Students working with the Kenya government officials on sexuality education
Credit: UNESCO/Kenyan Centre for the Study of Adolescence

Sexuality education programmes can be highly cost-effective, especially when compulsory, adapted from existing models and integrated into the mainstream school curriculum. This is the major conclusion emerging from a seminal study released by UNESCO during a meeting of the UNAIDS Inter-Agency Task Team on Education in New York on 27 April 2011.

The study, Cost and cost-effectiveness: Analysis of school-based sexuality education programmes in six countries, examines a range of programmes in Estonia, India, Indonesia, Kenya, the Netherlands and Nigeria. It highlights significant cost savings in a number of settings. It also shows that compulsory programmes are more cost-effective as they reap the benefits and greater impact of full coverage of the student population.

For example, in Estonia a national sexuality education programme was introduced and linked with accessible, youth-friendly sexual and reproductive health services. Between 2001 and 2009 some 13 490 ‘health events’ were averted in the country, including nearly 2 000 HIV infections, at a potential lifetime cost of US$ 67 825 per patient, approximately 4 300 unintended pregnancies and more than 7 000 sexually transmitted infections.

The report also provides a detailed breakdown of the costs per learner of each completed sexuality education curriculum in the six countries. This ranges from US$ 6.90 in Nigeria to US$ 32.80 in the Netherlands. There are significantly higher costs in smaller pilot programmes, such as Kenya and Indonesia.

According to Mark Richmond, UNESCO’s Global Coordinator for HIV and AIDS, the landmark study gives an economic basis to the argument that sexuality education provides a key platform for HIV prevention amongst young people.

“We now have the data and analysis to make a stronger and better informed case for investing in school-based sexuality education programmes, particularly in those countries most affected by the epidemic and prioritized for attention in the new UNAIDS Strategy 2011-2015.”

Reducing the sexual transmission of HIV by half by 2015, including among young people, is one of the goals of the UNAIDS Strategy. However, the 2010 UNAIDS global report shows a critical gap in comprehensive prevention knowledge about HIV amongst this age group and that about 40% of all new HIV infections among adults occur among young people aged 15-24. Cost and cost-effectiveness adds to the growing recognition that school-based sexuality education has the potential to play a key role in improving young people’s knowledge for HIV prevention.

Inter-Agency Task Team on Education

Formed in 2002, the Inter-Agency Task Team on Education is convened by UNESCO and brings together UNAIDS Cosponsors, bilateral agencies, private donors and civil society partners to accelerate and improve a coordinated and harmonized education sector response to HIV.

UNAIDS Executive Director Michel Sidibé poses for a team photo with the young people taking part in the Skillz Street practice session at the Football for Hope Centre. Capetown, 4 May 2011.
Credit: UNAIDS/AFP Photo G. Guercia

During the meeting of the UNAIDS High Level Commission on HIV Prevention, which is taking place in South Africa this week, commissioners took time out to visit the Grassroot Soccer initiative in Capetown.

The commissioners visited the Football for Hope Centre during a Skillz Street practice session involving around 100 girls. Grassroot Soccer uses the power of soccer to educate, inspire, and mobilize communities to stop the spread of HIV. It builds basic life skills that help boys and girls adopt healthy behaviours and live risk-free.

UNAIDS Executive Director Michel Sidibé thoroughly enjoyed getting a chance to play football with the girls and was struck by the impact the centre is having on the community. “Here in Khayelitsha, the Football Centre for Hope is not just a project. It is a social meeting point for girls to protect themselves from HIV and become tomorrow’s football stars,” he said.

“Grassroot Soccer is restoring dignity and building self-esteem of young girls living in a challenging environment, transforming them into actors for the HIV prevention revolution.”

The delegation also had a chance to interact with the local staff and coaches to hear about how the programme and curriculum work, as well as the other types of HIV prevention and testing interventions they run in the community.

UNAIDS partnered with Grassroot Soccer in the development of the Skillz Curriculum which includes interactive activities for young people to learn about HIV and get a chance to practice the skills necessary for sustainable behaviour change. Topics in the curriculum include making healthy decisions, avoiding risks, building support networks, reducing stigma and discrimination, increasing knowledge about testing and treatment, addressing gender issues, and assessing values. Each of the commissioners received a set of Skillz Magazines and Skillz Coaches Training DVD.

