CHAPTER 4: HEALTH EDUCATION PROGRAMMES AND TEACHING AND LEARNING MATERIALS RELATING TO HIV AND AIDS
4.0 Introduction
Judy Vegh, Principal of Hastings College, interviewed on the audio-tape, "The FE Programme", in a discussion on "Values in FE", said:
"Education should lead society's values, not respond to them"
In fact, educational policy and practice is at the same time a reflection of society's values and an influence on those values, in a cycle of reinforcement. Nowhere is this more so than in contemporary preventative health education programmes relating to HIV and AIDS, as this Chapter will show.
4.1 HIV/AIDS IN THE SCHOOL CURRICULUM
4.1.1 Legislation regarding the curriculum
The Education Reform Act (1988) required a National Curriculum to be identified at precisely the time when public concern about HIV/AIDS was peaking. Three members of the working party responsible for developing the National Curriculum for Science were based in Hertfordshire:
John Holman - Head of Science at Watford Boys Grammar School
George Walker - Headteacher of Cavendish School, Hemel Hempstead
Audrey Russell - Headteacher of Brookland Infants School, Cheshunt
(Rosalind Driver, University of Leeds, who has published widely on the theory of Maths and Science Education, was also a member of the group.) Through the Hertfordshire TVEI (Extension) programme and my involvement with the SATIS 16-19 programme, co-ordinated by Andrew Hunt, ex-Head of Science at Durrants School, Watford, and also formerly at Watford Boys Grammar School, I was informed to some extent about the deliberations of that group. They agreed that reference to specific organisms should be excluded from the National Curriculum, so that teachers would be free to choose their own examples of the life processes. However, ultimately the working party bowed to political pressure from government agencies concerned with health education, with the result that the only organism specifically included in the National Curriculum is Human Immunodeficiency Virus (HIV). It appeared by name in Science Attainment Target 2, "Life and Living Processes", at Key Stage 3 (see Appendix 11, an extract from Gascoigne(1993)).
Also in 1988, Health Education was identified as a cross-curricular theme and the National Curriculum Council Guidelines (booklet 5 in the series) recommended, but did not require, that sex education, delivered through a variety of subjects, including Science and PSE should enable pupils to:
"- - - recognise and be able to discuss sensitive and controversial issues such as conception, birth, HIV/AIDS, child-rearing, abortion, - - -"
at Key Stage 4 (i.e. later than the Science curriculum - see above).
The ERA (1988) also required governing bodies to define school policy on sex-education, giving them discretion over the inclusion of sex-education in the curriculum. Gascoigne found great variation in schools' approaches to sex education and her survey showed that many Hertfordshire schools still did not have sex education policies. Gascoigne analysed some of the conflicting requirements of the National Curriculum, of the kind identified above (see Appendix 12).
The Dearing Report, January 1994, requires schools, from September 1994, to include religious education and sex education in the core curriculum, for all pupils registered at the school. However, parents may withdraw their children from these classes. This contradiction has been the subject of extensive debate, recently, in the Times Educational Supplement (TES 18.2.94 p12 and 11.3.94 p4 and 1.4.94 p1 and 5) and the local (Watford Review 31.3.94 p1) and national press (Times 13.4.94 p6), the case of Sue Brady, the Leeds primary school nurse providing the focus. The Dearing Report states that sex education may be delivered as part of Science, PSE or as separate lessons and, in line with John Major's "Back to Basics" campaign, requires that it is set in a moral framework. The time allocation for sex education and careers guidance together, at Key Stage 4, is 2.5% of the total curriculum, which, assuming a 36 week year, equates to 37.5 minutes per week or 22.5 hours per year. This is quite a generous allocation and would enable schools to cover a substantial curriculum over the five years of compulsory secondary education.
Currently further legislation is being passed. Reva Klein wrote in the Times Educational Supplement, 15th April 1994, p13 in an article entitled "Tricky patch at point of delivery":
"An amendment to the Education Act 1993 due to come into force in August will ensure that national curriculum science deals only with straightforward biological information on reproduction. At the same time, governors of maintained schools will be required to provide sex education, including information on HIV/AIDS and sexually transmitted diseases, to all pupils. This will be carried out primarily through PSE. However parents will have the right to withdraw their children from part or all of those sex education lessons."
