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An aspect of the Center for Children and Families
Topic: HIV/AIDS Prevention Programs in the Schools
Researched and written by
Alesha T. Alston
I attest that the following report is a product of my own original work.


Summary
Full Report
Related Websites

References
 


Summary
 

Abstract

HIV/AIDS is a deadly disease that has caused many people through out the world to reevaluate the way that they live their lives. This disease has affected people of all ages, races, ethnicities and religions. Sadly, this disease is affecting children and adolescents and this population is steadily growing. This paper is focused on prevention programs that school systems throughout the United States and around the world are implementing to help decrease the transmission of HIV/AIDS from youth to youth.
 
Full Report

        In 1981, a fatal disease was discovered in the United States of America by the Center for Disease Control and Prevention. At this time, there were only 189 cases of infected persons with this mysterious disease. This disease would soon come to change the face of the world. It would be a disease that will change the thoughts and minds of people forever. This disease is nondiscriminatory. It will attack people of any age, race, ethnicity, and gender and to this very date, there is no known cure. In the past 23 years, this disease has grown from a disease that infected 189 people, to a disease that now infects over100 million, and that number increases by 14,000 daily. This disease is no longer a rarity. It has become an epidemic taking place worldwide and that has affected all us of either first or second hand (Britannica Student Encyclopedia, 2004).
        HIV (Human Immunodeficiency Virus) is the virus that leads to the fatal syndrome called AIDS (Acquired Immunodeficiency Syndrome). HIV can be transmitted into the body through a number of ways, such as blood transfusions (which today is very unlikely), sharing intravenous needles to use drugs, sexual intercourse, and from not handling infected body fluids properly, such as vomit and blood, by wearing rubber   gloves to prevent disease getting into open cuts on the hands. HIV enters the body and begins to attack and destroy certain white blood cells that are important in maintaining the immune system (CD4+ cells, a type of T lymphocyte). The disease infects other cells called the macrophages that are also essential to the operation of the immune system. Macrophages are not destroyed by HIV but it has been shown that that these cells could be a defining characteristic in AIDS dementia complex (ADC), something seen in those that have had AIDS for a long period of time. This is because the macrophage cells may carry HIV to the brain (Britannica Student Encyclopedia, 2004).
The disease is lethal and is distressing in every sense but it’s most sad because it affects children of all ages. Those children infected may not live to see the ages that many of us that are not infected have seen. There are a lot of children that are infected through birth, from mother to child, and there is a growing number of youth that are infected through sexual intercourse. (Britannica Student Encyclopedia, 2004)
        Burkholder, Harlow, and Washkwich (1999) stated that there has been an increase in heterosexual transmission and the number of heterosexual occurrences will continue to rise. This is because many heterosexuals are not taking advantage of the prevention methods that are available to them (e.g. condoms and abstinence). Stigmatization is a problem for those infected by the disease. It is believed by many that HIV/AIDS is associated with a specific group of people (e.g., Homosexuals) and this causes many non-infected people to distance themselves from that group of people and create hostility towards them. Certain groups of people are also thought to be at a greater risk than others. Some of those thought to be at a greater risk are men, homosexuals and people that are not getting a college education. Many homosexuals have heeded the advice of those telling them to protect themselves. The AIDS Risk Reduction Model (ARRM) is a model that shows the behavior change in homosexuals. There are three levels to the ARRM: 1) recognize and label your own risky behavior, 2) make it an obligation to perform low-risk behaviors and, 3) change behavior. Many heterosexuals are not taking part in this model to decrease their chances of transmitting or catching HIV/AIDS. What can be done to prevent HIV/AIDS from being transmitted from youth to youth? What can school systems d? Across the nation and worldwide, many schools are beginning to take action against this disease.
        Burkholder, et al. (1999) it also stated that adolescents are more likely to catch HIV/AIDS during the later part of adolescents and the incubation period for AIDS is about 8 years. This is why the number of individuals with AIDS, that are less than 20 years of age, is low. This means that for 8 years, these people live with HIV, then the virus is usually transformed into AIDS after the 8 year period is up, adding more people to the number of those with AIDS. Those who engage in risky sexual behaviors perceive themselves to be more at risk. These same people are more likely to pay more attention to the news and other media outlets when the risks are talked about. This shows that the media can play a major role in someone realizing that they are at a greater risk than they thought.
