1 Drawing AIDS: Tanzanian teachers picture the pandemic. Implications for re-curriculation of teacher education programmes LESLEY WOOD North-West University NAYDENE DE LANGE Nelson Mandela Metropolitan University KITILA MKUMBO University of Dar Es Salaam In this article, we explain how we engaged teachers in creating their own representations of HIV and AIDS in Tanzania as a starting point for re-curriculation of the undergraduate teacher education programme. We employed a qualitative design, using visual methodologies, to encourage 29 in-service teachers to draw their perceptions about HIV and AIDS in Tanzania, and to explain their drawing in a short narrative. Thematic analysis of the drawings revealed that, while teachers are aware of the social injustices that fuel the pandemic, they do not envision themselves as having much influence for social change of learner attitudes and behaviour. The discussion of the findings, compared to and recontexualised by relevant literature, leads us to argue for the need to engage teachers in participatory research to find contextually appropriate ways to conceptualise and practise HIV and AIDS education. The recommendations we offer have relevance not only for Tanzania, but for the entire sub-Saharan African region. Keywords: HIV and AIDS education, research for social change, participatory research, critical pedagogy, visual methodologies, teacher education, Tanzania Introduction Childhood in Tanzania and other sub-Saharan African countries is most often characterised by poverty, which increases vulnerability to a host of risks, including HIV and AIDS (Githinji, 2009). Estimates show that 17% of the child population in Tanzania aged between 0 and 14 years are vulnerable to HIV infection, poverty and associated threats to well-being, with 5% characterised as most vulnerable (Kaare, 2005; Lindeboom, Leach, Mamdani & Kilama, 2006). Research suggests that youth prefer to seek information on sexuality and HIV from teachers and turn to them for care and support (Zisser & Francis, 2006). Yet teachers in Tanzania are hampered in this respect by a lack of formal training in addressing HIV and AIDS issues, as well as by social and cultural constraints which tend to foster stigma and impede open discussion of the pandemic (Mkumbo, 2010; Wood, 2009). The need for effective teacher professional development in HIV and AIDS education is, therefore, a pressing matter at both pre- and in-service level. In this article, we report on the first stage of a larger action research project undertaken to begin the process of re-curriculation at one university in Tanzania. In keeping with the participatory and collaborative nature of action research (Piggot-Irvine, 2012), it was necessary to begin by generating data to answer our initial research question: How do teachers perceive and interpret the pandemic in Tanzania and what do they think their role might be in mitigating its impact on the lives of learners? An important assumption of our research paradigm is that teachers can play an important role in influencing social change through their capacity to guide the development of learner cognitive, affective and behavioural responses to the pandemic. 2 Perspectives in Education, Volume 31(2), June 2013 Contextual background of the study The behaviouristic, life skills-based, abstain/be faithful/condomise (ABC) approaches that have been the basis for most of the curriculum interventions in sub-Saharan Africa (HEAIDS, 2010a) have not been very successful in bringing about behavioural change (Baxen & Breidlid, 2009; James, Reddy, Ruiter, McCauley & Van den Borne, 2006; Nzioka & Ramos, 2008) and teachers, as a rule, have not been consulted in the design of these programmes (Clarke, 2008) or received training and support to enable them to comfortably and effectively teach HIV and AIDS content (Tiendrebeogo, Meijer & Engelberg, 2003). We believe that one of the reasons for this is that they tend to target individual behaviour, rather than focus on the social, cultural, economic and political factors that create a fertile terrain for the incubation and transmission of the virus as advocated by more recent approaches (see, for example, Baxen, Wood & Austin, 2011; Chege, 2006; De Lange, 2008; HEAIDS, 2010b). One of the criticisms of teacher education in Tanzania (Mkumbo, 2009) is that it tends to emphasise theoretical orientation with limited opportunity to actually translate knowledge into practice. Teachers are thus required to learn how to teach “on the job”. Furthermore, the teacher training approach in Tanzania tends to still be teacher-centred (Mkumbo, 2009). As such, the current approach of teacher training in Tanzania is arguably unsuited for sexuality and HIV and AIDS education, which calls for student- centredness and participatory teaching methodologies (HEAIDS, 2010). The provision of HIV and AIDS education in schools in Tanzania is guided by the Guidelines for implementing HIV/AIDS and life-skills education programmes in schools (Ministry of Education and Culture, 2004). According to these, the content of HIV and AIDS education should reflect two major elements; provide basic information and facts about the transmission and prevention of HIV and STI, and promote responsible sexual behaviours, including delaying the age of sexual