The Impact of Training on School Professionals' Knowledge, Beliefs, and Behaviors regarding HIV/AIDS and Adolescent Homosexuality
Remafedi, Gary, Journal of School Health
Since release of the Surgeon General's Report on AIDS in 1986, mass education has been a cornerstone in the fight against HIV/AIDS. The report urged that education begin "at the lowest grade possible as part of any health and hygiene program" and that it "include information on heterosexual and homosexual relationships."|1~ Likewise, the Centers for Disease Control encouraged schools to include HIV/STD prevention in comprehensive health education programs.|2~ According to the U.S. Congress Office of Technology Assessment, the goals of school-based AIDS education are to promote HIV prevention and to foster social cohesion in the interest of public health.|3~
By 1990, 50 states required or recommended AIDS education in schools.|4~ However, 65% of youth in the National Adolescent Student Health Survey reported they were unaware of classroom instruction on AIDS.|5~ A review of sexuality and AIDS curricula in 34 states found most focused on marriage and parenthood, rather than human sexuality, and that information about AIDS often was outdated. More than one-third of curricula referred to homosexuality as a "cause" or risk for AIDS; another one-third did not mention homosexuality at all.|4~
In a survey of U.S. secondary school teachers, homosexuality and "safer sex" were the topics most frequently omitted from human sexuality education. Real or perceived pressure from parents, administrators, and communities were the main barriers to inclusion in curricula.|6~ Similarly, a national survey of HIV educators found high levels of discomfort with the subjects of homosexuality, safer sex, and death and dying. Among various topics, inadequate knowledge of homosexuality and bisexuality was the most common deficiency, reported by 62% of the professionals.|7~
School-based surveys attribute students' persistent biases against persons with AIDS to negative attitudes toward homosexual people.|8,9~ Price et al|10~ speculated that instructors avoid talking about AIDS because they do not want to be involved in discussion of attitudes and beliefs toward homosexuality. HIV curricula often overlook concerns of homosexual students, who are among those most likely to benefit from preventive efforts.|11~
To improve school-based HIV education, an on going statewide demonstration program began in 1989 to teach secondary school professionals about adolescent homosexuality in the context of HIV prevention. Specific program objectives were to: 1) improve professionals' knowledge about adolescent homosexuality and HIV prevention, 2) encourage professionals to address the needs of homosexual youth in HIV prevention curricula, 3) support development of a school milieu that welcomes students to consult school professionals about sexual orientation issues and HIV prevention, and 4) promote referrals of students to community services for gay, lesbian, and bisexual youth. This retrospective study was undertaken in 1991 to examine program impact on professionals' knowledge, attitudes, and behaviors.
Contact persons in school districts and/or individual schools were identified through state and local departments of education and health and other professional networks. An invitation to participate in the program was extended to schools through these key individuals. The program expanded geographically, from major cities (|is greater than~ 500,000 persons) in 1989 and 1990, to their corresponding suburbs in 1990, and to smaller cities and rural areas in 1991.
Invited schools were offered professional training for teachers, administrators, and human service professionals in three phases, with one academic year devoted to each phase. Attendance was voluntary, and graduate school or continuing education credits were offered as incentives for participation. The frequency, format, and content of instruction were adapted to the specific needs of the participants. When possible, instructors honored special requests for meeting times, topic emphasis, and use of audiovisual and written materials, guest speakers, group discussion, lectures, and skill-building exercises. …