HIV Risk Prevention Educating Minority Adolescents

HIV Risk Prevention: Educating Minority Adolescents

Fighting HIV / AIDS involves no less than changing our whole sexual culture." Peter Piot, Executive Director of UNAIDS, feels that what is most vital is that preventive education be stressed into young people's behavior. (UNESCO Courier, October 1999). Around half of all new cases of HIV infection in the whole world involve young people between 15 and 24, and in more and more cases, below age 15. Why is this so? Because everybody knows that it is the age when you begin experimenting with sex and change partners most often which compounds the problem because it multiplies the risk of infection. Studies in Kenya and Zambia show that 23% of the girls between 15 and 19 are HIV-positive compared with only three to four percent of boys. Girls are more vulnerable because of two reasons: the female genitals are more susceptible to infection than those of males (because they have not yet developed) as well as socio-cultural ones (they are most often won by gifts or are the victims of force). They often have as partners adult men who because of their age are more likely to be HIV-positive than boys.

The roots of the problem are most often poverty and male chauvinism. Hence, it is important to educate boys who have to learn that their worth doesn't depend on the number of women they have seduced.

It's been statistically proven that preventive education makes people much more sexually responsible. Youth are more receptive to prevention messages and go on to adopt a more responsible attitude to sexuality than adults.

In countries where there's been a good response to prevention campaign we've seen a very marked drop in the rate of infection among the 15 to 24-year-olds. The rate in Uganda urban areas has dropped 40%. In Zambia it has dropped most markedly among school children.

All this shows that education has an important role to play. While it's true that many children in developing countries don't go to school, the majority pass through school. The opportunity must be grabbed to give them an education about AIDS adapted to their age group, right from the start of primary school. While people feel that this will still encourage children to have sexual relationships, individuals really don't wait for lessons before starting their sexual life.

It has been statistically proven that preventive education makes people much more sexually responsible, namely by having sexual relationships later and using protection. (UNESCO Courier, 1999).

CONCEPTUAL FRAMEWORK

While the highly industrialized world has successfully stemmed the tide of new HIV / AIDS infection and has sharply reduced the number of AIDS deaths through the use of new and more potent anti-HIV drugs, everywhere else in the world the pandemic is still spreading uncontrolled with the sick being treated poorly or left untreated. This is noticeable in South and East Asia and most specially in sub-Sahara, Africa (UNESCO Courier, 1999).

In the United States, HIV/STD infections are prevalent among the African-Americans, and the Latinas in urban and rural areas specially in districts where the unemployment rate is high and impoverished families cannot send their children to school. Out-of-school youth ages 12-19 are most stricken and while efforts are being heightened and the federal government and other funding organizations are helping out, HIV/STD cases still exist and programs don't seem to work out at all. The following glaring statistics stand out in surveys conducted throughout the United States:

as of June 2000, the Centers for Disease Control and Prevention reported that 431,924 individuals are living with HIV infection and AIDS in the United States

There are an estimated 250,000 Americans who are unaware that they are HIV-infected and many of them are young people.

Half of all new HIV infections are thought to occur in young people under 25 years of age.

More than 123,000 young adults in the United States have developed AIDS in their twenties. The delay between HIV-infection and the onset of AIDS means that most of these young people were infected with HIV as teenagers.

Although the total number of youth in the United States who have been infected with HIV is unknown, public health officials believe that 20,000 people between 13 and 24 years of age are infected with HIV every year at the rate of about 2 every hour.

In the United States, more females than males are now being diagnosed with HIV in the 13- to 19-year-old age group.

By 12th grade, 65% of American youth are sexually active and one in five has had four or more sexual partners.

In the United States, 25% of high school students who have had sex said they were under the influence of alcohol and other drugs the last time they had sex.

HIV infections are usually contracted sexually among American young people.

The percentage of high school students who say they have had sexual intercourse decreased from 54% in 1991 to 50% in 1999. The percentage of sexually active high school students who say they used a condom the last time they had sex increased from 45% to 58% during the same period. Their accounts were confirmed when in 1999, births to teenagers fell to their lowest rate in 60 years. (Office of National Aids Policy, Youth and HIV / AIDS 2000: A New American Agenda).