debut and practising protected sex. The Guidelines stipulate that HIV/AIDS and STI preventive education should be integrated into the core curriculum through Science and Social Studies for primary schools, Biology and Civics for ordinary secondary school, and General Studies and Biology for advanced secondary school. A recent content analysis study (Mkumbo, 2009) indicated that only a small proportion of possible sexuality and HIV and AIDS education-related topics are covered in the Tanzanian national school curriculum. Besides being too few, the sexuality education-related topics in the national school curriculum appear to be disorganised and scattered across the four subjects to the extent that they can hardly be said to constitute a meaningful sexuality and HIV and AIDS education programme. Studies have also shown that, although teachers in Tanzania support the provision of sexuality and HIV and AIDS education in schools, the majority of them express discomfort and feel incompetent to deliver such content (Mkumbo, 2010). We, therefore, conclude that the current approach to HIV and AIDS education in Tanzania needs to be revised. Theoretical framing There is no one “magic bullet” (Peabody & Cairns, 2008: 1) that will decrease HIV prevalence. However, the importance of social justice and human rights issues in addressing HIV and AIDS was highlighted at the 2008 AIDS conference in Mexico City. Although social change is a dynamic and unpredictable process, involving many different actors and usually not able to be transferred from one context to another (Ogden, 2008), teachers could have a significant contribution to make towards HIV prevention if they are able to contextualise HIV and AIDS education within the social challenges of their specific communities (Boler, 2003). Many teachers choose their profession, because they want to make a difference (Stiegelbauer, 1992). Yet, in practice, teachers tend to believe they occupy relatively powerless positions, hampered by a lack of resources and decision-making power (Price & Valli, 2005: 58). They are inclined to forget that, to the learner, they are not only a source of (usually) unquestioned and unchallenged knowledge, but are also role models whose attitudes, values and behaviour have tremendous influence to shape the same in learners (Martino, 2008). Teachers’ knowledge, attitudes and practices are critical in shaping both the formal and 3Wood et al. — Drawing AIDS: Tanzanian teachers picture the pandemic informal curricula in schools (Hoadley & Jansen, 2009). Research has demonstrated that teachers have the ability to shape and influence learners’ ways of thinking and responding to the pandemic (James-Traore, Finger, Ruland & Savariaud, 2004). Although the capability of the teacher as an agent of social change has been criticised (Lane, Lacefield-Parachini & Isken, 2003; Maylor, 2009), it is important to acknowledge the inherent power that teachers wield over the cognitive and value formations of learners (Bennell, 2004; Villegas & Lucas, 2002). We are not advocating that all teachers become radical social and political activists, but that they should at least become aware of how they can contribute to influencing how learners come to know, and hopefully embody, socially just ways of being. Given the role of social injustices in driving the pandemic in sub-Saharan Africa (Muthukrishna, 2009), we argue that a critical, emancipatory pedagogical approach (Freire, 2003) to HIV and AIDS education is, therefore, needed. Such an approach would enable teachers to shift from a view of HIV and AIDS education that is static, compartmentalised and predictable (Freire, 2003) towards one that acknowledges the dynamic, holistic and unpredictable nature of how the pandemic plays out in society. However, it is vital that education concerning social justice issues and the possibility of addressing them is embedded in a local context. Rights that are recognised as universal, such as equality for women, are often difficult to implement in societies where local conditions and cultural biases hamper their acceptance (De Cock, Mbori-Ngacha & Marum, 2002). What is regarded as social justice in the eyes of the Western world leaders and global donors may, in fact, be experienced as a threat in local populations (Stewart 2006; Benator, 2001). Our point of departure was, therefore, to engage with participants to help them explore how they, as teachers, perceive HIV and AIDS within their communities, with the aim of raising their awareness about personal bias, attitudes and behaviour which might negatively impact on their ability to implement HIV and AIDS education and fulfil their role as potential agents of change. Methodology We employed availability sampling (Grinnell & Unrau, 2005) to work with a group of 29 teachers (16 women and 13 men) who were enrolled in a Master’s in Education programme at the University of Dar es Salaam. Each teacher was requested to fill in a consent form, indicating his/her voluntary, informed consent to allow his/her data to be used for research purposes and assuring him/her of anonymity and confidentiality. We stressed that, should they become upset by any of the activities in the workshop, they could either speak to one of the researchers, who is a registered counsellor, or contact student