PRESIDENTIAL COMMISSIION ON THE
HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC

HEARING ON PREVENTION AND EDUCATION
The Hearing was held at the
Interstate Commerce Commission Building
Hearing Room B
12th and Constitution Avenue, N. W.
Washington, D.C.
Thursday, March 3, 1988
COMMISSION MEMBERS PRESENT:
ADMIRAL JAMES D. WATKINS (Ret.), CHAIRMAN
COLLEEN CONWAY-WELCH, PH.D.
JOHN J. CREEDON
THERESA L. CRENSHAW
RICHARD M. DEVOS
KRISTINE M. GEBBIE, R.N., M.N.-
BURTON JAMES LEE, III, M.D.
FRANK LILLY, PH.D.
BENY J. PRIMM !
PENNY PULLEN
CORY SERVAAS, M.D.
WILLIAM B. WALSH, M.D.
POLLY L. GAULT, EXECUTIVE DIRECTOR
COMMISSION MEMBER NOT ATTENDING:

JOHN CARDINAL O’CONNOR

 

 
 

 

I-N-D-E-X

PAGE
WELCOME
Admiral Watkins, Chairman - 316
William Bennett, Secretary of Education 316

PANEL ELEVEN
AIDS AND EDUCATION IN THE NATION'S SCHOOLS -
Dennis Tolsma, Director . \ 343
Center for Health Promotion and Education

Centers for Disease Control

Jonathon T. Howe, President : . 346
National School Boards Association

Manya Ungar, President ' 348
National PTA

Connie Hubbell, Kansas City State Board of 350
Fducation on behalf of the National Association
of State Boards of Education

Cherrie B. Boyer, Ph.D., Assistant Professor 353
Department of Epidemiology and Social Medicine,

Adolescent AIDS Program, Albert Einstein College of
Medicine, Montefiore Medical Center

Debra W. Haffner, Director of Information and 357
Education
Center for Population Options

PANEL TWELVE
VIEWS OF ELECTED OFFICIALS
Governor Edward DiPrete, State of Rhode Island 387

Congresswoman Claudine Schneider, 2nd District, 384
State of Rhode Island

Congressman Sander Levin, 17th District, State 393
of Michigan

PANEL THIRTEEN

 

STUDENT PERSPECTIVES .
Ryan Wayne White, Student 407

Hamilton Heights High School, Cicero, Indiana

Jill Steward, Student Council President 410
Hamilton Heights High School, Cicero, Indiana

 

 
 

 

I-N-D-E-X (continued)
PAGE

PANEL FOURTEEN
AIDS AND EDUCATION IN THE NATION'S SCHOOLS.
Mary Hatwood Futrell, President 417
National Education Association

Delores Hardison, President 420
National Association of Elementary School Principals

Eric Voth, M.D., Board Member 422
National Federation of Parents for a Drug Free Youth;
Medical Director, St. Francis Chemical Dependency
Treatment Center, Topeka, Kansas

Stephen Sroka, Ph.D., Cleveland Public Schools 425
Cleveland, Ohio

PANEL FIFTEEN
COLLEGE/UNIVERSITY EDUCATION ,

Arthur Sandee, Ph.D., Vice President for Student 450
Affairs

University of Florida at Gainesville

Richard Keeling, M.D., Director 453
University of Virginia Department of Student Health;
President-elect, American College Health Association
(ACHA); Chairman, ACHA AIDS Task Force

James A. Kellar, Student Counselor 458
University of Virginia

Laura Jill Flickinger, Student Counselor 459
University of Virginia

APPENDIX ~ SUBMITTED TESTIMONY

 

 
 

 

PROCEEDINGS

MS. GAULT: Ladies and gentlemen, members of the
President’s Commission, distinguished guests, my name is Polly
Gault. I am the designated federal official and in that
capacity, it is my pleasure to declare this meeting open today.
Mr. Chairman.

CHAIRMAN WATKINS: Good morning and welcome to our
third in a series of hearings on education. Yesterday we began
our examination of the various education strategies that can be
utilized to stem the spread of the HIV infection. When we opened
yesterday morning, I said that it is important that when we hear
the word education, we do not associate it only within the
context of a formal setting of a classroom. This point was
stressed over and over again as witnesses came before us and told
us how they are educating those hard-to-reach youth, most of whom
are out of the mainstream. We also heard testimony regarding the
educational efforts of community-based organizations and from
representatives of the media who told us what they are doing
today and what their more aggressive plans are for tomorrow.

Today, we are going to focus our attention on education
of our nation’s school children. These children do not pose the
same degree of challenge as to some of our hard-to-reach youth.
We know where they are. Nevertheless, the challenge to influence
them is also real, for while giving them a message about the HIV
epidemic is perhaps easy, giving them a message which they
understand sufficiently to alter behavior is not such an easy
task.

Today, we will hear the views of various educators
about what type of information concerning this epidemic is
appropriate to provide for our nation’s school children and what
is the best way to deliver it. I am now pleased to introduce our
first witness today, Secretary of Education William J. Bennett.
Secretary Bennett has served in his current position for three
years. Prior to taking over the leadership of the Department of
Education, he was the Chairman of the National Endowment for the
Humanities. Secretary Bennett has been a leader and spokesman
for better education in our nation. We are honored and
delighted that he has joined us today to present his views
regarding AIDS and education in our nation’s schools.

Welcome Secretary Bennett and please let us have your
statement.

SECRETARY BENNETT: Thank you, Mr. Chairman. As you
know, Mr. Chairman, I visit a lot schools around the country,
about 90 schools to date, and I often complain in those
classrooms and buildings that I do not often enough see maps. I
cannot complain this morning. You have got a map right there

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above you, and that is good. This would be a good place for the
next geography hearings that we hold.

I appreciate the opportunity to testify before you
today regarding our efforts to educate young people about AIDS
and to prevent the spread of the disease. My involvement in the
AIDS issue stems from my responsibilities as Secretary of
Education. From the beginning, all have agreed that education is
a critical part of our effort against. this disease. Much of what
I have sought to do is to insist that the information and advice
that young people receive about AIDS is medically and
pedagogically sound. In presenting this advice, we have been
acutely conscious of the fact that we must Speak to young people
in a manner that recognized their youth and the need to provide
guidance appropriate to their age. So, in some respects, we
speak to young people and adults differently.

Ij understand that at present, 32 states have mandated
that information about AIDS be presented in their schools. Many
schools and school districts are developing AIDS education
programs and others already have them. You will be hearing, I
take it, from other witnesses about this later on. To assist
parents, educators and state and local officials in January of
1987, the Surgeon General and I issued a set of principles to
guide AIDS education in the schools. And in response to numerous
requests for more detailed information about AIDS education for
young people, in October 1987, I released AIDS and The Education
of Our Children, A Guide for Parents and Teachers.

In producing AIDS and The Education of Our Children, we
relied on the best medical information available. We put that

information in an appropriate instructional context, emphasizing
that teaching our young people the time-honored lesson of
responsibility and self-control is the best lesson we can teach,
and the most reliable safeguard against contracting the AIDS
virus.

Response to our booklet has been overwhelmingly
favorable. At the Department of Education, we have never had
another publication generate the kind of interest that this
booklet has. Over two million copies of our book have been
requested since its release just five months ago. This two
million figure includes roughly 375,000 copies that have been
requested in excess of our present supply. In fact, I now intend
to devote most of my uncommitted discretionary funds to meet the
demand for this book. Even so, we are still uncertain that we
will be able to meet the public demand.

Parents, teachers, school principals, and
superintendents tell us that what we have to Say is sensible and
useful and thousands of them have written the Department
requesting additional copies. AIDS and the Education of our
Children has been distributed to family physicians around the

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nation as a public service by the editors of the journal,
Medical Aspects of Human Sexuality, and it is a recommended
reference in the Center for Disease Control’s "Guidelines for
AIDS Education in the Schools," published in January of this
year.

Nevertheless, there are still a few who have been
critical of us. They have argued that we are merely moralizing.
But, in fact, we have been doing something else. What we have
presented is the teaching of moral realism and such a teaching is
essential in this effort. Let me explain. We all know that
values, the moral beliefs of young people, are a powerful
determinate of their behavior. Thus, a 1987 National Academy of
Sciences’ report, Risking the Future, noted that young peoples’
view of themselves, their self-perception, their sense of who
they are, who they can be, who they want to be, is the single
most powerful influence on their sexual behavior. That is why we
seek to put AIDS education in a moral context, not just because
as adults we have a general responsibility to be concerned with
moral issues, but because moral beliefs and habits are key to
behavior, and behavior is the key to protecting against AIDS and
to curbing the spread of the AIDS virus.

I would note just parenthetically that there has been a
lot of discussion, obviously a lot of it stimulated by the
Commission, about treatment. In treatment as well, in successful
treatment, as you know, Mr. Chairman, once again the whole issue
of values and beliefs and aspirations is very important for a
treatment to be successful. In many cases the individuals
involved must commit themselves to a reordering of their
priorities. So these things matter.

Behavior is the key to protecting against AIDS and to
curbing the spread of the AIDS virus. We should not be afraid to
talk about the demands of decency, of self-respect and personal
responsibility in the presence of the young. Indeed, AIDS gives
us one more reason, indeed I think an urgent reason, to meet this
responsibility. If we refuse to speak in a morally realistic way
of internal restraints on behavior, we are abandoning the single
most effective means of influencing young peoples’ behavior.

With regard to AIDS education for young people, I
believe we are seeing encouraging signs of progress in facing up
to this reality. Not too long ago, for example, condoms and
safe sex were being hailed as the essential element of the AIDS
education enterprise. Some rushed to embrace condoms as a kind
of panacea. A few teachers even brought bananas to class to
illustrate the "technology", as they called it. At the time I
described this sort of faddishness as "condom-mania". I was glad
to see the Surgeon General refer to condom-mania a couple of
months after. I said that excessive reliance on condoms was a
species of self-delusion. We knew then and we know now that for

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all, but especially for young people, restraint and fidelity are
the best means of guarding against AIDS, against other dangerous
diseases and, of course, against other undesirable consequences.
Of course, if we do teach about condoms, and many schools will
decide to do just that, then we must be truthful in what we say.
We must be truthful in what we say in regards to what we know
about their reliability and their lack thereof.

Let me be clear. The differences that have emerged
regarding AIDS education for the young are not simply trifling
pedagogic ones. They are over basic philosophy. What is at
issue is whether or not personal responsibility should be
taught, expected of our children and used to our advantage in the
fight against AIDS. Those who seek a prophylactic solution to
AIDS are refusing to confront the more difficult, the more
pressing, the more real issues -- the issues of conduct and
personal responsibility, issues at the behavioral heart of the
AIDS epidemic and at the heart of much of the controversy
surrounding AIDS.

Whether with regard to condoms or clean needles, we
must reject the fruitless quest for a prophylactic solution.
This quest will fail. The search for a technologically fail-safe
method that will negate the harmful consequences of some sort of
human behavior will fail. "Find us a technology or a treatment
program to insulate us from the consequences of our own acts,"
says this modern sensibility. "Find us a way to compensate for
it, to protect against the consequences of all human behaviors,"
it says. "Find us a way to protect everyone from all his
actions, whatever they may be. But in fact, you do not have, and
I guess we will never have the technology that will make
irrelevant the demands of individual responsibility.

The false promise of such a solution is particularly
dangerous for teenagers. Teenagers are not notoriously prudent.
Indeed, teenagers are risk takers and risk takers are less likely
to alter their behavior when they hear an equivocal message.

With respect to AIDS, teenagers and others will not heed the
mixed message favored by some, namely, "go ahead, have sex, but
be sure to used a latex condom supplemented with jelly or cream
containing at least 65 milligrams of nonoxinal-9". Teenagers in
the heat of passion are not very likely to follow this advice.
Instead, I think our efforts must emphasize changing individual
behavior and we will do this and we will succeed in this only if
we reach young people during more tempered moments and offer them

good reasons to resist the temptations that are sure to arise in
their lives.

Let me add a word about proposals for expenditures for
drug treatment programs. As I said, this has been in the news a
good bit. I certainly have no desire, as you know, Mr. Chairman,

\
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to pinch pennies in fighting AIDS or drugs. It may well be that
more money for drug treatment is needed and desirable. But we
must also focus on improving the effectiveness of treatment and
we must be wary of sending the message that more treatment,
useful as that may be, is the major thing needed in the fight
against AIDS. In the prevention of the spread of this disease,
individual responsibility and prudent public health measures as
well as treatment I believe are key. Individual responsibility
can be fostered by sound government programs and policy,
including testing, counselling programs that provide the
necessary information for responsible behavior, drug treatment
programs that provide aid in altering behavior, and laws that
impose sanctions for irresponsible or dangerous behavior such as
knowingly transmitting the AIDS virus. These policies, like our
education efforts, must support and emphasize the necessity of
individual responsibility for sound behavior. Without individual
responsibility, we will be in the treatment business forever.

Your financial recommendations will triple or quadruple
every year as your clientele increases ad infinitum. You will
have more and more people at your doors unless we can get hold of
this problem before they get addicted to drugs or involved in
other problems. In preventing AIDS and in preventing illegal
drug use by young people, we largely know what works. It is not
a mystery but it requires that adults follow common sense when it
comes to educating young people and protecting their lives. It
requires sustained attention to raising the young with sound
standards of behavior in addition to providing the facts about
AIDS and drug use. In some cases, we adults must relearn these
facts if we are to meet the responsibilities of protecting our
children from AIDS and from the other pathologies that threaten
their lives today. Thank you very much.

CHAIRMAN WATKINS: Thank you very much, Mr. Secretary.
This morning I would like to start our questioning on the right
with Dr. Primn.

MR. PRIMM: No questions.
CHAIRMAN WATKINS: Dr. Walsh?

DR. WALSH: Mr. Secretary, in part you are preaching to
the choir, at least with this Commission when you talk about
behavioral change and the necessity for it as well as stressing,
as I think the Commission feels, in our ultimate and final
report, that individual responsibility is really going to be the
key to the success in the fight against AIDS. You have gone
around the country a great deal, and you have some opportunity to
follow up with the reception of your education brochure. We have
heard a lot of testimony indicating positive hope and that there
have been some outstanding examples of behavioral change.

320

 

 

 
 

 

I wondered if you would like to comment on the success
of our programs to this time, as to whether we have seen
behavioral change to a satisfactory extent in the high risk
groups that we are now concerned with such as the minority
population. Can we reach them through the schools with the
background of the type of pamphlets you distributed or the type
of communication that HHS is trying to send out?

SECRETARY BENNETT: Sure, Dr. Walsh, let me try to
mention a couple of things.

We do not have conclusive evidence yet in the specific
population we talked about. We have some evidence of certain
things. Let me just briefly describe it. Take drug use for
example. Among all teenagers it is generally down in most
categories but it is not down in regard to crack. Crack use is
level or up I believe. We do not, have the data to be able to
disaggregate by population. I think most observers on the scene,
would argue that among our inner city minority populations, young
kids, teenagers, drug use is not down. Not only is the use of
crack up I would guess, and I think it is an educated guess, that
the use of other drugs would be up in certain populations as
well. So that continues to pose a very great threat to our young
people, not simply in terms of the possible transmission of the
AIDS virus but for reasons of the dangers of crack in itself.

In other areas such as sexual activity in young people
-- sexual activity among young women in our inner cities -- there
is some evidence that there has been a decline in premature
sexual activity, early sexual intercourse for young black
females. This is obviously encouraging if this is true, and if
it is the case, we want to find out the reasons for its
effectiveness. The point I would make is that we should not
treat altering the behavior of young people as an impossible
task. We should not throw up our hands and say, as I have heard
some people say, well, kids will be kids -- which, of course, is
true, therefore let us just try to limit the danger of their acts
and limit the consequences of their acts. It is much easier to
alter the behavior of people when they are younger than when they
are older. And, again, I have no argument against sound
treatment programs, but a key to many successful treatment
programs is to alter the behavior, the value system of a person.
It is easier to do that with a young person before they get on
drugs than with an older person whose habits are ingrained. A
third group, I am not expert about, but have been reading a great
deal about, is the homosexual populations. I think that there
are a couple of reports that suggest there has been terrific
educational effort and a dramatic change in behavior and I am
confident that is true in certain areas and certain parts of the
country and certain cities where these efforts have been
undertaken and where they have been well received. I do not
believe, however, based on what I read, that one could say that

321

 

 

 
 

 

this is the case everywhere.’ There was an article in the .
Washington Post in November, interviews with a number of heads of
counselling clinics, saying that there are still a terrific
amount, a tremendous amount of casual, anonymous sex going on
without people who are engaging in it using condons ,/ taking
precautions and so on, but I am confident there is not much hard
data.

The overall point I would make, however, is that it is
possible to influence young peoples’ behavior. It is only in
1988 I suppose, that this would come as a shock to anybody.
People have been doing this for 2,000, 3,000, 5,000 years, and we
know what works. What works is to surround young people with
adults who care for them, who are good examples to them, who give
them sound precepts and encouragement in the right direction.

The National Research Council report, Risking the Future,
basically backs up Aristotle in saying that young people’s sense
of who they want to be, what they want to be, their aspirations,
their telose as Aristotle would put it, has a lot to do with the
kind of behavior they will engage in.

What can effect that behavior? Adults. What are the
settings? Good schools. Good schools make a difference.
Churches make a difference, churches and synagogues.
Neighborhoods make a difference. The intervention of
responsible adults, even if those institutions are not doing the
job, a mentor, a Eugene Lang in New York, or other people, can
make a very positive difference in peoples’ lives. There is no

mystery.

DR. WALSH: We have also heard suggestions about
perhaps random testing or some such sort of thing at the college
level. Do you have any particular attitude towards the problems
of testing or the value of testing at adolescent, say high school
or early college level? Or at any level? Or testing in general,

from the standpoint of giving us any baseline? |

I was disturbed by reading in our papers here in
Washington of that high school in suburban Virginia that turned
up with several youngsters that had tested seropositive between
senior year or during senior year and freshman year in college,
and again, you do not always believe what you read in the papers
but the fact was that there was expression of some of the
students that there was probably still significant casual sex
and probably a significantly larger degree of positivity although
there is no data to substantiate that at all. Do you have any
attitude on that?

