Teaching AIDS

Douglas Tonks

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781135964542
• Topic: Education
• Subtopic: Education General

Teaching AIDS begins with a discussion of how teachers can create an environment of support for an AIDS education programme. Recognizing that AIDS education must differ for students of different age groups, the author presents tailored, age-appropriate content - what and how teachers should communicate AIDS information to young children, older children and teenage students.Teaching AIDS also addresses actual methods teachers can use to influence their students' attitudes and behaviour by helping them to recognize problem situations in which risks might arise, and presenting them with the actual skills they need to protect themselves in such situations.

1

The Extent of the Problem of AIDS and HIV in Adolescents

Adolescent AIDS has been the subject of relatively little attention since the AIDS pandemic began. The majority of concern has been given to the more obvious presence of adult cases of AIDS and their implications. Perhaps this is as it should be; AIDS first came to our attention among adults, and the bulk of AIDS cases appear in adults. After adults, AIDS cases among children have received the most attention. AIDS babies born to HIV-positive mothers or infected by the virus in their mother’s milk are the embodiment of the innocent “victim” of the AIDS crisis. Helpless to aid themselves, they deserve and receive the sympathy of the world. Caught between the overwhelming manifestation of AIDS in adults and the compassionate portrayal of infants with AIDS are a vast number of adolescents at risk of HIV infection whose peril has been largely ignored by the media and by their parents and teachers. Grouped with either adults or children, or sometimes not present in the equation at all, the needs and responses specific to youths have fallen through the cracks of AIDS prevention and care.

Part of the reason that the effects of AIDS in adolescents have been relatively easy to set aside is that the number of reports of actual AIDS cases among teenagers has been quite small. Few teenagers have AIDS, for some very understandable reasons. Babies infected with HIV rarely survive into their teen years. On the other hand, adolescents who come into contact with HIV will likely not become symptomatic and be diagnosed with AIDS until they have entered their twenties. Just because there is not an overwhelming incidence of AIDS among teenagers, however, does not mean that many are not infected. In fact, researchers fear that HIV infection among this group has been drastically underestimated and that the actual number of HIV-positive teens doubles every year.¹

To see that AIDS is a problem among teens, we can take the number of AIDS cases or HIV infections currently present in young adults to identify how many teenagers were infected over the past decade. Dr. Michael Merson, Director General of the World Health Organization Global Programme on AIDS, estimates that half of worldwide HIV infections since the beginning of the pandemic occurred among fifteen-to twenty-four-year-olds.²

We must assume that HIV is currently active among the students in our junior high and high schools. Even if the incidence of AIDS itself never becomes a pressing issue in the schools, HIV is already there, and we must assume it is spreading. Dr. Karen Hein, the director of the Adolescent AIDS Program at the Montfiore Medical Center in the Bronx, and perhaps the leading advocate for studying the problem of AIDS among adolescents, suggests that only two factors are necessary for the rapid spread of HIV among teenagers: “unprotected sexual intercourse and the presence of the virus.”³ HIV, although hidden, is present among teenagers; unfortunately, so is Hein’s first factor, unprotected sexual intercourse.

Teenage Sexual Activity

Although adults often refuse to recognize or believe the facts of teenage sexuality, these realities are very difficult to deny. Societies throughout history have generally been unwilling to admit it, but some teenagers have always been active in exploring their sexual identities and abilities. It is a part of growing up. Whether or not she was sexually active may be a matter of interpretation, but Juliet was only thirteen when she began her star-crossed romance with Romeo, himself only a year or two older. The level of passion they shared remains a part of the adolescent experience. In the past generation, teenage sexual activity has increased. Recent surveys have revealed that three-quarters or more of all teenagers, male and female, have had sexual intercourse before their twentieth birthday.⁴

Making these numbers somewhat menacing is the fact that much of this sexual activity is risky in one form or another. For the most part, sexually active teenagers are not monogamous. The ages between fifteen and nineteen are the most likely ages for individuals to experiment with multiple partners. A simple exploration of high school romances can confirm this fact. Many teens juggle more than one partner of the opposite sex simultaneously, and even those who remain monogamous do so for a very short time. Teenage romances often last only a few weeks, the long-term couples staying together a mere matter of months, creating a pattern of serial monogamy. A teenager may be faithful to one partner at a time, but over the period of his or her teen years, several partners are likely to have come and gone. Further, when sex is practiced by adolescent couples, the use of condoms or any other sort of contraception is very low. Often up to a year can pass between a teenager’s first sexual experience and his or her reliable use of contraception. While various types of contraception can protect against unintended pregnancy, only condoms provide protection against HIV and other sexually transmitted diseases as well. As proof of these trends, we need look no farther than the one million teenage pregnancies and two-and-a-half million cases of sexually transmitted disease (STD) that occur among teenagers every year.⁵

Sexually Transmitted Diseases

It is in examining sexually transmitted diseases that the closest analogy to HIV and AIDS can be made. STDs, such as gonorrhea, herpes, and syphilis, are diseases that are transmitted from person to person, as their name implies, through sexual activity. Keeping track of these diseases provides researchers with one method of measuring sexual activity. Two-and-a-half million cases of STDs among teenagers each year sounds imposing enough; when taken as a percentage of sexually active adolescents, rather than the overall teenage population, STD rates are the highest of any age group—double that of adults in their twenties. Cumulatively, the proportion of teens who have ever been infected with an STD, not just within the last year, is estimated by the U.S. Department of Health and Human Services to be twenty-five percent.⁶ AIDS follows a similar pattern.

