This document from the United Nations Educational, Scientific and Cultural Organization (UNESCO) Literacy Matters series of the Education for All (EFA) initiative looks at the relationship between literacy and HIV prevention education. It examines working practices and ways to improve upon challenging aspects of combining the two.

The authors state that the relationship between education and HIV prevalence has two distinct stages. In the initial stage of the spread of HIV, according to statistical indicators, there is a positive relationship between education level and rate of infection, possibility related to increased mobility, but in the subsequent stages of the pandemic, the relationship is inverse, and education becomes a factor in changing behaviour related to risk. Access to education, shown by illiteracy rates as indicators, is influenced by gender, ethnicity, rural versus urban location, economic poverty, nomadic versus sedentary lifestyle, and disability.

The authors suggest combining literacy and HIV prevention. They identify a range of non-formal education (NFE) efforts that address not only HIV prevention but also HIV treatment and care. They cite examples of three types of programmes: 1) existing literacy programmes that have incorporated messages about HIV/AIDS; 2) HIV prevention/treatment/care programmes that have incorporated literacy components; and 3) comprehensive programmes in which literacy and HIV prevention are just two of many components (e.g. savings, micro-credit, livelihood).

Examples include:

• "The Reflect method [of instruction to meet the needs of women using anti-retroviral therapy (ART)], whose underlying principle is learner participation, allowed the women to take a more active role in their own treatment as they gained more skills in telling the time and reading dates, figures and their own prescriptions. Learner motivation was high and fewer than 8% abandoned the course." The Ministry of Basic Education and Literacy (MEBA) of Burkina Faso, the Swiss Development Cooperation (SDC), and the national healthcare sector were involved. "Finally, the PLWHA (people Living with HIV/AIDS) associations were involved as partners and took ownership of the project by providing rooms and checking on learners who failed to show up to classes. The involvement of PLWHA associations had a positive effect on members’ lives because it gave them something to do with their time and also made them feel good about themselves." 

• "The STAR approach is a combination of Stepping Stones and Reflect, both of which are participatory methods which are based on the principle that effective learning must start with the needs of the learners. The unpacking of gender issues is a key aspect of both approaches. Reflect was influenced by the work of Paulo Freire and uses participatory research to identify community issues. Stepping Stones, on the other hand, focuses on reproductive and health issues....[F]acilitators are trained to make use of group members’ existing level of knowledge and experiences when guiding group discussions, group projects, dialogues/debates, role playing activities, testimonials, etc. The main idea is that literacy represents just one of the needs of the community members and must be integrated with their other needs. So not only do the members learn to read and write, they also gain access to new kinds of information and develop appropriate knowledge." For example, in Mityan, Uganda, PLWHA involved in the STAR programme access group counseling on stigma and discrimination they face in the community. As reported here, their openness has promoted more community voluntary counseling and testing, identifying more PLWHA, and prompting increased access to treatment and information about positive living, including nutrition, the treatment of AIDS-related illnesses using local herbs, and access to competent services, information, and support (including financial for income-generating activities).

• Where HIV prevalence is low, literacy projects can be linked to other community needs and interests. As reported here, in Mali, Reflect/STAR circles are set up through key community members who are motivated to learn to read and write. "A trained facilitator from the local community leads these meetings, which start by focusing on a specific topic through the creation of a visual tool that allows everyone to take part in the discussions, regardless of whether they are literate or illiterate, male or female, old or young. The issue of HIV/AIDS is raised in the course of all topics discussed." The literacy lessons come from these discussions. Facilitator capacity building is done through 15 hours of Reflect training, 8 days of STAR training, and 5 days of additional training in project implementation techniques. "Refresher courses focusing on the issues identified in the course of monitoring assessments are held at least twice yearly and a quarterly facilitator forum enables success stories, problems and also potential solutions to be shared. In addition, facilitators are encouraged to participate in informal exchange visits that provide them with practical support." The project also develops village participants as peer educators for making "reproductive health and STIs (Sexually Transmitted Infections)/HIV/AIDS prevention services and items available to the community".

• A female teachers' group in Mali addresses the immigrant population, particularly female domestic workers, using the Samagoya method, which is based on group dynamics and aims to raise awareness and encourage learners to take responsibility so that they can be more self-sufficient. They involve the migrant girls themselves in information, education, and communication initiatives, using literacy materials focusing on HIV/AIDS, and also distribution of condoms.

• In Windhoek, Namibia, where a programme involving the organising of street vendors had worked on literacy and business training, the group asked that their concerns on the HIV/AIDS pandemic be addressed. An interactive, visual, story-telling technique was the primary learning tool used and enabled people with varying levels of literacy to participate in the programme.

• Further, communities in various countries are focusing literacy training on parents of school children using the topic of improving quality and equity in schools. The spread of HIV/AIDS is introduced in the materials because it has affected schools’ ability to function normally (teachers contracting the disease, children withdrawing from school to care for a sick family member, etc.)

The report concludes that community participation is of prime importance and "that this 'participation discourse' is translated into activities that involve members of the community at all stages of the programme from the conceptualisation phase to the final evaluation". It promotes the inclusion of men in HIV/AIDS prevention education because HIV education and prevention involves changes to gender relations and, thus, needs to address both women and men. "[I]f women understand the messages and develop the necessary skills, they are unable to apply their knowledge unless the men who hold power (fathers, uncles, older brothers, husbands and other male community leaders) are made aware of the issues at stake." The authors emphasise a need to forge multi-sectoral partnerships and policies that prioritise literacy. They call for the advancement of methods used to train facilitators and for addressing the strain placed upon them by promoting both HIV/AIDS prevention and literacy. "Undertaking either literacy or HIV prevention work is a daunting task as these must be tailored to the cognitive, emotional and behavioural characteristics and needs of individual women and men while also taking into account the social relations involved. The first step to success lies in understanding the way in which literacy and HIV prevention interact. The second consists of identifying the ways in which programmes are working to operationalise these links."

Eldis website [6] accessed on July 23 2009.