Ideas and Precautions for the Classroom
Worldwide attention continues to focus on the human immunodeficiency virus (HIV) disease, which may develop into AIDS. The incubation period between first contracting HIV and possibly developing AIDS can be exceptionally long in adolescents and adults, averaging 8 to 12 years. Given that AIDS is currently a leading cause of death among U.S. residents 25-44 years old (National Center for Health Statistics [NCHS], 2000), many people acquired the disease while adolescents. Consequently, the existence of this disease has affected schools. Medical experts have joined with educators to develop preventive curriculum. Individuals in the legal profession have focused on school policy and legal issues related to educating students with HIV/AIDS in public schools and health experts and school boards have created school policy mandating the use of universal health precautions by all school personnel.
HIV/AIDS in the Curiculum
As educators, we need to be concerned with teaching students with disabilities about HIV/AIDS. Research suggests that students with disabilities may be more vulnerable to acquiring the disease because of the increased likelihood of sexual and drug abuse, as well as more vulnerability to peer pressures (Prater, Serna, Sileo, & Katz, 1995). We must not ignore students with disabilities as we design and implement HIV/AIDS prevention education programs.
When AIDS was first identified, writers published a preponderance of nonfiction and a few fiction books for both adults and young adults (e.g., Hancock & Carim, 1986; Kerr, 1986; Miklowitz, 1987; Nourse, 1986). Since that time, medical knowledge about the transmission and evolution of the disease has improved exponentially. In response to this increased knowledge and concern about the rising incidence of the disease, educators and other related school personnel have taken more responsibility for teaching children and youth about HIV/AIDS by creating many preventive curricula; and authors have written additional books for school-aged students that include characters with HIV/AIDS. Curricular Uses of Literature Educators have advocated the use of juvenile literature in classrooms as (a) a way to teach about specific subjects (Dyches & Prater, 2000; Prater, 2000), (b) integrated thematic units (Rothlein & Meinbach, 1996), and (c) bibliotherapy (Sridhar & Vaughn, 2000). All three applications are appropriate to using juvenile literature in the area of HIV/AIDS. This article, however, focuses on the use of fiction and nonfiction in the first two areas:
* To teach about HIV/AIDS in concert with preventive curricula.
* To integrate books that happen to have characters with HIV/AIDS within other curricular areas as thematic units in the classroom.
Here, we discuss a sample of biographical and fiction books that include characters with HIV/AIDS. In selecting these books, we sought juvenile literature through a computerized search of books available through local public libraries and electronic bookstores. No books located were deliberately eliminated from our analysis. First, we discuss the type of information included in juvenile literature that may be used to teach about HIV/AIDS. Second, we present ideas for integrating juvenile literature with HIV/AIDS curriculum, as well as across other content area curricula. Last, we present precautions to consider when selecting and using these books in the classroom.
Teaching About HIV/AIDS
Educators can use juvenile literature effectively in teaching about concepts and emotions surrounding the topic of HIV/AIDS. We present examples of books that discuss (a) transmission of the virus, (b) effect of the disease, and (c) emotional responses to those who have contracted HIV/AIDS. Table 1 shows a list of the books and the type of HIV/AIDS information discussed in them.
Many juvenile books address transmission of HIV/AIDS and can help dispel the myths that HIV/AIDS is a "gay disease" or that it can be transmitted through casual contact with an infected person. In the sample of books reviewed, we located examples of discussions regarding casual contact; heterosexual and homosexual contact; and intravenous drug use, blood transfusions, and prenatal exposure.
Most of the books we examined addressed the issue of casual contact, usually in attempts at teaching the reader or characters in the story not to be fearful of acquiring the disease in everyday contact with those infected. For example, in the book entitled The Discovery (Baer, 1993), the teenage characters discuss AIDS in both their health class and with their pastor at a church function. The pastor tells the teenagers:
You're not going to get it from sitting on a toilet seat or shaking hands. The AIDS virus can't pass through skin that isn't broken or cut. AIDS has to enter your bloodstream. You don't have to be afraid to grasp a doorknob or use a telephone that's been touched by someone who has the virus. (p. 73)
In You Can Call Me Willy (Verniero, 1995), Willy's mother brings professionals to special school meetings to convince school officials and parents that no one can catch AIDS from toilet seats, doorknobs, sweat, or saliva. In another example, the school nurse in Alex, the Kid with AIDS (Girard, 1991) explains to Alex's classmates that they cannot catch AIDS from being around someone with the disease, even if that person were to "cough" or "throw up" on them. The only way to get AIDS is to have Alex's blood get inside their blood.
Some of the books we examined were explicit in providing details regarding sexual transmission of the virus. Other books alluded to the sexual manner in which the character contracted the disease.
