American Red Cross | Greater Carolinas Chapter

AIDS Education

Unless otherwise noted, the following data are from the CDC HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States and Dependent Areas, 2005.

Why is AIDS Education Important for Young People?
Why is AIDS education for young people an issue?
Different approaches to AIDS education for young people
What types of AIDS education can be offered outside schools?
AIDS education for the future
Who needs to be educated?
What form should AIDS education take?
Different people, different messages
How should AIDS education be carried out?

Why is AIDS Education Important for Young People?
The HIV epidemic has been spreading steadily for the past two decades, and now affects every country in the world. Each year, more people die and the number of people living with HIV continues to rise – in spite of the fact that we have developed many proven HIV prevention methods. We now know much more about how HIV is transmitted than we did in the early days of the epidemic, and we know much more about how we can prevent it being transmitted. One of the key means of HIV prevention is education – teaching people about HIV: what it is, what it does, and how people can protect themselves. Over half of the world’s population is now under 25 years old. This age group is more threatened by AIDS than any other; equally it is the group that has more power to fight the epidemic than any other. Education can help to fight HIV, and it must focus on young people.

There are two main reasons that AIDS education for young people is important:

To prevent them from becoming infected.
Young people are often particularly vulnerable to sexually-transmitted HIV, and to HIV infection as a result of drug-use. Young people (15-24 years old) account for half of all new HIV infections worldwide - more than 6,000 become infected with HIV every day 1. More than a third of all people living with HIV or AIDS are under the age of 25, and almost two-thirds of them are women. In many parts of the world, young people in this age-group are at particularly high risk of HIV infection from unprotected sex, sex between men and IV drug-use because of the very high prevalence rates often found amongst people who engage in these behaviors. Young people are also often especially vulnerable to exploitation that may increase their susceptibility to infection. Even if they are not currently engaging in risk behaviors, as they become older, young people may soon be exposed to situations that put them at risk. Indeed, globally, most young people become sexually active in their teens. The fact that they are – or soon will be – at risk of HIV infection makes young people a crucial target for AIDS education.
To reduce stigma and discrimination.
People who are infected with HIV around the world often suffer terribly from stigma, in that people who are HIV+ are somehow thought to be ‘dirty’, or to have ‘brought it on themselves’ by ‘immoral practices’. They often experience discrimination in terms of housing, medical care, and employment. These experiences, aside from being extremely distressing for HIV+ people, can also have the effect of making people reluctant to be tested for HIV, in case they are found to be HIV+. Stigma and discrimination often starts early – as name-calling amongst children. AIDS education can help to prevent this, halting stigma and discrimination before they have an opportunity to grow.

Why is AIDS education for young people an issue?
The problem seems to stem from the fact that HIV is often sexually transmitted, or is transmitted via drug use. Any subject that concerns sex between young people or drug use tends to be seen from a moralistic perspective. Many adults – particularly those of the religious right – believe that teens need to be prevented from indulging in these high-risk activities. They believe that young people shouldn’t – and don’t need to be – provided with any education about these subjects, other than to be told that they are ‘wrong’, and not to do such things. Unfortunately, however, adults have been trying to stop young people from having sex and taking drugs for many, many years with little success, so this method alone seems unlikely to offer any real relief in terms of the global AIDS epidemic.

There are other difficulties in taking an exclusively moral approach to HIV education. Firstly, this is what tends to perpetuate stigmatization of HIV+ people. By teaching young people that indulging in ‘immoral’ sex and drugs will lead to HIV infection, educators imply that anyone who is HIV+ is therefore involved in these ‘immoral’ activities. This stigmatization tends to make people reluctant to be tested for HIV, and therefore more inclined to remain ignorant of their status – and perhaps go on to infect others. AIDS education shouldn’t ever include a moral judgment – it is one thing to teach young people that promiscuous sex and intravenous drug use are unsafe, another thing to teach them that these things are morally wrong.

AIDS education shouldn’t ever include a moral judgment – it is one thing to teach young people that promiscuous sex and intravenous drug use are unsafe, another thing to teach them that these things are morally wrong.

