For best HIV/AIDS education, understand the target group

Tailor message to audience, and take it to those at risk

An HIV clinic for adolescents at Children’s Hospital of Philadelphia gives health care workers at the facility a fairly good picture of which teens are at risk for HIV/AIDS in this metropolitan area. Initially, most of the referrals were gay and transgender males, but by 1995, clinic referrals were about 50% young homosexual males and 50% young heterosexual females. In the last two years, referrals of young gay men are climbing once again.

The clinic was developed about 12 years ago when teens 14-16 years old were testing HIV-positive. "People didn’t know what to do with them because they weren’t infected by a blood transfusion or have perinatal AIDS but had behaviorally acquired HIV," says Christine Ambrose, MSW, LSW, program manager for the Adolescent HIV Initiative.

In addition to better understanding the group to target for prevention education, the clinic population provides information about how to make the message more effective. During a weekly support group for HIV-positive teens, the facilitator asks for suggestions on how to educate their friends who are at high risk. Also asked is what made them decide to get tested, says Ambrose. Most of the time it wasn’t planned; they just happened to see a sign for free testing.

Aware of the population, the Adolescent HIV Initiative staff have used many tactics to prevent the spread of HIV/AIDS. A new program will train the HIV-positive youth to speak about the disease to high-risk youth and possibly do some mentoring. The message will be that AIDS can be prevented and have details on what they can do to be safe. "Developing programs for our HIV-positive youth also empowers them and gives them a purpose in life," says Ambrose.

Many outreach tactics have been used to reach at-risk teens. A peer education program sends teen girls to beauty salons with goodie bags filled with condoms, lubrication, and written materials about STD and HIV prevention. This program is aimed at teens who contract HIV/AIDS from older men. Sometimes, the peer supervisors schedule a mini-workshop with the salon so the trained teens can provide some education as they hand out condoms.

Tailoring education to the target population is important, says Cleo Parker-Smith, RN, MSM/ HM, nurse department head for the immunology unit at South Miami Hospital. She goes out with the same message each time she is asked to speak, but the delivery depends on the audience.

Know your audience

Grade school children don’t hear the word "sex." Intimacy is discussed carefully and the message driven home with comic books. Education of this age group is important because it gives them the information they need to make better choices later when peer pressure begins, says Parker-Smith. "If they know the truth, at least they can approach it differently," she says.

Frequently teen groups are rowdy and have a short attention span. A technique she has found that works is a quiz of sorts where she asks the teens to tell her the definition of AIDS, and anyone who does receives an AIDS ribbon pin. Then she asks how someone can contract the disease, and as she gets the correct answers she throws the teens a pin.

It’s important to show people who are sexually active how to use condoms correctly because many don’t know the correct way to put them on, she says. Therefore, with at-risk teens, she brings along a banana to demonstrate.

Parker-Smith speaks to many different groups and has learned to tailor the message to the audience from experience and reading the literature on the subject. She began working with HIV/AIDS patients in 1981. There still are many misconceptions, she says. For example, blacks often think they are not susceptible to HIV/AIDS because they are not gay. They don’t understand how it is contracted.

Misconceptions leave the senior population vulnerable as well, says Collette Vallee, project coordinator for the Senior HIV/AIDS Prevention and Education Project run by the Department of Aging and Mental Health at the University of South Florida in Tampa. Regardless of age, people use drugs, including intravenous drugs, and prostitutes report that the majority of their clientele are older than age 50, she says.

"These are all risk behaviors, and age doesn’t protect you from HIV/AIDS. It has long been assumed that when you are older, unless you have a bad blood transfusion, you won’t get this disease, and that is a big misconception," says Vallee.

The beginning symptoms of AIDS are fatigue, weight loss, and forgetfulness, all of which could signal another disease in older adults. Many times, AIDS isn’t diagnosed in seniors until they present with an opportunistic infection or disease such as pneumonia. They probably were HIV-positive for quite a while and could have infected many people before their diagnosis.

Vallee takes the HIV/AIDS prevention message to seniors by visiting hospital senior programs, low-income housing facilities targeting seniors, and senior centers. The senior meal programs are a good location for teaching because there is a captive audience. She often talks about how an aging body might impact a person’s sexuality and weaves the information about HIV/AIDS and how to prevent it into the short lecture.

"Typically, older adults will not use a condom because they can’t get pregnant and condoms are for pregnancy prevention and not necessarily for disease prevention. The talks re-educate them," she notes.

Vallee even speaks to cognitively impaired audiences because some of them solicit sex, but with this group she keeps the message short. Also, she introduces herself to everyone before the talk. Afterward, she remains available for about 20 minutes in case anyone has questions.

It is difficult to know if the prevention message has an impact on behavior, the educators say. "I try to consistently repeat the message so it sinks in because it takes a long time for behavior change to take place," she says. More people older than 50 are being tested for HIV/AIDS in the state of Florida since the program began, so that is a sign that the message is getting through to some, she says.

Effectiveness also is being tracked by the number of condoms the program gives away. Vallee keeps them stocked in many places, such as senior centers, and makes sure the seniors are told. All they have to do is ask for them. "I have a 74-year-old volunteer who goes out to the bars and barbershops to supply them with condoms, and people know where to pick them up," she says.

In February 2002, the Adolescent HIV Initiative at Children’s Hospital of Philadelphia partnered with a juvenile detention center to target high-risk youth. They selected 16 teens for the pilot project who are considered to be at greatest risk. All have multiple sex partners and may be selling sex, and four transgender males are using intravenous drug hormones as well.

While incarcerated, teens regularly meet with the case manager in an effort to build a relationship. Once released, the case manager has weekly contact with the teens and also meets with other community agencies they are involved with, including their probation officer.

The last phase of the yearlong program is designed to help the teens realize that they can live a healthy life and provide them with options. For example, the caseworker will help them get into a job training program if they want or enroll in a continuing education program.

The prevention message is repeated time and again throughout the project, and the case manager helps the teens negotiate safer sex practices. For example, the transgender youth are referred to physicians who will write a prescription for hormones, and they also are referred to counseling so they can discuss being transgender and how that impacts their life. "Our hope is that some of these kids will make it through this program," says Ambrose.

The prevention programs work, but the effect is not immediate — at least not with teens, she says. Many continue with unsafe behavior long after they have heard the message. However, often something that happens in their lives causes them to begin being responsible, says Ambrose.

"The message that your partner won’t tell you that he or she is HIV-positive is a message that we give out frequently, especially with our gay kids," says Ambrose. Even the HIV-positive kids are at risk when they have unprotected sex because they can be re-infected with a resistant virus that will harm them even more, she says.

For more information on targeting HIV/AIDS education to specific populations, contact:

  • Christine Ambrose, MSW, LSW, Program Manager, Adolescent HIV Initiative, Children’s Hospital of Philadelphia, Research Administration, 34th and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-4943. E-mail: ambrose@email.chop.edu.
  • Cleo Parker-Smith, RN, MSM/HM, Nurse Department Head, Immunology Unit, South Miami Hospital, 6200 S.W. 73rd St., Miami, FL 33143. Telephone: (786) 662-8747. E-mail: cleos@bhssf.org.
  • Collette Vallee, Project Coordinator, Senior HIV/AIDS Prevention and Education Project. Department of Aging and Mental Health, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa FL 33612. Telephone: (813) 974-1910. E-mail: vallee@fmhi.usf.edu.