Implementation of Guidelines for Effective School-Based HIV Prevention Education

An article in the September/October 1999 issue of the Journal of Health Education examines how the U.S. Centers for Disease Control and Prevention's (CDC) guidelines for HIV prevention in schools have been implemented nationwide.

Researchers looked at data from the School Health Policies and Programs Study (SHPPS), an in depth assessment of five components of the school health program including health education, physical education, health services, food service, and health policies. Data for SHPPS was collected from school health professionals in all 50 states and the District of Columbia between March and June 1994.

For this study, researchers looked at the health education component of SHPPS to determine the extent to which the guidelines' recommendations were implemented. Each program was assessed to determine if it: included parent, teacher, and student involvement; was part of a comprehensive health education program; was taught by qualified and adequately trained health education teachers; was designed to prevent HIV infection; described the benefits of abstinence; was designed to help teens avoid risky sexual behaviors; had sufficient classroom time allotted to AIDS education; and was monitored and assessed.

Results

Classroom Time

• HIV prevention was taught in a required course in 79% of middle/junior high schools and 91% of senior high schools.

• Of the teachers who taught HIV prevention, 22% spent one class period on this topic, 25% spent two, 12% spent three, 8% spent four, 13% spent five, and 20% spent from 6 to 22 class periods on HIV prevention.

STDs/Pregnancy Prevention

• Of the 86% of schools that taught HIV prevention in a required course, 78% also taught pregnancy prevention in a required course, and 92% also taught STD prevention in a required course.

• However, only 45% of teachers who taught HIV prevention as a major topic also taught pregnancy prevention as a major topic, and 58% taught STD prevention as a major topic.

Topics Covered

• More than half of senior high school HIV-prevention teachers covered eight of the nine recommended topics (HIV transmission, needle-sharing behaviors, abstinence, sexual risk behaviors, alcohol and drugs, HIV/AIDS risk, condom efficacy, HIV testing/counseling.)

• The ninth topic, correct use of condoms, was covered by 37% of senior high school HIV-prevention teachers.

• In contrast, only four of the nine topics were covered by more than half of middle/junior high school teachers.

Teacher Qualification

• 96% of states provided training to teachers on HIV prevention and 82% provided such training to school health services staff.

• Approximately 36% of HIV-prevention teachers and 61% of health services staff received training on HIV prevention during the 2 years preceding data collection.

The authors conclude that much of school-based HIV prevention is consistent with CDC recommendations. They note, however, that "considerable room for improvement exists." They were particularly concerned that many HIV-related topics were not covered in middle/junior high schools and suggest that these topics need to be taught before initiation of sexual intercourse.

Recognizing that little time is spent on HIV, the authors suggest that teachers should narrow their focus to those subjects "most directly related to preventing infection in their students." For example, the authors explain that even though sexual intercourse is 25 times more common among high school students than IV drug use, needle-sharing behavior and sexual risk behaviors get equal class time.

The authors also note that although HIV, STD, and pregnancy prevention tactics share a common goal of preventing unprotected sexual intercourse, HIV-prevention teachers do not always teach about STD and pregnancy prevention. They suggest that these topics may be most effectively taught in tandem.

Finally, the authors recommend that more HIV-prevention teachers need pre-service training in health education, and that more schools need to teach HIV prevention as part of comprehensive school health education.

For more information:

N. D. Brener, "Assessment of Practices in School-Based HIV/AIDS Education," Journal of Health Education, September/October 1999, V. 30 n. 5, pp. S-28-33.