Many AIDS educators around the world are disturbed at this growing trend of providing AIDS education from a moralistic perspective, and argue that AIDS education ought to be non-judgmental, making young people aware of how HIV can be transmitted and how they can avoid becoming infected - without passing moral judgment on those who engage in infection-related behaviors, whether they do so safely or not.
The opposing, more conservative viewpoint, however, argues that young people shouldn’t be taught about sexual health and drug-related dangers at all. They feel that teaching them about these things, even teaching about their dangers, may encourage young people to indulge in these risk behaviors. Research suggests that this is not the case at all, and certainly young people themselves tend to be very enthusiastic about the fact that they need sex and sexual health education. Unfortunately, curriculum planners tend not to listen to the young people who will be their students. This viewpoint can result in no AIDS education at all being offered.

“I did not go to school and learn about the civil war and decide to start a civil war, nor would I have had sex because of a class in school.”
- Mark -

However, many young people become sexually active long before adults would prefer them to do so, or expect them to do, and teens are not all ‘innocent ‘. Quite simply, if teens are having sex, they need sexual health information. Fortunately, many curriculum planners and legislators have recognized this, and provide young people in many countries with abstinence-plus or comprehensive sex & HIV education. A more detailed look at the results of such curriculum in the classroom can be found in our Teaching AIDS in schools page.

Different approaches to AIDS education for young people

Most countries in the world offer teens some sort of sexual health and HIV education in their schools at some stage. AIDS education can also be targeted at young people in non-school environments – through their peers, through the media, and through doctors or their parents. In some countries, individual schools are allowed to determine what AIDS education they will offer. In other countries, this is determined by legislation passed by central government. And in other countries – especially poor ones that are severely affected by HIV – AIDS education is imported by foreign governments, charities and NGOs, that come in to the country and deliver AIDS education as part of a larger package of HIV prevention work.

AIDS education for young people today falls generally into one of two categories: either ‘abstinence-only’, or ‘comprehensive’. These are actually types of sex education, rather than AIDS education specifically - AIDS education in many schools comes as a part of a sex education program, if it occurs at all. The type of AIDS education program that is offered usually depends on the attitudes of those who determine the syllabus content. Right-wing organizations, some religious organizations, and the family-values lobby tend to prefer abstinence-only education, while those who feel that preventing young people from becoming infected with HIV is more important than keeping them ignorant about sexual behavior prefer comprehensive AIDS education.

A report found that over 80% of abstinence-only curricula contained false or misleading information
Abstinence-only education teaches students that they must say no to sexual activity until they are married. This approach does not teach students anything about how to protect themselves from STDs or HIV, how pregnancy occurs or how to prevent it, and teaches about homosexuality and masturbation only as far as to say that they are wrong. Those who favor this method of education claim that teaching young people about sex will make them want to try it, thus increasing their risk of contracting HIV, amongst other things.

Abstinence-only education is popular in America, especially so now that it has a Republican President. A House of Representatives report at the end of 2004 found that over 80% of abstinence-only curricula contained false or misleading information. 2 This is not only a concern for those living in America, but increasingly for the rest of the world, as America exports its HIV-prevention and education attitudes to countries with much higher levels of HIV infection. This is particularly worrying in that abstinence-only programmes have been shown not only to fail to reduce the numbers of sexually transmitted infections and unplanned pregnancies seen in pupils, but recent studies indicate that they might actually be related to an increase in these problems.

Comprehensive AIDS education teaches about sexual abstinence until marriage, and teaches that it is one way of protecting yourself from HIV transmission, STIs and unwanted pregnancy. It also teaches that there are other ways of preventing these things, such as condom use. People who favour this approach take the perspective that, while abstaining from sex until marriage is a good idea and should possibly be encouraged, there will always be some young people that do not choose to abstain – and these people must be provided with information that enables them to protect themselves. This type of education also teaches not only about the dangers of drug use, but also about methods of HIV-prevention that drug users can employ – the use of clean needles, for example.
Abstinence-only and comprehensive AIDS education have been combined to produce abstinence-plus education. This type of education focuses on sexual abstinence until marriage as the preferred method of protection, but also provides information about contraception, sexuality and disease prevention. Many abstinence-only campaigners complain that abstinence-plus and comprehensive education are the same thing, although abstinence-plus educators claim that this type of course contains more focus on sexual abstinence until marriage.

