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AMERICAN ACADEMY OF PEDIATRICS
Committee on Pediatric AIDS
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Education in Schools
ABSTRACT. The human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has grown during the past 15 years. Education
remains a critical component of our efforts to prevent
HIV infection/AIDS in school children and young adults.
To accomplish this goal, school personnel should receive
updated information about HIV infection/AIDS so that
accurate teaching on this topic can be included in the
K–12 health education curriculum. Informed pediatricians and nurses can serve as important resources for
school health services and administration to provide current information for the curriculum. Each community
should have a school health advisory committee that
enlists community support and provides input to health
education programs in schools.
ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS,
acquired immunodeficiency syndrome.
INTRODUCTION
S
ince the onset of the human immunodeficiency
virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic, in 1982, more than
7629 cases of AIDS have been diagnosed in the
United States among children younger than 13 years.
An additional 2754 cases have been diagnosed
among adolescents and more than 100 000 cases
among individuals in their twenties, many of whom
likely became infected during their teenage years.1
The common etiologic factors of sexual or drug use
behaviors lead to acquisition of the virus by adolescents and adults. These risk behaviors, predominantly heterosexual intercourse, result in the majority of HIV infections in childbearing women and
therefore are indirectly responsible for nearly all
perinatal HIV infection. Advances in current treatment regimens to decrease the rate of transmission of
HIV infection to newborns are essential for disease
control.2 Education leading to the reduction of risktaking behavior remains a critical component of our
efforts to prevent HIV infection. The responsibility to
provide such education is broadly shared by families, the media, health professionals, schools, and
community organizations that serve youth. Schools,
however, have a particular advantage in such educational initiatives because they have the opportunity and the expertise necessary to deliver an effecThe recommendations in this statement do not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking into
account individual circumstances, may be appropriate.
PEDIATRICS (ISSN 0031 4005). Copyright © 1998 by the American Academy of Pediatrics.
tive and comprehensive curriculum. They have
access to children and adolescents for many hours
over many years and they interact with students at a
time of their lives when they are developing knowledge, attitudes, and skills that will enable them to
develop healthy lifestyles.3
ORGANIZATION OF THE PROGRAM
Legislative Mandates
Many states presently mandate HIV/AIDS education.4 In some states, HIV/AIDS education programs
may exist without any other health education programs or may not be required for graduation. It
would be preferable if HIV/AIDS education were
required for graduation as part of a broadly based
K–12 comprehensive health education curriculum.
The Academy supports mandated comprehensive
health and physical education in all states and school
districts.
School Health Advisory Committees
HIV/AIDS education programs should be developed by the school medical advisor, school administrators, health educators, and the school nursing
supervisor. They should be promoted to the community by a school health advisory committee.3 Members of this committee, for each school or district,
should consist of the school medical advisor, community pediatrician and/or public health physician,
the school nurse, a health educator, a mental health
professional, the school administrator, a faculty
member, parents, students, and appropriate community representatives to reflect the ethnic diversity of
the student population.5
Education of Teachers
HIV/AIDS education should be included as part
of a comprehensive health education course at a
college level and updated when an educator is employed in school.6 At all levels teachers should be
educated in how to instruct students about child
health and development, human sexuality, AIDS as a
sexually and blood transmitted infection, and standard infectious disease precautions. They should be
taught to develop health education curricula that are
sensitive to ethnic and cultural differences.7 Qualified health educators should play an important role
in educator curriculum development, skills training,
supervision, and consultation with school medical
personnel. School boards need to allot time and re-
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sources for continuing educator training in these
subjects.
Physicians’ and Nurses’ Training
Physicians, especially pediatricians and school
physicians, and school nurses should receive continuing education about HIV/AIDS that includes information not only about HIV infection/AIDS as a
sexually transmitted infectious disease but also on
issues of ethics, testing, and counseling. This should
include information about modes of transmission by
injection drug use and an understanding of the interaction of substance abuse (including alcohol and
noninjection drug use) with high-risk behaviors such
as unprotected sexual intercourse. Physicians and
nurses with an active role in the schools should: 1)
participate in education programs for teachers,
school administrators, parent groups, community
groups, psychologists, and other mental health personnel; 2) assist schools and organizations in the
development of educational programs for special
groups8; 3) review, adapt, and develop educational
materials; 4) participate in public discussions, including radio and television programs and newspaper
articles; 5) take part in meetings between school administrators and staff and between administrators
and parents; and 6) facilitate networking among parents, educators, and AIDS community groups. Both
information and educational methods for teaching
this subject should be updated on a regular basis.
