Health Topics
Sexual Behaviors
School Health Guidelines
Guidelines for Effective School Health Education to Prevent the Spread
of AIDS
Introduction
Since the first cases of acquired immunodeficiency syndrome (AIDS) were
reported in the United States in 1981, the human immunodeficiency virus (HIV)
that causes AIDS and other HIV-related diseases has precipitated an epidemic
unprecedented in modern history. Because the virus is transmitted almost
exclusively by behavior that individuals can modify, educational programs to
influence relevant behavior can be effective in preventing the spread of HIV.1–5
The guidelines below have been developed to help school personnel and others
plan, implement, and evaluate educational efforts to prevent unnecessary
morbidity and mortality associated with AIDS and other HIV-related illnesses.
The guidelines incorporate principles for AIDS education that were developed by
the President's Domestic Policy Council and approved by the President in 1987
(see Appendix).
The guidelines provide information that should be considered by persons who
are responsible for planning and implementing appropriate and effective
strategies to teach young people about how to avoid HIV infection. These
guidelines should not be construed as rules, but rather as a source of guidance.
Although they specifically were developed to help school personnel, personnel
from other organizations should consider these guidelines in planning and
carrying out effective education about AIDS for youth who do not attend school
and who may be at high risk of becoming infected. As they deliberate about the
need for and content of AIDS education, educators, parents, and other concerned
members of the community should consider the prevalence of behavior that
increases the risk of HIV infection among young people in their communities.
Information contained in this document was developed by CDC in consultation
with individuals appointed to represent the following organizations:
- American Academy of Pediatrics
- American Association of School Administrators
- American Public Health Association
- American School Health Association
- Association for the Advancement of Health Education
- Association of State and Territorial Health Officers
- Council of Chief State School Officers
- National Congress of Parents and Teachers
- National Council of Churches
- National Education Association
- National School Boards Association
- Society of State Directors of Health, Physical Education, Recreation
and Dance
- U.S. Department of Education
- U.S. Food and Drug Administration
- U.S. Office of Disease Prevention and Health Promotion
Consultants included a director of health education for a state
department of education, a director of curriculum and instruction for a
local education department, a health education teacher, a director of
school health programs for a local school district, a director of a state
health department, a deputy director of a local health department, and an
expert in child and adolescent development.
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Planning and Implementing Effective
School Health Education about AIDS
The Nation's public and private schools have the capacity and
responsibility to help assure that young people understand the nature of
the AIDS epidemic and the specific actions they can take to prevent HIV
infection, especially during their adolescence and young adulthood. The
specific scope and content of AIDS education in schools should be locally
determined and should be consistent with parental and community values.
Because AIDS is a fatal disease and because educating young people
about becoming infected through sexual contact can be controversial,
school systems should obtain broad community participation to ensure that
school health education policies and programs to prevent the spread of
AIDS are locally determined and are consistent with community values.
The development of school district policies on AIDS education can be an
important first step in developing an AIDS education program. In each
community, representatives of the school board, parents, school
administrators and faculty, school health services, local medical
societies, the local health department, students, minority groups,
religious organizations, and other relevant organizations can be involved
in developing policies for school health education to prevent the spread
of AIDS. The process of policy development can enable these
representatives to resolve various perspectives and opinions, to establish
a commitment for implementing and maintaining AIDS education programs, and
to establish standards for AIDS education program activities and
materials. Many communities already have school health councils that
include representatives from the aforementioned groups. Such councils
facilitate the development of a broad base of community expertise and
input, and they enhance the coordination of various activities within the
comprehensive school health program.6
AIDS education programs should be developed to address the needs and
the developmental levels of students and of school-age youth who do not
attend school, and to address specific needs of minorities, persons for
whom English is not the primary language, and persons with visual or
hearing impairments or other learning disabilities. Plans for addressing
students' questions or concerns about AIDS at the early elementary grades,
as well as for providing effective school health education about AIDS at
each grade from late elementary/middle school through junior high/senior
high school, including educational materials to be used, should be
reviewed by representatives of the school board, appropriate school
administrators, teachers, and parents before being implemented.