A research system with an objective of applying science, technology, communication should be used to provide alternatives to meeting specific needs of adolescents. Each member included in the team plays a specific and essential role. An active exchange of resources must take place to enable each one to perform his particular task. As each one influences the other, there ensues dynamic interdependence. Interaction is fostered by which the program is able to survive, adapt, maintain itself and grow. The effectiveness of the program is entirely dependent on the communications established within it and between it and others. The successful conduct of the program requires that those responsible for its planning and implementation interact with the other factors in its environment. (Valdecanas, 1983).

THEORETICAL FRAMEWORK

The Theory of Reasoned Action (TRA) will be used as a framework for this proposal. First introduced by Fishbein in 1967, it suggests that a person's attitude toward any object is a function of his or her belief about the object and the evaluative aspects of those beliefs (Terry, 1993). The theory is based on the assumption that human are rational and behaviors are under voluntary control. It provides a framework that connects individual beliefs, attitudes, intentions and behaviors as shown in the model below Theory variables are defined by Fishbein and described by Demson (1996).

They are:

Behavior: A specific behavior defined by a combination of four components: action, target, context, and time

Intention: The intent to perform a behavior is the best predictor that a desired behavior will actually occur. To be able to measure it accurately and effectively, it should be defined using the same components used to define behavior, action, target, context and time.

Attitude: The individual's positive or negative feelings toward performing the defined behavior.

Behavioral beliefs: A combination of a person's belief regarding the outcomes of a defined behavior and the person's evaluation of potential outcomes. These beliefs differ from population to population.

Norms: A person's perception of the other people's opinion regarding the defined behavior

Normative beliefs: A combination of a person's beliefs regarding other people's views of a behavior and the person's willingness to conform to those views. These beliefs vary from population to population.

The theoretical framework supports a linear process in which the changes in an individual's behavioral and normative beliefs eventually affect the person's actual behavior. The theory forms a causal chain that links belief to behavior. According to the theory, cognitive structures, behavioral and normative beliefs, influence individual attitudes and subjective norms (Fishbein,1994). Consequently attitudes and norms shape a person's intention and remain the best indicator of the desired behavior.

The TRA has been used to successfully influence behaviors involved in the control and spread of STDs and AIDS. Other studies have used the TRA successfully. Ross and McLaus (1992) found that subjective norms were good predictors of intention to use condoms but attitudes were poor predictors of intention. However, research conducted by Fisher, Fisher and Rye (1995) with gay men, and heterosexual college and high school students, suggests that AIDS preventive behavior were predicted by behavioral intention and the behavioral intentions were a functions of attitudes and norms.

In a survey on 12- to 19-year-olds, attitude toward condom use, subjective social norms and self-sufficiency expectations are important determinants of condom use.

The theory has been used successfully as a framework in several AIDS studies. The theory suggests that by providing appropriate knowledge or information, the performance of a given behavior will be influenced. Also, the more one knows about the factors influencing decisions to perform or not to perform a given behavior, the greater the possibility one can develop successful intervention to change that behavior (Fishbein, 1994).

In conclusion, it would be advantageous to use the TRA for this project since studies have shown successful outcomes with this theory in past HIV / AIDS prevention programs. By providing appropriate knowledge or information, eventually the performance of a given behavior will be influenced. This HIV / AIDS prevention program will be education for seventh to eighth grade students in HIV / AIDS with the intent to change belief leading to a change in behavior. The TRA can provide a workable theoretical framework that has been used successfully in the past with HIV / AIDS education.

RESEARCH QUESTION/HYPOTHESIS

This study will attempt to answer the following questions:

Can an interactive school-based HIV / AIDS prevention/education program for multiethnic urban seventh and eighth graders increase their knowledge about HIV / AIDS, promote positive attitudes towards people with AIDS and encourage the desire for changes in the high risk behavior.

METHODOLOGY

RESEARCH DESIGN

An HIV educational program intervention will be used. The design consists of a pre-test and post-test evaluation of an educational intervention on HIV / AIDS prevention to seventh and eighth grade students. The pre and post test is a modified version of the Healthy Oakland Teens Survey developed by the University of California which can be completed in twenty minutes. The survey is intended to be used for a multiethnic, urban population of seventh and eighth graders. The same survey has been chosen for this study because it was designed for a similar population of students: multiethnic, urban, seventh and eighth graders, belonging to families not economically well-off, some barely managing to survive.

