PROPOSAL VCT in Schools: Making HIV testing accessible to school-aged children in Zambia Team Members Pragnya Yogesh Alekal (MIT) Nedialka Douptcheva (Harvard School of Public Health) Jeff Hsu (MIT) Victoria Fan (MIT) Alexis White (Harvard School of Public Health)TABLE OF CONTENTS I. GOAL ............................................................................................................2 II. STAKEHOLDERS .........................................................................................2 III. BACKGROUND ............................................................................................2 1. What is VCT ..............................................................................................2 2. Why schools .............................................................................................2 3. The need for VCT in Zambia....................................................................6 4. VCT Models...............................................................................................7 5. Components of a Youth VCT Program ...................................................9 6. VCT Monitoring and Evaluation ............................................................10 7. Considerations .......................................................................................10 V. PROPOSED WORK PLAN ......................................................................... 12 VI. MIT TEAM TASK LIST................................................................................13 VII. REFERENCES ............................................................................................15 12 I. GOAL To develop a pilot VCT program for secondary government schools in Lusaka, Zambia. Such a program can serve as an enhancement to the already existing HIV/AIDS education programs in schools, and will include pre- and post-counseling and testing services. The ultimate goal is to create a successful model that can be replicated across the city, and possibly country. II. STAKEHOLDERS • Ministry of Education • Ministry of Health / Central Board of Health • Zambian VCT centers o Latkings Mobile VCT • Zambian peer education/sensitization organizations o Ukani • Project Concern International (PCI) • School administrators/staff • School children • Parents III. BACKGROUND 1. What is VCT Voluntary counseling and testing (VCT) for HIV is a confidential, if not anonymous, process that tests a person’s HIV status while providing pre- and post-test counseling in order to help individuals make informed choices before and after HIV testing. As an entry point to other HIV/AIDS services, VCT supports individuals to access other HIV/AIDS related services, in particular, ART. Access to and maintaining the quality of VCT services must be scaled up if the target numbers of people are to have access to ART. VCT also serves as a means of social education and public awareness raising. 2. Why schools According to UNAIDS (2004), “Young people – 15-24 year olds – account for nearly half of all new HIV infections worldwide. They are the largest youth generation in history and need a protective environment – regular schooling, access to health and support services – If they are to play their vital part in combating the epidemic.”Zambia is no different from other countries, and women are much more susceptible to infection than men. Table 1 (HJKFF, 2005) shows how desperate the need is. Between 16-25% of young women between the ages of 15-24 are living with HIV. These are statistics that we cannot afford to ignore. According to Avert (2003) “most Zambians become sexually active at quite a young age. In 2003, among young people 15-19 years old, 28% of boys and 44% of girls reported having had sex within the last twelve months. The average age for first sex is around 17 in females and 17.5 in males. It is normal for men to be older than their partners; the average age difference is around 5 years. For many girls, their first sexual encounter is with an older boy or elderly man, some of whom entice them with money or gifts. This is one reason why girls aged 15-19 are six times more likely to have HIV than are boys of the same age.” Table 1: Indicators of HIV/AIDS in Zambia Source: HJKFF, 2005 A study in Zambia found a marked decline in HIV prevalence rates in 15- to 19-year-old boys and girls with a medium to higher-level education, but an increase among those with lower educational levels (Kelly, 2000). Considering that HIV or sex itself is a subject rarely tackled in the home or community, it is important that children have access to the information from somewhere. Schools are arguably the best setting to provide children with HIV/AIDS and sexual education because it is a pre-existing institution where theoretically a large percentage of children attend. In addition, Avert claims, “Men are targeting increasingly younger sexual partners whom they assume to be HIV-negative, and the "virgin cure" myth (which claims that sex with a virgin can cure AIDS) fuels much of the abuse.” A young girl, already scorned by society and 3abused by the people she turns to, is unable to get information she might need. In addition, breaking the cycle of myths starts with educating the next generation. According to the World Bank (2002), “education is a proven means of stopping the spread of HIV/AIDS… It has been proven to provide protection against HIV infection… It is among the most powerful tools for reducing girls’ vulnerability. Girls’ education can go far in slowing and reversing the spread of HIV by contributing to female economic independence, delayed marriage, family planning, and work outside the home. It offers a ready-made infrastructure for delivering HIV/AIDS prevention efforts to large numbers of the uninfected population – schoolchildren – as well as youth, who in many countries are the age group most at risk. It is highly cost-effective as a prevention mechanism, because the school system brings together students, teachers, parents, and the community, and preventing AIDS through education avoids the major AIDS-related costs of health care and additional education supply.” Figure 1: Effects of education on HIV infection rates. Source: World Bank (2002) Education does more than just reduce HIV/AIDS transmission rates; it benefits an entire country and community. It permeates well into other