AIDS EDUCATION OF SCHOOL-AGED YOUTH

THURSDAY, MAY 3, 1990

U.S. SENATE,

COMMITTEE ON GOVERNMENTAL AFFAIRS,

Washington, DC.

The Committee met, pursuant to notice, at 9:35 a.m., in room SD-342, Dirksen Senate Office Building, Hon. John Glenn, Chairman of the Committee, presiding.

Present: Senators Glenn, Kohl, and Heinz.

OPENING STATEMENT OF CHAIRMAN GLENN

Chairman GLENN. The Committee will come to order. Today's hearing is about children and teenagers who, in the words of one of our witnesses, are lovable, capable and of infinite worth. None of us would quarrel with that one, certainly. However, it is simply not good enough that we adults know this about our children. It is essential that every young person believe this about himself and channel that self-esteem to eliminate or reduce the risk of becoming infected with the human immunodeficiency virus (HIV), which causes AIDS.

Now, that is no easy task. As they grow up in the world today, young persons face increasing pressure to engage in high-risk behavior such as IV drug use and sexual activity. Too often, family constraints, guidance, and counseling are missing or just not there. Tragically, too many youths have no idea where their next meal or bed is coming from. It is not surprising that those realities tend to skew a young person's ability to evaluate the threat of death from AIDS 5 to 10 years down the road.

The Centers for Disease Control (CDC) is the lead Federal agency responsible for educating our school-aged youth about the dangers of AIDS and ways to avoid HIV infection. While CDC grants for such education have grown from $7 million in 1987 to over $40 million in 1990, information about the resulting programs-what is working and what is not working has been limited. As a result, the Governmental Affairs Committee requested that GAO evaluate CDC's efforts, and GAO has prepared its findings and recommendations in two reports, which we are releasing today. I believe those are probably copies of the two reports back there on the table that are available now.

The GAO's first report is based on its nationwide survey of school districts and their policies toward reaching kids who stay in school, and training teachers to teach about this very sensitive subject. The GAO found that for this nationwide problem, more Federal leadership is needed to improve not only HIV curriculum, but

also teacher training and information about students' knowledge, behavior and beliefs.

The second GAO report concerns the slow progress by the Federal, State and local governments to reach the small but critical percentage of youth who are not in school. This group includes the runaways, the homeless, the incarcerated, the migrants, and street youth who may be involved in a variety of high-risk behaviors such as IV drug use and prostitution.

As much as people may want to get AIDS behind them, get rid of it, thus get the problem solved and go on, the epidemic among youth may be only just beginning. According to CDC, there are 500 reported cases of AIDS among teenagers. Now, that does not sound like much, does it? Five hundred cases of AIDS among teenagers. And that figure is small when compared with the over 100,000 AIDS cases overall, but it is no comfort to the health experts who know it is possible to be infected with the human immunodeficiency virus and not show any symptoms of the disease for 10 years or more. So, that figure of 500 confirmed AIDS cases now among teenagers undoubtedly translates into many, many, many times that number who now have the virus that will progress to AIDS as the teens go into their twenties. In fact, health experts see that 20 percent of those people diagnosed with AIDS in this country are between the ages of 20 and 29.

And there are abundant signs that the virus is spreading. Some doctors report that they now have a dozen infected teenage patients, while only a year ago they had one or none. Studies indicate that as many as 1 percent of teenagers in cities like New York and Miami, where the virus is prevalent, are already infected-1 percent, 1 out of every 100 kids you would run into would have the HIV virus now in some of those areas. That translates into an enormous and expensive medical problem for our Nation until a cure and a preventive vaccine can be developed.

In the meantime, the battle against the disease can only be won if our children are taught how to fight against further infection. Indeed, the Presidential Commission on the HIV Epidemic has stated. "The term 'AIDS' is obsolete. 'HIV' infection more correctly defines the problem . . . Continued focus on the label 'AIDS' contributes to the lack of understanding of the importance of HIV infection as the more significant element for taking control of the epidemic." Since education is still the most potent weapon we have to control this epidemic, we need education programs that provide the facts about this disease. We need education programs that promote safe behaviors.

