Human Development 22620 188 >\0SOAL L August 2001 0Q / O,p Findings reports on ongoing operational, economic, and sector work carried out by the World Bank and its member govemments in the Africa Region. It is published periodically by the I/VOR L D BAN K Knowledge and Leaming Center on behalf of the Region. The views expressed in Findings are those of the author/s and should not be attributed to the World Bank Group. Sub-Saharan Africa: HIV/AIDS &?N MO on University Campuses he failure of many African presence of the disease in the uni- T universities to speak out and versities. This cloak is amply lined confront the HIV/AIDS crisis with layers of secrecy, silence, de- head-on means that valuable time nial, and fear of stigmatization and has been lost. The result is the discrimination." unraveling of hard-won develop- The first part of the report puts ment gains and crippling prospects this "turbulent ambiance" into the for future economic growth. broader context of African develop- The report, Challenging the Chal- ment and examines some of the lenger: Understanding and Expand- social and economic consequences ing the Response of Universities in of the epidemic. In 1999, over 2 Africa to HIVIAIDS, eloquently million AIDS-related deaths oc- documents this "conspiracy of si- curred in the 24 countries of Sub- lence". The report is based on seven Saharan Africa that have infection case studies commissioned by the rates of 5 percent or more. Accord- World Bank-led ADEA Working ing to some estimates, the number Group on Higher Education. It of AIDS orphans resulting from seeks to understand how the dis- these deaths stands close to or in ease is affecting African universi- excess of 1 million in each of the ties and to identify responses and following countries: Ethiopia, coping mechanisms that might Kenya, Malawi, Mozambique, profitably be shared with sister in- Rwanda, South Africa, Tanzania, stitutions in similar circumstances. Uganda, Zambia, and Zimbabwe. The case studies assess the expe- The disruptive consequences of the riences of seven universities in six disease on households, employ- countries: Benin, Ghana, Kenya, ment, health, education and other Namibia, South Africa and Zambia. systems are of fundamental impor- tance. The case studies reveal that A disquieting picture HIV/AIDS is unraveling hard-won development gains, with the worst The report paints a disquieting pic- affected countries experiencing ture. Its over-riding message is that major development reversals. Even the institutions studied remain in in those countries less affected, T O A the dark concerning the HIV/AIDS African universities are finding they situation on their own campuses. must operate in a deteriorating In the author's words, "a thick socio-economic environment. Pu- cloak of ignorance surrounds the ture prospects are not bright. Each of the case studies follows the rica is a high-risk institution for the tutional, academic, and personal same format and addresses the same transmission of HIV. "Sugar-daddy" levels. Consequently, universities six questions: practices, sexual experimentation, do not translate an awareness that *In what ways have the universi- prostitution on campus, unpro- they should be concerned with ties been affected by HIV/AIDS? tected casual sex, gender violence, HIV/AIDS into any form of mean- * How have the universities re- multiple partners, and similar ingful action plan. Universities sponded to the presence of the dis- high-risk activities are all mani- largely leave the responsibility for ease? fested to a greater or lesser degree." action to interested individuals and * What steps are they taking to con- Therefore, the report recommends, groups. They undertake no insti- trol and limit the further spread the entire university community - tutional response, such as framing of the disease in their communi- but in particular the university policy guidelines, taking a proac- ties? management - needs to face this tive role, mounting workplace edu- * What HIV/AIDS-related teaching, threat squarely. "In the HIV/AIDS cation programs for the protection research, publications, and advi- context of university life today, the of staff, or mainstreaming HIV/ sory services have the universities university culture is in danger of AIDS awareness into university cur- undertaken? affirming risk more than safety. It riculum, financial planning and . How douivesitispopois in danger of affirming death more management. anticipate and address the larger than life." In the absence of university poli- impact of HIV/AIDS on the na- One unsettling finding that cies, the inclusion of HIV/AIDS in tional labor market for university emerges from the report concerns teaching programs depends mainly graduates? the social life of students on cam- on individual or departmental ini- grShoulduniversitiessin c pus and the extreme vulnerability tiatives. The results tend to be * Should universities increase ac- of female students, workers, and piecemeal, though the case stud- cisstnce theircati courses, inc g those in precarious circumstances. ies concur in citing medical and distance education courses, to compensate for expected national The report says the case studies health-science programs as fre- "are shot through with concern quent exceptions to this rule. These losses in skilled professional per- about the subordinate status of fe- departments generally require stu- nmale students and, in particular, dents to participate in courses that their inability to negotiate for either cover all aspects of the disease, Many common features no sex or safer sexual practices." even though the focus is mostly on He speaks about "consensual rape," its medical and clinical aspects. In spite of differences in the details, whereby, because of her lack of The studies also note that other the studies show that HIV/AIDS is empowerment, the female partner departments occasionally try to in- having a serious impact on the fis- consents under duress to inter- tegrate relevant aspects at appro- cal situation of the universities in course in order to preserve a rela- priate points in the study of geog- much the same ways as it does on tionship, avoid a beating, ensure raphy, administration, education, other institutions. The disease in- financial support, or repay