Focus on Processes
Ensure advocacy from the earliest planning stages to garner commitment,and influence key national leadership and to mobilize the community to overcome the key barriers. In too many cases, policymakers are not aware of key information such as the extent of HIV infection, sexually transmitted infections, teen pregnancies and other sexual health problems among young people. Advocating with accurate and timely data can convince national leaders and communities of the importance of prevention, from an early age. It can also help ensure that programs focus on the real health needs, experience, motivation and strengths of the target population, rather than on problems as perceived by others. Communicating the evidence, listening and responding to community concerns, and valuing community opinions can help garner commitment, while effective resource mobilization will underpin the effectiveness of such efforts.
Coordination and intensity
Coordinate education programs with other consistent strategies and processes over time that are based on research, effective teaching and learning practice and identified learner needs.
Strategies that may enhance the effectiveness of education programs include policies, health services, condom promotion, community development and media approaches. Education programs work best in the context of other consistent strategies over time. Because the determinants of behaviour are varied and complex, and the reach and effect of any one strategy (e.g., school-based education) will be limited, there is a need for coordinated multi-strategy approaches to achieve the necessary intensity of efforts to yield sustained behaviour change in the long term.
Teaching and learning methods
Employ a range of teaching and learning methods with proven effects on relevant knowledge, attitudes, skills, and risk behaviour. While there is a place for lectures, interactive or participatory methods, which include opportunities to use knowledge, examine attitudes and values, and practice skills, have been proven more effective in changing key HIV/AIDS related risk behaviours such as delaying sex, increasing confidence or using condoms, and in reducing the number of sexual partners. Unilateral or single strategy approaches, such as testimonials alone, or information alone, have failed in many cases because they ignore local needs and tend to be based on unevaluated assumptions. Analysis of learner and teacher needs and broader situation assessment should be an important source of information for shaping programs.
Preparation and training
Deliver programs through trained and supported personnel within or attached to the school. A lack of ongoing training and support at both pre-service and in-service levels is an often cited reason for poor implementation, and ultimately, poor program outcomes. While a well trained classroom teacher is in many ways an optimal person to deliver the program, they may not be easy to find and the system or community may not provide sufficient support. Training and support needs to be provided to teachers and others, including young people themselves, if they are to be effective educators. Such training needs to address personal knowledge, attitudes and skills as well as professional needs to equip educators to facilitate change and support students and other colleagues. No matter who delivers the program, the regular classroom teacher needs to be involved and links need to be made with other activities and other aspects of the curriculum to reinforce learning across the broader school environment.
Develop mechanisms to allow involvement of students, parents, and the wider community in the program at all stages. A collaborative approach can reinforce desired behaviour through providing a supportive environment for school programs. The participation of learners, with others, in the design and implementation of HIV/AIDS prevention education, including parents, community workers, people living with HIV/AIDS and peer education, can help to ensure their specific needs and concerns are being met in a culturally and socially appropriate way. It can also foster commitment or ownership of the program, which can enhance sustainability.
Timing and duration
Ensure sequence within grade levels, progression across grade levels, and continuity throughout schooling. Learning activities about HIV/AIDS need to be regular and timely. They should start early, promoting positive protective factors from the first years of school, and addressing specific risks one to two years before students are exposed to these risks. Research with adolescents suggests that the duration of single-issue or -themed programs (e.g., HIV/AIDS prevention) should be at least 5-8 hours for intensive sessions (e.g., one day course, small group facilitated), to 15 hours for regular classes over a school year, although in practice programs may only be able to accommodate 8-15 hours.
Where separate issues or themes are to be covered (e.g., violence prevention, reproductive health, HIV/AIDS and STI prevention), some additional time needs to be added, although overlap is likely among related issues (a comprehensive health education program can address these links). The age and stage of the learner need to be taken into account, with the curriculum moving from simple to complex concepts, and later lessons reinforcing and building on earlier learning. Education and other prevention efforts, need to be sustained over time to ensure that successive cohorts of children and young people are protected and are able to protect themselves from HIV/AIDS risk.
Placement in the curriculum
Place HIV/AIDS prevention education in the context of other related health and social issues, , such as reproductive health and population issues relevant to children, young people and the community in which they live. For example, "carrier subjects" within the existing formal curriculum can be useful entry points by accommodating the necessary balance of knowledge, attitudes and skills together. Examples of carrier subjects include health education or civic education, or population education. Programs which are "integrated" or "infused" thinly throughout a curriculum rather than within a discrete, intensive module have been generally disappointing. Programs that are part of the national curricula and officially time-tabled the advantage of greater coverage as well as greater likelihood of training, support, and actual delivery. Where non-formal approaches are utilized, they should be clearly linked to other school-based activities and issues, such as human rights, gender, early pregnancy and reproductive health, violence and bullying, and general health promotion. Whether formal or non-formal approaches are employed, isolated or one-off programs should be avoided, as they tend to be unable to address the complexity and interrelationship of the full range of relevant issues.
Going to scale
Establish early partnerships, with leadership from key Ministries, for a vision of national program coverage of high quality. Without such a vision and political commitment, activities will not move beyond pilot program status. Political investment of Ministries of Education and Health are central to establishing large scale school-based programs. In most cases, links with other Ministries particular to the setting, non-formal mechanisms, and the community will be necessary to reach the overall goal of national coverage with high quality programs.