Education about AIDS may be most appropriate and effective when carried
out within a more comprehensive school health education program that
establishes a foundation for understanding the relationships between
personal behavior and health.7–9 For example, education about AIDS may be
more effective when students at appropriate ages are more knowledgeable
about sexually transmitted diseases, drug abuse, and community health. It
may also have greater impact when they have opportunities to develop such
qualities as decision making and communication skills, resistance to
persuasion, and a sense of self-efficacy and self-esteem. However,
education about AIDS should be provided as rapidly as possible, even if it
is taught initially as a separate subject.
State departments of education and health should work together to help
local departments of education and health throughout the state
collaboratively accomplish effective school health education about AIDS.
Although all schools in a state should provide effective education about
AIDS, priority should be given to areas with the highest reported
incidence of AIDS cases.
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Preparing Educators
A team of representatives including the local school board,
parent-teachers associations, school administrators, school physicians,
school nurses, teachers, educational support personnel, school counselors,
and other relevant school personnel should receive general training about
(a) the nature of the AIDS epidemic and means of controlling its spread,
(b) the role of the school in providing education to prevent transmission
of HIV, (c) methods and materials to accomplish effective programs of
school health education about AIDS, and (d) school policies for students
and staff who may be infected. In addition, a team of school personnel
responsible for teaching about AIDS should receive more specific training
about AIDS education. All school personnel, especially those who teach
about AIDS, periodically should receive continuing education about AIDS to
assure that they have the most current information about means of
controlling the epidemic, including up-to-date information about the most
effective health education interventions available. State and local
departments of education and health, as well as colleges of education,
should assure that such in-service training is made available to all
schools in the state as soon as possible and that continuing in-service
and pre-service training is subsequently provided. The local school board
should assure that release time is provided to enable school personnel to
receive such in-service training. Back to top
Programs Taught by
Qualified Teachers
In the elementary grades, students generally have one regular classroom
teacher. In these grades, education about AIDS should be provided by the
regular classroom teacher because that person ideally should be trained
and experienced in child development, age-appropriate teaching methods,
child health, and elementary health education methods and materials. In
addition, the elementary teacher usually is sensitive to normal variations
in child development and aptitudes within a class. In the secondary
grades, students generally have a different teacher for each subject. In
these grades, the secondary school health education teacher preferably
should provide education about AIDS, because a qualified health education
teacher will have training and experience in adolescent development,
age-appropriate teaching methods, adolescent health, and secondary school
health education methods and materials (including methods and materials
for teaching about such topics as human sexuality, communicable diseases,
and drug abuse). In secondary schools that do not have a qualified health
education teacher, faculty with similar training and good rapport with
students should be trained specifically to provide effective AIDS
education. The principal purpose of education about AIDS is to prevent
HIV infection. The content of AIDS education should be developed with the
active involvement of parents and should address the broad range of
behavior exhibited by young people. Educational programs should assure
that young people acquire the knowledge and skills they will need to adopt
and maintain types of behavior that virtually eliminate their risk of
becoming infected. School systems should make programs available that
will enable and encourage young people who have not engaged in sexual
intercourse and who have not used illicit drugs to continue to
- Abstain from sexual intercourse until they are ready to establish a
mutually monogamous relationship within the context of marriage.
- Refrain from using or injecting illicit drugs.
For young people who have engaged in sexual intercourse or who have
injected illicit drugs, school programs should enable and encourage them
to
- Stop engaging in sexual intercourse until they are ready to
establish a mutually monogamous relationship within the context of
marriage.
- To stop using or injecting illicit drugs.
Despite all efforts, some young people may remain unwilling to adopt
behavior that would virtually eliminate their risk of becoming infected.
