AIDS Research: Global Understanding and Engagement (ARGUE)

Sherryl Broverman, Associate Professor of the Practice, Department of Biology, Duke University

In 2000 Duke University modified its general education curriculum to place a greater emphasis on “the ability to make meaning of complex information…the ability to evaluate and discern among competing claims… the ability to collaborate… the ability to engage difference… and the ability to apply knowledge in the service of society.” This introductory science course for non-majors and pre-majors was developed in 2000 in response to these new curricular requirements and has been taught ever year ever since. The course links curricula at Duke University (USA) and Egerton University (Kenya) by teaching the science related to HIV/AIDS through collaborative learning and common research projects of value to an international community partner. The overarching goals of the course are to

  1. to increase the ability of students to evaluate, research, and communicate scientific knowledge clearly;
  2. to increase awareness of how science is perceived and utilized across cultures; and
  3. to foster an lifelong interest in understanding the role science plays in globalization and international development.

Students in the course explore the biology of HIV, including viral transmission, pathology, virulence and treatment, as well as the relationship that these scientific processes have to social, political, and economic life. They gain experience in evaluating the quality of scientific data and hypotheses and in effectively conveying results to their peers as they work on common assignments and collaborative research projects. The products of these collaborations have included the development of curricula on HIV/AIDS (which has been used by over 2000 students at Egerton), HIV peer education materials, resources on the relationship between gender inequality and health, and programs to support girls’ education. Since its inception, the course’s development has been supported by awards from the NSF, including the Women’s International Science Collaboration Grant (2003) and the Course, Curriculum and Laboratory Improvement program (2004). It received the Josiah Charles Trent Memorial Foundation Award in Medical Ethics and Humanities in 2006.

The Course

Course Learning Goals for Instructors and Students

Instructor’s Goals:
Introductory science education for non-major or pre-major students often leaves students unengaged by the material, uninterested in further study, and unaware of the relevance of science to personal as well as global issues. This course creates linked, international curricula at Duke University (USA) and Egerton University (Kenya) using the science of HIV/AIDS to enhance science literacy, personal engagement and research skills. The ARGUE course also adopts the goal from the NSF’s Strategic Plan to create ” a diverse, internationally competitive, and globally engaged workforce of scientists, engineers, and wellprepared citizens”. AIDS addresses that goal by combining scientific content with international collaborative learning and research projects of value to an international community partner. The overarching goals of the course are to

  1. to increase the ability of students to evaluate, research, and communicate scientific knowledge clearly;
  2. to increase awareness of how science is perceived and utilized across cultures; and
  3. to foster an lifelong interest in understanding the role science plays in globalization and international development.

Student’s Goals:
There are clear and measurable objectives for students participating in this course. After this course, students will be able to

  1. relate molecular biology and evolution to viral transmission, pathology, virulence and treatment;
  2. evaluate complex, real world situations to determine the impact scientific thinking and processes have on social, political, and international development issues;
  3. evaluate the quality of scientific data and hypotheses by analyzing the controversies surrounding HIV/AIDS;
  4. research and present information as they work collaboratively to convey scientific knowledge to their peers; and
  5. critically analyze the ethical complexities surrounding the disparate benefits of science and technology to developed versus developing countries.

Syllabus

Syllabus Part 1

Reading and Assignment Calendar

Reading Assignments

Web Readings

Web Readings

Assignment Calendar

Assignments 2

Course Design

Format and Pedagogies
ARGUE is usually offered as two cross-listed full credit courses in the same semester that students may choose between. Students enrolled in Biology 46 participate in a 300-person lecture course (the largest elective at Duke) that meets for 75 minutes twice a week. Students in Bio 46B also participate in the same two lectures a week, but also meet with the professor for another 75 minute period to focus on HIV/AIDS in the context of Kenya and work on a common research project. At Duke all courses carry one credit even if there are extra contact hours for discussion groups or laboratories. Thus, students in Bio 46 and Bio 46B receive the same course credit.

