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Schoeberlein, Deborah. (2001). Everybody: Preventing HIV
and Other Sexually Transmitted Diseases Among Young Teens
(Revised Edition). Carbondale, CO: RAD Educational
Programs.
Pp. v + 139
$39 ISBN 0-9679256-1-4
Reviewed by Beth L. Beck,
National Association of Student Personnel Administrators
July 24, 2002
As the United States enters the third decade of the HIV/AIDS
epidemic, we continue to see trends develop in how the epidemic
is disproportionately affecting our young adult population.
Surveillance data indicate that young people ages 13-24 account
for a much greater proportion of HIV cases (13%) than AIDS cases
(3%). Thus, even though the AIDS incidence is declining, there
has not been a comparable decline in the number of newly
diagnosed HIV cases among youth (Centers for Disease Control and
Prevention, 2000). Rosenberg (1994) estimates that at least half
of all new HIV infections in the United States (40,000 in 2001)
occur among people under age 25, and the majority of these young
people are infected sexually. Therefore, it is imperative that a
special effort be made to address this issue among all youth
(those found in school settings as well as those found in
out-of-school settings) so that these trends may begin to be
reversed.
The revised edition of the Everybody curriculum written
by Deborah Schoeberlein, founder of the non-profit organization
Redefining Actions and Decisions (RAD) Educational Programs,
presents an interactive, abstinence-based (not to be confused
with abstinence-only) HIV/STD prevention and education curriculum
that serves to build the skills of both the students and the
teacher. The primary target age for Everybody is middle
school (grades 5-9), although some of the exercises may be
adapted for older students depending on their emotional maturity.
A research-based, age-appropriate curriculum, Everybody
"affirms the premise that informed skillful adolescents are
capable of making healthy decisions to prevent HIV and other
STDs." As Schoeberlien states in her introduction:
I believe that an 'abstinence-only' approach at the
middle school level has proven irresponsible from an education
and public health perspective. Young teens can – and must
– learn to handle the far more responsible message that
there are two ways to prevent HIV and other STDs: you can avoid
all behaviors that pose a risk (risk elimination) or you can make
those behaviors less risky (risk reduction).
Clearly,
for middle-school aged youth the goal of HIV/STD prevention and
education should be risk elimination. However, according to the
Youth Risk Behavior Surveillance (YRBS) (2001), 7% of students
surveyed had initiated sexual intercourse before age 13, thus
demonstrating the need for comprehensive health education
programs that stress both risk elimination and risk
reduction.
Thus, Schoeberlien has designed a curriculum that can be used
as either a comprehensive HIV/STD curriculum or one that easily
can be easily integrated into other subject areas such as math,
science, language arts, social studies, visual or performing
arts. It can also be adapted for use by community-based
organizations outside of standard school settings. Schoeberlien
provides the instructor with a recommended sequence of activities
along with a set of assessment questions, which have been shown
to positively increase student's knowledge, attitudes, and
skills (Brett, 1998).
Everybody includes as an introduction sections (without
activities attached) on basic HIV/AIDS information, STDs, and
alcohol and other drugs, which is particularly useful for
instructors who don't have a lot of formal training in the
health sciences. While the "basic points" are
meticulously presented under relevant topics, HIV is a rapidly
changing field of study as new technologies develop yearly and
screening recommendations change in response to these
developments. As a result, some of these "points"
will become obsolete or outdated. For example, polyuthurane
condoms and dental dams are not mentioned as ways to reduce risk
for HIV/STDs. Male and female polyutherane condoms have been on
the market for several years and widely viewed as acceptable
prevention devices for HIV/STDs. In addition, the Food and Drug
Administration recently approved Sheer Glyde dental dams to be
used for risk reduction during oral-genital sexual activity.
Also, Schoeberlien mentions that "There are urine and
saliva tests for HIV; however, these tests are not used as
commonly as the blood test". HIV testing technologies are
changing quickly and an emphasis has been placed on
"alternative" testing modalities including urine and
oral fluid testing (not saliva, there is no saliva-based
testing), as well as rapid response technology. Many public
health and community-based testing sites use oral fluid testing,
which has been found to be as effective as the blood test. Also,
when Schoeberlien discusses HIV treatment, "undetectable
levels" of the virus are mentioned. Many youth
misinterpret this to mean that someone is cured (as Earvin
"Magic" Johnson proclaimed to be several years ago). A greater
emphasis should have been placed on the fact that even with
undetectable viral levels, someone still has HIV and can transmit
the virus to others. Care needs to be taken when citing
specifics from this section, especially if it is data-related as
new data is released regularly.