There has been debate for many years over which form of sex education is most effective in terms of preventing underage sex, unwanted pregnancy and STD and HIV transmission, although most studies seem to show that comprehensive sex and AIDS education is at least as effective as abstinence-only – and probably more so. However, currently the trend in America – and which is being exported to much of the developing world – is towards abstinence-only education. If it is as unsuccessful as studies indicate it to be, then we can expect this morality-induced type of education to become responsible for an increase in HIV figures amongst the young, especially in high-prevalence parts of the world to which America has taken its methods.
Fifteen percent of Americans believe that schools should teach only about abstinence from sexual intercourse and should not provide information on how to obtain and use condoms and other contraception. Forty-six percent believe that the most appropriate approach is abstinence-plus 3. Almost half of those surveyed felt that the word ‘abstinence’ included not only sexual intercourse, but ‘passionate kissing’ and ‘masturbation’, too.

What types of AIDS education can be offered outside schools?
Not all young people are fortunate enough to attend school. This might be for one of a variety of reasons. In some countries, it is necessary to pay for schooling, and poor families may be unable to afford to send a child to school, or may be unable to send all their children to school. Sometimes children will be required to work, making them unavailable for school. In other areas, young people may live in areas where a local school is not accessible. In some situations, young people may have been excluded from school for reasons that might be due to the young person’s behaviour, academic or intellectual abilities, or due to discrimination. Some young people play truant, and will have only very limited attendance. The proportion of young people who attend school differs markedly in various parts of the world.

Clearly, although AIDS education offered through the school might reach many young people, it will not reach all, and other forms of education are required.
One of these is the media. Most young people will, at some time, be exposed to the media. This can include newspapers, television, books, radio, and also traditional media such as street performances or murals. One advantage of media-based AIDS education is that it can target specific groups amongst the population. If the message is to be targeted at young people, then it will be placed in media that are favored by this audience.
Many countries have tried some form of AIDS education advertisements, films, or announcements. A good example of this is the LoveLife campaign in South Africa, an education program ‘by young people, for young people’. LoveLife used eye-catching posters and billboards to tell young people that sex was fun, but that it could be dangerous, too. The campaign also inserted its message into TV soaps that were popular with young people, and used rap and kwaito music to get its message across.

There are, however, problems with media-based campaigns. It is hard to know to what extent the AIDS information has reached young people, and it is difficult to gain continued funding for initiatives whose success is so hard to measure.
Another way in which young people receive information about sex and HIV is through their peers. This is something that happens anyway to a great extent – many young people receive their first information about sexuality from their friends, although this information is often distorted and inaccurate. This type of peer education can be harnessed, though, and used to convey accurate, targeted information. Peer education is, quite simply, the process by which a group is given information by one of their peers who has received training and accurate information. This is a method often used with groups which have been marginalized. Such groups might have cause to distrust information given to them by an authority figure; if the same information comes from a member of their own group, however, they may well listen. This method of information-provision is often used with such groups as sex workers, the homeless, or drug-users.
There is no reason that this method shouldn’t be used with young people, however, and in many parts of the world, it is used. Indeed, it is particularly appropriate for young people who do not attend schools and will not have an opportunity to benefit from an AIDS education curriculum.

AIDS education for the future
Although the debate continues about how much – if any – AIDS education young people should receive, studies continue to show that being informed about the facts and the dangers of HIV and AIDS enables young people to protect themselves and is a crucial tool in the battle against HIV. There is no cure or vaccine for HIV, so prevention is the only way in which we can place any limits on the epidemic. One of the most economical and effective means of HIV prevention is education – involving young people themselves in the HIV prevention effort.

On a global level, America’s disposition towards the promotion of abstinence-only education is cause for concern. America’s spending on HIV prevention around the world exceeds that of any other country, and is to be welcomed – as long as it doesn’t use this money to promote its pro-abstinence-only views of AIDS education. These views – which have been shown to be less successful than comprehensive AIDS education techniques which include an abstinence element – may prove to be damaging to America’s domestic AIDS prevention work 4. When exported to high-prevalence countries in Africa, they could prove disastrous.

Whenever educators and planners ask, and listen to young people, they are told time and time again that young people overwhelmingly ask for adequate AIDS education. In most parts of the world, this means more AIDS education than they are presently getting. Young people know that they have the right to the information that enables them to safeguard their lives and those of their sexual partners – they must be listened to, and provided with that information clearly, openly and honestly.

Who needs to be educated?

Anyone who is vulnerable to AIDS – and almost everyone is vulnerable, unless they know how to protect themselves. It’s not only young people, injecting drug users or gay men who become infected - the virus has affected a cross-section of society. This means that education ought to be aimed at all parts of society, not only those groups who are seen as being particularly high-risk. For instance, there may be a lot of AIDS education aimed at young people, but very little that targets adults, and this may lead to a rise in HIV infection rates amongst older age-groups. The people who are most urgently in need of HIV education are those who think they’re not at risk.