Collaborative linkages between students at Duke and Egerton for both the large and small classes were designed using input from students at both institutions, as well as Dr. Rose Odhiambo, who leads a SENCER course at Egerton University. The small class linkage is project-based, and the research topic is determined every year by the teaching and community-outreach needs of Egerton staff and students, and more recently by a partner school and community near Lake Victoria.

Visitng Africans

Claire Lauterbach working with students at a secondary school in Kenya.

Research products have included curricula on HIV/AIDS (which has been used by over 2000 students at Egerton), HIV peer education materials, resources on the relationship between gender inequality and health, and programs to support girls’ education. Having students involved in research produces an indeterminate learning path, which is a novel experience for many students, but one that most mimics real world problem solving, and which students rank as highly effective for learning.

The large class linkage uses a series of assignments to be completed collaboratively by Duke and Egerton students. The topics were developed collaboratively by Duke and Egerton students and took into account the resources and knowledge base of each student population. Students at Duke have technological access to published information about HIV/AIDS, but little personal engagement with the disease. Students at Egerton see the effect of the HIV/AIDS epidemic in all aspects of their daily lives, yet have little access to the huge body of literature about the science of HIV/AIDS. (An Internet cafe for students in the course was built at Egerton in order to foster communication during this project.) The assignments were developed using the strategies outlined in “Engaging Ideas: the professor’s guide to integrating writing, critical thinking, and active learning in the classroom” by John C. Bean. We have also used the recommendations for improving undergraduate education proposed by

Ernest Boyer (14). Boyer states that “students must learn how to convey the results of their work effectively both orally and in writing”; that “all student grades should reflect both the mastery of content and the ability to convey content”; and that courses should “allow for joint projects and collaborative efforts”. Assignments include critical thinking and writing exercises involving the following topics:

  1. The sufficiency of evidence that HIV causes AIDS and the political and social context that has caused some African leaders to doubt the evidence;
  2. Hypotheses and myths about where the HIV virus originated and how it has spread to become a global pandemic;
  3. How new drugs and vaccines are designed and the ethics of testing in developing countries;
  4. How gender roles in each community affect the transmission of HIV;
  5. How drug therapy compliance relates to the evolution of resistance to anti-retrovirals; and
  6. Balancing the need for economic development versus the danger of new zoonoses, like HIV, from ecological change.

A major difficulty of large courses is that students can feel anonymous and thus ‘off the hook’ for participation. I try to personalize the interaction by having music playing when students walk into the auditorium and then wander the room asking for new musical selections. Cruising iTunes with a group of students or having them offer to bring in CDs to introduce me to their favorite artist serves as a great icebreaker. Plus, having several hundred students in a room can be very noisy, but students quickly learn that when the music stops it’s time to start paying attention. I also have weekly lunches with students. Being able to call even a few students by name in a large lecture format helps personalize the setting.

Despite the large lecture format of Bio 46, multiple strategies are used to promote active learning, higher-level thinking skills, and personal engagement. For several years the Personal Response System was used to allow students to analyze problems as well as the responses of their peers. More routinely, strategies such as ‘think-pair-share’ are used, as well as team concept maps and group debates.

Movies play a significant role in stimulating student learning by quickly personalizing the AIDS epidemic. Early in the semester the film “A Closer Walk” is shown, which depicts personal stories of the AIDS epidemic in the US, Uganda, Russia, and South Africa. Students are challenged to dig below the different cultural contexts to identify the common social and biological factors that increase the risk of infection. Along with a visit from a person living with AIDS, these experiences set the overarching course motif of identifying causes of local and global disparities in infection, progression to disease, access to treatment, and impact of scientific knowledge.

Linking Science and Social Issues

How AIDS Research: Global Understanding and Engagement (ARGUE) Links Biology and Social Issues

ARGUE is based on a ‘pedagogies of engagement’ model that not only connects students personally to the material, but pushes them to actively manipulate and assess their knowledge. Active engagement is particularly necessary when teaching non-majors, the majority of who enroll in general education science courses simply to fulfill university distribution requirements. Bloom’s taxonomy of learning has recently been modified by Shulman to make the essential nature of student engagement more explicit. Shulman’s new taxonomy of learning begins with ‘engagement and motivation’, which he says should be used “not only to grab but to hold… interest, not only to entice but to instruct”. I have explicitly chosen the global AIDS epidemic for this course as the topic is likely to engage students and motivate them to want to understand, and even to take action.

