THE push to teach youths how to avoid AIDS is changing the face of traditional sex education in schools across the United States. Three years ago, no states required AIDS education. Today, 33 states do and the rest encourage it. More and more school districts have incorporated education on AIDS (acquired immune deficiency syndrome) into sexuality education, health, family life, and biology classes - even social studies. Many new teaching tools - pamphlets, videos, and even comic books - are being disseminated. And frank discussion about sexual practices and condoms as protection against disease, which would have been unthinkable in younger grades only a few years ago, is becoming common.
More states now mandate AIDS education than sex education, and according to a national study, 80 percent of sex education money is spent on AIDS education. While only 1 percent of AIDS cases involve adolescents, many public health officials say teenagers are increasingly at risk of becoming infected, because of their experimentation with drugs and sex. Twenty percent of all AIDS cases involve people in their 20s; because of the long incubation period for the AIDS virus, many believe those people contracted the disease in their teens.
Since 1981, more than 128,000 cases of AIDS have been reported in the United States, according to the Centers for Disease Control (CDC), the lead federal agency for AIDS prevention. The CDC estimates that as many as 1.5 million Americans may be infected with the human immunodeficiency virus (HIV), which researchers say causes AIDS.
Schools have found themselves on the front lines of educating youth about the disease. A recent General Accounting Office (GAO) report finds that two-thirds of all school districts require AIDS prevention education in some grades, but that teachers lack sufficient training to give such education. It also found that the subject received the least attention in the upper grades, when sexual activity is deemed most likely.
A National School Boards Association survey of AIDS education in 332 school districts found that 14 percent first discussed condoms in elementary school, 57 percent in the middle schools, and 28 percent in high schools.
In the San Francisco School District children as young as kindergarten are taught about AIDS, but at that level the focus is to relieve fears of having a classmate who has been diagnosed as having the disease, says Beverly Bradley, supervisor for the health programs office of the San Francisco school district. ``We have lessons designed to be taught in context of social studies, like other epidemics in the past,'' Dr. Bradley says.
Some observers say that the push to educate young people about AIDS has overshadowed education about pregnancy and sexually transmitted diseases. Others are concerned that the focus of AIDS education is in some respects too negative.
``The first time kids hear about sex, it's linked with death,'' says Devon Davidson, project director of Viviremos, an AIDS education project of the National Coalition of Advocates for Students.
``We believe that disaster prevention is only one goal of sexuality education,'' says Debra Haffner, executive director of the Sex Information and Education Council of the US. ``We need to be helping people learn how to ... develop a personal sense of values and ethics, and develop the capacity for meaningful interpersonal relationships. That's not happening.''
But others say the AIDS crisis has prompted schools to look at ways to promote positive healthy behavior early on in school.
``Many schools are talking about providing comprehensive health education that includes dealing with smoking, drinking, drug abuse, sexual abuse, violence prevention, as well as AIDS and sex education,'' says Tim Dunn, HIV-AIDS education coordinator for the Massachusetts Department of Education.
``The hypothesis now is that you need to start very early talking with kids about responsible decisionmaking,'' Mr. Dunn says.
Because abstinence from sexual activity is seen as one of the most effective ways to prevent the spread of AIDS, educators are focusing on it more than they did.
``There's complete agreement from all sectors that if we're going to keep our kids alive, we have to ...encourage abstinence, limit the number of partners, and be protected ... ,'' Bradley says.
``I don't think those are choices that are as unpopular as one would think,'' she says. ``The assumption that everybody's doing it is a perception of the media.'' A CDC study found that about half of 16-year-olds have had sexual intercourse; by age 19, 70 to 80 percent have.
``Five years ago if I'd brought up abstinence, they'd laugh in my face,'' says Sue Chelini, human sexuality teacher at Redwood High School in Larkspur, Calif. ``Now they take it more seriously.''
CDC officials say AIDS education should be age-appropriate and locally developed in line with community norms.
In San Francisco, with its large gay population, the curriculum also deals with scapegoating and stereotyping homosexuals.
The curriculum also has to be sensitive to the cultural needs of the large Hispanic and Asian populations, educators say.
Oklahoma was the first state to require AIDS education, and Oklahoma City has developed teachers' guides that includes the origin and history of the virus, corrects misconceptions about AIDS, and identifies high-risk behaviors.
By law, Oklahoma schools must hold a workshop explaining the AIDS curriculum to parents and guardians a month before it is taught. No student is required to participate if his or her parent or guardian objects in writing, says Carolyn Hughes, assistant superintendent of curriculum and program development for the Oklahoma City schools.
``The first year, not one parent objected,'' she says. ``They've been very supportive.''
First of two articles. The second will appear Friday.