counselling services. Visual methodologies were chosen as a data collection tool to help the teachers reflect on their constructions of HIV and AIDS, since the creation of the visual representation of a topic and reflection on it is in itself an intervention that can bring about a shift in mindset and the beginning of a subsequent change in practice (Guillemin, 2004). Visual methodologies also encourage teacher engagement and deep thinking about social issues; promote dialogue and sharing; increase enjoyment and, therefore, participation and commitment to change, and provide a tool for taking action (Pithouse, De Lange, Mitchell, Moletsane, Olivier, Stuart, Van Laren & Wood, 2010). Drawing is one powerful strategy that can be used with all age groups to elicit opinions and beliefs and to generate discussion about the topic in question (Stuart, 2006). We asked the participating teachers to draw a picture in response to the following prompt, “Draw how you see HIV and AIDS in Tanzania”, and to explain their drawing by means of a caption and a short narrative. The participants then presented their drawings to the larger group which allowed us to facilitate critical discussion on their interpretations. The drawings, narratives and the transcript of the critical discussion were thematically analysed by the three researchers independently, before they met for a consensus discussion (Bogdan & Biklen, 2006; Merriam, 2009). Trustworthiness of the research process was enhanced by this independent coding and re-coding, by triangulation of researcher, by recontextualising the findings within literature (Poggenpoel, 1998), and by explaining the process in detail (Leedy & Ormrod, 2001). 4 Perspectives in Education, Volume 31(2), June 2013 Discussion of findings The data analysis of the drawings, accompanying written explanations and the discussion revealed that the participating teachers did recognise that the severity of the pandemic in Tanzania was closely linked to inherent social injustices, but that they did not consider themselves able to influence the situation. Three main themes emerged, which will be critically discussed in the following sections, with relation to relevant literature. Theme 1: HIV and AIDS marginalises certain groups and renders them more vulnerable Many of the drawings depicted women and children as being most affected by the pandemic. This is, of course, true for sub-Saharan contexts (United Republic of Tanzania, 2007) – 6.6% of women are infected, in comparison to 4.6% of men; 3.9% of young women aged between 15 and 24 are infected in comparison to 1.7% of males in the same age group. However, the manner in which women and children were represented was cause for some concern about the potential stigmatising discourses evident in the drawings. Women were depicted as “victims”, unable to look after themselves. For example, the death of the economically active men in the community (drawing 3) resulted in women being widowed and, therefore, unable to support themselves or to contribute meaningfully to society. This notion of being “victims” was also depicted in drawing 10, where the caption read, “women are unable to protect themselves as they are dominated by men”. Men, however, could protect themselves, because they had knowledge on how the disease was transmitted. The explanation given for drawing 10 and comments in the discussion implied that the majority of the participants believed that education about how to prevent transmission is sufficient to stop the spread of HIV, and that women have the choice to decide whether to educate themselves or not. According to research, both of these beliefs are false (Kauffman, 2004; O’Sullivan, Harrison, Morrell, Monroe-Wise & Kubeka, 2006). Unless there is intervention to raise critical awareness and understanding of the complexity of human behaviour, this situation will remain undisrupted. Figure 1: Selection of drawings to illustrate Theme 1 3. 6 In Tanzania HIV/AIDS is the most dangerous disease which leads to many deaths of people and leaves many orphans and widows. Therefore the diagram represents orphans and widows caused by death of HIV/AIDS In Tanzania, women and children are the most affected people with HIV Pregnant women/girls are affected mainly 5Wood et al. — Drawing AIDS: Tanzanian teachers picture the pandemic 10 HIV/AIDS is a disaster in Tanzania. Tanzania without AIDS is possible. Women are unable to protect themselves as they are dominated by men. Theme 2: HIV and AIDS is closely linked to poverty According to the drawings and the subsequent discussion, the teachers are aware that HIV and AIDS leads to loss of human resources which, in turn, ravages the economy, thereby increasing poverty and rendering people more vulnerable to HIV infection (Kimaryo, Okpaku, Githuku-Shongwe & Feeney, 2004; UNAIDS, 2006). The gap between the rich and the poor (e.g. drawing 1) is a reality (TACAIDS, 2008) in Tanzania, but the perceptions illustrated in the drawings could lead to reinforcing the notion that it is the poor who must bear the burden of HIV rather than believing that they have the potential to improve their circumstances. The “poor” are depicted as uneducated and confused (cf. question marks above their heads, drawing 1) victims of the pandemic. Their inability to help themselves is implicit