**5. Results**

#### **5.1 School attendance**

Nearly all (99%) of adolescents perinatally infected with HIV had ever attended school with no significant difference between male and female respondents. In addition, 44% of those who had ever attended school reached secondary and above level of education (41% of male and 46% of female respondents; p=0.19). Most of those who had ever attended school (82%) were still in school at the time of the survey (81% of male and 83% of female respondents; p=0.49). As expected, current school attendance was significantly associated with age and whether the respondent lived with a biological parent (Table 2). In particular, older HIVpositive adolescents were significantly less likely to be in school compared to their younger counterparts (p<0.01) while those living with a biological parent were significantly more likely to be in school compared to those who did not live with a biological parent (p<0.05).


Notes: aAmong those who ever attended school; bAmong those currently attending school; Estimates are based on equation (1) in the text; Standard errors are in parentheses; ref: reference category; \*p<0.05; \*\*p<0.01.

Table 2. Coefficient estimates from random-effects logit models predicting current school attendance, experiences of stigma/discrimination, and receipt of any support from school

disturbance term due to unmeasured characteristics that may also affect the outcome for

The first dependent variable is measured by whether the respondent was still in school at the time of the survey conditional on having ever attended school. Stigma and discrimination, on the other hand, refer to whether those attending school had ever been teased, called nasty names, or suspected that rumours were spreading about them because of their HIV status. The third dependent variable is measured by whether the respondent received any support from groups, clubs or the school. The models control for age (single years), sex (male or female), district of residence (Kampala, Jinja, Masaka, Wakiso), and

Nearly all (99%) of adolescents perinatally infected with HIV had ever attended school with no significant difference between male and female respondents. In addition, 44% of those who had ever attended school reached secondary and above level of education (41% of male and 46% of female respondents; p=0.19). Most of those who had ever attended school (82%) were still in school at the time of the survey (81% of male and 83% of female respondents; p=0.49). As expected, current school attendance was significantly associated with age and whether the respondent lived with a biological parent (Table 2). In particular, older HIVpositive adolescents were significantly less likely to be in school compared to their younger counterparts (p<0.01) while those living with a biological parent were significantly more likely to be in school compared to those who did not live with a biological parent (p<0.05).

> Indicator of stigma/ discriminationb

Any support from groups/clubs/ schoolb

whether the respondent lived with a biological parent (yes or no).

Currently attending schoola

Age (single years) -0.47\*\* (0.06) 0.01 (0.05) 0.08 (0.06) Sex (Female = 1) 0.04 (0.22) -0.05 (0.18) -0.27 (0.21)

 Jinja -0.51 (0.53) 0.08 (0.26) -0.72 (0.41) Wakiso -0.71 (0.87) -0.10 (0.42) -0.03 (0.96) Masaka -0.84 (0.59) 0.84\*\* (0.24) 0.21 (0.38)

parent (Yes = 1) 0.62\* (0.24) 0.04 (0.18) 0.28 (0.21)

Number of respondents 710 583 583

Notes: aAmong those who ever attended school; bAmong those currently attending school; Estimates are based on equation (1) in the text; Standard errors are in parentheses; ref: reference category; \*p<0.05;

Table 2. Coefficient estimates from random-effects logit models predicting current school attendance, experiences of stigma/discrimination, and receipt of any support from school

individuals identified from facility *j*.

**5. Results** 

Covariates

\*\*p<0.01.

District (ref = Kampala)

Lives with any biological

**5.1 School attendance** 

Slightly more than half (52%) of the respondents attending school at the time of the survey missed going to school the previous term (Table 3) with no significant variations by age, sex or whether the respondent lived with a biological parent. Nonetheless, the proportion that missed school the previous term was significantly lower in Jinja compared to other districts. Further analysis shows that illness was the major reason for missing school (cited by 57% of those who missed school) followed by lack of school fees or education materials (23%), and going for treatment/ medication (12%). There were also significant variations in the major reasons for missing school by sex and district of residence (p<0.05 in each case). For instance, 60% of female respondents cited illness as the major reason for missing school the previous term compared to 51% of male respondents. In contrast, slightly more than twice as many male as female respondents cited going for treatment/medication as the major reason for missing school (18% versus 8%). Similarly, the proportion mentioning illness was about 10 percentage points higher in Jinja and Masaka (61% in each case) compared to Kampala and Wakiso districts (52% and 50% respectively) while the proportion citing treatment/medication was nine times higher in Kampala compared to Jinja district (19% versus 2%).


