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How is HIV transmitted?

HIV is transmitted when infected blood, semen, vaginal fluids, organs, or breast milk enter another person's body. This most often occurs during unprotected sex or during injection drug use (when needles are shared). Anyone who is infected with HIV can transmit it, whether or not they appear sick, have an AIDS diagnosis, or are taking effective treatment for their infection. Although effective treatment greatly reduces the amount of virus in a person's body, often virus remains in the semen and other sexual fluids, making the person still infectious. Infected women who become pregnant can transmit HIV to their newborns and are much more likely to do so if they are not treated effectively. Thus, it is now being recommended that every pregnant woman be tested for HIV, regardless of their risk profile.

HIV Transmission Requires

Infected body fluid:

· Blood, semen, vaginal secretions & breast milk.

Entry to the body:

· Mucous membrane – anal, oral or vaginal.

· Blood to blood – needle or broken skin.

· Prenatal – in utero, during birth & breastfeeding.

HIV is spread in the following ways:

Unprotected sexual intercourse

HIV can enter the body during sex through the mucous membranes of the anus, vagina, penis (urethra), or mouth; AND through cuts, sores, and abrasions on the skin. With each of these practices, the receptive partner (vagina, anus, mouth) is at somewhat greatest risk

Oral sex

The risk of becoming infected with HIV through unprotected (without a condom) oral sex (without a condom) is lower than that of unprotected anal or vaginal sex. However, even a lower risk activity can become an important way people get infected if it is done often enough. A recent study found that 7.8% (8 of 102) of recently infected men who have sex with men in San Francisco were probably infected through oral sex. Oral sex is reported as a more frequent activity than anal sex and is almost never protected by condoms. And because many people (especially youth) do not associate oral sex with risk, oral sex is more likely to be unprotected than anal or vaginal sex.

Injection drug use.

Using shared, unsterile needles and syringes carries a high risk of HIV transmission. Sharing drug injection equipment (such as cookers, cottons, and water for mixing) can also transmit HIV. After use, small amounts of blood can remain in the used needles, syringes, cookers, and cottons. Blood may also remain in the water used for mixing drugs. This remaining blood can enter the body of the next user when any of these items are shared. If this blood is HIV infected, transmission can easily occur. Sharing other types of needles also may transmit HIV and other germs. These types of needles include those used to inject steroids and those used for tattooing or piercing. Tattoos and piercings should be done by a qualified technician who uses only sterile equipment.

From an infected mother to her infant.

HIV can be transmitted from mother to child during pregnancy, more often during birth, or through breast-feeding. Before treatment with AZT became a routine recommendation for women near the end of their pregnancy and children following birth, about 1 in 4 or 5 babies born to HIV-infected women became infected. Now, when treatment is taken, the HIV transmission rate from a mother to her baby is greatly reduced. Consequently, all pregnant women should see their doctor, be tested for HIV, and obtain recommended treatment.

HIV is rarely, or never transmitted in the following ways:

Blood transfusions and organ transplants. The risk of acquiring HIV from a blood transfusion today is estimated to be 1 out of 600,000 transfusions. The risk of acquiring HIV from an organ transplantation is probably similar; however, with newly effective treatments for HIV some people who might otherwise die from immediate lack of an organ may prefer an HIV-infected one. Before 1985, there were no tests to screen blood and organ donations for HIV. Today, blood and organ banks screen out most potential donors at risk for HIV infection in advance. They then do extensive testing on specimens of blood, blood products, and organs for HIV and other blood-borne germs.

The health care setting. There is a very small, but real, risk of health care workers getting HIV from patients as a result of needle stick accidents and other substantial blood exposures. The risk of patients getting infected from health care workers is also very small. A large series of studies of HIV-infected surgeons and dentists have not shown any transmissions to patients. Nonetheless, seven patients may have become infected from a dentist with AIDS in Florida, and several other transmissions of HIV and of Hepatitis B & Hepatitis C viruses have been traced to surgeons.