SECRETARY BENNETT: Yes. From the beginning, I have
argued for a greater use of responsible testing, for routine
testing, and I do not think, unlike what I would say in other
areas, that I would draw a hard line of demarcation between

322

 

 
 

 

adolescents and adults here. A position I have held, and many
other people hold as well is that we should have routine testing
for people for admission to sexually transmitted disease clinics
and hospitals and the like and if that person is a 15-year-old, I
think we should treat that person the same way.

As members of this Commission know, we now estimate,
that, one million to 1.5 million people are HIV positive and only
10 percent or 15 percent of those people know it. Knowledge
should forever govern ignorance in all areas, in particular I
would think in the practice of medicine and public policy, we
need to know more. So I would not make an exception for
adolescents there. There are some issues here where one wants to
speak to the young people differently than one speaks to adults,
but on the issue of testing, I think we probably have the same
criteria for young people as for adults.

DR. WALSH: My final question, Mr. Secretary, would be
along the lines of again, other discussions we have had or
witnesses we have heard. Is the Department of Education
contemplating any modification of that bulletin, AIDS and
Children, which I thought was excellent and obviously it has had
great receptivity. Is consideration being given to modifying it
for minority populations? Because we have heard consistently
from minority representatives that one of the reasons they are
not being reached is that they have to be reached, in effect, in
their own language and at their own level of literacy and that
sort of thing. We have had other witnesses say that we have to
be much more explicit with some of these groups because of the
lack of educational background, and I wondered if ‘you were
contemplating doing anything that would be a variation perhaps on
the very good thing?

SECRETARY BENNETT: There are several possibilities,
Dr. Walsh. Weare considering a Spanish language version of the
book as one possibility. Second, we will continue to. update the
book and respond to any recommendations that are sensible in
terms of change. When we look at the requests for the book, I do
not think we can generalize from the mail we have received that
this book is not being well received in the inner city community.
It is, and we are getting requests for lots of copies. But, in
general, remember that we have not received one cent from the
Congress for our work on AIDS and education. We have been looked
to for guidance and recommendations and people have said, what is
the Secretary of Education going to do about this? They said
that six months ago in any case, but have not given us any money
to do anything with so we have been taking the money out of our
discretionary funds.

The lead agency here, of course, is HHS, and CDC
particularly has been given the major responsibility in the
development of guidelines, educational guidelines with

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ES

Congressional funds. Now, we work very well with CDC. As I say,
our book is on the CDC recommended list. My guess that is there
is to be another. major venture in this area, we will probably
not receive the funds, CDC or HHS will, but we will be glad to
help and offer advice. We are looking for some money for the
book. We still have 375,000 to send out. We wrote Mr. Creedon
about it. Maybe he has some money. Maybe he is considering my
letter this morning.

CHAIRMAN WATKINS: Conflict of interest. Dr. SerVaas.

DR. SERVAAS: Thank you for your very excellent
presentation. Secretary Bennett, when I was in medical school,
we were taught that AA was the best group that we had for
alcoholics to change their behavior and that it worked best,
better than anything else we had, but it almost never worked
unless there was a faith involved, and that interested me. We
did a lot of work with key challenges of drug addiction. It is a
group that has a 10 or 15 year track record, and when they look
back - they go back 10 years - they find about 87 percent of the
people are still-off drugs. That group also has a religious
component. My question is, have we ever done any studies where
we have looked at children who have been in parochial or church
or synagogue affiliated schools where moral issues are taken up
versus the children in inner cities who have not had any such
training?

 

Do these parochial school children end up having
behavior patterns that are better than the children who are in
secular schools and not exposed to spiritual values? It would
seem to me that there would be enough inner city children who
have been placed in religious schools so that we could make a
fair comparison and my question also is do you believe that some
TV programs are giving our youth the wrong signals about the
importance of developing high standards of behavior?

SECRETARY BENNETT: I will ask John Walters, my special
assistant to comment on the question about studies and then I
will come back and comment.

MR. WALTERS: Generally speaking the studies of
individual students have not focused on parochial school children
versus public school children. There have been a couple of
studies done on the religious convictions of students as it
relates to their behavior, and generally speaking, children who
have less trouble with the law, less problems with teenage
suicide, teenage pregnancy, drug abuse, are students that have
strong religious faith, greater involvement in extracurricular
activities, greater involvement in school. Obviously, there is a
connection between their lives being involved in healthy and
productive things rather than being left idle and allowed to

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i

wander, but there have not been specific studies, that I am aware
of, measuring parochial versus public school children.

SECRETARY BENNETT: Obviously, religion or faith can be
a helpful support to people’s beliefs and even a ground or
motivation for their actions. But we do not have any data, and
we certainly would not want to’suggest| that proper instruction in
a sense personal responsibility in the public schools, entirely
within the first amendment, could not achieve the same effect.
I believe that it can. But, of course, from time immemorial, the
relationship of persona] belief and personal action has been
clear.

In terms of TV programs, I pretty much regard TV as a
cultural wasteland anyway for the most part, and I do not look to
TV for great efforts of reform either in terms of students’
academic performance or in terms of teaching of a sound value
system. Occasionally good things are on television, of course,
everyone knows that. My main task as Secretary of Education has
been to be to reform the institution which is supposed to educate
people, which is school, rather than working on making television
more like school, I would rather make school less like television
because that is the institution that is supposed to be educating
people. TV never came into being by saying we are going to
educate people. There are a lot of hopes that TV would, but
schools do exist to educate people and to guide people and they
can do the job, but that is not to say that a lot of what is on
TV is helping. It is not helping.

 

One of the reasons that you are interested in this for
general purposes is that a lot of kids watch TV because they do
not have anything else to do, and one of the reasons they do not
have anything else to do is a lot of schools do not give out
homework. So I believe in the marketplace of ideas and I believe
that assignments in algebra should compete with "The Love Boat"
or MTV.

DR. SERVAAS: Thank you.
CHAIRMAN WATKINS: Dr. Crenshaw?

DR. CRENSHAW: Something that is not very widely
apparent in my opinion is that between the people who are liberal
sexually and those who are conservative sexually, in relation to
the AIDS issue, I think there is a great deal more common ground
than is acknowledged. First of all, everybody has the same goal.
We obviously do not want our teenagers to become infected and to
get sick and to die, and in my experience as I have talked with
individuals in the gay community, I have not heard one who is
against monogamy. They just simply do not believe it is
realistic for everyone. The same is true when I talk to people
of a more conservative orientation because they have expressed to

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Yo

me that if, in spite of all the advice and emphasis and effort to
get someone not to have sex at all, they do not want the kids
having sex without any protection and losing their lives if they
are not going to follow the very best advice.

So what I think and what I wonder about is if there is
not a way, since we are pulling in the same direction, even
though the modus operandi is different for different groups, to
achieve this common goal? I think it is a great advantage
because in a lot of areas, there is not even a common goal to
pull for. What can be done to improve the dialogue and the
negotiation and the communication between the differing points of
view to see if we cannot achieve even more cooperation so we
really can be pulling in the same direction? I think until we
achieve that in society, we fractionate the confusing messages.
I think that the ultimate solution is in the dialogue between
leaders in both camps. What do you think is possible, and what
do you recommend?

SECRETARY BENNETT: I agree with you, Dr. Crenshaw,
that there is a lot more agreement there than meets the eye. You
know, one finds with this issue, as with other issues, some have
a great interest in accentuating the differences between people
rather than the very large areas of agreement. I noted with
amusement, for months people saying that Dr. Koop and I were
virtually in opposition on this issue, when in fact we were in
virtual unanimity on the issues. I think what is required to
keep the dialogue going is candor, for one, people being
straightforward and honest. Second, sharing the information that
we have, and third, recognizing that there is a good deal we know
about what works and what is effective in the education of young
people. '

Quite apart from the AIDS debate, there are lots of
reasons for encouraging young people to be, if you will,
conservative, not politically, but sexually, when they are young.
How many more teenage pregnancies do we need? How many more
years of 400,000 abortions a year do we need? How many more
wrecked lives in the inner city of female headed households do we
need to make this case? Just bringing to light what is actually
going on, the study done of the young women at the Brady Hospital
in Atlanta, young, teenage black girls who were there, pregnant,
and they were asked about the instruction they received, and they
had had sex education courses. Nine out of ten of these girls
said that no one ever made the case to them that they actually
should not do it, that they should wait. No one had ever made
that case to them. °

Now, this does not shock me because, as I said, I go
into the schools and I find 17-year-olds who have never been told
why the United States is a freer country than Albania and all ;
sorts of things. This is the responsibility of the schools in —-

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which we are failing in many cases, but there is a lot we can do,
and it is important not to despair. It is very important to
realize that young people do look to us for guidance, and they
look to us for guidance whether they are in the suburbs or in the
inner city, and the power of a good adult role model, mentor,
helping hand, is one of the most powerful things there is.

A study in the New York Times about a month ago was
made of people who made it against the odds, people who, by
demographics, by socioeconomic background, seemed doomed to
failure. This was a profile of such people who had made it. In
every case, there was the intervention of a responsible adult.
Sometimes it was the parent, sometimes it was grandmother, uncle,
sometimes it was a stranger, a local policeman or counsellor, and
that one person was enough to stem the tide for that individual.
So let us speak candidly, let us share what we know and let us as
sure as heck not give up on our young people.

 

In the whole area of sexual activity, let me just
mention one statistic. At age 17, 70 percent of our young women
have not engaged in sexual intercourse, 50 percent of our young
men have not engaged in sexual intercourse. The way you hear
Some people talk about our teenagers, you would think they were
all engaged in sex all the time. That is not true, and let us
remember that when the social scientists measure sexual activity,
sexual intimacy among young people, they are talking about one
incident. Many young women and some young men -- the data I have
seen suggests it is more prevalent among young women, but it is
also prevalent among young men -- after their first sexual
encounter at a young age, feel -- and I guess I do not have to
tell you this -- feel very ambivalent about it. There, again, is
an opportunity for adults to teach.

DR. CRENSHAW: It seems to me there are two issues that
often get lost. One is that the differences that seem so wide
are usually more a matter of emphasis on, you know, a matter of
emphasis -- where you put your greatest push. Secondly, on the
question of what is feasible, what is realistic, what is
achievable, and there is debate about that, too. If there could
be some private forum because in public it often seems that
Sparks fly and people dig into positions, but if key leaders
could get together and sit down with the objective of advancing
that common ground even if not complete agreement can be reached,
it seems to me we have already made an enormous amount of
progress. We do net have too awfully far to go to get toa
place where we can pull together as a society more and better
than we are doing today. Thank you.

SECRETARY BENNETT: I agree. I think that in these
discussions, the reason I mentioned candor first is that for
public discussion, for recommendations in‘this issue and related
issues to be taken seriously, we have to speak in ways that

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recognize the differences between censorian public utterance and
the way people talk when they are in private, and we have to try
to capture some of the sense of what people feel and believe but
may not say publicly.

Take the example of teenage sexual activity. I have
had some people say to me privately, who would never say it ina
public forum, well, this is all well and good, but you know, in
the ghetto, all those girls do it. Well, that is not true, it is
just flat not true, and we need to come to grips with that kind
of statement, that kind of utterance and recognize that you do
not write off an entire group of people. Do not treat people as
a category when you talk about what works and what is effective,
but again that requires candor.

We can take you to some inner-city elementary, junior
high and high schools where there is not only a darn fine
academic program, there is a darn fine program at making people
realize their responsibilities as human beings, where there is a
good sex education program, where there are lots of things that
are making and forging good, responsible adults, and we need to
have those positive examples before us. Sorry to be long-winded
on that.

CHAIRMAN WATKINS: Dr. Primm?

MR. PRIMM: I wanted to particularly ask you about your
statement that drug addiction among our youth was down. On what
do you base that information? From the Michigan report on the
high school senior survey, you talk about high school seniors.
And of course there are household studies that have been done.
But there are a lot of people left out of those as you well know.
In my community it is not down. In areas that I travel to in
other parts of the country, it is not down, particularly in black
and Hispanic communities. When we talk about it being down, I
think we lull the American society into a complacency about drug
abuse and aS a consequence, communities that I serve are often
cheated in that process because we do not do any follow up or go
to drop outs. They end up in my program which brings me to the
second point that I want to make, and that is about treatment.

In your opening statement you talk about treatment. You
later on in the second to the last paragraph of your written
testimony go on to say treatment is necessary. You also allude
to using responsibility. In our country, we know that the
education about drug abuse in schools is not that good and
particularly in city schools. I have participated in those
programs myself.

They have generally been not sustained efforts through
elementary, junior high and high schools, and as a consequence, I
think we have never really given what we should have in this

328

 

 
 

 

nation to drug abuse treatment, to drug abuse education, and
therefore we end up at the end of the pipeline where a lot of
people are addicted to drugs. I did not want you to go away
feeling that there was not a dissenting opinion to maybe what you
have espoused here today.

SECRETARY BENNETT: I do not think we disagree, Dr.
Primm. If my remarks suggested to you that I was complacent-—in
the drug situation, I would be shocked. My views about the drug
problem, particularly lately, have been called a lot of things
but complacent they sure have not been called. We are awash in
drugs. Our cities are awash in drugs, and as I said to the first
question from Dr. Walsh, I think in our inner cities
particularly, which is what you are talking about, I take it, I
think drug use is up, and, as I mentioned, crack use is up. The
data is the data from Michigan, the NIDA study confirms the later
point. I think, frankly, that we have had some effect in some
communities in terms of attitudes and among some kids. I think
some attitudes have shifted. But I would never want to be
identified in the complacent category for drug use. As I said
yesterday, we have to up the ante, we have to be prepared to do a
lot more in our war against drugs.

 

In terms of drug education programs, we estimate about
80 percent of our schools now have drug education programs, and
they are of varying effectiveness. They are like sex education
programs. We find, and we think the research is pretty clear on
this one, Dr. Primm, that drug education programs without good,
sound school policy are of no effect. There was a story in the
paper not too long ago, a couple of students sitting in the
classroom with their beepers, and some other students came into
the schoolyard and hit the phone or whatever it is, the beepers
went off, the students went out, made their drug sale and came
back to class. The class they were coming back to was a drug
education class in which these professional pushers were learning

more about drugs thanks to public funds so they could be more
effective dealers.

As we have know from time immemorial, knowledge by
itself, the grasp of the facts by itself can be used for evil as
well as for good. Policy is the key to getting drug use down.

If you want to get drug use down in your schools, you have got to
have tough policy. You have to do what they do over in Anne
Arundel County. They have very clear rules. If you are a pusher
of drugs, you are expelled, you are gone, and you can go to some
alternative school or reform school, but you forfeit the company
of your peers. If you use drugs, you are suspended for five
days. If you use them again, you are expelled and you go to \ .,
reform school. We have seen this be effective in a number of
places. It is only because of the times that we have lost sight
of what is obvious: young people listen to what we say but they

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really pay attention to what we do.

Many of the nation’s campuses are awash in drugs.
Dormitories are, in many places, havens, dormitories on campus.
I think this is a very serious problem because I think the little
kids look up to the big kids but if a college adopts a policy of
no drug use, the students will listen. But what they will wait
and see is whether the authorities are serious and what
authorities have to do, college presidents and others, is act in
ways that show they are serious. If this is killing our children
and some adults, if this is leading to a greater transmission of
the AIDS virus and other things, then we have to get serious.

DR. PRIMM: Thank you.
SECRETARY BENNETT: Thank you.
CHAIRMAN WATKINS: Ms. Gebbie?

MS. GEBBIE: One of the areas we have heard about from
time to time is the potential of strengthening what we are trying
to do by the HIV infection and, in fact, also what we are trying
to do about drug addiction by looking at a more comprehensive
health oriented education for people rather than a sort of
disease of the month approach. I would appreciate some comments
from you on your views of a comprehensive health education
curriculum that might start very early and be supported
throughout education. Depending on how you feel about it, if you
feel positively about it, what might be being done through the
Department of Education to support that?

SECRETARY BENNETT: Sure. I think it is an interesting
idea. I agree with you about the sense of dissatisfaction about
the problem of the month. You know, our kids start cracking up
on the highways so we put in safe driving courses. They start
drinking so we put in a special module or unit on alcohol abuse,
sex education module, now an AIDS education module. One wonders
what the next one will be. I do not fault the schools for
responding to this kind of situation, indeed we have suggested in
many cases that they should. But there are two problems with it.
One, it seems rather piecemeal for one thing and then another
thing and then another thing.

And second, we do not know what they are going to be
facing in the future. This may educate them well about this
problem in 1988 in the fifth grade, what will they be facing in
1995 in the 12th grade? I think that we recommended before in a
publication that a comprehensive program of health education -- I
paused because I know Admiral Watkins is very much associated
with the wellness campaign of the Navy, that is when we first met
-- which talks about the importance of keeping oneself fit

internally and externally, and I think that efforts at such

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comprehensive programs are probably a good idea.

In many of these issues whether we are talking about
safe driving or AIDS education or sex education or drug
education, there are a lot of common elements. Again, I go back
to the National Research Council. Who are you? Who do you want
to be? What kind of a life do you want? What do you think is
possible for you? This is, again, so critical, not just to
sexual activity or possible drug use but to everything a person
does. If we could isolate as teachers, educators, that part of a
person which will keep that person safe as best we can judge, we
would be working very hard on those things which will enhance
self esteem, enhance self worth, a feeling about one’s person,
that it is important and precious. But to do that, we have to do
the kinds of things in our schools that are not being done in too
many of our schools.

For example, a lot of the low self esteem from a lot of
kids in poor settings in cities or in rural areas comes from the
fact that their schools are not serving them well in terms of
giving them enough opportunity to have self esteem, they are not
teaching students well enough. They are not giving these kids a
sense of their future, of their possibility. But we all have our
mortal sins. My view of a mortal sin of the classroom, this is a
small m, is the teacher or principal who takes a kid in the third
grade and says, “You are poor, you are minority, you are all from
Single parent families. You cannot make it. Forget it. You do
not disrupt this classroom and I will not give you a lot of
homework. We all know you are headed for welfare anyway so you
keep the peace and I will not lean on you too much."

That is the end. That sends those kids a message about
who they are and what they are going to be which is not merely
going to translate into academic work. This is going to
translate into how they behave outside of school, sexually, or in
terms of drugs use, or in terms of everything else.

MS. GEBBIE: I think that is well said. I think that
what has to go along with that is factual information as well as
some of those attitudinal things you have identified.

SECRETARY BENNETT: Sure.

MS. GEBBIE: My second question relates to how we make
the best of the federal bureaucracy that we have available to us.
You have already referred to the fact that sometimes media
coverage exaggerates differences rather than commonalities, and
some of the differences rather than commonalities between what
goes on in the Department of Education and what goes on in Health
and Human Services, do get a fair bit of publicity.