Notes: p-values are from Chi-square tests.

Table 3. Percentage of survey participants who missed school the previous term, percentage that ever repeated a class and percentage that considered schooling very important by background characteristics

More than half (55%) of the respondents who were still in school at the time of the survey reported ever repeating a class (Table 3). The proportion having repeated a class did not

HIV Infection and Schooling Experiences of Adolescents in Uganda 81

In spite of the challenges with absenteeism and class repetition, nearly all respondents who were still in school (95%) considered education very important to them with no significant variations by age, sex or whether the respondent lived with a biological parent (Table 3). Nonetheless, a significantly lower proportion of respondents from Wakiso compared to those from the other districts recognized that education is very important to them (p<0.01). Their major motivations for continuing with education included future career prospects (mentioned by 69% of the respondents), encouragement from others (19%) and the urge to gain new knowledge (12%; Table 4). A significantly higher proportion of older (18-19 years) compared to younger respondents mentioned future career prospects as a motivation for schooling (p<0.05). In contrast, the proportion of respondents from Masaka district mentioning future career prospects was nearly half of that of respondents from Jinja district (p<0.01). There were, however, no significant variations in the proportion of respondents mentioning encouragement by others as a motivation for schooling by the background characteristics considered. But a significantly higher proportion of younger (12-17 years) and female respondents cited the urge to gain new knowledge as a motivation compared to

Further analyses show that among respondents who had ever attended school but were out of school at the time of the survey, 63% cited lack of fees or education materials as the major reason for non-attendance followed by illness (16%) while 8% mentioned death of parent/guardian. There were no significant variations in the major reasons for nonattendance by age, sex or district of residence. However, the reasons differed significantly by whether the respondent lived with a biological parent (p<0.05). In particular, the proportion of those not living with a biological parent that cited lack of fees or education materials as the major reason for non-attendance was 24 percentage points higher than that of those who lived with such a parent (69% versus 45%). In contrast, the proportion of those living with a biological parent who mentioned illness as the major reason was more than

three times higher than that of those not living with such a parent (32% versus 10%).

Findings from in-depth interviews with school officials indicate that students with fullblown AIDS face greater challenges in school compared to those who are HIV-positive but asymptomatic. The challenges include being isolated and withdrawn as well as being shunned and stigmatized by other students. The existence of self-imposed stigma and discrimination as well as discrimination by others was also evident from the student essays. For instance, among students who knew a fellow student in their school who was HIVpositive, the reported actual reactions by students and teachers towards the HIV-positive students is at variance with reports of how they would react in the hypothetical case (Table 5). In most cases, the proportions reporting actual positive reactions towards HIV-positive students are significantly lower than those reporting similar possible reactions to a hypothetical case. In contrast, whereas only 2% reported that they would discriminate, isolate or stigmatize a fellow student who is HIV-positive, nearly half (47%) acknowledged that such students face considerable discrimination, isolation and stigmatization not only from fellow students and teachers but also self-imposed. This is further supported by the following excerpts from the essays representing the perspectives of both male and female

older and male respondents respectively (Table 4).

**5.2 Stigma and discrimination** 

students:

significantly vary by age, sex or whether the respondent lived with a biological parent. It, however, significantly differed by district of residence with the lowest proportion being in Kampala (46%) and the highest in Jinja (64%). Results of further analysis show that poor performance and illness were the major reasons for repeating a class the last time (cited by 35% of the respondents in each case) followed by lack of fees or education materials (20%). There were also significant variations in the major reasons for repeating a class by age (p<0.01) and district of residence (p<0.05). For example, the proportion of adolescents aged 12-14 years who repeated a class because of poor performance was more than twice as high as that of those aged 18-19 years (49% versus 22%). In contrast, the proportion of those aged 18-19 years who cited lack of fees or education materials was about four times higher than that of those aged 12-14 years (35% compared to 9%). Similarly, the proportion that repeated a class because of poor performance was highest in Jinja (42%) and lowest in Kampala district (22%) while the proportion that repeated a class because of illness was highest in Kampala (41%) and lowest in Jinja district (28%).


Notes: p-values are from Chi-square tests.