In 2002 Tommy Clark, the founder and CEO, started Grassroot Soccer with friends who had played professional soccer together in Zimbabwe. They instinctively knew that soccer represented an opportunity in the fight against HIV. The organization has been operating in South Africa since 2006.

Learn more about Grassroot Soccer in this brief video overview:

Panel on Social media and HIV prevention from left: Ms Helen Alexander, Sonke Gender Justice Network, Mr Richard Delate, The Johns Hopkins Health and Education in South Africa, Olga Rudnieva, Elena Pinchuk ANTIAIDS Foundation and Mr Ian Royer, What about HIV? Campaign. 2 May 2011.
Credit: Stefan Els, Stellenbosch University.

With more than 7 000 people newly infected with HIV everyday and 1 000 of these new infections occurring in South Africa, Stellenbosch University just outside Cape Town, was the ideal setting of a high level panel discussion on how social media and mobile technology has been and can be leveraged to prevent new HIV infections.

“The potential of new technologies to re-energize the AIDS-movement is clear. We need nothing less than an HIV prevention revolution, with social media and mobile technology at its core,” said Michel Sidibé, Executive Director of UNAIDS in his opening remarks.

Two panels one—on social media one on mobile technology—were livestreamed via the UNAIDS page on Facebook. The discussions brought together technology leaders, AIDS activists, and social media experts to share ideas of how these new tools can be integrated as part and parcel of HIV prevention programmes.

Mobilizing social networks for HIV and young people

During the social media session, a work in progress project was presented by Mr Ian Royer, a delegate at the recent Global Youth Summit on HIV in Mali. Participants at the summit launched a collaborative social media campaign together with an outcome document aimed at mobilizing youth organizations and networks globally to endorse the summit’s call to action. The website www.whatabouthiv.org is the hub of this initiative.

“So far we have had more than 1 000 endorsements and engaged more than 7 000 people from all around the world. Social media is an ideal tool to mobilize young people,” said Mr Royer. “We are scaling up our effort in the lead up to the High Level Meeting on AIDS in June to make sure that our call to action is heard loud and clear!”

With social media being all about two way conversations, the panelists took questions from Twitter and Facebook posed by people following the discussion online. Tweeter @baruchdom made the following comment: “Remember that the majority of  Sex Workers and Drug Users and trans people don't have access to internet or social networking.”

A reply came from panelist Helen Alexander, with the Sonke Gender Justice Network:  “In South Africa at least, the cell phone is an important tool of the trade for sex workers, as it helps them connect to their clients, and helps to keep them safe. So mobile phones are actually a great way to reach sex workers. It’s anonymous, you don’t have to track people down, and often these are people who are not comfortable coming to a community event,” said Ms Alexander.

Mobile platforms for social change

There are 500 million cell phones in Africa, and mHealth or mobile health is increasingly recognized as an effective channel for HIV programming.

“How can we begin to maximize the use of mobile technology for HIV prevention?” asked Marlon Parker Founder of Reconstructed Living Lab, a South African social enterprise. “We have to use this technology to educate, engage and empower people—and we can take this beyond the platforms to offline action!”

Ms Debbie Rogers, Lead Strategist of Praekelt Foundation, shared lessons learned from their free mobile platform Young Africa Live, which among other things aims to prevent new HIV infections in South Africa. According to Ms Rogers, the platform has reached 32 million page views and more than 950,000 comments posted since its launch.

App-development competition for HIV prevention launched

The internet and social media are widely used by young people everywhere—including low income countries. These tools have the potential to deliver HIV prevention programmes in a cost-effective way to young people through a media that they are already using.

Participants at the social media and mobile technology for HIV prevention hosted at the Stellenbosch University, South Africa. 2 May, 2011.
Credit: Stefan Els, Stellenbosch University.

To move forward this agenda, Ms Olga Rudnieva, Executive Director, Elena Pinchuk ANTIAIDS Foundation, closed the event by announcing a competition for developing social media and/mobile applications for HIV prevention.