Mosquitoes. There is no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. When an insect bites a person, it does not inject its own or a previous victim's blood into the new victim. Rather, it injects saliva. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and, therefore, cannot survive) in insects.

Casual contact. HIV is not spread by casual contact. It dies quickly outside the body and is easily killed by soap and by common disinfectants such as bleach. Additionally, if the blood is dry, the virus is definitely dead.

There is no risk of HIV infection from:

· Donating blood

· Mosquito bites

· Toilet seats

· Shaking hands

· Hugging

· Sharing eating utensils, food, or objects handled by people withHIV/AIDS

· Spending time in the same house, business, or public place with a person with HIV/AIDS.

How is HIV transmission related to other STD’s?

The results of multiple studies clearly demonstrate a strong causal relationship between the presence of other STDs and the transmission of HIV. STDs (including those which cause ulcerative lesions (e.g. Herpes) and those which cause inflammation (e.g.Gonorrhea and Chlamydia) increase the likelihood of HIV transmission many-fold. HIV and other STDs are connected in at least four ways.

1. Similar behaviors put people at risk for both HIV and other STDs;

2. The presence of an STD can make people more susceptible to infection with HIV;

3. People co-infected with HIV and another STD can more easily transmit HIV infection to others.

4. People with HIV and other STDs may have more frequent and serious symptoms related to those infections.

How do you find out if you are infected?

After a person becomes infected with HIV, the body's immune system recognizes the virus as a foreign intruder and begins to make antibodies to the virus. Antibodies against HIV usually take 1-3 months to develop, rarely longer. Tests to determine if a person is infected with HIV check for the presence of these antibodies. The current HIV antibody blood tests detect antibodies 99% of the time within 3 months of infection.

Testing in most situations involves:

1.   Giving informed consent, which may require signing a form.

2.   Talking before testing with a test counselor about one's sexual and drug using behaviors, ways to reduce risks for HIV transmission, the meaning of a positive or negative test result, the need for people at risk to learn their HIV status, and any other questions that may come up about HIV.

3.   Drawing a small amount of blood, or providing an saliva oral or urine sample.

4.   For regular antibody tests, results are given in about a week either by phone or in person. Rapid testing (in which preliminary results are provided within 30-40 minutes) is becoming increasingly available.

Positive HIV antibody tests results are over 99% accurate when confirmed. Negative HIV antibody tests are over 99% accurate if it has been at least three months after a contact with exposure to a potentially HIV-infected partner. False negatives or false positives occur very rarely.

The Window Period:

The time period between a person's exposure and actual infection with HIV and until HIV antibodies become detectable in blood or other fluids is called the "window period". Most people will develop antibodies detectable with the latest blood tests within 4-6 weeks or 1-3 months after infection with HIV. Some people may take longer; but nearly all (>99%) will have antibodies by 3 months following infection. Therefore, we recommend that people wait 3 months from the time of the possible infection with HIV (the date of latest exposure) before being tested for HIV antibodies, and in the meantime assume that they might possible be infected. The test may not give an accurate negative result if a person gets tested too soon after a potential exposure. People waiting three months from the time of the exposure before testing will have a 99% accurate test result. Very rarely, cases have been reported of people taking longer than three months to develop antibodies to HIV.

What are the HIV testing, consent, & disclosure laws?

For most individuals outside the criminal justice system, the decision to test for HIV infection is a voluntary one. In some situations, such as for employment or health insurance, mandatory testing is specifically prohibited. In other situations, such as for pregnant women, testing is voluntary but HIV information and/or testing must be offered. This section discusses those situations, the types of voluntary testing available, and the laws governing consent for testing and disclosure of test results.

Prohibitions against mandatory testing.

Employment

 Health and Safety Code Section 120980 prohibits the use of HIV testing to determine suitability for employment.

Insurance

Health and Safety Code Section 120980 also prohibits insurance providers from using an HIV test as a prerequisite to obtaining insurance. Health and Safety Code Section 1389.1 requires that health insurance applications carry a prominently displayed notice that California law prohibits health care service plans from requiring or using an HIV test as a condition of obtaining coverage. Insurance Code Sections 799-799.10 allow an exception for life and disability income insurance.