Heterosexual Contact. More people, worldwide, have been infected with HIV through heterosexual contact than any other exposure (NCHS, 2000). In some of the books reviewed, the character with HIV/AIDS did contract the disease through heterosexual contact. For example, in Something Terrible Happened, Gillian's mother becomes infected through sexual intercourse with a man. This is only alluded to, however, when Gillian states that her mom, "like any mom, felt the need for grown-up company ... a man's arm wrapped around her, reminding her she was a woman as well as a mother" (Porte, 1994, p. 21).
In the book What You Don't Know Can Kill You, Ellen's mother confronts Ellen about her relationship with her boyfriend Jack. She asks Ellen frankly, "Did you insist Jack use a condom?" Ellen responds that she did not because it was the first time for both of them. Unfortunately, that was not true. Later in the story, Ellen's younger sister, Debra, and Debra's friend, Brenda, discuss boys and dating. Brenda states: "We had the course. We know how you get the virus. We know how to be careful. We know the difference between safe sex and stupid sex. Remember?" Debra reminds Brenda that Ellen had the course, as well. But
Ellen trusted Jack because she loved him. She was stupid not to make him use a condom. . . . You're not just sleeping with one person you trust; you're sleeping with everyone he ever slept with! And everyone that person ever slept with! (Arrick, 1992, p. 144)
An example of an even more explicit and straightforward presentation may be found in the biographical book, HIV Positive, In this book, the story is told of Sara, a 29-year-old single mother of two children. After informing the reader that Sara has HIV/AIDS, the narration follows:
How did Sara get such a terrible disease? . . . When she was twenty and beginning her third year of college, she fell in love with a fellow student. He refused to practice safe sex. Sara became pregnant and left school. . . . Not until Anthony's birth did Sara discover, to her horror, that the young man she had given her trust to was an intravenous drug user who had contracted the HIV virus. When he had sex with Sara without wearing a condom, his infected semen was absorbed into her bloodstream. That's how she had become sick. (Wolf, 1997, np)
Homosexual Contact. Exposure to HIV/AIDS through homosexual contact is also addressed in juvenile books. In the books we reviewed, authors were not explicit in describing how HIV/AIDS is acquired through homosexual contact. For example, while Alex waits for the results of his blood test, in Good-Bye Tomorrow, he investigates more about the disease. He learns that most people acquired the disease through either sharing blood or through having sex, "particularly the way gay men made love" (Miklowitz, 1987, p. 71).
Characters often struggle with the fact that the person with HIV/AIDS is gay. In When Heroes Die, Gary cannot accept for some time that the man he idolizes, Uncle Rob, has acquired AIDS. When he finally accepts the truth, he questions how his uncle became infected. A neighbor friend gives Gary book on AIDS:
The book said that while most of those with sexually transmitted AIDS were gay, heterosexuals were beginning to test positive for the disease as well. Gary had never seen Rob out on a date. He couldn't remember Rob having a girlfriend. How could he have gotten it? Rob drove a Vette and had muscles the size of King Kong's! He couldn't be gay. (Durant, 1992, p. 69)
In another book, Night Kites, Erick, a high school teenager, learns that his seemingly perfect big brother, Pete, has been diagnosed with AIDS. His reaction is "How could Pete get that? . . . I remembered something about people getting it from blood transfusions. I remembered Pete always gave blood during the Red Cross drives. But how could you get it giving blood?" (Kerr, 1986, p. 88). Erick soon surmises that Pete is gay.
When 13-year-old Liam in The Eagle Kite learns that his father has AIDS, he also struggles with how his father became infected. His mother tells him he acquired AIDS through a blood transfusion. But Liam knows that blood transfusions are now safe, so he asks his father if he is on drugs, hoping his answer would be, "yes." But his father only responds, "No drugs." Liam previously saw his father affectionately hugging a man Liam did not know. Now Liam's earlier suspicions about his father's sexuality are confirmed.
Blood Transfusions/Blood Product Injections
The biography Ryan White: My Own Story recalls the courageous life of the well-known Ryan White, a hemophiliac who contracted the HIV virus through injections of lifesaving Factor VIII. Ryan discusses the groups of people who can acquire the disease, including hemophiliacs and other people who need blood products. At the time Ryan acquired the disease, however, little was known about the effect of the disease on hemophiliacs. "AIDS was kind of lurking around in the background for all families of hemophiliacs, but back then nobody I knew except Grandpa seemed to take it very seriously" (White & Cunningham, 1992, p. 47). Ryan's story can provide an excellent historical perspective on how knowledge about transmission of the disease evolved.