"By the end of the next week the criteria will be on the UNAIDS website. The challenge is to come up with a social network project with or without mobile applications to prevent HIV. We are welcoming projects up to USD 10 000. You have to be creative, innovative, do something good for you and for your community!” said Ms Rudnieva.

In the lead up to the High Level Meeting on AIDS, the social media and mobile technology for HIV prevention panels were co-hosted by UNAIDS and Stellenbosch University. It is part of UNAIDS strategy to inspire and catalyze young people to use social media to ignite an HIV prevention revolution.

UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway addressing young people at the Mali Youth Summit. 16 April 2011. Credit: UNAIDS\AFP H. KOUYATE

UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway travelled to Bamako, Mali to participate in the Youth Summit on HIV, an event convened under the patronage of the President of the Republic of Mali, Amadou Toumani Touré, and co-hosted by UNAIDS.

HRH Crown Princess Mette-Marit of Norway addressed an audience of more than 150 young leaders at the youth summit. Speaking at a session on transformative social movements, the Crown Princess highlighted the opportunities offered by the social media tools to empower young people in new areas of advocacy.

“Young people must be mobilized to respond to deeply entrenched stigma and discrimination and a growing conservative backlash which threatens their access to sexual and reproductive health services, sexuality education, sexual expression, harm reduction and safety as human rights defenders,” said HRH Crown Princess Mette-Marit.

She encouraged young people to learn from different social movements to engage others in the AIDS response. The Crown Princess emphasized that it is the young who are sitting with the solutions and must have the opportunity to be heard. 

“My message to you is: When you experience lack of core funding, lack of data on young people, lack of personal rights or lack of access to treatment, use your courage, use your ideas and start your own social movements,” said the Crown Princess. “Use your networks to create a momentum so that our leaders can't afford not to listen. Make them so powerful that world leaders cannot neglect them.”

Joint visit to a neighbourhood clinic

Together with UNAIDS Executive Director Michel Sidibe UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit visited a small clinic in one of Bamako's neighbourhoods that provides sexual and reproductive health as well as HIV services free of charge.

In less than 70 square meters, community members have access to information about HIV, training in the use of contraceptives and free HIV testing. The clinic also provides support for people living with HIV as well as HIV treatment.

Children and adolescents from rural communities of Guatemala participating in the 5th Rolling Fair called More information, less infection.

More than 1000 indigenous children and adolescents aged 9 to 15 years old from rural communities of Guatemala learned about HIV in the 5^th Rolling Fair called More information, less infection.  The initiative, which took place in San Pedro Yepocapa, was organized by the non-governmental organization (NGO) Comunicares, with support from local authorities, the ministry of education, the municipality, public schools, and the children’s parents.

"Before I came to the fair I knew nothing about HIV. Now I have learned that HIV and AIDS are not the same thing, and also that we are very young for sex," said a 10 year old student looking to her friend as she tried to recall more information, "Ah! And that our body is only ours and no one can touch it.”

The event was part of a broader project “HIV prevention for vulnerable populations: rural, indigenous and sexually diverse” supported by UNAIDS with financial grants from the Kingdom of the Netherlands.

UNAIDS Project Coordinator Ms Pilar Marín highlighted that the project is a great opportunity to reach people, especially children and youth in the rural areas of Guatemala who have not had access to HIV information. "In Guatemala and specifically among the rural and indigenous populations, HIV is often perceived as a taboo.  Through the project we are enhancing skills and knowledge to achieve a change in the behaviour of young people, to avoid risky practices," said Ms Marín.

From 8 am until 6 pm students travelled through an educational and creative journey to learn about HIV. The Rolling Fair is an innovative initiative that consists of a train with 11 illustrative wagons. Each wagon provides information, entertainment and fun games related to themes such as modes of HIV transmission and ways to prevent HIV infection, sexual education, understanding of stigma and discrimination, as well as prevention of violence towards children, especially girls.

"The aim is that children learn through teenagers living in their own community and speak their own language. This fair also includes training for teachers and parents," remarked Oneida Rodas, Director of Comunicares.

