Open Campus HIV-Related Stigma and Children's School Outcomes in St. Lucia Joan Thomas Caribbean Child Development Centre St. Lucia Country Conference May 3-4, 2012

Background Review of studies from developing countries Children living and affected by HIV: - Low school attendance - More school problems - Additional responsibilities - Stigma & discrimination in class Review of studies from the Caribbean Only 2 on Jamaican children: - Ignorance about HIV fueled stigmatization from others - Poor school attendance and performance among children

Objectives 1/2 Main objective: To describe the nature and extent of HIV- related stigma and discrimination among school children in the Caribbean.

Objectives 2/2 Specific objectives: To describe the experiences of stigma and discrimination by children living with and affected by HIV To describe the school experiences and learning outcomes of these children To relate the children’s experiences of stigma and discrimination to their school outcomes

Methods 1/4 Sample Children living with or affected by HIV & caregivers Criteria for inclusion years old - Aware of their own and/or caregiver’s HIV status Comparison children & caregivers - students of same age (± 6 months) and sex - same classrooms - not affected by HIV Children’s class teachers and school principals

Methods 2/4 Sample: Recruited 10 children living with or affected by HIV and their caregivers - 2 HIV affected by HIV - 5 caregivers 10 classmates and their 10 caregivers 7 principals and 10 teachers

Methods 3/4 In-country collaborator and project steering committee in place Appropriate instruments developed and piloted Ethical Approval obtained Children living with or affected by HIV and their caregivers screened Parent consent and youth assent obtained Interviews by a trained Research Assistant in-country

Methods 4/4 Data analysis Chi square and ANOVA to determine equivalence of groups on variables Hierarchical regressions to relate stigma and discrimination to school performance

Sample characteristics 1/2 Children - Age 12 – 17 years old - 2 HIV+ children older - Mothers their primary caregivers - Living circumstances of comparison children better

Sample characteristics 2/2 Principals and teachers - Males: 57% principals; 100% teachers - Public schools: 86% principals; 90% teachers - University education - Bachelors degree

Children’s school attendance Variables (n, %) HIV + (n=2) HIV Affected (n=8) Comparisons (n=10) Attends School ++ Yes No -- 2, 100 7, 88 1, 12 10, Current/Last School Secondary/High--6, 756, 60 Missed school Yes--6, 757, 70 Chi square: ++ p<0.01

Children’s school experiences Variables (n, %) HIV + (n=2) HIV Affected (n=8) Comparisons (n=10) Like(d) school Very Much2, 1004, 506, 60 Got along with Teacher Very Well/Well2, 1007, 889, 90 Got along with Classmates Very Well/Well1, 506, 758, 80

Children’s School Performance Math Reading Spelling

Stigma and Discrimination 1/2 Stigma and Discrimination 1/2 Perceived stigma (sample questions) ⁻People are uncomfortable around me ⁻People stay away from me ⁻I feel ashamed or guilty Enacted stigma (sample questions) ⁻Friends refused to hug me ⁻Others gossiped about me ⁻Others made fun of me

Stigma and Discrimination 2/2 Stigma and Discrimination 2/2 HIV+ and affected children experiences - Stigma: 60% combined group - Discrimination: 40% combined group Comparison children perceptions - Stigma: 90% classmates - Discrimination: 100% classmates

Stigma & Discrimination and School achievement Experiences of discrimination predicted lower performance on Math test for HIV+ and affected children (combined group) (β = , p< 0.05)

Attitudes towards HIV+ children – Children’s reports Variable (n, %) HIV + (n=2) HIV Affected (n=8)Comparisons(n=10) How would feel if a friend told you he/she has HIV? Not Afraid of Them2, 1008, 1009, 90

Attitudes towards HIV+ children – Principals’ & Teachers’ reports Variables (n, %)Principal (n=7) (n=7)Teachers(n=10) Children who live with an HIV positive person should not be allowed to attend school : Disagree/Strongly disagree6, 8610, 100 A child who is HIV positive should not be allowed to attend school : Disagree/Strongly disagree6, 869, 90 If it were up to me, I would allow a child with HIV to remain in my school : Agree/Strongly agree 7, 1009, 90

Variables (n, %) Principal (n=7) (n=7)Teachers(n=10) HIV positive students should be segregated for certain activities : Disagree/Strongly disagree6, 869, 90 If I had a student who had HIV in my school I would not treat him/her differently from other students : Agree/Strongly agree7, 1009, 90 If there was a separate class for students with HIV I would be willing to teach it : Agree/Strongly agree 7, 10010, 100

National HIV Policies and Programmes Variables (n, %) Principal (n=7) (n=7)Teachers(n=10) Aware of policies/laws addressing HIV issues : Yes 5, 714, 40 Country has HIV policy for school: Yes 5, 713, 30 Country has HIV Education Programme for students at schools Yes4, 574, 40

Schools’ HIV Policies and Programmes Variables (n, %)Principal (n=7) (n=7)Teachers(n=10) Your school has HIV policy: No6, 868, 90 HIV Education Programme for students at your school : Yes4, 575, 50 One time class or incorporated into curriculum: Part of Curriculum 3, 434, 40 Grades Apply to : All Grades 4, 574, 40

Summary 1/2 HIV+ and affected children: -were not enrolled in school -had similar school experiences as classmates -reported some experiences of stigma and discrimination -had poorer school performance -experiences discrimination predicted lower school performance

Summary 2/2 Principals and teachers : - and the children had positive attitudes toward HIV affected pupils - were aware of HIV national policies and education programmes - did not have school-specific HIV policies - had an HIV education programme for students

Conclusions HIV may affect school attendance and performance of HIV+ and affected children Some stigma & discrimination against these children Stigma & discrimination may negatively affect children’ school performance The findings should be: - Considered for programme development to support HIV+ and affected children - Cautiously interpreted due to small sample size

Acknowledgements Prof. Julie Meeks Gardner, Head, CCDC Marva Campbell, CCDC Programme Officer Amika Wright, Janet Desouza and Marilyn Brown UNESCO Kingston Cluster Office St. Lucia team - Veronica Simon, Head, OC St. Lucia - Pat Joseph, Research Assistant - Project Steering Committee members Study participants: children, parents, teachers and principals