Around one in eight South African teachers may be HIV-positive and South Africa risks losing at least 4,000 teachers a year for the rest of the decade unless more active measures are taken to diagnose HIV amongst the profession and provide treatment, according to research presented last week at the Second South African AIDS Conference. Changes in working conditions for rural teachers could also have a big impact on the infection rate, researchers argue.
Dr Olive Shisana, executive director of the Social Aspects of HIV/AIDS and Health unit at the Human Sciences Research Council (HSRC) of South Africa described some of the effects that HIV is having upon the on the nation’s education sector.
She presented the findings of an HRSC cross-sectional study investigating the extent of HIV and AIDS amongst educators in public schools, factors driving the epidemic, and the impact on teaching and learning.
Focus groups were drawn from a representative sampling of schools distributed throughout the nation. 17,088 participants were administered a questionnaire, and tested for HIV status, and if positive, for their CD4 cell count.
According to the survey, the average South African educator is a married black African woman, over 34 years old with medical aid.
Prevalence
Overall, the average HIV prevalence was 12.7% (95% CI 12.0-13.5%), but this varied markedly by race, age, province and income. The seroprevalence among black Africans was 16.3%, compared to 1% or less other racial groups. HIV prevalence was highest among the 4282 educators aged 25-34 at 21.4%. KwaZulu Natal had the highest HIV prevalence rate at 21.8%, followed by Mpumalanga at 19%, while the prevalence was lowest in the Western Cape at 1.1%. Those with low annual incomes were also more likely to be infected (17.5%).
There also appeared to be a difference in prevalence according to the field taught. 23.6% of educators who taught or spoke additional languages were infected, while those who taught technology had the lowest HIV prevalence (7.4%). Primary and high school educators had similar HIV prevalence.
Eligibility for ART
22% of the HIV positive educators had CD4 cell counts below 200. According to the study projections, 10,000 South African educators would be eligible for immediate ART. If a CD4 cell count of
The study estimates that about 4,000 teachers died from AIDS-related causes in 2004 and that 80% of those deaths were among people under the age of 45. With 60% ART coverage, Dr. Shisana estimates that 18% of educator deaths under the age of 45 could be reduced by 2010. If 90% were treated, about half the AIDS-related deaths could be averted by 2010.
Factors driving the epidemic
Condom use was poor among the educators. Only 30% of educators who were aware that they were HIV positive used a condom consistently with a regular partner.
Another risk factor was that women tend to partner with men about ten years older than themselves. Mobility (spending more nights away from home) and having multiple partners were also associated with a higher risk of being HIV-positive.
Recommendations
The HSRC study made various recommendations for increased prevention education — including warning educators of the risk of “age” mixing. Another recommendation, said Dr. Shishana, is to “discourage mobility practices to reduce the number of work related nights educators spend outside their homes.” There should be a “deliberate effort to place teachers near their homes… and to provide incentives for educators to work in rural areas where they have family roots.”
Finally, the government should “provide [opportunistic infection treatment] and ART to educators as a matter of urgency in order to reduce morbidity, mortality and improve the quality of life of educators, so that educators can stay longer in the profession and teach,” concluded Dr. Shisana.