Infusing may mean diffusing: the case against "integration"

Attempts to integrate HIV/AIDS across core subjects, taught by different teachers, have not met with great success. Below are some research findings and examples that explain why. Based on this evidence and experience, UNICEF is encouraging countries to move away from the integration approach, and toward the "carrier" or separate subject approaches, i.e., teaching the necessary knowledge, attitudes, and skills together in one (existing) subject, in the context of other related issues and processes. Where a separate course is possible, delegates at the International Conference on Population and Development (Cairo, 1994) recommended the establishment of comprehensive school-based education covering a range of health issues, including basic health and nutrition, the physiology of reproduction, reproductive and sexual health, family planning, STD, and HIV/AIDS prevention.


A study by the Centers for Disease Control, USA (Kann, et al., 1995), showed that compared to "health educators", "infusion teachers" teaching HIV/AIDS prevention were:

  • less likely to be trained, and were trained on fewer of the relevant topics;
  • less likely to cover the necessary topics, especially the more sensitive and relevant topics regarding prevention;
  • more likely to cover the science and biology of HIV/AIDS than prevention elements;
  • less likely to include family and community elements in their programs;
  • spent less time on the subject;
  • were less likely to utilize recommended resources (including the formal curriculum);
  • used fewer interactive methodologies, and covered fewer of the skills and offered less practice of skills than "health educators".
  • more specific to developing countries, a review of life skills-based programs in East and Southern Africa found that infusion approaches have not had the expected impact, often because teachers are not sufficiently trained and do not implement the program properly. For example, teachers often overlook sensitive issues and realistic situations that would personalize the risks of young people. Not having a specific allocation in the timetable was also a barrier to effective implementation, (Gachuhi, 1999 for UNICEF). The author concludes: "stand-alone life skills programmes or having one lesson a week entirely separate and on its own, or a special lesson within a subject like health education or biology, have a better chance of succeeding than those that are infused in the curriculum."


  • Lesotho has integrated some HIV/AIDS and STI information in such subjects as health and physical education in the primary school curriculum and in the biology curriculum in secondary schools, although the subject is not compulsory in all schools. In an assessment conducted by Chendi (1999), the life skills programme is intended to equip the youth with life skills to enable them to deal effectively with the demands and challenges of everyday life. Head teachers have not received training on life skills and many teachers state that they lack the confidence to handle such sensitive topics. In conclusion, while a certain amount of activity is taking place, the coverage is unknown and the methods are ineffective with the exception of those that are implemented by a few NGOs. [From: Gachuhi, 1999]
  • In Botswana, the Ministry of Education has infused life skills across the curriculum in secondary school subjects such as development studies, biology, religious education, integrated science, and social studies and especially focusing on the Guidance and Counselling programme to work on skill development. Unfortunately, AIDS education is presented as one-off lessons, taught as biomedical facts to be learned for a test by teachers who are uncomfortable discussing the topic. Teachers lack participatory methods to ensure effective learning and there is little understanding of the important role life skills plays in the development of young people. [From: Gachuhi, 1999]

In its own efforts to implement a life skills approach, UNICEF has recognized that infusion of psycho-social life skills within core subjects is too broad and too slow to have an impact on the sexual behaviour and skills of adolescents, and is thus not protecting them against HIV/AIDS and pregnancy. After years of promoting infusion of life skills, UNICEF found that many teachers were still not using the manuals in classrooms. They were too complex for the average teacher to use; for example, they did not focus on health issues, but took a broad concept of "thinking skills" to be infused into any subject. [Gillespie A, Education Section, UNICEF]



Chendi, H. HIV/AIDS Life Skills Programmes in Lesotho. Unpublished, 1999.

Chendi, H. HIV/AIDS Life Skills Programmes in Malawi. Unpublished, 1998.

Ford N, D'Auriol AF, Ankomah A, Davies E, & Mathie E, 1992. Review of literature on the health and behavioral outcomes of population and family planning education programmes in school settings in developing countries. Institute of Population Studies, University of Exeter.

Gachuhi D, 1999. The impact of HIV/AIDS on education systems in the Eastern and Southern Africa Region, and the response of education systems to HIV/AIDS: Life Skills programmes. Prepared for UNICEF ESARO.  [see Documents below]

Kann L, Collins JL, Pateman BC, Small ML, Ross JG & Kolbe LJ, 1995. The School Health Policies and Programs Study (SHPPS): Rationale for a nationwide status report on school health. Journal of School Health, 65, 291-294.

Molobe, E & Salewski T, 1999. Education for Citizenship: Life Skills in the Botswana Classroom. Paper presented at the 1999 BOLESWA Symposium, 1999.

Smith G, Kippax S, & Aggleton P, 2001. HIV and sexual health education in primary and secondary schools: Findings from selected Asia-Pacific countries. October, 2000.


Gachuhi D, 1999. The impact of HIV/AIDS on education systems in the Eastern and Southern Africa Region, and the response of education systems to HIV/AIDS: Life Skills programmes.