There are a number of reasons that someone may not be at a risk for contracting HIV/AIDS (Burkholder, et al., 1999). Family involvement is one to reduce the number of HIV/AIDS cases. If the family is involved, the adolescent will have more self-efficacy, meaning that they will have more confidence in themselves. If you talk to your child and affirm that it is a good thing to use condoms, then the child will more than likely use them. Also, knowing someone that is infected by the disease, and the media, can also increase perceived risk for contracting the disease. Knowledge acquired about HIV/AIDS does not assist an individual in noticing that they are at a great risk for contracting the disease if they engage in risky behaviors, therefore, more education is needed and needs to be embedded into everyone’s brain.
        In order for HIV/AIDS prevention programs to be even slightly successful in the school system, those implementing the prevention strategies should be knowledgeable about the information pertaining to HIV/AIDS. Grier and Hodges (2001) says that teachers that teach in the elementary, middle and high school settings are at a great risk for contracting HIV/AIDS from students that attend their schools as well as transmission from student to student. For young children, nose bleeds, scratches, cuts, and bleeding gums from lost teeth are some of the modes of possible transmission from student to teacher and from student-to-student. For adolescents, sexual behaviors, violence, and intravenous drug use with needles are possible modes of transmission. Teachers have to take every precautionary method possible when coming into contact with any bodily fluids from anyone. The teachers are not sure as to who is infected with what. Many teachers have not been trained properly in HIV/AIDS prevention and luckily, to date, there have been no known cases of transmission in the school setting.
        Grier and Hodges (2001) state that when HIV/AIDS began to become a major problem, there were serious debates in literature about whether or not to let children infected with the disease attend public schools and also whether or not to teach HIV/AIDS prevention in the schools. There was fear that if these children were in the schools, that the disease would spread more than what it already had and, many parents did not want their children taught about HIV/AIDS in the school. Also, many parents of infected children with the disease did not want their children to attend public schools because there was a fear that their child’s condition would not be kept confidential. Today, HIV/AIDS infected children and HIV/AIDS prevention programs are accepted into schools nation and worldwide.
        The major problem with HIV/AIDS prevention in the school setting is that teachers need to be trained in AIDS prevention, according to the World Health Organization, Scientific, and Cultural Organization (UN-ESCO). Also, past research has usually focused on the virus and how it can be treated, not prevented. It is now seen that it is also important to deal with the Universal Precautions, which are needed in schools. However, there are only a few people in the school system that believe that extra training is not necessary. Grier and Hodges focused on finding out how much information teachers knew about HIV/AIDS and what their mode(s) of education were. The findings of the study show that the staff questioned from all schools had almost perfect knowledge about HIV/AIDS, had fact-based beliefs about HIV/AIDS but, did not have a good concept of what the Universal Precautions were and how to implement them. They also showed that the television, radio, and newspapers were effective resources to gain accurate information but, attitudes and beliefs are hard to alter. Surprisingly, it showed that there was a low usage of gloves before the teachers were trained about HIV/AIDS and transmission. After the HIV/AIDS training, the glove usage increased (Grier and Hodges, 2001).
         Fisher, Fisher, Bryan and Misovich (2002) stated that half of all new HIV cases in the United States were from people between the ages of 13 and 24 and almost half (49%) of those cases are African Americans and Hispanics. This article also states that there were many schools that have implemented HIV/AIDS prevention programs but many of them do not utilize them. Fisher’s et al., research study implemented the Informational-Motivation-Behavioral Skills Model. This model is something that is shown to increase change in risky behaviors that could lead to HIV/AIDS. In this study, they used four different inner-city high schools, which were populated mainly by minority students. In one school they used classroom intervention (teacher teaching the students HIV/AIDS prevention facts in the classroom), in the second school they used peer intervention (training a group of popular students and having them teach HIV prevention and motivate their peers to make use of non-risky behaviors). In the third school the researchers used a combination of classroom intervention and peer intervention. Lastly, there was the standard-of-care school. This school served as the control and did not receive any intervention.
         Results from the Fisher, et al. (2002) article shows that at the three-month check-up, the use of condoms had increased significantly in all of the schools that received some form of sex education. The combined intervention school and the school with peer intervention had a profound effect on those minority youth in the inner-city schools after three months. The risky behaviors that they indulged in before (not using condoms during sexual intercourse) were decreased after interventions as well. During the one-year follow-up, at the combinations intervention school, results showed that the positive results seen during the three-month follow-up had regressed but at the one-year follow-up at the classroom intervention school, progress seemed to hold a steady, significant effect on the children in HIV/AIDS prevention. The combination intervention school could have been unsuccessful after the one-year because of peer pressure. This could be true of the other schools as well.