Mandatory offering of HIV/AIDS information and/or testing.

Marriage

An HIV test is not required prior to obtaining a marriage license in California. However, Family Code Section 358 requires that information concerning AIDS and the availability of HIV testing be distributed to marriage license applicants.

Pregnant Women

Health and Safety Code Section 125107 requires prenatal care providers to offer HIV information and counseling to every pregnant patient for whose prenatal care the provider has primary responsibility. In addition, the provider must offer an HIV test to every pregnant patient unless the patient already has a documented positive test result or AIDS. The provider must document in the patient’s medical record that both counseling and testing have been offered.

Anonymous Testing.

In anonymous HIV testing, the identity of the test subject is not linked to the test result. In accordance with Health and Safety Code Sections 120885-120895, anonymous testing is available at Alternative Test Sites (ATS) administered by county health departments. HIV tests at these sites are free and test site counselors do not collect any identifying information (e.g., name, Social Security Number, driver’s license, etc.) from test subjects. Instead, test subjects receive a unique number that corresponds to their specimen and test result. Health and Safety Code Section 120895 requires that, at a minimum, individuals testing at an ATS be informed about the validity and accuracy of the HIV antibody test before it is performed, and that the results of this test be given in person. Anonymous testing is also available in some clinical settings other than an ATS; for example, some family planning and sexually transmitted disease clinics.

Confidential Testing.

In contrast to anonymous testing, confidential testing links the test subject’s identity to the test result. However, the confidentiality of test results is specifically protected by California law, which prohibits unauthorized disclosure (see “Disclosure of Test Results”). Confidential testing is available at publicly-funded confidential test sites as well as private health care settings. To protect the privacy of individuals taking an HIV test, Health and Safety Code Section 120975 provides that no person shall be compelled in any civil, criminal, administrative, legislative, or other proceeding to identify any individual who takes an HIV test.

Rapid HIV Testing.

Section 120917 of the Health and Safety Code authorizes participation by the Department of Health Services, Office of AIDS in a rapid HIV test research program conducted with the federal Centers for Disease Control and Prevention. In Department-designated HIV counseling and testing sites, an HIV counselor who is trained by the Office of AIDS may, under identified conditions, perform any HIV test that is classified as waived under the federal Clinical Laboratory Improvement Act. A rapid HIV test is a screening test that produces results quickly enough to allow for same-day results to be given to the patient. Under the rapid HIV test research program, the Department may perform and report clinical test results using a rapid HIV test for diagnosis, prior to test approval by the Federal Food and Drug Administration. A second, approved test shall be used to confirm initially reactive test results.

Consent Required for Testing.

In General

Except in the case of a treating physician and surgeon, Health and Safety Code Section 120990 requires written consent for HIV testing. The statute requires a treating physician and surgeon to obtain informed consent for HIV testing. Health and Safety Code Section 120990 requires specific consent for HIV testing - a general consent for medical care is not sufficient.

At an Alternative Test Site

Health and Safety Code Section 120990 does not apply to tests performed at an ATS, tests on a cadaver, donated body or organs, or blood tested anonymously as part of a scientific investigation. As previously noted, Health and Safety Code Section 120895 requires that individuals testing at an ATS be informed about the validity and accuracy of the antibody test before it is performed.

Disclosure of Test Results.

Laboratory Test Results

Section 123148 of the Health and Safety Code permits certain laboratory test results to be posted on the Internet or other electronic method if requested by the patient and deemed appropriate by the health care provider who ordered the test. Consent of the patient is to be obtained in a manner consistent with requirements of Section 56.11 of the Civil Code. The electronic delivery of clinical laboratory test results or any other related results for HIV antibody tests are specifically prohibited under this statute, regardless of authorization.