ARGUE also shows students how ideas and issues can cross disciplinary boundaries, using what could be called a “unified course design’ strategy where the topic acts as a reverse prism uniting traditionally disparate disciplines.

A Course Chart
By weaving in historical, political, cross-cultural, and ethical themes, ARGUE show students both how scientific endeavors can be a product of culture and time, as well as the differential benefits across the globe from “universal” scientific knowledge. Examining how social paradigms direct the scope of scientific inquiry and the validity of its conclusions enables students to see how ideas evolve over time, and hopefully, to assess the status of current scientific inquiry. There are multiple topics within the course, such as anti-retroviral drugs, that ‘explode’ out into learning from multiple perspectives.
Anti-viral Drug Chart

ARGUE also explicitly try to stretch students’ understanding by taking them out of their intellectual comfort zone. Analyses of non-intuitive results make them more aware of their subconscious assumptions. Unexpected answers also pique their curiosity about what the forces that shape their world. To this end the course is organized around questions they may not have even thought to ask, such as how technological advancement can enhance the spread of disease or why someone would refuse to take antiretrovirals. I believe that repeatedly challenging their preconceived notions stimulates students to be more open to new ideas. A goal for this course is also to increase a student’s sense of ‘global citizenry’ and an openness to cross-cultural interactions, valuable attributes in an increasingly global economy. The AIDS epidemic offers myriad opportunities to examine cultural responses to health, science, and technology. The course provides the multiple connections to people and topics in Kenya via the internet, post-course travel, and the instructor’s personal experiences. The strong emphasis on HIV/AIDS in Kenya throughout the course has led to over 30 students completing service projects in Kenya as well as the development of a new student group on campus dedicated to enhancing health for girls in rural Kenya.

Anti-viral Drug Chart

Tyla Fowler after a lesson at Shining Star Primary School in Kenya

Linking Science Concepts and Civic Issues

Anti-viral Drug Chart
Anti-viral Drug Chart

Evaluating Learning

Student Evaluation

In a busy semester, students often do not think deeply about the material unless they know they will be assessed on their learning. To promote ‘constant engagement’ this course uses frequent assignments that assess learning at different levels of sophistication. Four quizzes measure knowledge, comprehension and application. To assess higher levels of thinking students must complete 2 five-page papers relating scientific knowledge to social and political situations. To explore student grasp of cross cultural approaches to science, students must work with a Kenyan partner three times to answer a common prompt, as well as to reflect on the interaction. As a further push towards reflection on their own learning, students must write a brief essay during the first week of class that indicates their response to this quote “At some point the people in a village or community have to decide – accept the reality that they must abstain, or use protection, or die”, then write a second essay in response to the same quote during the last week of class and compare the two responses. There are also three exams that include a range of question types. Students enrolled the course section that focuses on Kenya complete the same three exams, but not any of the quizzes or papers. Instead, they iteratively research and write sections of a report, manual or program description for a community partner in Kenya. They are assessed by their research, writing, and presentation skills.

Sample Paper Prompts and Grading Rubric

Bio 46

First paper

Due 9/19 in class

President Thabo Mkbeki of South Africa has resisted admitting to the fact that HIV causes AIDS. From his writings and speeches some believe that one reason is a desire not to have post-apartheid S. Africa perceived as a ‘diseased country’, and not to have Africans associated in the public mind with sex, disease and a highly stigmatized disease.

Several other world leaders have been notorious in failing to identify and accept HIV infection in their countries. For example, Libya sentenced to death six foreign health workers after convicting them of deliberately infecting hundreds of children with HIV. (Fortunately, the workers were released a few weeks ago, but only after eight years in prison.) Scientific evidence has suggested that the children were likely infected through the use of hospital equipment contaminated with HIV-positive blood (nosocomial infection). Data also suggests that the children were infected before the foreign workers entered Libya.

