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Although it’s becoming increasingly clear that the HIV epidemic cannot be fully halted without a more powerful emphasis on prevention, controversy continues to erupt over school programs that teach youths about HIV and safe sex.
While the dichotomy between abstinence-only advocates and those who believe in teaching children about condoms is unlikely to be resolved, there is at least one prevention program that has bridged the gap. The Parent HIV/AIDS Education Project at Cornell University in Ithaca, NY, has successfully taught parents and guardians how to teach their children about HIV and HIV prevention.
The project’s focus is on community-based programs, taught by peers to parents and guardians, called Talking with Kids About HIV/AIDS.
"This assists parents and guardians in being partners to their kids as they learn about HIV in school classes," says Jennifer Tiffany, RN, MRP, director of the Cornell University Parent HIV/ AIDS Education Project.
Because the program is directed to parents, giving them ideas of how to communicate prevention messages to their own children, it has an inherent buy-in among adults. Even if some of the parents disagree with the "safe sex" message, they at least can hear different opinions on the topic within a non-threatening group environment.
"In addition to that, it’s the parenting generation that’s dealing with the heaviest weight of AIDS diagnoses, really the 25-49 age group, the parenting years," Tiffany says. "So at the same time we’re giving parents skills to teach their children, we’re reaching those parents and guardians with information that might help them make changes that would keep them healthier."
A study of the program found that parents participating in the program were three times more likely to discuss HIV risk reduction with their children than parents enrolled in educational workshops, and they gave their children a broader scope of information.
Parents involved in the program had more conversations about HIV with their children, an average of five in the past month, compared with one or two conversations among the control group. This proved to be important because when teenagers were asked what they wanted to hear from their parents about HIV, they often said that they didn’t want it to be one big conversation and would rather their parents had a series of small conversations on the topic.
The likelihood that parents and children would discuss HIV risk behaviors increased due to the program; HIV testing increased among the parents; and the parents also were more likely to make behavioral changes themselves.
The program, available in English and Spanish, has been duplicated or modified and used over the years by various other groups, including a Tennessee Parent-Teacher Association, the National Development and Research Institutes in New York City, and by communities across the nation and the world. Peer volunteers have translated the program into various other languages, as well. Most recently, the program has been duplicated in Mexico City. (See "Common Sense About AIDS" for a sample of what the program includes, in this issue.)
Here’s how the program works:
1. Peer volunteer educators hold meetings for parents.
The Cornell project recruits and teaches peer volunteers how to educate parents and facilitate group sessions within their communities. AIDS service organizations, churches, PTAs, and other groups could do the same.
"We offer these sessions to parents in a wide range of community settings," Tiffany says. "Peer educators have done creative things like negotiating with manufacturing plants to offer sandwich seminars, and they’ll do a series of six or eight seminars."
Employers have cooperated by extending lunch hours and allowing educators on site to conduct the seminars. Sometimes the volunteers even obtain small grants to pay for sandwiches and lunch food.
"These seminars will center around the issues of teaching kids about sexuality, HIV/AIDS, risk reduction, and other issues between kids and parents," Tiffany says. "The overarching theme is to take it to the parents, maybe in an employment setting, prison, shelters for people who are homeless, and others."
One unemployed volunteer even conducted mini-educational sessions while she waited in long lines at the unemployment office. "She would take her kit with her, and while in line she would offer some of the communication activities about learning about HIV/AIDS," Tiffany says.
2. Use the Cornell program’s standard curriculum.
The Cornell curriculum includes information for three sessions of 2.5 hours each. It’s available at no charge at the program’s Web site (www.human.cornell.edu/pam/extensn/hivaids/) or copies may be purchased for a nominal fee.
"There’s a lot of flexibility in how people offer the workshops, but we recommend they do it in multiple sessions, because a lot of learning happens in between the sessions," Tiffany says. "Parents will initiate conversations with their kids, and the educators ask them to tell stories when they come back to the next session."
This ongoing dialogue about what happens at home and what is being taught in the workshop is what facilitates behavioral changes and lasting education.
The self-explanatory curriculum is easy to use. Facilitators can adapt the material to suit their own group’s needs. "People do need to fold in local content, because the program looks at people’s experiences with HIV/AIDS," Tiffany says.
The program also includes illustrations and graphic details about condom use and other risk reduction strategies. A chapter on "How to Talk to Kids about AIDS" suggests that parents tell their toddlers, "This is your hand, this is your knee, this is your vulva/penis, this is your foot, this is your nose." The idea is to bolster the child’s comfort with and respect for the human body and build a foundation for talking about sexuality later.
"What you tell your kids about HIV is mediated by where they are in the process of growth and development," Tiffany says. "But this is valuable, life-saving information, and everyone needs to know it whether or not they use it at this moment."
The program has been well-received by parents and other participants over the years, Tiffany says. "I think the reason it’s well-received is the process of talking about these things as a dialogue instead of having an expert lecturer talk to people."
3. Give parents/guardians tools and incentive to discuss HIV with their children.
Some of the program’s activities help parents first become comfortable with discussing HIV/ AIDS with other adults. For example, in one activity, the facilitator asks group members to discuss their own experiences of when they first heard about HIV/AIDS. They can further discuss what sort of impact it had in their community.
"When you have a small group of six to eight people talking about these things and saying, This is my experience,’ and then talking as a group about AIDS, then you show that there has been an impact from the disease," Tiffany explains. "It’s gone from being some distant disease that you blame others for to a more personal concern."
Some other activities give parents suggestions for discussing the disease with their children. These explain how the children might be at risk and what the children can do to reduce that risk.
Rather than have a polarized debate about the virtues of abstinence only and condom use, parents can talk about these strategies as part of a bigger continuum, each useful in its own time.
"It does a disservice to people’s health to say that we have to back one and exclude the other," Tiffany says. "People who come to the workshops have the opportunity to say where they’re coming from."
Sometimes participants will say, "I don’t support the fact they are teaching XYZ in the classroom, and this is why," Tiffany says.
Then other parents in the group might comment, "Hmm, well, I think about it this way," she adds. "Sometimes people’s hearts and minds are changed, and sometimes they’re not, but the discussion is civil."
The important thing is for parents to learn how important it is for them to be involved in discussions about HIV with their children. Studies show that when parents discuss HIV comfortably with their children, the children are more likely to be able to discuss risk behaviors with their sexual partners and also are more likely to delay first-time sexual activity and to use a condom for their first sexual intercourse experience, Tiffany says.
Some of Cornell’s research about teenagers and parents suggests that teens want more dialogue and support from their parents, but they want to be recognized as people who are becoming more independent and responsible for their own actions, Tiffany says.
"They want parents who are good listeners and who are sources of information," she explains. "Teens also want their parents to not restrict their activities, but to recognize that they soon will be on their own and need to learn how to become independent."