In 1987 in the UK, a leaflet about AIDS was delivered to every household, and the government also launched a major advertising campaign with the slogan “AIDS: Don’t Die of Ignorance” This is an example of non-targeted education, or rather, education with a very broad target, intended to blanket the whole population. To plan an effective AIDS education strategy with smaller sections of the population, it helps to know the characteristics of the group who are to be educated.

It is possible to identify three distinct groups of people who require targeted education:

People who have not yet been educated and may be at risk of becoming infected.
This usually means young people, who need to know the risks involved in unsafe sex and drug use before they are old enough to find out for themselves.
People who have already been educated for whom the education was not effective.
If AIDS education were completely effective, there wouldn’t be nearly so many new infections. These infections do not only occur amongst young people - many people who have already experienced AIDS education continue to become infected with HIV.
“ A few months after we started having unprotected sex, I fell gravely ill. . . I recovered slowly but . . . I guess the warning signs have been there since I fell sick earlier this year, I’m educated on HIV and some of my symptoms literally had the warning bells ringing inside my head. Still, the shock of discovering my status is something I will never wish on my worst enemy. “
- TK, a South African woman -
People who are already infected.

On top of this, everyone needs to learn how and why not to discriminate against positive people. People who are not HIV positive must learn about how the virus is transmitted in order that they are able to protect themselves from infection. At the same time, they must also learn how the virus is not transmitted. People need to know that they cannot become infected from things such as sharing food, towels or toilets. This will help to reduce discrimination against positive people by reducing ignorance and fear.

The only people who do not fall into one of these groups are those who have received AIDS education, have taken it in, and have the resources to turn knowledge into action. One group who should hopefully fall into this category are AIDS educators. This may seem obvious, but in many cases, teachers may require teaching themselves. They may be called upon to act as AIDS educators when they themselves have little experience or knowledge of the subject. Peer educators must also receive training, even if they themselves are HIV-positive. Information for teachers and HIV educators can be found on our lessons and activity plans page.

If AIDS education that had been done up until now had been fully effective, then there wouldn’t have been 4.3 million new infections in 2006.1 It is clear that the campaigns carried out so far have failed to prevent the spread of HIV, so the message needs to be repeated, in different forms, until people appreciate it, or until, hopefully, education is no longer needed.

What form should AIDS education take?

AIDS education doesn’t always take place in a classroom. It can be presented in many ways and put across by many forms of media, which should be selected with the target group in mind. Some people can be best reached via newspapers and magazines, whilst other people might be more used to street theatre as a form of media. AIDS education needs to embrace culturally appropriate and relevant media.
These might include radio, television, billboard advertising, street theatre, comic strips, etc. Sometimes AIDS education is about giving people information which they will remember on a long term basis, about how to protect themselves, the difference between HIV and AIDS, and helping to reduce discrimination. On other occasions, an education strategy might intend to have a more immediate effect and target people when they are most likely to take part in risky behaviour - in nightclubs or holiday resorts, for example.

There is no set or prescribed form that AIDS education should take, but when considering an education campaign, the following points are relevant:

What age are the people to be educated?
Where and when will the target group be most receptive?
Are there cultural issues to be considered? For example, attitudes to sexuality, or laws against portrayal of explicit images or language.
Are the people to be educated already sexually aware?
Have the people been exposed to AIDS education before?
Are the people literate?
What language do they speak?
Is the education program targeted at a specific risk-group - e.g. injecting drug users? What is the best way to reach the group being targeted?
Is it better to tell people how they should behave or inform them of the dangers and let them decide?
Are people able to do what you’re suggesting they do? There’s no point in advising people to use condoms if none are available to them, or to use clean needles if needle exchanges are illegal.

Different people, different messages

If AIDS education had completely succeeded, there wouldn’t be many new infections and you probably wouldn’t be reading this. It is very difficult to say for sure whether there would have been many more infections were it not for the campaigns to date, but what is certain is that there has been a huge number of new infections in spite of them. In many countries, AIDS education began shortly after the epidemic began to take hold. Governments tend to react in response to public health problems, rather than to avert them before they occur.

Messages warning about sexual matters and HIV come to us from a number of different sources, amongst them schools, our peers, religion, the legal system, and the government. Those messages are not always accurate, and they don’t always agree.

