HIV, Other STD and Pregnancy Prevention Education in Public Secondary Schools -- 45 States, 2008-2010

Editorial Note

CPSTF recommends group-based comprehensive risk reduction interventions delivered to adolescents, in schools or communities, to promote behaviors that prevent or reduce the risk for HIV, other STDs, and pregnancy. This recommendation is based on evidence of effectiveness in reducing engagement in any sexual activity, frequency of sexual activity, number of partners, and frequency of unprotected sexual activity, and in increasing the self-reported use of protection against STDs and pregnancy.³

Although a median of 90% of all public secondary schools across the 45 states in this report taught HIV prevention in a required course during 2010,⁷ the findings indicate that little progress was made in increasing the number of specific topics covered as part of HIV, other STD, and pregnancy prevention education during 2008-2010. The percentage of secondary schools that taught all HIV, other STD, and pregnancy prevention topics in a required course also varied widely across states. Further research is needed to understand determinants of the number of specific HIV, other STD, and pregnancy prevention topics taught in secondary schools.

HIV, other STD, and pregnancy prevention education in grades 6-8 is particularly important because most students in those grades are not yet sexually active.^1,2 HIV, other STD, and pregnancy prevention education that is taught before most young persons engage in risk behaviors, and that includes information on the benefits of abstinence and delaying or limiting sexual activity, can prevent behaviors that might lead to HIV infection, other STDs, and pregnancy.²

Because many students become sexually active during high school,¹ HIV, other STD, and pregnancy prevention education in these grades also is critically important.² HIV, other STD, and pregnancy prevention education that includes information on condom efficacy, the importance of using condoms consistently and correctly, and how to obtain condoms taught to those who might decide to be or are sexually active also can prevent behaviors that might lead to HIV infection, other STDs, and pregnancy.^4-6

HIV prevention education also can address misconceptions about how HIV is transmitted.² A 2011 public opinion poll indicated that 20% of persons aged 18-29 years believe incorrectly that a person can become infected with HIV by sharing a drinking glass, or are unsure whether the statement is true or false.⁸

The findings in this report are subject to at least three limitations. First, these data apply only to public secondary schools and, therefore, do not reflect practices at private schools or elementary schools. Second, these data were self-reported by lead health education teachers or their designees, and the accuracy of their description of the HIV, other STD, and pregnancy prevention topics taught in required courses was not verified by other sources. Finally, the effect of changes between 2008 and 2010 in the percentage of secondary schools in a state that taught HIV, other STD, and pregnancy prevention topics varies by the number of students attending public schools in the state during those years. States with fewer students would have less of a nationwide impact.

HIV prevention education supports strategies required to achieve the National HIV/AIDS Strategy goal of lowering the annual number of new HIV infections by 25% by 2015.² Families, the media, and community organizations, including faith-based organizations, can play a role in providing HIV, other STD, and pregnancy prevention education. However, schools are in a unique position to provide HIV, other STD, and pregnancy prevention education to young persons because almost all school-aged youths in the United States attend school.⁹ School policies can provide critical support for implementation of comprehensive HIV, other STD, and pregnancy prevention education in secondary schools.¹⁰

Acknowledgment

State School Health Profiles coordinators.

References

1. CDC. Youth risk behavior surveillance -- United States, 2009. MMWR 2010;59(No. SS-5).
2. Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington, DC: The White House; 2010. Accessed December 9, 2011.
3. CDC. Guide to community preventive services. Prevention of HIV/AIDS, other STIs and pregnancy: interventions for adolescents. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Accessed March 28, 2012.
4. CDC. Health Education Curriculum Analysis Tool (HECAT). Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Accessed December 13, 2011.
5. Kirby D, Laris BA, Rolleri L. Sex and HIV education programs for youth: their impact and important characteristics. Scotts Valley, CA: ETR Associates; 2006. Accessed December 13, 2011.
6. Kirby D, Coyle K, Alton F, Rolleri L, Robin L. Reducing adolescent sexual risk: a theoretical guide for developing and adapting curriculum-based programs. Scotts Valley, CA: ETR Associates; 2011. Accessed December 13, 2011.
7. Brener ND, Demissie Z, Foti K, et al. School Health Profiles 2010: characteristics of health programs among secondary schools in selected U.S. sites. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Accessed December 9, 2011.
8. Kaiser Family Foundation. HIV/AIDS at 30: a public opinion perspective. Menlo Park, CA: Kaiser Family Foundation; 2011. Accessed December 9, 2011.
9. Snyder TD, Dillow SA. Table 7. Percentage of the population 3 to 34 years old enrolled in school, by age group: selected years, 1940 through 2009. In: Digest of education statistics 2010. Washington, DC: US Department of Education, National Center for Education Statistics, Institute of Education Sciences; 2011. Accessed December 9, 2011.
10. National Association of State Boards of Education. Someone at school has AIDS: a complete guide to education policies concerning HIV infection. Alexandria, VA: National Association of State Boards of Education; 2001.

* Additional information and questionnaires are available at www.cdc.gov/healthyyouth/profiles.

† Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Florida, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Washington, West Virginia, and Wisconsin.

§ Delaware, Hawaii, Idaho, Maine, Massachusetts, Montana, Nevada, New Hampshire, Rhode Island, South Carolina, Utah, Vermont, and Wyoming.

¶ In 2008, lead health education teachers were asked, "During this school year, did teachers in this school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in any of grades 6, 7, or 8?" for a list of 11 topics (Table 1) (e.g., how HIV and other STDs are diagnosed and treated; how to prevent HIV, other STDs, and pregnancy; and the benefits of being sexually abstinent). Respondents were instructed to mark "yes" or "no" for each topic or "not applicable" if their school did not include grades 6, 7, or 8. Teachers also were asked the same question for grades 9-12 for a list of eight topics (Table 2) that repeated some of the 11 topics and added others (e.g., the relationship between alcohol and other drug use and risk for HIV, other STDs, and pregnancy), and three condom-related topics (Table 3). In 2010, lead health education teachers were asked, "During this school year, did teachers in your school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in each of the grade spans below?" The topics, grade spans, and possible responses were the same as those specified in 2008.

** Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.