Table 4. Percent distribution of survey participants by three most commonly cited motivations for schooling according to background characteristics

significantly vary by age, sex or whether the respondent lived with a biological parent. It, however, significantly differed by district of residence with the lowest proportion being in Kampala (46%) and the highest in Jinja (64%). Results of further analysis show that poor performance and illness were the major reasons for repeating a class the last time (cited by 35% of the respondents in each case) followed by lack of fees or education materials (20%). There were also significant variations in the major reasons for repeating a class by age (p<0.01) and district of residence (p<0.05). For example, the proportion of adolescents aged 12-14 years who repeated a class because of poor performance was more than twice as high as that of those aged 18-19 years (49% versus 22%). In contrast, the proportion of those aged 18-19 years who cited lack of fees or education materials was about four times higher than that of those aged 12-14 years (35% compared to 9%). Similarly, the proportion that repeated a class because of poor performance was highest in Jinja (42%) and lowest in Kampala district (22%) while the proportion that repeated a class because of illness was highest in

> Future career prospects (%)

Age group p<0.05 p=0.49 p<0.01 12-14 64.6 16.9 16.5 15-17 67.3 20.5 10.5 18-19 77.1 21.1 5.7 Sex p=0.72 p=0.13 p<0.01 Male 68.1 22.3 6.7 Female 69.5 17.3 15.0 District p<0.01 p=0.14 p=0.08 Jinja 86.2 14.5 9.7 Kampala 74.7 19.1 9.8 Wakiso 64.7 14.7 5.9 Masaka 48.6 24.3 16.6 Lives with a biological parent p=0.18 p=0.57 p=0.85 Yes 66.7 20.1 11.9 No 71.8 18.3 11.4

motivations for schooling according to background characteristics

Notes: p-values are from Chi-square tests.

All respondents 68.9 19.3 11.6 Number of respondents 585 585 585

Table 4. Percent distribution of survey participants by three most commonly cited

Encouraged by

Gain new knowledge

(%)

others (%)

Kampala (41%) and lowest in Jinja district (28%).

Background characteristics

In spite of the challenges with absenteeism and class repetition, nearly all respondents who were still in school (95%) considered education very important to them with no significant variations by age, sex or whether the respondent lived with a biological parent (Table 3). Nonetheless, a significantly lower proportion of respondents from Wakiso compared to those from the other districts recognized that education is very important to them (p<0.01). Their major motivations for continuing with education included future career prospects (mentioned by 69% of the respondents), encouragement from others (19%) and the urge to gain new knowledge (12%; Table 4). A significantly higher proportion of older (18-19 years) compared to younger respondents mentioned future career prospects as a motivation for schooling (p<0.05). In contrast, the proportion of respondents from Masaka district mentioning future career prospects was nearly half of that of respondents from Jinja district (p<0.01). There were, however, no significant variations in the proportion of respondents mentioning encouragement by others as a motivation for schooling by the background characteristics considered. But a significantly higher proportion of younger (12-17 years) and female respondents cited the urge to gain new knowledge as a motivation compared to older and male respondents respectively (Table 4).

Further analyses show that among respondents who had ever attended school but were out of school at the time of the survey, 63% cited lack of fees or education materials as the major reason for non-attendance followed by illness (16%) while 8% mentioned death of parent/guardian. There were no significant variations in the major reasons for nonattendance by age, sex or district of residence. However, the reasons differed significantly by whether the respondent lived with a biological parent (p<0.05). In particular, the proportion of those not living with a biological parent that cited lack of fees or education materials as the major reason for non-attendance was 24 percentage points higher than that of those who lived with such a parent (69% versus 45%). In contrast, the proportion of those living with a biological parent who mentioned illness as the major reason was more than three times higher than that of those not living with such a parent (32% versus 10%).

#### **5.2 Stigma and discrimination**

Findings from in-depth interviews with school officials indicate that students with fullblown AIDS face greater challenges in school compared to those who are HIV-positive but asymptomatic. The challenges include being isolated and withdrawn as well as being shunned and stigmatized by other students. The existence of self-imposed stigma and discrimination as well as discrimination by others was also evident from the student essays. For instance, among students who knew a fellow student in their school who was HIVpositive, the reported actual reactions by students and teachers towards the HIV-positive students is at variance with reports of how they would react in the hypothetical case (Table 5). In most cases, the proportions reporting actual positive reactions towards HIV-positive students are significantly lower than those reporting similar possible reactions to a hypothetical case. In contrast, whereas only 2% reported that they would discriminate, isolate or stigmatize a fellow student who is HIV-positive, nearly half (47%) acknowledged that such students face considerable discrimination, isolation and stigmatization not only from fellow students and teachers but also self-imposed. This is further supported by the following excerpts from the essays representing the perspectives of both male and female students:


HIV Infection and Schooling Experiences of Adolescents in Uganda 83

"Her dormitory mates normally insult her when they see her going back home on a monthly basis for treatment, for example they say 'kigenze kuleta biweke' ['she has gone to get

"They don't associate with us and always make insulting comments... Even teachers should

"Teachers have also resorted to nick-naming him like for example 'musuja' [fever] and

"I know of a boy in our school who is HIV-positive…However much other students try to

"Yes, I know one boy with HIV and he is not always healthy. He does not associate with

Adolescents perinatally infected with HIV who participated in the survey and were still in school were asked whether they had been teased or called nasty names because of their HIV status and whether they suspected rumours spreading about their sero-status. Sixteen percent reported being teased because of their HIV status (similar proportions of male and female respondents), 19% reported being called nasty names (22% of male and 16% of female respondents; p=0.07), and close to a quarter (24%) suspected that rumours were spreading around in school about their sero-status (23% of male and 25% of female respondents; p=0.56). Results from the random-effects logit model predicting the likelihood of experiencing any of the three indicators of stigma and discrimination show no significant differences by age, sex, or whether the respondent lived with a biological parent (Table 2). District of residence is, however, significantly associated with experiencing stigma and discrimination (p<0.01) with those from Masaka being significantly more likely to report such experiences compared to their counterparts from Kampala (p<0.01), Jinja (p<0.01), and

Only 16% of in-school HIV-positive adolescents reported having support groups or clubs for HIV-positive students in their learning institutions (18% of male and 14% of female respondents; p=0.19). Of those who had, 73% belonged to and received support from the groups/clubs (74% of male and 71% of female respondents; p=0.75). In addition, only 15% reported receiving any kind of support from school (19% of male and 13% of female respondents; p<0.05). Results from the random-effects logistic regression model predicting the likelihood of receiving any support from the groups, clubs or school show no significant differences by age, sex, district of residence, or whether the respondent lived with a biological parent (Table 2). However, nearly all those who received some kind of support from the groups/clubs (94%) or schools (92%)—where these exist—were satisfied with it. Additional analysis shows that the kind of support provided by the groups, clubs or schools mostly included taking medicine, counselling or moral support, basic needs, and life skills

School officials also reported during in-depth interviews that once they found out that a particular student had HIV or other chronic illness, they exempted them from engaging in heavy extra-curricular activities, provided them with special meals where possible, and

medication' but in a derogatory manner]." (19-year old female student).

comfort him, he always wants to be alone." (18-year old female student).

others. Every time he is in a bad mood." (16-year old male student).

stop back-biting us." (17-year old HIV-positive male student).

rebuke him in public."(18-year old male student).

Wakiso districts (p<0.05).

training.

**5.3 School-based support** 


Notes: aPossible reaction refers to the hypothetical case whereby students were asked how they would react if they found out that a fellow student was HIV-positive; bActual reaction refers to how the students themselves, other students, and teachers react to the presence of an HIV-positive student; ARVs: antiretroviral drugs; Differences between proportions for possible and actual reactions are statistically significant at: \*\*p<0.01; \*p<0.05; ns: not significant.

Table 5. Distribution of most commonly cited possible and actual reactions as expressed in the essays by students who knew of a fellow student living with HIV in their school

"Yes we have someone in our school who is HIV-positive. I don't like to even touch her I think I can even get tempted to loving her and get infected. Other students don't want to talk to her."(17-year old male student).

"At first I did not like her and any person around her because I thought they also had the virus." (14-year old female student).

"Yes I know someone in the school with AIDS … some students isolate him some are friendly to him. But even some do not share with him, some beat him up, some do not want to be nearer to him." (20-year old male student).

"Students always feel disgusted with her sickness and tend to keep a distance from her." (17-year old female student).

"Students tend to nickname such student for example there's a boy who was nicknamed 'woliru woofira' [poison]." (18-year old male student).