We have found at the state and local level that a good

331

 

 
 

 

deal of collaborative effort between school districts and local
health departments has to go on to make anything work. I would
appreciate your comments on that interaction between the health
and education bureaucracies federally and whether there are some
barriers that are a problem there, or some things that could
strengthen the collaborative efforts of health and education on
behalf of our young people.

SECRETARY BENNETT: I am going to ask John Walters who
is the Department’s representative to the Interagency Working
Group to comment on that.

MR. WALTERS: Generally speaking, we have got to
remember that a lot of these programs for AIDS that the Federal
Government has undertaken are new, so there is going to be a
period of trying to establish relationships and get people
working together. There has been a good deal of cooperation.
There is a problem caused by the fact that Congress has chosen to
put essentially education responsibilities for AIDS in one
agency, and it is not the Department of Education. We have
provided consultation, but there are still people who have to
administer the funds and set up the programs. We have tried to
provide advice when we have been asked to, and we have cooperated
in the evaluation and the formation of some of these prograns.

I think, if you are asking can we do more, I think we
can do more to work together on some of these things. There has
been some reluctance on the part of some health educators to move
beyond the issue of simple factual information and talk about the
ethos of the school, the issues of building character, the issues
of building self esteem, because those are not common areas where
they have a lot of experience. And we would like to see more
involvement in the direction of some of the tenets in AIDS and
the Education of Our Children, but we are very pleased, as the
Secretary mentioned, to see that the CDC guidelines reflect a lot
of those same principles. So we are moving in that direction but
I think we will make more progress.

MS. GEBBIE: May I ask one related question? To what
extent in that process do you bring in a variety of state or
local education officials to participate in that process? I am
more familiar with the experience on the health side which is if
we do not find people with a range of views from a range of
geographic areas to sit with us and consult, we often get into
very confusing problems. Is that a similar process on the
education side? ‘

SECRETARY BENNETT: Well, again, we have not been
charged by Congress or given any funds to do this. So whatever
we do, we do on our own. We have consulted as widely as we
could. When I travel, this is one of the issues I talk about
with school officials. I think it is important for Department of

332

 

 
 

 

Education to have a voice here, a voice in this issue because the
Secretary of Education, Surgeon General, Secretary of HHS, might
have, indeed ought to have, given their responsibilities,
somewhat different lenses and perspectives on this but whatever
we have done, we have had to do in a somewhat ad hoc fashion
because we do not have any money specifically dedicated to this
problem.

CHAIRMAN WATKINS: Dr. Lilly?

DR. LILLY: First I would like to briefly pick up on
the point that Dr. Primm was talking about. I do not think you
really meant this literally, but I wrote down that you said
apropos of the IV drug problem that without responsibility,
meaning responsibility on the part of the’ individual, we will be
in the treatment business forever. I do not really believe that
you think that we are ever going to be out of the treatment
business either for IV drug abuse or for sexually transmitted
diseases, that there exist tactics, short of imposing the death
penalty, for avoiding those altogether.

SECRETARY BENNETT: You mean, you are saying we will be
in this business forever?

DR. LILLY: Yes, to at least an extent.

SECRETARY BENNETT: Right. Of course we will, but the
point, was that not only will we be in this business, but if
there is not more emphasis on user responsibility and prevention,
the business will be ever larger.

DR. LILLY: Okay, fine. Then my main question has to
do with the idea of standards of conduct. I am very much for
standards of conduct. I would like you to develop this a little
bit, your ideas about what kinds of standards of conduct should
be inculcated for homosexuals.

SECRETARY BENNETT: What kinds of standards of conduct
should be inculcated for homosexuals? In the schools?

DR. LILLY: Right. What kinds of standards of conduct
would you teach of homosexuals?

SECRETARY BENNETT: Homosexual students in the schools?
DR. LILLY: All homosexuals.

SECRETARY BENNETT: Well, I am Secretary of Education,
as I said, my focus here is on talking to young people.

DR. LILLY: Presumably what you are trying to teach

333

 

 
 

 

them in school is what you hope they will practice as adults. |

SECRETARY BENNETT: Yes, but it is very important, Dr.
Lilly, to distinguish: A) my responsibilities which are to talk
primarily to young people, and B) what one says in different
situations. I think as the message of AIDS and the Education of
Our Children. makes clear, we want to teach young people restraint
and self control and when they are young, abstinence. I think
that is pretty clear and pretty straightforward.

If you want me to comment about homosexual activity,
homosexual behavior generally among the adult population, I think
as a citizen, I would feél very much along the lines that Randy
Schiltz wrote in his book, that widespread promiscuity certainly
is not helping in the struggle against AIDS, and that the
counsellors and doctors at clinics for gay men who counsel people
to exercise precaution, to use condoms, to exercise restraint, ~
are teaching the right kind of standards. I identify with that

100 percent. Wouldn’t you?
DR. LILLY: Indeed.
SECRETARY BENNETT: Good.

DR. LILLY: Given the fact that in going through your
pamphlet, there, of course, is no mention made of potential
homosexuality and that may or may not be justifiable within the
context of children --

SECRETARY BENNETT: I am sorry, I did not hear, there
is no mention --

DR. LILLY: I say, within the context of this pamphlet
that you have put out that there is no mention of potential
homosexuality. I think insofar as teaching in school though, in
fact, many kids know already at that age that they are
homosexual.

The other thing that somewhat bothers me about the
pamphlet is there is never any allowance for an alternative to
the classical family, and as you know, homosexuals are, nowhere
that I know of, allowed to get married and thereby establish a
classical family. There was a Commission recently that
recommended to the President that homosexuals not be allowed to
adopt children.

SECRETARY BENNETT: Well, again, the book is not
basically about family structure, it is about what should be said
to young people in regard to --

DR. LILLY: It refers extensively to family structure
which I am all in favor of. I think families are wonderful

334

 

 
 

 

things.

SECRETARY BENNETT: I think they are, too. We are both
pro-family. That is good. I do not see the significance of the
point. You do not think I understand that there are different
kinds of families? Of course there are.

DR. LILLY: I am not quite sure you understand the
problems that homosexuals have with families and trying to
establish a family structure that is recognized by the world
abroad.

SECRETARY BENNETT: I am aware of their complaints
about this, but I do not see that it is particularly germane to
the book. Do you mean the book should recommend that in talking
with young people about AIDS it should emphasize or stress more
than it does the homosexual family? I do not see any reason for
doing that.

DR. LILLY: I think I have made my point.
CHAIRMAN WATKINS: Ms. Pullen?

MS. PULLEN: Would you elaborate on your comment
concerning equivocal messages and how you view the comparative
utility of equivocal messages in addressing AIDS, particularly
for young people, versus messages that are consistent.

SECRETARY BENNETT: Sure. What I mean by equivocal is
trying to stress to a young person that a certain kind of
behavior is not right for them because of their age, because of
their immaturity, or because of possible consequences. And if
one says this in a kind of incantation, say the context here is a
sex education course, then proceeds to talk for the duration of
the class or the lecture about ways in which one can -protect
oneself one is sending an equivocal message. I am not saying
that should not be done if that is what the community decides it
wants to do in the area of sex education or instruction about
AIDS or teenage pregnancy. The community is free to do it, the
Secretary of Education cannot make them do otherwise and would
not want to make them do otherwise, but I think there is a
problem with equivocation.

In the same way, if one said, "Look, do not smoke, but
if you do, smoke low tar cigarettes. Do not drink, but if you
do, keep it to 70 proof". I think these are confusing messages
for young people. That is what I mean by equivocation.

MS. PULLEN: What do you see in young people in
particular as the effect of an equivocal message?

SECRETARY BENNETT: Confusion. It is a, as William

335

 

 
 

 

James said, a blooming, buzzing confusion out there for all of
us, the reality, the world. For young people, it is particularly
adifficult, and in the world of television, in the messages they
are getting from radio, from movies, from lots of things, there
is not a lot of steady ground out there. There is not a lot of
steady, reliable, cultural support for, if you will steady and
constant behavior.

The best thing that an adult can do for a young person
in this regard is to speak in a steady, steady and clear and
firm; manner standing for something and hopefully standing for
the right thing.

MS. PULLEN: Thank you.
CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: Mr. Secretary, let me start off with a plea.
We had a panel here yesterday talking about abandoned, homeless,
runaway kids that made an unbelievable impression on me. Ms.
Bucy said, and made the excellent point, that they are running
from things, they are not running in search. They have
extraordinarily abusive and deranged family structures. The
title of her book is, To Whom Do They Belong. I know they belong
to me; I know they belong to you; I know they belong to everybody
in this room; and they are the least of these. I am not a
particularly religious person, but I make a plea to you to try to
help these people who are working with these kids. I know you
are. They need more help than they are getting.

This leads me into my question which I could easily ask
of every panelist who is going to come before us today, and I do
not have time to elaborate. I will just say large parts of our
public school system appear to me to be custodial in nature. The
Western civilization, most of Western civilization and Asia do
not operate on this. Excellence is rewarded, poorer students are
funneled in different directions, etc., etc. Personally, I would -
strongly favor revamping our whole educational system and going
for that type of thing. But what do we do with the kids that are
shunted off. Do we send them to trade schools? Do you have
ideas on this type of thing?

. SECRETARY BENNETT: Yes, sir. I agree with you about
where you started. I think not only is it my responsibility in
this job, but it is part of the best response to these children
that we take a very good and hard look at the educational system.
You are absolutely right that a lot of these schools are
custodial, and the reason that a lot of them are custodial is
that they do not have sufficient incentives to be anything else.
You see, this is the basic problem with American public
education. If you serve up a rotten hamburger to kids in this
society at your restaurant you will be closed-down by local,

336

 

 
 

 

state, federal authorities. If you serve up rotten education to
10,000 kids a year in a district in Chicago, nothing happens.
Now, you want to talk about consequences to the lives of children
in the area that this Commission is addressing and other areas, I
will give you a very powerful predictor, the quality of those
schools. ;

Let us take an example. $4,000 per child was spent in
Chicago in the public schools. Fifty per cent of those kids
dropped out, the kids you are talking about. Of the kids who
remain, 50 percent of them score in the bottom one percent in the
United States in standardized tests. Do you know where they are
going? A fair percentage of them are going into crime, a fair
percentage are going into delinquency of various sorts, into
drugs, into all sorts of things. Could it be better? You bet.

I could take you to some schools -- some of them are
parochial schools in Chicago, a couple of them are public
schools -- that take the same population of kids, from the same
neighborhoods, and 80 percent are graduating, 90 percent are
graduating, 85 percent are going on to college. Those schools
are blessed with good principals, with good teachers, with a high
degree of parental involvement. But the other schools are not.
Is there any penalty? Is there any penalty for wasting five or
six years of a child’s life in our system? There is no penalty
whatever. We have said that there should be penalties, that
people who do not teach children, who do not run schools that are

effective, should be fired. This turns out to be controversial.
Fine. It can be controversial. We can debate this ad infinitum.

Meantime, there are lots of schools that are doing
nothing but destroying, not only children’s educational
opportunities, but their life chances in this area and every
other area. We want accountability in education, and that will
require some tremendous changes. You know, it is interesting you
use the word custodial because there is a big debate in New York
City going on right now about who runs the'schools, and some
people believe it is the custodians’ union in New York that runs
the schools. It seems to the be most powerful group. If you |
want to have a special session in New York on some problem, AIDS
or drugs, you cannot do it unless the custodians say you can.

DR. LEE: But my question was what do you do with the
people that are winnowed out of the school system, and if we do
it right, a lot will be winnowed out?

SECRETARY BENNETT: First of all, if you do it right,
if you have good schools, you are going to have fewer dropouts
than you have now. We do an annual report card. We call it the
wall chart, Dr. Lee. We find that the better the school -- the
more demanding the school, the higher the quality of teaching,

337

 

 

 
 

 

the more rigor -- the lower the dropout rate. . Most kids do not
tend to leave because it is too demanding. They leave because it
is boring and they leave for something that they think will. give
quicker thrills outside, but there are a whole range of
alternatives. Alternative education programs is one of then.
Technical schools, trade schools is another one. Another kind of
learning environment. We have seen some experiments done around
the country where some kids just do not work well ina ;

aditional setting but they work very well in another setting.
But the point is to stay at it and not to give up and to have
/accountability in the system.

_ We wanted to put in a bounty, we proposed to the
Congress a bounty. If a kid who has dropped out of school is
reclaimed -- oo

DR. LEE: You proposes a what? I did not hear.

SECRETARY BENNETT: A bounty, the bounty system. It
works for dropouts. A kid drops out of school, another
educational institution -- Catholic, Jewish, non-sectarian,
trade, technical, we do not care -- reclaims that child. That
is, finds that child, and graduates him, reaches certain
standards, that school gets the per capita expenditure for that
child after he graduates -- an incentive system. It did not go
anywhere on the Hill because the established educational
interests, of course, hated this. The very idea of competition
in our educational system is regarded with some, not with some
dismay, but as anathema by a lot of the educators. We can do
this, we can do this. The success stories in our schools show
that it can be done.

There may not be a greater story than that story in Los
Angeles of Jaime Escalante, a poor Hispanic neighborhood which
was low performing, very.low performing until the mid-1980’s. A
new principal, a new superintendent, a new math teacher. Kids
who before had been dropping out, very high dropout rate, there
are now almost no drop outs at Garfield High School, are now
going on to college, not just college. Eighteen kids presented
themselves. Low income Hispanic kids presented themselves to the
college board people to take advanced placement in calculus.
They took the test, 14 of them passed. The people at Princeton,
suffering from the same stereotype a lot of people do, said,
somebody said, not all the people, somebody.said, hey, this
cannot be, you are poor low income Hispanic kids. You cannot
take advanced placement in calculus. They had to take the test
again. They all got advanced placement in calculus.

Why? Because you have a few possessed teachers... I.
have met them and they are possessed, they are rational but they
are inspired and enthusiastic people. They have said, "Although
you are low income Hispanic kids we are not going to let you

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down; we are not going to let you die; we are not going to let
you get into drugs; we are not going to let you get into
pathology; we are going to get you into calculus." I went out
there and visited that school. They are doing it. It can be
done.

Do you think that teacher and that principal are
getting one cent more because they are successful? Not one cent.
Do you think they are treated with regard and acclaim by their
colleagues? A lot of their colleagues do not like them because
they were successful and they put the lie to a lot of excuses -
that are going on. You can put all the responsibility you want
aS a group on the educational institutions if it is something
proper for the educational institutions to do and I will take it
because they are very powerful predictors of what people can be.

If I can just make one other comment. There was a
belief in the 1960’s and 1970’s that socioeconomic class was
destiny. Where you were born, whether you came from an intact
family, or the color of your skin was destiny. The research now
is pretty clear. Socioeconomic background is a fairly strong
predictor of what is going to happen to you, but schools can make
an extremely positive difference in all aspects of a young
person’s behavior. Give people a really good school, and you can
overcome an awful lot of deficits.

CHAIRMAN WATKINS: Mr. Secretary, I know your schedule
is busy. We have to close out, I will close out this particular
part of the hearing with a few questions. First, I would like to
make a statement about the drug treatment we have recommended.

It is a comprehensive drug treatment effort which includes
resources to go into counselling that would certainly include
behavioral change recommendations. Without it, there is no drug
treatment. So we are in total agreement, I think if you read our
package you will see it is quite an integrated package -- and
certainly does not avoid the tough issues that you brought up.

The one compelling thing that has come before this
Commission is the wide divergence in educational treatments that
are necessary to reach the real situations existing in the nation
today. So if the nation were to accept, let us say, the Bennett
model for the year 2000, if we were to pursue that, we still have
to get from the photograph of the nation today to that point.

The people that come before us state that there have to be a
variety of educational intervention concepts in the nation to be
able to pull kids out of the mainstream, back into the
mainstream, to get people that are out of the workplace and
illiterate, literate and back into the workplace.

The whole range of cultural differences have to be
addressed. The various educational packages have to be sensitive

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to cultural differences. It is difficult -- even if you have an
end product that you are trying to achieve -- to understand how
we get to the point where we reach the self esteem, the personal
worth and dignity, the concepts in the mind of the child. We are
all familiar with the problems of teen pregnancy -- light birth
weight, cognitive development problems, lack of participation in
Head Start -- we have a whole host of medical issues that the
Department of Health and Human Services’ 1985 report, stated that
we have to address. Otherwise we are going to have big
educational problems that are not just teaching values. We do
not have the baseline built into the young people today,
particularly as the demographic changes take place and the ethnic
groups grow in size such as the Hispanic group.

As we go around and listen we have people ask us the
question, "Why is Dr. Koop here and Secretary Bennett there?" My
answer is "I do not think they are that far away from each
other." I really believe what we need to do is destroy that
perception and bring you into harmony because I think both are
right. We heard Dr. Koop tell us the very thing you would tell
us, but he walks through a different logic train, down into the
swamp that we find ourselves in in so many places in our society
today, and tries to pull us back up towards the same worthwhile,
objective goal that you have. It seems to me that there is an
opportunity here to make positions mutually compatible instead of
mutually exclusive as we all move together to try to achieve a
better society, perhaps by the turn of the century, and set our
sights on some long range goals to achieve what you are saying.
But how do we get from here to there is what this Commission
probably is all about.

I would like to have your comments on that because I
can tell you that the perception of divided leadership is a real
issue brought before this Commission. It is not this
Commission’s position. We hear it from persons with AIDS, from
community-based organizations, from school districts, from state
leaders, and whether it is real or non-substantive, it is a
perception that is very powerful out there. It seems to me
there is an opportunity now to try to weld these things together
in a more integrated, longer range plan which allows flexibility
and educational intervention strategies which may not be able to
achieve your objective today but might be able to achieve a
longer term objective. I would like to have your views on that.

SECRETARY BENNETT: Sure, just a couple of things. I
am not just giving you a photograph of what it would look like.
We have been, I guess, doing little else for three years, but
trying to say how to get there. We have a whole list of
publications, apart from the AIDS publication about what works in
schools; how to make them work, how to make them more effective.
There is no mystery about this. This is not a problem of not
knowing the state of the art, not know the science. We know what

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to do, we know how to make schools better. The problem is
dislodging certain very strong political interests right now.
The educational establishment in large part does not want to do
what it needs to do.

