Sue Warman on AIDS 7 of 8

CHAPTER 7: A STUDY OF FE COLLEGE STUDENTS' EXPERIENCES OF SCHOOL HIV/AIDS EDUCATION

7.0 Student Survey: Introduction
Chapter 5 explains the rationale for the Student Survey conducted at West Herts College, Watford, in the Summer term 1993, of first year FE students' perceptions of the HIV/AIDS education they had received at the secondary schools, from which they had progressed to college in September 1992. This chapter reports and discusses the findings of that survey. The student survey was conducted at the same time as the teacher survey described in Chapter 6, with the objective of comparing the perceptions of the two geographically separated groups, to obtain an accurate picture of secondary school HIV/AIDS education programmes. As discussed in Chapter 5, the schools of origin of the students did not correspond exactly with the schools responding to the teacher survey.
The questionnaire (Appendix 2) was divided into three parts. Questions 1-3 identified the student's school of origin and current course of study, but for the reasons discussed above, this information was not used in the analysis. Questions 4-14 were concerned with students' perceptions of and satisfaction with their HIV/AIDS education. Questions 15-26 explored their understanding of information about HIV/AIDS. The purpose of the survey was two-fold:
- to explore recent school-leavers (at 16+) perceptions of HIV/AIDS education
- to explore their understanding of HIV/AIDS and establish whether they were aware of the controversies described in Chapter 2.
An oversight was that the questionnaire failed to ask about the AIDS epidemic in Africa or the efficacy of AZT.

7.1 Sample size and response rate
In total, 129 questionnaires were distributed via group tutors, completed by students during tutorial sessions and collected in.
The following responses were obtained:

Course	Number of student responses
	Male	Female	Not known	Total
A level Chemistry			3	3
A level Economics	5	9		14
Science - Health Studies			9	9
GCSE Biology	10	7		17
BTEC National Diploma	2	15	2	19
Travel and Tourism
Hair and Beauty		16		16
Hairdressing	1	11		12
Pre-nursing		14		14
BTEC First Diploma Caring		25		25
TOTAL	18	97	14	129

Responses spanned 34 schools with a maximum of 12 students from the same school. The maximum number of students from a school, where teachers had responded, was 5.

7.2 FINDINGS
The findings of the survey are summarised below. Not all students responded to every question.

7.2.1 Student Perceptions of HIV/AIDS Education
Questions 4, 5 and 6 - Sources of HIV/AIDS education
Question 6 established that 85 of the 123 respondents (69%) had received HIV/AIDS education at school.
In response to Question 4, only 36 out of 123 respondents (29%) said school was the main source of their HIV/AIDS education, i.e. slightly less than half the number receiving HIV/AIDS education at school (see above).
For those who received most of their HIV/AIDS education from other sources, responses showed those sources to be, in the main:

Parents	13 ( 7%)	Friends	23 (13%)
Television	66 (37%)	Newspapers	35 (20%)
Magazines	41 (23%)

Questions 7 and 8 - School subjects delivering HIV/AIDS education
HIV/AIDS was covered in PSE for 48 (43%) of respondents, in Science for 47 (42%) and in other subjects for 17 (15%) of the 112 students who responded. The other subjects mentioned were RE, Drama and Social Studies.

Question 9 - Age at which HIV/AIDS was covered
The 120 responses were:

Year 7	Age 11-12	3	2%
Year 8	Age 12-13	3	2%
Year 9	Age 13-14	8	7%
Year 10	Age 14-15	36	30%
Year 11	Age 15-16	62	52%
All equal		7	6%
None		1	1%

Questions 10, 11 and 14 - Knowledge, values and behaviour modification
110 students responded as follows to Question 10 "Did you learn factual information about HIV/AIDS in - - ?"

Science	28 (25%)	PSE	25 (23%)
Neither	36 (33%)	Both	21 (19%)

107 students responded as follows to Question 11 "Were you given the opportunity to discuss your feelings and attitude towards HIV/AIDS in - -?"

