Sue Warman on AIDS 6 of 8

CHAPTER 6: A STUDY OF HIV/AIDS EDUCATION IN HERTFORDSHIRE SECONDARY SCHOOLS

6.0 Teacher Survey: Introduction
Chapter 5 explains the rationale for the survey of PSE and Science teachers at Hertfordshire secondary schools and the methodology employed in implementing the survey in May 1993. This Chapter reports and discusses the findings of that survey.

6.1 Sample size and response rate
A total of 166 questionnaires (see Appendix 1) was sent out on 28th April 1993, two to each of the 83 Herts LEA maintained schools, whose addresses had been supplied by the County Health Education Co-ordinator. At each school, the Science teacher most involved in the teaching of HIV/AIDS and one PSE teacher were asked to respond by 31st May 1993. A total of 48 questionnaires was returned (including some late returns), a response rate of 48/166 = 28.9%. In 8 cases the same individual responded as both a science and a PSE teacher. These responses were counted in both categories, giving a total response for analysis purposes of 56/166 = 33.7%.

6.2 Findings
The analysis of responses is summarised below.
6.2.1 Nature of School and HIV/AIDS Policy (Qs 1, 2, 4, 5 & 10)
Questions 1 and 2 - Schools

Number of schools making 2 responses	13
Number of schools making 1 response	22
Total number of responding schools	35

Of these, 32 were mixed schools, 2 were girls' schools (though one now takes boys also) and 1 was a boys' school.

Question 10 - Ethnicity of school
Of the 35 schools responding, 25 were predominantly white UK, 7 said they had an ethnic minority or ethnic mix and 3 were predominantly Roman Catholic.

Questions 4 and 5 - HIV/AIDS policy
24 schools had an HIV/AIDS policy (1 of these was not written, but was to follow the National Curriculum, which at the time of the survey had HIV in it). 8 had no HIV/AIDS policy (but 1 attached DES guidelines which the school follows) The schools with no policy included 1 of the Roman Catholic schools.
In 3 schools, the teachers involved in delivering HIV/AIDS education were unsure whether the school had a policy. In these cases there were conflicting responses from the two teachers (Yes/Don't Know, Yes/No and No/Don't Know).
Of the 24 schools that had a policy, it was part of a policy on sex education at 23 and at 1 the respondents were not sure whether it was part of a sex education policy.
Policy statements/guidelines were attached by 4 schools and 3 other schools said their policy was currently being produced or updated.

6.2.2 Who teaches about HIV/AIDS? (Questions 3, 6, 7, 8 & 9)
Question 3 - subject specialism of staff
Of 30 PSE respondents the subject specialisms were:

Biology	11	37%
PE	4	13%
Home Economics	4	13%
English	2	7%
Technology	2	7%
Religious Education	2	7%
Languages	1	3%
Art	1	3%
Drama	1	3%
PSE	1	3%
No response	1	3%

Of 26 Science respondents the subject specialisms were:

Biology	22	61%
Physics	2	8%
Chemistry	2	8%

Question 6 - Gender of staff
Of 30 PSE teachers, 8 (27%) were male and 22 (73%) female.
Of 26 Science teachers, 9 (35%) were male and 17 (65%) female.

Question 7 - Age of staff
Among 30 PSE teachers, the age distribution was:

Under 25	0	0%
25-34	7	23%
35-44	10	33%
45-54	9	30%
55-64	4	13%

Among 26 Science teachers, the age distribution was:

Under 25	0	0%
25-34	9	35%
35-44	10	38%
45-54	6	23%
55-64	1	4%

Question 8 - Ethnicity of staff
Of 30 PSE teachers, 27 (90%) described themselves as white UK, 2 (7%) as white other European and 1 (3%) preferred not to say.
Of 26 Science teachers, 24 (92%) described themselves as white UK and the other 2 (8%) as white other European.

