Projections of rates of HIV infection, AIDS illness and deaths were performed for teaching staff listed in EMIS data.29 Estimation of HIV/AIDS risk was based on their age, gender and geographic
29
Data on the profile of other employees was not available.
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Chapter 3: How will HIV/AIDS affect capacity to deliver education 37 distribution, and assumed that educators risk is no different to that of equivalent adults in the general population. A further scenario was produced to identify the effects if 85% of educators with AIDS access antiretroviral drugs (ARVs) after 1997. This scenario was produced as current medical aid entitlements mean that there are few barriers to access these treatments by educators. Some scenarios were produced that assume that educators change their behaviour. The full details of how these scenarios were produced are given in Annex C.
Projections suggest that around one-in-seven educators are HIV infected in 2002. Regional projections (Figure 3.2) should be interpreted with caution.30 However they suggest that levels of HIV infection reach one-in-four in Katima Mulilo, the region with the most advanced epidemic. They also illustrate that traditionally more disadvantaged areas are and will continue to be harder hit by the epidemic.
In all areas projections suggest that rates have the potential to increase markedly if risk behaviour does not change among educators and trainees.
Figure 3.2 Levels of HIV Infection among educators by region
Projections indicate that the AIDS epidemic among Namibian educators is at an early stage (Figure 3.3). The figure also shows that, although projections do indicate that prevention efforts can save a significant number of educators from HIV infection over time, prevention efforts phased in from now are unlikely to substantially affect illness and death rates for some time.
30
The projections for educators cannot be assumed to be accurate at region level. They are based on current knowledge of levels and timing of the epidemic in the general populations in each area, and cannot be assumed to fully capture particular risks and protective factors affecting groups such as educators teachers, especially in regions where smaller numbers of staff are located and greater variation purely because of chance is likely.
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1995 1997 1999 2001 2003 2005 2007 2009 2011 2013Caprivi Erongo Hardap
Karas Kavango Khomas
Chapter 3: How will HIV/AIDS affect capacity to deliver education 38 Figure 3.3 Projected AIDS cases a s a percentage of educators (no ARVs)
Projected numbers of deaths among educators are shown in Figure 3.4. The graph shows the massive reduction in the expected number of deaths if large numbers of educators have access to ARVs.31 They suggest that HIV/AIDS deaths accounted for 60% all deaths among educators in 2001. Of note, ARVs decrease mortality considerably but do not avoid it completely.
Figure 3.4 Projected AIDS deaths among educators
31
Projections assume that around 85% educators will be able to access ARVs when they develop AIDS. This can be considered a “best case” scenario, but seems possible if there continues to be unrestricted access to medical aid at low cost to educators, and because most educators should be able to recognise their illness and make plans to ensure that they can reach appropriate quality medical care ahead of becoming terminally ill.
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0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 5.0% 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
Chapter 3: How will HIV/AIDS affect capacity to deliver education 39 Projected annual total death rates without ARVs are equivalent to around 1.4% of educators in 2001, and reach almost 3.5% by the end of the decade. This is shown in figure 3.5 below. Under the ARV scenario, 2001 death rates for all causes would be around 0.7% rising to around 1.4% by 2010. Importantly, the projections indicate that for the next few years, less than 3 in 100 educators are expected to die under any scenario. These levels of impacts are easy to miss but should not be seen as any cause for complacency. Also, this rate is an average. Some schools are already experiencing illness and death among educators. This is shown by the results of the school survey, which is discussed below.
Figure 3.5 Projected educator deaths per year from all causes as a percentage of educators, including actual data from the GPIF and the School Survey.
The potential cumulative loss of educators to AIDS is large (Figure 3.6). Between 2002 and 2010, the number of educators lost due to AIDS could be 860 -3 360 under the ARV and non-ARV scenario respectively, equivalent to between 5% or 19% of the current workforce.
Figure 3.6 Cumulative deaths due to HIV/AIDS amongst educators 2002-2010 (under ARV and no ARV scenarios) 0 . 0 % 0 . 5 % 1 . 0 % 1 . 5 % 2 . 0 % 2 . 5 % 3 . 0 % 3 . 5 % 4 . 0 % 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 N o A R V S A R V s A c t u a l G I P F d e a t h + i l l h e a l t h S c h o o l s u r v e y 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 0 1 , 0 0 0 2 , 0 0 0 3 , 0 0 0 4 , 0 0 0 5 , 0 0 0 6 , 0 0 0 7 , 0 0 0 A R V s No A R V s
Chapter 3: How will HIV/AIDS affect capacity to deliver education 40 Interpretation of projections
The above projections should be interpreted with caution:
• General assumptions and limitations discussed in Annex C should be considered in any use of projections.
• Recorded rates of illness and death seem to be consistent with projections. However, the data from the GPIF may not be very reliable, and it is possible that sampling or response biases could also have influenced the result from the 116 responding schools.
• It is not clear how many educators have access to antiretroviral drugs. This will have a major impact on mortality rates, as can be seen in the graphs above.
Nevertheless, several key conclusions can be reached from projections.
Key conclusions – demographic impacts of HIV/AIDS on educators
• Infection rates among educators can still grow if prevention among educators and trainees is not
effective.
• Death rates could rise substantially over the decade and result in a cumulative loss of a high number of educators if ARV access is low.
• Death rates due to AIDS are unlikely to exceed 3 per 100 educators per year nationwide in the near future. This level may be easy to overlook and is unlikely to destabilize the overall system,
but is no cause for complacency.
• ARV treatment can substantially lower the increase in death rates and cumulative loss of teachers. ARVs can also narrow the range of uncertainty about AIDS death rates that has to be
considered in planning.
• Under ARVs scenarios, a rapidly expanding number of educators on chronic medication will accumulate. Due to reduction in the number of people who die of AIDS each year, up to 3000
educators could be on ARV treatment by 2010. They will probably need systematic support to ensure good treatment outcomes.
• Considerably higher (or lower) than average rates of death and illness may occur in many schools, circuits and regions, either in a given year or over time.