In another biography, Jonathan in My Name Is Jonathan (and I Have AIDS) also acquired AIDS through a blood transfusion:
I needed to have some blood from someone else put into my veins. No one knew that some of the blood I would get had the AIDS virus in it. The virus got into my blood, and I got AIDS. (Schilling & Swain, 1989, p. 4)
Other books with fictionalized characters who became infected through transfusions include Be Still My Heart (Hermes, 1989); Good-Bye Tomorrow (Miklowitz, 1987); Sixteen and Dying (McDaniel, 1992); and Alex, the Kid with AIDS (Girard, 1991).
Injection Drug Use
Approximately 25% of all adult and adolescent HIV/AIDS infection cases are acquired through injecting drugs (sharing needles; Centers for Disease Control and Prevention [CDC], 2000). Yet, none of the main characters in the books we examined became infected directly through injection drug use. Several characters, however, were exposed to the virus through someone else who used drugs. For example, Sara's boyfriend, in HIV Positive, "did drugs," as did Alicia's mother in Baby Alicia Is Dying and Billy's mom in Watch Out, He's Got AIDS.
Around the world, more than 16,000 babies are born with HIV each day (CDC, 2000). A few books we located addressed prenatal exposure to the virus. Desi in Baby Alicia Is Dying visits the ChildCare house with her aunt, who is a nurse. They are put immediately to work feeding the babies. Desi becomes infatuated with Alicia and asks why her mother abandoned her. She is told that Alicia, like all of the babies in the unit, was born testing HIV positive and that they all acquired the disease from their mothers who, as intravenous drug users, had shared needles and passed the virus on to their fetuses. The nurse also explains to Desi that many babies develop "full-blown AIDS" before they're a year old and others develop an immune system of their own and stop testing positive.
In another example, Wilhelmina in You Can Call Me Willy states,
It's not easy to catch HIV and get AIDS. You have to get the virus into your blood first. Many children like me got HIV from their mothers when they were born. (Verniero, 1995, np)
Another example of a prenatal exposure to HIV is found in Watch Out, He's Got AIDS (Handis, 1998), a book that was written and illustrated originally as a report on HIV/AIDS by a fifth-grade student.
Effect of HIV/AIDS
Several books address the initial symptoms that the person living with HIV/AIDS experiences. in a fictionalized account in the book The Discovery, Nancy's only symptom is weight loss until she is diagnosed with a rare pneumonia called pneumocystis carinii (PCP). Other characters even question how Nancy could have AIDS when she doesn't look sick.
Anne, in Sixteen and Dying, is described as experiencing nagging tiredness for months, no matter how much sleep she got. There were other problems too: Her vision blurred while she was doing schoolwork; her appetite was poor, and she was losing weight. (McDaniel, 1992, p. 7)
As an infant, Billy, in Watch Out, He's Got AIDS, begins to have severe colds and influenza, accompanied with very high fevers. He begins to lose weight and has little energy. The medical professionals have a difficult time diagnosing the problem until Billy's mother confesses past injection drug use. Then Billy is tested and found to have the HIV virus. Alex, in Good-Bye Tomorrow, has similar symptoms-- weight loss, fever, and severe sore throats.
When Liam learns in The Eagle Kite that his father has AIDS, he reflects on the things he had noticed without thinking about what they meant. He noticed his father's "increasing thinness and how often he came home early from the office to rest in the afternoons, and his frequent colds and fevers" (Fox, 1995, p. 14).
Biographies also discuss initial symptoms. Sara, in HIV Positive, is described as follows:
She began to lose weight and she felt dizzy, nauseous, and weak. Her body ached, and she had splitting headaches. When she tried to eat, she had intense diarrhea. Her hands and feet swelled up. Her beautiful long hair started to fall out in large clumps when she combed it. (Wolf, 1997, np)
Ryan White, in his autobiography, states:
Mom claimed I looked like a concentration camp inmate: just skin and bone. I'd dropped almost twenty pounds, and I'm not chubby normally. But I did have all my hair, thank you very much. (White & Cunningham, 1992, p. 82)
AIDS is a debilitating disease. Some of the books describe the physiological condition of the character with AIDS either at one point in time or as the disease progresses. For example, It Happened to Nancy is based on a true story from the diary of an anonymous teenager. Fourteen-year-- old Nancy is date raped and acquires HIV. In one passage she describes her condition as follows:
More tests, more medications, more IV stuff. My chest hurts, my neck hurts, my bum hurts, I hurt every inch of my body like I didn't know hurt could hurt! (Anonymous, 1994, p. 107)
One of the more descriptive fictionalized accounts of the effect of the disease on the body appears in The Eagle Kite. After Liam's father is diagnosed with AIDS, he moves away from his family. Liam visits his father about one year later and is surprised by what he sees:
His hair, once so thick, was like a handful of dry straw. His nose looked longer, his teeth larger. But it was his thinness, the flesh barely covering his bones, that made Liam's heart grip in his chest. (Fox, 1995, p. 37)
Later Liam notices an "irregular blotch like a flattened pinkish leech on the pale skin near his father's shin" (p. 61). His father tells Liam he has Kaposi's Sarcoma, a kind of cancer that is treated with a drug that weakens the immune system even further. When his father is admitted to the hospital, Liam visits and thinks he looks like an "inert, withered child" (p. 106).