Although adolescents are infected as a result of homosexual sexual activity and intravenous drug use, the presence of heterosexual transmission is higher than among the general population. Fortyone percent of adolescent women with AIDS were infected as a result of heterosexual contact.⁷

Adolescent AIDS Knowledge

Unfortunately, adolescent risk activity is not due to a lack of knowledge concerning HIV and AIDS. There is little doubt that the majority of teenagers have mastered basic AIDS information. They can tell you that there is no cure, that HIV infection more often than not leads to death, that the virus spreads through blood and sexual fluids, and which activities are likely to put them at risk. Most teens are aware of all this, yet they continue to engage in activities putting them at risk. Simple knowledge is not enough to change risky behavior. In virtually every documented case, adolescents have practiced the same level of risk behavior after learning the facts about AIDS as before.⁸ Information is not enough to bring about any meaningful change in behavior. In fact, in what may be a precursor to attitudes among teenagers in the near future, a new generation of young gay men is returning to the high-risk sex of the pre-AIDS era. Older gays saw their community decimated by the disease, and learned to practice safer sex to protect themselves. Younger gays, perhaps envious of the apparent freedom practiced by their predecessors, have begun to live their sex lives as if AIDS had never existed, engaging in unprotected intercourse with multiple partners.⁹ If teenagers follow this example, jealous of the sexual liberties taken by the generation preceding them and determined to seize those sexual liberties for themselves, they will usher in a new wave of HIV exposure and AIDS devastation.

Adolescent Attitudes Toward Sexuality

Teenagers hold a peculiar place in our society. They are taking their first few steps into adulthood, but are not yet free of all the restrictions of childhood. They are changing both psychologically and physiologically, but are discouraged from acting out or exploring many of these changes. Because most teenagers remain under their parents’ wing, their experiments with independence must be carried out either within the confines of parental control or without their parents finding out.

Sexual activity is one of the basic areas in which adolescents begin to exert their independence. In many ways, teens feel that sexual exploration is expected of them. Our society recognizes sexual activity as a normal behavior among adults, and teens merely want to join in, to assume the mantle of maturity sex appears to bring with it. Instead of providing socially acceptable routes of sexual expression for young people, society instead contributes convoluted and confusing messages through movies, television, and advertising that characterize sex as extremely enticing but denied to young people. As childhood turns into adolescence, youths experience new sexual appetites that demand some sort of reaction. In the absence of socially approved methods of sexual exploration, teenagers will investigate their newfound interests on their own. In the process, their sexual activity provides an enticing avenue through which they can forge their independence and join the adult world.

Sexual activity, particularly under the specter of AIDS, also allows the opportunity for that time-tested adolescent activity, teenage rebellion. To some degree, it may not really matter what rules adults set down about sex or what attitudes they hold on the subject. Some teenagers will act against what they perceive the attitudes of adults to be, no matter what the reality is. Adults, and particularly parents, stereotypically hold the view that adolescents should stay away from any and all sexual activity, and this in and of itself may be enough to encourage many teenagers to begin their experimentation.

On top of this desire to experiment, many teens may also hold a degree of anger over the intrusion of AIDS into their reality. They are warned to abstain from sex, or at the very least to practice “safe sex,” by the very people whose generation initiated the “sexual revolution.” Instead of studying the facts about AIDS, too many adolescents, intent on carrying out their own personal sexual revolution, ignore the message of parents whom they see as recent converts to a new moral standard that they themselves previously threw off. In fact, too many teens take the attitude that AIDS is one more barrier to their sexual liberty. “If you won’t abstain because of morality,” they imagine adults to be thinking, “we’ll threaten you with death.”

Communication between parents and adolescents on any subject has never been strong, and the record is even more dismal on the subject of sex. Parents tend to shy away from raising the subject with their children at any age, and thus lose their authority to present either information or their own attitudes on the subject. Some research suggests that parental communication, when it does take place, has very little effect, positive or negative, on sexual behavior. Instead, friends fill the vacuum.¹⁰ Adolescents, by and large, turn their backs on all adults, from parents and teachers to scientists and public health experts, when it comes to this subject. The adult agenda on sex seems clear to them: “Just Say No.” Teenagers take their defiant attitude even farther in dealing with AIDS, tending to be skeptical about basic AIDS facts and trusting no information from any source.¹¹ In fact, AIDS education may even suffer a backlash from teens, just as anti-drug efforts did in the sixties, if the message seems to overstate the actual facts of HIV and AIDS in an attempt to frighten teens into adopting safe behaviors. An initial thrust of AIDS educators must be to reinforce and, if necessary, regain the trust of teens. The only influence parents can wield to delay their children’s sexual initiation is through their teaching of values. When teenagers share their parents’ values and feel close ties within their family, they tend to wait longer before taking part in sexual intercourse.¹²