in the way in which they have been depicted by the teachers, and a sense of othering is evident, since teachers portray themselves as part of the “educated” and “rich” communities. In drawing 2, the teacher has positioned herself (subconsciously perhaps) with the rich OECD countries by using the preposition “we” in this regard and “they” to refer to the poor sub-Saharan countries. There is also evidence of an oversimplification of the pandemic, equating it only with poverty (e.g. drawing 2) and lack of education, negating the important social embeddedness of the pandemic (Baxen & Breidlid, 2009). Teachers’ perceptions, as depicted in the drawings, could promote a stigmatising discourse, stemming from misperceptions and a feeling that HIV and AIDS is not associated with teachers, but only with the “poor and uneducated” (drawing 1); that women are to blame for their own victimisation, because they do not take charge of their situation (drawing 10), and that AIDS originated with the youth (drawing 12), who have now infected adults. Such discourse is not uncommon among teachers in sub- Saharan Africa (Wood & Webb, 2008). 6 Perspectives in Education, Volume 31(2), June 2013 Figure 2: Selection of drawings to illustrate Theme 2 1 2 HIV/AIDS is a threat in the society as a snake in the diagram above. We are living with it but the poorest are much threatened than the rich (non-educated and educated). However, collective effort from both the poor and the rich is required to defeat it. Rich and powerful communities with small % of HIV infection “OECD” (we’re safe) Poor communities affected with HIV (SSA) (they are not safe) 13 16 Loss of manpower in Tanzania form 1980s to 2009. Indicates loss in economic status as deaths increase. My name is …. What came in my mind is that HIV/ AIDS is the most dangerous disease which causes death to the people. This is due to the fact that it has no cure nor medicine to treat the disease. 7Wood et al. — Drawing AIDS: Tanzanian teachers picture the pandemic Theme 3: Teachers are silent on their role as agents of change Several drawings indicated that the teachers primarily blamed the government for not taking action to improve the circumstances of the poor, including ensuring that education is available for all. Figure 3: Drawings illustrating Theme 3 17 27 “Wait for a moment, you are too many, we cannot af- ford to support you” “Infected and affected people, we need our rights”. Though the government and other non-governmen- tal organisations receive money from other donors or well-wishers to support people living with HIV/ AIDS, there are no serious efforts made to help or provide treatment and other related needs and infor- mation to the people as they require. Children staying with their grandmother after their parents died from HIV AIDS. Solution: Education: more education is needed, peo- ple need to be conscientised to avoid new spread. Govt: assist the vulnerable groups. 14 19 HIV AIDS kills women, men and children. The transmission rate is growing very fast, because of lack of education and ignorance. The government should ensure education on HIV AIDS is provided in each society so as to educate people on the impact of HIV AIDS in the society. The symbol above shows that HIV and AIDS is dan- gerous to the life of Tanzanians, especially people from 18-30 years. So the government should take care of it so that we can reduce the spread of HIV and AIDS in Tanzania. 8 Perspectives in Education, Volume 31(2), June 2013 While we agree that governments are socially responsible for providing adequate services, participants’ drawings suggest that they regard government as being solely responsible for educating and raising awareness about HIV and AIDS (cf. drawings 17, 14 and 19) and that such knowledge would suffice to curb the spread of HIV. None of the drawings or narratives explicitly stated that teachers themselves should educate the learners about HIV. Although drawing 27 acknowledged the importance of education, the participant did not mention that teachers were responsible for this education. Instead, the participants turned to “researchers” (drawing 11) and government to discover ways to reduce HIV infection, rather than stating that teachers are able to play a meaningful role in this. The drawings reveal a narrow and naïve understanding of HIV education, equating it with condom use (drawing 4); the promotion of “moral behaviour” by preaching the ABC message (drawings 15 and 16), and biomedical knowledge (drawings 24, 27 and 28b). Figure 4: Drawings depicting a narrow view of HIV and AIDS education 4 11 20 15 Only 20% of the people do not know how to control HIV As the years increased, the impact of HIV increased in the community. (on other side) – The government should educate the people; we need more researchers to investigate good ways of reducing the impact of HIV on our community. In my picture it shows that girls are more af- fected by boys by HIV, therefore there is a need to educate about it. Grandmother remains with children. My drawing is about HIV/AIDS transmission through unpreventine (sic) sexual relation- ships between male and female. Thereafter advice that it is possible to live in an HIV free zone by being faithful to your partner. 