Therefore, school systems, in consultation with parents and health
officials, should provide AIDS education programs that address preventive
types of behavior that should be practiced by persons with an increased
risk of acquiring HIV infection. These include the following:
- Avoiding sexual intercourse with anyone who is known to be
infected, who is at risk of being infected, or whose HIV infection
status is not known;
- Using a latex condom if they engage in sexual intercourse;
- Seeking treatment if addicted to illicit drugs;
- Not sharing needles or other injection equipment;
- Seeking HIV counseling and testing if HIV infection is
suspected.
State and local education and health agencies should work together to
assess the prevalence of these types of risk behavior, and their
determinants, over time. Back to top
Content
Although information about the biology of the AIDS virus, the signs and
symptoms of AIDS, and the social and economic costs of the epidemic might
be of interest, such information is not the essential knowledge that
students must acquire in order to prevent becoming infected with HIV.
Similarly, a single film, lecture, or school assembly about AIDS will not
be sufficient to assure that students develop the complex understanding
and skills they will need to avoid becoming infected. Schools should
assure that students receive at least the essential information
about AIDS, as summarized in sequence in the following pages, for
each of three grade-level ranges. The exact grades at which students
receive this essential information should be determined locally, in
accord with community and parental values, and thus may vary from
community to community. Because essential information for students
at higher grades requires an understanding of information essential
for students at lower grades, secondary school personnel will need
to assure that students understand basic concepts before teaching
more advanced information. Schools simultaneously should assure that
students have opportunities to learn about emotional and social
factors that influence types of behavior associated with HIV
transmission. Back to top
Early Elementary School
Education about AIDS for students in early elementary grades
principally should be designed to allay excessive fears of the epidemic
and of becoming infected. AIDS is a disease that is causing some adults
to get very sick, but it does not commonly affect children. AIDS
is very hard to get. You cannot get it just by being near or
touching someone who has it. Scientists all over the world are
working hard to find a way to stop people from getting AIDS and to
cure those who have it. Back to top
Late Elementary/Middle
School
Education about AIDS for students in late elementary/middle school
grades should be designed with consideration for the following
information. Viruses are living organisms too small to be seen by the
unaided eye. Viruses can be transmitted from an infected person to
an uninfected person through various means. Some viruses cause
disease among people. Persons who are infected with some viruses
that cause disease may not have any signs or symptoms of disease.
AIDS (an abbreviation for acquired immunodeficiency syndrome) is
caused by a virus that weakens the ability of infected individuals
to fight off disease. People who have AIDS often develop a rare
type of severe pneumonia, a cancer called Kaposi's sarcoma, and
certain other diseases that healthy people normally do not get.
About 1 to 1.5 million of the total population of approximately 240
million Americans currently are infected with the AIDS virus and
consequently are capable of infecting others. People who are
infected with the AIDS virus live in every state in the United
States and in most other countries of the world. Infected people
live in cities as well as in suburbs, small towns, and rural areas.
Although most infected people are adults, teenagers can also become
infected. Females as well as males are infected. People of every
race are infected, including whites, blacks, Hispanics, Native
Americans, and Asian/Pacific Islanders. The AIDS virus can be
transmitted by sexual contact with an infected person; by using
needles and other injection equipment that an infected person has
used; and from an infected mother to her infant before or during
birth. A small number of doctors, nurses, and other medical
personnel have been infected when they were directly exposed to
infected blood. It sometimes takes several years after becoming
infected with the AIDS virus before symptoms of the disease appear.
Thus, people who are infected with the virus can infect other
people–even though the people who transmit the infection do not feel
or look sick. Scientists have developed drugs that can help people
infected with HIV live longer and healthier lives. In the United
States and other countries where new treatments are available,
people who know they are HIV positive can take medicines that keep
them healthy for a long time. It is important for people at risk for
HIV to be tested and seek treatment if they are infected. The AIDS
virus cannot be caught by touching someone who is infected, by being
in the same room with an infected person, or by donating blood. Back to top
Junior High/Senior High
School
Education about AIDS for students in junior high/senior high school
grades should be developed and presented taking into consideration the
following information. The virus that causes AIDS, and other health
problems, is called human immunodeficiency virus, or HIV. The risk
of becoming infected with HIV can be virtually eliminated by not
engaging in sexual activities and by not using illegal intravenous
drugs. Sexual transmission of HIV is not a threat to those
uninfected individuals who engage in mutually monogamous sexual
relations.