After the instructor introduction, Everybody is divided
into a series of fourteen activities and nine discussion
sections. Schoeberlien adds a "Bill of Rights and
Responsibilities" which serves to empower students and
provide them with the basic understanding that their bodies are
theirs to "respect and protect", that they can
"prevent HIV and other STDs", and they have the
"right to say "no" to anything that is not safe
or healthy". She provides two versions of the Bill (Basic
and Advanced depending on grade level, developmental maturity,
community norms, etc.). This section may be one of the most
important sections of the curriculum in that the message students
receive is an important one and is reinforced throughout the
curriculum activities and discussion sections. It also provides
an appropriate way to introduce the topic, reinforcing that
students have the ability to make healthy decisions based out of
respect for their physical and emotional selves.
Schoeberlien devised the activities that are highlighted in
Everybody from her own classroom teaching experience. As
she notes in the Introduction, "Everybody activities
are unusual and, in many ways, radical." They are in fact
"unusual" and in some cases will require practice in
front of a mirror before they are attempted in front of a class.
Each activity involves participation by the instructor and
students together in an effort to demonstrate a series of complex
topics such as immune system function and cell division, viral
replication and division, and differences between male and female
sexual organs. The latter is particularly creative in that the
instructor creates anatomical models through the use of hands and
arms in order that students have a clear understanding of why
young girls are affected differently in regards to pregnancy and
diseases than young boys. This is also an alternative that can be
used in school districts, which do not allow
"anatomically" correct models of reproductive organs.
"It Could Happen to Me Activity", "Risk
Taking Activity", and "Walk Like Activity" seek
to challenge students' preconceived notions and myths about
HIV infection as well as force them to use their problem solving
skills. Some of the activities may take more than an initial read
to develop a full understanding, as the concepts are complex to
begin with. One of the benefits to all of the activities, besides
the creative aspect, is that students are engaged as a group and
can learn from one another.
Schoeberlein also does an excellent job of suggesting
discussion questions to go along with each activity section. The
questions are numerous, introspective and guide the activity
along so that students not only build skills but also engage in a
critical thinking process as well. One important skill that is
not included in the activities, but which can be incorporated, is
assertive communication. Several of the activities have class
discussions about social situations and interactions, but there
is not an activity in which students learn specifically about
communication styles. This creates a gap in regards to fostering
healthy decision-making as it is not only about the decisions
that are made, but also the decision-making process. However,
many of the classroom discussions may become a "teachable
moment" to include communication skills, as several of the
scenarios require that students discuss with each other and
communicate how they would handle the situation.
As a comprehensive health education curriculum focusing on
HIV/STDs, Everybody stands out in comparison to the other
curriculums available primarily due to its focus on
skills-building and that it teaches the biology of HIV disease in
an easy-to-understand format. Ultimately, in the current climate
that exists around sexual health education in the school system
there will be some educators who will not be able to use this
curriculum because it does teach correct and consistent use of
condoms as a form of risk reduction. Everybody was
scientifically evaluated and involved assessments of teachers,
community and students (student outcomes were measured on
questionnaires developed by the Centers for Disease Control and
Prevention) and was found to have significant positive impacts on
students' knowledge, perceptions, and attitudes about HIV,
AIDS prevention and personal risk-taking (Brett, 1998). Students
who had completed the curriculum were also found to maintain low
levels of actual and intended risky behaviors (Brett, 1998),
which is an important finding considering that the middle-school
age group is usually the age in which youth begin experimenting.
For her effort, Schoeberlien gets an A+.
References
Brett, J., Pownell, S., Stone, t. (1998) The Fernwood
Project: Final Report on Statistical Data. Denver, CO:
Author.
Centers for Disease Control and Prevention (2000). Young
People at Risk: HIV/AIDS Among America's Youth. Retrieved
July 19, 2002, from
http://www.cdc.gov/hiv/pubs/facts/youth.html.
Centers for Disease Control and Prevention. Surveillance
Summaries, June 28, 2002. MMWR 2002:51 (No. SS-4).
Rosenberg, P.S., Biggar, R.J., Goedert, J.J. Declining age at
HIV infection in the United States [letter]. New England
Journal of Medicine. (1994) 330 pp. 789-790.
About the Reviewer
Beth L. Beck, M.A., CHES, currently serves as the
Associate Director of the Health Education and Leadership Program
for the National Association of Student Personnel Administrators
(NASPA) in Washington, D.C. As a community health educator, Ms.
Beck has worked in community health settings including a local
health department and a community-based organization. She has
successfully designed, implemented, and evaluated HIV prevention
interventions specifically targeting adolescents, women, and
substance users. Ms. Beck has presented locally and nationally
on the health care needs of women, HIV prevention, and harm
reduction methodology. She is a current Board Member of a
Washington DC-based community organization, Helping Individual
Prostitutes Survive (HIPS), and a former member of the State of
Maryland HIV Prevention Community Planning Group. She currently
serves as an Adjunct Faculty Member at Montgomery College and the
University of Maryland, Baltimore County.
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