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Conceptual framework of the review on HIV/AIDS-related problems and... | Download Scientific Diagram

The heart of a university’s business is knowledge. Its teaching and research functions are both essentially concerned with knowledge. Its ability to serve
society is based ultimately on its knowledge. Society invests heavily in its universities so that they may accumulate knowledge, transmit it through teaching and training, develop, elaborate and
evaluate it through study, expand and generate it through research, disseminate and spread it through publications and conferences, promote its utilization through engagement with institutions and
individuals within and outside the university world. Although the emphasis may vary from one university to another, each of these knowledge-oriented endeavours is found in every university worthy of the

The presence of HIV/AIDS in a society does not change this mandate. However, the imperious demands of such a pernicious disease necessitate that a university
in a society affected by AIDS recognize that HIV/AIDS adds specific qualifications to its mandate. It is frequently stated that in a world with AIDS it can no longer be business as usual. Similarly, in
a university that serves a society with AIDS it can no longer be university business as usual. The HIV/AIDS dimension must enter into every facet of the university’s business, especially its core
business of knowledge transmission (teaching), knowledge generation (research), and knowledge sharing (engagement with society).

In view of this, universities, such
as those in India and South East Asia, that serve societies where
HIV/AIDS is giving rise to growing public concern must interpret their basic mandate in terms of
HIV/AIDS and its many implications. We can gauge the extent of the problem by recalling that
globally one in every nine or ten of those with HIV/AIDS lives in India.
Further, each day brings at least sixteen thousand new HIV infections throughout the world. As many as one-quarter of these are in India alone—four thousand a day or almost three every minute (Specter,
Universities that work in such circumstances could express the key task that has been entrusted to them by society as being
to respond to the needs of an AIDS-affected society through HIV/AIDS-informed knowledge, training, research and engagement with external agencies and individuals.

How a University Should Respond to HIV/AIDS

An all too frequent response to HIV/AIDS is denial. There may be notional assent to all that is said about the
epidemic, but this is accompanied by a practical denial that the disease is a matter for major personal or institutional concern, denial that the situation is as bad as is made out, denial that there is
urgent need to take steps aimed at prevention, care, impact management and mitigation.

India has had its experience of such denial, the belief that because of
cultural and other factors HIV did not and would not pose a threat to the country. The disease was put down to commercial sex workers and a “five star culture” (Saksena, 2000), with little recognition
of the fact that once the epidemic gets to a certain level among high-risks groups only a few years need pass before it shifts to the general population. Since the first HIV cases were detected in
Chennai in 1986, this is what has been happening, especially in Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Manipur and Nagaland. In the intervening years, HIV/AIDS has progressed as a swirl of
epidemics, transmitted through unsafe blood supplies, a large and multidimensional sex industry, an enormous migrant population—migrant workers constitute 30 to 40 percent of the population in the
cities at any one time—and significant injecting drug use in the northeast (Shreedharr, 1995). The spread of the disease has been further facilitated by the excellent network of highways and roads. The
current estimate is that 3.97 million people, slightly more than 0.7 percent of the adult population (those aged 15–45), are living with HIV/AIDS, and from data released by the National AIDS Control
Organisation we can deduct that over the past few years the number of new infections has been increasing at an annual rate of 4.3 percent (CDC, March 2002). Even more alarming is a report, authored by
the joint secretary of India’s Department of Commerce, that appeared in the British Medical Journal in January this year. The report stated that “…If effective prevention efforts are not implemented
immediately, and sustained long term, the World Bank warns that India could have 37 million people infected by HIV by the year 2005. This is roughly equal to the total number of HIV infections in the
world today” (Ramasundarum, 2002).

Denial can be found in a university as much as elsewhere, even in a university in a country where millions are HIV infected. Therefore one of the first elements of a
university response to HIV/AIDS is the honest recognition that it confronts a major problem and challenge—a problem that could jeopardize its own ability to survive as a functioning institution, a
challenge to what it perceives as its core business in the AIDS-affected circumstances of society. No university is an AIDS-free enclave in a society where HIV is on the rampage. Quite the contrary, the
university may well be more severely affected than the surrounding society. This is because the great majority of those who form the university community are young, in their late teens or early
twenties, ages where the prevalence of HIV infection is particularly high—according to UNAIDS, almost one-third of those currently living with HIV/AIDS are aged 15–24 (UNAIDS, 2001). The risks for a
university are also heightened by the liberal atmosphere that tends to be characteristic and by campus cultures which may be open to activities and life-styles which facilitate HIV transmission.

