Introduction

Youth is societies’ utmost asset and investments in youth can benefit both communities and nations. By supporting schools in preparing young people to take an advantage of satisfying and productive lives, investments in youth can be exploited. HIV/AIDS and other sexually transmitted infections are challenges to be overcome to ensure these preventive health problems do not interrupt learning, lives, and overall development of adolescents.

Adolescents are particularly vulnerable to contracting the Human Immunodeficiency Virus (HIV), the virus responsible for various infections associated with Acquired Immunodeficiency Syndrome (AIDS). Because of AIDS latency period, over 20 percent of people reported with AIDS worldwide are under the age of 30 and were probably infected during their teens (WHO, 1993). Tempted by curiosity, desire to experiment, peer pressure or low self-esteem, and lack of knowledge, teenagers involve in high risk behaviors. Advocates assert that without a vaccine, the only approach to AIDS prevention is through education (Aiken, 1987).

Schools need to provide HIV education along with education about sexuality, reproductive health, life skills, substance use and other vital health education topics. Data showed that in Armenia most young people do attend school, and school is a starting point where these topics can be addressed. The potency of a school setting is that school children there would have a curriculum, teachers, and a peer group. And school can teach them not only knowledge, but also skills and help to shape attitudes.

Research on investigating possibilities of integrating HIV/AIDS/sexuality education into Armenian school curriculum conducted with the kind support of the International Policy Fellowships Program suggested that various "gatekeepers" such as policy-makers, school administration, teachers, parents and parents' associations generally support an idea of AIDS education to be taught in schools. Based on the conducted research and in the light of distinctive educational reforms and changes at the national level, it appears the right time to further on the proposal for developing AIDS educational policies, designing a good curriculum for HIV/AIDS education, developing teacher manuals, conducting teacher training, and developing, implementing, and evaluating pilot school-based AIDS education program.

While the proposed activities are considered necessary and of urgent need by major stakeholders, time and recourse restrictions put forward an important first step to be development of national guidelines and strategies for HIV/AIDS/sexuality education as a part of comprehensive school health education. The proposed research is aimed to set HIV/AIDS/sexuality education on the agenda of school health education sector within the Ministry of Education and Science (MOES) of the Republic of Armenia (RA) and to develop a draft curriculum for school-based HIV/AIDS pilot program.
 

Important Considerations for AIDS Education in School

Results of the IPF research showed that despite the desirability of AIDS education in schools, there are a number of considerations that should be taken into account while planning AIDS education programs.

There are no policies on AIDS education and no nationally set AIDS education guidelines and strategies. The development of specific AIDS curriculum guidelines are essentially challenging. Politicians and educators are conscious not only of resource allocation but of constituent and public opinion associated with the “sensitivity” surrounding AIDS topic. While necessity of changes in national strategies and regulatory documents is typically accepted and supported by policy makers, only few education specialists and top-level officials are enthusiastic and confident in their expertise offering their efforts in introducing new program and advocating for policy changes on higher levels.

At the level of schools, one major issue is that often the subject can be considered by policy-makers, teachers and parents as too sensitive for children or too controversial. Another problem often mentioned by MOES officials and school administration is that the school curriculum is already full and that it is therefore impossible to find a slot for AIDS education.

As a result, the mission of delivering a curriculum which addresses such questions as: What is AIDS?; How is it transmitted?; How can it be prevented?; Who should teach this? continues to be programmatically charged. In addition, few teachers have the training and theoretical tools to address such questions in the classroom.

Developing a Consensus: National Strategy for HIV/AIDS School Education

Various stakeholders such as policy-makers, education experts, international organizations, teachers, and parents should determine whether and what kind of AIDS education is taught in schools. Although they may consider some aspects of AIDS education controversial or unacceptable, there is likely to be some consensus among them on certain issues. For example, that students need protection from sexual abuse, that they should be able to refuse drugs, and that there should be educational equality between boys and girls.

This consensus can be a starting point, and it can then be extended to other matters such as the argument that adolescents can learn how to make sound decisions about avoiding risk behaviors, and that society should help rather than hinder them in such matters. Through this multi-stage process a consensus basis for development of national strategy for HIV/AIDS school education can be established.

Designing a Good Curriculum

The initial point for designing a good curriculum for AIDS education is having proper knowledge of adolescents' patterns of behavior relating to the risk of HIV and of the average age at which they first have sexual intercourse, most common forms of sexual behavior and of drug consumption (including alcohol). A number of recent assessments indicate that Armenian adolescents are sexually active with the average age of the first sexual intercourse being 15/16 years, and that they practice unprotected sexual intercourse with multiple sexual partners and are involved in substance abuse including tobacco, alcohol and drugs. The curriculum should clearly be designed based on the results of these assessments of the patterns of behaviors.