Written Authorization Requirements

Health and Safety Code Section 120980 requires that persons responsible for the care and treatment of an individual who takes an HIV test obtain written authorization prior to any disclosure of the individual’s test results in an identifying manner. This statute requires a separate written authorization for each disclosure, and must state to whom the results will be disclosed. Further, the statute provides for a civil penalty of up to $1,000 for each negligent unauthorized disclosure and $1,000-$5,000 for each willful disclosure. A negligent or willful disclosure that results in economic, bodily, or psychological harm to the test subject is a misdemeanor punishable by imprisonment of up to one year and/or a fine of up to $10,000.

Physician Exceptions to Written Authorization Requirements

Inclusion of a person’s HIV test result in his/her medical record is not considered a disclosure under Health and Safety Code Section 120980. Health and Safety Code Section 120985 permits a physician who orders an HIV test to record the results in the patient’s medical record, or otherwise disclose it without written authorization to the patient’s health care providers for the purpose of diagnosis, care, or treatment of that patient. Recording or disclosing test results in accordance with Section 120985 does not authorize further disclosure unless otherwise permitted by law. Providers of health care are to be defined as in Civil Code Section 56.05(d), with the exclusion of group practice pre-paid health care service plans.

Partner Notification Exception to Written Authorization Requirements

Health and Safety Code Section 121015 permits (but does not require) a treating physician and surgeon to disclose an individual’s confirmed positive HIV test result to the local health officer, the individual’s spouse, or any person reasonably believed to be the sexual or needle-sharing partner of the individual. Such disclosure may be made only for the purpose of diagnosis, care, and treatment of the person notified or to interrupt the chain of HIV transmission. The disclosure must not include any identifying information about the HIV-infected individual.

Prior to disclosing an individual’s test result, the physician and surgeon must discuss the results with the patient and offer appropriate emotional and psychological counseling, including information on the risks of transmittingHIV and methods of avoiding those risks. Further, the physician and surgeon must inform the patient of the intent to notify partners and must attempt to obtain the patient’s voluntary consent for partner notification. Upon notifying a spouse or partner of an HIV infected person, the physician and surgeon must refer the spouse or partner for appropriate care, counseling, and follow-up.

County health officers may notify a spouse or partner of an HIV-infected individual but cannot identify the person or the physician and surgeon making the report. As with physicians and surgeons, county health officers must refer the spouse or partner for appropriate care and follow-up. Upon completion of partner notification efforts, all records regarding the contacted person maintained by the county health officer, including but not limited to identifying information, must be expunged. For as long as records of contact are maintained, the county health officer must keep confidential the identity and HIV status of the individual tested as well as the identity of the persons contacted.

How many people have HIV/AIDS?

HIV/AIDS Worldwide

· At the end of 2003, an estimated 40 million people worldwide - 37 million adults and 2.5 million children younger than 15 years - were living with HIV/AIDS. Approximately two-thirds of these people (26.6 million) live in Sub-Saharan Africa; another 18 percent (7.4 million) live in Asia and the Pacific.

· Worldwide, approximately 11 of every 1000 adults aged 15 to 49 are HIV-infected. In Sub-Saharan Africa, about 8 percent of all adults in this age group areHIV-infected.

· An estimated 5 million new HIV infections occurred worldwide during 2003; that is, about 14,000 infections each day. More than 95 percent of these new infections occurred in developing countries, and nearly 50 percent were among females.

· In 2003, approximately 2,000 children under the age of 15 years, and 6,000 young people aged 15 to 24 years became infected with HIV every day.

· In 2003 alone, HIV/AIDS-associated illnesses caused the deaths of approximately 3 million people worldwide, including an estimated 500,000 children younger than 15 years.

HIV/AIDS in the United States

· The Centers for Disease Control and Prevention (CDC) estimate that 850,000 to 950,000 U.S. residents are living with HIV infection (nearly 75,000 of whom live in California), one-quarter of whom are unaware of their infection.

· Approximately 40,000 new HIV infections occur each year in the United States, about 70 percent among men and 30 percent among women. Of these newly infected people, half are younger than 25 years of age.

· Of new infections among men in the United States, CDC estimates that approximately 60 percent of men were infected through homosexual sex, 25 percent through injection drug use, and 15 percent through heterosexual sex.