Risk-Taking

Of course, simple defiance is not the only reason for adolescents to experiment with their sexuality. Adolescence is a time of testing boundaries, of questioning previously held ideas, of probing oneself, and of trying new things. One of the hallmarks of adolescence is taking risks. Teenagers do not limit their risk-taking simply to sex. One way to gauge the extent of teen risk-taking is to examine the risks that do not work out, such as accidents. Teens have a higher rate of all forms of accidents than do adults, particularly automobile accidents. This adolescent risk-taking also extends to risks with their health, of which unsafe sex is only a part.

The psychology of adolescent risk-taking is not completely understood, but one apparent factor is the assumption of teenage invulnerability. This term is misunderstood by many people who insist that teenagers do not consciously think that they can withstand any threat, that they are impervious to harm. Of course teenagers are not foolish enough to imagine that bullets will bounce off them or that they will walk away unhurt from a smashed car. Teenagers do not believe they cannot be harmed, they believe that they will not be harmed. Adolescents can take risks with unsafe sex because they do not suppose they will ever come into contact with someone infected with HIV.

It is far too easy for teenagers, as well as many adults, to see AIDS as someone else’s disease. When AIDS first came to national attention, it was portrayed primarily as a disease of gay men and IV drug users. Health experts have always maintained that HIV would make its way into the mainstream heterosexual community, but that initial image of HIV risk groups has held steady. Sexually active heterosexual adolescents look at themselves and see that they and their partners are not gay men and do not take IV drugs. Based on such reasoning, they assume that they do not need to worry about becoming infected with HIV. Even those to whom the idea of becoming infected does occur dismiss it out of hand as an insubstantial risk.

Fear and Denial

Another element that will influence adolescent response to the threat of HIV and AIDS is fear. A modicum of fear might be helpful in persuading teenagers to protect themselves from the virus, but too much fear can backfire. Fear can spawn different types of reactions, primary among them regression and denial. Faced with overwhelming fear, teens might regress to depression and a state of dependence. Denial, however, is an entirely different matter. Instead of the fatalistic assumption that a teen has probably already been infected with HIV and has nothing else to lose, denial will not allow a teen to examine the problem at all. Denial is a very dangerous state for a teenager to reach, because any information that contradicts the assumption of denial will be immediately dismissed. Instead of facing up to the horror of a terrible, life-ending disease, teenagers find it much easier to pretend that this disease does not happen to people like them.

Making the reality of AIDS even easier for teens to deny are the very characteristics of the infection itself. HIV infection can remain asymptomatic for more than ten years. Because asymptomatic HIV-positive individuals show no apparent sickness, it is virtually inconceivable to most youth that these individuals can be carrying a fatal virus. Much of our society remains in denial over the issue of AIDS, so one can hardly be surprised when teenagers follow suit. But the effects of denial should not be underestimated. Denial has been shown to be so extreme in some cases that pregnant teenage girls will deny the fact of their pregnancy until they enter labor.¹³

Recent surveys that reveal the numbers of teens who overstate their own risk of becoming infected with HIV have illustrated the seeds of the overwhelming fear that can lead to denial among adolescents. One study found that seventy-five percent of those questioned feared getting AIDS. Students in another poll greatly exaggerated the risk of infection from one act of unprotected sex.¹⁴ While the risk to these adolescents is present and must be addressed, it is not as high as they believe. Such overstatements of risk can lead adolescents to feel overwhelmed with the entire issue of AIDS, and set the stage for massive denial.

Self-Esteem and Peer Pressure

Adolescent decision-making is also dependent on two factors that circle back and forth and around each other: self-esteem and peer pressure. Teenagers’ ability to resist the pressure exerted on them by their peers hinges on the strength of their self-esteem, which, in turn, is influenced to some extent by those same peers. But self-esteem is affected by other considerations as well. As mentioned earlier, parents can still influence their adolescent children through the values that they have instilled in them throughout their lives. Adolescents with deeply held religious beliefs and practices appear in general to have higher self-esteem and tend to enter into sexual activity at a later time than adolescents who do not. Self-esteem is also tied into academic performance. High academic achievers appear to have higher self-esteem than do low achievers. When low- achieving students come to the conclusion that school is a dead end, they quickly lose interest and often turn to risky behaviors in their search for self-affirmation. These students engage in a variet...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Preface
• Acknowledgments
• 1. The Extent of the Problem of AIDS and HIV in Adolescents
• 2. Preparing an AIDS Education Program
• 3. Facts and Information
• 4. Age-Appropriate Information
• 5. Individual and Group Activities to Uncover the Facts
• 6. Skills to Change Student Attitudes Toward AIDS and Risky Behavior
• 7. Modeling the Skills
• 8. Skill-Building Classroom Activities
• Notes
• Bibliography
• Index