Community Support
Programs of sex education including AIDS education may be controversial in the community. Economic pressures have led to reduction or elimination
of some health education programs. The pediatrician
should function as an advocate and resource in developing education programs for parents and the
community. An informed community could provide
support to the school health administration and
health services to ensure successful implementation
of these programs.
CURRICULUM
In the face of controversy surrounding sexuality
education and despite economic limitations affecting
curricula, the current epidemic of AIDS has increased the importance and urgency of comprehensive health education including human sexuality
education.9 Pediatricians should advocate the maintenance and expansion of such curricula. There is an
emerging body of information on what constitutes
AIDS education.3 School curricula should be based
on that body of information. These programs should
have a concentrated focus; give accurate information;
use active learning methods, including small group
discussions; examine media and social influences;
and most importantly, emphasize skill modeling and
practice, including decision-making and refusal
skills and should also address the issue of selfesteem. Studies have shown that these HIV/AIDS
education programs can increase a student’s knowledge and tolerance and influence subsequent
behavior.10
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HIV/AIDS education in the schools should be
taught in developmentally appropriate grade-specific
programs by skilled educators who are ethnically
and culturally sensitive. The curriculum should be
developed through a cooperative process involving
members of the community, educators, and health
care professionals, and should reflect the ethnic diversity of the student body.
The elementary school modules for HIV/AIDS education should emphasize general concepts of health
and disease, cleanliness, the role of microorganisms
in disease, and the prevention of infection. The content
should define HIV infection and AIDS and differentiate between myths and facts regarding transmission, explain the effects of HIV on the immune system, and identify appropriate resource people such
as physicians and nurses to clarify further unresolved issues.11
Middle school and high school students need
intensive exposure to health education, especially
because of their potential participation in high-risk
behaviors that lead to HIV infection. The curriculum
should include: 1) the spectrum and natural history
of HIV infection/AIDS as an infectious disease;
2) the effect of HIV on the human immune system;
3) methods of transmission of HIV; 4) testing issues;
5) the prevention and treatment of HIV infection/
AIDS; 6) an understanding of the relationship of
substance abuse and HIV transmission; and 7) social
and psychological aspects of HIV infection/AIDS,
including legal and discrimination issues.
The curriculum must emphasize behaviors that
minimize the transmission of HIV. In some school
systems, peer-led participation in high school and
college HIV/AIDS education programs may be a
useful adjunct to teaching.12 The curriculum should
also describe the right to receive health service in a
confidential manner if there is reason to believe that
a student has a sexually transmitted disease, including HIV infection.3 To understand prevention, students need to learn about all modes of transmission.
Infection among adolescents occurs through blood
transmission by intravenous injection or the sharing
of needles, resulting in exposure to blood containing
HIV, and transmission of genital fluid containing
HIV by sexual intercourse. Students need to understand that increasingly HIV is spread by unprotected
heterosexual intercourse. HIV may be transmitted
from infected mothers to their babies in utero, during
the birth process, or through breastfeeding.13 Discussions should include the need for standard precautions for contact with blood and other potentially
infectious (high-risk) body fluids. Such discussions
must be culturally sensitive and grade-specific.
Prevention
The prevention of HIV infection/AIDS and its consequent illness must be the primary component of
any education program. This requires an overall approach to responsible sexual behavior and decisionmaking that includes prevention of all sexually transmissible infections. The best strategy to prevent
sexual transmission is to practice abstinence until a
mutually faithful relationship is established with a
HIV/AIDS EDUCATION IN SCHOOLS
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person who has never been exposed to HIV infection.
Education programs should provide adolescents
with the knowledge, attitudes, and skills they need
to both refrain from sexual intercourse and to use
contraceptives and condoms effectively if they
choose to have intercourse.10,14,15
Sharing needles exposes individuals to blood that
may be infected with HIV, hepatitis B or C virus, or
other infectious agents and therefore poses a significant risk. In addition, the use of psychotropic drugs,
including alcohol, increases the likelihood of engaging in risky behavior. The role of drug use and the
value of sterile needles to prevent transmission of
HIV should be discussed.16 The likelihood of transmission of HIV from an infected woman to her infant
can be decreased by the use of antiretroviral medications during pregnancy and labor and during the
newborn period.2 It should be emphasized to students that all pregnant women should know their
HIV status to enable them to make informed decisions about appropriate medical care including antiretroviral treatment.17
PROGRAM ASSESSMENT
AIDS education curricula should be periodically
updated by the school medical advisor and public
health experts to conform with current knowledge.
Pediatricians, acting in concert with school health
services, administration, and the community at-large
can be effective in educating students and faculty
about HIV infection.