Klein goes on to highlight the difficulties schools face in implementing the legislation, given:- that few LEAs still have health education co-ordinators, who formerly played a key role in helping schools embed health education in the curriculum. (Their work, Klein says, will be replaced by the "hit and run" approach of Health Promotion Units, making visits to schools to deliver talks on specific subjects such as AIDS.)
- the lack of staff development to enable teachers to deal with this sensitive subject area.
Legislation concerning teaching about homosexuality is another area of confusion and conflict. On the one hand, section 28 of the Local Government Act (1988) requires that local authorities "shall not intentionally promote homosexuality" and that teachers "shall not promote the acceptability of homosexuality as a pretend family relationship" (note the January 1994 "Romeo and Juliet" case, involving the primary head, Jane Brown, in Hackney). On the other hand, schools are required to have policies on Equal Opportunities and if that policy includes sexual orientation, then the rights of homosexuals must be protected and their views respected. So teachers feel an obligation to support the minority of potential gays and lesbians among the adolescents they teach, feeling that these young people can be particularly isolated, if the sexual questions they are grappling with are disregarded in all school sex education programmes. (Kinsey, in his report, estimated that 10% of the population, a very substantial proportion, was homosexual, and it is only as recently as March 1993, that this myth has been exploded by the Guttmacher survey, which reduced the figure to 1%.) When the age of consent for homosexual men was reduced from 21 to 18 (rather than 16), on 21st February 1994, the debate centred on the age at which a young man can be totally sure of his sexual orientation, given that adolescents mature at different rates and shyness of the opposite sex is, for many, a normal developmental stage, that has to be lived through.
4.1.2 Limitations on HIV/AIDS education - ignorance and self-censorship
The confusion is compounded by the ignorance of teachers about homosexual practices. The director of Student Services at my college, a notoriously broad-minded person, confessed herself shocked at the news coverage on 9.2.94 of the case of the Tory MP, Stephen Milligan, found dead after indulging in an auto-erotic process that involved wearing silk stockings, a polythene bag over his head and an orange in his mouth. Amyl nitrite abuse was initially suspected but later discounted. This was probably the first time that bizarre sexual practices were brought to the attention of a large proportion of the monogamous heterosexual community, to which most teachers belong. It is unlikely that many teachers know that "poppers" (amyl nitrites) are an essential part of anal sex, (just as I did not, until I read Duesberg's papers). You cannot teach what you do not know and if teachers are unaware of homosexual practices, they cannot assess or communicate the relative significance of the various factors that contribute to the destruction of the immune system, leading to AIDS. Some things are unsayable ("Taboo", according to Freud, in "Totem and Taboo"). As a white, middle class, female biology teacher, myself, I dared not explore the extent of teachers' knowledge on this subject, in my questionnaire, for fear of damaging the reputation of my college, on whose notepaper, the covering letter was printed, and for fear of giving offence, which might have led to a poor response rate. Nor could I explore the extent of young people's knowledge, in the student questionnaire (Chapter 7), since it would be unethical to ask students explicit questions about homosexual practices, for fear that the questions themselves might offend or corrupt. On the TV programme "Vive la Difference", 22.4.94, the English "Don't die of ignorance" campaign was compared with the equivalent French anti-AIDS media campaign. The programme noted that a much more explicit campaign was possible in Britain than could be contemplated in France. Clearly cultural factors influence what can be said on sensitive subjects. So although we believe we enjoy total freedom of speech, even in the U.K., as teachers, we are restricted by the mores of the society in which we live and into which we have a duty to socialise young people.
Andrew Tyler, writing in the Observer, says that all journalists, like teachers, have internalised self-censorship. The same is true in science, through both self-censorship (there is little point in writing something too shocking to be published - better to water it down a little and at least get part of the message across) and peer review.
