AIDS Education Programs Research Articles

Parental knowledge and attitudes toward children with AIDS: influences on educational policies and children's attitudes.

Surveyed AIDS-related knowledge and attitudes of parents and their children to provide descriptive information on views about school policies concerning HIV-infected children and to test hypotheses regarding links between parents' and children's AIDS-related knowledge and attitudes. Results indicate that parents desire more information about presence of persons with AIDS (PWA) in the schools than is permissible by law and that a significant minority of parents objected to allowing HIV-infected students in schools. As predicted, more accurate parental knowledge of AIDS and knowing a PWA were associated with greater willingness to allow their children to interact with PWA and with greater acceptance of allowing HIV-infected children to attend regular classes. Support was also found for links between parents' and children's attitudes toward PWA. Implications for educating parents about AIDS transmission and inclusion of parents in the implementation of AIDS educational programs are discussed.

HIV-1 antibody testing among drug users participating in AIDS education

This study aimed to identify factors which predict participation of drug users in HIV-1 antibody testing. The study was part of a randomized controlled trial of three small group AIDS educational programs, in a 21-day in-patient drug detoxification and rehabilitation program. Subjects ( n = 497) were clients admitted to the program who consented to participate in the evaluation and who completed baseline data collection. All subjects received pre-test counseling. Testing was offered after 1 week in treatment; 52% decided to be tested. Factors which predicted participation in testing included: no previously reported positive result, a longer stay in treatment, a greater frequency of injection, a greater perceived probability of being infected, and the type of AIDS education. Both actual and perceived level of risk, and the type of AIDS education provided can affect participation in testing programs.

Outcomes of intensive AIDS education for male adolescent drug users in jail

Objectives: The purpose of the study was to conduct and evaluate an intensive AIDS education program for incarcerated male adolescent drug users. Methods: The study was conducted in New York City's main jail facility for detained and sentenced male youths aged 16–19 years. A four-session, group-oriented AIDS education program based on Problem-Solving Therapy was conducted. The program was voluntary and all youths on designated dormitories were invited to participate. The evaluation compared youths participating in the AIDS education with waiting list controls who were discharged or transferred before they could be offered the education. Behavioral outcomes for AIDS education participants and controls were determined at a five month follow-up after release from jail. Behaviors were measured through personal interviews at baseline and follow-up. Results: High rates of HIV risk behaviors were documented, including alcohol, marijuana and cocaine/crack use that may predispose youths to sexual risk-taking: practice of heterosexual anal sex; multiple and high-risk sexual partnerships; and no, or inconsistent, use of condoms. Education participants as compared with controls were significantly more likely to increase their condom use, to increase positive attitudes towards condoms, and possibly to decrease high-risk sexual partnerships. However, other sexual risk variables and substance use were unchanged. Conclusion: Intensive AIDS education provided in jail can be useful in reducing certain HIV risk behaviors of criminally-involved male adolescents.

Executive Commentary

The article presents a commentary on the paper ‘AIDS in the Workplace: An Executive Update,’ by Romuald A. Stone. The author stresses the importance of ongoing AIDS education initiatives. He notes that AIDS education has failed to keep pace with the changing needs of the workforce and the community at large. The author contends that a reasonable expectation is that companies providing medical benefits to firms act as a source of education and prevention expertise. He recommends that organizational leaders include communities in company-sponsored AIDS education programs.

Vigs-voorligting: kennis, houdings en gedrag in ’n multi-kulturele, heteroseksuele konteks<sup>1<sup>

The first decade of the AIDS epidemic was mainly characterized by the dissemination of information, without taking the needs of different target groups into consideration. The objective of this study was to examine the knowledge, myths, causaI attributions, attitudes, susceptibility, sexual behaviour, sexual behavioural change and obstacles preventing behavioural change in a multi-cultural, heterosexual context. Possible cultural differences were established and recommendations made for AIDS education programs. A survey was conducted and data collected through questionnaires obtained from 1494 subjects. Although marked cultural differences were evident, the results indicated that all AIDS prevention programs should contain certain basic components, which should be modified to suit the needs of specific target groups. The purpose of AIDS education programs should be to give practical advice about AIDS; to dispel myths about the spread of HIV; to correct faulty attributions about the causes of AIDS; to change attitudes and to establish a sense of compassion for infected people; to alleviate anxiety and to establish a realistic sense of susceptibility, to motivate people to change their sexual behaviour, and to determine and rectify the obstacles preventing people from changing their sexual behaviour.

Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa.