Question 9 - Religion of staff
Among the 30 PSE teachers, 16 (53%) described themselves as Christian (Protestant), 2 (7%) as Christian (Roman Catholic), 9 (30%) as having no religion and 3 (10%) preferred not to say. Among 26 Science teachers, 15 (58%) described themselves as Christian (Protestant), 1 (4%) as Christian (Roman Catholic) and 10 (38%) as having no religion. It is of interest that at one Roman Catholic school, HIV/AIDS is taught as part of RE not PSE. Three of the 6 respondents from the three Roman Catholic schools were non-religious and 1 was a Protestant.

6.2.3 Staff Development (Questions 11-14)
Question 11 - Any staff development?
19 out of 30 PSE teachers (63%) had participated in staff development compared with only 11 out of 26 Science teachers (42%).

Question 12 - Duration and provider
The total duration of staff development varied between 2 hours and 5 days for both PSE and Science teachers. The dominant provider was Herts LEA. There was virtually no in-house staff development.

Question 13 - Type of staff development

Subject of course	PSE		Science
Subject of course	Number	%	Number	%
Information	18	60	11	42
Teaching and Learning Styles	16	53	10	38
Values	14	47	5	19

Question 14 - SD needs
Two PSE teachers said they would appreciate any form of staff development (implying that they had had none), 2 wanted updating, 1 wanted ideas for lessons and 1 information. Among Science teachers, 1 wanted information, 1 updating, 1 ideas for lessons, 1 co-ordination with PSE and 1 development of a school policy.

6.2.4 Education or Training? (Questions 15-17)
Question 15 - What do you consider the main aim of HIV/AIDS education?

	PSE		Science
	Number	%	Number	%
to modify behaviour	7	23	5	19
to impart knowledge	27	90	22	85
to affect values/attitude	15	50	8	31

Many teachers ticked more than one box.

Question 16 - in teaching about HIV/AIDS do you cover:

	PSE		Science
	Number	%	Number	%
knowledge only	2	7	4	15
mainly knowledge	14	48	14	54
values and knowledge	11	38	8	31
mainly values	1	3	0	0
alues only	1	3	0	0

Question 17 - How far do you think your own values affect your teaching?

	PSE		Science
	Number	%	Number	%
a lot	8	29	3	12
to some extent	17	61	16	64
not much	3	10	3	12
not at all	0	0	3	12

6.2.5 Teaching styles (Question 18)
Question 18 - Which of the following learning strategies do you use?

	PSE		Science
	Number	%	Number	%
Teacher delivery of information	25	83	24	92
Dictating or copying notes	1	3	0	0
Giving handouts	18	60	12	46
Answering student questions	20	67	20	77
Discussion (teacher led)	22	73	21	81
Discussion (student led)	13	43	9	35
Simulation	4	13	1	4
Role play	9	30	4	15
Watching videos	21	70	13	50
Learning packs	10	33	3	12
Other	0	0	0	0

6.2.6 Learning Materials (Questions 19-25)
Question 19 - Use of the HEA pack "Teaching about HIV and AIDS"
This is the definitive document published by the Health Education Authority in 1988 and revised in 1991. Seventeen out of 28 PSE teachers (61%) said they used it compared with only 7 out of 25 Science teachers (28%), i.e. its use is substantially higher in PSE than in Science programmes.

Question 20 - Use of the DES video "Your choice for life"
At the time of the survey this was thought to be the video most widely used in schools. In fact 16 out of 30 PSE teachers (53%) used it compared with 11 out of 26 Science teachers (42%), a less marked difference than in Question 19.

Question 21 - Sources of information used by teachers
Twenty eight PSE teachers and 26 Science teachers responded to this question. The materials used by them in preparing their lessons were as follows.

	PSE		Science
	Number	%	Number	%
Newspapers and Magazines	20	71	12	46
TV Documentaries	21	75	13	50
General Scientific Journals	5	18	10	38
Specialist Scientific and Medical Journals	4	14	4	15
Health Promotion Literature	26	93	23	88

Only 2 teachers named the specialist science journals they referred to. They were The Institute of Biology book on HIV/AIDS and the HIV/AIDS newsletter of the HEA. Thus, there was clearly a mis-understanding of the question and some of these responses probably referred to HEA materials, rather than original scientific papers.