         There have also been programs in public schools that believe that making condoms available to the students will reduce the risk of HIV/AIDS transmission. In an article written Blake, Ledsky, Goodenow, Sawyer, Lohrmann, and Windsor (2003), an experiment was conducted in an inner-city school. They wanted to test to see if making condoms available inside of a school would increase sexual activity. The participants were 4166 students that attended a high school that did not already have a condom availability program enforced. It is believed that if these condoms are made available to the students, they will be more likely to use less risky behaviors, which would increase their chances of being infected with HIV/AIDS and/or other sexually transmitted diseases.
        Blake, et al., (2003) Results indicated that those students enrolled in a school with condom availability received more condom instruction as well as more instruction on how to engage in more healthy behaviors (using condoms and abstaining). The students were also more likely to report, during the follow up, that they had not or had not recently engaged in sexual intercourse. If they did engage in sexual behaviors, they were more likely to use the condoms and least likely to use any other form of contraceptive. These programs have benefits such as possibly lowering the risk of becoming infected with HIV/AIDS and/or becoming pregnant, but only if the program was enforced properly (including instruction and education from a teacher or advisor). If these programs are put into place and education and instruction is not taught to the students, it could result in inappropriate use of the condom, HIV/AIDS, and/or pregnancy.
         Carasso (1998) indicated, 25% of all new cases of HIV/AIDS were in children under the age of 20. There were 27,860 reported cases of HIV/AIDS in children between the ages of 13 and 24 years old. All together (including adults and children below the age of 13) in 1998 there were 688,200 reported cases of this deadly virus by the Center for Disease Control and Prevention. It is the sixth leading cause of death for youth between the ages of 15 and 24 years old with 1:3 deaths being an African American male. She writes that there are some variables that may increase the risk of being infected with HIV/AIDS. Those variables are 1) condom use, 2) Substance abuse, and 3) Alcohol. In telephone surveys conducted by Hingson, Strunin, Berlin, and Heeren (as cited in Carasso, 1998), showed that only 27% of sexually active youth use condoms when they engage in sexual intercourse. Carasso states that it is important that these youth understand the importance of using condoms every time they engage in sexual activities and that they know how to use them properly. With substance abuse, it is shown that after using substances, the chances of engaging in risky behaviors increases. This may result in having sex with someone that is HIV positive, which could put you at risk for contracting the disease. Alcohol interferes with decision-making because youths are more likely to engage in risky sexual behaviors if they are intoxicated (e.g. not using condoms). Carasso (1998) stated in her article that there were a number of things that should go on in order to decrease the risks of HIV/AIDS transmission. Some of those things included: School based education, Peer education, educating the educators, as well as developing community incubator.
          Engquist, Coyle, Parcel, Kirby, Banspach, Carvajal, and Baumler (2001) stated that the Safer Choices program is a program that encompasses several components. Those components consist of a behavioral theory-based HIV, STD, and pregnancy prevention program, on unsafe behavior, school atmosphere, and psychosocial variables. This is an intervention program that is based on models of school changes, social cognitive theory, and social influence models and has five key components. Those components include having a school based program, the second is having a curriculum for 9th and 10th graders, and the third component is having a peer based and community based program, therefore the youths will not only be learning in school but from their peers and the outside environment. The results of the study showed that if this program was also implemented properly, there would be a reduction in the amount of youths that engage in sexual intercourse without a condom. The program has also been shown to reduce the number of sexual partners an adolescent may have. Like any program, there were some downfalls. The downfall to this program is that it is not effective on how often an adolescent engages in sexual intercourse.
         Schools in the United States are not the only school systems that are implementing HIV/AIDS prevention programs. Schools in Canada and Asia have also become involved in the worldwide fight against HIV/AIDS. The direction that these school systems have taken do not differ much from the direction that many schools in the United States have taken. Lebrun and Freeze (1995) state that in Manitoba, Canada, there is a question as to whether teachers are ready to teach about HIV/AIDS in their schools? The study in Manitoba, which tested to see how educated teachers were about HIV/AIDS, if the teachers were homophobic, and if they had respect for the confidentiality right of those infected with the disease, found that the teacher had a pretty good knowledge of the disease, and had a great respect for those students with HIV/AIDS. Many of the teachers believed that there should be further instruction as to how to handle this fairly new group of people in the schools.