An AIDS education programme was developed and evaluated in a high school in a socio-economically disadvantaged, urban, African area in South Africa. The programme, which addressed the whole school community, aimed to raise awareness about AIDS using a variety of educational methods and operating through a number of channels. Students and teachers were actively involved in its design and implementation. Students' knowledge of and attitudes towards AIDS prevention were investigated before and after the AIDS programme, and compared to a neighbouring school, in which no AIDS education was conducted. The programme greatly improved student knowledge of HIV transmission and prevention. It increased levels of acceptance of people with AIDS and had a small impact on behavioural intentions. The process of involving the school community in the design of the AIDS education programme is discussed.

Unprotected anal intercourse in HIV‐infected and non‐HIV‐infected gay men

In 1990, gay men (N = 296) in Sydney, Australia, were asked to recall two sexual encounters from the preceding year: one in which they had unprotected anal intercourse (“unsafe” encounter) and one in which they had resisted a strong temptation to have unprotected intercourse (“safe” encounter). The aims were to record self‐justifications for unprotected intercourse used in the unsafe encounter and to identify situational factors distinguishing between the encounters. Among men who had been HIV infected at the time of the unsafe encounter (n = 88), the most common self‐justification had been the thought that they had nothing more to lose; among uninfected men (n = 207), it had been a resolution to have intercourse without ejaculation. The first factor emerging from a factor analysis of the infected group's self‐justifications involved reactions to a negative mood state; in the uninfected group it involved inferring from perceptible characteristics that the partner was unlikely to be infected. Some variables (e.g., closeness of the relationship to the partner, mood, communication, and use of “dirty talk”) distinguished between the unsafe and safe encounters equally among those who had been infected in both encounters (n = 76) and those who had been uninfected in both (n = 170). Other variables (knowledge that unprotected intercourse is a high risk activity, drug use, use of pornography, and condom availability) did not distinguish between the encounters in either group. Desire to seek adventure and excitement through sex distinguished between the encounters only in the infected group, and level of intoxication did so only in the uninfected group. Results are discussed in relation to those obtained in our earlier studies of gay men in Melbourne; we also discuss how such data might be put to use in AIDS education programs for gay men.

Program: AIDS Education and Training Program for Homeless Shelter Staff Sponsor: Homeless Health Care Los Angeles

Program: AIDS Education and Training Program for Homeless Shelter Staff Sponsor: Homeless Health Care Los Angeles

AIDS in Haiti: 1982–1992

Haiti was one of the first countries where AIDS was recognized, a burden that led to the stigmatization of an entire nation resulting in serious long-term economic, social, and psychological consequences. Sixty percent of urban hospital beds are now occupied by patients infected with human immunodeficiency virus (HIV). AIDS is the leading cause of death in sexually active adults and increasingly has become a disease of women and children. AIDS threatens to reverse the decrease in infant mortality achieved during the past decade. In spite of educational efforts, the "silent epidemic" continues in all parts of the country and within all strata of society. The current HIV seroprevalence is 10% in urban areas and 5% in rural areas. AIDS is known but not understood; counseling modifies behavior in only 10%-20% of at-risk persons. This distressing situation is likely to worsen in view of the ongoing political crisis since almost all AIDS-education programs are dependent on foreign support.

AIDS education is more than telling people what not to do.

Education is only one of may approaches which may be used to bring about behavioral change. While it is clear that awareness in Africa about AIDS has grown since education campaigns were launched in the late 1980s, significant misunderstandings and misconceptions remain. The author invited seventeen nongovernmental organizations to participate in a review workshop in 1992 with the goal of learning about which communication methods are currently being used in AIDS education programs in Zimbabwe. Talks, lectures, leader controlled discussions, focus groups, drama/role play, posters, stories, and client counseling are being used to teach about AIDS. Little evidence, however, indicates that sexually active individuals within targeted risk groups have changed their behaviors to reduce the risk of HIV transmission. The denial of risk due to traditional beliefs about disease causation stemming from God or other external forces and the tendency to shift the blame for infection to women are cited as causal factors for the lack of behavior modification. Program planners and administrators must reach beyond the vague and diffuse education campaigns implemented thus far. AIDS workers must instead by trained to focus their attention upon the development of effective, targeted interventions involving communities and at-risk subpopulations.