Most of all, we need education programs that work, and today that is what we are trying to explore, what is working and what is not, and how do we know.

Now, I want to do something a little unusual this morning. I do not usually do this, but I am going to read from the report. I know the report is available and the press people and all the rest of you can read it as well as I can, so there is no need to read it. But I was rereading some of it this morning, and it was so shocking that I think it is worthwhile to read this into the record and draw special emphasis to it, so we realize what the risk is and what the situa

tion is with regard to trying to control the spread of this HIV virus among our young people.

Let me just quote in part from this and, for those of you who have copies of it, it is on page 10 of the report on school programs. Starting out at the bottom:

Yet the myth that there is no need to educate heterosexuals because the disease is not spreading beyond homosexual or drug-using people persists, the Citizens commission says. This belief hinders adequate education efforts.

Many teenagers engage in sexual behavior, such as unprotected intercourse or intercourse with two or more partners, that can transmit HIV. Data show that:

1. Youth have sex at an early age-the average age of first intercourse is 16. The Office of Technology Assessment reports that 78 percent of males and 63 percent of females have sex while teenagers.

2. For many adolescents, sexual activity is frequent or often with more than one partners. Among unmarried females 15 to 19 years old, about 40 percent reported having sex once a week or more, and 51 percent reported having two or more part

ners.

This is the age group 15 to 19 we are talking about.

An official of a national organization serving youth said that adolescents interpret a "long-term monogamous relationship" to be one with their current lover that lasts for several months.

3. Much of teenagers' sexual intercourse occurs without the protection of condoms. Although estimates vary, studies we reviewed found that only about one-quarter of sexually active adolescents used condoms. Serial monogamy in combination with the reluctance to use condoms with one's monogamous lover exposes youth to the risks associated with unprotected intercourse with multiple partners.

Homosexual youth, particularly males, are of special concern as they have been one of the high-risk groups for HIV transmission in the United States. As youth, these teens also search for their identity and struggle to establish satisfying relationships, leading them, in some cases, to experiment with heterosexual affiliations. This places lesbian youth, who generally would be in a low-risk category, at heightened risk of infection. Such exploration also serves as a possible link between homosexual and heterosexual youth in the transmission of HIV.

Thus, many teenagers are at risk of HIV infection through sexual contact. The gravity of the situation is indicated by the fact that young people have the highest incidence of sexually transmitted disease (STD)—as it is called-in comparison with other age categories.

Listen to this:

Nearly one-half of the 20 million STD patients are under age 25. About 2.5 million teenagers contract a sexually transmitted disease annually. The incidence of STD among minority youth is generally far higher than among their white counterparts.

Women who become pregnant through unprotected sexual activities place not only themselves, but also their unborn children, at risk of HIV infection, as the virus can be transmitted perinatally. Ten percent of teenage women become pregnant every year, and 40 percent of U.S. teens will become pregnant at least once before age 20, the Guttmacher Institute reports. There are 1 million teen pregnancies each year.

I guess the answer to that is you do not just say "don't," because that is not going to work. But I found those figures really shocking. As I say, I think I am pretty well up on things and keep in touch with the kids and all, but that kind of stuff shocks me and there just is no way around it. We have a bit of a problem, it is a national problem and it is one we are trying to address here today.

I do not want to go on. We are here to hear our witnesses, not me today, but I found that shocking enough that I thought it was good to draw special emphasis to it this morning.

One of our Committee members who has repeatedly expressed a

people and how we can improve their lot and do things here at the Federal level where we address problems that are national is Senator Kohl. He has been active in looking into these different areas and supporting our efforts in that area. He has another hearing this morning he has to go to and preside over, at 11 o'clock, so he could not preside over the whole hearing this morning. But he will be taking the lead in some of these areas and I am particularly grateful for his help and for the wonderful work that he is doing in this area. I am glad he can be here at least for the first hour or so of the hearing this morning, and he will be taking the lead in a lot of these areas for the committee in the future.

Senator Kohl.

OPENING STATEMENT OF SENATOR KOHL

Senator KOHL. Thank you very much, Mr. Chairman.

