The public debate over the content and tone of AIDS curricula tends to overshadow some of the practical challenges of putting an effective program in place. The costs of curricular materials and teacher training alone can be prohibitive. "Many districts face inadequate resources," says Brenda Greene, manager of school health programs for the National School Boards Association, "and so they're going to focus on the core subjects." Even in schools with both the funding and enthusiasm for effective AIDS education, she adds, there may not be enough time in the school day to teach it.
"The most effective AIDS education is peer-to-peer talk, in
clubs and social settings, not necessarily in schools."
At Kennedy High, Carreras sandwiches his three-week Skills for Life course in between lessons on Mesopotamia and the evolution of human culture. "We always have to ask what we can displace to make room for this," says Bernadette Seick, a district administrator. What's more, several Denver teachers who were trained in the Skills for Life curriculum have transferred or retired, and the district has found it hard to find replacements. Says Seick, "Not every teacher wants to get into the classroom and show kids how to use a condom." Similarly, many parents balk at the detail considered vital to making such teaching effective, even though national surveys show substantial parental support for teaching about AIDS in schools.
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," says Chris Yu, program coordinator for Funders Concerned about AIDS, a New York City-based association of grantmakers.
A study published in The Journal of the American Medical Association in 1991 found that small-group counseling sessions with runaways ages 11-18 were effective in promoting abstinence and reducing instances of unprotected sex. After undergoing three months of counseling, the percentage of youths living in runaway shelters who reported using condoms nearly doubled, from 33 percent to 63 percent, according to Mary Jane Rotheram-Borus, a professor at Columbia University and lead author of the study. And researchers at the University of California at San Francisco found in a 1996 study that educating young gay men about AIDS at social events like picnics and volleyball games influence them to practice safer sex.
While these kinds of community-based approaches have succeeded in reaching gay youngsters, a group particularly at risk for AIDS, 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 curricula tailored to gay students and by students' lack of candor or understanding about their sexual identities. Some young students, researchers say, simply do not know their sexual orientation.
One thing AIDS education advocates and researchers agree on is that school-based initiatives should not be abandoned. "For people who say this is an experiment that has failed, we say it has never been tried," says Carolyn Patierno, director of program services for the Sexuality Education and Information Council of the United States.
"For people who say this is an experiment that has failed, we
say it has never been tried."
Santelli of the CDC says it's important for AIDS educators to take the long view. He points to the sluggish progress of several other national health campaigns: It took years for people to start wearing seat belts, for example. And while the surgeon general issued a report linking cigarettes to cancer in 1964, our culture has only recently begun to shift away from smoking. "It's been a large effort by a lot of people over many years," Santelli says. "What really changes behavior is hearing things over and over again; your wife nagging you to stop smoking cigarettes actually works.''
Tim Dunn, director of school health at the Education Development Center in Newton, Massachusetts, says he has already begun to see a change in the way schools approach AIDS education. "Most programs," he says, "are moving toward these proven, effective methods."
Still, much more needs to be done. Kristin Moore, director of the Washington-based Child Trends Inc. and an expert on teenage pregnancy, points out that 85 percent of young women ages 15-19 who have children out of wedlock are from low-income families. Only programs that address poverty, attempt to prevent school failure, and provide job training will have a sustainable impact, Moore argues.
"Kids think it doesn't matter if they have sex or have a child," she says, "because they are going to be working at a fast-food restaurant anyway."
The "Research" section is being underwritten by a grant from the Spencer Foundation.