Various treatments for HIV/AIDS are portrayed in juvenile literature. Books written for younger children discuss treatment in simplified form. For example, in You Can Call Me Willy, Willy takes "many kinds of medicines" and "lots of pills."
Some make my cheeks puff out, The pills I take now taste better than the syrup I used to take. (Verniero, 1995, np)
In Daddy and Me (Moutoussamy-- Ashe, 1993), a photo essay about the famous tennis professional Arthur Ashe, the story is told from the perspective of his young daughter, Camera. The photographs show Camera helping her father take pills and breathe into a machine that gives him medicine.
Several books address the use of the drug AZT. For example, Billy and his parents, in Watch Out, He's Got AIDS, are told that if he tests HIV positive he will need AZT and gamma globulin. The doctor explains:
AZT is an anti-viral drug which slows down the destruction of the immune system. Children receive gamma globulin twice a week. It makes their blood stronger to fight common infections. (Handis, 1998, np)
Eight years later, Billy participates in a new drug therapy. "Doctors call it a 'cocktail; a combination of powerful virus fighting drugs" (Handis, 1998, np).
Anne's father, in Sixteen and Dying, researches AZT on the Internet. He tells Anne:
AZT's a powerful chemical. You'll have to take it several times a day and put up with the side effects-nausea, vomiting, tremors, depression. (McDaniel, 1992, p. 20)
Anne reacts, "Sounds like a real lifesaver, all right" (p. 20).
In a true story, It Happened to Nancy, Nancy's treatment and feelings are detailed in her diary. After developing an eye infection, she visits a doctor:
Another kick in the heart and head. How many more can I take? One medicine I can take will save my eyesight; another will keep me alive, but I can't take both. I can take AZT, which is a medicine that slows the AIDS virus, or I can take Ganciclovir, a medicine that can stop this blinding eye infection. (Anonymous, 1994, p. 123)
Nancy then learns about another drug:
I've got to choose between Ganciclovir and a newer medicine called Foscarnet by tomorrow. What a choice. Ganciclovir causes anemia and Foscarnet harms the kidneys. (Anonymous, 1994, p. 124) ]
Books also portray alternative treatments. In Something Terrible Happened, Gillian's mother, after experiencing traditional medicine, searches for alternative treatments: "First there was the medicine prescribed by the hospital: experimental pills, blood thinner, antibiotics, medicine to prevent seizures, pills to help her over feeling sick from all the other pills" (Porte, 1994, p. 35). So she substitutes "strong-smelling herbal teas and broths steeped with twisted roots and barks" (p. 36); Chinese tonics that come in glass vials; baths that make the water too hot, salty, oily, brown, or green for her daughter to want to join her; and cocoa butter massages-all to no avail.
Death is an inevitable subject when discussing and teaching about HIV/AIDS. Some characters in juvenile literature die within the story (e.g., Baby Alicia, Ryan White, Liam's father, and Gillian's mother). Others who do not die still wrestle with their own mortality, for example, Sara in HIV Positive (Wolf, 1997). In one story, A Name on the Quilt (Atkins, 1999), the person with HIV/AIDS has already passed away. The whole story, told from Lauren's point of view, centers on family and friends creating an AIDS memorial quilt panel for her Uncle Ron.
In What You Don't Know Can Kill You (Arrick, 1992), Jack, after he and his girlfriend test HIV positive, suggests they engage in a suicide pact. He views suicide as the only way to protect themselves and their families from further agony and harm, including humiliation, physical pain, and financial burden. Fortunately, Jack does not convince his girlfriend, Ellen. She, however, is not successful in convincing him otherwise; and he commits suicide alone.
