Rural Prevention Report
(Spring 1996, Vol. 3, No.1)

Government Report Examines Impact of HIV/AIDS on America's Youth

One of four of all new HIV infections in the United States are estimated to occur in young people between ages 13 and 20. That means two Americans under the age of 20 become infected with HIV every hour. Further, the rate of infection among our young p eople is increasing as the epidemic spreads into the nation's heartland and suburban communities.

These troubling trends are highlighted in a recently released report to President Clinton by the White House Office of National AIDS Policy. The report, Youth and HIV/AIDS: An American Agenda, examines the current state of the impact of HIV and AIDS on America's young people and presents a series of actions that can be taken to reverse the problem.

The report notes that an estimated 40,000 to 80,000 Americans become infected with HIV each year, with one-half of new infections occurring among people under age 25. Experts expect this high rate of infection to continue unless a greater commitment to HIV prevention is made by young people themselves, their families, their educational and cultural institutions, their religious institutions, and their peers. (The cumulative number of AIDS cases for 13-19 year olds is 2300. See Figure 1).

Figure 1. Number and Percentage of Total Cases of 13-19 Year Olds with AIDS and Period of Report - United States, 1981 - October 1995*

Cumulative cases = 2,300 (0.5%)
*Based on MMWR, 1995, 44(46): Table 1, p. 850

According to the report, adolescents can protect themselves from HIV infection if they are given comprehensive information and the tools, skills, and reasons to use them. Suggested prevention strategies include:

• Parents can be the best teachers for their children.
• Efforts to encourage sexual abstinence should continue to be supported.
• It is inadvisable to separate HIV prevention from STD prevention, pregnancy prevention, substance abuse prevention, sexuality education, self-esteem activities, and human development education.
• Successful prevention efforts concentrate on providing access to accurate information, personalizing this information to motivate change, providing training in behavioral skills to build competence, communication, and self-esteem.
• 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.

Individual copies of the report can be obtained by calling the National AIDS Hotline at (800) 342-AIDS.

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RPC Publishes Monograph of Conference Papers

The RPC recently sponsored the publication "HIV/AIDS Education in Rural Communities" as a special edition of The Health Education Monograph Series. The monograph, edited by RPC co-director Mohammad R. Torabi, is published by Eta Sigma Gamma, the National Professional Health Education Honorary.

The monograph includes eight articles featuring manuscripts of the presentations made at the RPS's first annual conference in Febrary 1995. The articles address several important issues related to HIV/AIDS in rural areas, such as HIV and women, intera ctional HIV/AIDS prevention activities for adolescents, HIV/STD risk and health behaviors the modeling of the HIV/AIDS epidemic in Indiana, and AIDS drug treatment.

Up to five copies of the monograph are available free upon request to the RPC.

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Study Shows Ongoing Risk of HIV Infection for Young Adults

While the rate of new AIDS cases reported among white men born prior to 1960 seems to have reached a plateau, the rate among other groups including younger Americans continues to escalate, according to report from the National Cancer Institute publishe d in Science magazine. The report indicates the ongoing risk of HIV infection among successive generations of young adults.

The study analyzed reported AIDS cases and estimates of HIV infection by age and race, finding that the epidemic varies drastically by demographic group. Between 630,000 and 900,000 Americans are living with HIV as of January 1993.

The estimated incidence of HIV infection declined markedly over time among white males, especially those older than 30 years. HIV incidence appears to have remained relatively constant among women and young adults. As of January 1993, prevalence was hi ghest among young adults in their late twenties and thirties and among minorities.

As each generation comes to age, there is a substantial increase in the rate of infection as individuals enter their late teens and early twenties, with infection rates peaking in the mid- to late-twenties. The study concludes that, "If HIV infection rates remain at the levels indicated, HIV must be considered an endemic infection affecting successive cohorts of young adults." Numerous studies have suggested a falling average age of infection. The study underscores the need to intensify prevention efforts for young Americans, particularly minorities. Sustained, targeted prevention for each group entering young adulthood will help control HIV infection in young people.

SOURCE
Rosenberg, P. S. (1995). Scope of AIDS Epidemic in the United States. Science, 270, 1372-1375.

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RPC Conducts Adolescent Projects

Several RPC projects focus on adolescents. Current or completed projects concern the assessment of rural adolescent and special education students' HIV/STD education needs, determining rural youth preferences for delivery of HIV/ AIDS prevention messag es, determining the estimates of school groups and the community concerning rural adolescent HIV/STD risk behavior, and the examination of sexual behavior and alcohol use of at-risk rural adolescents.

Other adolescent-related projects include conducting a youth peer educator training conference and the creation of a training manual, development of HIV/STD educational cartoon books and computer software, development of safer sex and ethics educationa l activities, and evaluation of a school based STD/HIV education curriculum.

The RPC has also produced two Fact Sheets specifically related to adolescents: Preventing HIV/STD Among Adolescents and Creating HIV/STD Education Messages for Adolescents.

The RPC is currently conducting several other projects involving faculty and graduate students from Indiana University and Purdue University. A booklet describing the 1996 RPC projects is available free upon request to the RPC. The title, a brief abstr act, and investigator's address is given for each project.