Questions 22-25 - Use of materials and sources
Answers to these questions were sketchy and it is difficult to draw clear conclusions. Some teachers were not aware of which materials originated from the HEA and which from other sources. Some only gave titles and it was not possible to identify the type of learning resource and its source from the response. In many cases vague reference was made to "Pamphlets" and "booklets". TV documentaries mentioned were Horizon, Panorama, Ruby Wax and QED. There was no reference to the controversial Dispatches programmes on whether HIV causes AIDS and whether there is an African AIDS epidemic. One teacher used the Terrence Higgins Trust video. Four PSE teachers recommended the DES video "Your choice for life", and one recommended "Taught not caught", by Dixon and Mullinar (1990). One Science teacher used SATIS (Science and Technology in Society) 16-19 Unit 84, "Understanding AIDS", published by the Nuffield project.

6.2.7 Is HIV/AIDS education delivered in the context of other STDs?
(Questions 26 and 27)
Of the 28 PSE teachers who responded to Question 26, 24 (92%) taught about other STDs, as did 20 (83%) of the 24 Science teachers who responded. Question 27 asked what other STDs were covered. Responses were as follows:

	PSE		Science
	Number	%	Number	%
Gonorrhoea	6	20	7	35
Syphilis	6	20	10	38
Thrush	2	7	2	8
Herpes	5	17	3	11
Warts	1	3	2	8
Urethritis/Vaginitis	2	7	2	8

6.2.8 Coverage of controversial issues

Question 28 - controversies covered

	PSE		Science
	Number	%	Number	%
AIDS in Africa	17	57	11	42
AZT efficacy	12	40	10	38
Cofactors in causation	3	10	2	8
HIV causes AIDS?	9	30	9	35
Discovery of HIV	0	0	1	4
Origin of HIV	7	23	7	27
Definition of AIDS	6	20	6	23

Questions 29 to 31 - to what extent and at what age should controversies be covered?
In response to Question 29, 27 (90%) of the 30 PSE teachers thought controversial issues should be covered to some extent, 2 (7%) not at all and none thought they should be covered in depth. Among Science teachers the spread was similar - 19 (73%) to some extent, 5 (19%) not at all and 2 (8%) in depth. Reasons given for not covering controversial issues (Question 30) included:
Shortage of time/ the need to cover basics
The need to focus on matters of immediate relevance to pupils
Fear of misleading pupils
Avoiding false information
Lack of expertise
If pupils want to know, they will ask, especially if prompted by the media
Why cover them when there are experts around to do it (PSE teacher)
Only relevant post-16
Information changes too fast
Must avoid powerful views arising
Need a balanced approach
Not on the syllabus (Science teacher)

Question 31 - the best age for dealing with controversial issues
Teachers responded to this question whether or not they had considered it sensible to cover controversial issues. The 29 PSE teachers and 25 science teachers who responded, considered the best ages to be:

	PSE		Science
	Number	%	Number	%
11-12	3	10	5	20
13-14	12	41	12	48
15-16	8	28	5	20
16-18	6	21	3	12

6.3 Discussion of findings
6.3.1 The Nature of the Responding Schools
It is realised that results are likely to be skewed, since conscientious teachers, who take their work seriously, are more likely to have responded. No grant maintained or private schools were included in the survey. So results do not reflect the full range of educational provision in the area.
Hertfordshire is a predominantly white UK community and only 20% of schools have significant ethnic minorities. The vast majority of schools are co-educational and only three Roman Catholic schools participated in the survey (8.6%). The majority (69%) of schools surveyed had a policy on sex education. (This compares with 90% in Gascoigne's survey - p123). In most cases (64%) the policy embraced HIV/AIDS education (which confirms Gascoigne's figure of 60%). It is a cause for concern that at 8.6% of schools, even the teachers involved in delivering HIV/AIDS education were not aware of the school's policy.

6.3.2 Who teaches about HIV/AIDS?
Clearly not all HIV/AIDS education is delivered by PSE and Science teachers, but the bulk almost certainly is, and the scale of the survey precluded covering other subjects.
Although 20% of schools sampled have a significant ethnic minority, teachers of HIV/AIDS at those schools are exclusively white and the majority of UK origin. In fact the teachers are predominantly white female middle-aged biology teachers. This raises two significant questions
- about the role models presented to young people, regarding who is concerned about sexual health in our society
- about how well informed these teachers are regarding the sexual practices of the high risk HIV/AIDS groups.