Having all the above mentioned in mind, the following steps should then be undertaken:

o  Define the type of program (including the age at which it is to be introduced).
o  Select objectives for the program.
o  Make a curriculum plan.
o  Plan for the production of learning materials, and for activities of the school children.
o  Develop teachers' guides and instructional manuals.

Ensuring an Effective AIDS Education Program

Effective programs are those that have had a positive influence on behavior as regards sex, drug use and non-discrimination, and not simply increase in knowledge and changes in the attitudes of adolescents.

Literature review clearly shows that effective programs have the following important features:
 

• They focus on life skills with the aim of delaying first sexual intercourse and encouraging protected intercourse.
• They concentrate on personalizing risk through apt role playing and discussions.
• They discuss clearly the possible result of unprotected sex, and in clear terms the ways to avoid such an outcome.
• They explain where to ask for help among peers, school staff, and outside school.
• They stress that skills useful for self-protection from HIV also help build self-confidence and avoid unwanted pregnancy, sexual abuse, and substance abuse  including tobacco and alcohol.
• They reinforce values, norms and peer support for practicing and supporting safe behavior and avoiding unsafe behaviors.
• They provide sufficient time for classroom work and interactive teaching methods such as role play and group discussions.
• They start at the earliest possible age and undoubtedly before the initiation of sexual activity. Experience of other countries suggest that age appropriate programs should start at primary school level.

Project Objectives and Strategies for Fulfillment

The aim of the proposed project is to develop a draft curriculum for school-based HIV/AIDS pilot program. For this, the following objectives and strategies for fulfillment are proposed:
 

1. Building a consensus among major stakeholders is an important first step to set up the issue of HIV/AIDS education on a policy agenda. To achieve this, regular discussions, meetings, seminars and wider mass media activities will be organized with the support of the Ministry of Education to ensure close collaboration between policy-makers from various ministries (including the Ministry of Education and Science, Ministry of Health, and the Ministry of Youth), education experts, international organizations, teachers, and parents. It is expected that a draft plan for the national strategy for HIV/AIDS school education will be developed as a result of this consensus building process.
2. Review effective HIV/AIDS education curricula developed and used in a number of European countries including the Nederland, Sweden, and UK. For this purpose specific AIDS education curricula developed in these countries will be studied. Selected programs will be examined in terms of their impact on behavior of adolescents, their benefits and possible limitations. Possibilities of incorporating proven frameworks for designing AIDS education curricula appropriate for Armenian schools will be considered.
3. Development of an outline of draft curriculum for school-based HIV/AIDS pilot program. And outline of draft curriculum will be developed based on the experience of and using the frameworks that have proven working in other countries (as discussed above in the point 2). The development of the outline of draft curriculum will be made in close collaboration with local education experts and education specialists from the Ministry of Education and Science, and their preliminary agreement to be involved in this process is already solicited. Curriculum outline will be tailored at age of school children and will cover topics to be taught starting from elementary school and through high school. Drafting of HIV/AIDS education program will be done with a consideration that it should become an integral part of a more comprehensive school health education program. Life skills subject which is currently taught in a number of pilot schools all over Armenia with the help of the Canadian government will serve as a framework for integration of comprehensive, family life education program that includes chapters on sexuality, relationships, health, violence prevention and community responsibility as well as chapters on skills-building, values, self-esteem, parenting, employment preparation, and reducing sexual risk. For that reason, a broad-based Life Skills education program will be evaluated in terms of how it has been received by students, teachers, school administration, and parents. Quantitative and qualitative assessment tools will be employed to assess the acceptance of this program.

Practical Implications of the Proposed Project

Many young people cannot talk about AIDS either at home or in the community. Nor can they talk about the risk behaviors that can lead to HIV infection. Young people are reluctant to talk about sex to doctors or nurses, either out of embarrassment or because they are worried that confidentiality will not be respected. They feel equally uncomfortable talking to their parents, and their parents in turn usually also are embarrassed or lack the confidence to discuss the subject with their children.

Yet, data clearly show that young people are sexually active and that they are placing themselves and their partners at risk for infection with HIV and other STIs. These young people must be provided the knowledge, skills, and support they need to protect themselves. Development of a draft curriculum for HIV/AIDS school education program is first step in these efforts.