The school has a total of seventh and eighth grade students in the total population of the school. All of these students will be enlisted in the HIV educational program based on the curriculum for the Healthy Oakland Teens Project.

The investigation will perform the intervention which will consist of an interactive two and one half hour HIV / AIDS educational program adapted from the curriculum for the Healthy Oakland Teens Project.

Students will be given a pre-test and a post-test at the beginning of the program. Each pre and post-test handed to the student will have the same number on the left-hand corner so that pre and post-tests could later be matched. Students will be told not to place their names on either test. All pre-tests are pink and all post tests are blue. Students are handed both tests in a blank manilla envelope at the same time. Students will be instructed to take the pink pre-test prior to the HIV program and to place the test back in the envelope when finished. After the programs students will be instructed by the investigator to take the blue post test out of the envelope and when finished taking the survey place the test back in the envelope. All the blank manilla envelopes will be collected after the post tests are completed. No names or identifiers will be used. The tests are randomly handed to the students in the blank manilla envelopes. No name is used and there is no way to link students' names with the data. All the results are recorded as group data.

Setting: The study will take place during the students' science class at the charter school.

Research Sample

The sample will consist of 37 seventh and eighth grade students. This include students in seventh and eighth grade at the school who had permission by their parents to attend a program on HIV. This program is part of the school's customary educational practices and philosophies. The students whose parents do not want the child to participate in educational learning on controversial topics such as HIV are to be identified by the co-directors of the school and are removed from the program and given an alternative assignment by their teachers.

INDEPENDENT VARIABLE

The independent variable in this study is an HIV / AIDS interactive educational program to seventh and eighth grade students. The educational program is a modified version of the Healthy Oakland. Teens Project 1995-1996 curriculum which includes a system and HIV, transmission, protection, and myths and facts about HIV / AIDS, a 20 minute video, "In Our Own Words: Teens and AIDS" by Jean Blake, will be shown as part of the program. A question and answer session by the investigator follows the video and students are encouraged to express their thoughts. Also an interaction HIV transmission will be implemented during the program

RESEARCH RESULTS

The first problem this study will address is whether educational intervention could change a student's attitudes towards HIV / AIDS. Several aspects of the student's attitudes will be assessed: student's comfort level in discussing HIV / AIDS related topics with their parents/guardian.

This study focuses on the educational content towards only students. To efficiently facilitate communication between students and parents the educational program should focus on educating both parents and children.

The study will also assess the students' comfort level associating with someone with HIV / AIDS. As part of the educational program, the students will be shown the video "In Our Own Words: Teens and AIDS. This video will present "Give your love to individuals infected with HIV" and talking candidly to peers about HIV / AIDS issues. The purpose of the video's format is to encourage a more comfortable rapport with individuals infected with HIV.

The second problem to be addressed by this study is whether an educational intervention could change a student's intent toward risk-taking behavior. One manifestation of the student's risk-taking behavior is his attitudes toward condoms. Therefore, there will always exist a group of students that must be made to understand the importance of condom use in the practice of safe sex.

The California study produced interesting results as to how educational intervention affects the fears and concerns students have towards sexually transmitted disease. Two questions focused on the students' concerns about contracting HIV / AIDS or sexually transmitted diseases. Both questions showed that educational intervention caused a shift from students who were "very worried" to students who were "somewhat worried." These results are encouraging because they suggest that the educational interventions effectively addressed the concerns of students and positively influenced their attitudes.

The strongest data that the previous study produced shows a significant increase in the knowledge of students concerning HIV / AIDS. The questions showed an increase in knowledge is a result of the educational intervention concerning the transmission of the HIV virus. Several questions addressed some of the false myths about HIV transmission like "you can get AIDS from a swimming pool or toilet seat (questions 14 & 15. Table 3). Both of the questions showed a statistically significant (p-value

In conclusion, the data collected from the California study indicate that a 2-hour educational intervention can have statistically significant effects on student's knowledge. Student's intent for behavioral change was not statistically significant although results indicated a trend toward. HIV / AIDS infected individuals indicated improvement after undergoing the educational program.

