AIDS Draining S. Africa’s Schools

This picturesque hamlet set amid rolling hills and lush green valleys in the heart of Zululand is the epicenter of an ugly reality. Teachers take sick leave for up to six months at a time. Student enrollment in the first grade is falling. Funerals have become a common family excursion.

“Almost every week, we are burying a number of educators and learners,” said Godfrey Mashaba, manager of the Hlabisa school district, which has 191 schools and about 90,000 students.

Doctors, researchers and community leaders blame a dramatic increase in the number of deaths caused by complications from AIDS.

With the disease growing among students, many of whom have reached an age of sexual activity, and teachers, widely seen as eligible partners in this rural society, medical researchers warn of a looming catastrophe in the schools.

“I have a profound sense that we’re heading down a slippery slope, about which we can do very little,” said Peter Badcock-Walters, a research associate at the University of Natal’s Health Economics and AIDS Research Division, or HEARD. “That’s the most depressingly awful thing about it. We have gone past the point where we can nip it in the bud. Even if a vaccine was found tomorrow, the impact on education will be felt 30 years from now.”

A recent study by HEARD and the provincial Education Department found that this academic year’s first-grade enrollment in eastern KwaZulu-Natal province, where Hlabisa is located, was 20% lower than in 1998.

Although economic hardship was a factor as households struggled to find money for school fees, uniforms and transport in the face of a rising burden of health care and funeral costs, the study also determined that some children were not living long enough to enter school.

Among teachers, nationwide AIDS-related deaths have soared by more than 40% in the last year, according to statistics compiled by the South African Democratic Teachers Union. The figures were based on claims submitted to the union’s funeral plan between June 2000 and last May.

The union, which represents about 216,000 teachers, reported that 1,011 educators died of AIDS-related causes in the 12-month period and that their average age was 39. In KwaZulu-Natal, where the rate of HIV infection among the general population is pushing 40%, the average recorded age of teachers dying was 34.

“The system of education is under assault and is very likely to collapse in the face of HIV/AIDS, which is exacerbating the problem,” Badcock-Walters said.

At Nkodibe High School here in Hlabisa, a community where the scale of the pandemic is virulently apparent and terrifying, Principal Heaven Zulu said the rate of absenteeism and loss of teachers are having a devastating effect on learning.

“The loss of working hours is terrible,” said Zulu, who has been with the school for 10 years. A teacher “comes for only two weeks, then becomes too weak to work again. Soon he exhausts his leave credit.”

Zulu said that in recent times, he knows of only two teachers at his school who died of undisclosed causes. But several of his 29 teachers take sick leave on a regular basis, to the detriment of the school’s 1,148 students. Others simply disappeared.

“I am losing teachers, even support staff,” he said. “But the teachers are not forthcoming. Mostly, they deny [having HIV or AIDS]. We have teachers now who are teaching who have not disclosed, but I can tell they have the symptoms.”

Zulu’s sister-in-law died this year of AIDS-related complications, and he suspects that his brother has HIV, the virus that causes AIDS.

Most of the deaths reported in the teachers union study were listed as due to “natural” causes; doctors often cite a secondary infection--such as tuberculosis, pneumonia or meningitis--that strike AIDS patients.

As for the students, Zulu said it was difficult to determine how many had abandoned school because of HIV or AIDS, because once a child falls ill and goes home, there is no system of following up on his or her condition.

“Many of them drop out, and I never see them again,” Zulu said.

Since the beginning of the year, at least 30 students from Nkodibe High School have dropped out because of illness, such as tuberculosis, Zulu said. He doesn’t know whether any are alive. Scores from other schools in the district are known to have perished.

“I stay in the townships, and I know a number of kids, and we have been burying them continuously,” the principal said. “They are school-going kids. It’s pathetic. It’s horrible, because there is a lot of promiscuity. As far as teenagers are concerned, sex is a hobby.”

That is most frightening, researchers and medical experts say. In general, young people appear to be ignoring the reality of acquired immune deficiency syndrome. Many adolescents deny its very existence, despite the figures showing that the death rate among them is increasing.

In October, the state-appointed Medical Research Council reported that an estimated 40% of deaths nationwide last year among people ages 15 to 49 were because of HIV and AIDS. The study also found that the mortality rate for those 25 to 29 years old was 3 1/2 times higher in 1999 and 2000 than it was in 1985, and twice as high in the 30 to 39 age group.

“What we are seeing now are the people who were infected in the early ‘90s,” said Tanya Welz, an epidemiologist at the Africa Center for Health and Population Studies, a privately funded research institute based in Hlabisa. “It really is the tip of the iceberg.”

