Despite strong government commitment and support from external donors, HIV & AIDS remain a major challenge among adolescents and young people in Lesotho. The prevalence of HIV is the second highest in the world for the general population aged 15-49. Among youth (aged 15-24) and HIV prevalence is twice as high among women, compared to their male counterparts. The prevalence of STIs is also higher among young women. Early and unintended pregnancy is also high in Lesotho, particularly among poor girls and girls living in rural areas. Early marriage is among other major factors fuelling the spread of HIV, especially among adolescent girls and young women. HIV & AIDS poses serious challenges to the education sector in Lesotho and was declared a ‘national emergency’ by the Government in 2000. In 2005, a comprehensive sexuality education (CSE) curriculum for primary and secondary education was specifically developed, and reviewed and revised in 2012 and 2013. According to the 2005 School Health Policy of Lesotho, school health instruction should aim to ' promote wellness and motivate health maintenance, and not merely prevent disease'.
The terms used to refer to sexuality education across government documents, such as the 2019 National HIV and AIDS Policy and 2016-26 Education Sector Plan, include 'life-skills based sexuality education' and 'comprehensive sexuality education'.
3.1. Relevant international/regional agreements to which Lesotho is a signatory
Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Ratification date: 1995
Acknowledges the need to guarantee sexuality education free from discrimination and stereotypes, conveying gender equality values.
Convention on the Rights of the Child (CRC)
Commits to the right to access appropriate health-related information.
Convention on the Rights of Persons with Disabilities (CRPD)
Ratification date: 2008
Commits to the highest attainable standard of health for persons with disabilities.
International Covenant on Economic, Social and Cultural Rights
Ratification date: 1992
Acknowledges that the right to sexual and reproductive health is an integral part of the right to health.
UNESCO Convention against Discrimination in Education
Reaffirms that education is a human right. It highlights states' obligations to ensure free and compulsory education, bans any form of discrimination and promotes equality of educational opportunity.
In 2021. Lesotho also signed up to champion the Education Plus launched by UNAIDS, UN Women, UNESCO, UNICEF and UNFPA. The initiative aims to accelerate action and investments for increasing access to secondary education for all young people and to advance adolescent girls’, as well as young women’s health, education and rights, including sexual and gender-based violence and early and unintended pregnancy. The Permanent Secretary for Education pledged that the country would strengthen the implementation of CSE and work with parents and communities to reduce sexual and gender-based violence against adolescent girls and young women.
3.2. Relevant national laws and policies mandating comprehensive sexuality education
Sexuality education is legally recognized in the 2011 Children’s Protection and Welfare Act, which stipulates that a 'child has a right to sexual and reproductive health information and education appropriate to his/her age' (Article 11). The 2010 Education Act does not include a reference to life skills, health education, or sexuality education, but stipulates that the Minister of Education should 'ensure that a learner is provided with opportunities and facilities to enable him or her to develop physically, mentally, morally, spiritually and socially in a healthy, normal manner and in the conditions of freedom and dignity' (Article 4).
The introduction and promotion of life-skills-based sexuality education and CSE is mainly guided by government policies, such as the 2011 Education Sector HIV and AIDS Policy, the 2005 School Health Policy and the 2009 Curriculum and Assessment Policy.
The 2005 School Health Policy includes sections on adolescent sexual and reproductive health (SRH) and school health instruction that support the development, delivery, and evaluation of a planned, sequenced curriculum from the preschool to secondary school level, highlighting major content areas and aiming for 'no person to be denied access to reproductive health information'.
The 2019 National HIV and AIDS Policy provides for the Ministry of Education and Training to: i) facilitate HIV mainstreaming in learning institutions; ii) Develop examinable HIV curriculum from Primary to Tertiary Institutions; iii) Enhance prevention among children and young people including through CSE delivery, promotion of HIV prevention and treatment services and product uptake; and iv) Ensure Social Protection of Children in Schools. The previous 2006 National HIV and AIDS Policy also included provisions for the development of guidelines and standards on peer education and life skills education, with the aim to ensure that young girls and boys, both in and out of school, have 'access to life skills education which addresses unequal gender relations, to enable them to protect themselves from HIV infection or live positively with HIV and AIDS if they are already infected'.