IMPLICATIONS FOR FAMILY/

COMMUNITY HEALTH NURSE PRACTITIONERS

These encouraging results show that educational intervention can increase knowledge of HIV / AIDS. This study focused on pre-high school students and shows that these students can be effectively educated. The implication for nurse practitioners is that they should begin the education of their younger patients before they enter high school. Knowledge can hopefully give students the resources to make wiser decisions in the future regarding their health. Education is an important prevention technique for nurse practitioners.

This study used a variety of strategies to educate students. Lecture, video presentation and role-playing were all used to present and reinforce critical information about HIV and virus transmission. The multimedia and interactive forum maintained the interest of the students and promoted discussion in the class. Interactive education needs to be utilized in practice to actively involve the individual in the learning process.

Results from this study justify the use of education to help reduce the risk of HIV transmission among adolescents. Given the high evidence of HIV infection among younger adults the evidence supports the use of education as a desirable intervention for risk reduction by nurse practitioners. Measures should be taken to provide education to students during early adolescence continuing throughout adolescence and young adulthood. Educational interventions should be implemented both in schools and in clinical settings by nurse practitioners.

IMPLICATIONS FOR TARGET POPULATION/COMMUNITY

The target population of this study focused on minority adolescents in seventh and eighth grades at one charter school. Past research has indicated that minority adolescents are at an increased risk for HIV / AIDS. HIV presently continues to be the leading cause of death among Americans 24 to 44 years of age. Results of this study show that the students' knowledge increase on HIV / AIDS was statistically significant. Therefore, educational program in this school and other schools throughout the city promote healthy behavior of the students.

Education on HIV / AIDS plans an important role in prevention for adolescents. Implementation of an educational HIV / AIDS program can help promote healthy behavior. This will help improve the safety and healthy behavior of the students in high-risk communities. Through knowledge, minority adolescents will hopefully be able to empower themselves and be able to make informed choices, thus decreasing the HIV transmission rate.

SUMMARY

HIV / AIDS, an extremely serious health issue affects young people in America. Teenagers most especially in the minorities in multiethnic communities are showing escalating trends in risk-taking behavior and subsequent increase in HIV infection rate. This study attempted to address the problem of HIV / AIDS in minority adolescents by developing and presenting an effective educational program to increase student's knowledge of HIV / AIDS. The design of the educational program also encouraged positive attitudes towards individuals infected by HIV.

Education can make a positive impact on behavior. The Theory of Reasoned Action used in this paper provided a framework for this study that led to positive knowledge outcomes. The results of the study show that the educational intervention significantly increased the student's knowledge of HIV / AIDS and promoted positive attitudes towards individuals infected with HIV. The majority of students completing self- reported surveys felt that this program was beneficial and contributed to their greater understanding of HIV / AIDS.

Everybody - Preventing HIV and Other Sexually Transmitted Diseases

Among Young Teens, Revised Edition

The RAD Educational Program

The book, reviewed by Heather Froeschi provides the core curriculum for Grades 5-9. It is all about HIV, AIDS and STD prevention. Teachers, counselors, and parents will find the book, actually a curriculum complete in itself, a most effective most helpful, and most insightful guide to help save the life of the youth in the United States and elsewhere.

Communication is essential in the fight against communicable discusses. There should be an effective communication between the child and the adult, between teacher and student and everybody else involved in dealing with unsafe behaviors. The book "Everybody" uses communication very effectively. The activities call for discussions and where there is discussion, there necessarily ensues empowerment in the individual.

According to Froechi, lessons are shared in the book "Everybody." Discussed are details of STD and prevention methods, risk taking, reduction and elimination, stereotypes. Students emerge from the sessions understanding better the topics and more important, understanding themselves better.

Everybody" is developmentally appropriate and various extensive researches prove that it indeed meets the needs of adolescents of today. Statistics show that half of all HIV infectious occur among individuals under the age of 25. One in four new infections occur between the ages of 13 and 20. The majority of American adolescents are sexually active by 12th grade. This is threatening behavior. Addressing the problem head on is the only way to avoid fatal mistakes.

Everybody" as a curriculum does not occur as a lecture and testing methodology. The students assume the role of individuals in lessons - they literally act out the lessons and therefore assume the subject matter. For example, students observe how marker ink representing infectious body fluids, makes its way from student to student and they therefore see how easily they can become infected. They also learn in the process, how they can prevent infection from happening. This very simple exercise, hits home and gets the message across that HIV prevention is indeed a very serious matter.

