Part 2: Prevention

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Until a vaccine is found, the only way to prevent new HIV infections is through education. Adolescents can protect themselves if they are given comprehensive information, tools, and skills, and the reasons to use them. It is incumbent on all adolescents to demonstrate personal responsibility by protecting themselves and others. Communities promoting the close cooperation of parents, teachers, coaches, clergy, physicians, and other adults interacting with youth can ensure that every young person has access to this information. Every adult who touches a young person's life will be equipped to impart this knowledge in a clear, accurate, sensitive manner.

Parents can be the best teachers for their children and HIV prevention approaches for adolescents so it should ideally start with parents. Parents should be key participants in HIV prevention programs. If parents aren't convinced of the risk to their children, they may fail to recognize their child's risk-taking behavior. More must be done to educate the parents of adolescents about the risks their children face and about the means that are available to protect their children from this disease.

Efforts to encourage sexual abstinence should continue to be supported. Teens who are thinking about becoming sexually active should be encouraged to consider the implications of their decision and to examine whether they are prepared to deal responsibly with these behaviors(including taking personal responsibility for the consequences of these behaviors and protecting themselves and their partners against disease and unintended pregnancy). It is important that young people make healthy and safe choices about sex. To help them make those decisions, families and communities should help their young citizens to grow and develop to their full potential and provide a safe environment to accomplish that growth through schools, role models, and other opportunities. Without community support and reinforcement, even the best HIV prevention approaches will falter or fail.

Effective HIV prevention is neither a single program nor a single event; it must take place over the course of many years and be developmentally appropriate. Therefore, it is inadvisable to separate HIV prevention form sexually transmitted disease prevention, pregnancy prevention, substance abuse prevention, sexuality education, self-esteem activities, and human development education.

National Institutes of Health programs on adolescent risk behavior and HIV infection include programs to identify and develop potential intervention strategies for decreasing the high-risk behaviors of young people. Model programs are being developed to increase adolescent STD/HIV prevention knowledge, improve attitudes, and develop skills to delay adolescent sexual activity. Many of these programs are developing and testing culturally sensitive and gender appropriate interventions that target the reduction of AIDS risk behaviors among diverse groups of adolescents. Some of these interventions have already produced positive behavior change among homeless and runaway youth.

Successful prevention efforts concentrate on providing access to accurate information, personalizing this information to motivate change, providing training in behavioral skills for implementing decisions, an reinforcing and rehearsing skills to build competence, communication and self-esteem. Reality-based approaches recognize that people sometimes use faulty judgment and incorporate efforts to emphasize the ability of individuals to recommit their long-term goals.

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Schools are a highly effective and appropriate place to teach young people HIV prevention information and skills before they begin the behaviors that put them at risk for HIV infection. An estimated 98 percent of young people between the ages of 5 and 17 are enrolled in schools. The Centers for Disease Control and Prevention (CDC) has implemented a multifaceted program to help schools and other agencies that serve youth across the nation and provide effective health education to prevent the spread of HIV. This program is based on the principle that the specific scope and content of HIV education in schools should be consistent with parental and community values. CDC provides funding and technical assistance to the departments of education, six territories, and 18 large cities. CDC also has developed "Guidelines for Effective School Health Education to Prevent the Spread of AIDS."

Beginning at the earliest appropriate age, young people should receive sexuality and HIV/AIDS education as part of a comprehensive curriculum of health education. Such a curriculum should include accurate information about HIV and modes of transmission, the opportunity to assess personal risk of infection, and skills training. HIV prevention information should be age-, language-, and culturally-relevant and designed to accommodate the context of the lives of young people and their families.

There is a compelling need for comprehensive school-based HIV prevention education, yet those school-based efforts are just one step in a long journey to effectively protecting adolescents from HIV. School-based programs do not reach all youths at risk. Those adolescents not in school -- because they have graduated or dropped out -- will need to be reached with the same kind of basic information that schools provide to all others.

Misconceptions and misunderstandings about HIV transmission and high-risk behaviors often arise when relevant information is omitted. Sexuality education, when done properly, reflects the needs of the community and acknowledges the value of both abstinence and safer sex as tools to prevent HIV infection. Yet in some school districts, education policies preclude discussion of subjects such as intercourse, homosexuality and bisexuality, and condom use. Discussion of the facts concerning such matters is not inconsistent with also encouraging abstinence or delayed sexual activity.

The job of HIV prevention is too important to be left to health educators alone. As mentioned before, all adults who work with young people should be armed to impart HIV prevention information effectively and sensitively to adolescents in their charge. This requires approaches that work--those designed to work will in a given community--and that can be employed to meet a variety of prevention needs.

Yet, teaching young people something and ensuring that they will follow through with what they've been taught are two separate things. To be successful, HIV prevention efforts much be targeted and they must be sustained. Lessons learned from efforts to prevent smoking, substance abuse, and teenage pregnancy demonstrate that such efforts can positively affect adolescents' behavior.

In 1994, the Centers for Disease Control and Prevention (CDC) launched the Prevention Marketing Initiative (PMI), a comprehensive HIV/AIDS education and prevention program involving partnerships between Federal, state, and local organizations throughout the U.S. The PMI specifically targets young adults between the ages of 18 and 25. In 1994 and again in 1995, CDC prepared and distributed public service announcements aimed at young adults that communicate two central messages. First, sexual abstinence or delaying sexual activity is the most effective way to prevent sexual transmission of HIV. Second, for those who are sexually active, the correct and consistent use of latex condoms is an effective method of preventing HIV transmission.

Successful HIV prevention efforts also have recognized that behavior isn't changed with knowledge alone. An analysis of approaches that are successful in reducing high risk behavior among young people found that schools often were at the focal point of these efforts and that community-wide, multi-agency efforts were needed both in terms of funding and reinforcement of messages. Successful prevention efforts also have been designed to meet the specific needs of target audiences and offer their services outside the traditional school-based setting.

Community-based organizations are also a valuable an credible source of prevention messages. They can supplement, support, and reinforce messages from within families and schools.

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Peer counselors--young people trained in providing HIV/AIDS-specific information--have been shown in NIH-sponsored studies to be particularly successful messengers. Peer educators have repeatedly demonstrated that they can present material in a way that addresses the relevance of HIV and HIV prevention to young people's lives. Adolescents often find prevention messages more believable when they are delivered by their peers.

Peer-led prevention efforts are currently being conducted at a variety of sites around the country but many more such efforts are needed. The challenge lies in the development and application of programs that are innovative and address the needs of adolescents.