Show love, compassion, friendship, kindness 60.7 56.4ns

living 46.9 12.9\*\* Show pity, sympathy, feel bad, sad or sorry 43.9 56.8\*\* Discourage sexual activity/relationships 32.3 5.0\*\* Encourage to pray and/or trust in God 22.8 5.6\*\*

always 23.1 6.3\*\* Encourage balanced diet 17.2 0.3\*\*

tests 15.2 0.7\*\* Stop sharing sharp instruments and other things 13.2 2.6\*\* Assist with class or house work 11.9 4.3\*\* Keep information confidential/secret 11.6 4.0\*\* Discriminate, isolate, stop friendship, stigmatize 2.0 46.9\*\* Tell others/gossip about it 1.7 5.9\*\*

Number of students 303 303 Notes: aPossible reaction refers to the hypothetical case whereby students were asked how they would react if they found out that a fellow student was HIV-positive; bActual reaction refers to how the students themselves, other students, and teachers react to the presence of an HIV-positive student; ARVs: antiretroviral drugs; Differences between proportions for possible and actual reactions are

Table 5. Distribution of most commonly cited possible and actual reactions as expressed in the essays by students who knew of a fellow student living with HIV in their school

"Yes we have someone in our school who is HIV-positive. I don't like to even touch her I think I can even get tempted to loving her and get infected. Other students don't want to

"At first I did not like her and any person around her because I thought they also had the

"Yes I know someone in the school with AIDS … some students isolate him some are friendly to him. But even some do not share with him, some beat him up, some do not want

"Students always feel disgusted with her sickness and tend to keep a distance from her."

"Students tend to nickname such student for example there's a boy who was nicknamed

Provide hope, encouragement, advice/counsel for positive

Encourage/remind to take ARVs and other medicines

statistically significant at: \*\*p<0.01; \*p<0.05; ns: not significant.

talk to her."(17-year old male student).

to be nearer to him." (20-year old male student).

'woliru woofira' [poison]." (18-year old male student).

virus." (14-year old female student).

(17-year old female student).

Encourage/support to seek medical treatment including lab

Possible reactiona (%)

Actual reactionb (%)

Reactions

"Her dormitory mates normally insult her when they see her going back home on a monthly basis for treatment, for example they say 'kigenze kuleta biweke' ['she has gone to get medication' but in a derogatory manner]." (19-year old female student).

"They don't associate with us and always make insulting comments... Even teachers should stop back-biting us." (17-year old HIV-positive male student).

"Teachers have also resorted to nick-naming him like for example 'musuja' [fever] and rebuke him in public."(18-year old male student).

"I know of a boy in our school who is HIV-positive…However much other students try to comfort him, he always wants to be alone." (18-year old female student).

"Yes, I know one boy with HIV and he is not always healthy. He does not associate with others. Every time he is in a bad mood." (16-year old male student).

Adolescents perinatally infected with HIV who participated in the survey and were still in school were asked whether they had been teased or called nasty names because of their HIV status and whether they suspected rumours spreading about their sero-status. Sixteen percent reported being teased because of their HIV status (similar proportions of male and female respondents), 19% reported being called nasty names (22% of male and 16% of female respondents; p=0.07), and close to a quarter (24%) suspected that rumours were spreading around in school about their sero-status (23% of male and 25% of female respondents; p=0.56). Results from the random-effects logit model predicting the likelihood of experiencing any of the three indicators of stigma and discrimination show no significant differences by age, sex, or whether the respondent lived with a biological parent (Table 2). District of residence is, however, significantly associated with experiencing stigma and discrimination (p<0.01) with those from Masaka being significantly more likely to report such experiences compared to their counterparts from Kampala (p<0.01), Jinja (p<0.01), and Wakiso districts (p<0.05).

#### **5.3 School-based support**

Only 16% of in-school HIV-positive adolescents reported having support groups or clubs for HIV-positive students in their learning institutions (18% of male and 14% of female respondents; p=0.19). Of those who had, 73% belonged to and received support from the groups/clubs (74% of male and 71% of female respondents; p=0.75). In addition, only 15% reported receiving any kind of support from school (19% of male and 13% of female respondents; p<0.05). Results from the random-effects logistic regression model predicting the likelihood of receiving any support from the groups, clubs or school show no significant differences by age, sex, district of residence, or whether the respondent lived with a biological parent (Table 2). However, nearly all those who received some kind of support from the groups/clubs (94%) or schools (92%)—where these exist—were satisfied with it. Additional analysis shows that the kind of support provided by the groups, clubs or schools mostly included taking medicine, counselling or moral support, basic needs, and life skills training.