According to Froeschi, the lessons are well-written, comprehensive and easily understood. "Everybody" should be prescribed to all middle schools. The youth need to learn responsibility for their health.

Prevention education is most likely to be successful if introduced before youth begin risky behavior. Developmentally appropriate interventions from 5th to 9th grade is probably the last best chance to introduce and implement HIV prevention education before adolescents' attitudes and behaviors are solidified. As Froechi has already stated, "Everybody" the book is the perfect curriculum for 5th through 9th grade students about HIV, AIDS, and STD preventions. Basic topic areas offer developmentally appropriate information about HIV / AIDS, disease transmission, antibody testing, prevention (risk elimination and reduction e.g. abstinence, condom use) as well as the development and practice of refusal, negotiation, and communication skills.

There are 24 sequential activities in Everybody's curriculum. These are accompanied by guiding questions, step-by-step instruction, assessment measures and lesson extensions. Students act out the lessons and in essence, become the subject matter. Such hands-on activities have been shown to facilitate the storage of information to memory. Methods and techniques are based on such behavioral change theories as Becker's Health Belief model, Fishbein and Azjen's Theory of Reasoned Action and Bandura's Social Learning Theory.

A formative research on Everybody was conducted in 1997 in three ethnically diverse middle schools serving socially conservative communities. The research revealed that typical classroom teachers were comfortable using "Everybody" and the students actually enjoyed the program. Because of its simple, comprehensive directions and hands-on experiential exercises, the teachers reported the program to be focused, concrete and clear. The results also showed that students learned and retained important knowledge about HIV prevention and demonstrated desirable changes in HIV-related attitudes and beliefs.

Most important were the findings that after participating in Everybody, students maintained low levels of behavioral intentions to engage in the HIV related risk behaviors of sexual intercourse and injection drug use. Findings show that students were most likely to engage in risk behaviors not addressed by "Everybody" (i.e. cigarette, alcohol, marijuana, etc.). Also noteworthy was the finding of increased comfort levels in talking with peers and teachers about HIV and related topics. This feeling of comfort is important because many adolescents know how to prevent HIV but experience difficulty in negotiating risk-reduction behavior. By increasing comfort when talking about HIV and related subjects, "Everybody" strengthens adolescents' capacity for successful negotiation of HIV prevention.

The research conducted on "Everybody" was based on a convenience, rather than a random sample and did not use control groups. Despite its limitations, the study proved that middle schools can make use of Everybody and potentially contribute to positive changes in young adolescents that can be empowering and potentially life-saving. The strengths of this evaluation helped in the selection of Everybody as the featured curriculum of a five-year federally funded national dissemination project. In the Fall of 2001, an outcome assessment of "Everybody" began in ethnically diverse school districts. It improved on the formative survey in two ways: it used a randomized control design comparing student changes across program participants and non-participants, and providing longitudinal data. Because of the scientific requirements of its design, this particular evaluation should provide a more definitive evidence of "Everybody's" merit.

Everybody is integrated in the following subjects: Science: topics include scientific method; biology; human biology; microbiology; virology; sexually transmitted diseases; the human immune system; human reproduction epidemics; epidemiology; population studies; HIV research; current ethical issues in HIV-related research, etc.

A ics in Social Studies focus on prejudice and discrimination; historical responses to epidemics; legal issues and public health; morality and public health; cultural responses to illness; death and dying; implications of public education about personal behaviors; media messages about sexuality, risky behaviors and HIV/STD prevention; geography of the pandemic, biographies of the major contributors to the fight against HIV & AIDS, etc.

Visual and Performing Arts: full range of media to express perceptions, responses, messages and observations of HIV/STD related issues; drama, music and dance to educate about HIV and STDs from psychosocial issues to pure science; artistic expression of issues related to living with HIV or AIDS; artistic contributions of persons with HIV, AIDS and other significant illnesses, school participation in "A Day Without Art," in celebration of World AIDS Day, etc.

Everybody" is within Coordinated School Health Programming

It is a fact that good health and academic success go hand in hand. Students enrolled in schools with coordinated school health programs are most likely to be well-prepared for middle level HIV / AIDS education. They are also likely to receive reinforcement of prevention messages.

