Reports from Institutions

Reports from Institutions

Each of the eight participating East African universities and research institutes presented status reports of HIV-related activities at their institutions to date. Rather than present each institution's report individually, here a summary is provided of typical challenges identified and measures taken, with specific references to particular details as necessary. Note that Session V occurred on the morning of Day Two, December 4.

Most of the institutions reported first of all that they had each been hit very hard by the HIV/AIDS epidemic. Statistics were more easily available for infection and death rates among staff than they were for students, since staff members tend to remain attached to the university after the onset of illness whereas students tend to disappear. Estimates of percentage of staff infected range from 12 percent to over 50 percent (Maseno University reports a rate of 51.5 percent of staff members between the ages of 30 and 39, and 35 percent of those over 40 -- of these nearly three quarters are support staff, with some 17 percent being academic staff and the rest, about 9 percent, administrators). Many institutions reported an average death rate of about 2 staff members per month, with University of Nairobi reporting an average death rate of 2 staff members per week. In each case the numbers of students infected and dying were unknown.

Each of the universities has already taken a variety of measures to respond to the HIV crisis, including awareness-raising and prevention, care and treatment, and medical research. Most of the universities reported the establishment of AIDS committees, known by a variety of names, e.g., AIDS Control Board, AIDS Control Unit, Technical AIDS Committee, and so on. These AIDS committees typically perform functions including seminars and workshops for HIV awareness, provision of educational materials (and often a resource center), provision of medical advice and counseling, promotion of voluntary testing, distribution of condoms, and the establishment of peer education/counseling mechanisms. In addition to direct functions of these AIDS-specific committees, most universities reported HIV-related educational efforts in other contexts, including centers for women's studies and gender issues, health departments, and courses. Most universities reported administration-led, faculty-led, and student-led activities; notably, in most cases it has been the students who have been most open about discussing the issues and who have exhibited the strongest leadership on campus.

Most of the universities are also engaging in some form of community outreach as well, for example offering home-based care, support groups, partnerships with NGOs, schools, and churches, education and counseling, research, medical treatment, and open women's and youth groups. University of Nairobi has been involved extensively with research ("both good and bad" according to its representative), including epidemiological research, observational studies, gender studies, risk, transmission, and impact assessments, and intervention trials (e.g., vaginal microbicide and VCT trials, an infant formula study to prevent breast milk transmission, and a DNA vaccine initiative in collaboration with Makerere University and University of Dar es Salaam). The Kenya Forestry Research Institute is also heavily involved in medicinal research and reports that some 15 plants have shown promise as possible treatments.

Most of the universities report similar challenges in terms of observed behaviors and socioeconomic factors. Many point to poverty as a root cause, driving students to engage in high-risk income-generating activities including involvement with drugs and prostitution. Most have noted that individual behaviors after infection contribute to the perpetuation of the virus and the deterioration of the educational environment. For example, HIV-positive staff members typically have been observed to engage in heavy drinking and increased promiscuity, while withdrawing from the community of peers, becoming markedly moody and temperamental, and exhibiting poor health resulting from lifestyle and nutrition factors, decreased productivity, and increased absenteeism. Similarly, students are observed to engage in "reckless" high-risk activity (heavy drinking, promiscuity), poor academic performance, absenteeism, and lifestyle-related health problems.

Despite measures taken to provide voluntary testing with assurances of confidentiality, most universities have noted that students are reluctant to get tested on campus, preferring the greater anonymity of city or national testing centers because of privacy concerns. This reality makes it more difficult for a university to provide counseling and treatment and to record accurate measures of the scope of the problem. Other challenges and difficulties widely noted among the universities are a lack of available funds in support of AIDS-related programs, a continuing reluctance on the part of many people to speak openly and address the issues (fear, shame, and silence), a low level of sensitivity to the plight of the already infected, and lack of a comprehensive, coordinated, university-wide HIV policy and work plan. Although the universities are aware of the desirability of policies to guarantee non-discrimination, the mounting strain on university health care systems creates pressure to screen employment recruits for HIV. Unfortunately, despite the efforts that have been made so far, most of the universities report observing little or no change in high-risk behaviors among students and staff.

While all of the universities are undertaking an impressive array of activities, most are taking place outside the classroom. These are clearly necessary and they help the universities to achieve their core goals in higher education. But there remains little connection between what is happening inside the classroom and what is happening outside the classroom. Significant exceptions are medical school courses and courses in the health sciences and allied health professions. This workshop catalyzed creative thinking about how to promote responsible engagement with HIV/AIDS issues in the classroom, especially through natural and social science coursework.