Political correctness is another factor that reduces honest discussion of AIDS and HIV. Plumley (1993) refers to the tendency to engage in political correctness when devising AIDS awareness and prevention campaigns. Teachers tend to emphasise that heterosexuals are just as much at risk as homosexuals (though the evidence suggests otherwise), perhaps at least in part, for fear of being dubbed homophobic. Plumley says that "while it is true that we are all at risk, (the main thrust of such campaigns), it is also true that some groups are vastly more at risk than others". Yet teachers tend to de-emphasise the latter message, while emphasising the former, maybe in part for reasons of political correctness.
At no level is an honest and open discussion of the factors that may contribute to AIDS possible in contemporary Western society. The film "Philadelphia" released in March 1994 attempted to explore this issue, demonstrating some public awareness of the limitations on communication.
4.1.3 Political and economic influences on HIV/AIDS education
Section 4.1.1 (above) describes how the political climate influences the teaching of HIV/AIDS (e.g. the inclusion of HIV in the National Curriculum and the effect of the "Back to Basics Campaign" on PSE programmes). Aggleton, Homans and Warwick (1993) demonstrate that throughout the twentieth century, health education practice has reflected the political agenda of the government of the day.
Economic factors are another major influence on HIV/ AIDS programmes. A case in point was the conference "AIDS education in schools: the way forward", which I and 145 other teachers attended on Saturday, 8th May 1993 (referred to in Chapter 2). The conference, which cost only £25, was lavish in its hospitality and heavily subsidised by the Wellcome Trust, at whose head-quarters in Euston Road, it took place. The Chair was Lady Margaret Jay and speakers included Eric Forth MP, Prof Anthony Pinching and Prof Roy Anderson. The conference coincided exactly with news of the fall in share prices of Burroughs Wellcome, following the results of the Concorde trials of AZT. Yet the only reference to this was a mention of "irresponsible and alarmist reports in the gutter press" (see Chapter 2 for dates of newspaper reports). Is the Times the gutter press? The conference message was clear: HIV causes AIDS, the epidemic is still growing and is a major threat to all sections of the population, globally, and Wellcome is the major contributor to prevention and cure (i.e. straight establishment view).
Anderson, one of the main speakers at the event, is enjoying a successful career in the epidemiology of AIDS, sponsored by Wellcome, predicting catastrophic death rates. He has recently taken a chair at Oxford. Turney, THES 27.5.94, p15 says "His models of the epidemic are far in advance of the data."
4.2 NON-CURRICULUM ISSUES RELATING TO HIV/AIDS
4.2.1 HASAWA Legislation
The Health and Safety at Work Act (1974) requires employers to provide a healthy and safe environment for employees (teaching and non-teaching staff in the case of schools and colleges) and clients (pupils). In order to fulfil this responsibility, schools must have procedures to deal with emergencies, which could present a risk of transmitting HIV (e.g. blood spillage). I have been unsuccessful in attempting to collect from schools guidelines on first aid procedures and have the impression that there is little in writing. However, I attach at Appendix 13, West Herts College's [Footnote: West Herts College was formed in November 1992, by the merger of Cassio College (referred to in Chapter 1) with Watford and Dacorum Colleges.] notes for guidance to first aiders and emergency first aiders (Autumn 1993). This document is enlightened in pointing out that the risk of transmitting HBV (which causes Hepatitis B) is far in excess of the risk of transmitting HIV.
For some years, as part of my teaching responsibilities, I have prepared Hairdressing and Beauty Therapy students for the Royal Institute of Public Health and Hygiene examination for the Certificate of Salon Hygiene. The RIPHH requires students to be conversant with the risks of transmitting HIV through the use of unsterilised equipment for services which involve piercing the skin, e.g. ear piercing, acupuncture, electrolysis and tattooing. Students must also learn the safety procedures required to avoid transmitting HIV when dealing with accidents and emergencies such as nose-bleeds and cuts. In fact, evidence of HIV transmission through salon services is suspect and evidence of AIDS cases attributable to salon services, even more so. In the late 1980s and early 1990s, a few cases of AIDS were attributed to dental services but re-examination of these cases by Root-Bernstein (1993), p314, casts doubt on whether AIDS was the cause of death and in any case, no other factors, e.g. life-style of the patient, were taken into account.