School officials also reported during in-depth interviews that once they found out that a particular student had HIV or other chronic illness, they exempted them from engaging in heavy extra-curricular activities, provided them with special meals where possible, and

HIV Infection and Schooling Experiences of Adolescents in Uganda 85

support at school or through school is almost non-existent. Sick-bays—where they exist in schools—are not equipped with essential medicines while school-based caregivers (school nurses, guidance and counselling teachers, and senior teachers) are inadequately trained to handle the healthcare needs of HIV-positive students. Existing attempts at addressing the needs of in-school HIV-positive young people are ad hoc, at individual level, and crisisdriven. The absence of formally established mechanisms could also partly be due to nondisclosure of students' sero-status by parents/guardians during admission given that in certain cases, school authorities often discovered when the student became symptomatic while at school or because of continued absenteeism or seeking permission to go for

These findings have important programmatic implications for the education sector not only in Uganda but other SSA countries affected by HIV/AIDS. Specifically, they suggest the need for: (1) school-based programs to assist orphans and other vulnerable children, including those living with HIV, so that they do not miss attending school for lack of essential materials; (2) strengthening the school-based healthcare program including treatment, care and support for HIV-positive students, encouraging in-school young people to undergo testing and counselling for HIV, and equipping sick-bays—where these exist with essential medicines; (3) pre- or in-service training for school-based caregivers (school nurses, guidance and counselling teachers, and senior teachers) on HIV counselling, care and support; (4) putting in place psychosocial support mechanisms for HIV-positive young people, orphans and other vulnerable children in schools, which should be expanded to incorporate all students irrespective of their HIV status in order to reduce stigma and discrimination through innovative ways such as child-to-child communication; and (5) putting in place measures to discourage stigma and discrimination against HIV-positive students through sensitizing school officials and students on the consequences of the same

Although this chapter identifies possible responses by the education sector to the needs of in-school HIV-positive young people, its major limitation is that it does not consider acceptable, feasible and effective strategies for addressing these needs. This is largely because it relies on data from an exploratory study whose aim was to provide a better understanding of the schooling experiences of this subset of the population. Operations research is best suited for providing answers regarding acceptable, feasible and effective strategies for responding to these needs. Operations research can, for instance, provide answers to the following questions: What school-based support programs are appropriate and effective in meeting the education needs of orphaned and vulnerable children, including those living with HIV? How can school-based health care programs be strengthened to better meet the needs of in-school HIV-positive young people? Does training of school-based caregivers improve the provision and quality of care and support for HIV-positive learners? What strategies and psychosocial support mechanisms can

1In Uganda, parents/guardians complete medical forms upon student admission so that the information can be used to identify those with needs that might require special attention. However, most parents/guardians tend to conceal certain ailments including HIV, perhaps, for fear that their children might not be admitted if their conditions are known or to protect them from stigma and

treatment on specific days.1

on those who are exposed to them.

discrimination.

reminded them to take medicine in cases where they were aware that the children were on antiretroviral drugs (ARVs). Nonetheless, the interviews revealed that the support was mainly non-formal and a lot seemed to depend on the goodwill of particular head teachers, other teachers, and school nurses who sometimes use their own resources. In one school, for example, a teacher reportedly helped HIV-positive students to pick their monthly refill of ARVs so that they did not miss lessons while in another, the head teacher invited the guardian of one of the students to the school, counselled them, and connected them to a treatment centre. As one senior female teacher in one of the primary schools explained:

"Sometimes their guardians do not genuinely have the money but others [guardians] are just negligent they feel that 'after all the child may not have long to live'. In cases where the child knows that they are HIV positive this adds to their psychological stress. At school we ask them 'where are the materials we sent you for'; at home they are being told 'we do not have money'. When we do not know their special circumstances we think they are just being stubborn and not informing their parents. But when we find out, we try as a school to see how best to help them. Some teachers even buy them the materials using their own money but this is after they have found out the circumstances."

Findings from the in-depth interviews further show that HIV-positive young people in boarding institutions face additional challenges such as poor diet, adherence to ARVs, and taking cold showers. Whereas these have implications for their academic performance, schools lack formally established mechanisms for meeting these needs. For instance, sickbays—where they exist in schools—are ill-equipped; they do not commonly stock antibiotics, have no full-time nurses while the available staff members are equipped to provide First Aid treatment only. Moreover, school-based caregivers (school nurses, guidance and counselling teachers, and senior teachers) are inadequately trained to handle the healthcare needs of HIV-positive students.