Science	21 (20%)	PSE	26 (24%)
Neither	46 (43%)	Both	14 (13%)

Of the 106 students responding to Question 14, 68 (64%) felt that their HIV/AIDS education at school had influenced the way they led their lives.

Questions 12 and 13 - Evaluation of school HIV/AIDS education by past pupils
In response to Question 12, "Were you satisfied with the school's programme of HIV/AIDS education?" 66 out of 111 respondents (59%) said they were not satisfied. Question 13 asked how the HIV/AIDS education could have been improved. Those who had received no HIV/AIDS education responded that any would have been preferable to none. Among those who had received HIV/AIDS education, the comments centred almost exclusively on the desire for more information. Some examples were:
More information and talks
To have discussed it earlier in school and been told more about it
Should be explained more and made more explicit. Should not be embarrassed.
They should have answered questions more
More videos and questions
Talked about it in more detail
More lessons, longer lessons, more information
Some could have had more detail
A lot more detail
Gone into more depth
It wasn't even mentioned in the lessons it should have been
They could have told you factual information instead of role plays
Other frequent comments were that it should have been dealt with at a younger age, that there should have been more discussion, that it should have been revisited (spiral curriculum model) and that it should have been treated as a discrete module in its own right.

7.2.2 Students' understanding of HIV/AIDS and awareness of controversies
Question 15 - What is AIDS?
Several students ticked more than one box (205 ticked boxes). Responses were:

a	killer disease caused by HIV	49 (24%)
b	range of symptoms which together can lead to death	25 (12%)
c	wasting disease that kills in an HIV positive person	10 ( 5%)
d	breakdown of the immune system leading to death	58 (28%)
e	breakdown of the immune system leading to death in an HIV positive person	63 (31%)

Question 16 - What is HIV?
The responses were:

a	a harmless virus	0 ( 0%)
b	a virus, which with other factors, can lead to Aids	49 (3%)
c	the virus which causes AIDS	78 (61%)

Question 17 - Risks of contracting AIDS

ACTIVITY	High risk	Some risk	Low risk	No risk
Sharing razors	31 (25%)	45 (36%)	40 (32%)	9 (7%)
Ear piercing	23 (19%)	48(39%)	35 (28%)	18 (14%)
Blood transfusion (UK)	47 (38%)	38 (30%)	31 (25%)	9(7%)
Sharing toothbrushes	4(3%)	13 (10%)	52 (42%)	57 (45%)
Anal sex	101 (82%)	14 (11%)	7 (6%)	1 (1%)
Givingfirst-aid	14 (11%)	49 (40%)	36 (29%)	25 (20%)
Kissing	1 (1%)	3 (2%)	24 (19%)	98 (78%)
Masturbation	0 (0%)	5(4%)	18 (15%)	98 (81%)
Dentistry	2 (2%)	38(30%)	50 (40%)	36 (28%)
Vaginal sex	106 (85%)	17(14%)	2 (2%)	0 (0%)
Organ transplants	28 (22%)	45 (36%)	34 (27%)	18(15%)
Oral sex	28 (23%)	42 (35%)	24 (20%)	27(22%)

Question 18 - Which of the following reduces the body's immunity?
Students sometimes ticked several boxes or none. There were 195 ticks, as follows:

HIV	81 (42%)
AIDS	53 (27%)
Use of recreational drugs	15 (8%)
Homosexual practices	2 (1%)
Repeated use of antibiotics	22 (11%)
Medication used after organ transplant	5 (2%)
Don't know	17 (9%)

Question 19 - The HIV test
Of the 152 responses, students thought that the HIV test involved:

Animal dosing	4 ( 3%)
Microscopic examination of blood for HIV	48 (32%)
Testing blood for antibodies to HIV	66 (43%)
Chemical tests for the presence of HIV	19 (12%)
Don't know	15 (10%)

Question 20 - The contribution of four scientists
There was a nil response against the names of all four scientists mentioned - Gallo, Duesberg, Anderson and Montagnier.