Evaluator collaboration across diverse AIDS-related education programs

The discipline of program evaluation demands careful examination, measurement, and consideration of alternative explanations for results. Focused evaluation requires distance, and “distance breeds suspicion” (Green & Lewis, 1986). Furthermore, an evaluation report is rarely viewed as a neutral document (Berk & Rossi, 1990). Thus, program evaluators, even when they work closely with program planners and implementers, often function in isolation-separated by focus, by a critical stance, and by the political climate generated by real or perceived judgmental assessments (Rossi & Freeman, 1993). This paper offers a description of the events and activities that brought independent evaluators together to address common problems and issues with the goal of problem solving and improving site specific evaluative activities. The usual pattern of isolated work was broken when the evaluators of twelve independent AIDS-related programs came together and formed a working group which supported an on-going dialogue and exchange of ideas among various projects across the United States. The efforts of this working group served to significantly influence the final evaluation strategies adopted by the individual programs. It provided opportunities for the exchange of information and encouraged cooperation in the development of data collection formats, instruments, and assessments across twelve programs. The focus of discussion here is on the development and accomplishments of a collaborative effort undertaken by a working group of evaluators of separate AIDS education and training programs funded by the National Institute of Mental Health

Special Educators' Knowledge of HIV Transmission: Implications for Teacher Education Programs

In light of the magnitude of the AIDS epidemic, schools are addressing the issues of school attendance of HIV-infected children and the delivery of AIDS education programs. Special educators may become increasingly involved in the education of students with HIV and AIDS, and the delivery of AIDS education programs to students with disabilities. Special educators (teachers; speech-language clinicians; and preschool, early childhood, and at-risk personnel) were surveyed as to their knowledge of documented and nondocumented modes of HIV transmission. The findings suggest that special educators have limited knowledge of verified and nonverified modes of HIV transmission. Implications for preservice and inservice training programs are discussed.

Evaluation of an AIDS education programme for young adults.

To evaluate the impact of an AIDS education programme designed for young adults. A randomised trial with a pre-post test design. Participants were drawn from six youth training centres in the city of Nottingham, England. All trainees aged 16-19 years attending the six centres were included in the sample and centres were randomly allocated to experimental (n = 173) and control (n = 164) groups. The response rate to both questionnaires was high (71%). Data on sexual behaviour, knowledge, and attitudes towards HIV/AIDS were obtained by confidential questionnaire. Two thirds of the sample were sexually active. There were no differences between groups at pre-test and no differences by sex. The experimental group had a significantly higher level of knowledge than the control group post-test. Significantly more experimental than control trainees knew post-test that HIV could be transmitted via anal sex and through broken skin. In addition, twice as many experimental (53%) as control trainees (25%; p < 0.001) were aware that a cure for AIDS was unlikely in the near future. There were no observed effects on sexual behaviour, intentions, or attitudes. The Streetwize UK educational programme had a significant impact on young adults' knowledge of HIV/AIDS transmission and prevention in the short term. If community based AIDS education is to do more than merely inform, however, resources must be made available for peer led interventions and skills training.

Use of condoms by heterosexually active drug abusers before and after AIDS education.

This study identified variables associated with increased condom use among drug abusers in a randomized trial of three AIDS educational programs in a short-term inpatient detoxification program. Participants (n = 301) completed baseline and follow-up interviews and were heterosexually active on both occasions. At baseline, 10% always, 24% sometimes, and 66% never used condoms, and this distribution changed only slightly at follow-up. Among the latter two groups, 21% increased their use. There was no differential intervention effect on changes in condom use. Women, but not men, were more likely to initiate condom use than to increase to consistent use with all partners, and to initiate use if they had multiple partners. Although beneficial attitudes and beliefs about condoms were more common among women at baseline, positive changes in these attitudes/beliefs were associated with increased condom use among men only. Among men, personal attitudes and beliefs were associated with increased condom use, while among women, perceptions of the attitudes of sexual partners were more important.

AIDS Education in U.S. Prisons: A Survey of Inmate Programs

Prisons and other correctional environments are in many ways optimal settings for the development, delivery, and study of AIDS education and prevention programs. Prior research has shown such programs to be widespread, but little is known about their impact. This article presents findings from a recent nationwide survey of AIDS education efforts in U.S. prisons. Results (a) provide baseline information about major program variations that evaluators must take into account and (b) serve as a catalyst for discussion of the types of questions that require their attention.

Investigating children's knowledge and understanding of AIDS.