The Dutch Ambassador Jan-Jaap van de Velde and UNAIDS Country Coordinator Enrique Zelaya also participated in the fair. They then traveled to San Juan Comalapa to take part in another event organized by the Association of Community Health Services (ASECSA). This initiative brought together 200 young students between 15 and 18 years of age from public institutions to participate in dynamic workshops and HIV awareness-raising talks as well as a play.

These activities have provided young people in this municipality with information about HIV prevention which is complementing the sexual and reproductive education received at school. According to government data, in 2009 only 23% of young people age 15 – 24 years old knew how to correctly identify ways of preventing sexual transmission of HIV and reject major misconceptions about HIV transmission.

UNAIDS Executive Director Michel Sidibé (second from the left) and President of the Republic of Mali, Amadou Toumani Touré (fourth from left) at the opening of the Youth Summit in Bamako, Mali. 15 April 2011.
Credit: Kris Krug

Thirty years into the response to HIV, an estimated 3000 young people are newly infected with HIV everyday. Many young people living with HIV still do not have access to treatment and only 34% of all young people have correct and comprehensive knowledge about HIV and how to protect themselves.

That is why more than 150 young HIV activists from across the world have gathered for a three day summit in Bamako, Mali, to rally a youth-led response on HIV in lead up to the United Nations General Assembly High Level Meeting on AIDS taking place in New York from 8 to 10 June 2011.

Convened under the patronage of the President of the Republic of Mali, Amadou Toumani Touré, and co-hosted by UNAIDS, the summit provides a forum for young people to explore and commit to innovative ways to mobilize young people in the AIDS response.

“I am ready to take the call to action coming out of the Mali Youth Summit on HIV to the High Level Meeting at the UN. Young people must take the leadership of the AIDS response, and they must be given the space to lead,” said President Touré. 

Speaking at the opening of the summit, UNAIDS Executive Director Michel Sidibé urged young leaders to claim their space in the AIDS movement: “You are the most powerful engine we have for transformation and progress. Do not let anyone tell you that you are the leaders of tomorrow. You are the leaders of today.”

A Call for Action to articulate the vision of the youth movement is being developed by the delegates. It will be launched online at the closing of the summit, marking the start of an intensive period of online and offline social mobilization to get endorsement of the declaration by young people all around the world.

Participants at the Youth Summit on HIV.
Bamako, Mali. 15 April 2011. Credit: AFP

"We now feel that it is time for us to reclaim our future using every energy and power. We call on world leaders to respond to the Call for Action that will come out of this summit, but we also call on young people everywhere to mobilize for the AIDS response," Marie Tamoifi Nkom, steering committee member of the Mali Youth Summit on HIV from Cameroon.

While youth organizations and networks focusing on HIV are increasingly mobilized in the response, young people continue to face difficulties in accessing and influencing decision-makers and are not equal partners. Therefore, the Summit will also serve to link and strengthen existing youth networks across different regions and deepen their connections with the AIDS community.

Young people are still at risk of HIV, with about 40% of all new HIV infections among adults occurring among young people aged 15-24. Young women are particularly vulnerable, accounting for 64% of new infections among young people worldwide.

Participants in the workshop learn how to engage youth in the development, implementation and monitoring of Global Fund proposals. Panama City, Panama. 2-4 April 2011

Young people working on AIDS issues in Latin America are learning how to engage youth in the development, implementation and monitoring of Global Fund proposals through national mechanisms.

“We want to be able to speak on our own behalf. This workshop will give us tools to advocate at country level to ensure the creation of youth-centred programmes that reflect our needs,” said Ivens Reyner from the Youth Coalition—an international organization of young people committed to promoting adolescent and youth sexual and reproductive rights—and one of the young people responsible for organizing a training.

The event, which took place in Panama City from 2-4 April, is part of a series of regional workshops organized by the Youth Coalition and the Secretariat of the Global Fund to fight AIDS, Tuberculosis and Malaria.

The Global Fund Board of Governors recognized in its meeting in late 2009, the need to include more young men and women in the various processes both at global and national level. In recent months youth representatives from the Africa and Asian Pacific regions have been attending similar workshops in Cape Town and Bangkok respectively.