Do you want to know what that really is, apart from all
the bureaucratic talk? It means people have to get fired.
Principals who are no good have to get fired. It means teachers
who are no good have to get fired. Counsellors: who do not
counsel have to get fired, and people who are doing a great job
teaching and principalling and counselling need to get higher
salaries and need to be recognized for that, but that runs /
against a great current of thought in a lot of the education
business. But I can get you there. You make me education czar,
I can get you there. Now, I do not want to be education czar. |

/

It is a free country, and at the state and local level, I think
there is an enormous consensus among the American people, if you
will, on my issues, the education issues, plus I think enormous
agreement among the American people on our approach to this
issue. What is not missing here is political consensus, or
public opinion rather, but the willingness to act, the
willingness to do it.

In terms of leadership and the perception of
differences of leadership, again, Dr. Koop and I are extremely.
close, very close. Some people have an interest in exaggerating
the differences and disagreements between us, but with that said,
then I think Koop and I agree 95 percent of the way. I would
just say two things. It is all right for a Surgeon General and
the Secretary of Education to speak a little differently about
these things. Think of Koop and Bennett, if you will, at the
level of the school, not talking to an entire country, but
talking to an individual, a young woman, a young man, goes to see
a doctor and talks about what he or she is doing. The doctor’s
advice and the doctor’s recommendations might be different than
the recommendations given by that young person’s counsellor or
teacher.

The doctor’s advice would probably emphasize the
medical aspects, it probably should. That is what you go toa
doctor for. The teacher or counsellor’s advice might emphasize
other things, but the teacher or counsellor should talk about it.
So some shading of difference I think is okay.

Second, some measure of disagreement is okay. I think
it is critically important, you did not ask for my advice to the
Commission, but I will close in just 30 seconds. It is much more
important to acknowledge candid disagreement if there is such
than to try to suggest that on this issue, or other issues, but
this one particularly, that everybody is unanimous, everybody
agrees in terms of points of emphasis and so on. The American
people, when they ask for leadership, I do not think they are

341

 

 

 
 

 

saying we are a bunch of dummies, tell us what to think. They
want to know our best thinking and if our best thinking is
divergent on some points, they can handle it. They can live with
it. Every four years, they listen to divergent thinking when it
comes to an election and they make up their own minds. I think
the points of agreement, Mr. Chairman, among the members of the
Commission, will have more credibility where they are unanimous
if, when there are points of disagreement, that one does not try
to paper over them.

CHAIRMAN WATKINS: I could not agree more with that. I
was just trying to ferret this out because there have been a
constant barrage of witnesses in this regard: I will close it
out with a last point and that is that you talked a little bit
about how Congress has not allowed dollars for a certain
integration of education health promotion from the Surgeon
General and HHS side to the Department of Education.

Have you, in fact, come together and found that there
is a strong need to reinsert into the schools in a more
comprehensive health education, health promotion curriculum at
this particular time when all the projections are so serious on
the health of our young people so that they impact significantly
on their potential schoolwork? Have you explored a much more
coordinated HHS-Department of Education effort to look at health
education in a very fundamental way, not ina band-aid way, but
something on the order of human biology, a life science
continuum, from preschool all the way to baccalaureate, at the
right level of maturation, trying to encourage some kind of a
better understanding of our own human biology in which to place
all these various things? How aggressive has that been and have
you been turned down for dollars you have requested to do that
kind of thing? :

SECRETARY BENNETT: No, we have not requested dollars.
The reason I mention it was not to pout or complain about
dollars, only that when Congress turned to us and said, we need
to hear something about education in AIDS and then did not give
us any wherewithal to do it, that was a bit of a problem. Now,
it did not cost anything to write the book, but it does cost
something to publish and distribute it. ;

I think our cooperation with HHS is pretty good. Our
noses are not out of joint because we are not a lead agency. It
js fine for HHS to be a lead agency, as long as we can get in and
as long as we can talk, as long as we can make the suggestions we
made. ‘As long as I can get the Surgeon General or the Secretary
of HHS on the phone, and say,"hey, there is a couple of mistakes
in your book, you had better change them, at least we think they
are mistakes based on CDC data, that is all we are seeking, just
that kind of access.

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In terms of the schools, remember we do not have any
authority to dictate curriculun. In ‘fact, we are proscribed from
dictating curriculum. But we can and I think what we should do
is identify what we regard to be model programs, both in general
terms as we have done in the book and by pointing to schools and
districts that are actually doing things that we could make
successful elsewhere. That is, I think, probably the best way
for us to continue to act.

CHAIRMAN WATKINS: Thank you very much, Mr. Secretary,
for being with us today.

SECRETARY BENNETT: Thank you.

This morning we have the subject of AIDS and education
in the nation’s schools. Dennis Tolsma, Director, the Center for
Health Promotion and Education, Center for Disease Control;
Jonathon T. Howe, President of National School Boards
Association; Manya Ungar, President, National PTA; Connie
Hubbell, Kansas State Board of Education on behalf of the
National Association of State Boards of Education; Dr. Cherrie B.
Boyer, Assistant Professor, Department of Epidemiology and Social
Medicine, Adolescent AIDS program, Albert Einstein College of
Medicine, Montefiore Medical Center; Debra W. Haffner, Director
of Information and Education, Center for Population Options.

On the panel here this morning, because of the numbers
of you, please restrict your statements to about five minutes.
We have asked you to do that so we have time for dialogue. So we
will start now with Mr. Dennis Tolsma.

MR. TOLSMA: Thank you, Mr. Chairman. Obviously, if
AIDS is the national priority, all institutions of society need
to be involved in it. Such institutes in our society therefore
include our schools and the organizations that serve young
people.

The risk of HIV infection among adolescents is
determined by two things. One is their behavior, what they
choose to do, particularly with regard to drugs and sex, and the
other is the prevalence of infection among people with whom they
choose to interact. I will not go into my statement in detail in
that regard but clearly there are data about the prevalence of
HIV and AIDS among young people, and there are data about the
prevalence of behaviors that place them at risk of AIDS.

The nation’s systems of public and private schools, the
organizations that serve the education and health needs of youth,
both in and out of school, have vital roles to play, and cCDdc is
instituting a number of activities to insure that educators
nationwide have accurate information about AIDS and HIV
transmission. The CDC program is based on a successful 15-year

343

 

 
 

 

history of working with, the nation’s schools to protect and
improve the health of young people. However, in 1987, we
launched an $11 million program in education in preventing the
spread of AIDS. The budget for fiscal year 1988 is $29.9 million
and next year will be $36.5 million. It is, however, a program
built on working relationships with state and local education
agencies, with our nation’s public health departments, and with
other organizations in the nation.

I will mention only briefly that today we are providing
financial assistance to 15 state education agencies and 12 local
departments of education. By this time, well, not by this time
next year, in a few months, we will be extending this program to
all state education agencies in the nation. In addition, I would
like to mention to you that we have made awards to 15 private
sector organizations, some of which are represented on this panel
this morning. I just want to highlight one aspect of the awards
made to national organization. Five'of those fifteen
organizations are either minority organizations or organization
whose programs are directed in very substantial measure towards
meeting the educational needs of minority adolescents.

I want to mention briefly behavioral sciences in the
evaluation. We need to know both what we can do and what we are
doing. In addition to intramural work that we are carrying out
in our center, the contract has been awarded to the National
Academy of Sciences. The purpose is a systematic assessment and
summary of the most important behavioral research that has been
and is currently being conducted nationally and to identify
additional research to prevent HIV transmission in children and
adolescents. That effort will be completed in September of this
year. In January of this year we issued guidelines for effective
school health education to prevent the spread of AIDS. The
document is called the CDC Guidelines and, in fact, they are a
collaborative product of multiple state, local, and national
education and health agencies. They contain information and
recommendations to help educators and others implement a package
of programs.’ I will not go into them in detail. I merely wanted
to highlight two or three of them that I think are important,
although all nine of the recommendations are important.

The first is that parents, teachers, students, and
appropriate community representatives have to be involved in
developing and implementing education policies and programs.

The second is that AIDS education programs should help
students acquire essential knowledge at edch appropriate grade.
Our Guidelines identify appropriate knowledge of AIDS for early
elementary students, for late elementary and middle school
students, and for junior and senior high school students.

woe,
Another point that is made is that AIDS education

344

 

 

 
 

 

programs should emphasize abstinence for young people and
mutually monogamous relationships. Equally important is that.
education about AIDS should be designed to help teenaged student
avoid specific behaviors that increase their risk of becoming
infected.

Last, but not least, AIDS education should be developed
and provided as an important part of comprehensive school health
education. Perhaps I can just take a couple of minutes to
emphasize that last point. Of course we should provide
information, but information alone is'not going to get the job
done. The essential information in the guidelines is presented,
can be presented in a brochure, a pamphlet, a 15-minute lecture.
We cannot delude ourselves into thinking that providing
information as an isolated topic on a one or two time basis is
sufficient. It is not, and the guidelines do not suggest that it
is. We argue that AIDS education needs to be carried out within
the framework of a comprehensive program of school health.
Comprehensive programs establish the foundation for understanding
the relationship between personal health and personal behavior,
based on an organized, sequential, developmentally-appropriate
curriculum, preferably from kindergarten through the 12th grade.

We have studied the benefits of comprehensive school
health. We have carried out a randomized school health education
study. Leading evaluation experts say that this is the most
careful study of its type even undertaken. There were 30,000
young people in the schools included in the study. Just to
illustrate a major finding, the study showed that exposure to
comprehensive school health education resulted in a 37 percent
reduction in the onset of smoking among 7th grade students,
13-year-old students. Let me be clear about this. This ‘
curriculum was not a categorical tobacco education program. It
was comprehensive school health education approaches.

We are convinced that we educate better about AIDS and
to better ends if we incorporate AIDS education into a
comprehensive approach, a curriculum that provides a context for
children and adolescents, to understand their bodies, their
feelings, and the factors that influence them for good or ill.-
We are talking about what you said, Mr. Chairman. We are talking
about promoting a sense of self-worth. We are talking about a
curriculum that equips young people with skills that are crucial
for making positive behavior choices, such skills as decision
making, such skills as communication skills. We are emphasizing
that today. We are going to continue to emphasize it, and we
know that just saying it is good is not necessarily going to make
it happen. It is going to take a lot of effort on the part of
educators and on the part of those who work with them to get this
accomplished. It is not easy to influence the nation’s youth or
we probably would not need to hold this series this morning.

345

 

 

 
 

EE

Recently, a 17-year-old girl sent a note to the staff
at the Center for Health Promotion and Education. It was short
and to the point. She wrote, "I truly believe that monogamy
would be the best way to slow the AIDS virus down. I wanted to
keep the same sex partner for my whole life but I messed up."
Well, adolescents often learn by experimenting and taking risks
but it is for all young people who are growing and developing
into independent adults that we join forces in this local, state
and national partnership. We know we will succeed when community
after community across the land undertakes to education children
well about health, helping them to develop the knowledge, the
skills, and the support they need to take the responsibility for
their health. If we fail in this, we will have failed one of our
most fundamental responsibilities, and that is, protecting the
nation’s youth. Thank you.

CHAIRMAN WATKINS: Mr. Howe? Thank you, Mr. Tolsma.

. MR. HOWE: Thank you, Mr. Chairman. I am Jonathon
Howe. I am President of the National School Boards Association,
and I am a member of the Northbrook, Illinois, Board of
Education. I appreciate this opportunity to appear before you
today. The National Schools Boards Association is the only major
educational organization representing some 95,000 school board
members in the 15,000 plus public school districts in this
country.

 

I would like to emphasize a few points, if I may, in
our written statement which has been submitted for the record.
The National School Boards Association is indeed proud to have
been an early leader in encouraging education about AIDS. We
work to prevent the further spread of AIDS and today the only way
that this can be done is through education.

Briefly, NSBA believes strongly in the need for
educational programming to combat AIDS. We believe that a high
quality AIDS curriculum emphasizes accurate, factual information,
and the need to avoid high risk behavior. We believe AIDS
education should be a comprehensive program that begins in the
early years, and continues through high school. We agree with
cbc in their recommendations which you have just heard.

We believe that AIDS education should be something that
is founded upon community involvement and that it meets the needs
of the community. All children must receive this type of
education. Leadership at the national level is equally
essential.

NSBA does not believe that there is one magic formula
for AIDS education. It can be taught in health classes; it can
be taught in science classes or even in social studies.
Dimensions of the issue cut across different disciplines. It

346

 

 

 
 

 

should begin in the early years with discussion of infection,
progressing logically to discussion of the actual disease itself
in the middle school years, and then to specific preventive
practices as well as the social issues involved. AIDS
instruction cannot be a one-shot, once a year deal. Research
about student learning indicates that the retention rate for such
information received that way is very limited.

Quality instructional materials must be made available.
Beyond the basic perimeters, the details of each district’s AIDS
curriculum are issues appropriately addressed within the local
school district. In my written statement, I list a number of
criteria that local school districts could use to develop their
own AIDS education programs. Many local districts will look to
outside resources as they develop an AIDS education program, and
I, too, believe a model curricula that can be adapted to local
communities can be very useful and should be undertaken.

In my written statement, we have indicated some 10
criteria that should be used in developing the model curriculun.
What do school districts need to meet their obligation to provide
AIDS education? They need good courseware. This is a new and
rapidly changing field. Up-to-date courseware and information is
essential and the ability to continue to update as research
advances is an absolute. The need also for inservice training -
goes without questions. It is extremely important that all
teachers and administrators be well informed with the latest
information on AIDS so that they can answer questions factually
and, in an age-appropriate manner, answer the questions that
students may have.

There are significant costs involved to launch any kind
of successful curriculum initiative but the issue is not a local
or a regional one, it is a national social issue and federal
funding support is not only necessary, it is vital for the
national self-interest. A funding initiative similar to federal
funding of substance abuse education is very much needed.
Coordination with other community agencies is an important
component as well. Demonstration programs and projects that
stress community cooperation would be very helpful.

The best curriculum in the world is not going to help
prevent AIDS if it is not used. I assure you that local school
board members are aware of the AIDS crisis and they want to be in
the position of being able to provide the right kind of
information to the students within the public schools. They are
aware that AIDS is a threat of tremendous proportion, and not
simply in certain urban areas. It is not a regional or local
thing, it is a widespread problem that we have to face.

There is a local dimension to education about sexuality
and contraception. A mandate from outside may well fall on deaf

347

 

 

 
 

 

ears. Each community school board is in the best position to
assess the type of teaching that will best convey the universal
message. I want to make it clear that I do not believe that
local school boards see AIDS education as an optional activity,
but the how and the when may differ from one community to
another. I cannot emphasize too strongly the concerns of the
National Schools Boards Association about AIDS education. We
believe that this national, this worldwide health risk requires
an aggressive educational progran.

Education is, for now, the best protection against
AIDS. Each of the 95,000 individual school board members in this
country and the National School Boards Association as an
organization, accepts the challenge to educate our children
about this major health problem. Thank you very much, Mr.
Chairman.

CHAIRMAN WATKINS: Thank you very much, Mr. Howe. Ms.
Ungar?

MS. UNGAR: Good morning. My name is Manya Ungar and I
am President of the 6.2 million member National PTA, the
preponderance of whose membership is parent membership although
certainly we have been long time partners with the educational
community and the medical community. So what I have to say will
not be new, I assume, to most of you sitting here now.

Obviously National PTA believes that parents play an
important, pivotal, crucial, and critical part in all of the AIDS
issues. There has to be information, there has to be
communication. But we also understand that parents, like their
children are in many ways uneducated, not only about the facts
and the important technical information about how AIDS is or is
not transmitted, but they are also unaware of or have not yet
developed the kinds of skills that will make it possible to
communicate those facts and, indeed, to communicate their values
to their own youngsters.

We have, in another project, talked about parenting as
being the underdeveloped skill and therefore, our association,
now 91 years old, and founded on the premise that the most
important way in which to rear, protect and nurture children, is
to have parents who are educated, has taken on gladly the chore
of trying to communicate to our 28,000 local PTA leaders, and
beyond them to the 6.2 million members as to what AIDS is, how it
is transmitted, and how you should go about talking to your
children. Even more important, how you can go about assuring
that every school board in the United States will adopt an AIDS
policy that reflects parental and local concerns but will assure
our long term goal that there will be a comprehensive school
health education policy with progression, sequence,
age-appropriate, faces the facts, and that transmits those

348

 

 

 
 

 

important things like self esteem and self worth which teaches _
children how to make critical choices.

Therefore, we were very happy to be one of those groups
that was a recipient of the CDC grant. But I want you to know,
regardless of what will happen in subsequent years and this is
not a plea, although it is also not to say forget us, Mr. Tolsma,
that National PTA would have undertaken this kind of project
anyway on our 50 cents a member per year because we think it is
so important.

We believe that parents have to be allies in this
effort, or whatever goes on in the school is not going to be
effective at all. Therefore, the project that we undertook that
is funded, in part, by CDC, is to support parent involvement at
home, by providing information to them designed for parent to
parent, which speaks to them as non-professionals, trying to tell
them what might be good ways for them to learn how to communicate
their own concerns and facts and find out what their children
know and do not know.

We also believe that it is very difficult for parents
to talk many times on what they say is their purview and should
be their primary role. But it is tough to talk to your child
about death; it is tough to talk to your child about sex; and it
is tough to talk to your child about drugs. So parents need to
have some sort of guidelines and assistance in how to go about
doing just these things.

Through disseminating reports such as that of the

Secretary of Education, the Surgeon General, the CDC guidelines,
SEICUS and the Life Insurance brochures, we have already started
to provide them that information. We also gave them guidelines
as to how parents can conduct a meeting on AIDS what to look for,
what are the pitfalls, and how to avoid confrontation even before
they get to the discussion of communication on this most critical
and important issue.

You have, I know, our position statements attached so I
will not take your time for that, but we have approached the idea
of AIDS in resolutions in our national conventions. I was very
proud of the fact that, before AIDS became an issue, first, that
National School Boards Association asked me some three years ago
aS a representative of the parents and the PTA, to come and talk
with them about the parent concerns and perspective in regard to
AIDS education and whether AIDS should be addressed in board
policy. And second I am even prouder of the fact that delegates
to our PTA national convention took a very firm stand a féw years
ago that there should be no ostracization, no further victimizing
of the victims in this terrible disease and equally terrible
problem that: faces us, and that our commitment as adults should
be to assure that children are protected, nurtured, and have the

349

 

 

 
 

 

right information about AIDS and that if, indeed, they are
themselves AIDS carriers or AIDS victims, that they will be
treated with the kindness, compassion, understanding, and help,
for as long as we are fortunate to have them with us.