The 2016-26 Education Sector Plan discusses HIV, health and well-being as cross-cutting issues. The goal is to promote healthy living and well-being, including curbing the spread of HIV & AIDS in the education sector. Specific objectives include the implementation of topics relating to CSE and SRH and the mainstreaming of HIV & AIDS into a range of educational activities.
Similarly, the 2018/19-2022/23 National Strategic Development Plan II promotes compulsory adolescent SRH programmes in schools.
Mandatory or optional
According to the 2011 Education Sector HIV and AIDS Policy and the 2018/19-2022/23 National Strategic Development Plan II, HIV & AIDS and Life Skills Education remains a compulsory subject at the upper basic level in all schools, in line with the learners’ level of development. Any learner being eligible for exclusion or exemption from attending parts of or all the health courses is based on guidelines set by the Ministry of Education and Training.
Model of delivery
The Life Skills-Based Sexuality Education curriculum is well integrated into the personal, spiritual and social learning area, and the scientific and technological learning areas at primary school level. At secondary school level, it is taught as a stand-alone subject called Life-Based Sexuality Education. In the primary level syllabus, some elements of CSE also appear in languages, integrated science and integrated social sciences and technology studies as well. The content is age -appropriate and appropriate for the particular learning level. As a stand-alone subject, the curriculum for Life-Skills Based Sexuality Education for secondary students addresses six main themes: knowing oneself and living with others; human rights and child protection; gender norms and equality; SRH; STIs and HIV; and drug, alcohol and substance abuse.
According to the 2016-26 Education Sector Plan, the Ministry of Education and Training revised its life-skills education curriculum to incorporate CSE for the period 2005-2015. To assist children and young people to make informed choices about their sexuality, the 2006 National HIV and AIDS Policy aimed to develop guidelines for the incorporation of life-skills education into the school curricula, including SRH education. Building on the 2009 Curriculum and Assessment Policy, Life Skills-Based Sexuality Education was integrated into subjects at the lower basic education level. It does not yet cover learners in grades 11 and 12 (16-17 year-olds).
Comprehensiveness of content
The CSE curriculum promotes healthy behaviours in sexual intercourse, delaying sexual debut, and avoiding concurrent sexual partnerships. It provides information on condoms but does not discuss barriers to obtaining condoms or using contraceptives. CSE content for 9-12-year-olds includes human rights and child protection; gender norms, equality and roles; STIs, including HIV & AIDS; and substance abuse. Self-esteem, changes in puberty, human growth and development, refusal skills and coercive sex are also covered. However, topics relating to marriage are not discussed at this level and are covered for more advanced levels. Learners at this level are rather encouraged to avoid early marriages and pregnancy. Delaying sexual debut and abstinence are emphasized, while condom use is not discussed. The programme taught in secondary schools covers topics such as: valuing oneself; understanding relationships; adolescents' rights and responsibilities; the difference between gender and sex; STIs and HIV & AIDS; and drugs, substance and alcohol abuse. While the Ministry of Education and Training declares abstinence as the first behavioural choice for prevention, the 2011 Education Sector HIV and AIDS Policy states that learners will be given proper information about sex, the risks associated with sexual activity, and how they can protect themselves. Topics on natural and emergency contraception and use of pregnancy test kits are not dealt with.
The 2005 School Health Policy highlights that school health instruction should be provided from early childhood to senior secondary education level, covering the following major content areas: mental and emotional health; family living; consumer and community health; environmental health; growth and development / human sexuality; nutrition; personal health; communicable diseases and chronic disorders; injury prevention and safety; substance use and abuse; and gender and human rights. According to the Policy, concepts presented at early childhood and lower education levels should focus primarily on the individual and family, and by the end of the senior secondary level should expand to include community, national and global health.
According to the 2011 Education Sector HIV and AIDS Policy gender-sensitive teaching and learning materials have been developed to assist the teaching about HIV & AIDS as prescribed by the curricula. Learners, staff, and key stakeholders are involved in the creation of all HIV & AIDS instructional materials and programme strategies. While there is a manual for teaching CSE and instructors have been trained to use it, some teachers do not appear to be comfortable teaching CSE, resulting in uneven standards of delivery.
