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Teaching AIDS

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AIDS education encourages role-playing. "If you can't even talk to your partner, you can't tell them no."

John Santelli,

Another way to strengthen refusal skills is through role-playing. A student might rehearse in class a conversation with a boyfriend or girlfriend about the dangers of unprotected sex. "If you can't even talk to your partner, you can't tell them no," explains John Santelli, an epidemiologist at the CDC's division of adolescent and school health, which evaluates AIDS education.

Successful programs, Kirby says, employ a wide range of instructional methods and settings. One curriculum encourages students to initiate the dreaded "facts of life" talk with their parents, while another dispatches high school students to a family planning clinic to quiz professionals about contraceptives. Mixing experiences like these with different classroom activities, Kirby's research found, seems to works best with kids.

It's a winter afternoon in Denver, and four 9th graders at John F. Kennedy High School are on a "condom hunt" at a local supermarket. Their assignment: collect information about condom prices and brands and any literature the store carries on sexually transmitted diseases. Once their mission is accomplished, they are to report back to their social studies class.

Standing near the vitamins, feminine-hygiene products, and cold remedies, Oscar Campos and three of his classmates study the condom display. They are surprised by the variety of colorful contraceptives. As he plucks a shiny Gold Coin condom package off the shelf to check the price, the 14-year-old admits he hasn't yet had occasion to use one. He says that when he does, he'll feel less intimidated about making the purchase.

Erika Mendez, a petite 14-year-old, nods in agreement. "When I'm older," she says, "I'll know how to protect myself."

When the four students return to class, teacher Paul Carreras is standing next to a collage of multicolored prophylactics. He rips open a foil package and rolls a condom onto two fingers, seeming quite at ease discussing such intimate topics with his students. "If you want to be abstinent, I applaud you," the 53-year-old educator tells the two dozen freshmen. "But if you're having sex, you need to protect yourself from something that will kill you."

Long after the final bell, students fire questions at him: Are condoms reusable? How many sperm does it take to get pregnant? Like most 9th graders in the 63,000-student district, those in Carreras' class are not sexually experienced. But he believes it is vital that they be prepared for eventual sexual activity. "We know that 100 percent of these students are not going to be celibate," he says. "So we have to make sure they're safe."

Both the condom hunt and demonstration are part of a curriculum called Skills for Life, which was first tested in Denver in 1993 by the CDC. The Denver schools require AIDS education, but the district doesn't dictate a particular curriculum. Skills for Life, which uses the nine strategies detailed in Kirby's study, is one of only a handful of AIDS education curricula endorsed by the CDC.

Although there has been little opposition to the curriculum in Denver, some religious organizations and parents' groups across the country have condemned approaches like these, saying that teaching kids safe-sex strategies actually encourages sexual activity. Such arguments have derailed efforts to adopt courses in dozens of school districts in recent years.

"If you go through explicit demonstrations, you undermine your own message of abstaining until marriage," explains Gracie Hsu, a policy analyst for the Family Research Council, a Washington, D.C.-based research and advocacy group.

Kirby says this simply isn't the case. "The overwhelming weight of the evidence," Kirby writes in his 1995 report, "demonstrates that sex and AIDS education programs do not cause harm as some people fear." In fact, he says, research shows that courses employing a combination of the nine strategies help delay the start of sexual activity. And for those already active, they help reduce the frequency of sex and increase the use of condoms and other contraceptives.

Some religious organizations and parents' groups across the country have condemned AIDS education, saying that teaching kids safe-sex strategies actually encourages sexual activity.

Many researchers believe that distributing condoms on school grounds--some 50 districts have such programs--increases their use among sexually active students, although they admit that confirming evidence remains sketchy. A three-year study by the Academy for Educational Development, a national research and policy organization, promises to shed some light on the issue. Set to be published later this year, the study compares condom-distribution programs in two big-city districts and is expected to provide the best documentation so far of the theory that making condoms available in schools can reduce risky sexual conduct among students.

The bulk of the research on "abstinence only" curricula--which promote sexual abstinence until marriage and eschew discussion of contraceptives except to detail their failure rates--has been less convincing. "The weight of the evidence," Kirby writes, "indicates that these abstinence-only programs do not delay the onset of intercourse."

Hsu argues that such an assessment is premature. A study last year of a sex education program in the District of Columbia showed that abstinence-only teaching can yield positive results, she says. The evaluation of the program run by Best Friends, a Washington, D.C.-based organization that promotes abstinence education, found that 1.1 percent of the girls in grades 5-12 enrolled in the course became pregnant, compared with a 25 percent pregnancy rate among girls of the same age in the city's population as a whole. "This study," Hsu says, "found that participants were far less likely to have engaged in sex than were nonparticipants."

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