· Of new infections among women in the United States, CDC estimates that approximately 75 percent of women were infected through heterosexual sex and 25 percent through injection drug use.

· The estimated number of AIDS diagnoses through 2002 in the United States is 886,575. Adult and adolescent AIDS cases total 877,275, with 718,002 cases in males and 159,271 cases in females. Through the same time period, 9,300 AIDS cases were estimated in children under age 13.

· The estimated number of new adult/adolescent AIDS diagnoses in the United States was 43,225 in 1998, 41,134 in 1999, 42,239 in 2000, 41,227 in 2001, and 42,136 in 2002.

· The estimated number of new pediatric AIDS cases (cases among individuals younger than age 13) in the United States fell from 952 in 1992 to 92 in 2002.

· From 1985 to 2002, the proportion of adult/adolescent AIDS cases in the United States reported in women increased from 7 percent to 26 percent.

· As of the end of 2002, an estimated 384,906 people in the United States were living with AIDS.

· As of December 31, 2002, an estimated 501,669 people with AIDS in the United States had died.

· The estimated annual number of AIDS-related deaths in the United States fell approximately 14 percent from 1998 to 2002, from 19,005 deaths in 1998 to 16,371 deaths in 2002.

How do you prevent HIV infection?

Abstain from vaginal, anal, or oral sex:

The surest way to avoid the sexual transmission of HIV infection is to abstain from sexual activity with other people. The next surest way is to have sex with only one partner who is known to be uninfected with HIV and who only has sex with you.

 For someone with an HIV positive partner, a partner who does not know their HIV status, or multiple sexual partners:

Touching, dry kissing, body rubbing, and mutual masturbation are the safest sexual activities. For any penetrative sex acts such as vaginal, anal, or oral sex, condoms are highly effective at reducing the risk of HIV transmission especially when used consistently and correctly.

For those with a new sex partner:

Abstain or use condoms for at least 3 months and then get tested for HIV antibodies. If you and your partner are both HIV negative and each of you are not engaging in other risk behaviors (e.g., sharing needles or having other sex partners), then you won't have to worry about HIV infection.

Abstain from injection drug use:

The surest way to completely avoid HIV infection from injection drug use is to abstain. The next surest way is to use a brand new syringe every time you inject. If brand new syringes are not available, properly bleaching a used syringe may be an effective method of reducing HIV transmission.

Sharing drug injection equipment (such as cookers, cottons and water used for mixing/bleaching) also can transmit HIV. To avoid infection, these items must not be shared.

Drugs -- injected or not -- can also increase a person's risk for HIV by impairing judgment, decision-making ability, and/or by increasing sexual drive. Studies have shown that - even when drunk or high - people can successfully use condoms and clean needles/syringes. Nonetheless, people who are drunk or high often take more risks than if they were sober.

How effective are condoms?

The proper and consistent use of latex or polyurethane condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection. Safer sex means always assuming that your partner could be HIV-infected, and never allowing his or her risky body fluids (blood, semen, vaginal fluids, and breast milk) to enter your body. Touching, dry kissing, body rubbing, and mutual masturbation are the safest sexual activities. Safer penetrative sex means always using a latex barrier for vaginal, anal, and oral intercourse. This includes using a condom on a man or barrier protection such as plastic wrap, a dental dam, or cut condom for oral sex on a woman and for oral-anal contact. A latex condom wall is approximately .05 mm thick and has no pores. HIV is approximately .001 mm in size and thus would have to move through a barrier 500 times thicker than the virus itself. More-over, laboratory studies show that intact latex condoms do not allow air, water, viruses (e.g. HIV, Herpes,       Hepatitis B), or other organisms such as bacteria to pass through. "Natural" condoms, made from animal intestinal tissue, do have pores, some of which are large enough that HIV and other viruses might pass through and thus are not recommended for HIV or other STD prevention. 

Following these basic rules will further reduce the small chance of condom failure:

1. Use latex (rubber) or polyurethane condoms. These are preferable to “natural skin” condoms, which may have tiny holes in which HIV may pass.