Everybody," the curriculum, has a role to play in school health programming. The model for coordinated school health programs has eight components. Of these eight, Everybody is directly connected to health education; health services; counseling; psychological and social service; as well as parent/community involvement. The other components of coordinated school health programming also pertain to HIV/STD related issues.

Everybody and Diversity Issues: Educators and community numbers are encouraged to tailor activities to meet local norms and needs. There are common themes throughout the curriculum as personal rights, public or community responsibilities, safety, health, respect and compassion. These themes are considered universal for a United States audience although application and interpretations may vary according to the specific ethnic, cultural, racial, etc.

Assessment (Evaluation)

The success of Everybody's curriculum is the students' behavior outside of the classroom. Several formal and informal activities can help teachers find out the extent to which students are learning and internalizing the curricular content.

The following topics form the core elements of HIV/STD education at every grade level:

The life science of HIV, AIDS and other STDs

HIV/STD transmission

HIV/STD prevention

HIV antibody testing

Psychosocial issues related to HIV/STDs

Every activity begins with guiding questions. They indicate what the students should be able to answer by the end of the activity. Extensions of lessons and evaluation activities measure the student's ability to answer the guiding questions. The teacher can also observe students "in action" during those activities with students assigned to small working groups.

In each activity there is a section on Lesson Extension and assessment. Assessment activities should develop creativity skills, personalization of HIV/STD prevention messages, and development of communication skills. The performance of the students should be linked to the overall quality of their work, the thoughtfulness of their responses and the depth of their analysis.

In 1996, the Elizabeth Glaser Pediatric Aids Foundation funded a 21-month national demonstration project. The idea was to find out if the teachers could use the RAD model in varied middle schools from four states. Charles Deutsch of the Harvard School of Public Health and John Brett, Ph.D. from the University of Colorado at Denver were principal investigators for one independent evaluation that accompanied this project. The quantitative and qualitative data derived from the investigation showed significant positive impacts on students' knowledge, perceptions and attitudes about HIV / AIDS prevention and personal risk-taking. The students manifested significant positive impacts on their knowledge, perceptions, and attitudes about HIV, AIDS prevention, and personal risk-taking. Students demonstrated significant gains in comfort with talking to peers and teachers about HIV prevention. Also, at a time when young teens often increase risky behaviors, students in this study maintained low levels of actual and intended risky behaviors from baseline through three-month post test. In addition, students, teachers, administrators, parents, and other community members strongly supported the curriculum. This really means to say, the research showed that Everybody works: it is memorable, durable and portable.

As the name implies, Everybody is for everybody: teachers, families, health professionals, others who work with youth, and most importantly young teens, themselves. Above all, "Everybody" is about helping adolescents develop the habits of being informed regarding their own health and being responsible for preventing HIV and other STDs. Everybody is developmentally appropriate and the research shows that it matches the needs of today's youths. Everybody targets young teens, many of whom have not initiated risky behaviors with the objective of providing a prevention paradigm to help students shape their future activities. Everybody also provides potentially life-saving contents for those youth already at risk for HIV and other STD.

Everybody has a very specific mission: to facilitate communication about HIV/STD prevention and to promote safe behavior among young teens. Everybody does not seek or claim to do everything that comprehensive health education can and must do. In the context of HIV/STD education. "Everybody" does touch on alcohol and drug prevention and the impact of the media. But the curriculum does not focus on these areas. Furthermore, "Everybody" assumes that students, teachers and other adults have some familiarity with basic communication skills. If needed, the reader is urged to seek out additional resources to supplement "Everybody."

With the publication of this book, attention can now be focused on supporting teachers, families, health professionals and others as they use Everybody to promote HIV/STD prevention among youth. RAD continues to offer professional development training in "Everybody." In addition, interactive website www.preventaids.netprovides an online opportunity for dialogue about HIV/STD education and the process of implementing "Everybody."

Everybody" is not a static curriculum. It should be used, adapted and enhanced. It is a bit like the bones that stabilize our bodies. "Everybody" provides a solid structure that can support a unique and valuable individual with particular experiences and needs. "Everybody" is a way to prevent HIV/STD infections and also endorses risk reduction as an important component of HIV/STD prevention strategies. Lessons and activities promote the development, internalization, and actual use of prevention related skills and knowledge; commitment to lifelong health; self-efficacy; hope for the future, and courage.