In another example, the Chinese government has tried to suppress information about HIV infection rates. The most notorious incident is the blood selling scandal in Henan province. Poor farmers were encouraged to sell their blood to supplement their meager incomes. The blood was pooled together (untested for HIV), the plasma extracted and sold, and then the remaining cells transfused back into the farmers. In some areas 80% of the people in a village are infected.

These examples showcase the devastating effect government leaders can have on health of their nation when they do not acknowledge the reality of HIV/AIDS. Your assignment is to write an article for the Chronicle on the lessons that can be learned from governmental responses to AIDS. Explore the following questions in your article:

  • Pick one example above and explain the scientific evidence that became socially contentious.
  • What economic, political or cultural issues may have led to these decisions being made?
  • How do you think stigma played a role in the responses of each government?
  • What is the proper role of scientists in resolving these issues? Should they be writing open letters to world leaders?
  • Analyze each scenario and propose what concrete lessons can be learned. (In other words, don’t just summarize what happened!)

The article should be three to five pages in length where a 12-point, doublespaced font is used. It is due at the beginning of class on Wednesday, September 19. It should be written as an article for the Duke Chronicle, assuming the background knowledge level of the ‘average Duke student’ . Even though Chronicle articles do not contain references, your does need to include them. Your references and bibliography should follow the APA format for in-text parenthetical citations with a formal bibliography at the end. See info at: APA Guide

You will be graded on ‘higher order’ thinking skills, not just your ability to assemble information from multiple sources. For writing this paper, and for all assignments in this class, please think about Bloom’s Taxonomy of Learning in the attached file.

Paper Prompt #2

Sample paper topic:

Paper 2: Risk of pandemic disease: science vs media representation

You are a guest columnist for Scientific American’s “The Skeptic” (The Skeptic column). You have been asked to write an article that first summarizes the media representation (including quotes and references) of the risk of global pandemic from avian flu, HIV, and ebola. Does the media portray these diseases as having different risks? Are ‘scare tactics’ used more for one than the other? If so, why do you think the diseases are portrayed differently? In the second part of your column please use the scientific literature to describe the relative risk of these diseases to global humanity; i.e., explain your understanding of the science of why these diseases are or are not likely to become global threats. (Hint for thinking about this: how does an outbreak transition to a pandemic? What are the characteristics of a disease that make it difficult to control?)

GRADING RUBRIC

(adopted from Moskovitz)

Your writing will be assessed using the following criteria:

_____ SUBSTANCE and SOPHISTICATION (10 pts):

  • The paper recognizes (rather than avoids) the inherent complexity of its subject matter.
  • The paper seriously considers alternative interpretations and points of view, counter-arguments, and/or contrary evidence.
  • The work reflects a reasonably skeptical but fair attitude toward the claims and ideas of others
  • The work reflects an attitude of humility toward the authors’ own argument and ideas, including the making of concessions and qualifying of claims

_____ ARTICULATION AND ORGANIZATION (5 pts): The authors’ claims/reasons/points:

  • are clearly identifiable through careful articulation and placement within the text
  • are effectively organized and clearly related to one another—both within and between paragraphs and sections
  • are clearly distinguished from the ideas of others, while the ideas of others
  • are clearly attributed to their sources

_____ SUPPORT (5 pts):

  • Support provided for authors’ claims is likely to be compelling for target audience
  • All evidence (numerical results, quotations, paraphrase, illustrations, tables, and so on) is presented with appropriate comments introducing and explaining the relevance of the material.
  • Information is accurate.

_____ FORMAT/PRESENTATION (5 pts):

  • In-text citations and list of references follows prescribed format
  • Prose is stylistically appropriate for the rhetorical situation
  • Extraneous content and prose have been removed
  • Work is very well proofread

Prompts for international collaboration with a Kenyan student

Globally it is calculated that at least 50% of those infected with HIV do not know their status. Who do you think should be tested for HIV, and why? Who would you tell your results to? Do you think some countries should have mandatory testing, as Botswana is considering?