2. Choose a condom that fits. Condoms come in different sizes, shapes, and styles. Experiment with different condoms and practice putting them on before intercourse. Also practice talking with a close friend about your desire and intention to use condoms.

3. Open and handle condoms carefully. Never use a condom in a damaged package or one that is past its expiration date. Do not store condoms in hot or sunny places (for example, in a wallet or by a window).

4. Use plenty of water-based lubricant to reduce the friction that can cause breakage. Never use oil-based lubricants like Vaseline, hand cream, Crisco, or mineral oil, which can rapidly break down latex and allow the virus to pass through. Water-based lubricants include K-Y Jelly, Slippery stuff, ForPlay, and most contraceptive jellies.

5. Put the condom on after erection but before insertion. Leave some room at the tip for the discharged semen (some condoms have a reservoir tip for this). It is important to pinch the tip as you roll it down onto the penis to be sure that there are no air bubbles that could pop under pressure. If the penis is uncircumcised, pull back the foreskin before unrolling the condom all the way down to the base of the penis.

6. After intercourse, withdraw the penis while still erect, holding the base of the Condom to prevent it from slipping off or spilling semen.

7. Remove the condom and wash the penis with soap and water.

8. Use a condom only once and dispose of it in the garbage; do not flush condoms down the toilet. Never reuse a condom.

9. Use a condom EVERY TIME during sex when transmission or acquisition of HIV is possible.

Most condom failures can be blamed on the user, not the condom. In order for condoms to provide maximum protection, they must be used consistently (every time) and correctly. Incorrect use contributes to the possibility that the condom could leak or break. When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception.

Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection. In a two-year study in Europe, among couples in which one partner was infected with HIV and the other uninfected (HIV discordant couples), researchers demonstrated that consistent use of condoms significantly reduced the chance of passing HIV from the infected partner to the one not infected. Among 124 discordant couples who used condoms consistently over the study period, none of the uninfected partners became infected with HIV. In contrast, among 121 discordant couples who did not use condoms consistently, 12 (10%) of the uninfected partners became infected during the study period. Other researchers concluded that the “per contact” probability of transmission of HIV was reduced 90-95% by the use of condoms.

Condoms do not need to be 100% effective to be strongly promoted for two reasons: 1) at least 90% efficiency is significant protection; and 2) 100% efficiency is not now and has never been a criterion for promoting any safety device, (e.g. seatbelts, smoke alarms, helmets, or even vaccination).

Condoms are classified as medical devices and are regulated by the Food and Drug Administration. Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. Several studies of correct and consistent condom use clearly show that condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.

Condoms help preventSTDs and unwanted pregnancies and studies show that increasing availability of condoms through community campaigns and school availability programs does not increase sexual activity in targeted populations. Latex condoms are highly effective in preventing pregnancy and most sexually transmitted diseases, including HIV infection, but only if they are used consistently and correctly.

Educational programs designed to increase adolescent self-efficacy in practicing HIV/STD prevention and risk reduction are an important key to overall control efforts. Schools, youth-serving organizations, and minority organizations must conduct HIV/STD prevention programs. Special attempts should be made to reach out-of-school youth and youth in high-risk situations, such as runaway, migrant, incarcerated and homeless adolescents. HIV and STD prevention messages should be combined into one program.

Contact SCAP at 572-2437 to find out more about our Youth, High-Risk Populations, Migrant and Minority Communities, and Business education and prevention outreach programs.

Research on specific, school adolescent HIV/STD and sexuality education programs have shown positive results, such as delaying onset of coitus, increasing the use of protection against HIV/STD and pregnancy, and reducing the frequency and number of sex partners. Research studies of sexuality and HIV/STD education programs revealed that such programs do not hasten the start of coitus in adolescents. The successful programs (1) had a specific focus on reducing specific sexual risk-taking behaviors, (2) emphasized the modeling and practice of prevention and risk reduction skills, (3) reinforced values and group norms against unprotected sex, and (4) discussed social pressures to have unprotected sexual activity.

The U.S. National Commission on AIDS recently made several recommendations concerning educational approaches for HIV prevention in adolescents, which are also applicable to a combined HIV/STD education program.