The young people who participated in the South Africa and Thailand workshops subsequently joined the Country Coordinating Mechanisms in their countries. They also participated in the proposal development and even become sub-recipients of the Global Fund grants.

“Young people taking ownership and demanding involvement in national programmes and Global Fund processes is core to ensure we reach universal access to HIV prevention, treatment, care and support in Latin America,” said UNAIDS Regional Director, Dr Cesar Nuñez.

Over three days, participants learned about how the Global Fund works. From the perspective of their fictional country “Youthland”, and using interactive methods and role play, young participants simulated all the processes involved in grant implementation from proposal development to disbursement of funds. They also developed advocacy and communication plans to be able to engage with their national partners.

“UNFPA is supporting this joint initiative between the Youth Coalition and the Global Fund because it is strategic to ensure that youth and their sexual and reproductive rights and health are adequately incorporated in the Global Fund programmes,” said Cecilia Maurente, Youth Regional Focal Point on behalf of Ms Marcela Suazo, Regional Director of UNFPA for Latin America and the Caribbean.

There are an estimated 1.8 billion adolescents and youth in the world today aged 10 to 24 years, accounting for more than a quarter of the world's population. Some 18% of the total population in Latin America is young people.

“Now we have 20 knowledgeable young people going back to their countries ready to engage with their Country Coordinating Mechanisms and national programmes to take the lead in developing new HIV prevention efforts for youth,” said Ricardo Baruch from the Youth Coalition and organizer of the training. “With young people on board we can make it, we can reach zero new infections in Latin America.”

The Tanzania Youth Alliance (TAYOA) is a national, non-profit organization that empowers young people to engage in meaningful activities that improve their quality of life.
Credit: UNAIDS/AFP - Siegfried Modola

During a visit to the Tanzanian Youth Alliance (TAYOA), a national non-profit organization based in Dar Es Salaam, UN Deputy Secretary-General Dr Asha-Rose Migiro and UNAIDS Executive Director Michel Sidibé praised the young people for the extraordinary responsibility they have shown in addressing HIV.

TAYOA operates a National AIDS Helpline to respond to queries from young people on a range of HIV-related issues. Individuals call the Helpline free of charge using a landline or mobile phone. Medical students volunteer their time to counsel other youth across the country.

Starting with single phone line in 2001, the organization now runs eight lines for 12 hours a day. One thousand callers, on average, are counselled daily, and one million callers have been reached since 2008. Information is provided confidentially.

“Young people like you don’t want to sit around and be passive beneficiaries of programmes—they want to be dynamic agents of change!” said Mr Sidibé, addressing an audience of more than 200 youth at TAYOA headquarters. “What you are doing here to create space for young people is truly inspirational,” he added.

TAYOA’s National Helpline is the result of a unique public-private partnership between the Government of Tanzania, the United States Centers for Disease Control and six national phone operators: TiGO, Vodacom, Airtel, TTCL, Sastel and Zantel.

“In an era of real-time communications, this kind of strategic partnership is the lifeblood of effective HIV responses,” said the UN Deputy Secretary-General, after touring the TAYOA grounds. “I salute the young people who are working on this impressive project,” she added.

According to TAYOA staff, callers ask a range of questions around condom use, sexual relationships, HIV testing, antiretroviral treatment and the prevention of HIV transmission from mother to child. More than 200 young people support the National AIDS Helpline and other TAYOA programmes, including youth outreach clubs and an information technology project.

“One of the great lessons we have learned in our journey is the need to embrace and cultivate a culture of volunteerism in our society,” said Peter Masika, Country Director for TAYOA. “We have learned that when young people are meaningfully engaged, they can take charge and act to improve their own quality of life, and the lives of their friends.”

Over the past decade, young people in Tanzania appear to have adopted safer sexual behaviours: according to a UNAIDS study, HIV prevalence among Tanzanian youth aged 15 to 24 fell by more than 25% between 2001 and 2009.

Sri Lanka captain Kumar Sangakkara (second from left) joins the youth drama group during their play on the impact of stigma and discrimination for those living with HIV.