Death is a subject that cannot be avoided, even by those very young people who are living with HIV/AIDS. Sixyear-old Jonathan, in My Name Is Jonathan (and I Have AIDS), contemplates death:
I like to watch the baby fish and frogs hatch in my aquarium. It makes me sad when one of them dies. My mom says that everything dies. I guess I know that, but sometimes I worry about dying. (Schilling & Swain, 1989, p. 44)
Rachael, age 9, states the following in the book Be a Friend: Children Who Live with HIV Speak: If only I didn't have HIV, then I wouldn't have to worry so much about dying. If only I knew more about what dying was like, then I would probably feel a little better about the fact that it might happen. If only I could talk to someone in Heaven, then they could tell me how it is there, what things there are to do there, and what I should bring. (Wiener, Best, & Pizzo, 1994, p. 12)
One book that addresses death directly is Losing Uncle Tim. Young Daniel enjoys spending time with his uncle but sees him deteriorate physically, go into a coma, and finally die. Tim's death is difficult for everyone. But Daniel remembers something Uncle Tim told him about the sun always shining somewhere even though we cannot always see it. Daniel thinks, "Maybe Uncle Tim is like the sun, just shining somewhere else" (Jordan, 1989, np).
When Crystal's Uncle Joe comes to town in Life Magic, he calls the two of them "soul mates," primarily because they both have a learning disability. By the time Uncle Joe dies from AIDS complications, they have developed a strong relationship. One of the things they enjoy doing together is making angels in the snow. After Uncle Joe dies, Crystal discovers a perfect snow angel without any footprints in the snow around it. She remembers talking about this possibility with her uncle and his words, "Only real angels can do that" (Cooper, 1996, p. 110).
Many examples and nonexamples of compassion and sensitivity to those living with HIV/AIDS are characterized in juvenile literature. Truthful accounts are particularly compelling. For example, 8-- year-old Becky, in Be a Friend: Children Who Live with HIV Speak, provides counsel on how to treat those living with HIV like herself:
I would like for everyone to know that please do not be scared of us-we have feelings, too. . . . Be nice, and treat us like everyone else. The worst thing about having AIDS is not knowing if people will be your friends. So please, be our friends. We need you to be our friends. (Wiener et al., 1994, p. 39)
In a fictionalized account, Nancy, in The Discovery, learns on the verge of her wedding day that she has AIDS. Her fiances brother struggles, "How could she do this to us? . . . I could never forgive her for this."
His mother responds,
I realize you are upset and angry. But your anger isn't going to help right now. . . . Your brother loves her. We love her. Now, we've got to put that love into action and be there for her when it counts. (Baer, 1987, pp. 48-49)
While Anne is homebound in Sixteen and Dying (McDaniel, 1992), she is visited by a group of volunteers called the "Good Samaritans." The volunteers provide support for AIDS patients by assisting them in practical ways. Mrs. Hankins, for example, visits Anne several times a week, straightening up the house, as well as helping her bathe, blow-dry her hair, and put on make-up.
Small thoughts of kindness toward individuals with HIV/AIDS are portrayed in other books. For example, after Liam's father moves away from his family in The Eagle Kite (Fox, 1995), Mrs. Motley keeps an eye on his father. She visits him at least weekly, bringing library books and food. In another example, the students in Be Still My Heart (Hermes, 1989) show greater compassion toward their teacher's husband who has AIDS than did their parents. The students invite Mr. Adams to spend a day with them at school. In everyone's eyes, Mr. Adams turns from a teacher's husband who might contaminate others, into a real person who has much to offer the students.
Prejudicial feelings against those with HIV/AIDS and their families, caregivers, friends, and associates are portrayed vividly in the books examined. Pete's father, in Night Kites (Kerr, 1986), has difficulty accepting his son's disease and his homosexuality. To protect himself and his son, he refuses to use the word "AIDS" and makes certain that everyone who learns about Pete's condition keeps it confidential. In A Name on the Quilt, Uncle Ron's father doesn't attend his memorial services or participate in making the quilt. The excuse provided is "Grandpa says he doesn't know how to sew" (Atkins, 1999, np). In Baby Alicia Is Dying, Desi is caring for Alicia, who lives in a child care facility. Desi's friend, Brian, resists working with her on an AIDS project for their biology class. He finally confesses that his uncle, who was gay, died from AIDS. He states, "Doing the project would only have reminded me of how badly I treated him" (McDaniel, 1993, p. 137). He explains that he tore up the letters his uncle sent him and that he was preoccupied with "What if my friends find out?"
A strange woman at the bus stop douses Debra, in What You Don't Know Can Kill You, with a bucket of water only because her sister, Ellen, tests HIV positive. The woman screams, "You don't belong with decent young people, you and your whoring family! Maybe this will clean you up" (Arrick, 1992, p. 192).
In a true story, Ryan White experienced many ordeals on both ends of the emotional spectrum-from being denied access to his neighborhood school to receiving international celebrity. On what he describes as his worst day at school, someone broke into his locker, stole a mirror, and left folders with "faggot" and "queer" scrawled all over them. Inside the locker, someone had spray painted "Why don't you get butt-f_____?"