Everybody" aims to prevent interconnected high-risk behaviors and encourage interconnected protective strategies. Young adolescents are understood as more than the sum of their risk and resiliency factors. The curriculum focuses on the importance of healthy self-esteem as it presents prevention strategies for the youth, for individual, the community and society.

Everybody" realizes the complex behavioral implications for HIV/STD prevention: individuals must understand, internalize and remain committed to safe (safer) behaviors. Young adolescents know that the world is complicated. "Everybody," the curriculum affirms the experience of reality and provides practical, acceptable prevention strategies for youths.

Everybody" focuses on relevant psychosocial issues as the feeling of fear and anger in the context of HIV/STD prevention. Healthy fear can be a motivator for safer behaviors. However, unhealthy fear can be destructive. The curriculum reduces fears related to ignorance and misunderstanding. This method of approach helps the youth to identify, acknowledge, and transform the energy of fear into productive action or understanding.

Aside from this, the curriculum "Everybody" with its activities examines anger as an uncomfortable emotion and guides the students to see that such emotions do not call for (self) destructive risk-taking. Young adolescents can understand that people can feel anger about HIV and still be able to protect themselves.

Prevention Strategies

The curriculum (Everybody) addresses high-risk behavior as opposed to high-risk groups. The program communicates that it's not who you are, but what you do that can place you at high risk for HIV. Everybody outlines the mechanism of risk for HIV/STD infection beyond listing specific risky behaviors. The possibility of HIV/STD infection is described through an equation in which the riskiness of personal behaviors interacts with other variables a such as the frequency of risky behaviors, the prevalence of HIV/STD in the community, underlying health status access to care, and chance.

Everybody" addresses sexuality as a normal part of human experience. Sexual behaviors are discussed in clinical terms that are non-threatening and non-sensational. Activities include mention of the three highest risk-sexual behaviors: vaginal, anal, and oral intercourse. The curriculum does not suggest limiting this description as students may mistakenly assume that any behaviors not termed risky are safe.

Everybody" presents two major prevention strategies: risk elimination and risk reduction. From a public health perspective, risk elimination is the measure of true safety. Yet many individuals, especially the youth do not opt for this safe measures or do not have the capacity to exercise their right to such a choice (as in cases of rape or trauma). Therefore, developmentally appropriate discussion of risk reduction, including the subject of safe sex, is critical.

Risk Elimination

Maintaining a lifestyle for an indeterminate period of time does not include any behaviors that put one at risk of HIV/STD infection, including sexual intercourse (vaginal, oral and/or anal); use of alcohol or other illegal drugs, and any needle-sharing activities.

Risk elimination" - is used by "Everybody" instead of "abstinence" because of the common association between abstinence and religious or moral beliefs. Risk elimination is a more precise or to the point description of the desired behavioral outcome.

Safe Sex - sex within a mutually monogamous, trusting relationship between people who have tested negative for HIV and other STDs, don't share needles, and have no other risky behavior. Typically such relationship has a high level of mutual respect and communication.

Safer Sex - sex involving use of risk reduction techniques. This type of sexual activity is safer than unprotected sex, but still contains some risk of disease transmission.

One of the objectives of "Everybody" is for students to adopt risk elimination as an active choice and feel good about their choice. People have different expectations for how long they are willing to adopt risk elimination. "Everybody" suggests that it is most important to focus on prevention in the present and immediate future. Staying healthy now is of the utmost importance, and sets precedence for future behavior.

Everybody" shows risk elimination as an investment in a person's future opportunities and choices. Safe sex is possible for healthy people. However, the option for safe sex can be jeopardized if one or both partners are infected with a transmissible disease.

Everybody" tackles risk elimination from a positive perspective - focusing on the benefits of eliminating risk rather than using scare techniques, i.e. "you'll die if you don't choose risk elimination.

Everybody" teaches that correct and consistent use of condoms can prevent transmission of HIV and STDs but does not promise total safety. Condoms can fail. However, risk reduction can save lives and is a valid public health choice for sexually active people.

To some, risk reduction is an intermediate step toward risk elimination. For others, reduction is a healthy way of life. In "Everybody," the students themselves create strategies to foster risk reduction, fascinating, intense, often challenging and remarkably resilient.