HIV may be transmitted in any of the following ways: (a) by sexual
contact with an infected person (penis/vagina, penis/rectum,
mouth/vagina, mouth/penis, mouth/rectum); (b) by using needles or
other injection equipment that an infected person has used; (c) from
an infected mother to her infant before or during birth. A small
number of doctors, nurses, and other medical personnel have been
infected when they were directly exposed to infected blood. The
following are at increased risk of having the virus that causes AIDS
and consequently of being infectious: a) persons with clinical or
laboratory evidence of infection; b) males who have had sexual
intercourse with other males; c) persons who have injected illegal
drugs; d) persons who have had numerous sexual partners, including
male or female prostitutes; e) persons who received blood clotting
products before 1985; f) sex partners of infected persons or persons
at increased risk; and g) infants born to infected mothers. The
risk of becoming infected is increased by having a sexual partner
who is at increased risk of having contracted the AIDS virus (as
identified previously), practicing sexual behavior that results in
the exchange of body fluids (i.e., semen, vaginal secretions,
blood), and using unsterile needles or paraphernalia to inject
drugs. Although no transmission from deep, open-mouth (i.e.,
"French") kissing has been documented, such kissing theoretically
could transmit HIV from an infected to an uninfected person through
direct exposure of mucous membranes to infected blood or saliva.
In the past, medical use of blood, such as transfusing blood and
treating hemophiliacs with blood clotting products, has caused some
people to become infected with HIV. However, since 1985 all donated
blood has been tested to determine whether it is infected with HIV;
moreover, all blood clotting products have been made from screened
plasma and have been heated to destroy any HIV that might remain in
the concentrate. Thus, the risk of becoming infected with HIV from
blood transfusions and from blood clotting products is virtually
eliminated. Cases of HIV infection caused by these medical uses of
blood will continue to be diagnosed, however, among people who were
infected by these means before 1985. Persons who continue to
engage in sexual intercourse with persons who are at increased risk
or whose infection status is unknown should use a latex condom (not
natural membrane) to reduce the likelihood of becoming infected. The
latex condom must be applied properly and used from start to finish
for every sexual act. Although a latex condom does not provide 100%
protection–because it is possible for the condom to leak, break, or
slip off–it provides the best protection for people who do not
maintain a mutually monogamous relationship with an uninfected
partner. Behavior that prevents exposure to HIV also may prevent
unintended pregnancies and exposure to the organisms that cause
Chlamydia infection, gonorrhea, herpes, human papillomavirus, and
syphilis. Persons who believe they may be infected with the AIDS
virus should take precautions not to infect others and to seek
counseling and antibody testing to determine whether they are
infected. If persons are not infected, counseling and testing can
relieve unnecessary anxiety and reinforce the need to adopt or
continue practices that reduce the risk of infection. If persons are
infected, they should: a) take precautions to protect sexual
partners from becoming infected; b) advise previous and current
sexual or drug-use partners to receive counseling and testing; c)
take precautions against becoming pregnant; and d) seek medical care
and counseling about other medical problems that may result from a
weakened immunologic system. More detailed information about AIDS,
including information about how to obtain counseling and testing for
HIV, can be obtained by telephoning the AIDS National Hotline (toll
free) at 800-342-2437; the Sexually Transmitted Diseases National
Hotline (toll free) at 800-227-8922; or the appropriate state or
local health department (the telephone number of which can be
obtained by calling the local information operator). Back to top
Curriculum Time and
Resources
Schools should allocate sufficient personnel time and resources
to assure that policies and programs are developed and implemented
with appropriate community involvement, curricula are well-planned
and sequential, teachers are well-trained, and up-to-date teaching
methods and materials about AIDS are available. In addition, it is
crucial that sufficient classroom time be provided at each grade
level to assure that students acquire essential knowledge
appropriate for that grade level, and have time to ask questions and
discuss issues raised by the information presented.
