Is HIV Education in Our Public Schools Up to Speed?

As more young adults come of age in a world where they've always known HIV, sex ed is often the first place they separate facts from fiction and get definitive information about a disease that is still beset by stigma and misconceptions. The HIV field has come a long way in treatment and prevention; breakthroughs are constantly being made, but does sex ed stay up to speed? Is HIV still implied to be a death sentence in the classroom, or do teens know it as a manageable, but preventable, disease? It's a difficult thing to assess, but, for the most part, experts say it's the latter. Stigma, however, remains a challenge.

"I would say that by and large, socially and culturally, people have caught up that it's no longer a death sentence and many school jurisdictions have great educators, nurses and health resource centers that are up to speed," said Angel Brown, a Washington D.C.-based activist who heads the GLBTQ division at Advocates for Youth, a national nonprofit that pushes for comprehensive sex education.

"I think there are still some communities that are struggling with having conversations about HIV, and a lot depends on the school jurisdiction, school by school, educator by educator," she said. "It really has to do with whether or not the school has someone teaching sex ed and health courses who is informed and comfortable explaining information and having conversations with students that speak beyond the textbook."

Since HIV is often taught alongside with other STIs, students might not get into details like antiretroviral medications and viral loads, but they know HIV is treatable, preventable and that contracting it no longer means you can't live a long, healthy life. The Internet has also changed things; teens now have handheld access to answers and information.

"I think schools and teachers have to think about what is relevant to teach young people about HIV," said Elizabeth Schroeder, executive director of Answer, a national sex ed advocacy group based at Rutgers University in New Jersey. "I don't think it's particularly relevant to lecture 10th graders about statistics unless they're relevant to their lives. What we really want them to know has to do with prevention, safety, health and not to stigmatize people with HIV."

Currently, 33 states and the District of Columbia mandate HIV education, with 13 of them requiring HIV-only sex education, according to the Guttmacher Institute.

In 2011, the Centers for Disease Control and Prevention reported that more than 15 percent of teens reported not learning about HIV or AIDS in school, an increasing number.

Advocates for Youth has an effort underway to push for Congress, the president and the U.S. Department of Health and Human Services to make April 10 National Youth HIV & AIDS Awareness Day.

The "Backfire Effect"

With the advent of life-saving medications in the '90s, the HIV narrative in sex ed changed drastically.

"I remember being a peer educator when we first saw drug cocktails and saying to young people, 'It's no longer a death sentence; you can live longer,'" Brown said.

As advancements were made and the messaging shifted, she and other educators noticed a new problem: students began taking HIV less seriously.

"The backfire effect is that many people don't think HIV is such a big deal anymore and they think about HIV the same they would as say, Chlamydia," Brown said. "That's one of the biggest issues now. The treatment and wellness conversation is working so well, but we still want young people to protect themselves; HIV isn't a walk in the park."

Schroeder, too, remembers seeing lax attitudes emerge among students she gave presentations to over the years.

"I saw a lot of young people in the '90s who were saying, 'HIV is no big deal, look at Magic Johnson.'"

The challenge for sex educators today is to strike a balance between keeping the narrative up-to-date and not fear-based, while not downplaying the seriousness of the disease and losing the core message of prevention.

"It's a fine line between educating and not stigmatizing," said Malek Guerbaoui, a community educator at the Pacific Pride Foundation in Santa Barbara, California, who's given HIV presentations to college students. "I try not to scare them, but make it seem like it applies to everyone, not just certain groups."

Getting Gay-Specific

Whether or not to direct the conversation toward students with the greatest potential of being affected by HIV is another challenge sex educators face. While some argue that addressing the prevalence in the gay community makes other students think they aren't susceptible to contracting HIV, others say keeping the conversation general can come off as heteronormative and doesn't help young gay men who may be at risk in the future.

"I try to use blanket terms and not single out or alienate different communities," Guerbaoui said. "MSM (men who have sex with men), for example, who may be dealing with internalized homophobia, I don't want them to think that since they're not gay, they can't get the virus. I talk about how risky behaviors spread the virus through certain groups of people, rather than gay men having it more than straight men."

In Los Angeles, Martha Chono-Helsley regularly has young gay men who test positive come into her office with a serious lack of information about HIV.

"In high school, we find that gay young men aren't even approached unless by outside agencies. It's rare to see HIV taught specific to gay men in sex ed. Sometimes HIV is taught separately from sex ed in biology courses," said Chono-Helsley, executive director of Reach LA, a nonprofit serving youth of color in metropolitan Los Angeles.

"Even when we target gay men, they're still getting infected, so we have to address other issues that aren't specific to the biology of HIV, but are more about self-esteem," she said. "What is it that's stopping them from using condoms, protecting and loving themselves?"

Budget Woes

Budget cuts to education present another set of challenges. It isn't so much schools being unable to buy the most up-to-date learning materials as it is health curriculum being threatened altogether.

"Schools everywhere are being affected," Schroeder said. "Health is not a tested subject, so we're pretty low on the food chain. We tend to see health being cut all together."

When Guerbaoui took a job giving presentations to students in sexuality courses at the University of California, Santa Barbara, he knew the temporary, part-time position used to be full-time UC staff.

"I'd say that they decided sex ed was the fat that could've been trimmed," he said.

The Los Angeles Unified School District, which has made severe budget cuts in the past several years, has only one HIV intervention specialist.

"It's very hard for him to get out there and train every health teacher," Chono-Helsley said. "We also see threats of cutting health classes at major high schools altogether."

"We still have a long way to go," Brown said. "There are many communities, towns and cities that still need resources and federal government dollars to support sex ed advocation."

Stigma Still a Powerful Hurdle

For all the advancements and strides the HIV world has made, sex educators still run into outdated myths and misconceptions from students. Questions about "catching" HIV from toilet seats aren't uncommon. Stigma is still a powerful hurdle in educating youth about HIV.

"A lot of topics around HIV education kind of bring up unmentionable topics, like homosexuality or people using drugs," Guerbaoui said. "It's not as simple as, 'Wear a condom.' There are a lot of social things that come into play that people don't feel comfortable talking about. There's a whole invisible community of HIV-positive people who don't want anyone to know because there's this judgment of, 'You did something bad and this is a consequence.'"

But while HIV is still surrounded by stigma, another result of modern treatment is the fact that more and more young people know HIV-positive loved ones who are living long, healthy lives. An hour-long class might not be enough time to break down hurdles created by stigma, but keeping the conversation open, honest and away from a context of fear, is a progressive start.

"Stigma and prejudice come from ignorance and fear," Schroeder said. "So when students don't understand, they're afraid, which leads to stigma, shame and bullying. I think schools have a valuable role to play."