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The Virginia Department of Education's Family Life Education Curriculum (1991) describes some of these factors which increase special education students vulnerability for not only HIV infection but other sexually transmitted diseases, sexual abuse, and teen pregnancy as well:

• Knowledge. Students with disabilities are generally less knowledgeable than other students about their bodies and their sexuality. This leads to poor decision-making related to their sexuality and an inability to protect themselves. This lack of information can be attributed to the following causes:
  • They have generally been excluded from sex education programs in schools.
  • Parents, who are sometimes uncomfortable teaching sexuality to their children, often feel even more insecure teaching a child who has a disability.
  • Many students do not know when and whom to ask for help and may lack the cognitive or communication skills necessary for asking questions.
  • Students are often unable to get information from written materials, because few publications are written on their reading level.

• Misinformation. Some students with disabilities are more likely than other students to believe myths and misinformation because they are unable to distinguish between reality and unreality. They may also become easily confused or frightened by misinformation.

• Social Skills. Students with disabilities may have limited opportunity for social development. Their chances to observe, develop, and practice social skills are limited or nonexistent. Many students do not have such basic social skills as knowing how to greet others and how to show affection appropriately.

• Power and Control. Some students with disabilities are easily influenced by others. These students may do whatever others suggest without question, due to their dependency and desire to please.

• Self-Esteem. Students receiving special education services may have low self-esteem. In an effort to be accepted by others or to gain attention (either positive or negative) students with low self-esteem are more likely than other students to participate in risky behaviors.

• Judgment. Students in special education may have poor judgment, poor decision-making skills, and poor impulse control. Without direct instruction, they are unable to recognize the consequences of their actions.

Status of Prevention Education for Special Learners

In an unpublished (as of August, 1991) survey of 2,150 school districts, the National School Boards Association (NSBA) discovered that 67 percent of respondents require some form of HIV prevention education for their students. HIV Education Specialists from the Centers for Disease Control estimate that by the year 2000, 75 percent of the nation's school districts will provide planned sequential HIV education from Kindergarten through Grade 12. At present, most districts teach about HIV prevention within the health education curriculum.

Unfortunately, many special education students who are not in mainstream classes do not participate in health education. The NSBA survey indicates that 80 percent of students with learning disabilities, i.e., those likely to be mainstreamed, receive HIV prevention education; however, only 46 percent of those with moderate mental retardation receive similar instruction. Seventy percent of the students with communication disorders receive instruction in HIV prevention, but the proportion drops to 21 percent for students with autism. Approximately 49 percent of the students with emotional disturbance receive instruction aimed at changing behaviors that put students at risk for HIV infection.

Purpose of Effective Education about Aids

According to the Centers for Disease Control (CDC), the main purpose of education about HIV and AIDS is to prevent HIV infection. Specific goals of HIV prevention education are to (a) help students learn how to resist social influence to engage in risk-taking behavior, (b) increase students' perceptions of their ability to adopt self-protective behaviors, and (c) create an environment conducive to candid discussion of sensitive topics. (DiClemente & Houston-Hamilton, 1989).

The Center for Disease Control's Guidelines for Effective School Health Education to Prevent the Spread of Aids state that school systems should make programs available that will enable and encourage young people who have not engaged in sexual intercourse and who have not used illicit drugs to continue to:

• Abstain from sexual intercourse until they are ready to establish a mutually monogamous relationship within the context of marriage.
• Refrain from using or injecting illicit drugs.

For young people who have engaged in sexual intercourse or who have injected illicit drugs, school programs should enable and encourage them to:

• Stop engaging in sexual intercourse until they are ready to establish a mutually monogamous relationship within the context of marriage.
• Stop using or injecting illicit drugs.

Despite all efforts, some young people may remain unwilling to adopt behavior that would virtually eliminate their risk of becoming infected. Therefore, school systems, in consultation with parents and health officials, should provide AIDS education programs that address preventive types of behavior that should be practiced by persons with an increased risk of acquiring HIV infection. These include:

• Avoiding sexual intercourse with anyone who is known to be infected, who is at risk of being infected, or whose HIV infection status is not known.
• Using a latex condom with spermicide if they engage in sexual intercourse.
• Seeking treatment if addicted to illicit drugs.
• Not sharing needles or other injection equipment.
• Seeking HIV counseling and testing if HIV infection is suspected.

For all students, HIV prevention education should focus on personal behavior and the linkage to HIV infection. The aim is not to cause fear but to (a) enhance students' receptivity to the notion of modifying their personal behaviors and (b) increase their motivation to adopt and maintain changes in their behaviors. For special education students, in particular, it is important to emphasize the choices individuals can and should make. Learning activities should give students the opportunity to role play situations where they have to make choices and communicate their decisions to others. Special education students require instruction and practice in assertiveness techniques, including skills for negotiation and resistance to peer pressure. Instruction should also include resources that students can contact to obtain more information and help (NSBA, 1990).

The content of this digest was developed with funds provided by a cooperative agreement with the Division of Adolescent and School Health, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, GA 30333. The project entitled, Aids Education: Interdisciplinary, Multicultural Approaches for Students and Teachers, is aimed at advancing skills and knowledge in the area of HIV prevention. CEC had a subcontract with the Association for the Advancement of Health Education (AAHE) to deal with the special education component.

References

DiClemente, R. J. & Houston-Hamilton, A. (1989). "Health Promotion Strategies for Prevention of Human Immunodeficiency Virus Infection among Minority Adolescents." In Health Education, 20(5), 39-43.

Family Life Education: Effective Instruction for Students in Special Education (1991). Richmond, VA: Virginia Department of Education, Division of Special Education Programs.

"Guidelines for Effective School Health Education to Prevent the Spread of AIDS (1988)." Centers for Disease Control MMWR--Morbidity and Mortality Weekly Report. 37(S-2) 4-8.

Reducing the Risk: A School Leader's Guide to AIDS Education (1990). Alexandria, VA: National School Boards Association, HIV and AIDS Education Project.

Surgeon General's Report on AIDS - U.S. Dept. of Health and Human Services, U.S. Public Health Services, 1987.

Additional Resources

Bigge, J. L. (1991). Teaching Individuals with Physical and Multiple Disabilities (3rd ed.) Columbus, OH: Charles E. Merrill.

Byrom, E., & Katz, G. (1991). HIV Prevention and AIDS Education: Resources for Special Educators. Reston, VA: The Council for Exceptional Children.

Caldwell, T. H., Sirvis, B., Todaro, A. W., & Alcouloumre, D. S. (1991) Special Health Care in the School. Reston, VA: The Council for Exceptional Children.

Columbus, Ohio Health Department, AIDS Program (1990). Aids Education— Teaching Guide. Columbus Health Department, 181 Washington Boulevard, Columbus, OH 43215.

Kaiser, M. (1988) "Educating Children about AIDS." In Pediatric Review, 2 (9), 2-4.

Rubenstein, A. (1987) "Supportive Care and Treatment for Pediatric AIDS." In Report of the Surgeon General's workshop on children with HIV infection and their families (pp. 19-31). Washington, DC: U.S. Department of Health and Human Services.

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