Teachers receive capacity building support through both pre-and in-service teacher education programmes. The Lesotho College of Education and the Faculty of Education of the National University of Lesotho provide teacher preparation programmes. The Lesotho College of Education's pre-service teacher education curriculum currently includes CSE, and the National University of Lesotho authorized a course to be delivered, starting in August 2016.
According to the 2016-26 Education Sector Plan, the Lesotho College of Education offers a life-skills course in pre-service teacher education, while the education faculty of the National University of Lesotho is introducing the course in its pre-service teacher education programme. The Ministry of Education and Training has also collaborated with UNESCO and UNFPA to implement an online CSE course for In-service teacher training.
The 2011 Education Sector HIV and AIDS Policy mandates training for school and institution workers in HIV prevention, SRH, counselling and support.
The Ministry of Education and Training is required to establish partnerships to facilitate access to appropriate treatment, support and referral services. Students and faculty have access to contraceptive devices and services. This involves the distribution of condoms at health centres and youth-friendly services such as health corners, peer counselling groups and leisure facilities for all students. The 2005 School Health Policy has a dedicated section on school health services, stating that health clinics within each health services area shall complement school-based initiatives by providing health services to school students with unmet health needs through prevention education, screening, testing, diagnosis, counselling or treatment of any ailment.
According to the 2016-26 Education Sector Plan, the Ministry of Education and Training collaborates with the Ministry of Health and other relevant stakeholders to ensure the provision of friendly health services to learners. In addition, the 2018/19-2022/23 National Strategic Development Plan II additionally endorses compulsory adolescent SRH programmes in schools, youth resource centres, and other related activities and facilities. This is part of the objectives of ensuring universal access to SRH care services, with a focus on adolescents, youth, and other vulnerable groups, and expanding access to SRH facilities for women and men.
4.1 Responsible ministries
The Ministry of Education and Training is responsible for implementing CSE, with specific objectives including: the facilitation of HIV mainstreaming in learning institutions; the development of an examinable HIV curriculum from primary to tertiary institutions; the enhancement of prevention among children and young people, including through CSE delivery; and the promotion of HIV prevention and treatment services and an increased uptake in products and services. The mandate of the HIV and AIDS Coordination Unit under the Ministry of Education and Training is expanding to include the broader health and well-being of learners in the Lesotho education system. The Unit ensures that the Ministry of Education and Training is responding appropriately to the HIV pandemic in a coordinated and collaborative manner in the areas of HIV management, information dissemination, research and social responsiveness.
The Ministry of Health, whose mandate is to spearhead, coordinate and manage the health sector, collaborates with the the Ministry of Education and Training to ensure the provision of accessible and friendly health services to learners.
Any issues arising on gender are referred to the Ministry of Gender, Youth, Sports and Recreation.
4.2. Level of responsibility/decentralization and autonomy
According to the 2005 School Health Policy, curriculum development adopts a multisectoral panel system involving learners, teachers, parents, health professionals, community representatives, education policy makers and development partners, among others. Sensitive and controversial health topics such as sexuality are taught under the direction of the Ministry of Education and Training in collaboration with school committees and school boards. Health teachers and facilitators are responsible for structuring and organizing the body of health knowledge systematically for the purposes of planning and conducting meaningful health instruction. The views of parents and the community are considered along with the needs of the learners when developing HIV activities for the school-age population. Each school district is responsible for establishing guidelines for handling reported cases f child abuse in the school setting, based on Ministry of Education and Training regulations.
4.3. Government budget allocation
No information was found.
The EMIS ER42 form, a data-collecting instrument for the annual school census, covers several pertinent aspects of CSE and SRH, such as distance from the nearest clinic, reasons for dropping out of school, including early marriage and pregnancy, and HIV and sexuality education. In addition, every two years, the Examinations Council of Lesotho conducts the National Education Assessment to review the education system's health, including HIV & AIDS-related indicators. The Global AIDS Progress Report and the Demographic Health Survey both gather information that is pertinent to CSE. Some CSE-specific investigations are also commissioned.
The 2019 National HIV and AIDS Policy aims to integrate HIV interventions, including the empowerment of out-of-school girls and boys and men and women, into the national and district monitoring and evaluation frameworks. This is in addition to monitoring and evaluating the progress on gender indicators in relation to HIV, tuberculosis and SRH rights.