Question 21 - Relative risks to the future of the human race
201 boxes were ticked, showing that the relative risks to the future of mankind were perceived to be:

Famine	38 (19%)
AIDS epidemic	102 (51%)
Nuclear disaster	49 (24%)
Genetic engineering	7 ( 3%)
Don't know	3 ( 1%)
None	2 ( 1%)

Question 22 - Where were the earliest cases of AIDS reported?
Some respondents ticked more than one box. There were 143 ticks:

Brighton	0 ( 0%)
South Africa	44 (31%)
South America	8 ( 6%)
Central Africa	56 (39%)
San Francisco	6 ( 4%)
Poland	0 ( 0%)
New York	11 ( 8%)
Haiti	0 ( 0%)
Don't know	18 (12%)

Question 23 - How is AIDS thought to have been introduced into humans?
The 127 responses were fairly broadly spread:

Malaria vaccine development	14 (11%)
Monkey bite	42 (33%)
Sex between a human and a monkey	31 (24%)
Polio vaccination	1 ( 1%)
Development of germ warfare	5 ( 4%)
Smallpox vaccination	3 ( 3%)
Don't know	31 (24%)

Question 24 - Can AIDS occur in someone who is not HIV antibody positive?
Of the 124 respondents, the majority, 68 (55%) thought it could not, 23(18%) thought it could and 33 (27%) said they did not know.

Question 25 - relative incidence of AIDS and Hepatitis B in the UK
There were 114 responses:

More AIDS than Hepatitis B	39 (34%)
About the same amount of each	12 (11%)
More Hepatitis B than AIDS	25 (22%)
Don't know	38 (33%)

Question 26 - What is syphilis?
The 127 responses were as follows:

A respiratory disease	1 ( 1%)
A Sexually Transmitted Disease caused by a virus	48 (38%)
A vaccine used to treat TB	1 ( 1%)
A Sexually Transmitted Disease caused by a bacterium	48 (38%)
Don't Know	29 (22%)

7.3 Discussion of Findings
7.3.1 Students' perceptions of and satisfaction with HIV/AIDS education
Questions 4, 5 and 6 - Sources of HIV/AIDS education
The figure of 69% receiving HIV/AIDS education at school (Question 6) is surprisingly low, since at the time the students had been in year 9, HIV was part of the Science National Curriculum for that school year. However, sex education was not compulsory at that time (see Chapter 4).

Question 5 shows that apart from school, the major source of information for young people is TV, followed by newspapers and magazines (in other words the mass media). Friends are less important and parents are the main source of information for less than 10% of young people. This last emphasises the important role of the school.

Questions 7 and 8 - School subjects delivering HIV/AIDS education
These results confirm Gascoigne's findings that PSE and Science are the major curriculum areas used.

Question 9 - Age at which HIV/AIDS education covered
This again confirms Gascoigne's finding that HIV/AIDS education peaks in years 10 and 11. However, the teacher survey reported in Chapter 6 showed that teachers considered the best age at which to deal with controversial issues would be at 13-14 years (in years 9-10). It would therefore be desirable to reduce the age for the peak in HIV/AIDS delivery by one year. Student responses to question 13 showed that many also thought information should be delivered earlier.

Questions 10, 11 and 14 - Knowledge, values and behaviour modification
The high proportion of students (33%) who say they received no factual information in either Science or PSE (Question 10) contrasts strongly with the perception of teachers in both disciplines, that giving factual information is a significant part of their responsibility (See Chapter 6).
With regard to feelings and attitudes (Question 11) students' experiences (43% feel that they have had no opportunity to discuss their feelings) reflect about 50% of teachers' perceptions that their main job is to deliver knowledge (see the results of the teacher survey question 16 in Chapter 6). However, Question 18 of the teacher survey (Chapter 6) showed that teacher-led discussion is a widely used teaching style (70-80% of teachers). The students' perceptions suggest that more student-led discussion (used by only about 35-45% of teachers) may be desirable.
Responses to Question 14 confirm Gascoigne's claim that protection of the individual is a major consideration in HIV/AIDS programmes (64% said their behaviour had been influenced by their HIV/AIDS education) but conflicts with teachers' responses to Question 15 of the teacher survey (see Chapter 6) in which only about 20% considered behaviour modification the main aim of HIV/AIDS education, compared with imparting knowledge (about 90%). It also conflicts with anecdotal evidence I obtained in conversation with a senior member of staff at a local Family Planning Clinic, who said that teenage girls continue to use the pill and reject the condom, despite school and media messages about the need for safer sex.