         Asia is a continent that is strict with traditions but as people move away from those traditions, become more sexually promiscuous, and drug usage increases, the HIV/AIDS epidemic hits there as well. According to an article written by Smith, Kippax, Aggleton, and Tyrer (2003), Cambodia is affected the most by HIV/AIDS with 4.04% (heterosexual transmission) of its population infected. Thailand comes in second with 2.15% (heterosexual transmission) of its population infected. In the study, they mailed out questionnaires and conducted interviews in certain Asian countries (some were: Brunei, Cambodia, China, Malaysia, Philippines, and Mongolia), and they found that the children in the schools were being taught information about HIV/AIDS but most of the education was about life-skills. The life-skills they were teaching were negotiating and assertiveness. They were not yet teaching about detailed sexual practices, possibly because of the strict traditions, but those countries that were being affected by the virus the most were considering changing their teaching methods. That change could possibly result in lowering the transmission of HIV/AIDS in those countries as well.
         In an article written by Cobia, Carney, and Waggoner (1998), it was believed that in the near future, every teacher would have to come in contact with a student infected by HIV/AIDS, especially with 10,000 children being diagnosed with the disease in 1998. This article focused on the role of the school counselor. It states that it is important for school counselors to look at AIDS as the disease that it is and not from their moral point-of-view. The counselors themselves have to be well educated about HIV/AIDS in order to teach others about the disease and to imply prevention methods/programs in their schools. The Rehabilitation Act of 1973, Section 504 has influenced policies that respond to concerns that are associated with HIV positive students. These policies give instruction about the rights of these students in the general education classroom.
          Many teachers are worried about having students infected with HIV in the classroom because they have a fear of transmission. This is a reason why many of those teachers want to know who is infected so that they can know when to use the Universal Precautions (e.g. using gloves if blood is visible). It is important for the counselor to train the teachers so that the teachers will know that it is important use the Universal Precautions in all situations when body fluid are involved.
            Cobia, et al., (1998) stated that counseling students with HIV/AIDS could be different based on the age of the student. Children are usually counseled with the school counselor and his or her teacher(s). Children with this disease have a fear of isolation, rejection, and death and they may act those fears out by acting-up or withdrawing from others. To prevent this, the counselor may want to work with the child to increase his or her self-confidence and self-efficacy so they can communicate their emotions and fears in a more positive manner. Role-play therapies are a good way to help the child overcome their fears and to boost confidence.
         Cobia, et al., (1998) also stated that counseling adolescents is different. The counselor has to first find out if the student is sexually active to make sure they do not pose a risk to others. If they have not told their parents about their condition, it may be because they are also in fear therefore, role-plays are also useful in this situation. If the adolescent had anything to do with his or her exposure to the disease he or she may feel guilty which can lead to depression and suicidal thoughts. The symptoms that a depressed adolescent my display may be: withdrawal, change in weight, and irritability. The role of the counselor is to help build the adolescent’s self-confidence and to help the adolescent come up with coping skills (to help deal with the stressors that may come along with the disease) and engage in problem solving. Social support is also important. The adolescent may need to interact with a group of his or her peers that make them feel good about himself or herself and let them know that he or she will not be rejected by them.
         HIV/AIDS has affected everyone in the world one-way or another. With the number of HIV/AIDS infected children and adolescents rising, it is important to come up with ways to make them feel comfortable in the classroom. It is also important for school systems to come up with ways that will help prevent the transmission of this deadly disease. The schools are important in this prevention process but it is also important for the community to get involved. Developing programs that not only teach youth’s healthy sexual practices but, also developing programs that teach youths not to stigmatize those with this disease is an important component of this intervention process that so many have taking part of. If these programs are taught, then the transmission could be reduced and those with HIV/AIDS will be accepted more and perceived more positively by the general public.
        For additional information on HIV/AIDS in the schools, check out these sites:


References

References

AIDS Britannica Student Encyclopedia. Retrieved October 25, 2004, from Encyclopedia

            Britannica Online. http://www.search.eb.com/ebi/article?tocId=9272756

Blake, S.M., Ledsky, R., Goodenow, C., Sawyer, R., Lohrmann, D., & Windsor, R.

(2003) Condom availability programs in Massachusetts high schools: Relationship with condom use and sexual behavior. American Journal of Public Health, 93(6), 955-962.

Burkholder, G.J., Harlow, L.L., & Washkwich, J.L. (1999). Social stigma, HIV/AIDS

            knowledge, and sexual risk. Journal of Applied Biobehavioral Research, 4(1),

            27-44.

Carasso, M., (1998). Renegotiating HIV/AIDS prevention for adolescents. Issues in

            Comprehensive Pediatric Nursing, 21, 203-216.

Cobia, D.C., Carney, J.S., & Waggoner, I.M. (1998). Children and adolescents with

            HIV disease: Implications for school counselors. Professional School Counseling,

            1(5), 41-45. Retrieved September 27, 2004 from PsycInfo.

Engquist, K.B., Coyle, K.K., Parcel, G.S., Kirby, D., Banspach, S.W., Cavajal, S.C., &

Baumler, E. (2001). Schoolwide effects of a muticomponent HIV, STD, and pregnancy prevention Program for high school students. Health Education & Behavior, 28,(2), 166-185.

Fisher, J.D., Fisher, W.A., Bryan, A.D., & Misovich, S.J. (2002). Information-

            motivation-behavioral skills model-based HIV risk behavior change intervention

            for inner-city high school youth. Health Psychology, 21(2), 177-186.

  <>Grier, E.C., & Hodges, H.F. (1998). HIV/AIDS: A challenge in the classroom. Public

            Health Nursing, 15(4), 257-262.

Lebrun, M., & Freeze, R. (1995). HIV positive students in the Manitoba public school

            system: Are Manitoba’s teachers ready? Developmental Disabilities Bulletin,

            23(2), 32-42.

Smith, G., Kippax, S., Aggleton, P., & Tyrer, P. (2003) HIV/AIDS school-bases

            education in selected Asia-pacific countries. Sex Education, 3(1), 3-21.






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