Sample student answer (with names changed)

“I do think some countries should have mandatory testing for HIV. If 50% of those infected with HIV do not know their status the rate of new infections is tremendous. Increasing the proportion of people who know they are HIV positive and educating them on how HIV is transmitted will significantly reduce the rate of new infections. This will lead to fewer people with AIDS and to fewer deaths. I believe the importance of lowering the rate of new infections is crucial and outweighs most problems that mandatory testing may arise.

Although I do support mandatory testing, I do realize, especially after corresponding with Robert Ochieng, that I am being idealistic. The issue is much more complicated than I have so far presented it. Robert argued against mandatory testing, claiming that it is humiliating and lowers one’s social status. I would, therefore, support confidential mandatory testing, and therefore, only the doctor would know the result of the test. What the patient decides to do with the result is up to him/her. However, they would receive the necessary education about preventing future transmission, which I believe would reduce the number of new infections. They could also choose whether or not they wished to be treated. Although more reluctantly, Robert still opposed confidential testing. He argued that if the state made testing mandatory if would change the “patient-provider relationship to an enforcing rather [than] facilitating role….then the programs may results in the state placing itself between the mother and child, implying that the state is a better caretaker than the mother.” This would make some mothers avoid being tested or seeking care out of fear that the government would take their baby away. Robert also said that he would be offended if he was forced to be tested even though he knew he was not at risk of having contracted HIV.

He repeatedly brings up the issue of stigma. He would feel very much offended at the idea of being tested since he is positive he does not have HIV. He also says that the biggest “hurdle facing women and men living with HIV or living with AIDS is staying employed.” Men and women are therefore scared of being tested because of the social ramifications, such as being stigmatized, ostracized, and even loosing one’s job. I still believe, however, that confidential testing would prevent these problems in the sense that it would still be up to the patient whom he wants to tell.

I also understand the point Robert brings up about the relationship between the doctor, the state, and the patient. However, the state is already enforcing certain things on citizens’ bodies. In countries around the world, citizens must receive certain immunizations. There is not much protest against mandatory vaccination. Since no vaccine exists against HIV, mandatory testing is the closest the government can come. It is important for the state to know what the state of HIV infection is within its borders. Important education can also be given to those infected. What the patient then does with their knowledge and with their body is completely up to him or her.

Along with stigma, and what rights the government has over its citizen’s bodies, there are also many other problems with mandatory testing. One of them is how this would actually be implemented in countries such as Kenya. I am not sure if the infrastructure is there to assure patients of confidentiality and also, to assure the state that everyone is actually being tested. Although idealistically I believe confidential mandatory testing of all people would significantly slow the spread of HIV, I do realize it may not be very realistic. The most important thing to do, therefore, is to educate the people. The more education people receive, the more willing they will be to be tested voluntarily.”

Course Evaluation

Besides the traditional course evaluations used by Duke University, this course uses the SENCER-SALG assessment rubric as both a “pre” and “post” course tool to measure if course objectives have been met. To do this the ‘core’ SENCER-SALG has been enriched with questions specific to the ARGUE course goals, such as student confidence in the ability to: 1) understand a hypothesis and judge its merits; 2) understand how science affects social, political, and economic issues; 3) understand the relationship between science and international development; and 4) explain the ethical issues regarding how science benefits the developed versus developing world. Another set of questions explores the impact of the course on the student’s sense of ‘global citizenry’: 1) How connected do you fell to people (who are not family) in other parts of the globe? 2 How much do you consider yourself to have a ‘global world view’?; and 3) How comfortable do you feel with someone from a different culture?; and 4) How much impact did your collaboration with a student in Kenya affect your interest in global issues?

Background and Context

Course History

In 2000 Duke modified its general education curriculum to place a greater emphasis on “the ability to make meaning of complex information… the ability to evaluate and discern among competing claims… the ability to collaborate… the ability to engage difference… and the ability to apply knowledge in the service of society.” ARGUE debuted in 2000 in response to these new curricular requirements and has been taught once a year ever since. In addition, Duke has developed distinct ‘modes of inquiry’ for addressing learning; e.g., the Science Technology and Society (STS) mode challenges students to explore how science and technology have affected societal development, as well as how the needs of society have influenced scientific and technological progress. AIDS fulfills one of the two STS requirements for graduation.