At Nkodibe, educators are struggling to drive home the AIDS prevention message to young people.

“They act all sarcastic about it,” Zanele Manzini, 17, said of her peers. “They say, ‘I’m too young to get it.’ They also say that if I’m meant to get it, then I’m going to get it anyway. I don’t think they really understand that it is deadly.”

Boys can get condoms free at the school. Still, many don’t use them.

“Some of them believe that the condoms they take have AIDS on them,” said Qinsile Ngubane, 14, adding that there was lots of pressure from boys on girls to have sex. “Others are too shy to go and get” the condoms.

Mashazi Mzwandile, 17, said some of his friends refused to use condoms because they favored unprotected sex.

“They say that using a condom is like eating a sweet with the plastic [wrapper] on it,” Mzwandile said.

Ennie Nsele, a life-skills orientation teacher at the high school, said boys often used psychological tactics to pressure girls to have unprotected sex.

Manzini said the best way to spread awareness about the danger of AIDS is for young people who have the disease to speak about it with their peers.

This is unlikely to happen.

“There is so much pure and simple stigma in terms of ostracism that in general terms you cannot afford to open your mouth,” said Badcock-Walters, the university researcher. “And there are no role models. Sports stars, politicians, no one is coming out in the way modern society would like.”

South African President Thabo Mbeki has been criticized for his reluctance to acknowledge that there is a link between HIV and AIDS and that the disease constitutes a national emergency.

At a local level, chiefs also are an obstacle in the fight to teach AIDS prevention among students, school officials said, because they believe that the distribution of condoms to teenagers encourages sex.

A few teachers also are presenting a problem: There have been numerous cases of educators raping students, Mashaba said. He noted that the assaults were driven by the misperception “that if you are HIV-positive and you have sex with a virgin, the HIV will be gone.” Some teachers argued that girls sometimes prostituted themselves in return for good grades or money.

Researchers say one of the most challenging tasks is determining how to get young people to change risky behavior.

LoveLife, a nonprofit HIV prevention program targeting people ages 12 to 17, believes that it can make a difference.

The program touts itself as “a new lifestyle brand” for young South Africans, promoting healthy living and positive sexuality. Its aim is to reduce the rate of HIV infection among 15- to 20-year-olds by 50% in five years.

LoveLife uses television talk shows and skits, public service announcements and advertising to send its message. Trained counselors at a call-in center in Johannesburg offer advice about sexuality to teenagers or refer them to other sources. A separate line is dedicated to parents who want to learn how to talk to their kids about sex.

“What we are trying to do is get a national discussion going, where young people can see the adverts on TV but also taste the lifestyle,” said Dr. David Harrison, LoveLife’s chief executive. “We want to create an environment in which there can be open and frank discussion of sexuality to motivate young people and start talking in concrete terms.”

At 10 youth centers around the country, young people can spend after-school hours and weekends playing basketball, shooting pool, watching videos, participating in drama classes, or taking lessons in health and sex education.

Motivational classes encourage youngsters to believe in themselves, learn from their experiences and plan their lives in a positive fashion.

Although some parents and community elders express concern about the frank way LoveLife is teaching about sex, many teenagers at one of the centers, the Mandeni Youth Club, said the program had changed their lives.

“Before, I didn’t believe in myself,” said Thembi Mhlongo, 16, who joined the club in January. “I was easily influenced by my friends. They pressured me in a way that I couldn’t say no. I couldn’t stand up for my rights. Now, I have learned about motivational skills and how to use a condom.”

Despite the encouraging impact of programs such as LoveLife, doctors and researchers lament that for a large number of South African youth, help has come too late.

Hlabisa Hospital bears testimony to this.

On any given day, the 296-bed facility has 500 or more in-house patients. Although many in the overcrowded general wards sleep on the floor, patients in the female tuberculosis ward lie two to a bed. Doctors say most are HIV-positive.

“Almost every day, you will see a young person, particularly females, who exhibit symptoms which are suggestive of this illness,” said Dr. Daniel Mbatha, the hospital superintendent.

Infection rates for AIDS-related illnesses have skyrocketed in recent years. According to Africa Center statistics, the number of new tuberculosis cases each year has grown from 200 in 1990 to 2,000 today.

The forecast is daunting.

“Even today, if not a single other person gets infected, the kind of death and suffering that is coming--the iceberg under the water--is going to be horrific,” said Welz, the epidemiologist.