AN ASSESSMENT ON THE INTEGRATION OF REPRODUCTIVE HEALTH AND DRUG ABUSE ISSUES ON HIV EDUCATION IN JUNIOR AND SENIOR SECONDARY SCHOOLS IN PAPUA, MALUKU, WEST KALIMANTAN, RIAU ISLANDS, DKI
Indonesia is facing a progressing HIV epidemic. Despite 20 years of increasingly concerted effort, largely downstream, to prevent the spread of the epidemic, new cases of HIV infection continue to rise. Estimation shows that by the end of 2009 there were 333,200 people living with HIV (PLHIV) in Indonesia. The number of reported cumulative AIDS cases has risen sharply from 2,682 cases in 2004 to 19,973 by December 2009. Among the cases 25% are women .
Outside the protective cover of the family, the education sector, theoretically, provides the best prospects to prevent maturing youth from engaging in behaviors that compromise their long term well-being. The HIV epidemic is clearly a social and behavioral problem where certain conducts in some social-cultural contexts, put the individual at risk of being infected with the inconspicuous virus. Education, whether it is formal, non-formal, or informal, engages its participants to one particular purpose – to acquire knowledge and skills. Learning about self and others, personal hygiene, sexual and reproductive health, cultural and religious values, history and many other important issues are essential to prepare youth to lead and to assume responsible and productive adult lives. As a basic human right, to enable youth to make necessary decisions to prevent HIV infections requires access to correct and comprehensive knowledge about the disease, how it is transmitted, and how it can be prevented. The same right applies to the most at risk youth and those living with HIV, in an enabling environment free from stigma and discrimination. Deliberating the fact the infection is predominately related to certain risky behaviors involving sex and drugs, students must understand which behaviors will put them in danger of acquiring HIV.
Parents and improperly trained teachers are generally unwilling or unable to provide sexuality and drug abuse education either due to denial or shame; hence it is important for policy makers to seriously consider comprehensive life skills-based education in the school setting. In Asia, and Indonesia in particular, commitment is growing by educational authorities to include HIV as part of the life skills-based education in national strategic plans. However, implementation of such programming remains limited. While policy development has taken place across the region on HIV and SRH (sexual reproductive health) education; many countries still lack a comprehensive education sector policy and detailed strategic plan for implementation. This gap can be bridged with evidence based implementation plans from the region, to provide the needed incentive. Currently international evidence is sidelined under the guise a ‘Western’ or ‘African’ concern. Promising lessons can be gained with evidence from education sector efforts by Cambodia’s Inter-Departmental Committee on HIV and AIDS (ICHA) since 1999 and Thailand’s Empowerment in Practice as part of the TeenPATH HIV Prevention Programme by PATH since 2003.
Indonesia’s education sector was one of the regional pioneers in 1997 with two MoNE decrees supporting the 1994 National Strategic Plan (NSP) on AIDS and considered a strategic element in the response to HIV preventions. The first decrees called for all levels of education to enhance learner’s knowledge and awareness on HIV and engage in activities to prevent further infections. The second decree provided instructions on integrating HIV in the relevant subject matter of the curriculum and training to be provided for teachers and administrators. Regrettably this momentum was deflated by the financial and political events of that time. In 1997 Indonesia suffered the most during the Asian Monetary Crisis with the local currency depreciating seven times its original value in a span just a few months. This crisis paved the ground for political reform that toppled the New Order Regime of President Suharto and established a system of government focused on decentralization. This change shifted the responsibility of HIV education to the province and district level resulting in various outcomes depending on the commitments by local authorities on the perceived threat. The central authorities reengaged in 2004 with a HIV/AIDS Prevention Strategy through Education booklet, which was reprinted in 2007. Efforts were made to socialize these guidelines but decentralization has proven this difficult. The findings and recommendation in this review expand on past initiatives by MoNE, their effectiveness and actions needed to fill the existing gaps.
This assessment is about how the education sector in Indonesia prepares students to acquire knowledge and related life skills that will help them prevent HIV infections. Systemic internal review of policies, activities, and related studies were conducted. Interviews with key personnel were performed, including school administrators, teachers, school appointed students and representatives of the education authorities in the provinces and municipalities, AIDS Commissions at national and provincial/ municipal level, NGOs, and related sectors such as health, social, and BKKBN (National Family Planning Board) in Jakarta and in the five provinces/ municipalities (DKI Jakarta, West Kalimantan, Maluku, Riau islands, and Bali). Relevant textbooks were reviewed (see Table 03) in addition to programs that may provide information on what is available, how is it presented and delivered, and what possible impacts may be measured. A list of published books and modules covering HIV and AIDS, Drugs, and Reproductive Health by or in collaboration with PUSJAS (National Centre for Physical Quality Development) in MoNE was prepared (see Table 04). Draft of the assessment was presented to stakeholders for peer-review and roundtable feedback.
(1) The education sector formulated its policy to respond to the establishment of NAC and its first National Strategic Plan in 1994 and formed an interdepartmental mechanism in 1997 to respond to the emerging epidemic but unfortunately it was dismantled during the political reform when the government was decentralized in 1999.
(2) In 2004 the HIV focal point in MoNE published “HIV/AIDS Prevention Strategy through Education” to integrate HIV into school curricula and how teachers should be informed and trained to carry out the mandate. Although this policy document was socialized nationally, it appears to be neglected as many in the field are unaware of it.