There is no question among experts that AIDS is the most dire public health crisis facing our country today. Over 120,000 Americans have already been diagnosed with the disease and, of these, over 70,000 have died.

It is estimated that more than 1 million people in our country are HIV infected. There are very many who are not learning about AIDS. They are not being taught to avoid the behavior that leads to HIV infection, nor are they learning how to deal compassionately with persons with AIDS. Without adequate education, two things happen: Kids continue to believe they are immune from this disease and misunderstanding and prejudice are allowed to fester.

The GAO reports that one-third of America's schools are not providing AIDS education. The GAO also reports that many of the schools that do provide AIDS education are not doing enough. Many students only learn about AIDS once in the 7th or 8th grade, when they are low risk of infection.

In my own State of Wisconsin, the only money being spent on inschool education is $246,000 of Federal money allocated by the CDC. This effort is grossly under-funded. Recent legislation passed by the State Legislature would have required students to take at least two comprehensive AIDS education programs, but this legislation was vetoed. The rationale was lack of funds, not the expense to society caused by an increasing number of kids coming down with AIDS.

As tough as it is to get the message to kids in the classroom, it is infinitely more difficult to reach kids on the street and they are at incredible risk. A report released just 2 weeks ago by the Wisconsin Division of Health stated that 1 in 500 Wisconsin residents became infected with the HIV virus in the 1980's. In the next decade, between 9,300 and 14,000 more will become infected. Kids on the street are easy targets for both the pusher and the pimp, and if we cannot find a way to reach out to these young people, we will be writing a lot of death sentences.

Part of what we hope to learn here today is what is being done right. It seems important that, if we are going to stem the spread of this disease in both high school and out-of-school populations, we need a sense of what is happening in those kids' lives and what

their needs are, then we have to match our resources with these needs.

One of the things that strikes me is how different it is to be a kid growing up in the 1990's. I did not have to worry about AIDS or drugs or street crime. I could just be a kid and have fun, and sooner or later start taking responsibility for a life full of hope and bright prospects. If I screwed up-which I want to assure the Chairman I never did-it was not a life or death sentence, it was just part of growing up and I could learn from my mistakes and move on. The stakes for that screw-up today are much higher.

With dangers like AIDS, ignorance kills. Getting the word out to today's young people is a special challenge and I hope some of our witnesses can shed some light on the best ways to face that challenge.

So, I thank the Chairman for his leadership on this critical issue and look forward to hearing from our witnesses.

Chairman GLENN. Thank you, Senator Kohl.

Senator Heinz, any comments?

OPENING STATEMENT OF SENATOR HEINZ

Senator HEINZ. Just briefly, Mr. Chairman.

First, It was my hope to spend a fair amount of time here this morning, but I have two other hearings, both starting at 10:00. I did want to come by to commend you for conducting this hearing, Mr. Chairman, on AIDS prevention and education, activities. And, I agree with Senator Kohl, on the need to be directed more than ever before at our young people. I think Senator Kohl was extremely eloquent about the costs of being wrong today.

Twenty or 30 years ago, if you made a mistake, the cost was not fatal. Today, life literally depends on avoiding mistakes. Outside of the research laboratory, education and counseling on HIV is our best line of defense to combat the growing AIDS HIV epidemic. I for one see absolutely no alternative to early intervention with education as a means of helping control the spread of HIV infection. I particularly want to commend and applaud the Centers for Disease Control for their efforts in this area.

I say that, because the Centers for Disease control has developed a range of HIV risk assessment prevention activities, including efforts targeted to school- and college-age youth. I hope, indeed I anticipate that today's hearing is going to illustrate that more must be done to strengthen HIV education and prevention outreach for our youth.

An effective cure for AIDS, in spite of newspaper articles that might lead you to conclude, is out of our immediate grasp. Notwithstanding the possibility at some future time of perhaps a vaccine, that is not where we are today, let alone any place close to a cure. As long as people do not delude themselves into believing there is some immediate magic technological, biological fix just over the horizon, then I think we should focus and will focus correctly on the prevention, education, and outreach that is necessary and a sound investment.

Mr. Chairman, I look forward to working with you, Senator