Questions 12 and 13 - Evaluation of HIV/AIDS education by past pupils
The fact that 59% of students were dissatisfied with the HIV/AIDS education they had received is a substantial indictment of the system, which should not be ignored. Virtually all students wanted more information and several requested a spiral curriculum or that they be given information sooner. (The teacher survey, Chapter 6, shows that teachers agree).
Student answers to the second part of the survey (Questions 15-26) demonstrated variation in their knowledge with some fairly marked widespread gaps. This confirms their self perception that they are not well informed. It is worth bearing in mind, in looking at their responses, that the majority of students participating were on health or personal service-related courses and might be expected to be more aware and better informed than others of their age.

7.3.2 Students' understanding of HIV/AIDS and awareness of controversies
Question 15 - What is AIDS?
The question was designed to test whether students linked AIDS absolutely with HIV. In fact they did not, since about the same number ticked (a) and (d). This suggests about an equal awareness that AIDS is linked with HIV and that it is caused by a breakdown of the immune system. Superficially it suggest some awareness of the controversy over the causation of AIDS. However, analysis is confused by the fact that several students ticked both (a) and (d). The majority thought that AIDS is a breakdown of the immune system linked with HIV infection(e).

Question 16 - What is HIV?
Responses clarified the question of whether students were aware of controversy over the causation of AIDS by HIV. All the students believed HIV was implicated in the causation of AIDS (no adherents to Duesberg's view), but a significant proportion thought other factors were involved too (Montagnier's view). The majority conform to the establishment view of a direct causal relationship.

Question 17 - Risks of contracting HIV
This question was designed to establish whether students were aware of differences in risk levels associated with various activities. It is regrettable that mother/child transmission and treatment of haemophiliacs were omitted from the question. In fact, Tessman (1994) points out that there is, in any case, considerable doubt about relative risks. He says that risks of social contact with AIDS patients may have been played down for reasons of political correctness.
Responses to this question demonstrate:
- a general acceptance of the conventional view that activities most likely to transmit HIV are ipso facto most likely to cause AIDS
- no significant difference in the perception of the relative risks of anal and vaginal sex (and hence, in fairly general terms, between homo- and heterosexual acts). Again this is in line with the main message of conventional HIV/AIDS education programmes, which avoid emphasising the vastly higher incidence among gay men than among heterosexuals, in Europe and the USA, and propose heterosexual activity as the main route of transmission in the "African epidemic".
- students believed that anal and vaginal sex were much higher risk activities than kissing and masturbation but were much less clear (because there was a broader spread of responses) about the relative risks of modes of transmission not related to sexual activity, e.g. organ transplants and blood transfusions). This suggests that HIV/AIDS education programmes are delivered in the context of sex education.
Interestingly, there was variation in student responses, which reflected the vocational courses they were following. For example, hair and beauty students perceived ear piercing as high risk and social care students were more aware of the risks of first aid. Thus, college syllabi, rightly or wrongly, perpetuate and re-inforce the need to protect clients from HIV infection and hence from AIDS.

Question 18 - Which of the following reduces the body's immunity?
There was a significant difference between students' awareness of AIDS-related damage to the immune system compared with other factors that reduce immunity, the latter being very low indeed. It is noteworthy that most students thought HIV damaged the immune system (i.e. they perceived the virus as the cause) rather than AIDS itself.

Question 19 - The HIV test
Only 43% of students realised that the HIV test depends on testing for antibodies and is therefore an indirect method. This suggests that coverage of the limitations of the test and the care needed in interpreting a result is inadequately covered in HIV/AIDS programmes.