6.3.3 Staff Development on HIV/AIDS
More PSE than Science teachers have participated in staff development. In both cases the staff development focused mainly on information and least on values. Where there is staff development it is mainly provided by Herts LEA. The Health Promotion Unit is a secondary provider of staff development. Only 4 staff had participated in activities arranged by other providers and of these, only two were universities (Cambridge and London). There are only a few instances of in-house team development work. The time allocated is short (1-2 days total) and is often made up of several brief sessions (after school), which is not conducive to in-depth study. Comments from the few teachers who responded, suggested that they were dissatisfied both with the quantity and relevance of what was available. It is clear that the range of sources of staff development for teachers is severely limited. The reason may be funding limitations or competition for time and resources from other curriculum change. The most significant result was that at 14 of the responding schools there had been no staff development at all. Roman Catholic schools were among the worst (only 1 hour for 1 science teacher, in-house). There had been significantly more staff development at the 2 girls' schools than at the 1 boys' school, but Gascoigne, who surveyed the same schools warns against drawing hard and fast conclusions from such a small sample. In her survey, only one year earlier, no responding schools reported any staff development related to HIV/AIDS (p127) and only 2 schools perceived a need for training (p123).

6.3.4 Education or Training?
In both PSE and Science, the majority of teachers believe the main aim of HIV/AIDS education programmes is to increase knowledge and supply information (Question 15). Values are only about half as important in Science programmes as in PSE programmes, which is to be expected. In both Science and PSE, behaviour modification was only considered the main aim by a minority of teachers. M M Gascoigne's results showed (p129) that HIV/AIDS teaching concentrates on factual information and emphasises protection of the individual. Thus the teachers of Hertforshire clearly perceive themselves as important sources of information about HIV/AIDS. Yet they have had very little staff development on the subject and, at the time of the survey, their awareness of the controversial issues or their willingness to discuss them in the classroom was minimal.
Responses to question 16 show that teachers see themselves as imparting both knowledge and values, with a slight bias towards knowledge in both PSE and Science. Predictably, the bias is greater in Science than PSE. In both disciplines a minority of teachers deliver knowledge only but only in PSE do a minority of teachers deliver values only.
From question 17 it is clear that the vast majority of PSE and Science teachers consider that their own values affect their teaching to a considerable extent. A small number of Science teachers but no PSE teachers thought their teaching was completely independent of their own values.

6.3.5 Teaching styles
Some teaching styles dominate in both PSE and Science. In order of importance they are:
Teacher delivery of information
Discussion
Answering student questions
Watching videos
These results confirm the findings of M M Gascoigne (p127). So it would appear that teachers depend on their own expertise, more than paper-based materials produced by the Health Education Authority or others. If they do use outside sources, it is mainly in the form of videos.

6.3.6 Use of Learning Materials
Responses to questions 19-25 show that teachers depended heavily on the Health Education Authority as a major source of information. The HEA pack "Teaching about HIV and AIDS" was widely used in PSE and to some extent in Science. The DES video "Your choice for life" was used by about half of all teachers and chosen by some for special recommendation. Both these sources deliver the conventional view and fail to address any controversial issues.
As might be expected by the nature of the subjects, PSE teachers derive information mainly from newspapers, magazines and TV documentaries, whereas Science teachers depend rather less on these sources and rather more on general Scientific Journals (though they declined to specify which). 90% of all teachers use health promotion literature, which emanates from the HEA, as a principal source, i.e. there is a paucity of sources used by teachers for information gathering. This will tend to reinforce the conventional line and drive out alternative views.

6.3.7 Is HIV/AIDS education delivered in the context of other STDs?
92% of PSE teachers and 83% of Scienc teachers cover other sexually transmitted diseases too. The proportion of Science teachers doing so is surprising given that HIV is the only micro-organism singled out as having to be specifically covered by the National Curriculum. However, it is possible that GCSE syllabi specify other STDs. Gonorrhoea and Syphilis are the other STDs most covered (by 20-40% of teachers) with Herpes next (11-17% of teachers).