· Abstinence messages, such as postponing sexual activity, should be included and encouraged, and adolescents that choose abstinence should be supported.

· HIV prevention programs should include information, examination of values and attitudes, skill building such as decision-making, negotiation, and refusal, and access to health care and social services.

· School-based HIV education should be presented as part of a comprehensive health science education curriculum that begins in elementary school, which includes sexuality education and teaches general prevention skills.

· Schools and other youth-serving institutions should select curricula and teaching strategies that have been shown to be effective by evaluation.

· Parents and young people should be involved in the development of prevention programs.

· HIV prevention programs must be culturally and specific population sensitive, developmentally appropriate, nonjudgmental in approach, repeated, sustained over time, and complemented with efforts to change behavioral norms and to empower individuals.

· Utilizing peers as educators can be valuable if combined with other approaches in a comprehensive program.

· Prevention efforts limited to instilling fear or that omit important information will not facilitate wise health behavior or sustain risk reduction.

· Information and skill enhancement about methods of HIV/STD prevention other than abstinence, such as use of condoms, should be included. This information is needed immediately for the sexually active youth and by other youth who will be active in the future.

Educational strategies dealing with prevention must be dealt with in a manner acceptable to the community. However, withholding complete prevention information can place adolescents at risk for HIV/STD.

What works in HIV prevention education?

Educational programs designed to increase adolescent self-efficacy in practicing HIV/STD prevention and risk reduction are an important key to overall control efforts. Schools, youth-serving organizations, and minority organizations must conduct HIV/STD prevention programs. Special attempts should be made to reach out-of-school youth and youth in high-risk situations, such as runaway, migrant, incarcerated and homeless adolescents. HIV/STD prevention messages should be combined into one program.

Contact SCAP at 572-2437 to find out more about our Youth, High-Risk Populations, Migrant and Minority Communities, and Business education and prevention outreach programs.

Research on specific, school adolescent HIV/STD and sexuality education programs have shown positive results, such as delaying onset of coitus, increasing the use of protection againstHIV/STD and pregnancy, and reducing the frequency and number of sex partners. Research studies of sexuality and HIV/STD education programs revealed that such programs do not hasten the start of coitus in adolescents. The successful programs (1) had a specific focus on reducing specific sexual risk-taking behaviors, (2) emphasized the modeling and practice of prevention and risk reduction skills, (3) reinforced values and group norms against unprotected sex, and (4) discussed social pressures to have unprotected sexual activity.

The U.S. National Commission on AIDS recently made several recommendations concerning educational approaches for HIV prevention in adolescents, which are also applicable to a combined HIV/STD education program.

· Abstinence messages, such as postponing sexual activity, should be included and encouraged, and adolescents that choose abstinence should be supported.

· HIV prevention programs should include information, examination of values and attitudes, skill building such as decision-making, negotiation, and refusal, and access to health care and social services.

· School-based HIV education should be presented as part of a comprehensive health science education curriculum that begins in elementary school, which includes sexuality education and teaches general prevention skills.

· Schools and other youth-serving institutions should select curricula and teaching strategies that have been shown to be effective by evaluation.

· Parents and young people should be involved in the development of prevention programs.

· HIV prevention programs must be culturally and specific population sensitive, developmentally appropriate, nonjudgmental in approach, repeated, sustained over time, and complemented with efforts to change behavioral norms and to empower individuals.

· Utilizing peers as educators can be valuable if combined with other approaches in a comprehensive program.

· Prevention efforts limited to instilling fear or that omit important information will not facilitate wise health behavior or sustain risk reduction.

· Information and skill enhancement about methods of HIV/STD prevention other than abstinence, such as use of condoms, should be included. This information is needed immediately for the sexually active youth and by other youth who will be active in the future.

Educational strategies dealing with prevention must be dealt with in a manner acceptable to the community. However, withholding complete prevention information can place adolescents at risk for HIV/STD.

This information is not intended to diagnose, treat, or cure any symptoms or diseases.

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