Desi, in Baby Alicia is Dying, also experiences the prejudice and hatred of others. One day she arrives at school to see spray-painted red letters across her locker, "Get Out, Nigger Queer Lover." She discusses this with her friend Brian and questions how people could hate her so much. Brian responds, "The operative word is hate, Desi. Hate has its own agenda and doesn't need a reason." He continues to explain that some people "hate everyone who's different-- black, gays, any minority-it doesn't matter... I think it's a disease worse than AIDS" (McDaniel, 1993, p. 61).
Admitting Students with HIV/AIDS A few of the books we reviewed addressed admitting students with HIV/AIDS into school. Ryan White describes thoroughly the difficulty his family encountered when it came to his returning to school. The prejudice and persecution was so great that Ryan and his family moved to another city, where they were welcomed with open arms. In another true story, Jonathan's mother, in My Name Is Jonathan (and I Have AIDS), is described as attending meetings
to help other parents understand that their children wouldn't catch AIDS from me. It was hard for my mom but she thought it was important. (Schilling & Swain, 1989, p. 15)
In a fictionalized account, Willy, in You Can Call Me Willy, tells the reader that her mother takes doctors, lawyers, and social workers to school meetings to prove that Willy's presence in school will not make anybody ill. And in Be Still My Heart (Hermes, 1989), it is a teacher, rather than a student, who may be denied access to the school. Mrs. Adams's job as a teacher is threatened when rumors begin that her husband has AIDS.
Using Universal Health Precautions Although medical professionals indicate that communities need not worry about the transmission of HIV in the school environment, professionals nonetheless advocate proper hygienic practices and universal precautions (Prater et al., 1995). Only a few of the juvenile fiction and biographical books reviewed addressed these practices. In both Alex, the Kid with AIDS (Girard, 1991) and Watch Out, He's Got AIDS (Handis, 1998), the school nurse or health teacher instruct classmates to be extra careful not to touch any of Alex's or Billy's blood (e.g., nosebleed or cut). In You Can Call Me Willy, health professionals show Willy's teachers what to do if she "gets a cut" (Verniero, 1995).
Ideas for the Classroom
The books reviewed here address HIV/AIDS topics, as well as other general curricular areas. Given the emphasis in many schools on integrating literature across the curriculum, we present ideas for using these books when teaching about HIV/AIDS and other content areas.
Although all the books reviewed discuss issues regarding HIV/AIDS, these discussions should not stand alone. We suggest, therefore, that the books be used to supplement HIV/AIDS curriculum. Table 2 presents specific ideas for integrating these books with prevention curriculum.
All books we reviewed can also be integrated into content across the other school curriculum. Teachers can easily imbed literature into thematic units. After teachers develop the theme, focus, objectives, and activities for a unit, they can select literature that addresses the topic. They can then create prereading activities, as well as activities and questions related to the book as part of the unit plan. A full discussion of thematic unit development using literature may be found in other sources (e.g., Rothlein & Meinbach, 1996). Table 1 lists curricular topics addressed by the books discussed in this article. Table 3 presents global curricular areas, with sample classroom activities tied to the books reviewed.
We need to address several precautions related to the use of juvenile literature to teach about HIV/AIDS. Specifically, teachers should be cautious when using books that (a) include dated or nonfactual material, (b) portray characters in stereotypical fashion, (c) fail to identify diverse characters, or (d) do not address appropriately the issues of confidentiality. In addition, teachers are cautioned to ensure appropriateness of the books' content for their students' age, level of background information, and ability to understand and comprehend the intended meaning. Teachers must also be sensitive to the community attitudes and values regarding the issues addressed, as well as learn their local school district policy regarding the use of specific books before implementing them in the classroom.
First, information about HIV/AIDS discussed in the text of various books may not be up to date or factual. If this is the case, teachers have an obligation to provide more recent and factual information to their students. The books reviewed in this article were published between 1986 and 1999. When AIDS was first identified in 1981, little was known about the disease. Scientific and medical advances over the years have changed the way we view and understand HIV/AIDS. Initially, those with the disease had limited life expectancies. Thanks to advances in the production and use of various types of pharmaceuticals, many people living with HIV/AIDS can now lead active, productive lives.
Many of our society's perceptions about HIV/AIDS and people with AIDS have also changed over time. During the 1980s and early 1990s, HIV/AIDS was thought to be a gay man's disease and was often portrayed in the literature as such-partly because of an initial high incidence of HIV/AIDS in gay men. Over time, however, it became clear that HIV/AIDS did not discriminate among victims and that anyone could acquire HIV. Concomitantly, when the disease was first identified, the public was ignorant about the disease. People feared they would "catch" it through casual contact. Although fear will always exist, people's attitudes and beliefs can change as they learn more about the disease.