favors. ethics, psychology, gender studies creases operating costs, reduces pro- The case studies suggest the pre- or life sciences. But to achieve a ductivity (especially through high vailing climate on university cam- meaningful impact on student and absenteeism), diverts resources, and puses may encourage such violence staff behavior, such initiatives threatens sources of income. Al- and thereby facilitate the spread of should be extended to all aspects though the case studies provide lim- HIV/AIDS. of university programs, including ited evidence in these areas (univer- teaching content, research priori- sity record-keeping does not help Individual initiatives but few ties, management, field-work ar- here), they make it clear that uni- institutional responses rangements, curriculum design, versi,ties mareexeriencingr tall furi professional training, strategic versities are experiencing all four Describing university responses to planning, budgeting and human the HIV/AIDS crisis, the report resource development. Evidence from the case studies says the case studies point to an suggests that the university in Af- "awe-inspiring silence" at the insti- Good university research on Need for a proactive policy and The report closes by outlining a HIV/AIDS total commitment two-pronged strategy for African universities to consider in shaping One of the more positive findings The report describes how universi- their own responses to HIV/AIDS. Of the case studies concerns re- ties have begun to take steps in the The two thrusts reflect the inward- search and the contribution of Af- right direction, how they bring to- looking and outward-looking di- rican universities to international gether the multidisciplinary knowl- mensions of the traditional univer- understanding of HIV/AIDS. Uni- edge and expertise to respond to the sity mandate and mission. The in- versity research on HIV/AIDS cov- epidemic, and how they benefit ward-looking dimension pursues ers all areas-scientific, medical, from the commitment of those few the concern that a university social, and communication - and individuals who are already in- should have to sustain itself as a frequently includes community volved. Yet it emphasizes that a co- functioning institution and keep outreach and advisory/ ordinated strategy is conspicuously itself in good working order. To this consultancy activities as well. A absent, and labels this "the essen- end, the report summarizes what steady output of research emanates tial weakness of the university re- inward-looking actions and strate- from graduate degree programs. sponse to the disease." The report gies are needed. The outward-look- University staff draw upon this ex- suggests that universities can learn ing dimension relates to the perience to help frame national much from how African industry university's core functions of teach- policies, conduct workshops for has responded to the HIV/AIDS ing, research, and community ser- government departments, and pro- crisis and cites the South African vice. Its discussion focuses on what vide support for non-governmental industrial group, Anglo-American, is needed to produce quality gradu- organizations. But although com- as a possible model. The company's ates who have the skills and flex- mendable research is being pro- starting point for its comprehensive ibility needed to understand and duced, the case studies make it HIV/AIDS-prevention program is manage the HIV/AIDS crisis in clear that this information is not Total Management Commitment. their country. well shared within or among uni- versities themselves. F in din g S Vs rFindings can be accessed via the World Bank Group's website at http://www.worldbank.org/ Click on Publications, then Periodicals. Or, Findings would also be of interest to: click on Countries and Regions, then Africa Name Institution Letters, comments, and requests for publications not Address available at the World Bank Bookstore should be addressed to: Editor, Findings Operational Quality and Knowledge Services Africa Region, The World Bank 1818 H Street NW, Room J-5-055 Washington, D.C. 20433 e-mail: pmohan@worldbank.org In conclusion, the report outlines * Ensure that the entire university * Coordinate university plans and the fundamental principles that culture is enlightened by human programs with those at the na- must support such a two-pronged rights principles. Use deliberate tional level so as to ensure greater strategy . They are: and conscientious adherence to synergy, unity of direction, * Get the facts about HIV/AIDS out these principles to reduce vulner- complementarity of activities, ac- into the open and break every ability to HIV/AIDS and to help cess to resources, and more effi- form of silence, secrecy, and those infected or affected by the cient use of resources. shame that enshrouds the dis- disease to live in dignity. Allow ease. no form of stigma or discrimina- The case studies insist that for * Recognize the extent to which tion to find a haven within the these strategies to be effective, HIV/AIDS has been feminized institution. committed leadership among the and benefits from the subordi- * Recognize that persons living university's top management is the nate status and subjugation of with HIV/AIDS are among the foremost requirement. HIV/AIDS is women. In response, act urgently most important actors in any pro- a matter of life and death, for indi- to promote greater gender equity, gram to contain and control the viduals and for institutions. Imple- to overcome the social and other disease. Without in any way us- menting an institution-wide HIV/ constraints to enhanced female ing or manipulating them, the AIDS prevention program requires participation, and to lead by word university should draw upon commitment, people, skills, mate- and example in transferring their expertise and insights and rials, and funds. But most of all, it power and responsibility to fully involve them in every aspect requires leadership that recognize women. of its HIV/AIDS campaign. the urgency of the situation. Professor M.J. Kelly, Challenging the Challenger: Understanding and Expanding the Response of Univer- sities in Africa to HIV/AIDS. For more information, please e-mail William Saint, Lead Education Spe- cialist, Africa Region, the World Bank: Wsaintaworldbank.org