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PEDIATRICS Vol. 101 No. 5 May 1998, pp. 933-935
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ABSTRACT |
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Top
Abstract
Introduction
Recommendation
References
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The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has grown during the past 15 years. Education remains a critical component of our efforts to prevent HIV infection/AIDS in school children and young adults. To accomplish this goal, school personnel should receive updated information about HIV infection/AIDS so that accurate teaching on this topic can be included in the K-12 health education curriculum. Informed pediatricians and nurses can serve as important resources for school health services and administration to provide current information for the curriculum. Each community should have a school health advisory committee that enlists community support and provides input to health education programs in schools.
Since the onset of the human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome (AIDS) epidemic, in 1982, more than 7629 cases of AIDS have been diagnosed in the United States among
children younger than 13 years. An additional 2754 cases have been
diagnosed among adolescents and more than 100 000 cases among
individuals in their twenties, many of whom likely became infected
during their teenage years.1 The common etiologic factors of sexual or drug use behaviors lead to acquisition of the
virus by adolescents and adults. These risk behaviors, predominantly heterosexual intercourse, result in the majority of HIV infections in
childbearing women and therefore are indirectly responsible for nearly
all perinatal HIV infection. Advances in current treatment regimens to
decrease the rate of transmission of HIV infection to newborns are
essential for disease control.2 Education leading to the
reduction of risk-taking behavior remains a critical component of our
efforts to prevent HIV infection. The responsibility to provide such
education is broadly shared by families, the media, health
professionals, schools, and community organizations that serve youth.
Schools, however, have a particular advantage in such educational
initiatives because they have the opportunity and the expertise
necessary to deliver an effective and comprehensive curriculum. They
have access to children and adolescents for many hours over many years
and they interact with students at a time of their lives when they are
developing knowledge, attitudes, and skills that will enable them to
develop healthy lifestyles.3
Legislative Mandates
Many states presently mandate HIV/AIDS
education.4 In some states, HIV/AIDS education
programs may exist without any other health education programs or may
not be required for graduation. It would be preferable if HIV/AIDS
education were required for graduation as part of a broadly based K-12
comprehensive health education curriculum. The Academy supports
mandated comprehensive health and physical education in all states and
school districts.
School Health Advisory Committees
HIV/AIDS education programs should be developed by the school
medical advisor, school administrators, health educators, and the
school nursing supervisor. They should be promoted to the community by a school health advisory committee.3
Members of this committee, for each school or district, should consist
of the school medical advisor, community pediatrician and/or public health physician, the school nurse, a health educator, a mental health
professional, the school administrator, a faculty member, parents,
students, and appropriate community representatives to reflect the
ethnic diversity of the student population.5
Education of Teachers
HIV/AIDS education should be included as part of a comprehensive
health education course at a college level and updated when an educator
is employed in school.6 At all levels teachers should
be educated in how to instruct students about child health and
development, human sexuality, AIDS as a sexually and blood transmitted
infection, and standard infectious disease precautions. They should be
taught to develop health education curricula that are sensitive to
ethnic and cultural differences.7 Qualified health
educators should play an important role in educator curriculum development, skills training, supervision, and consultation with school
medical personnel. School boards need to allot time and resources for
continuing educator training in these subjects.
Physicians' and Nurses' Training
Physicians, especially pediatricians and school physicians, and
school nurses should receive continuing education about HIV/AIDS that
includes information not only about HIV infection/AIDS as a sexually
transmitted infectious disease but also on issues of ethics, testing,
and counseling. This should include information about modes of
transmission by injection drug use and an understanding of the
interaction of substance abuse (including alcohol and noninjection drug
use) with high-risk behaviors such as unprotected sexual intercourse.
Physicians and nurses with an active role in the schools should: 1)
participate in education programs for teachers, school administrators,
parent groups, community groups, psychologists, and other mental health
personnel; 2) assist schools and organizations in the development of
educational programs for special groups8; 3) review,
adapt, and develop educational materials; 4) participate in public
discussions, including radio and television programs and newspaper
articles; 5) take part in meetings between school administrators and
staff and between administrators and parents; and 6) facilitate
networking among parents, educators, and AIDS community groups. Both
information and educational methods for teaching this subject should be
updated on a regular basis.
Community Support
Programs of sex education including AIDS education may be
controversial in the community. Economic pressures have led to
reduction or elimination of some health education programs. The
pediatrician should function as an advocate and resource in developing
education programs for parents and the community. An informed community could provide support to the school health administration and health
services to ensure successful implementation of these programs.
In the face of controversy surrounding sexuality education and
despite economic limitations affecting curricula, the current epidemic
of AIDS has increased the importance and urgency of comprehensive health education including human sexuality
education.9 Pediatricians should advocate the
maintenance and expansion of such curricula. There is an emerging body
of information on what constitutes AIDS education.3 School
curricula should be based on that body of information. These programs
should have a concentrated focus; give accurate information; use active
learning methods, including small group discussions; examine media and
social influences; and most importantly, emphasize skill modeling and
practice, including decision-making and refusal skills and should also
address the issue of self-esteem. Studies have shown that these
HIV/AIDS education programs can increase a student's knowledge and
tolerance and influence subsequent behavior.10
HIV/AIDS education in the schools should be taught in
developmentally appropriate grade-specific programs by skilled
educators who are ethnically and culturally sensitive. The curriculum
should be developed through a cooperative process involving members of the community, educators, and health care professionals, and should reflect the ethnic diversity of the student body.
