Teaching AIDS

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Studies reveal that students need strategies—not just information
—to protect themselves from the deadly disease.

Anyone who has ever tried to quit smoking, lose weight, or forgo sweets knows how difficult it can be to kick a habit. Research has shown that altering basic human activities--from eating to sleeping to having sex--can be a very tricky task.

It's particularly challenging to persuade adolescents--more than half of whom say they have had sex by the time they turn 18--to practice safer sex. The same belief in their immunity from harm that makes teenagers vulnerable to drinking and driving has proved especially difficult to overcome when trying to educate them about the dangers of AIDS.

In the past several years, however, research on AIDS education has shown that certain strategies, employed both in and outside the classroom, can change sexual behaviors that put young people at risk for the deadly disease.

But the research also highlights the fact that few schools follow those strategies. The importance of safer practices for those who are sexually active is not a lesson students will absorb from a lecture or a pamphlet. Unless schools are willing to commit the time and effort to teach about AIDS properly--and in the graphic detail that pays off in altered student behavior--they might as well not teach about it at all.

According to the federal Centers for Disease Control and Prevention, more than 200,000 people under age 20 in the United States are infected with HIV, the virus that causes AIDS. And the CDC expects that one of every four new infections will be in people ages 13 to 20. Although some young people may get the virus through intravenous drug use, the majority will become infected as a result of unprotected sex.

Many researchers believe most courses taught in schools do little or nothing to deter adolescents from risky sexual behavior.

Since 1986, when then-U.S. Surgeon General C. Everett Koop released an unusually frank report outlining precautions people should take to prevent the spread of AIDS, states and school districts have spent millions of dollars educating young people about the disease. A majority of states require that the subject be taught in schools. In fact, more than 86 percent of high school students say they receive some sort of AIDS education during their school years. But in a 1995 poll by the Sexuality Education and Information Council of the United States, a New York City-based research and advocacy group, only 5 percent of high school students nationally said the instruction was comprehensive.

Many researchers believe most courses taught in schools do little or nothing to deter adolescents from the risky sexual behavior that can place them in the path of the disease. Besides teenagers' resistance to behavioral changes, external factors such as poor curricula, institutional resistance, public and political opposition, and a lack of financial resources to train teachers often block effective AIDS education efforts.

"Although most American students will tell you they've had AIDS education, the vast majority of that is learning and regurgitating the facts," says Jerald Newberry, executive director of the Health Information Network, a Washington-based advocacy group supported by the National Education Association. "It's better than nothing, but it isn't good enough."

Sex education has had a long and often tumultuous history in U.S. schools. At the turn of the century, teachers hoping to calm hormonal urges delivered stern lectures about the ravages of venereal disease. It wasn't until the 1960s that teachers began to do more, accenting traditional lectures on anatomy and personal hygiene with information about healthy sexual behavior. But only in the past decade or so, since AIDS became widely recognized as a major public health crisis, have sex education curricula begun to emphasize the skills students need to protect themselves.

Teachers must try to dispel the common myth among adolescents that all their peers are having sex.

Building knowledge is an important foundation of AIDS education, but young people also need to learn specific strategies to shield themselves from infection, says Douglas Kirby, director of research at ETR Associates, a nonprofit education, training, and research group in Santa Cruz, California. In 1995, Kirby, one of the country's leading experts on adolescent health, sifted through 49 studies of existing school-based sex curricula conducted by researchers at the CDC, dozens of universities, and other research institutions. He identified nine classroom strategies that can help reduce risky sexual behaviors among young people. ("What Works," from this issue.)

To be effective, he found, courses should last at least 14 hours, focus narrowly on AIDS and unintended pregnancy, and include accurate, detailed information about the risks of unprotected sex. Teachers must try to dispel the common myth among adolescents that all their peers are having sex. Indeed, research shows that a crucial element of effective AIDS education is instruction that abstinence is the surest way to avoid the disease.

To do that, Kirby says, courses need to reinforce students' "refusal skills." One popular lesson directs students to set goals and limits. If a young person's objective is to lose 10 pounds, the student might practice abstaining from fried foods and cakes for a week. The idea is that by doing something as simple as renouncing a snack, students may develop the confidence to assert themselves in more challenging situations.

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