‘We would ask this Commission and this distinguished
panel .when you make your final recommendations, to include
something which would address the fact that we need continued
government support for AIDS education in schools and that means
financial resources as well as philosophical support and that we
have a policy which encourages confidentiality and protection for
those parents and those children who are AIDS victims or carriers
and that only under the policies of need to know should that
information be shared with the community so that we can avoid the
kind of terrible thing that we saw happen in South Florida.

We would urge you also to encourage the government to
provide special support for the counselling, and the assistance
of those whose children are suffering from AIDS, and to try and
face the problem of what are we going to do about those infected
babies being born and abandoned by their parents and left to
die. We would also encourage research in pediatric AIDS and
would hope that your statement would address the research, the
education, the continued treatment, the prevention, and support
for all people with AIDS. Certainly National PTA has made its
pledge in that regard.

I thank you very much for having allowed me to come and
participate in this.

CHAIRMAN WATKINS: Thank you very much, Ms. Ungar. Ms.
Hubbell?

MS. HUBBELL Good morning, Mr. Chairman and members of
the Committee. It is indeed an honor and a pleasure to be here
this morning to visit with you about an issue that is very
important to all of us. I am Connie Hubbell, a member of the
Kansas State Board of Education and currently serve as a board
member on the National Association of State Boards of Education.
Recently I had an opportunity to participate as a member of the
Governor’s Task Force on AIDS in Kansas, and served as the
Chairman of the Subcommittee on education. I am delighted to be
here this morning representing both the National Association of
School Boards, NASBE, and the Kansas State Board of Education.

State board members are volunteers who represent a
variety of organizations and occupations. We believe we have the
opportunity to build a consensus of parties seeking to impact on
various’ issues in our country and especially to impact on the
issue of AIDS. NASBE has a five-year contract with CDC to help
states develop or strengthen education policies to prevent the

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spread of AIDS. NASBE is the only organization that is currently
working to help develop state policy. We have a national network
that we can distribute that information among all states in the
United States. We are also working to assist states in their
AIDS development projects. I feel it is essential for states to
take a very strong leadership in this deadly disease, AIDS.

When state leaders explain the needs of AIDS, of AIDS
education, they inform the public and help prevent individual
groups having to go over and over and repeat the need of AIDS
education at the local district level. NASBE is also here to
help in the serious gap of information that is being distributed
from the national level clear down to the local level. Local
school districts do not always have the staff, the expertise and
the time to put together all the information that is necessary.
NASBE as a national organization can help distribute that
information to the local levels to help to not reinvent the
wheel many different times.

In December, NASBE did ‘conduct a state by state survey
that indicated currently 18 states are mandating AIDS education
in their schools. This is not a large number of states, but I
want you to know it has tripled just since last June. The
policies that these 18 states are using vary in comprehensiveness
and some of them do still have serious gaps remaining. A few
states have provided funding through departments of education for
AIDS education. I would like you to know that in Kansas, the
Governor has recommended a million and a half dollars in his
appropriation budget in 1988 for AIDS education to our local
school districts. That is around $3.75 per student to the local
schools that has been requested in funding in Kansas.

Few states have addressed the problem of educating
about high risk of infection and few states have plans for
evaluating and monitoring AIDS education in the local school
districts. In November of 1987, the Kansas State Board of
Education voted to require AIDS education in all school
districts, accredited schools, public and private, by September
1988. We voted this mandate despite our state’s strong history
of local control. Before we acted, very few districts in our
state were providing any AIDS education. I still believe local
districts would not be providing it had that mandate not been
made.

Under our requirement, local school districts have the
option to decide who will teach the information, what will be
taught, and when it will be taught. We are mandating a
comprehensive, health education, sex education program, including
the teaching of AIDS by September 1988, K through 12. When we
took this endeavor on in May of 1987, there was tremendous
outpouring of letters against the issue to all state board

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<<

members. We took the first vote, and it barely passed, six
voting yes and four against. Between May and November when our
final vote was made, we took the opportunity to educate our
publics that we were educating the youths about AIDS, not safe
sex. Through this education, our mail turned around entirely.
The public understood that this was an incurable, fatal disease,
and that education was the only tool that we could use at this
time.

When we took the vote in November, 1987, to change the
Kansas rules and regulations, it was an almost unanimous vote to
mandate AIDS education in all schools in our state by this coming
fall. In Kansas, a conservative midwestern, state, we saw the
need, we took action before we had an epidemic in our state. We
have only had one student in our schools currently who had died
of AIDS. We mandated AIDS education because Kansans are
convinced that there is no other way to stop this terrible
disease.

We want AIDS education to calm our students’ fears.
Our goal is to provide abstinence and fidelity, to give the
children the confidence to say no, to say no to illegal drugs, to
premarital sex, we want to address other health issues in our
comprehensive program. We want to address teenage pregnancy as
well as the prevention of AIDS. As CDC said, AIDS education
belongs in a broader context. That is what our state is doing,
that is what our National Association of State Boards of
Education is advocating, a comprehensive health education program
that will have a long term effect on all youth and be designed to
effect the attitudes and behaviors. We must see behavioral
changes in our students.

 

If schools are not already doing a comprehensive health
program, though, they must begin AIDS education immediately.
They cannot wait. AIDS education must be age-appropriate and
developméntally appropriate for each individual in the school
districts. Young children need to be reassured that AIDS, a
disease they cannot control, cannot harm them if they are
educated adequately. Communities need to address this issue
frankly with their individuals. Communities need to know the age
that their students are beginning to get pregnant, that they are
beginning to be sexually active so they can begin that education
before the students have already taken on these issues. We must
strongly encourage abstinence, but we must also speak very
frankly about the issues of control and prevention. If the
students choose to be sexually active, they must be informed
about the other alternatives.

The other issue is training teachers. All teachers,
all school personnel must be trained in the area of AIDS and
routine sanitation. prevention. We must educate and involve our
communities, our churches, our parents and our students.

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TO

Without support of our communities, the program will not survive.

We recommend that the Federal Government number one
support research about AIDS and research about educational
programs that can change our students’ attitudes, behaviors and
beliefs. We recommend that the Federal Government support AIDS
education by building a capacity of a range of already existing
organizations to meet the diverse needs of the different groups
in our country. We urge that you speak out on the importance of
promoting healthy lifestyles. We must stress compassion for
those who are infected with the AIDS virus. We must encourage
the public to volunteer, to support local school programs, and
our sixth recommendation is to encourage the media to use their
public forum to provide information about AIDS. In one state
survey, the youth of that state said that 73 percent received
their information on sex from the television. We know how
important that media can be in getting the information across to
our youth. :

I do not need to convince you how important AIDS is. I
do want you to know how important funding of AIDS education
across the country must be. We cannot take a chance with our
children’s lives. Right now, education is our only tool. The
National Association of State Boards of Education and the Centers
for Disease Control are involved in this long term effort. It is
a good example of how education and health agencies are working
together to fight this epidemic through education.

 

Mr. Chairman, I would like to thank you for having the
opportunity to visit with you. We stand ready to work with you
in any way we can. Thank you.

CHAIRMAN WATKINS: Thank you very much, Ms. Hubbell.
Dr. Boyer? ,

DR. BOYER: Good morning. I appreciate the, opportunity
to talk to you and I am very delighted to be here.

CHAIRMAN WATKINS: We have had the entire faculty, I
think, of Albert Einstein.

DR. BOYER: Yes, I am a health psychologist on the
faculty of Albert Einstein College of Medicine at Montefiore
Medical Center. My primary interests are centered around
developing scientific interventions for adolescents within the
school system. That is where my energies are currently being
placed.

As we know, adolescents represent a small portion of
all the AIDS cases that have been reported to the Centers for
Disease Control, but there is mounting evidence to indicate that
the rates are doubling each year, largely due to heterosexual

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intercourse. The prevalence of HIV infection among adolescents
is currently unknown, however, the long and varied latency period
suggest that many of the 11,000 cases of adults between the ages
of 20 and 29 were infected while they were adolescents. The
behaviors that place adolescents at risk for infection with HIV
are common. They are a part of the normal process of adolescent
development which include the early age of onset of sexual
activity among some adolescents, inadequate utilization of
barrier method contraceptives, the high incidence of sexually
transmitted diseases among adolescents and widespread
experimentation with drugs.

However, if we are to be effective in successfully
preventing further viral spread among this population, we must
actively and aggressively pursue methods to educate and as well .-
train them to help prevent and reduce their risk for HIV
infection. School-based education, while certainly is not the
only means, represent, the most practical, feasible and cost
effective method for reaching large groups of adolescents.

As we have heard today on the panel, which was
eloquently stated several times, is that developmentally
appropriate education should begin as early as kindergarten and
has been proposed by Dr. Koop. However, when we are talking
‘about AIDS prevention and education, it should be emphasized in
early adolescence between the ages of 13 and 14, just before they
are beginning to engage in those high risk taking behaviors that
were mentioned before. This is also, I believe, a period when
adolescents are beginning to establish adult behaviors and are
perhaps more amenable to change. Therefore we cannot wait until
they are in 11th or 12th grade to begin our efforts of
prevention and education. Data from surveys conducted over the
past three years regarding adolescent’s knowledge, attitudes and
beliefs about the transmission and prevention of AIDS indicate
that adolescents are still limited in their knowledge, and there
are tremendous gaps in the facts of what they believe is to be
true. An overall finding is that many adolescents are not
informed about the preventive measures to be taken during sexual
intercourse. There are several studies that corroborate that
misconceptions are prevalent among adolescents. Many of them
believe that AIDS can be contracted through hugging, kissing or
being near someone with AIDS or by wearing a sweater of someone
with AIDS or by touching a doorknob that someone with AIDS has
touched. They fail to recognize the fact that one could get AIDS
by engaging in unprotected sexual intercourse or sharing
intravenous drugs. They gloss over these facts, but focus on
misconceptions which often prevent them from recognizing the
behaviors they need to change. We therefore need to address this
problem by targeting interventions to dispel those myths and
misconceptions and change behavior.

A rather striking but not surprising finding of one

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study indicate that adolescents are still engaging in high risk
behaviors. It is important to note that adolescents who are at
highest risk have the least knowledge. They are the ones who

are not aware of ways that they can protect themselves as against
HIV infection.

What we can glean from this body of research and
information from other health education research is that
increasing knowledge alone is simply insufficient. It is not
the way to prevent or modify behaviors. Behavior change require
that adolescents become active participants in their education as
opposed to being passive recipients of information. Prevention
programs which combine education with cognitive and behavioral
skills training have been found to be effective in decreasing
negative health behaviors associated with smoking, drug and
alcohol use as well as sexual activity.

Cognitive and behavioral skills training appears to be
a promising method for preventing or modifying behaviors that
place adolescents at risk for HIV infection. The content of
these programs should include, one, assertiveness and
communication skills development. For example, how to
communicate with sexual partners or how to negotiate the use of
condoms for sexually active adolescents, or how to say no and to
feel that it is appropriate to do so. It is important to give
adolescents the skills to be able to communicate their feeling
and to not be forced by peer pressure to engage in behaviors that
they feel are not appropriate behaviors for then.

Another component of the skills training programs
should include cognitive problem solving skills such as
sensitivity and recognition of high risk behaviors. For example
what are the behaviors that place adolescents at risk for HIV
infection. It is important that they recognize that one cannot
get AIDS by touching or kissing and to understand what are the
real ways in which one can get AIDS. I think we should also give
them skills in identifying alternative behaviors to sexual
intercourse. There are other ways to express love and affection
without having to engage in sexual intercourse. I think this
should be explored and that should be a skill that many
adolescents have.

Adolescents should also have an increased ability to
think about future consequences of engaging in risky behaviors.
In early adolescence, many teenagers cannot calibrate risk or
cannot project into the future. They generally do not understand
that something they may do today will have an impact on their
health in the future. We have to give them the skills to
understand and be able to realize that their behaviors will
impact their future health outcome. —

Another component should be appropriate decision making

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a

~_——=_ A —- -_—
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skills. Adolescents must decide if and when to engage in certain
behaviors or, if adolescents are sexually active, what to do to
protect themselves. It is very important that they have this
information. Another component is that skills training should be
conducted in a group format as opposed to individual therapeutic
situations. Modeling behavior among adolescents can be

effective and can develop peer support for encouraging positive
behaviors. Making it the norm to say no, or making it the norm
to say I will not get involved in these risky behavior, I will
not drink, or I will not have sex without condoms, making that
the norm as opposed to engaging in what is seen as glamorous, or
risky, sexy behaviors will be beneficial.

In essence, while it is important to continue efforts
to increase knowledge, it is only the first step. It is
imperative that we go beyond merely providing information. We
must explore what are the methods by which we can prevent and
modify risky behaviors. We have to go beyond merely showing
films and just passing on facts. I do realize information is
important, but we are now at the point where we have to take it
another step further. We are at a luxurious time with
adolescents in that there is still time to make an impact, while
the numbers are still relatively low. AIDS has not hit
adolescents as hard as it could have and still can. Therefore
the time is now to get involved in developing preventive
interventions.

I will not go into further detail about the content of
what the interventions should include. That information is in my
written testimony and therefore I will not take your time to do
so now.

Before closing, I would like to take a few minutes to
talk about what are some of the barriers that I perceive to
developing and implementing preventive interventions. It has
been stated several times today, and I will just echo the point,
that, the lack of resources is the major barriers both financial
and personnel. There is a need for additional monies to be
allocated specifically to develop and implement new prevention
and risk reduction programs. Funding agencies should take the
risk of funding research interventions when they are not sure
that the interventions will be effective, but we have to find out
whether or not it will work and what are the means by which we
can make it work. We are, essentially engaging in uncharted
territory but it is very necessary.

I think there is an additional need for personnel to
train and support individuals within the school systems and to
assist in designing and implementing such programs and, as
important, evaluating them. Evaluation is as important as
designing and implementing preventive interventions.

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Another barrier is the problem that comes up often in
discussions with teachers and principals that I have encountered
is the dilemma of adding to an already overcrowded curriculun.
There is the need to explore how might AIDS curriculum fit into
the overall academic curricula where they do not feel that by
putting energy into providing AIDS education they will not be
taking away from other important curricula which are also
important. Education and prevention should not be in competition
with other academic efforts. We have to find ways in which it
can be incorporated. As much as math, and science, AIDS
prevention is equaily important. In fact, it maybe more
important. We are talking about life and death.

Another potential barrier to developing and
implementing these new prevention programs, is the lack of
involvement of other social institutions such as parent
associations, religious organizations and other community-based
agencies who can have a positive impact on these programs. If we
are to be successful in implementing these programs, we have to
involve these groups in a very serious way. AIDS, as we know, is
a very sensitive topic, particularly with regards to adolescents.
Given the social and emotional issues engendered by this epidemic
it is important for schools to have open dialogues and enlist the
help and support of leaders from these groups and organizations.

Another barrier which is quite frustrating in our
efforts to make sense of adolescents’ knowledge, attitudes and
behaviors is many schools forbid asking behaviors about sex and
sexuality. If we are to intervene, if we are to help change and
modify these behaviors, we have to understand what they are and
the patterns in which they are occurring. We have to be allowed
to talk about those sensitive issues and to ask what behaviors
they are doing and why you are doing them. As psychologists we
always want to know why and I think that this is the key into
changing behaviors. Therefore we have to be allowed to ask
questions and explore what the issues are.

Finally, and perhaps most important, is the need for
guidance and support from our government to increase awareness
and to legitimize the importance of addressing issues of sex and
sexuality. We can no longer skirt around those issues but we
have to see them as important and we have to take it from a very
non-judgmental, non-moral perspective and I think only then we
can have a positive impact on adolescents.

Thank you very much.

CHAIRMAN WATKINS: Thank you very much, Dr. Boyer. Ms.
Haffner?

MS. HAFFNER: Good morning. My name is Debra Haffner.
I am with the Center for Population Options, and I, too,

357

 

 

 
 

 

appreciate the opportunity to address you today. I have
submitted written testimony and I also understand that you
received copies of the monograph I have written on AIDS and
adolescents. c

My perspective is perhaps a little bit different from
some of my colleagues. I ama sexuality educator and have
provided sexuality education to young people for the last 15
years. We are very pleased with the amount that is happening in
the states, the fact that 18 states now mandate sexuality
education is a huge leap from where we were just a year ago. But
one of the lessons ‘that we have learned, is that information
alone is not enough. Unfortunately, people know information
but often do not act. If information alone was effective adults
would always use seat belts, never drink and drive, never smoke
cigarettes and weigh in the appropriate range. We know that
health information alone does not necessarily impact on behavior.
Dr. Walsh asked the Secretary whether teens were hearing the
message, and the answer is yes and no. We know that teenagers by
and large know how AIDS is transmitted. They identify that it is
through sexual intercourse or through IV drug use. They also
know that it is transmitted through such ways as toilet seats and
mosquitoes. But perhaps what is most important is the fact that
although they can identify the primary transmission routes as sex
and drugs, only 15 percent of sexually active teenagers say they
are changing their behavior. And less than two percent of those
are doing those things that could be considered effective at
preventing HIV transmission.

We have just completed a series of focus groups of
inner city teenagers. What we found was that they know about
AIDS, but what they know is it has nothing to do with them. If
they are not gay, if they are not white, if they are not male and
if they are not an adult, they will not be affected by this
epidemic. We are clearly not reaching them with the message that
they are vulnerable to HIV. " '

We have identified four primary goals of AIDS
prevention programs for youth. The first is that we need to
reduce the panic and the misinformation that surrounds this
disease. The second is we need to help teenagers delay the onset
of sexual intercourse. The average age of first intercourse in
the U.S. is 16. Among inner city young people, it is 12.5. We
can clearly reach societal consensus that 6th and 7th and 8th
grade is too young for teens to be having sexual intercourse.

The third primary goal is that for those teenagers who
are sexually active, we need to promote consistent and effective
condom use. The fourth major goal is we need to reduce
experimentation with drugs and prevent IV drug use among our
young people. _

~ a

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We have identified eight key components of a successful
AIDS education program for youth. The first, is that AIDS
education needs to be part of a comprehensive program. The
specific messages about AIDS take no more than a 15-minute
lecture: how AIDS is transmitted, how AIDS is not transmitted
and how to prevent transmission. However the context of AIDS
education may take a lifetime. In our programs, AIDS
information needs to be provided only after we have talked with
students about values, decision making, peer pressure, dating,
relationships, communication, sexuality, and family planning.
AIDS must become part of a total package of health education,
teachers must be specially trained to provide this information.

