Teaching About AIDS
"We always have to ask what we can displace to make room for this," said Bernadette Seick, an assistant superintendent of the Denver schools. Teacher attrition can also be a barrier to a consistent approach, she added.
Several Denver teachers who were trained in the Skills for Life curriculum have transferred or retired, and district leaders have found it hard to find replacements. "Not every teacher wants to get into the classroom and show kids how to use a condom," Ms. Seick said.
A lack of parental involvement can also stand in the way of successful AIDS-prevention programs, researchers say. While a number of national surveys show substantial parental support for teaching about AIDS in schools, many parents balk at the level of detail considered so vital to making such teaching effective, researchers and advocates say.
Reaching Gay Students
Because of these barriers, some experts argue that community efforts, not school programs, should be the central focus of AIDS education campaigns.
"The most effective AIDS education is peer-to-peer talk, in clubs and social settings, not necessarily in schools," said Chris Yu, the program coordinator for Funders Concerned about AIDS, a New York City-based association of grantmakers that encourages public-private partnerships to respond to the AIDS crisis.
Research indicates, however, that both school and community approaches can be effective.
The CDC recently launched a "social marketing" effort that will target AIDS education money to particular populations of high-risk youths, such as homosexuals and intravenous drug users, in several communities. Community-based approaches have been successful in educating young people who are at high risk for contracting HIV.
A study published in The Journal of the American Medical Association in 1991 found that small-group counseling sessions with 67 young runaways ages 11-18 were effective in promoting abstinence and reducing the instances of unprotected sex. After undergoing three months of counseling, the percentage of youths living in runaway shelters who reported using condoms consistently nearly doubled, from 33 percent to 63 percent, according to Mary Jane Rotheram-Borus, a professor at Columbia University and the lead author of the study.
Researchers at the University of California, San Francisco, found in a 1996 study that educating young gay men about AIDS at social events like picnics and volleyball games influenced them to practice safer sex.
While these community-based AIDS education approaches have been successful in reaching gay youths, who are disproportionately at risk for the disease, there has been little research on which classroom-based programs specifically work to protect gay teenagers from HIV infection.
Such investigations have been stymied by a lack of AIDS curricula tailored to gay students and by students' unwillingness or inability to identify themselves as gay, experts say. Some may not even know their sexual orientation at that age, researchers say.
AIDS education experts point to several other areas that warrant rigorous study. Research is already under way on which AIDS-prevention curricula work in middle schools, which are increasingly adopting such programs.
Another unanswered question is the degree to which a particular curriculum's successful implementation determines its effectiveness.
Other researchers cite a need for greater understanding of why young people engage in risky behaviors to begin with. Understanding a teenage girl's motivation to have a child, for example, could help educators devise better curricula, they say.
Many AIDS education advocates and researchers say that despite the obstacles before them, school-based initiatives shouldn't be abandoned.
"For people who say this is an experiment that has failed, we say it has never been tried," said Carolyn Patierno, the director of program services for the Sexuality and Education Information Council of the United States.
SEICUS commissioned the national poll in 1995 that found that only 5 percent of high school students said they had had sex education that was "comprehensive in nature."
Dr. Santelli of the CDC suggests that AIDS educators view their efforts in light of the sluggish progress of several other national health campaigns during this century.
It took years for people to start wearing seat belts in cars, he said. And while the U.S. surgeon general issued a report in 1964 that linked smoking cigarettes with cancer, he said, only in recent years has there been widespread evidence of a cultural shift away from smoking--bans on airplane flights, in restaurants, and workplaces--and a drop in the percentage of adults who smoke.
"It's been a large effort by a lot of people over many years," Dr. Santelli said of anti-smoking efforts. "What really changes behavior is hearing things over and over again, like your wife nagging you to stop smoking cigarettes actually works.''
Tim Dunn, the director of school health at the Education Development Center in Newton, Mass., which tracks curriculum developments, said he already sees evidence of a shift in schools' approach to AIDS education.
"Most programs are moving toward these proven effective methods," said Mr. Dunn, noting that more school systems are providing AIDS education in middle schools. "Five years ago that wasn't the case."
But ultimately, some researchers say, AIDS and sex education in schools must be completely retooled in an effort to provide students with reasons to stay abstinent and delay parenthood.
Eighty-five percent of young women ages 15-19 who have children out of wedlock are poor or low-income, said Kristin Moore, the director of the Washington-based Child Trends Inc. and an expert on teenage pregnancy.
Only programs that address poverty, attempt to prevent school failure, and provide job training will have a sustainable impact, she argued. "Kids think it doesn't matter if they have sex or have a child because they are going to be working at a fast-food restaurant anyway."