have sexual and reproductive health needs that are seldom addressed in any formal
sex education curricula.11 In this era of expanded access to antiretroviral therapy (ART), the population of children
living with HIV is growing as their life expectancy increases. There are an estimated 2.3 million children (below the
age of 15) living with HIV worldwide.12 With access to treatment, HIV-positive children can expect to develop into
healthy adults who, at some point, will start having sexual relationships. For an HIV-positive young person who has
never benefi ted from education programmes about sex, relationships and HIV, these kinds of programmes – which
assume all students are HIV-negative – will not suffi ce. Furthermore, the implicit and pervasive assumption that
all students are HIV-negative can render invisible those who are living with HIV or AIDS. It may also inadvertently
increase stigma through the creation of an ‘us’ and ‘them’ mentality.
Debate also exists regarding the intended focus and outcomes of sex, relationships and HIV education. Should sex,
relationships and HIV education focus narrowly on specifi c measurable outcomes such as condom use or delayed
sexual initiation? Or should its focus be expanded to address the broader underlying issues, such as poverty,
gender inequality and discrimination, which make people vulnerable to HIV, STIs and unintended pregnancy?
This review considers sex education and HIV education in schools (with a focus on the prevention of the sexual
transmission of HIV). Effective delivery of each is unimaginable without discussion of the other. Clearly, sex education
must address the prevention of HIV infection, given that the overwhelming majority of HIV infections in the
, of necessity, will also involve discussion of sex.