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When is the best time to plant a tree?
Twenty Years ago
Feature article, Michigan HIV & STD News, Winter-Spring 2007 Issue
Prevention resources are decreasing and the number of HIV
positive persons continues to grow. Nationwide, federal resources for HIV
prevention have shrunk by $25 million in the past three years. Even while
funding shrinks, the epidemic grows. The latest statistics released by MDCH
indicate more persons than ever before are living with HIV in Michigan. MDCH now
estimates that 17,000 Michigan residents are infected with HIV. (January 1, 2007
Quarterly HIV/AIDS Analysis, page 6).
Faced with increases in prevalence and diminishing funding,
CDC, state and local health departments and the prevention service providers
they support are working harder than ever to stem the tide of HIV. In an attempt
to work smarter and make the best use of scarce resources, programming supported
by these dollars is targeted to populations at increased behavioral risk for
HIV.
CDC supports this approach, requiring its funded programs to
follow epidemiologic profiles and stacking its list of supported evidence-based
interventions (DEBIs) with those targeting communities of color. This clearly
isn’t enough. CDC recognized the need for broader impact in its “Revised
Recommendations for HIV Testing for Adults, Adolescents, and Pregnant Women in
Health-Care Settings.” The revised recommendations, released in September 2006,
advise routine HIV testing (for ages 13-64) in high prevalence health care
settings. However, CDC has provided neither additional funds, nor a clear road
map on how to implement these recommendations.
The question remains on how to round out targeted
interventions and reach the broader community. Twenty-two years ago, when the
American Red Cross targeted gay men and Haitians in a campaign to stop those
most at-risk from donating blood, a precedent was set and a perception
reinforced that only certain populations were vulnerable to HIV infection. The
unspoken message was that if individuals were not in the targeted population
there was no need to worry. Today, as the composition of the communities hardest
hit by HIV/AIDS looks dramatically different than that of twenty-two years ago,
we have to wonder who will comprise the next wave of infection. Who are we
missing now with prevention?
One place to start is sound, evidence-based, culturally
appropriate education for all teens.
“Abstain until marriage” – not helpful advice for the 31 percent of Michigan
high school students surveyed in 2005, who already had sex before the age of
163, not realistic when 95% of Americans polled in 2002 reported they had
premarital sex, and completely irrelevant for a 16 year-old MSM, when the news
headlines tell him he can never get married to another man in Michigan.
Unarguably teens are having sex and they aren’t all using protection. The
evidence is in the reported sexually transmitted disease statistics. The highest
rates of two of the three reported STDs in Michigan, chlamydia and gonorrhea,
are among those ages 15 – 241. Besides the health risks that these infections
themselves pose, there is also the known risk that some sexually transmitted
infections increase risk of HIV2.
How many of the estimated 17,000 Michigan residents infected
with HIV (approximately 5,800 of who don’t know about their infection) would
have made better choices, and would have used the tools to protect themselves if
their teachers had been honest with them, respected them for who they are, and
given them the tools to live safe and healthy lives?
Twenty years ago many Michigan schools had progressive,
comprehensive and honest health education, when their school boards adopted The
Michigan Model for Comprehensive Health (now The Michigan Model for Health® 4).
This very innovative curriculum facilitated interdisciplinary learning through
lessons that integrate health education into other curricula, including language
arts, social studies, science, math and art. Teacher training in the
implementation of the Model ensures that students and school staff get maximum
benefits from this carefully structured program.
But not all school systems adopted the model. Social mores
and politics got in the way. And as politics increasingly overshadowed science,
Michigan legislators added a host of new requirements for sex education into the
school code that were not based on research or best practice5. This resulted in
Michigan Department of Education (MDE) having to make changes to the Michigan
Model.
Under the direction of the MDE a compromise package for high schools has been
developed and will be released this Spring. This new 9-12 grade HIV/STD
Prevention Module of the Michigan Model for Health offers an abstinence-based
program with an abstinence-only option is available.
Michigan HIV/AIDS Council (MHAC) members were provided a
sneak preview at the November meeting. Several MHAC members were advisors in
creating this new curriculum, which is skill-based and comprehensive. While this
curriculum is not perfect, it meets the objective of many different stake
holders as well as new legal requirements and objectives.
“This new curriculum provides one-stop shopping for districts
wanting a research-based curriculum that complies with the new Michigan laws,”
said Laurie Bechhofer, MDE HIV/STD education consultant.
It’s a new year. Each of us has an opportunity to make an
impact locally. If we are truly committed to STD and HIV prevention, our voices
need to be heard in support of using the abstinence-based comprehensive school
health curriculum in every community.
The education of children, pre-adolescents and adolescents
must be conducted in a safe environment that protects each individual student’s
right to be who they are, as long as the rights of others are not denied.
Regardless of the cultural milieu, all teens need support to make healthy
decisions.
Civil rights must be upheld by school staff through
anti-bullying policies6. Teachers, administrators and other school staff can be
trained to create safe environments in schools for sexual minority youth7. We
can all support the pending
anti-bullying
legislation.
After-school and alternative education programs offer great
opportunities to reach young people. Peer education programs allow for the
provision of comprehensive education and training of teens and youth. However,
funding for these programs is scarce, in contrast to abstinence-only programs.
These programs receive federal funding with little to no scrutiny of their
scientific accuracy, according to a Government Accountability Office report,
released last year.
Here in Michigan many good out-of-school programs that reach
youth are still operating, and new programs that target those most at-risk are
starting up. At the last Michigan STD, HIV and Adolescents Networking Committee8
in January, members shared news of some exciting developments around the state.
Taylor Teen Health Center has added a new peer ed group in
Romulus. And the teens in Taylor, who were trained by the Planned Parenthood
Peer to Peer program, decided to create their own six presentation program,
“Taylored” to their local needs, called IMPACT for Informing My Peers About
Choices for Teens. Program coordinator Jesse Rvelle said she is a former peer
educator herself, and she realizes that the teens need ownership of the program.
Horizon’s Project, a Detroit Medical Center program, is
planning to “spice up” their HIV 101 presentation. And big news – they just
received permission from the Detroit Public Schools to do their programs in the
schools. Horizon’s Project works with HIV positive teens and does prevention
programming.
Barb Flis, formerly with the Michigan Parent, Teacher and
Student Association, has a new venture, Parent Action for Healthy Kids. She now
works with parents and provides technical assistance for school districts’ PA226
required Sex Advisory Committees. Recently Flis worked with the first district
in Michigan to meet the new MI law requirement for at least 50% participation by
parents on PA 226 committees. This district, which previously had dropped sex
education, is now using the research-based Safer Choices curriculum.
This “proved the point that if you talk to (parents) and you
don’t hide anything, they want more,” she said. A well known advocate for parent
involvement, Flis was appointed to coordinate the Governor’s 2005 initiative,
“Talk Early, Talk Often” program for parents. The pilot was very successful and
there is still funding available for communities that would like to hold this
program. For more information contact
Barb@parentactionforhealthykids.org .
Each of us has an opportunity within our own community to
make a difference, to speak up for comprehensive science-based health education
for the next generation and to respect young people in their diversity.
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