The second major component is that we need to emphasize
prevention information, not biomedical information. Most
curricula from around the country talk about retroviruses,
transcryptase and disease symptoms. Although students may find
that information interesting, it is not going to prevent them
from becoming infected.

We need to be skill-based. If we want teens to "say
no", we need to let them practice saying no. If we want them to
talk about their decision to have sex, we need to help provide
that opportunity. , If we want those who are sexually active to
use condoms, we need to tell them how to use them, where to get
them, and most importantly help them practice how talking about
condoms with a partner.

The third key element is that we need to emphasize
behaviors in talking to young people, not groups. The teenagers
that I have talked to continue to distance themselves from this

disease, because "it happens to other people". We need to
emphasize that it is behaviors that put you at risk, not your
group identity. The fourth component is that there need to be

ample sessions. Sexuality educators report that schools are
inviting them to give a 45-minute lecture on AIDS, so.the school
can say it has "done AIDS", AIDS education is not an
inoculation. Once is not enough. Teens need to hear this
information consistently and effectively. The unfortunate fact
of life in this country is that health education often stops in
the 10th grade. We give teens information once and our
obligation is over. We need to make sure teens hear information
repeatedly, in a variety of settings and by a variety of
messenger.

A fifth component is to develop peer mediated programs.
We are not listening to the young people of America tell us what
they need to know about AIDS, and I am very glad you are having
some young people talk to you this afternoon. Some of the most
effective health interventions for young people. have been those
where the young people have taken the responsibility themselves
for transmitting the message. One of the leading example are

359

 

 
 

 

the Students Against Drunk Driving chapters, in which young
people have actually changed the student norms around drinking
and driving.

The question was asked this morning, are we giving kids
conflicting messages. What is conflicting is that what we are
telling them in school and what the government tells them
conflicts with what they hear in the hall. We say "just say no".
They say “everybody is doing it", and that is often the behavior
that makes them more socially acceptable. I would challenge our
culture to come to the same agreement that we have about young
people and drinking. We do not want our young people to consume
alcohol. We say to our children, "we do not want you to drink,
but if you are going to drink do not get behind the wheel of a
car because we care about you. Call us and we will give you a
ride home".

I think that this must be the same message with sex.
We can say "We do not want you to have sexual intercourse now.
But, If you are going to have sex, protect yourself because we
care about you. Do not kill yourself".

The sixth component is that AIDS education must be
based on values. There is a myth that what we can do in our
schools can be value-free.

We, too, believe that abstinence is the best method of
AIDS prevention, and that we need to help get that message out.
We also believe that long term committed monogamy in a
heterosexual marriage is one effective prevention strategy.
Monogamy to many teenagers is some place from three weeks to
three months. That is not the kind of monogamy the Secretary of
Education is talking about. Young people choose relationships
for love, but often these relationships are short-tern.

I believe that a critical value, and it is a value that
I hope this Commission adopts, is that it is immoral and
unconscionable to say to the young people of America, "just say
no or die". Instead, we have to say to teens, "we will provide
you with the information to save your lives".

A seventh key component is that AIDS education must be
sex-positive. We have gone from talking about the joy of sex to
talking about the dangers of sex. I believe that we may be
raising, because of the AIDS epidemic, a generation of sexually
dysfunctional adults who are learning that sex kills. We need to
tell teens that sex is wonderful, but that it needs to be
practiced responsibly. We need to recognize that among the young
people of America, there is a diversity of sexual behaviors. In
particular, not all young people are heterosexual. There are gay
young people in our schools, and they need special support and

360

 

 

 
 

 

services.

Finally, we need our message to be empowering. Many of
the programs that I have looked at are trying to scare our
children; they believe that if we just scare them enough, their
behavior will change. Decades of health education interventions
tell us that that is not going to work. What a few young people
have told me is that AIDS is now inevitable. "It is going to
happen, so why try to protect ourselves?" The message, then,
needs to be an empowering one. It needs to say to young people,
"everyone who is not currently infected never has to be. We now
know the information that will protect you. The 53,000 people
who now have AIDS did not have a chance because we did not know
what behaviors they needed to adopt. We now understand
transmission. You never have to become ill with this virus
because you can make the decisions to adopt safe behaviors".

My plea to you all is that you not just mandate AIDS
education in your report but that you call for effective
education, education that gives our young people the message that
we care enough about them to have the political will to help them
develop the skills needed to protect their lives. Thank you.

CHAIRMAN WATKINS: Thank you very much, Ms. Haffner.

CHAIRMAN WATKINS: We will start the questioning of
this panel with Ms. Gebbie. :

MS. GEBBIE: My apologies to a couple of the witnesses
that I did not get a chance to hear you. I have looked through
your written remarks. I think I will start with a question to
Dr. Boyer and Ms. Haffner. I want to pick up again on this issue
of messages that sound ambivalent, that say "Do not do it, but if
you do it, here is the safe way". I think a lot of folks have
trouble sorting that out as to whether that is not somehow a
covert message that it is okay to do it. The front part is just
a sham, and they do not quite understand how we can be doing
both. I tend to agree. I do not want to have a child who made
what I think is a wrong first decision to end up dead or with
some other problem because of what could have been safer second
Gecisions. Can you talk more about how you would do that kind of
education without sounding wishy-washy, ambivalent or somehow
confusing to the kids?

DR. BOYER: It is evident by the data that we see that
adolescents are engaging in risky behaviors. They are having
sexual intercourse, they are having it at an early age. They are
becoming pregnant at early ages. Sexually transmitted diseases
are highest among adolescents to indicate that they are engaging
in unprotected sexual intercourse, and that, we can point the
evidence to them and say this is what is happening, but you do
not want to be in that same position. They are thinking

361

 
 

 

a

Avdividuals. It is not like their brains are made of mush. They

re thinking individuals. All we can do is provide the
information for them and reduce their anxieties about these
different values and different things that they are hearing and
hopefully they will make the best choice for themselves. I think
that we have to be frank and honest with them although this is
a@ifficult. It requires some thought, and they must think before
acting. That is one way of making it a little easier in helping
to make sense out of it without sounding like we are giving them
double messages.

MS. HAFFNER: I think part of it is what is age and
developmentally appropriate. The "Just say no" programs that
have been effective have been the ones that are aimed at the
sixth, seventh and eighth graders who, before they are sexually
active. At this point we can be successful with positive
reinforcement about saying no and resisting peer pressure. My
experience as a lecturer in schools is that when I tell a class
of juniors, 11th graders, that half of them are sexually active,
but half of them are not, there are always sighs of relief.
Teens believe that "everybody is doing it", even though studies
tell us that not everybody is doing it. I think we have to look
at the fact that young people in our classrooms have a range of
sexual experiences. Some of them are upset, that they are 16 and
never been kissed: some of them are upset that they are 16 and
are still virgins, and some of them are upset that they are 16
and not mothers yet. There is a wide range in our classrooms
and that we need to provide education that encompasses all these
young people.

MS. GEBBIE: Thank you. My other question is to the
people that represent the national associations related to
schools. The process of getting the executive board or the top
level of a national association together and applying for a grant
and getting a position paper on a subject like this seems to me
to be relatively simpler than getting 5,000 local school
districts together to do something. Your statements are very
articulate and very supportive of some of the things that I think
this Commission is interested in doing, but I suspect, as I know
from school districts in my own state, there are a lot of school
districts who might read these sentences and say, my gosh, what
is going on here? How did the PTA get in favor of this radical
stuff or something like that? Can you talk a little bit about
that process of translating through the nation to some very
independent local situations the kind of thing that we are
talking about here and that you seem to be supporting in your
statements? How does that work? What kind of mechanisms do you
have? What kind of credibility you have? How readily are you
turned to? What impact can you have? How does that work at the
local level? -

MS. UNGAR: Since you mentioned the PTA, let me tell

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you how we work. It is a two-pronged effort. Number one, most
of our position statements and programmatic thrusts come about
through the 26,000 to 30,000 local PTA’s that incorporate our 6.2
million members. They have representatives, in a pyramid fashion
that go up to their state level. They meet annually to adopt
resolutions from the several states. That is one way in which we
arrive at position statements. The national board is composed

of the state presidents of all 50 states, the District of
Columbia, and those parents whose children are in the Department
of Defense schools around the world. So we have 52 state
presidents and we have widely elected officers like myself. They
will take the input, if you will, from all of that leadership and
grass roots concerns. We will adopt position statements that we
feel are reflective of, representative of, or in some way that
will be acceptable to, our own constituencies. So we adopt our
positions and arrive at those positions in that fashion.

The people who have come to those conventions have
written and debated those resolutions, and have elected us to
speak for them. We have very close contact with them. As a
volunteer, I travelled last year 82,000 air miles so that I could
go out and speak to local unit members and, more importantly, so
I could hear from local unit parents, teachers, administrators,
and others who the A stands for in Parent-Teacher Association.

I feel very comfortable, as does our leadership, that
this is something that the majority of parents in this country
are asking for. I also want you to know that our association,
unfortunately for us, does not represent every single parent in
the United States. We feel that the information that we have
should be made available to any parent, indeed any community,
that wants it. You do not have to be a parent to be a member of
PTA. You just have to care about kids.

The other thing is that they already know, because of
what we have told them in our dialogue, that it was in 1898, one
year after this association was formed at the national level,
that they adopted a resolution which said that they believed that
there should be teaching about sexual activity before puberty.
Therefore, we do not come to this lightly.

MS. GEBBIE: That is an interesting fact. Thank you.

MR. HOWE: From the standpoint of representing local
school boards, we are the elected or appointed representative of
the community who sit as the policy makers, on the national
level. We have to give an example and to do so in a way that it
is a positive reinforcing type of situation. I think that what
Ms. Ungar has said is education is a key factor, not only as to
what we are going to be doing in the schools, but to educate
those of us who are in policy making or the administrative
capacity to be prepared to do it.

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Consistent with that, the National School Boards
Association has issued a number of publications. One, I think you
have, is AIDS and the Public Schools. This is not a recent
publication. This is about two years old if I am not mistaken.
We have had the Surgeon General of the United States address our
assembly, our convention, which is the largest convention of
school board policy makers in the United States. Our forthcoming
convention in New Orleans which is coming up at the end of this
month will have a very involved panel discussing AIDS education.
What you as a local school board member should be doing relative
to an AIDS program within your curriculum within your community
will be discussed.

 

So we are trying to not only do as we say, we are
trying to do as we do and to get that example across. I think
each of the organizations on a national level has taken a very
positive thrust and positive approach. We need resources; we
need more information; we need people to understand; we need good
communication as to what the real situation is and what the real
world is out there there. I come from Illinois, where we have
had, I think, unfortunately in some situations some
misinformation. But we have also had a number of school
districts that have met this crisis head on in a positive way,
have garnered support of their community and garnered the
understanding of their community by being prepared and having
good policies in place.

MS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Dr. Lilly?

DR. LILLY:: I do not have much in the way of
questions. I just want to thank you for cheering me up a little
bit after the initial panel this morning. I have the feeling
that some of you are perfectly prepared to suspect that these
young people should, at some point, be taught that there is a
word penis rather than any of a number of other words that have
been learned and that one can use a condom and be unsafe as
opposed to immoral, and that you might not even drop dead if the
words anal intercourse were mentioned in your presence.

There are still hard communities that are against, at
least I am told this, that are against AIDS education, that are
against health education, that are against sex education. Since
all of you believe strongly in it, what do you think should be
done about it because I think it is rather widely believed that
communities should have a good bit of say in what goes on in
their communities.

MR. HOWE: Let me take a crack at that again from a
policy making point of view. I think one of the difficulties

364

 

 
 

 

that we face is that if we are going to look at this as an
educational issue, then let us look at it as an educational
issue, not a political issue. If we look at it in the way that
this is something that is vital to the welfare of the people who
reside in this country and the citizenry of this country, then we
should go at it educationally. A person’s politics or other
views should not necessarily cloud our opportunity to provide
truthful, factual, informative materials in the classroom setting
as is appropriate for the level of the age of the child or as it
may be needed within the community. Yes, you are correct. There
are communities which probably do have strong resistance to
anything dealing with sex.

We are dealing with something here which hits two
issues that are very strong -- personal issues -- sex and drugs.
When we start talking about those behaviors we know and we can
guarantee we are going to have some kind of reaction from the
segments of our community that are not going to be in favor of
going forward with the program. That is why we have to set a
good example; that is why we have to set the parameters of going ©
forward with this aggressively, forthrightly and saying, "Yes,
you may have disagreement, but once in a while we do have to make
the hard decisions and we ought to make the decision in favor of
life."

MS. HUBBELL I might just speak a moment to that same
issue, having come from a state that has just recently mandated
that every district must provide AIDS education. We represent a
lot of very small, rural districts as well as urban city
districts. It was the rural, small districts who were saying the
state must take the leadership and must mandate all districts ‘to
teach AIDS education, because their public were against the
issue. '

But we found once we educated our publics of that fact
that this is a life and death issue, I believe they turned
around. I feel very positively that every school district will
do more than show a film in our state or just present a pamphlet.
They know that they must do it, but it was not that way six or
eight months ago. It was because we educated the individuals in
those local communities to the fact that it is an educational
matter, it is a health matter and we must work together so from a
personal standpoint, I do believe it can be done, but it is not
easy and we did take that strong leadership to tell them that it
must happen.

DR. LILLY:: I am very encouraged by your optimisn.
MS. HUBBELL I hope so. Thank you.

CHAIRMAN WATKINS: Ms. Pullen? Dr. Lee?

365

 

 
 

 

DR. LEE: First of all, can you tell me what the Center
for Population Options is? What do you do? What is the story.
there?

MS. HAFFNER: We are a national organization founded in
1980 to promote life options for young people. Our primary goal
when we began was the prevention of unintended teenage child
bearing, premature teenage child bearing. We see that in a very
broad spectrum: we believe that in order to prevent teenage
child bearing, we need to make sure that young people know that
they have adequate life options, and that includes quality
education, quality employment opportunities, adequate housing, as
well as family life education and services.

’ DR. LEE: Nobody else does this? Where, why did you
create this organization?

MS. HAFFNER: We felt that there were many
organizations dealing with issues related to family planning, and
but that very few groups were concentrating on the very special
needs of adolescents. As a national organization, we primarily
work with many of the groups at this table. I work with a
partnership program of 60 national organizations ranging from
NASBE to the Junior League to the Boy Scouts to the America
Camping Association who look to CPO for leadership and guidance
on development of family life, sexuality education, teen
pregnancy prevention and now AIDS prevention programs.

DR. LEE: I want to compliment you on your bibliography
in here. It is quite a nice one. I think it is going to be
helpful to us. One of the things that upsets me personally and
it must be one of your major problems, is that schools in this
country seem to be increasingly parent substitutes. I mean, I
was told by my wife to tell my son about the facts of life when
he was 10 or 12 and I made a pass at it, but I do not know why,

why is all of this loaded on the schools?

We have a Catch-22 here in AIDS. The people who are
running around really getting AIDS are not the people who are
paying attention to you. The very much higher percentage of AIDS
is in the people who have drug habits, who have dropped out and
are into prostitution, who come from these terrible families and
who the school system just cannot address. I mean, your best
students are not your problems. I mean, anybody who is sitting
around listening to Dr. Boyer and Albert Einstein, I mean, I
think is in the clear. So are your organizations reaching out
and grabbing people that are not coming to your schools? Are you
approaching the Catch-22 that we have here? Education is like
mother’s milk. We love it, but there are a lot of people who are
not in your system. Are you reaching to them in some way?

366

 

 
 

 

MS.HUBBELL: In comprehensive health education
programs, we are reaching the youth and we are reaching the
students in fifth and sixth and seventh and eighth grades before
they choose to possibly not continue their high school education.
As a national association it is our goal in the next three to
five years to have educated 100 percent of the youth that are
still in school and that are of the younger age groups. So ina
comprehensive health education program, when we think of that as
AIDS education, in the coming three to five years, we should have
educated the youth that will be the teenagers and the young
adults in five years. Currently, not all of those young adults
are being educated.

The other portion of that is the fact that we need to
tie into community groups so we can get the students that are
dropouts and are currently not in school. We are not hitting
those 15-, 16-, 17-, 18-year-old students who are not currently
attending a public or private institution and we must also talk
to those. We have talked a lot about sexual intercourse. We
have not talked about the IV drug users and that is another very
large group that are difficult to reach because they are not
always rational in their decision making. It is our goal as a
national association and as a state association, too, in the next
three to five years, to have educated all youth, but also to work
with community groups who those youth are tying into, to put our
brochures in the blood banks and the plasma centers so that they
will pick them up and begin to be educated. It is a very
difficult issue to address. I agree.

%

MR. HOWE: Unfortunately, I think it has just been our
lot in life in that the schools have been looked upon, in the six
hours we have a child 180 days a year, as solving all the
problems of society through education. We cannot and we know
that and what we have to do is play our part in the
responsibility here. I think that is what we are all saying,
but there are others who are involved: the parents and the
teachers. Members of the community are involved and should be
involved. The churches, other social agencies have to take their
responsibility, but unfortunately many times that responsibility
is shifted to the schools. We bear the brunt. It is not our
fault but we get the blame. It is not the child’s fault. The
child gets the blame. We need to back away from that and look at
what our mission really is in providing education, and in doing
that I think it is very important that we address some of the
issues that we have talked about here this morning as part of the
total educational program.

MS. UNGAR: I guess my role in all of this as the only
non-professional seated at this table, is that we recognize
preaching to the choir. Very frequently in our own PTA meetings,
only those who are already very well informed are there. We

367

 

 
 

recognize that also societally, because of the changing
demographics and the nature of our society. We recognize that
we, aS an association, PTA, can no longer be the afternoon
groups, the study groups for parents. We have to find new ways,
strategies, to reach out to not only those members who are not
there, present, physically, at our meetings, but also to reach
out and include others who, unhappily, but in all candor have
been traditionally underrepresented in associations. Ours is the
fifth largest association of any sort in the United States. I
think we are exceeded only by the AARP and the AAA, two of the
four that I know of, and some of us are meubers of all three, who
are still in PTA.