Though AIDS education in schools reaches many adolescents, the incidence of adolescent HIV infection has risen dramatically. Reasons for failure to properly educate adolescents include not educating children prior to adolescence and neglecting to assess and address children's varying levels of cognitive development when designing AIDS education programs. Citing examples from a study of more than 600 elementary-age schoolchildren, this paper focuses on the importance of assessing children's understanding of disease processes rather than accepting their use of key phrases in appropriate contexts as reflecting knowledge, and using the level at which they understand disease processes rather than age as the primary determinant of students' readiness for comprehending AIDS-related concepts. Guidelines for assessing how well children understand disease processes, including use of nonleading probes, are presented.

AIDS knowledge and risk behaviours among traumatic brain injury survivors with coexisting substance abuse.

An exploratory needs assessment for AIDS education and prevention was conducted at a traumatic brain injury (TBI) rehabilitation facility among 29 clients that also experience coexisting substance abuse disorders. The results suggest that the surveyed clients possessed a moderate level of information about AIDS. Their knowledge level was variable with a major source of misinformation surrounding the use of condoms. The sample members' knowledge was not related to the type or severity of substance abuse, nor was it associated with safer sexual practices. The present results are compared to earlier findings that used an identical survey with a dual disordered population of psychiatrically impaired substance abusers. The results should help in developing an AIDS education and prevention programme for clients with the dual diagnosis of TBI and substance abuse. Clients need up-to-date information that can be comprehended and used. Education will need to be coupled with approaches that present both behavioural and attitudinal change strategies that are best suited to these clients.

Using the PRECEDE model to determine junior high school students' knowledge, attitudes, and beliefs about AIDS.

The effectiveness of a one-period school-based AIDS education program on an adolescent population of seventh and eighth grade students (N = 585) was determined. An instrument based on the PRECEDE model was used to assess program effectiveness. Three-way analysis of variance indicated significant differences (p v .01) between pretest to posttest scores for knowledge, attitude, and beliefs for those who received the program versus those who did not by grade and gender of students. The intervention group scored significantly higher than the comparison group on knowledge gain for both seventh and eighth grade students and for males and females. On attitude items, a significant increase occurred from pretest to posttest for eighth grade students who received the program, but not for seventh grade students. The experimental group of eighth grade students scored higher on the attitudes component than the comparison of eighth grade students on the posttest. When attitudes were examined by gender for females in the educational intervention, an increase occurred in attitude scores from pretest to posttest. While belief scores increased significantly from pretest to posttest for the experimental seventh and eighth grade students, significant increases occurred only for experimental group females. Findings support the contention that a one-class period AIDS education program can affect more than just knowledge since attitudes and beliefs also were partially affected.

Sexuality and AIDS: attitudes and behaviors of adolescents in East and West Berlin

The study which was conducted in 1990 in Berlin, Germany, compares two samples of 542 adolescents from West Berlin and 340 from East Berlin. The present investigation shows that the general trend toward sexual liberality among adolescents is continuing and that necessary processes of adolescent sexual development appear not to be influenced by the threat of AIDS. Though the level of knowledge about the threat of AIDS is, on the whole, satisfactory, this does not in itself guarantee determined and consistent AIDS-preventive behavior. Fewer than one-third of sexually-active adolescents, and even fewer than one-fourth of those in the most sexually-active group, can be described as consistent users of condoms. The attitudes of adolescents in regard to contraceptive characteristics only partly suggest a preference for condoms. When adolescents are asked directly about condoms, they additionally emphasize their effect of reducing feeling and pleasure. Adolescents with experience of sexual intercourse rate condoms more negatively than do those without such experience. However, AIDS-education efforts can make use of the fact that consistent condom-users expressed clearly more positive attitudes to condoms than did others. Although the comparison between East and West Berlin adolescents yielded differences in certain details, these differences are not of significance to AIDS-education programs which seek to increase AIDS-preventive behavior.

African Americans in the South: issues of race, class, and gender

This volume reflects a new commitment by American anthropologists to engage in what has been called the anthropology of racism: the analysis of systems of inequality based on biological differences. Comprising 9 papers and related commentary, African Americans in the South examines racism, class stratification and sexism as they bear on the African-American struggle for social justice, equality and cultural identity in the South. The essays fall into three broad categories: economic survival strategies, health and reproductive problems and religious responses to the larger society. Essays in the first category discuss African-American teen pregnancy and mutual aid societies. The second group focusses on health practices and knowledge among blacks in a Georgia town, African-American midwifery in North Carolina, an AIDS education program in a Tennessee city and eating habits in rural North Carolina. The essays in the last category emphasize the diversity of the African-American religious experience by focussing on black Pentecostals, Jews and Mormons in the South.