The elementary school modules for HIV/AIDS education should emphasize
general concepts of health and disease, cleanliness, the role of
microorganisms in disease, and the prevention of infection. The
content should define HIV infection and AIDS and differentiate between myths and facts regarding transmission, explain the effects of
HIV on the immune system, and identify appropriate resource people such
as physicians and nurses to clarify further unresolved issues.11
Middle school and high school students need intensive exposure to
health education, especially because of their potential participation
in high-risk behaviors that lead to HIV infection. The curriculum
should include: 1) the spectrum and natural history of HIV
infection/AIDS as an infectious disease; 2) the effect of HIV on
the human immune system; 3) methods of transmission of HIV; 4)
testing issues; 5) the prevention and treatment of HIV infection/AIDS;
6) an understanding of the relationship of substance abuse and HIV
transmission; and 7) social and psychological aspects of HIV
infection/AIDS, including legal and discrimination issues.
The curriculum must emphasize behaviors that minimize the transmission
of HIV. In some school systems, peer-led participation in high school
and college HIV/AIDS education programs may be a useful adjunct to
teaching.12 The curriculum should also describe the right
to receive health service in a confidential manner if there is reason
to believe that a student has a sexually transmitted disease, including
HIV infection.3 To understand prevention, students need to
learn about all modes of transmission. Infection among adolescents
occurs through blood transmission by intravenous injection or the
sharing of needles, resulting in exposure to blood containing HIV, and
transmission of genital fluid containing HIV by sexual intercourse.
Students need to understand that increasingly HIV is spread by
unprotected heterosexual intercourse. HIV may be transmitted from
infected mothers to their babies in utero, during the birth process, or
through breastfeeding.13 Discussions should include the
need for standard precautions for contact with blood and other
potentially infectious (high-risk) body fluids. Such discussions must
be culturally sensitive and grade-specific.
Prevention
The prevention of HIV infection/AIDS and its consequent illness
must be the primary component of any education program. This requires
an overall approach to responsible sexual behavior and decision-making
that includes prevention of all sexually transmissible infections. The
best strategy to prevent sexual transmission is to practice abstinence
until a mutually faithful relationship is established with a person who
has never been exposed to HIV infection. Education programs should
provide adolescents with the knowledge, attitudes, and skills they need
to both refrain from sexual intercourse and to use contraceptives and
condoms effectively if they choose to have
intercourse.10,14,15
Sharing needles exposes individuals to blood that may be infected with
HIV, hepatitis B or C virus, or other infectious agents and therefore
poses a significant risk. In addition, the use of psychotropic drugs,
including alcohol, increases the likelihood of engaging in risky
behavior. The role of drug use and the value of sterile needles to
prevent transmission of HIV should be discussed.16 The
likelihood of transmission of HIV from an infected woman to her infant
can be decreased by the use of antiretroviral medications during
pregnancy and labor and during the newborn period.2 It
should be emphasized to students that all pregnant women should know
their HIV status to enable them to make informed decisions about
appropriate medical care including antiretroviral
treatment.17
AIDS education curricula should be periodically updated by the
school medical advisor and public health experts to conform with
current knowledge. Pediatricians, acting in concert with school health
services, administration, and the community at-large can be effective
in educating students and faculty about HIV infection.
The American Academy of Pediatrics has been a long-time advocate
of comprehensive school health education and makes the following recommendations:
INTRODUCTION
Top
Abstract
Introduction
Recommendation
References
ORGANIZATION OF THE PROGRAM
CURRICULUM
PROGRAM ASSESSMENT
RECOMMENDATIONS
Top
Abstract
Introduction
Recommendation
References
COMMITTEE ON PEDIATRIC AIDS, 1996 TO 1997
Catherine Wilfert, MD, Chairperson
Donna T. Beck, MD
Alan R. Fleischman, MD
Lynne M. Mofenson, MD
Robert H. Pantell, MD
S. Kenneth Schonberg, MD
Gwendolyn B. Scott, MD
Martin W. Sklaire, MD
Patricia N. Whitley-Williams, MD
LIAISON REPRESENTATIVE
Martha F. Rogers, MD
Centers for Disease Control and
Prevention
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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HIV, human immunodeficiency virus. AIDS, acquired immunodeficiency syndrome.
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REFERENCES |
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Top
Abstract
Introduction
Recommendation
References
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Statement of retirement:
This article has been cited by other articles:
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  E. J Brown and E. M Simpson Comprehensive STD/HIV Prevention Education Targeting US Adolescents: review of an ethical dilemma and proposed ethical framework Nursing Ethics, July 1, 2000; 7(4): 339 - 349. [Abstract] [PDF]
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 Committee on Pediatric AIDS Education of Children With Human Immunodeficiency Virus Infection Pediatrics, June 1, 2000; 105(6): 1358 - 1360. [Abstract] [Full Text]
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Committee on Pediatric AIDS and Committee on Infec Issues Related to Human Immunodeficiency Virus Transmission in Schools, Child Care, Medical Settings, the Home, and Community Pediatrics, August 1, 1999; 104(2): 318 - 324. [Abstract] [Full Text]
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