Mixed messages
‘The media’ is a term which covers a number of different organisations. Both broadsheet and tabloid newspapers, magazines, the internet, television, billboard advertising, leaflets - all come under the umbrella of ‘media’. It’s hardly surprising that they communicate in different ways, but it’s alarming that they sometimes communicate different messages.
The messages from the media and those from the government are not always the same. The government should be driven by a desire to inform the public to the best of it’s ability, whilst the media usually wants to make a profit and keep people interested. Sometimes the media may focus on a particular, often controversial aspect of the HIV epidemic in order to capture people’s interest, which can ultimately be damaging.

How should AIDS education be carried out?

Peer education

Peer education is, quite simply, a social form of education without classrooms or notebooks, where people are educated outside a ‘school’ environment but still have the opportunity to ask questions. Sometimes the ‘peer educators’ will be from the group that is to be educated - a group of workmates might pick someone from amongst them to become the educator. On other occasions the educator may be someone who has a similar social background, age and gender to the target audience, sometimes a person who is HIV+. Most peer education focuses on providing information about HIV transmission, answering questions and handing out condoms to people. The sessions take place wherever is convenient - sometimes in the workplace, or perhaps in a bar, or where a group of women gather to wash clothes.
Peer education gives people the opportunity to ask questions outside an academic environment, and with someone who isn’t an authority figure.
Peer education should be an ongoing thing, and most peer educators make contact with their target audience at least weekly and their sessions will usually be in the context of informal discussions with individual people or groups. This gives people the opportunity to ask questions outside an academic environment, and with someone who isn’t an authority figure, and isn’t going to test them or expect them to perform activities such as might be expected in the context of a classroom-based lesson. This form of education also has the advantage of avoiding the possibility of embarrassment, which might make people feel unable to ask questions of a teacher of person they find more difficult to relate to.
Peer education tends to be used mostly with adults, who can not be reached through the school system, although it has also been found to be effective with young people. It has been found to be an effective method of reaching groups who might not listen to a teacher or someone from a different background to themselves - it has been found to work well in prisons, for example, and with risk groups such as prostitutes. The peer educators provide a credible link between the target audience and the education project, by whom the educator is trained.
Peer education is often effective when targeted specifically at a particular group, as people seem more willing to listen to someone who understands their social background. It also does not have the effect, as is risked by a media-based campaign, of making the target audience appear to the public as a whole to be a danger.

Active learning

In order to understand ‘active’ learning, it is first necessary to understand ‘passive’ learning. Passive learning occurs when a learner is given a set of facts, often in a classroom environment, and is the type of learning that has been traditionally favoured by academic institutions.

AIDS education in Congo, where there is a shortage medical personnel and AIDS educators.
More recently, however, educators have realised that people are more likely to both remember information and to relate it to themselves if they are given an opportunity to put it to use as they learn.
An example might be a chemistry lesson in school - who is more likely to remember the information - the child who sits in silence and records the nature of the chemicals in a textbook? Or the child who performs an experiment to discover the information for themselves.
Active learning can sometimes link into peer education, especially when AIDS education is aimed at young people, as one of the best methods of learning something oneself is to teach it to others.

Blanket education

This is a general message aimed at the population as a whole. In many countries, the general population is seen as being at a fairly low risk of HIV infection, and blanket education usually aims to inform the population about which behaviours are risky and to give them support in changing these behaviours. This gives the opportunity for people who are already infected with the virus to avoid transmitting it to others, and for people who have not been infected to protect themselves.

Targeted education

This type of strategy is usually used to speak to social groups who are perceived as being at a high risk of HIV infection - injecting drug users, for example. This type of education usually tends to focus on risky activities particular to the specific target group - in this case, the risky behaviour is injecting drugs. Blanket education is inappropriate when wishing to communicate with specific risk groups, as it can incite discrimination in the general population towards the group, and can tend to promote ‘somebody else’s problem’ thinking.
The difference between AIDS education and AIDS prevention
Education is an important part of AIDS prevention, but it is only one part. AIDS prevention work being done around the world covers such diverse topics as the search for a vaccine, distribution of condoms, research into microbicides, lobbying governmental organisations, and testing people to monitor the trends of the epidemic. Education, however, is a crucial factor in preventing the spread of HIV, and, given the huge numbers of deaths that might still be prevented, the importance of effective education cannot be overestimated.