6.3.8 Coverage of controversial issues
Analysis of responses to question 28, shows that none of these controversial issues was covered by more than 60% of teachers. PSE teachers covered controversy over the AIDS epidemic in Africa quite well (57%) and Science teachers less so (42%) as might be expected. The next best covered controversy (by about 40% of teachers) was over the efficacy of AZT. Coverage of these two issues certainly resulted from recent media coverage at the time of the survey, since several teachers said they used TV and newspapers as sources of information. AIDS in Africa was the subject of a Dispatches programme on Channel 4 on 23.3.93 and news of the share crisis at Wellcome had just broken (See chapter 2 for details). There was virtually no coverage of the discovery of HIV by Gallo and Montagnier. While it was heartening that there was some coverage of the role of HIV and of cofactors in the causation of AIDS, only 20-35% of teachers dealt with this. In interpreting results, it must be remembered that those teachers most interested in the subject are likely to have responded and that they are likely to have over-stated their coverage. All teachers like to think that their classes are stimulating, topical, thorough and wide-ranging. It is also worth noting that six teachers were double counted as both PSE and Science teachers. Thus, if these individuals were exceptionally well informed (which is likely, since they were involved in two aspects of HIV/AIDS education), the results would be significantly affected by their contribution. The question arises whether teachers were sufficiently well informed to know what was meant by the question. For example, they may have thought that referring to wide-spread heterosexual transmission in Africa and a high mortality rate on that continent, they were covering the "Controversy over the AIDS epidemic in Africa". This is the kind of limitation due to use of questionnaire, without clear expansion of the questions or follow-up interviews, which were precluded by the scale of this study.
Most teachers thought that controversial issues should be covered to some extent but more science teachers (19%) than PSE teachers thought they should not be covered in their classes (Question 29). Reasons given for not covering controversial issues (Question 30) may be classified broadly into three categories, namely, shortage of time, awareness of their own lack of expertise and fear of confusing pupils. In fact there is probably considerable overlap between Science and PSE. By defining more clearly what was to be covered where, it is likely that time could be freed to cover the issues. Lack of expertise could be remedied by better staff development, targeted at subject specialists, once the topics had been assigned to a curriculum area. A major concern is that in their concern to "cover the basics", without confusion, it is likely that staff are actually delivering mis-information, for example, over-emphasising the possible risks of heterosexual intercourse in a long-term relationship and under-emphasising the possible risks of drug abuse. Anyway, in conversation with a health worker from a family planning clinic, she told me that despite all the awareness raising campaigns, teenage girls still prefer to use the pill rather than condoms. Most PSE and Science teachers (approximately 40%) thought the best age at which to cover these controversial issues was 13-14, i.e. in years 9-10. Gascoigne's earlier survey had shown that in fact, most HIV/AIDS education occurs in years 10-11 (ages 15-16).

6.9 Summary
The teacher survey shows that in Hertfordshire during 1993:
- about 64% of secondary schools had HIV/AIDS education policies
- the majority of teachers involved in delivery of HIV/AIDS education are white, female, middle-aged, biology specialists
- most HIV/AIDS staff development is short courses offered by Herts LEA and Health Promotion Units and teachers felt that they needed more staff development opportunities
- most teachers think the main purpose of HIV/AIDS education programmes is to deliver information/knowledge
- most teachers think their own values influence their teaching to some degree
- teacher delivery, discussion, answering pupils' questions and watching videos are the predominant learning styles used
- most HIV/AIDS education is set in the context of other STDs
- up to 57% of teachers referred to the African AIDS epidemic in their teaching and about 40% to the efficacy of AZT. There was virtually no reference to the work of Gallo or Montagnier or any other controversial issues raised in Chapter 2.
In the next Chapter, the findings of the survey of student perceptions of the HIV/AIDS education they had received at school will be reported and discussed. Conclusions from the two surveys are presented in Chapter 8.

Click here to move to the next chapter, Chapter 7: ... Students' Experiences of School HIV/AIDS Education

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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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