In crafting its response to the AIDS epidemic it is necessary, therefore, for a university to recognize that HIV/AIDS is a matter of vital concern that demands a coordinated
university response. This response must comprise two dimensions. One dimension looks inward and relates to the concern that the university should have to maintain itself as a functioning institution
when it is already experiencing HIV/AIDS within itself. HIV/AIDS does to institutions what it does to the human body: it undermines the capacity to defend itself against what would otherwise be
relatively tractable problems. Ultimately it destroys the potential to function and deliver mandated services. The university needs to take full cognizance of this and hence to take whatever steps are
necessary to ensure that, notwithstanding HIV/AIDS, it keeps itself in good working order.

The second dimension is outward looking and relates more strongly to the
university’s core functions of teaching, training, research, engagement with society, and service to the community. As indicated in Box 1, in a society which is affected by HIV/AIDS, the operations of a
university in each of these areas must take full account of the disease.

How Universities in Africa have Responded to HIV/AIDS

The epicentre
of the AIDS epidemic currently lies in Africa, and more particularly in the countries of Southern Africa. Sixteen sub-Saharan African countries report overall HIV prevalence rates of more than 10%,
while in several areas data show that more than 30% of the pregnant women visiting antenatal clinics are HIV-positive.

Given this calamitous situation, it is
instructive to know how universities in the region have tended to respond.

Reports coming from a number of institutions speak of the absence of good information on
the extent and impacts of the disease on campus. In practical terms, there is much denial and secrecy, but this cannot mask the increase in the number of deaths, more extensive sickness, and some
faltering in teaching and research functions (with older members of staff having to fill in for the absence through sickness or death of their younger colleagues). While there is increasing student
sickness on campus, there is less evidence about student deaths. But this is offset by considerable evidence of high death rates among recent graduates from the universities. Thus, more than 30% of
nurses graduating from the University of Natal in Durban Natal are dying within three years of completing their study programme. This tremendous loss corroborates the estimates for South Africa, that by
2005 more than 30 percent of undergraduate students in the country’s 25 public universities and more than 35 percent of those in its polytechnics will be infected with HIV. Evidence on death rates among
academic and support staff is patchy, but seems to suggest that approximately two percent of academic staff and three percent of non-academic staff may be dying each year.

In this climate of death within or very proximate to university years, it is astonishing that there is so much silence at institutional, academic and personal levels. This is
partly due to the colossal overwhelming nature of the problem and the difficulty of coming forward with any coherent solution. It is also partly due to the fear of openness, anxiety about
stigmatization, and some tendency to petty but hurtful discrimination.

The result is that responses tend to be very piecemeal and uncoordinated. It is only within
the past twelve to eighteen months that universities have begun to develop worthwhile institutional responses, and even today many are taking little formal action. However, the absence of strong
institutional response is compensated for by many generous individual initiatives, with academic members of staff valiantly striving to incorporate HIV/AIDS issues in their courses, a reasonably healthy
corpus of research undertakings, several student-initiated anti-AIDS programmes (unfortunately, often short-lived), and considerable involvement of knowledgeable academics with agencies dealing with the
disease in the non-university sector.

Notwithstanding staff losses, universities have tended to regard the disease as being principally a student problem that should
be dealt with through campus student support and health services. There is extensive student awareness of the problem, even to the extent of AIDS fatigue, with students not welcoming any initiatives
that have the manifest objective of encouraging them to develop a personal lifestyle in which they will not put themselves or others at risk of HIV infection. In addition to this, student attitudes are
frequently characterized by denial, fatalism, inevitability, and invulnerability.

AJAN Calls on Jesuits in Africa toIntegrate the Struggle Against AIDS in All Apostolates

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