Curriculum affirm - promise that informed skillful adolescents are capable of making healthy decisions about themselves.

Everybody fosters active learning - format responsive to one wide perspective: Youth cognitive and emotional maturity, life experience and resiliency.

Everybody explores the boundaries between trusting and doing, perceiving and knowing.

Interactive, experiential learning techniques engage youth and adults - education, account, structured yet spontaneous, and above all safe.

Provides accurate health information respectful of students' personal beliefs and family norms.

Provides information respectful of students' personal beliefs family norms. Activities guide teachers to separate personal belief from professor responsibilities.

Offers safe proxy for actual real life experience.

In everybody, prevention of these diseases is directly linked to human connection, personalities as well as public response.

Everybody meets students where they are - relevant, engaging and practical. Pertains to students reality.

An abstinence-based approach about attitudes, knowledge and skills.

Recommended sequence for each grade takes a minimum of several grades to complete.

Recommended sequence might not match every student's needs and/or every community's norms.

Activity formal: Overview section begins each activity and provides following information:

Content Categories (attitudes, knowledge and skills)

____ Grade Level 5-9

Correlative to National Education Standards

Science Education (A.G) and Health Education (1-7)

Estimated time excluding lesson extension and assessment ranges from 10-35 minutes per activity

Materials - when required

Set Up - when required

Summary

HIV / AIDS in an extremely serious health issue focusing on young people - American Teenagers, especially minorities, are showing increasing trends - risk taking behavior and subsequent increases in HIV infection rate.

Development and risk preventing needs an effective education program to increase knowledge.

The theory of reasoned action predicts that education can make a positive impact on rational behavior. This theory was helpful in providing a framework for this study that led to positive knowledge outcome. Results of this study show that the education intervention significantly increased the students' knowledge of HIV / AIDS and promoted positive attitudes toward individuals infected by HIV. The majority of students completing self-requested surveys felt that this program was beneficial and contributed to their understanding of HIV / AIDS.

OTHER INTERVENTION PROGRAMS FOR ETHNIC GROUPS

Some sexually active young African-American and Latina women are at especially high risk for HIV infection especially those from poorer neighborhoods. A study of disadvantaged out-of-school youth in the U.S., Job Corps found that young African-American women had the highest rate of HIV infection, and that women 16-18 years old had 50% higher rates of infection than young men. Another study of African-American and Latina adolescent females found that young women with older boyfriend (3 years older or more) are at higher risk for HIV.

What Puts Adolescents at Risk?

Adolescence is a developmental period marked by discovery and experementation that comes __ a myriad of physical and emotional changes. At this time of growth and change young people get mixed messages. Teens are urged to remain abstinent while surrounded by images on television, movies and magazines of glamorous people having sex, smoking and drinking. Double standards exist for girls who are expected to remain virgins and boys who are pressured to prove their manhood through sexual activity and aggressiveness. And in the name of culture, religion or mortality, young people are often denied access to information about their bodies and health risks that can help keep them safe.

A recent survey of teens in school showed that from 1991 to 1997, the prevalence of sexual activity decreased 15% for male students, 13% for white students and 11% for African - American students. However, sexual experience among female students and Latina students did not decrease. Condom use increased 23% among sexually active students. However, only half of sexually active students (57%) used condoms during their last sexual intercourse.

Not all adolescents are equally at risk for HIV infection. Teens are not a homogenous group and various sub-groups of teens participate in higher rates of unprotected sexual activity and substance use, making them especially vulnerable to HIV and other STDs. These include teens who are gay/exploring same sex relationships, drug users, juvenile offenders, school dropouts, runaways, homeless and migrant youths. These youths are often hard to reach for prevention and education efforts since they may not attend school on a regular basis and have limited access to health care and service-delivery system.

Can Education Help?

Yes. Schools are an important venue for educating teenagers on many kinds of health risks, AIDS, HIV, STD and unintended pregnancy. Across the U.S. And around the world, studies have shown that sexuality education for children and young people does not encourage increased sexual activity and does help young people remain abstinent longer. Effective educational programs have focused curricula, have clear messages about risks of unprotected sex and how to avoid risks, teach and practice communication skills, address social and media influences, and encourage openness in discussing sexuality. In addition, HIV prevention programs that are carefully targeted to adolescents can be highly cost effective.