9Wood et al. — Drawing AIDS: Tanzanian teachers picture the pandemic 24 28B 22 HIV is being transmitted by many ways, including sexual intercourse. When you are doing sex with a victim of HIV you will get infected and when you sex with another person, you will transmit it and so the trend continues. In Tanzania orphans suffer a lot, there are many who do not attend school, do not have homes and they are not sure whether they can have anything to eat. Some of the orphans engage in things they do not like because of the situa- tion they are in. There are many cries in towns and villages as AIDS does not choose a specific place. It is about a person who is very ill, he is in bed, cannot sit or talk. His family is crying. They think he is going to die soon. Also, be- cause of the sick person the fam- ily members do not work, they stay with him, thus increasing poverty. Solution: it is important to give hope to the person and try to work hard instead of waiting for his death. Implications of the findings Based on our findings from this study, we are led to conclude that the participating teachers do have a limited and biased understanding of HIV and AIDS in Tanzania. They equate it with biomedical interventions, assuming that knowledge about the virus will help to curb the spread of HIV. Although there is awareness of the link between HIV and AIDS and social injustices, this is not regarded as something that they are able to influence, rather relying on government to take action. We tend to agree with Fullan (1993:5): “… teachers will never improve learning in the classroom … unless they also help improve conditions that surround the classroom”. We, therefore, propose that teacher education curricula provide opportunities for teachers to engage in reflection and debate about their own epistemological and ontological understandings to deconstruct and reconstruct their own philosophies and theories on behavioural change towards a more socially just society. They need to learn how to develop teaching strategies that will enable them to engage learners in a similar process, leading to authentic learning rather than parrot-fashion repetition of facts about human rights and social justice. Social justice in education can be promoted by including service learning and community involvement requirements in a curriculum that centralises the vision for social justice (Duncan-Andrade, 2007), as well as by modelling and embodying values that promote social justice. We add our voices to the call made by other researchers (Baxen, Wood & Austin, 2011; HEAIDS, 2010) for a transformation in teacher education curricula to allow for the engagement of teachers with the political, social, cultural and economic contexts that give rise to social inequalities, so that they are in a position to “create effective pedagogical spaces” (Macedo, 2006: xii) for the integration and debate of such factors in their everyday interaction with learners. Given that there is no one solution to stemming the spread of the 10 Perspectives in Education, Volume 31(2), June 2013 virus, continual critique and disruption of existing social, cultural, economic and political ideologies and structures (Fine, 1994) needs to be woven into the fabric of the curriculum. Conclusion As Borrero (2009) admits, teacher education programmes can never offer all that is required to address social injustice. However, they can help the teacher develop a passion and vision for social justice and the skills of knowing how to engage with learners on these issues in pedagogically appropriate ways, offering opportunity for real engagement with regard to learning. In this article, we have shown how the use of a participatory visual methodology created a space for teachers and researchers to explore participant constructions of HIV. The data analysis reported on in this instance has alerted us to the need to engage with the participating teachers to raise their awareness about their potential role as agents of change. We are fully aware that our interpretation of the drawings cannot be taken as ‘truth’, and further exploration of how the participants envisage their contributions to HIV and AIDS education is necessary. Having the actual drawings in front of them will help facilitate such discussion and permit us to make our interpretation clear as a point of departure for further exploration. This article has argued that teacher education should be founded in a critical paradigm, where the aim is to enable teachers to critically analyse the status quo and find ways to move towards a more just way of being (Perumal, 2009). If this is not the foundation of learning in university and schools, then education could become a tool for maintaining the status quo and perpetuating social injustices in society (Villegas & Lucas, 2002). In this age of AIDS, no one can afford to let this happen. References Baxen J & Breidlid A (eds) 2009. HIV/AIDS in sub-Saharan Africa. Understanding the implications of culture and context. Cape Town: UCT Press. Baxen J, Wood L & Austin P 2011. Reconsidering and repositioning HIV and AIDS within Teacher Education. Africa Insight, in press. Bennell P 2004. AIDS in Africa: Three scenarios for the education sector. Retrieved from www.eldis.org/ fulltext/UNAIDSscenariosfinal.pdf on 22 March 2011 Bogdan R & Biklen RC 2006. 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