But the most important thing is that we recognize that
we have to reach out and to include others who would not
ordinarily come to us so we are doing consciously just that. We
are doing it through coordination and collaboration with groups
that traditionally we have not collaborated with. We are going
to different sites and are not saying come to the school in the
afternoon or evening, recognizing that many of those parents -
and it is not just the poor and it is not just the minorities -
are now unable to go to the traditional kinds of meetings to get
educated. We have to find out another way of reaching them. We
are experimenting with that. We are going to where they are and
where the need is in trying to include all of it. We are all
partners in this, and we ought to be cooperating and
collaborating with each other.

DR. LEE: I want to hear from Dr. Boyer and also Ms.
Haffner.

DR. BOYER: My sense is that it has to be a dual
pronged approach. While the school, I think, represents only one
part of that effort. It is an important effort even though the
highest risk kids are not in the schools, we still have to teach
them prevention. There is still a small percentage of kids in
school that our research shows is representative of national
statistics. That one percent of the individuals in the schools
we surveyed were IV drug users and that kids in schools are
engaging in high risk behaviors, and having unprotected sex, so
there is a role for the school to educate them as well. I think
that is where our prevention efforts should be targeted.

When we talk about community-based efforts, we are
talking about remedying a situation that is already bad. You
have the kids who are at highest risk on the streets, who are
‘prostituting. That is another approach, and I see the school as
only one part of the effort but it has a real impact or the
potential for impacting on preventing adolescents who may be
exposed to HIV infection.

On a community-based level, we have to deal with

368

 

 
 

changing situations that has nothing to do with HIV except that
these kids are homeless, they are not educated, they are your
disenfranchised. I think it takes a different approach if we are
going to be effective in reaching all adolescents, it has to
happen on both levels.

MS. HAFFNER: Dr. Lee, I just wanted to add something,
we beliéve, and I know most people at this table believe that
parents are the primary sexuality educators of their children. ;/
We do not do this through that one "talk", that big talk, but
rather through our behaviors: how we treat our young people from
the time they tell us in the delivery room it is a boy or it is a
girl, whether we teach our children the correct names of thei
body, whether we, in the bath say "this is your tummy and this is
your knee" and we forget to name some parts of their body at, all.
As they watch our relationships within our home, they learn jabout
sexuality.

Unfortunately, 80 percent of the parents of this
country, say that they know it is their primary responsibility,
but they are not comfortable. They do not feel they have the
information. Their parents did not-:talk to them. What I think
the schools can do, and community agencies such as the Y, the
Red Cross, the Girl Scouts and Boy Scouts can do is to provide
supplemental information as well as providing programs for
parents to come in and learn the information so that they can
feel more comfortable educating their children at home.

DR. LEE: You know, I am a very liberal person myself.
I do not care what goes on in school. If the professionals tell
me it is worthwhile, and the sexuality is good to teach, fine.
But I have personally met some "sex educators" that I would not
send my kids off to say, well, good luck, pal, and when you come
back I will give you a Coca Cola and I hope you get through it.
It is a very, I think in many ways, it is a very difficult thing
to be dumping on the schools. But I realize that it has to be
done. I understand that.

MR. TOLSMA: If I might also respond on the youth out
of school question I think part of what you say is true. There
are a lot of kids out there with a lot of problems, and can we
teach them something that is going to stick and make up for all
the problems that they face in their lives? Amongst the national
organizations that are funded there are several that focus on the
needs of young people out of school. One of the minority :
organizations, for example, has an Hispanic out-of-youth focus.
They are trying to reach this particular population. Another
funded organization, the National Network of Runaway and Youth
Services, comprises 300 youths serving organizations. We are
working through that network to reach youths out of school.

This is not to say that many of these organizations

369

 

 
 

 

that are school-focused and school-based do not recognize that
youth out-of-school continue to be a responsibility, and I have
seen local school systems do very useful programs, schools
without walls ‘and this sort of thing, in an effort to reach that
very difficult population. We are not without some ways to carry
out these kinds of educational activities, even for that
aifficult to reach population.

CHAIRMAN WATKINS: I would have to say, Mr. Tolsma,
that the impression we get as we move around the country is that
education is in the schools. The perception by most American
people is that it is in the schools. Yes, we know we have one
million out of four million that reach 18 year olds each year
that are not in the schools. They are in the high risk group.

We ‘know about the growing numbers of minorities in the country,
the significant growth in.the Hispanic community that will exceed
the black demographics by the turn of the century. It will give °
a whole new dimension to what might be happening so I would like
to know if this panel feels that somehow we have to kind of
define an educational concept in dealing with the AIDS epidemic,
to make sure we focus on all elements, out of school, in school,
out of the workplace, in the workplace, health care providers
education, all very much a part of the picture. I do not think
that the education needs of this epidemic has been well
articulated yet, let alone everything else that we needed to deal
with regarding to this epidemic.

I have given a number of presentations to the White
House symposium on education partnerships for two consecutive
years, with a: thousand educators there, and I asked the
questions: "How many health promotion czars are there in the.

room?" "How many Secretaries of Health or their equivalents or
representatives from the states are here?" The answer was
"None". Now, it seems to me that education includes health

education as curricular and not extracurricular any more. When
are we going to get to that point? What are we doing to try to
raise the understanding of what we are talking about in education
on this issue as something that is more comprehensive along the
lines that were presented by a variety of panelists right here in
this particular panel?

I think CDC cannot be the sole entity for all of this.
It is so large, it engulfs us all. There has to be much more
emphasis on the variety of educational strategies we are dealing :
with because in the mind of one beholder, it is in the school.
In the mind of others it is totally out of school.

‘MR. TOLSMA: ‘You aré right, and we have got 48 million
kids in school, another million and a half not in school, and
that is a big and elusive sort of thing to wrap your mind around.
What I was trying to say was that we do not want to leave out of
our equation the young people at risk right now but will want to

uo.
370

 

 

 
 

 

find and use the channels as best as they are, to get to then.
But I think there is a vision. It is a vision of the year 2000.
The class of the year 2000 starts first grade in about six
months; we have about six months left is one way to look at it.
I would like to see that generation be a smoke-free, drug~free
and an AIDS-free group of young people. To do that means to
adopt in our nation the kind of strategy you have heard described
here, and as Manya Ungar pointed out, we have these young people
in our schools, even if they are someday going to be dropouts,
for a number of years. In too many schools, they are not at
present receiving the kind of program that they ought to get.

Yes, I understand the barriers that the school
administrator faces. The curriculum is like, it is like a case
of Coca Cola which has 24 cans in a case. If you want to put
another can in, you have got to take a can out, and schools have
to find a way to fit into the 180 days, six hours a day the sorts
of things that everybody wants. Comprehensive health education,
including effective education about AIDS, has to become a higher
national priority; it has to become a higher local priority.

That is to say, we need to provide the leadership. Your
Commission can provide that leadership from the national level.
These organizations can provide that leadership from the national
level. That document that was shown to you is called the
leadership report. Leadership at the national level is very
important, but also leadership is needed from the grass roots,
from organizations like the PTA that are out there in the grass
roots saying that we have to raise our concern about health of
young people to a high level and make a greater commitment to it
in our community.

CHAIRMAN WATKINS: I agree with you 100 percent, but as
you know, the Youth 2000 project that is going on in the
Department of Health and Human Services, it includes the
Department of Labor, National Alliance of Business, members of
the National Assembly and the National Collaboration for Youth.
Fourteen top youth organizations are represented here today. One
group that will not get in the Youth 2000 effort is the
Department of Education. It will not join it. That seems to me
that we are at that point where we simply have to pull it all
together on this educational concept because when the rhetoric is
passed around the nation it results in confusion. One person is
talking about one set of issues, another is talking about a
different world. I am just asking the panel to comment on
whether or not it is not time to clean up what we are talking
about in education, in more clear terms.

MR. HOWE: I think the key to the answer here is that
one of the reasons that the Department of Education was created
in the first place was to provide a focus at the federal level as
to educational programs, and I think it will be extremely
beneficial. We have been talking about mixed messages. I think

371

 

 
 

 

we need to have one voice speak on the educational issue relative
to AIDS education from the federal perspective. That can be done
by leadership; that can be done by example; that can be done
through solid programs which support the local level, support the
state level, get down to the grass roots, get down into the
classroom, get down into the community because it is going to be
a big project. The schools alone cannot be responsible for all
education. A lot of education takes place outside of the
schoolhouse, and it is our need to correct some of that education
that takes place outside of the schoolhouse. I think that
becomes an imperative here.

“

MS. UNGAR: The worst that can happen to me is that I
have to go home and do the dishes so let me say something. From
my personal perspective and as somebody who has had frustration
in the last eight years of having to explain to our membership,
I foundd frequently that what the U.S. Department of Education
has been saying is not necessarily what the state Departments of
Education and local boards of education would like to do. There
has been a different ideology in the Department of Education.

I speak from this not just because I am currently
President. For four years, I served as the sole registered
lobbyist, if you will, a little "one", unpaid lobbyist, as Vice
President of Legislative Activities, for National PTA, and during
that period of time we found ourselves going in to testify at the
request of various committees on where we thought the Federal
Government and the state and local governments ought to be going
in regard to education. .We thought we would go in there and
find ourselves united. Our problems were not with the National
Associations of Administrators or School Boards of Principals or
State Boards of Education. All of us, separately and together,
seemed to be able to come to some sort of consensus. When we
came in, we discovered that the chief opponent of that
particular issue about the need for education, the need to fund
it, the need to provide seed money, the need to provide that
leadership, guidance and the underpinning of moral support, if
not resource in greenbacks, was the Department of Education
representative. I do not know why.

But I really think that that is the truth as I have
seen it, and it has been a big bother to us, and we represent all
kinds of people. We are, I suppose, a microcosm of the United
States. We do not have any litmus test for membership. We do
not ask you what political party you are, we do not even ask you
to be a parent to be a part of PTA so I would guess that we are
very reflective of all the political parties in this country, all
socioeconomic levels and I would hope sexes, {ages and religions
in my association and all or at least some of us seem to have
felt at some point, that there, for some reason or other, has not
been that kind of support. There has been a lot of rhetoric.
There has been a lot of saying everybody ought to hunker down,

372

 

 

 
 

 

 

tighten their belt, be good, say no, but there has not been the
resources and the commitment to put all of those things in
practice.

MS.HUBBELL: I might just add one other comment very
similar to that in the fact that the national education
associations such as NASBE, and all the others represented here,
seem to be working together, very cooperatively in this agreement
and along with the health agencies. It is my goal that the
health agencies who have the knowledge, and the expertise, on the
issue, and the educators who have the knowledge and the expertise
on how to give that information to the students and how best to
put it forward in the curriculum decisions of what is appropriate
at what age level so the two organizations, the education
organizations and the health organizations must work together to
make this successful from the national level clear down to the
local level.

We are finding that as in the National Association of
School Boards, and the National Association of State Boards of
Education, work with CDC on these grants, and we also find it at
the local level, a local school board working with their local
health nurse to give that information to the students, to the
parents and to the communities so it must be a cooperative
effort and it must start, I think, at the top and the bottom and
work together to be a continual program to educate our youth. I
do not have the answer either but I do believe that most national
associations both health and education are trying very hard to
cooperate and to communicate with the public.

CHAIRMAN WATKINS: Dr. Crenshaw?

DR. CRENSHAW: I want to especially thank Ms. Haffner
for her comments about putting all the information to our
teenagers about AIDS infection in a positive context. It is
really important that we not give the message that sex is death,
and we can give the message that sex is health if good judgment
is a part of our choices. The other: point that you raised that I
think is really valuable and would be important to be more widely
understood is that when we are talking about teaching sex with or
without values, I personally, with all the sex educators I have
dealt with, have never seen anybody teach sex without some
values.

People who say they are neutral are mostly people with
undeclared values and they may not even realize what the bias
they are coming from is, but I think this can be clarified. What
we need to come to terms with as a society is what are the best
values to preserve health without horribly offending communities
that could not cope so that we, again, can come to more common
ground. I have seen more and more common ground achieved because
we are, aS a society, all on the same wave length right now that

373

 

 

 
 

 

/

 

rm

we/must have AIDS prevention education in the school system. /
There is more debate about sex education, but it is becoming/ more
ahd more clear. You cannot.have one without the other, and/ it
can be in the context of health, of biology. One needs to/start
very early but be age-appropriate. I think all of these are
tremendous steps forward.

I would say that one of the real obstacles that we have
not confronted yet is that when it comes to the nature’ of the
education, exactly what is taught, there is great disagreement
because there are two camps. One fears that information is
synonymous with permission and it is going to cause /the very
behavior you are trying to prevent. The other camp’ believes that
information and judgment can prevent behaviors and/ can engender
responsible behavior. One of the things I would really
encourage is more dialogue on this point because/I have seen
model programs where parents and communities and teachers have
gotten together and, once they have sorted these things out,
they really worked hard in the best interest of our kids.

Even though I did not hear it quite’ so directly, the
spirit I got of what you were saying is that we tend to
underestimate our adolescents, and there is a lot more that is
possible. I mean, a lot of times people kind of sell them short
and do not try to achieve certain things. You were talking about
the extent of sexually transmitted diseases in the population, I
agree with Dr. Lee that homeless people are very, very hard to
reach. Your programs do not always access them. I think it is
really important not to become oblivious to the fact that these
sexually transmitted diseases could be AIDS five years from now
and are just very, very rampant through the populations that you
are addressing directly.

The one other thing I would like to comment on, and
then I would like some comments from you, is that somebody
mentioned that education is not enough. Information is not
enough. It does not engender the behavior change you are
necessarily looking for. One of the things I have seen
overlooked is the importance of rehearsal behavior -- how to
implement, what to say to discourage sexual activity, the actual
words. If you do not give the kids the words, they do not often
put the concept into practice. What techniques are available
that you are aware of that may move forward in that arena of
making the translation between information and the social skills
to put that information into practice...

. The last point I would make is probably the only area
where we have disagreement. I was quite mad that you did not
have condoms for pregnancy prevention. I have no discomfort with
them. I do not have the confidence in them for AIDS prevention
that many people do. With pregnancy prevention, if they fail,
you gain a life even if you do not want it. With AIDS

374

 

 
 

 

prevention, if it fails, you lose your own, so to me the jury is
still out. I am worried about giving teenagers or adults a dose
of a false sense of security where we have to retroactively
revise our perspective. I hope that we are just really
thoughtful and careful in putting the recommendations in
perspective so that we do not oversimplify the solution. But in
any event, particularly with rehearsal behavior, I would be -
really interested to know what is going on and what you are
suggesting.

DR. BOYER: I would like to respond to that. I agree
with you 100 percent, Dr. Crenshaw. I think that that is the
point at which we are now, we have to explore ways in which we
can prevent those behaviors and as I mentioned in both my written
and oral testimony, that there is a need for communication skills
training. We have to train adolescents as you are suggesting,
and I think we have to start on a small level to be sure that
what we are reporting as happening is in fact, effective. That is
the point I would like to make, that we have to have support for
pilot projects to do more focus groups and more training of
skills and to empower adolescents with this information and with
the confidence that they can effect change in their lives and
that they can make appropriate decisions.

I think that there has been very little work done to
date. I do not know of any research in which that has been done
with adolescents. We have some sense from the gay community that
prevention and education has been effective. We know from other
areas of research such as smoking and drug abuse that skills
training have been effective. I do not know of any efforts to
date of which that has been applied to AIDS education as well as
sex education. I think that is where our energies should be at
this point, in exploring those mechanisms by which we can
implement that, and I must say that is where our energies are
being focused in the Adolescent AIDS Program at Montifiore
Medical Center and, in fact, we will be implementing very soon a
pilot project to explore this and I would like to encourage
funding agencies to take the chance on those pilot projects and
to give us opportunities as researchers to find effective ways in
which we can make that happen on a larger scale, both within the
school system as well as in the communities around then.

DR. CRENSHAW: I sure agree with you, and I hope we can
do something to help in that.

MS. HAFFNER: There is some body of literature on
teenage pregnancy that looks at some of the interventions. For
example, the Emory program, which both Secretary Bennett and I
applaud, for the seventh and eighth graders has shown that
through having teens practice saying no, and helping them
identify the pressure they feel, there may be a delay in the
onset of sexual intercourse.

375

 

 
 

 

The Girls Clubs have also an excellent evaluation of
their programs. At the Center for Population Options, we have
just started another pilot project. We are starting "Teens for
AIDS Prevention chapters in two D.C. schools. To help teens to
take responsibility for educating each others, to help to stop
the spread of HIV in their schools. In one school, we had 100
teens apply for 12 positions, and that was a very positive
affirmation that young people do want to get involved.

I would like to tell an anecdote, which shows that
effective AIDS education will be very difficult. I had done
about six hours of skill practice with a group of teens. We had
really practiced saying no, communicating, talking about condoms,
decision making, etc. At the end of it, I turned to one
17-year-old boy and said, "Let us say you are at home. You are
alone. There is no one there. You are with-a young woman. She
is coming on to you. You have no condoms. What are you going to
do?" He said," Mrs. Haffner, how pretty is she?" I was struck
then that this is going to be very tough. Even with all of the
good exercises, it boiled down to an immediate need. And that is
why I think it is so important we talk to teens and ask them what
will make a difference to then.

DR. BOYER: If I may, I would like to add another point
that it is not only a matter of skills training. I think we have
to also help them to problem solve, to find ways in which they
can work through a problem as opposed to just practicing a
particular behavior or an answer to a behavior. I think it takes
more. It has to happen on a cognitive level as well as building
their self esteem, to build their self confidence that they can,
in fact, have an impact on their behavior, and that they are in
control of the behaviors that they engage in. So it is more than
just practicing positive outcomes.

DR. CRENSHAW: I agree. I think one thing that needs
to be underscored is that while there is an awful lot of
criticism aimed at sex education programs for their effectiveness
in preventing pregnancy and a variety of other reasons, one of
the things that is not very well appreciated is the ébstacles
faced by the educators beyond just political turmoil. The fact
that they do not have money for texts and usually have to work
from syllabi, the fact that because of the pressures, they are
not able to respond to questions without fear of being fired or
great turmoil and significant. If we try to teach history or
English under these circumstances, nobody would say English
education does not work or history education does not work. We
would change our system so it would become more effective I
would be the first to admit that sex education programs have not
been of consistent quality and good and they need massive
improvements, but we need the support of parents and society and
a great deal more funding in order to achieve that.

- 376

 

 

 
 

OO

CHAIRMAN WATKINS: Dr. Walsh?