When using juvenile literature that portrays characters with HIV/AIDS, teachers should know the facts. An example of misinformation or nonfactual information occurs in Baby Alicia is Dying (McDaniel, 1993). A nurse tells Desi that many children develop "fullblown AIDS" before they are a year old, and also indicates that many babies develop an immune system of their own and stop testing positive. While this information is based in fact, the author fails to note that many infants develop an immune system of their own and remain HIV positive or have AIDS, because the virus has entered the infant's system. During the 1980s and early 1990s, many professionals and laypersons thought that some infants were miraculously cured of HIV between 18 and 24 months of age. In truth, an infant may stop testing positive for HIV once the mother's immunoglobulin (Ig) G antibody is no longer present in the infant's system (Diamond et al, 1990; MacDonald, 1992; Sileo, 1998).
When the information in a book is dated, teachers should place it in a historical context. For example, books that address the exclusion of students with HIV/AIDS from public schools can be approached from the "way it was" perspective, as compared with the "way it is" today. To facilitate such discussions, teachers need to know the laws in their states that ensure equal access to public schools for people with HIV/AIDS. When possible, educators should read and review the books and any supplemental materials in advance of their students. This will allow them the opportunity to anticipate questions, gather resources, and prepare answers.
In selecting books, teachers should also take into consideration the characterization portrayed. Using a variety of books with characters representing differences in gender, sexual orientation, and ethnicity, for example, can help reduce the perpetuation of stereotypes. For example, books such as Losing Uncle Tim focus on the stereotypical gay male with HIV/AIDS and should be used in conjunction with other materials to help students learn that anyone can acquire HIV/AIDS. Interestingly, only one of the books reviewed for this article included a person with a disability who also had HIV/AIDS, Uncle Joe in Life Magic (Cooper, 1996). Teachers need to emphasis that all individuals, including those with disabilities, may acquire the disease.
Discussing confidentiality issues with students is a critical portion of HIV/AIDS education. Several books discussed in this article do not adhere to confidentiality of those with HIV/AIDS. For example, in Alex, the Kid with AIDS (Girard, 1991); Watch Out, He's Got AIDS (Handis, 1998); and You Can Call Me Willy (Verniero, 1995), the character's HIV/AIDS status was known by classmates, parents, and school staff. Confidentiality was not addressed. In Ryan White: My Own Story (White & Cunningham, 1992), Ryan discusses his exclusion from public school, and the prejudice and fear he felt from the community at large because his HIV/AIDS status was disclosed. Yet in most cases, a person's HIV/AIDS status is not widely known and is often a closely guarded secret. In tne Unite unted States, people have a right to confidentiality regarding their HIV/AIDS status. Teachers should learn their state and local school district policy regarding the rights of a person with HIV/AIDS and be prepared to discuss these issues with their students.
Given the sensitivity and maturity level required of some HIV/AIDS material discussed in juvenile literature, teachers must be certain that the books they select are appropriate for the students they teach. In particular, we caution teachers to consider the students' age, background knowledge, and ability to comprehend the intent of the material being read. Inasmuch as students with disabilities have more difficulty acquiring and generalizing information, the use of juvenile literature may help them connect abstract concepts to concrete people and stories, thus improving their knowledge about the disease.
Importantly, teachers should consider the values of the community and the cultural background of the students before they select books to use in the classroom. Many of the books discuss sensitive and, in some communities or cultures, taboo subjects. The community and parental values should be reflected in the school policies regarding implementation of HIV/AIDS prevention curriculum. Although we advocate the use of juvenile literature to supplement HIV/AIDS curriculum or infuse into the general curriculum, teachers need to ensure that the content of the literature reflects the content and values supported by parents and the community and adopted by school policy.
Also, before using any juvenile literature, teachers should check with the local school district policy to ensure that the books do not appear on a "banned books" list. If they do, teachers should determine the proper procedures for (a) using the texts in the classroom and (b) having the books removed from the "banned books" list, if appropriate.
Even if the topics discussed in the books are considered appropriate for the students, discussion can still be difficult. Teachers may not feel prepared to handle, for example, emotionally charged discussions or students' specific questions. HIV/AIDS curricular materials generally include procedures and strategies for facilitating discussion and answering questions. Teachers who are not comfortable teaching about HIV/ AIDS have resources available to them. They may ask, for example, a health professional in the school or district to co-teach the material with them. Others may seek additional training about HIV/AIDS and how to teach it.