RECOMMENDATIONS
The American Academy of Pediatrics has been a
long-time advocate of comprehensive school health
education and makes the following recommendations:
1. Educators should become knowledgeable about
HIV infection/AIDS as part of comprehensive
health and human sexuality education during
their certification process and in faculty workshops. Such education must be ongoing, for which
resources and time should be allocated.
2. HIV/AIDS education should be included as part
of comprehensive health education from grades K
through 12. This education should be developmentally appropriate, ethnically and culturally
sensitive, and should be mandatory for graduation.
3. Physicians and nurses should receive continuing
HIV/AIDS education. Together with school
health services and administration they can then
serve as important resources for school HIV/
AIDS education programs.
4. School health advisory committees, which include
individuals who reflect the ethnic diversity of the
student body, should be formed to oversee and
garner community support for health education
programs in school.
5. Curricula should be reviewed periodically and
updated to reflect current knowledge including
prevention, treatment, and testing issues, as well
as the psychosocial aspects of HIV infection/
AIDS.
Committee on Pediatric AIDS, 1996 to 1997
Catherine Wilfert, MD, Chairperson
Donna T. Beck, MD
Alan R. Fleischman, MD
Lynne M. Mofenson, MD
Robert H. Pantell, MD
S. Kenneth Schonberg, MD
Gwendolyn B. Scott, MD
Martin W. Sklaire, MD
Patricia N. Whitley-Williams, MD
Liaison Representative
Martha F. Rogers, MD
Centers for Disease Control and Prevention
REFERENCES
1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance
Report. Atlanta, GA: Centers for Disease Control and Prevention; 1996;8
2. Centers for Disease Control and Prevention. Recommendations of the
US Public Health Service Task Force on the use of zidovudine to reduce
perinatal transmission of human immunodeficiency virus. MMWR.
1994;43(RR-11):1–20
3. Bogden JF. Someone at School Has AIDS: A Complete Guide to Education
Policies Concerning HIV Infection. 2nd ed. Alexandria, VA: National
Association of State Boards of Education; 1995
4. Lovato CY, Allensworth DD, Chan FA, eds. School Health in America: An
Assessment of State Policies to Protect and Improve the Health of Students. 5th
ed. Kent, OH: American School Health Association; 1989
5. American Academy of Pediatrics, Committee on School Health. School
Health Policy and Practice. 5th ed. Elk Grove Village, IL: American
Academy of Pediatrics; 1993
6. Health instruction responsibilities and competencies for elementary
(K-6) classroom teachers. J School Health. 1992;62:76 –77
7. American Academy of Pediatrics, Task Force on Minority Children’s
Access to Pediatric Care. Report of AAP Task Force on Minority Children’s
Access to Pediatric Care. Elk Grove Village, IL: American Academy of
Pediatrics; 1994
8. American Academy of Pediatrics, Task Force on Pediatric AIDS. Education of children with human immunodeficiency virus infection. Pediatrics. 1991;645– 647
9. Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually
Transmitted Diseases. Washington, DC: National Academy Press; 1997
10. Kirby D, Short L, Collins J, et al. School based programs to reduce
sexual risk behaviors: review of effectiveness. Public Health Rep. 1994;
109:339 –360
11. Centers for Disease Control. Guidelines for effective school health education to prevent the spread of AIDS. MMWR. 1988;37:1–14
12. Shulkin JJ, Mayer JA, Wessell LG, et al. Effects of peer-led AIDS intervention with university students. J Am Coll Health. 1991;40:75–79
13. American Academy of Pediatrics, Committee on Pediatric AIDS. Human milk, breastfeeding and transmission of human immunodeficiency
virus in the United States. Pediatrics. 1995;96:977–979
14. Kirby DM, Waszak C, Ziegler J. Six school-based clinics: their reproductive health services and impact on sexual behavior. Fam Plann
Perspect. 1991;23:6 –16
15. American Academy of Pediatrics, Committee on Adolescence. Condom
availability for youth. Pediatrics. 1995;95:281–285
16. American Academy of Pediatrics, Provisional Committee on Pediatric
AIDS. Reducing the risk of human immunodeficiency virus infection
associated with illicit drug use. Pediatrics. 1994;94:945–947
17. American Academy of Pediatrics, Provisional Committee on Pediatric
AIDS. Perinatal human immunodeficiency virus testing. Pediatrics. 1995;
95:303–307
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Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Education in Schools
Committee on Pediatric AIDS
Pediatrics 1998;101;933
DOI: 10.1542/peds.101.5.933
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and
trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove
Village, Illinois, 60007. Copyright © 1998 by the American Academy of Pediatrics. All rights
reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Education in Schools
Committee on Pediatric AIDS
Pediatrics 1998;101;933
DOI: 10.1542/peds.101.5.933
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/101/5/933.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1998 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on April 29, 2017