The criteria recommended in the foregoing "Guidelines for
Effective School Health Education To Prevent the Spread of AIDS" are
summarized in the following nine assessment criteria. Local school
boards and administrators can assess the extent to which their
programs are consistent with these guidelines by determining the
extent to which their programs meet each point shown below.
Personnel in state departments of education and health also can use
these criteria to monitor the extent to which schools in the state
are providing effective health education about AIDS.
- To what extent are parents, teachers, students, and
appropriate community representatives involved in developing,
implementing, and assessing AIDS education policies and programs?
- To what extent is the program included as an important part of
a more comprehensive school health education program?
- To what extent is the program taught by regular classroom
teachers in elementary grades and by qualified health education
teachers or other similarly trained personnel in secondary grades?
- To what extent is the program designed to help students
acquire essential knowledge to prevent HIV infection at each
appropriate grade?
- To what extent does the program describe the benefits of
abstinence for young people and mutually monogamous relationships
within the context of marriage for adults?
- To what extent is the program designed to help teenage
students avoid specific types of behavior that increase the risk
of becoming infected with HIV?
- To what extent is adequate training about AIDS provided for
school administrators, teachers, nurses, and counselors–especially
those who teach about AIDS?
- To what extent are sufficient program development time,
classroom time, and educational materials provided for education
about AIDS?
- To what extent are the processes and outcomes of AIDS
education being monitored and periodically assessed?
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References
- US Public Health Service. Coolfont report: a PHS plan for
prevention and control of AIDS and the AIDS virus. Public Health Rep
1986;101:341.
- Institute of Medicine. National Academy of Sciences.
Confronting AIDS: directions for public health, health care, and
research. Washington, DC: National Academy Press, 1986.
- US Department of Health and Human Services, Public Health Service.
Surgeon General's report on acquired immune deficiency syndrome.
Washington, DC: US Department of Health and Human Services, 1986.
- US Public Health Service. AIDS: information/education plan to
prevent and control AIDS in the United States, March 1987.
Washington, DC: US Department of Health and Human Services, 1987.
- US Department of Education. AIDS and the education of our
children, a guide for parents and teachers. Washington, DC: US
Department of Education, 1987.
- Kolbe LJ, Iverson DC.
Integrating school and community efforts to promote health:
strategies, policies, and methods. Int J Health Educ
1983;2:40–47.
- Noak M. Recommendations for school health
education. Denver: Education Commission of the States, 1982.
- Comprehensive school health education as defined by the national
professional school health education organizations. J Sch Health
1984;54:312–315.
- Allensworth D, Kolbe L (eds). The
comprehensive school health program: exploring an expanded concept.
J Sch Health 1987;57:402–76.
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Appendix: The President's Domestic Policy
Council's
Principles for AIDS Education
The following principles were proposed by the Domestic Policy
Council and approved by the President in 1987:
Despite intensive research efforts, prevention is the only
effective AIDS control strategy at present. Thus, there should be an
aggressive Federal effort in AIDS education.
The scope and content of the school portion of this AIDS
education effort should be locally determined and should be
consistent with parental values.
The Federal role should focus on developing and conveying
accurate health information on AIDS to the educators and others, not
mandating a specific school curriculum on this subject, and trusting
the American people to use this information in a manner appropriate
to their community's needs.
Any health information developed by the Federal Government that
will be used for education should encourage responsible sexual
behavior–based on fidelity, commitment, and maturity, placing
sexuality within the context of marriage.
Any health information provided by the Federal Government that
might be used in schools should teach that children should not
engage in sex and should be used with the consent and involvement of
parents.
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Epidemiological Data
Current epidemiological information may be obtained from the
following sources:
HIV/AIDS
Among America's Youth
Adolescent Sexual Risk Behavior
Trends in Sexual Risk Behaviors Among High School Students—United
States, 1991–200
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