Question 20 - The contribution of four scientists
Not one student knew about the work of any of the four major researchers in the field of HIV and AIDS. Clearly there is no mention of the scientific basis of the subject in any Hertfordshire schools HIV/AIDS programmes. This is perhaps the strongest evidence of all that what is delivered is training in the conventional dogma, rather than true education. Even the 9 students following the Health Studies course failed to answer, which suggest that the situation is not even remedied in post-16 vocational education related to health.

Question 21 - Relative risks for the future of the human race
More than half the participating students perceived AIDS as a major global threat. So the media message about the likely future scale of the epidemic has certainly been effective (or even over-stated?). However, this result must be moderated, since the nature of the questionnaire might have led students to suppose that this was the desired answer.

Question 22 - Where were the earliest cases of AIDS reported?
Analysis is complicated by the fact that some respondents ticked more than one box. Responses showed that the majority of students (70%) believed that AIDS arose in Africa and of these, the majority pin-pointed Central Africa. There was an awareness also that the USA was the location of early reports of the disease and New York, rather than San Francisco, was thought to be the main centre. It is surprising that no students were aware of the theory that AIDS was brought to the USA by Haitian immigrants.

Question 23 - How is AIDS thought to have been introduced into humans?
About a quarter of students admitted that they did not know and it may be that many others simply guessed. There is no clear correlation between answers regarding the involvement of vaccine development. Only 1% knew of Pascal's theory that polio vaccine was the source and similarly few chose smallpox vaccine, while significant numbers (11%) believed malaria vaccine development to have been the cause. This latter is surprising, since media coverage of this theory post-dated the questionnaire by one year (see Chapter 3). However, 57% of students identified a link with monkeys by selecting one of the two answers relating to monkeys. These responses correlate with responses to question 22, which identified Africa as the source in most students' minds.

Question 24 - Can AIDS occur in someone who is not HIV antibody positive?
Responses to this question should be analysed in the context of responses to Questions 15-18. It tests more overtly whether students believe there is a direct causal relationship between HIV and AIDS. However, the terminology "HIV antibody positive" may have confused those who do not understand the principle on which the HIV test is based (see Question 19). It may have been better to ask "Can AIDS occur in someone who does not have HIV?" Perhaps because of a misunderstanding of the question, a surprisingly high 18% subscribed to the dissident view of Duesberg, but the majority, 55%, supported the established view that AIDS can only occur in someone who is HIV antibody positive.

Question 25 - Relative incidence of AIDS and Hepatitis B in the UK
As Question 21, this question set out to see if students had an inflated view of the incidence of AIDS, this time in relation to another viral STD. Hepatitis B is vastly more common than AIDS and there are far more carriers of Hepatitis B Virus (HBV) than of HIV. Hair and Beauty students had been taught this during their time in college. Yet despite this factor, which must have skewed the result towards the right answer, over-riding school HIV/AIDS education, the majority of respondents (45%) still thought that AIDS was at least as common as Hepatitis B. Therefore there is a widespread misconception about the frequency of AIDS, possibly because it is lethal, whereas Hepatitis B usually is not.

Question 26 - What is syphilis?
The purpose of this final question, was to test whether students hadaccurate information about a very common STD, which they are therefore much more likely to encounter than AIDS.
Fewer than 40% knew that syphilis is a STD caused by a bacterium and an alarming 25% had no idea what it was. This suggests that more effort should be devoted to teaching about other STDs as well as HIV/AIDS.

7.9 Summary
Broadly the survey showed that students, who had left school in July 1992:-
- were far from satisfied with the HIV/AIDS education they had received at school and would value more accurate and detailed information, delivered without embarrassment. They particularly wanted the opportunity to have their questions answered and some felt that the topic should be covered earlier than years 10-11 or revisited in a spiral curriculum.
- had been socialised into the conventional dogma about HIV and AIDS while largely having been denied opportunities to learn about the history of AIDS, its origin or the scientific exploration of the relationship between the virus and the syndrome.
- were poorly informed about other more widespread STDs such as Hepatitis B and Syphilis.
Conclusions from this Student Survey and from the Teacher Survey (Chapter 6) are presented in Chapter 8.

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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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