4.2.2 Extra-curricular factors
The life of an educational establishment extends beyond the classroom, with clubs and societies, guest speakers and outside agencies coming in for a variety of reasons. Though I have little direct experience of these extra-curricular activities in schools, except through my children, I have experienced the equivalent provision in a college of further education, which I consider to be analogous. Indeed, many of the agencies are those used by schools, e.g. the local Health Promotion Unit, TACADE, Terrence Higgins Trust and Youth and Community Service. The people involved in delivering these activities vary from highly expert to amateur and those at the amateur end of the scale can do a great disservice to HIV/AIDS education by their muddled thinking, which leads to misinformation. One constant and continuing problem is the confusion over statistical data relating to HIV infection and AIDS. For example, the TES of 29th April 1994, p2, advertises:
"Next week: Reva Klein visits Edinburgh, where 650 children are affected by HIV/AIDS"
What does it mean? Do 650 children have disease symptoms? Are 650 children HIV antibody positive? Do 650 children have friends and relations who are HIV antibody positive? Do 650 children have one or more parents dying of AIDS? The statement simply aims to give an impression of a large problem and in doing so, perpetuates the conventional view of a major epidemic rampaging through the population at large.
4.3 Learning Materials and Teaching Methods
In the late 1980s and early 1990s, in response to public concern about AIDS, the Health Education Authority produced a mass of educational literature on HIV and AIDS, both student resource material and teacher training packs. Sponsored by the Health Education Authority, organisations such as Tailor Made Training came into being, specifically to meet the enormous demand for teacher training on health education. (It is no coincidence, that during the academic year 1990/91, Hertfordshire LEA allocated £7,000 to Cassio College of Further Education to fund the research project described in Chapter 1.) Also at that time, money was poured into surveys of sexual attitudes and behaviour among young people, in studies such as those of Clift and Stears (1989) and Mays (1987). These informed the development of educational policy and it is noteworthy that every document emanating from the HEA starts from the premise that HIV causes AIDS, that tests are reliable and that there is a global epidemic threatening heterosexuals as much as homosexuals and drug users. It is also noteworthy that recently, doubt has been cast on the integrity of the HEA, since its publication of "Your Pocket Guide to Sex" (Times 25.3.94, p6), which has been widely criticised for its choice of language and has been accused of being written to titillate rather than to educate.
A review of the most widely used HEA literature, listed in Table 2, p54, showed no reference to any of the six controversies listed in Chapter 1. The topics dealt with by the materials are:
- the risk of transmission of HIV (and hence of "catching AIDS") through unprotected heterosexual sex
- the risks to intravenous drug users posed by sharing needles
- the need to use a condom to avoid infection and assertiveness training to enable discussion between partners of condom use
- that there is no risk to health from social interaction with AIDS patients
- exploration of moral conflicts, e.g. between religion and contraception.
4.4 EVALUATION OF HIV/AIDS EDUCATION PROGRAMMES
4.4.1 Review of Gascoigne's work
In her 1991/92 study, Margaret Gascoigne carried out a detailed survey of health education programmes, by means of a questionnaire to all Hertfordshire middle, special and secondary schools. The questionnaire was designed to obtain the following information:
- details concerning the school - size, type, mixed or single sex, denominational or county-maintained
- position of sex and HIV/AIDS education within the curriculum
- topics included in programmes, years of delivery and subject areas involved
- teaching methods utilised
- staff involvement - overall responsibility, delivery teams, form tutors, subject teachers etc.
- INSET provision for staff concerned
- parental and governor involvement
- evaluation of sex and AIDS education programmes.
The conclusions and recommendations appear at Appendix 4.