Funding and Support

This course began with funding from SENCER to attend a Summer Institute in 2002. Follow up funding has included:

  • Women’s International Science Collaboration Grant, WISC (NSF), 2003
  • CCLI (NSF) Do linked international curricula in Biology enhance science literacy and engagement in non-science or pre-major students?, 2004
  • Josiah Charles Trent Memorial Foundation Award in Medical Ethics and Humanities, 2006
  • Projects for Peace, 2007
  • Funding from Duke’s Center for International Studies, Office of Service Learning, DukeEngage, and the Department of Biology

Resulting Projects, Research, and Recognition

Undergraduate Research

Bio 46B students have been involved in research service-learning projects that have generated a course manual for teaching about HIV/AIDS in the Kenyan context that has been used by over 2000 students in Kenya. They have also generated a peer education manual and a manual for a program on gender, health and development in Kenya.

Working With Students

Every year since the original funding from SENCER in 2002 Duke students have traveled to Kenya to participate in research and service projects. Upon their return students often become peer teaching assistants to share they understanding of HIV in Kenya. As students realize the complex connections between gender, economics, access to information, and HIV risk they have develop a series of projects to empower Kenyan students, particularly girls in a rural area. Duke students have installed the first solar panels and computer cluster in an unelectrified school district near Lake Victoria and given computer lessons to students and staff.

Computers and Students

Another major project for Duke students has been to help girls stay in school (which delays marriages and HIV risk) by providing them with sanitary pads, an inaccessible item in the area. Without sanitary pads, girls in Kenya miss several days of school each month leading to increased dropping out, are stigmatized, or use unhygenic items that cause inflammation and increase the risk of infection with HIV. By partnering with Johnson & Johnson, Duke students have developed a sanitary pad distribution program and are working on a reusable pad program that will serve as a microfinance program for village women.

Girl With Pads

In recent years Bio 46 and Bio 46B students have focused on programs to enhance education for girls in a rural village in Kenya, leading to a ‘summer camp’ program on gender and health, and plans for a new school and community center, the Women’s Institute for Secondary Education and Research, WISER, near Lake Victoria.

Students and Africans

Land for site of new school for girls with students from campWISER

More information about the student generated holistic program to improve health, education and economic development in Muhuru Bay can be found at www.wisergirls.org.

Publications related to the development of this course:

  • Ogwang-Odhiambo, R. and Broverman, S. (2005) Globalizing the Microbiology Curriculum. ASM News 71 (10): 448-449.

Presentations related to the development of this course:

  • “United Nations Millennium Development Goals and HIV/AIDS in Africa”, Meredith College. November 2005
  • “Innovative Course Design: HIV/AIDS courses for secondary school teachers in training” Makerere University, Uganda. October 2005
  • “How Much Can One Course Multi-task: scientific, multi-disciplinary and international education” Association of College and University Biology Educators. October, 2005
  • “International Collaborative Learning on HIV/AIDS: linking students and courses” SENCER Summer Institute, August 2005
  • “Effect of Linked, International Curricula on Science Literacy and Civic Engagement” National Science Foundation, DUE/OISE May 2005
  • “Mainstreaming HIV education into the undergraduate curriculum in African Universities” Association of African Universities 11th meeting, Cape Town, South Africa, February 2005
  • “Origins of HIV: comparing hypotheses”, Rand Afrikaans University, Johannesburg, South Africa, February 2005.
  • “Using Social Controversy to Stimulate Problem Based Learning in the Sciences” SENCER Summer Institute, August 2004
  • “International Perspectives on Microbiology” American Society for Microbiology, May 2004
  • “Teaching Science, Exploring Controversy, Taking Action: Perspectives on Global Education” American Association of Colleges and Universities National Meeting, January 2004
  • “Teaching about HIV/AIDS without textbooks”. Egerton University, Kenya, May 2003
  • “Teaching HIV/AIDS: Science and Ethics” American Society for Microbiology, May 2003