To establish the need for education amongst the population and its vital role in reducing HIV transmission.
To assess the effectiveness (and thus the strengths and limitations) of various educational campaigns in preventing spread of HIV.
To determine the psychological and social factors that may contribute to the effectiveness of such campaigns.
During the 1980s and 1990s, the spread of HIV increased dramatically within the UK, however has slowed down over the last 20 years (1). Currently there are approximately 33 million people around the world who are living with HIV, and each year more and more people are being infected (2). There are several methods in place to help prevent the spread of HIV, including interventions for sex workers, treatment of STI’s, voluntary counselling and testing and needle exchange programmes (3). However, perhaps one of the most important methods in preventing the spread of the virus is educating the population both as a whole and as individual groups. Once people have the knowledge about how HIV is transmitted and what it is, they are then able to take their own necessary precautions in preventing themselves from getting infected (4). For those already with HIV, educational campaigns can help increase awareness about how to cope and live with the disease as well as showing them how to prevent its transmission. Generally, educational campaigns naturally tend to focus on ‘at risk’ groups, such as men who have sex with men, sex workers and intravenous drug users (5, 6). Although this is a sensible approach, it is also important that the campaigns do not exclude the education of many other groups who are not considered directly at risk, such as the elderly (6). This is important as it can increase stigmatisation of the ‘at risk’ groups, as well as not respecting the fact that HIV is a non discrimative virus and can infect anyone. By taking a detailed look at 4 types of educational campaigns, it is possible to assess the strengths and limitations of each, as well as determining the psychological and social factors that might make a campaign more or less effective.
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Mass Media Campaigns
Mass media campaigns are generally used by governments as a method to dramatically increase general awareness amongst the whole population (2). Many forms of media can be used, for example advertisements on television, internet websites, flyers and posters distributed to each household. This type of educational campaign ensures that everyone has the same awareness of HIV, and can also be used to prompt people into further research for themselves (7). In the 1980s, the UK launched one such campaign, with the slogan: ‘AIDS: Don’t die of ignorance’ (8). This had a great effect in increasing general awareness amongst the whole population, however this type of mass education also has its limitations. The overall effectiveness is difficult to assess, as it is such a general form of education, as well as the fact that it is not the only method of HIV prevention tactics that were put into place at that time (9). Also, it does not target specific behavioural issues that need to be changed and with its widespread strategy it also is difficult to reach marginal groups (2).
Another aspect that is a major downfall is that it may even increase stigma and discrimination as some early campaigns used fear as the main factor in reducing HIV spread, which caused many people to become fearful of those with HIV (10). It also could have led to a decrease in people getting tested for HIV as they were so worried about the effects, both social as well as physical. If these fear campaigns were focused to specific risk groups, it could cause a major stigmatisation of these people which would encourage the view that if you were not a part of the risk group there was no need to be concerned about HIV (2).
HIV education in schools
Approximately 1 in 6 new HIV infections in 2008 were among people who were under 15 years old (2). Therefore it is extremely important for young people to be equipped with the knowledge about what HIV is, how it is transmitted, and how they can reduce their risk of becoming infected regardless of whether they are sexually active or not. Schools are an excellent place to increase young people’s awareness as they are so universal and therefore would be able to target a wide audience. Also evidence shows that when targeted at a young age, educational campaigns for health promotion tend to be met more receptively by the young (11). By instilling young people with knowledge about HIV risks and diminishing discrimination against those with HIV at an early age, these ideas and values will be held throughout their lives and aid in the long term decrease in HIV prevalence (12).
However there are still some limitations to educational campaigns within schools. The nature of the education may not be universal, as some schools may focus on abstinence-only programmes, which would not teach about safe sex and condom use (12). Since 1997, USA funding has increased in promoting these sorts of programmes within its schools despite studies showing that there is ‘no long term effect on sexual health outcomes’ (12). Some religious schools across the world also prevent the teaching of safe sex and condom use amongst not only the young but also the general population (2).
HIV education in the workplace
As well as schools, the workplace is also an ideal place to target a wide audience who would be receptive to detailed information about HIV and its transmission. By increasing awareness about HIV and AIDS within the workplace, people who are both delivering as well as receiving this information would then be able to implement the practices both in their working lives as well as teaching their friends and families (2). There are also many professions that may in fact carry an increased risk of HIV transmission, for example those that work in health care (13). These workers would be at an increased danger of percutaneous injuries and specific education about how to avoid such injuries and what to do in the event of one occurring is vital to preventing the virus’s transmission (14). Increased knowledge about the disease would also have the benefit of reducing the stigma surrounding HIV and AIDS and prevent discrimination in the workplace.
This type of education, although effective, may not be put into place at every workplace therefore some infections may still occur through lack of awareness. Also stigma and discrimination against those who are infected may also sill exist.
HIV and Peer Education
Peer education is an excellent way of educating different groups, especially those groups which tend to be marginalised by society (2). It is a way of helping people within these groups to relate to the speaker and to be receptive about the content of discussion (15). As the peer educators are generally from a similar social background as the group, it is therefore a much more relaxed and social way of education. People also may feel a lot more comfortable asking questions about sensitive topics and issues to someone they can relate to and feel more relaxed around (16). Studies have shown that peer education works particularly well with members of society who are at risk of HIV but distrustful of authoritative figures, such as those in prisons (2). This is important as it provides an excellent way of reaching out to those in marginalised groups who need HIV education to increase awareness but may not know how to go about receiving this. As with all the above methods of educational campaigns, peer education would be reliable and accurate, as those who are educating would have undergone recent and relevant training (16).
However, peer education may be difficult to set up, and would also be dependant on government support and private organisations and charities setting them up in the first place. Issues such as national discrimination against homosexuals would also reduce the level of education provided, for example in countries such as Zimbabwe, where the president has openly condemned homosexuality (17).
Although these are not the only types of educational strategies available, each has several strengths and well as a few limitations. The limitations tend to be focused towards a level of stigma and discrimination against those with HIV and a fear of the virus itself by both individuals as well as governments. However it is only with correct understanding and education in the issues surrounding HIV that people can learn to avoid unnecessary infection and respect the fact that HIV is a universal problem and can affect anyone.
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Education is highly important, however on its own it can only go so far in stopping the spread of HIV. Other methods of harm prevention must also be put into place to ensure that HIV transmission is minimised, for example needle exchange programmes, open clinic testing and accessible condoms would be required (4). Once people understand the social as well as physical factors associated with HIV, they must be able to have places to go that offer support and can help them if they wished to further their knowledge about the virus. In conclusion, educational campaigns must both be widespread to access the population as a whole, as well as targeted to individuals and specific groups in order to change risky behaviours both in the short and long term.
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