Effects Of Hivaids And Interventions To Mitigate The Epidemic At Public Primary And Secondary Schools In Addis Ababa Ethiopia

BackgroundrnGlobally, HIV/AIDS is one of the most profound developmental challenges faced in the humanrnhistory. Despite the fact that the epidemic is affecting almost all development sectors, it is widelyrnasserted that the education sector has been profoundly affected. The effects of the epidemic onrnthe education sector are complex.rnIn its current disposition, education remains the most human intensive public sector in Ethiopia.rnCumulatively, the sector has a total of 17,413,176 students, 314,524 teachers and more thanrn80,000 non-teaching staff (constituting a total of more than 24% of the country’s population).rnMitigating the effects of HIV/AIDS on the education sector is especially important, since thisrnsector trains all public servants. Moreover, it is crucial to provide all concerned at differentrnlevels with some research based and up-dated data on the effects of HIV/AIDS on the educationrnsector and interventions to mitigate the epidemic for evidence based prevention, control, and carernand support programs.rnObjective of the study: To assess the effects of HIV/AIDS and interventions against thernepidemic with particular emphasis on the public primary and secondary schools in Addis Ababa,rnEthiopiarnMethodology: This study consisted of community and school based longitudinal, cross-sectionalrnand quasi experimental study designs which were conducted among teachers and students atrnpublic primary and secondary schools in Addis Ababa in the year 2012/13. The selection ofrnschools was conducted in three phases: 103 primary and secondary schools in phase I, 30rnsecondary schools in phase II and 4 secondary schools in phase III. The selections were donernrandomly in Phase I and II and purposively in Phase III. Furthermore, triangulations of variousrnmethods of data collection were used to increase the validity of the study. For the specificrnobjective I or assessing the trend of mortality among teachers in the era of HIV /AIDS arnlongitudinal study with a verbal autopsy approach was used. But for the specific objectives II, IIIrnand IV or examining the proportion of students who lost one or both parents due to HIV/AIDSrnrelated causes, investigating factors associated with HIV Counselling and Testing /HCT/ amongrnxiiirnsecondary school students, and assessing factors associated with HCT up-take and itsrncorrelations with risky sexual practices among primary and secondary school teachers in AddisrnAbaba a cross- sectional study design was used. In addition, for the specific objective V orrnexamining the effects of school- based HIV prevention interventions on sexual behaviours ofrnstudents at secondary schools a quasi-experimental study design was used.rnSampling techniques and sample sizes varied as per the five different, but practically interrelatedrnspecific objectives in order to address each of them effectively and adequately. Datarncollections were conducted by 12 diploma graduate nurses under the supervision of 2 seniorrnhealth professionals and the principal investigator. Data were entered first into Epi-Info software,rnversion 3.5.4 for cleaning and were transported to SPSS software version 20.0 for analysis.rnVarious statistical methods, including descriptive statistics, Chi squared test and multiple logisticrnregressions were used to show the magnitudes of the problems and the relation-ships of differentrnfactors with the effects of HIV /AIDS and the interventions to mitigate the epidemic byrncontrolling various confounders at the same time.rnResultsrnAs the verbal autopsy data of deceased teachers demonstrated the proportionate mortality ratiornbetween the total and HIV/AIDS related mortality declined from 0.33 to 0.18 during the first twornyears (Nov.2005-Oct.2007) and the last two years (Nov.2012-Oct.2013) of the study period,rnrespectively. The decline in the HIV/AIDS related mortality was statistically significant withrnMantel Haenszel Chi-square=7.04(P18 (AOR= 2.64 ; 95%rnCI, 1.46-4.77) and having multiple sexual partners in the previous year (AOR= 2.08 ; 95% CI,rn1.21-3.57 were positively associated with being ever tested for HIV (paper III).rnAs the comparative cross sectional study /Paper IV/ indicated, the proportion of teachers whornhad ever been tested for HIV was 739/1034 (71.5%) with 95% CI (69.1% -74.2 %).rnMultivariable binary logistic regression analyses showed that male teachers (AOR=0.63 ; 95%rnCI, 0.44-0.90) had lower chance of being ever tested for HIV compared with female teachers.rnMarried teachers (AOR=0.30;95% CI,0.19-0.47) also had lower chance of being ever tested forrnHIV compared with unmarried teachers. Age being >45 (AOR= 4.05 ; 95% CI, 1.82-9.03) , highrnHCT related knowledge (AOR=3.56;95% CI,1.73-7.32) and perceived risk of HIV AOR=1.43;rn95% CI,1.04-1.96) were positively associated with determinants of HCT.rnRegarding factors associated with HIV Counseling and Testing, teachers who never had HCTrnwere more likely to have multiple sexual partners than their counterparts (AOR=1.85; 95% CI,rn1.08-3.15). In contrast, those teachers ever tested for HIV were less likely to use condomsrnconsistently compared to those who were never tested (AOR=0.55; 95% CI, 0.32-0.96 (PaperrnIV).rnThe quasi-experimental study (Paper V) showed that students in the peer education interventionrngroup were more empowered compared to the control group. Comprehensive knowledge of HIVrnxvrn(P-Values =0.004) and willingness to go for HIV counseling and testing (P-value= 0.01)rndemonstrated significant differences among intervention group during post intervention period.rnStudents in the intervention group were more likely to use condoms during post interventionrnperiod compared to students in the control group [AOR=4.73 (95% CI (1.40-16.0)] (Paper V)rnConclusionsrn The findings of this study have demonstrated a statistically significant decline in the totalrnand HIV/AIDS related mortality between November 2005 and October 2013 amongrnteachers at public primary and secondary schools in Addis Ababa.rn Significant proportion of secondary school youths lost at least one parent due to variousrncauses including HIV/AIDS. High knowledge of HIV/AIDS, positive attitude towardsrn‘ABC’ rules for HIV prevention, being tested for HIV and chewing khat were more likelyrnto be factors associated with multiple sexual partnership among secondary schoolrnstudents in Addis Ababa.rn The observed proportion of HCT among secondary school students was low. Of thernselected predictors, age, grade level, having sexual intercourse and practicing sex withrnmultiple sexual partners in previous year were associated with ever having HCT as wellrnas showing willingness to go for it in the near future.rn Gender, age, marital status, knowledge of HCT, and perceived risk were found to bernfactors associated with HCT uptake among primary and secondary school teachers. Beingrnfaithful to a partner and inconsistent use of condom were observed correlates of HCTrnamong teachers.rn Despite the short follow up period, students in the peer education intervention grouprndemonstrated positive changes in HIV related comprehensive knowledge and showedrnxvirnbetter interest to go for HIV testing in the near future. In addition, positive changes onrnrisky sexual behaviors were reported from the intervention group.rnRecommendations:rn The Ministry of Education and its collaborators should inject more resources to improvernthe quality of teaching and learning of HIV / AIDS Program for the School Communityrn HIV/AIDS related interventions in the education sector should also be strengthened withrnpractical strategies of controlling health risk habits such as chewing Khat and drinkingrnalcohol, besides sexual risky behaviors.rn Since the present study has focused on schools in Addis Ababa only, there is a need forrnlarge scale or nationwide studies with more representative sample size to consolidaternmuch needed empirical evidence on HIV/AIDS effects among the school community.rnKeywords:rnEducation Sector, Primary and Secondary schools, Teachers, Students, HIV/AIDS , RiskyrnSexual Behavior, Orphans, Mortality, Peer Education, Factors associated, and HIVrnCounseling and Testing

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