(3) In 2008 MoNE Decree No. 39 on Guidance and Supervision of Student Activities (Pembinaan Kesiswaan) was enacted in which HIV and Drug Abuse prevention are mandatory activities. This opens opportunities to impart information on HIV and life skills within existing curricular and co-curricular activities like UKS, OSIS, and Student Scouts.
(4) MoNE has been collaborating with UN Agencies (UNICEF, UNESCO and UNFPA) and NGOs in publishing teachers and training manuals on sexual and reproductive health, HIV, and drug abuse. Due to limited resources, however, distribution and utilization of these important materials are very limited.
(5) HIV has been included in the school curricula in junior and senior secondary schools through the minimum standard requirements of subject matter known as KTSP 2006, providing guidelines for school textbook writers and teachers. But reference to KTSP 2006 in textbooks is not coherent, with varying quality.
(6) Not all MoNE provincial/Municipal offices are actively engaged in HIV education in schools, except in Papua, West Papua, West Kalimantan, DKI Jakarta, and Bali. In Papua, where the HIV epidemic has been generalized, information on HIV is being mainstreamed within the school curricula from the primary level in select districts. Teachers receive in-service training on HIV and students are trained as peer educators
(7) In Papua and West Papua, prevention of HIV is complicated by level of education, socio-cultural, and geographic factors. These two provinces have the lowest school participation rates in all levels (with many out of school youth at high risk), people speak different languages and live in dispersed geographical areas, and many practice risky behaviors such as having multiple sexual (and commercial) partners.
(8) Inter-sectoral collaboration is rarely realized where MoH, BKKBN, MoSA, and MoRA running their own programs leading to inevitable overlap. Some direct their programs to out of school members of the community. The actual impacts of these sectoral programs are unclear since comprehensive assessments have yet to be conducted.
(9) HIV, sexuality and reproductive health, and drug abuse are subjects of interest to students. Unfortunately only limited numbers of teachers have received comprehensive in-service training in these subjects in an interesting and engaging manner. Many students were not satisfied with what they learned from textbooks and they look for further information in popular media or cyberspace without supervision.
1. A concerted effort is urgently needed to ensure that the national policy to prevent HIV through education is disseminated and socialized properly down to the district level. This can be executed through an interdepartmental mechanism in MoNE involving both central, provincial and district offices to support MoNE Decree No. 39/2008 on Guidance and Supervision of Student Activities (Pembinaan Kesiswaan) through school based activities of UKS, OSIS, Student Scouts and through non-formal education channels.
2. The minimum standard requirements outlined in KTSP 2006 need to be adhered to by textbook writers and teachers. PusJas as the HIV Focal Point in MoNE, in collaboration with the National Curriculum Centre may be able to improve the quality of HIV information through monitoring and reviewing these minimum standard requirements.
3. The education sector should look for international (Cambodia and Thailand) and national (Papua and West Kalimantan) evidence-based best practices of HIV prevention in schools.
4. Due to decentralization, multi sartorial coordination with other institutions such as NAC and BNN and sectors, especially MoNE, MoSA, MoH, MoRA, BKKBN teacher unions, local religious leaders and relevant education commissions in the central and provincial parliaments (commission 10 in DPR and commission D in DPRD) should be improved, especially to deal with children who are outside of the formal education system.
5. The new role of the school principal needs to be tapped in a decentralized education sector that allocates more authority and autonomy to the headmaster who influences how and where skills-based HIV/AIDS, drugs, and sexuality prevention education is mainstreamed in the curriculum.
6. The use of user-friendly and modern communication technology, i.e. Facebook and other social networks should be thoroughly exploited.
7. The use of traditional media such as performing arts, radio and local TV networks should be considered. Information on HIV and related issues needs to be imparted to parents and community leaders as part of minimizing social and cultural barriers to children learning about the issues and persons living with HIV and AIDS in the community.
8. MoNE support needs to be strengthened for more sustainable partnerships for many NGOs operating at the national or local level which are known to have culturally appropriate or sensitive training on HIV and AIDS, sexuality and reproductive health, and drug abuse.
9. Since children affected by and living with HIV and AIDS are already within the education system, the sector should develop strategies to deal with stigma and discrimination, and other possible barriers which may prevent their participation in school. Protocols or ministerial decrees may be needed to overcome these socially sensitive challenges.
10. For Papua and West Papua, the successful implementation of its new strategic plan is very crucial to comprehensively mainstream HIV in the education sector, covering primary school, intensive pre and in-service teacher training, teachers from district to village levels, non-state schools, the large school age children out of the school system and parents. A multi-sectoral approach should be in place to overcome cultural, language and geographic barriers, as advocated by EDUCAIDS framework.
The education sector, especially in the high prevalence provinces like Papua and West Papua, can benefit from the EDUCAIDS, Global UN Initiative on Education and HIV and AIDS, framework that focuses on the role of education in preventing HIV transmission and on efforts to mitigate the epidemic’s impact on the sector, led by UNESCO.
[Team: Prof. Irwanto, Ph.D; Raymond A.I. Tambunan; Octavery Kamil; Sari Lenggogeni; Emmy; Siska Natalia; Natalia Christiane; Hoshael W. Erlan and Yohanes Hartadi]
 Republic of Indonesia Country Report on the Follow up to the Declaration of Commitment On HIV/AIDS (UNGASS) Reporting Period 2008 – 2009 NAC
 Clarke, David J. 2010 Draft -Plan International, Asia Regional Office, Realising adolescent sexual health rights through education in Asia.
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