Teachers can use both fiction and nonfiction to strengthen and supplement existing HIV/AIDS materials and curricula. Books that are of interest to students often have a bigger and longer lasting effect than do traditional classroom material. For example, students may relate and respond better to characters in a book who failed to practice universal precautions, such as Jack and Ellen in What You Don't Know Can Kill You (Arrick, 1992), than to a traditional lecture and demonstration.
Anonymous. (1994). It happened to Nancy. New York: Avon.
Arrick, F. (1992). What you don't know can kill you. New York: Dell.
Atkins, J. (1999). A name on the quilt. New York: Atheneum.
Baer, J. (1993). The discovery. Minneapolis, MN: Bethany House.
Centers for Disease Control and Prevention. (2000). HIV/AIDS Surveillance Report, 12(1). [Online]. Atlanta, GA: Author. Available: http://www.cdc.gov/hiv/ stats/hasr120l.htm
Cooper, M. (1996). Life magic. New York: Holt.
Diamond, G. W., Gurdin, P., Wiznia, A. A., Belman, A. L., Rubinstein, A., & Cohen, H. J. (1990). Effects of congenital HIV infection on neurodevelopmental status of babies in foster care. Developmental Medicine and Child Neurology, 32, 9991005.
Durant, P. R. (1992). When heroes die. New York: Simon & Schuster.
Dyches, T. T., & Prater, M. A. (2000). Developmental disability in children's literature: Issues and annotated bibliography. (PRISM Series). Reston, VA: Mental Retardation and Developmental Disabilities Division of the Council for Exceptional Children.
Fox, P. (1995). The eagle kite. New York:
Girard, L. W. (1991). Alex, the kid with AIDS.
Morton Grove, IL: Whitman.
Hancock, G., & Carim, E. (1986). AIDS: The deadly epidemic. London: Gollancz. Handis, M. (1998). Watch out, he's got AIDS.
Sudbury, MA: Water Row.
Hermes, P. (1989). Be still my heart. Hermes, NY: Putnam.
Jordan, M. K. (1989). Losing Uncle Tim. Niles, IL: Whitman.
Kerr, M. E. (1986). Night kites. New York: HarperCollins.*
MacDonald, M. (1992). Vertical transmission of HIV: Management of the pregnant mother and her infant. In M. L. Stuber (Ed.), Children and AIDS (pp. 3-21). Washington, DC: American Psychiatric Press.
McDaniel, L. (1992). Sixteen and dying. New York: Bantam.
McDaniel, L. (1993). Baby Alicia is dying. New York: Bantam.
Miklowitz, G. D. (1987). Good-bye tomorrow. New York: Delacorte.
Moutoussamy-Ashe, J. (1993). Daddy and
me. Ashe, NY: Knopf.
National Center for Health Statistics. (2000). National vital statistics reports, 48(11). [Online]. Hyattsville, MD: Author. Available: http://www:cdc.gov/nchs/fastats/aids-hiv.htm
Nourse, A. E. (1986). AIDS. New York: Franklin Watts.
Porte, B. A. (1994). Something terrible happened. New York: Toll Medallion.
Prater, M. A. (2000). Using juvenile literature with portrayals of disabilities in your classroom. Intervention in School and Clinic, 35, 167-176.
Prater, M. A., Serna, L. A., Sileo, T. W, & Katz, A. R. (1995). HIV disease: Implications for special educators. Remedial and Special Education, 16, 6878.
Rothlein, L., & Meinbach, A. M. (1996). Legacies: Using children's literature in the classroom. New York: HarperCollins.*
Schilling, S., & Swain, J. (1989). My name is Jonathan (and I have AIDS). Denver, CO: Prickly Pear.
Sileo, N. M. (1998). Pediatric HIV/AIDS: Knowledge, attitudes, and perceptions of early childhood professionals. Doctoral Dissertation. Greeley, CO: University of Northern Colorado.
Sridhar, D., & Vaughn, S. (2000). Bibliotherapy for all: Enhancing reading comprehension, self-concept, and behavior. TEACHING Exceptional Children, 33(2), 74-82.
Verniero, J. C. (1995). You can call me Willy. Washington, DC: Magination.
White, R., & Cunningham, A. M. (1992). Ryan White: My own story. New York: Dial.
Wiener, L. S., Best, A., & Pizzo, P. A. (1994). Be a friend: Children who live with HIV speak. Morton Grove, IL: Whitman.
Wolf, B. (1997). HIV positive. New York: Dutton.
Mary Anne Prater (CEC Chapter #412), Professor and Chair, Department of Special Education, University of Hawaii at Manoa.
Nancy M. Sileo, Assistant Professor, Department of Special Education, University of Nevada at Las Vegas.
Address correspondence to Mary Anne Prater, University of Hawaii, 1776 University Avenue, Honolulu, HI 96822 (e-mail: email@example.com).…