The main findings regarding HIV/AIDS education, and therefore of particular relevance to this study, were that:
- 90% of responding schools had a sex education policy, of which two-thirds mentioned HIV/AIDS
- about 50% of responding schools had a spiral curriculum covering HIV/AIDS from years 7-12
- maximum input on HIV/AIDS occurred in years 10-11
- PSE and Science were the main areas of the curriculum in which HIV/AIDS education was covered
- teaching methods were often non-interactive and inappropriate to the subject
- 40% of responding schools did not have anyone with overall responsibility for co-ordination of HIV/AIDS education
- INSET provision was not comprehensive
- parental involvement was negligible and the level of governor involvement was difficult to assess
- there was little evidence of systematic evaluation of HIV/AIDS education programmes. Verbal feedback was the most commonly used method.
4.4.2 Other studies of school HIV/AIDS education programmes
Aggleton, Homans and Warwick (1993) evaluate the effectiveness of school HIV/AIDS education and conclude that current approaches are largely ineffective. They call for more detailed and realistic information to overcome ignorance. This confirms the findings of my Health Education project in 1990/91 (see Appendix 3).
4.4.3 National HIV/AIDS awareness campaigns
The "Don't Die of Ignorance" campaign in 1991 used TV and newspaper advertisements, showing a tombstone, plus a house to house mail-drop of a leaflet giving essential information on how to avoid contracting HIV. The message was a simple one, aimed at achieving substantial behaviour modification among the heterosexual population. The campaign was designed to reduce unsafe sex by encouraging condom use and so limit the heterosexual transmission of HIV.
James Le Fanu evaluated the "Don't Die of Ignorance" campaign in the Sunday Times on 6.5.93 "The High Cost of the AIDS panic" and concluded that it had been wholly ineffective in increasing condom use. According to the article, more than £800,000,000 has been misdirected into counselling, support and educational programmes, to little avail. There is one AIDS support organisation for every three AIDS patients, quite disproportionate to all other fatal diseases. (An acquaintance runs an AIDS support agency in Jersey and is constantly busy training and co-ordinating volunteers. However, as yet, the agency has not encountered a case of AIDS.) The latest MORI survey of sexual behaviour also suggests very low condom use and anecdotal evidence from the Hillingdon family planning clinic, in April 1993, confirms this too. Thus, the multi-million pound national preventative health education and awareness campaign cannot take credit for the failure of the anticipated AIDS epidemic to materialise. We must look elsewhere for the reason, which takes us neatly back to the controversies in Chapter 2. Opening the minds of the public to the complexities of the new disease and encouraging discussion of the possible role of life-style in its causation (i.e. real education), will do far more to combat AIDS than simplistic behaviour modification programmes, which are all we have had so far.
4.9 Summary
There is absolutely no reference, in any educational literature studied, to the debate, which is raging in the scientific community, regarding the knowledge base about HIV and AIDS, although these controversies are now being aired in the mass media. The message emanating from the Health Education Authority, whose integrity has been challenged, is monolithic and simplistic. That message is likely to have a major impact on what is delivered in the classroom in the name of HIV/AIDS education. Teachers are deprived of information. Moreover, their teaching is likely to be hampered by confused legislation regarding issues of sexual orientation and by a tendency towards self-censorship, coupled with ignorance of homosexual and substance-related practices.
The following chapters describe the methodology and findings of the current study, to investigate how contemporary health education practice relates to the literature review, described in this and preceding chapters.
Click here for TABLE 2: WIDELY USED HEALTH EDUCATION RESOURCE MATERIAL
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CONTENTS & ACKNOWLEDGEMENTS & ABSTRACT
CHAPTER 1: INTRODUCTION
CHAPTER 2: THE SCIENCE OF HIV AND AIDS
CHAPTER 3: MEDIA COVERAGE OF HIV AND AIDS
TABLE 1 - HIV/AIDS NEWSPAPER COVERAGE
CHAPTER 4: HEALTH EDUCATION PROGRAMMES...
TABLE 2 - WIDELY USED ... MATERIAL
CHAPTER 5: RESEARCH STRATEGY AND METHODOLOGY
CHAPTER 6: ... HIV/AIDS EDUCATION IN 60 ... SCHOOLS
CHAPTER 7: ... STUDENTS' EXPERIENCES OF SCHOOL HIV/AIDS EDUCATION
CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS
BIBLIOGRAPHY
APPENDICES
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