Planning Effective AIDS-Education Programs
Even though teachers are on the front line of education about acquired immune deficiency syndrome, they are often the last ones consulted about the methods and materials used to address the subject in their classrooms.
This reality suggests the flaws of the AIDS-education programs currently being developed. Indeed, most of these programs are doomed to prove not only costly--in terms of both money and time--but also ineffective .
The success of school-based AIDS education depends on the refinement of strategies and materials focused on the needs of teachers--who must present the information--and of teen-agers--who must understand it.
In addressing the problems of such efforts, we must first overcome the crisis orientation that surrounds the subject of AIDS.
In fact, we do not need AIDS education per se. When school officials show me their AIDS-education program, I ask, "Where is your herpes program from two years ago?''
We must develop an educational framework that places AIDS within a broader context, such as a unit on sexually transmitted diseases within a communicable-disease or family-health content area. A rational, conceptual approach would help teachers allay fears, and desensationalize and clarify the issues of AIDS and other sexually transmitted diseases.
AIDS education should fit into a comprehensive K-12 health curriculum: A sound program would still be viable tomorrow even if we were to discover a miraculous cure for AIDS tonight. Most existing programs could not stand this test.
Weaknesses in content also mar the materials now in use. They often fail, for example, to allow for local determination of community needs. To treat such controversial subjects as homosexuality and the use of condoms with sensitivity to the values of the community, programs must be flexible.
Built into materials must be a respect for those who will use them; programs should reflect the counsel of parents and churches.
And existing materials are not teacher-friendly. They have been developed by physicians, college professors, nurses, counselors--not classroom teachers. Yet the authors try to tell teachers how to do things the writers themselves have never done.
These programs do not recognize the constraints faced by the classroom teacher: the necessity of presenting as many as six lessons a day, with perhaps 50 students in each class; the lack of functioning media equipment; the need for good evaluation instruments.
Nor do most programs address the reality that the faculty member who teaches about AIDS is usually not a health teacher but a gym teacher--who needs not only facts but also teaching skills to make him feel comfortable with the subject. Unless such help is provided, the subject will not be taught effectively.
Teachers should be viewed as an integral part in the process of developing AIDS STD (sexually transmitted disease) training programs, not just as an afterthought.
For the subject matter itself, facts are not enough in AIDS education. Most programs are too biomedical: Knowing about T-4 helper cells does not suffice to change behaviors.
Programs should stress behavioral strategies for preventing AIDS and other STD's. The development of skills in decisionmaking, assertive communication, stress management, and self-esteem will empower students to take control of their lives and practice healthy behaviors.
Such skills should be introduced in the lower elementary grades and emphasized throughout the remaining school years. As in advertising, selling a product means pitching it over and over again. Teaching a skill just once in the 9th grade is futile.
Students must understand that AIDS is a disease for which one chooses to put oneself at risk. Most teen-agers, in fact, do not feel in danger, even when they are sexually active.
Yet it is frightening to consider the risk of sexually transmitted diseases among teen-agers: The federal Centers for Disease Control estimates that one out of seven teen-agers--and a total of 2.5 million young people between the ages of 15 and 19--will contract such a disease this year.
At present, only a few hundred people in this age cohort have AIDS. But 21 percent of all AIDS victims are between 20 and 29. Some of these may have been infected as teen-agers.
Students tell me that they can't get "the AIDS'' because they are not gay. They say they would rather die than stop having sex.
In fact, for 9th graders, the threat of death is not a sufficient reason to alter behaviors. And the perspective of some teen-agers is reflected in this challenge from a minority student: "If AIDS is such a risk to minorities, name one famous minority person who ever died from AIDS.''
Exhortations to "just say 'no''' are not enough for all students. Statistics show that 57 percent of our 17-year-olds have had sex. A more realistic message that has proven useful is the ABC's of STD prevention:
- A: Abstinence from sex and drugs is the best guarantee of avoiding such diseases.
- B: Be monogamous. Young people should refrain from sexual activity until--as adults--they are ready to establish mutually faithful relationships.
- C: Condoms reduce but do not eliminate the risk of STD's for those who choose to put themselves at risk.
In some communities, especially at the high-school level, a frank lesson about condoms may be justified. As a nun in an urban Catholic school told me after we had worked a message about condoms into the school's health curriculum: "We do not condone the use of condoms, but if someone decides to live outside the limits of the Catholic teachings, let's teach him some skills to help keep him alive long enough so that we may kick some Christian ethics into his head.''
For some students in some communities, to teach only "say 'no''' would be morally irresponsible. The message should instead be "say 'know.'''
But in many instances the activism of various interest groups has
prevented students from receiving a consistent message on AIDS
prevention. One group insists on teaching safer sex; another insists on
teaching only abstinence. Blacks, whites, Hispanics--every group is
calling for its own program.
enough, with the net result that they stigmatize the very groups they are attempting to help. There is already a strong homophobia in this country; soon to come is a minority phobia in relation to AIDS.
Schools must work with health departments and churches. We need total community involvement to offer consistent, sensitive, and realistic messages regarding AIDS for all our young people. Their lives are too valuable to give them less.
Poor communication also hinders the development of effective AIDS-education programs. It seems as if everybody who wins a grant sets out to create his own curriculum, his own video, his own pamphlet. Few people are sharing ideas about how to proceed with AIDS education.
Moreover, the materials now in use are too costly. AIDS education is suddenly big business. Publishers push bound books--which can only be updated with morebooks--and student manuals. An alternate approach--the use of a three-ring notebook and photocopied or mimegraphed student-activity sheets--greatly reduces costs. Updating is simple and inexpensive.
The problem with everyone reinventing the wheel is that it takes a lot of money and a lot of time--and with AIDS, time is lives.
We must share our materials and information; we should use effective existing programs, such as those of the American Red Cross, or at least modify them to fit special needs.
And government agencies and foundations should stop funding programs that duplicate those already in existence.
Education is our only weapon against AIDS. Numerous though the problems are with current programs, we must attack them promptly and firmly. Enlightened leadership, a sense of commitment, and high-quality preparation will ensure educationally sound, locally determined, and cost-efficient programs.
Vol. 7, Issue 31, Page 36Published in Print: April 27, 1988, as Planning Effective AIDS-Education Programs