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Report Suggests HIV Prevention Strategies for Rural Youth

Providing rural young people with safe alternatives to risky behavior is one HIV prevention strategy suggested in the report, NO IMMUNITY: Preventing HIV Among Rural Youth, published by Advocates for Youth. The report, which resulted from a meet ing of professionals concerned with HIV and teen sexuality issues in small communities, identifies barriers to HIV prevention education and suggests approaches for overcoming the barriers. A concern about the growing need for effective HIV prevention effo rts in rural areas and the inadequacy of current programs in many rural communities prompted the meeting.

Although there are obstacles to educating all youth, several barriers that are intensified in rural areas were cited, which include:

• Limited resources available to rural youth serving agencies.
• Conservative and judgmental attitudes about sexuality education.
• Lack of confidentiality in small communities.
• Hostility toward agency staff attempting to provide education/services.
• Youth boredom/isolation leading to adolescent risk taking.
• Ignorance/denial among adolescents about personal risk for HIV infection.

Prevention efforts must be directed by committed leaders to insure quality programs. Recommended methods for overcoming barriers to adolescent AIDS education were:

• Develop intragency, interagency, and media support for HIV prevention programs.
• Develop programs and materials relevant for rural youth by incorporating HIV education into existing youth health programs, by involving youth, by adapting existing resources, and by creating materials which are age and culturally appropriate.
• Create alternatives to risky behaviors.

Copies of the report can be obtained by contacting Advocates for Youth at (202) 347-5700.

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Teen Study Shows HIV/STD Educational Needs

Nearly one-half of sexually experienced and those not yet experienced say they need more information about preventing AIDS and other STDs, according to a new survey of 1,510 American youth, ages 12-18. Other findings include:

• Many say they need information before sexual involvement.
• 52% who had sex worry about getting AIDS or other STDs.
• 63% and 55% said they have talked to a parent about AIDS and other STDs, respectively.
• 57% said that the information they receive about sex and birth control often comes too late, and nearly one-half noted that it does not include enough detail about how to use birth control and where to get it.
• Many indicated that they need help with difficult decisions they face about sexual relationships and that drugs, alcohol, and peer pressure compromises their decision making ability.

SOURCE
The Kaiser Family Foundation Survey on Teens and Sex: What They Say Teens Today Need to Know, And Who They Listen To. To obtain a copy contact the Publication Request Line at (800) 656-4533.

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National Youth Summit Report Available

The National Association of State Boards of Education has released The National Youth Summit on HIV Prevention and Education Summary Report and Recommendations.

More than 160 people attended the conference to debate which HIV prevention programs have shown promise and to reach consensus on recommendations. NASBE also has the video, The National Youth Summit on HIV Prevention and Education: Video Highlights. Copies can be obtained from the NASBE Publications Dept. at (800) 220-5183.

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In the Literature

Preventing Adolescent Pregnancy, STD and HIV: A Promising New Approach. D.M. Grimley, R.J. DiClemente, J.O. Prochaska & G.E. Prochaska. Family Life Educator 13 (Spring 1995):7-15.

• This article describes the applicability of the Transtheoretical Model (TTM) as a framework for understanding and modifying adolescent high-risk sexual behavior. TTM defines behavior change as an incremental, continuous and dynamic process which has four constructs: stages of change, processes of change, decisional bal ance (pros and cons) and self-efficacy. TTM has demonstrated its applicability across a broad spectrum of diverse populations differing on such characteristics as gender, socioeconomic status age and ethnicity.

Cultivating Heath: An Agenda for Adolescent Farm workers. A.C. de Schmidt. (1994). National Coalition of Advocates for Students: Boston.

• This book is a report of a national conference NCAS convened to prioritize the health needs of adolescent farm workers, identify effective strategies for working with migrant youth, and shape a national agenda for addressing their physical and mental h eath needs. The report offers action agenda focusing on HIV prevention, sexuality, substance abuse, mental health issues and occupational health.

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Teenagers Know More about STDs than Adults, But Knowledge for Both Groups is Low

American teenagers are more likely than adults to know that STDs are widely prevalent, that some STDs other than HIV/AIDS are incurable and that some STDs have no symptoms, according to a recent study commissioned by the American Social Heath Associati on. However, fewer teens than adults were able to name an STD other than HIV/AIDS.

The study also found that 43 percent of adults and 30 percent of teens know someone who has had an STD and that schools are increasingly importance as primary educators about STDs. Also, over half of the adults and over one-third of teens said their he ath care providers spend "no time at all" discussing STDs with them. For more information about the survey contact ASHA at (313) 361-8400.

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National Hotlines

National AIDS Hotline

• English Service (7 days/week, 24 hours/day): (800) 342-2437
• Spanish Service (7 days/week, 8 a.m.-2 a.m. EST): (800) 344-7432
• TDD Service for the Deaf (Monday-Friday, 10 a.m.-10 p.m. EST): (800) 243-7889

National STD Hotline

• (Monday-Friday, 8 a.m.-11 p.m. EST): (800) 227-8922

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