Sri Lankan cricket captain Kumar Sangakkara took time off the pitch during the Cricket World Cup tournament to speak to hundreds of young people about the importance of being informed and responsible about HIV. The event was part of the International Cricket Council (ICC), UNAIDS and UNICEF’s Think Wise campaign for the ICC Cricket World Cup 2011.

“You need to educate yourself and become more aware of the world around you and HIV. Be unafraid and unashamed to speak openly about these subjects with your friends, family and your teachers in school,” said Mr Sangakkara, during the event which was held at his old school, Trinity College, in the city of Kandy.

As part of the event, a youth drama group staged a play to demonstrate the impact of stigma and discrimination for people living with HIV. The drama reinforced the need for more education and life skills to prevent the spread of HIV, particularly among adolescents.

"To use theatre and cricket together was a great idea. No one expected Kumar to be a part of the play and when he came on with us, people really listened. Everything we were saying was reinforced by his presence and in his own words," said Kapila Rasnayaka, one of the young people involved in the drama group.

Kumar Sangakkara, along with other leading international cricketers including Graeme Smith (South Africa) and Virender Sehwag (India), is a ‘Champion’ spokesperson for the joint Think Wise partnership. In Kandy he was joined by Sri Lanka team mates Ajantha Mendis and Upul Tharanga who also showed their support for HIV prevention efforts in the country.

“If we are going to ‘get to zero’ on HIV, we need the active engagement of young people—the leaders of tomorrow’s response—now,” said UNAIDS Country Coordinator for Sri Lanka, David Bridger. “Sangakkara’s involvement in the campaign has helped push the boundaries, inciting discussion and a buzz around HIV that we will build on with the hope that young people will take the HIV response into their hands,” he said.

More than 7 000 people worldwide are newly infected with HIV each day—one out of three is a young person between 15 and 24 years-old. The Think Wise campaign encourages young people to be informed, take appropriate action to prevent HIV infection and stand together against the stigma and discrimination often facing people living with HIV.

Participants of the ‘Mini Cricket World Cup’ schools tournament are presented with awards in Bangladesh

As the overs are bowled, the wickets fall and the crowds go crazy in the 2011 Cricket World Cup, host-country Bangladesh is giving the tournament an HIV spin. Through the Think Wise campaign the tournament is raising awareness among young people on HIV prevention and reducing stigma.

The Think Wise campaign, led by the International Cricket Council (ICC) in partnership with UNAIDS and UNICEF, harnesses the power of cricket to prevent HIV. Together with co- host countries—India and Sri Lanka—Bangladesh is organizing a number of “Think Wise” activities throughout the World Cup tournament that runs from 19 February – 2 April.

One such activity was the Schools Programme event where the World Cup was used as a platform to promote the sport, as well as to share information on HIV. Sixty of the country’s schools participated in the orientation which included the lively presence of “Stumpy the elephant”, the official mascot of the ICC event.

“I really appreciate this initiative! We don’t get to know this information about HIV usually and my perception about AIDS has changed,” said one of the young participants. A selection of the schools then took part in a ‘mini world cup’ cricket tournament, where HIV messages were shared with players and supporters through video, information and education materials in English and Bangla. “I’m now educated about HIV by coming here! It’s a great initiative for young people,” said one of the young men visiting the special UNAIDS booth.

The Bangladesh campaign received a high-profile boost from an announcement of the country’s team captain Sakib Al Hasan. “As Think Wise Champion, I’m happy to use my current popularity to raise awareness on AIDS,” said Mr Hasan at a press conference announcing his role. “We [cricketers] want to leave behind a legacy of social awareness of AIDS so young people will get to know more about HIV.”

“The involvement of cricketing heroes helps raise the profile among young people—and all cricketing fans,” said UNAIDS Country Coordinator for Bangladesh, Salil Panakadan. “Through the Think Wise campaign we have established important relationships with the Bangladesh Cricket Board, business partners, the media and we have sparked the interest and passion of young people. This gives us a tremendous opportunity to build on even after the last tournament over is bowled,” Dr Panakadan added.

A host of additional activities will take place in Bangladesh, India and Sri Lanka as the tournament continues including site visits and interaction between star players and key affected communities. Cricket teams will wear red ribbons on their shirts in key matches and HIV prevention messages will be promoted at venues on all match days.