DR. WALSH: I am encouraged by the fact that we are all
trying. That is a good beginning. I think one of the real
problems that we are facing is that the most horrible phrase that
ever hit society in this battle is the phrase "safe sex." That
scared the living daylights out of parents because they
envisioned all of you as sitting up in front of the classroom and
teaching their kids that promiscuity is fine and here is how to
do it. We are going to show you how to do it so get out there
and do it. Despite the modifications that have been attempted on
that original phrase once it was let loose, at least in most of
my experience, everybody still harps on that phrase. That is
why I like so much the concept that you have of including your
efforts in a program of health education - even getting away
from the phrase sex education.

The very same parents that Ms. Haffner refers to, the
80 percent that do not want to discuss sex with their children,
are somehow repelled by the whole concept of sex education,
primarily because they do not understand it. I think one of the
great things that the PTA could be doing, however, perhaps with
the cooperation of the schools, is to concentrate a good bit of
time on the parents to give a health ‘education course and
curriculum to the parents so they will let the children be
exposed to it. While I feel the parent has a basic
responsibility, I do not think that we can in any way denigrate
what the school can do. It is in that six hour day that Mr. Howe
speaks of that the student is exposed to peer pressure. That is
where he gets the pressure from his classmates that. he is not one
of the boys or not one of the girls if he is not doing things
that everyone else is theoretically indulging in, even if most of
the time it is in their imagination.

 

There are two things that I would like to ask, you.
Ms. Hubbell pointed out that 18 states now have so-called AIDS
education. In health education, does this mean that sex
education per se is included in all the 18 states’ curriculums?
I cannot believe that because certainly I hate the thought of
AIDS education as something that has to set by itself as you have
all spoken to the problem of teenage pregnancy, other sexually
transmitted diseases, just plain old fashioned sexual behavior,
sexual habits, respect for one another - all of these things are
all part of health education. I hate the thought of our ‘
pinpointing AIDS education because this will not get public
support by the year 2000.

MS.HUBBELL: I fully agree. Of the 18 states that
have mandated AIDS education, I cannot tell you how many of those
are comprehensive health education programs, but of the 50
states, many of those have health education programs in their

377

 

 

 
 

 

schools. There is a difference in the state mandating it and
requiring it and the local district providing it. In our
situation, we chose, as I said, a comprehensive health education
program, including the teaching of sexually transmitted diseases,
including AIDS is how our statement is written, and we also, even
in our funding from the state government, are requesting health
education/AIDS education funding because we know that that is
politically saleable.

Our local school boards were asked to do a blueprint of
what is actually already going on in their schools in the area of
comprehensive health education and then where information was
lacking to fill in the gaps and to include the AIDS education as
a portion of the sex education K through 12. I do /not have any
exact statistics and will be glad to get those for 'you on how
many states are doing health education programs. Many more are
doing it than the 18 that are required in the sex education/AIDS
education but it is not happening in every school, and it needs
to happen in every school, accredited public and private
throughout the country, so it is a beginning and I fully agree
with you.

DR. WALSH: I agree with that. Another concern that I
have heard expressed, and I do not know the validity of it is
that many parents who may be less liberal than my friend Burt Lee
over there are concerned of how these courses are taught. They
envision wild-eyed liberals teaching all sorts of awful things to
their children. Is it customary in the school systems to allow
representatives of PTA to sit in a room? You see how far back it
was when I went to school. That was never done. Is that done to
allay those anxieties and those fears because if you do not
convince the parents, we are never. going to get them.

MR. HOWE: I could not agree with you more, and I think
that one of the things we very strongly suggest to the local
boards of education is that as they are developing these
curricula, they involve parents, they involve health
professionals, they involve doctors in their community,
pediatricians and the rest so that we develop a program that is
going to be saleable.to parents - they are not going to withdraw
their child’s participation in that program which many states
allow a parent to do. Many states allow a parent to remove a
child from a program even though it may be mandated or otherwise,
if that parent has an objection to that particular program. That
parent may remove the child. We do this to have a program that
does pass muster with the community, that does meet the needs, of
a child at an appropriate age, and yes, we encourage having
parents come to the schools ahd see what we are doing so that
they feel better about it. They are proprietary in what is going
on. One of the’ hard parts that we have now in our communities is
that only 22 percent of the voters in a community now reflect the
parents in that community.

378

 

 

 
 

 

DR. WALSH: Yes, that is right.

MS. UNGAR: I would like to add that not only have we
been making the effort to try and educate the parents, indeed for
the last 10 years in cooperation with the March of Dimes, we have
been providing and are continuing something called Parenting
Seminars in which we are helping parents to get over that
discomfort in trying to communicate what they know they should be
communicating but as you rightly point out, 80 percent just do
not know how or are afraid to. I think the commitment to that
is that more than 80 percent of the parents have said they would
like the schools to do the job for then.

The other thing that I think is very interesting and
Jonathon Howe knows, is that if the school boards do not invite
the parents into this process, the PTA will also communicate to
them the skills of how they can become a part of that shared
decision making.

DR. WALSH: A third question that I have is I believe
the Secretary of Education said this morning, and I think some of
you pointed out today that there has been considerable
cooperation between the Department of Health and Human Services
and Department of Education. I think that he did bring out this
morning that it would facilitate what the educational group
could do if there were more direct grants made to the Department
of Education or budgeted to the Department of Education so it
could make direct grants without going through a process of
having to justify it to the central funding of HHS. I am not
sure how that is done, but I think I understood that you felt
that that would be helpful. Am I wrong or right in that? This
would be a specific possibility that we would consider for a
recommendation if, indeed, that would be helpful.

MS.HUBBELL: I do not think I was speaking directly to
the grants going to one specific agency or organization, be it
the Department of Education or CDC. Funds are definitely needed
in all areas, health education, health prevention as well as
education. I cannot personally tell you how best I think the
funds should be distributed. Currently the funds that the
National Association of State Boards of Education are receiving
in cooperation with CDC, are having a positive impact at the
state level with our programs and projects. NASBSE will begin
working with seven states in the near future,. helping them set
state policy, working with the local districts on current issues
about AIDS. It is a very complex issue, as you know.

& I do not have a specific recommendation on the funding,
distribution who should be funded in order to get the funds to
the local districts. My goal is ‘to. get it to the state
organizations and to the local districts so that they can impact

379

 

 

 
 

=

with good curriculum. The other thing I really wanted to stress
was good in-service education for our teachers. Every teacher in
every district must be educated and understand AIDS education and
sex education, and feel comfortable talking about the issue
because each one of our students feel more comfortable with
certain teachers so everybody must be prepared. Dr. Walsh, I
cannot answer with a specific recommendation. Somebody else on
the panel might be more informed to better on the funding.

CHAIRMAN WATKINS: We are going to have to move on, Dr.
Walsh.

DR. WALSH: Can I get an answer to my question please?

MR. HOWE: Very quickly, I think unfortunately too
often in education, we have a tendency of circling the wagons and
then firing inward, and I think it would be a lot better if we
had one spot that we are familiar with dealing with that we could
go. The most important factor, though, is getting the money out
as fast as possible with some solid criteria behind it.

CHAIRMAN WATKINS: Dr. Primm?

DR. PRIMM: Yes, Mr. Tolsma, I have a question
concerning the CDC’s large budget for education and for both in
and out of school kinds of programs. What is the CDC doing to
monitor and evaluate the programs that become the recipients of
those dollars that you will funnel through state and local
education agencies? That is the first question.

 

MR. TOLSMA: The grant procedure we actually enter into
is what we call cooperative agreements, which in fact define
roles for both the recipient and the sending agency, in this
case, CDC. It requires that as part of their applications,
recipients both commit themselves to evaluation and show us how
they are going to do that, and we have a plan to do that.

In addition to that, we have been working as well on
several things on how one defines what the outcome should be that
should be measured. I mentioned the National Academy of
Sciences’ project a little earlier. That includes advice to us
on what indicators ought to be monitored to show whether or not
something may be accomplished in behavior change. We have worked
with the first 15 state and 12 local recipients to agree on what
we call common data items. These common data items are basically
AIDS-related knowledge, attitudes, beliefs and behaviors that
have been developed into a joint survey instrument. Data
gathered by this instrument will be used by funded stated and
local education agencies to track and monitor the level of these
knowledge, attitudes and practices in the population.

I do not have specific information at this point in

380

 

 

 
 

time, but we have something on the order of 20 or 30 state and
city school districts that either already have administered that
instrument or are in the process of doing that on a random sample
of young people in their state or in their city to assist the
district. So we would hope that within the year, we would have
some sense of what is the distribution out there of knowledge,
attitudes and, indeed, of practices. Not all of them have asked
the practice questions in getting to sensitive ‘questions of human
behavior but a number of them have, so we are going to, I think,
begin this process of saying where are we because in order to
know where we have gotten, we have got to know where we were or
we have started.

DR. PRIMM: Dr. Boyer, you have spent time in Atlanta
and New Orleans and San Francisco and now in the great city of
New York, and you probably have witnessed in all of those major
urban areas, the decay, the disillusionment, the disenchantment,
the disenfranchisement, the poor housing, and all of the other
things that the Kerner Report reports now after 20 years of
happening in our inner cities, in particular to our minority
community. This is the kind of person that you get in the
schools that you have to impact with your AIDS education. You
also stated in your presentation today that in your survey, there
was less knowledge found among the minority youth than among
white youth. What do you suggest to this panel and to this
nation that would be a way to get that knowledge gap up among
those youth, and to engage them in a process where they would,
say, embrace what we are doing?

 

None of you talked about the dropouts; except you
mentioned the number - 1.2 million, 1.5 million’ and God knows
what that true number really is. I would think that the emphasis
and education in terms of HIV infection and AIDS ought to be
concentrated on elementary school, intermediate school and junior
high school before they drop out, because those great numbers or
percentage of dropouts who participate in that at-risk behavior
are far greater than the people who stay in the school would have
been had there been an impact prior to dropping. If you can
answer that, Dr. Boyer, I would certainly appreciate that.

DR. BOYER: I will respond to your first question. The
point I would like to make, first of all, is that I think the
discrepancy in level of knowledge, attitudes and beliefs among
minority adolescents has nothing to do with intelligence per se.
I think it has to do with a lack of sensitivity to information
targeted specifically at this population. Largely, until very
recently, it has been a perception that AIDS is largely a gay, ©
white, male disease, and I think for many reasons, minorities in
general but adolescents in particular have ignored, the messages
about AIDS and who can be infected and who are infected. I think
that is changing a little now with the increasing numbers of IV
drug abusers being infected, largely in inner cities.

381

 

 

 
 

 

I think that there has to.be some sensitivity to those
barriers to receiving information. Talking openly about
homosexuality and in a lot of communities it is taboo, but it is
also a particular issue in minority communities, to openly talk
about homosexuality and the risk of engaging in homosexual
behaviors so that has to be, understood when you are targeting
minority adolescents, that you can talk about these things and
you have to get over their barriers to say that is not an issue
for me, even though they may, in fact, be gay or bisexual so
there has to be sensitivity to those cultural factors as well
when targeting information. I think that is a key.

In terms of your second point, if I understood it
correctly, is that we have to "catch," as you said, adolescents
at an early age, before they drop out. A large number of them
drop out by the 10th grade, and if we want to implement
education, say, as it now exists in a lot of school districts, in
the 11th and 12th grade, it is much too late. We have to start
earlier than that, and I think we can then have an impact perhaps
on behaviors for those kids who will not return to school after
10th grade. I am not sure I answered all of that question.

DR. PRIMM: I think you did well. I tried to drag you
into the whole Kerner report and make you all think about some of
the social dislocations that our people face in this nation which
make them disenchanted with the schools themselves. What is the
need to go to school if I am not going to be able to achieve very
much and get a job? If I am going to join the list of the
unemployed like my daddy and like my uncle, etc., etc., I think
that when we talk about this problem, and particularly in
education, that we have to begin to think about the dislocations,
the social dislocations within our society that predispose to
some of these deleterious effects that we are witnessing today.

I want you all to take that into consideration as you make
suggestions to the Commission. That is all.

CHAIRMAN WATKINS: Dr. Conway-Welch, I think we have
time for one quick question.

DR. CONWAY-WELCH: Yes, my apologies for being late. I
am addressing this to Mr. Tolsma but perhaps any of you could
help answer. On page nine of his testimony, recommendation
number two states "Education about AIDS should be taught by
regular classroom teachers in elementary grade, by qualified
health education teachers for others in the secondary grades."
My question to you is that obviously, school nurses are a
possible resource for this education. I am aware of the fact
that in many of the states across this country, there are no
school nurses in any of the public school systems in the state.
Tennessee is considering legislation even now about the issue.
What specific obstacles other than money have you been able to

382

 

 
 

 

identify that have prevented or would prevent the expansion of
nurses into school health programs. There are many other reasons
besides AIDS education, but certainly that would be part of it.
If it is a long, lengthy answer, I would appreciate receiving it
in writing, but if you have any ideas other than money, verbally,
I would appreciate your answer.

MR. HOWE: Real quick, one of the problems is
certification of that individual to teach within the classroom
and to be acceptable to the state regulatory agencies which
govern how we operate our local schools and who is allowed to
teach and who is allowed to have pedagogical responsibilities.

DR. CONWAY-WELCH: It was pointed out to me that as
Dean of the School of Nursing at Vanderbilt, I could not teach in
the state,.in the public school system, but I was not aware that

that was one of the big barriers for school nurses. Are there
any others that you are aware of? Again, other than money.

MR. TOLSMA: The point about training and in-service
training was brought up. The American School Health Association
is one of the participating organizations here and that is a
professional organization in which school nurses are involved.

MR. HOWE: I might note, too, that again, from the
standpoint of what we do is in the development of curriculum,
those districts which do have school nurses or school health
access will definitely rely upon and involve those people in the
development of curriculum.

DR. CONWAY-WELCH: Thank you.

MS.HUBBELL: And in many states, the school nurse can
come into the classroom and be a resource person. There must be
a certified teacher in the classroom, but health professionals
can give the information and be there as resource peoples. They
cannot teach the course entirely without a certified teacher in
the classroom.

DR. CONWAY-WELCH: And that varies state by state.

CHAIRMAN WATKINS: Thank you very much, panel members.
It was a very valuable panel to the Commission, and we will stand
recessed now until 1:15.

(WHEREUPON THE MEETING WAS RECESSED FOR LUNCH TO BE
RECONVENED AT 1:15 P.M.)

383

 

 
 

 

AFTERNOON SESSION

CHAIRMAN WATKINS: Welcome back. Our first panel this
afternoon concerns the views of elected officials about AIDS.
Governor Edward DiPrete, from Rhode Island and, also, from Rhode
Island, Representative Claudine Schneider, and Congressman Sander
Levin from the 17th District, State of Michigan will be able to
join us.

We have pressing time constraints particularly today on
Congresswoman Claudine Schneider who has a vote coming up
shortly. She must go back to Capitol Hill. So, with the
Governor’s permission, we would like very much for Congresswoman
Schneider to give us her statement first.

CONGRESSWOMAN SCHNEIDER: Thank you very much, Admiral,
and let me say at the outset that I appreciate the opportunity to
testify, and I want to begin by commending you for the leadership
that you have provided in what has to be one of the most
incredible challenges that this country has ever faced and let us
hope that we will ever have to face.

I know I speak for Governor DiPrete when I say that we
appreciate this opportunity to inform you about the AIDS battle
in Rhode Island and what I believe is a model program for other
states to emulate. Rhode Island, as you know, is a very small
state, but it is not so small as to be unthreatened or untouched
by the AIDS virus. By the end of last year we had diagnosed
about 144 of our citizens with AIDS. Sixty-six of those,
regrettably, have already passed away. These statistics are,
granted, below the national average. Our response to then,
however, I believe, has been well above. While the numbers are
frightening to us, for many, the letters A-I-D-S are even more
so, and this fear has been perpetuated most through ignorance of
the disease.

Unlike the disease itself, the myths and the
misperceptions about AIDS seem to spread by mere casual contact.
There is nothing blissful about this kind of ignorance. Like an
unreliable blood test for AIDS, it creates false positives --
undue fear -- and false negatives -- insufficient concern. It is
incumbent on government, therefore, I believe, to provide our
citizens with the most accurate information available about the
disease. Pending a cure, AIDS education is our most effective
weapon to stop the spread.

Now, let me share with you, and you will probably hear
from Congressman Levin shortly, members of Congress are very
anxious to respond to the AIDS threat. Despite the budget
crunch most of us fully support and will continue to support the
growing budget, for AIDS research. We should, also, do what we
can to remove the bureaucracy from the researchers so that they

384

 

 

 
 

TT

can expedite the search for and production of a cure for AIDS.
Beyond that I would hope that my colleagues will join me in
legislative caution. For now AIDS is not a question in search of
a legislative answer. Still, we in Congress are asking ourselves
what is it that we can do to help educate our constituents about
AIDS? While we can provide federal funds and incentives to
develop AIDS education programs, we do not possess the kind of
sweeping powers of office that governors have at their disposal..
So, instead we have to look for creative ways to reach the people
of our states.

Over the past several months I have been endeavoring
to do just that. Late last year I sent a 20-question survey
about AIDS to every household in my Second Congressional
District. It looked like this. First of all, the purpose of
this was to determine as best as I could through a very
unscientific sampling the extent of the awareness among my
constituents, and secondly, perhaps most importantly, I wanted
to create a sense of inquisitiveness among Rhode Islanders. I
wanted to ask them or have them ask themselves if they really
knew all that they should about the disease. Whether or not
they took the time to fill out the response card and send it in,
most of all the survey got them thinking about AIDS. More than
5000 families responded to the questionnaire which is rather
significant as any congressional survey goes, and overall I
believe the results were outstanding.

 

On questions that were relating to the spread and the
prevention of AIDS respondents scored around 90 percent or even
better, and I would ask the Chairman’s permission to include
this questionnaire and the results in the record, if I may?

CHAIRMAN WATKINS: Without objection, it will be
entered. Thank you.

CONGRESSWOMAN SCHNEIDER: Another part of my AIDS
strategy, of course, was to send out the answers to the
questionnaire, and with those answers, I, also, included the
Surgeon General’s report on AIDS which as you know, is one of
the most comprehensive booklets on the disease.

Just this past Monday I added another dimension to my
AIDS education effort. I spent the day meeting and talking
with professionals around the state included in the AIDS
research, prevention, treatment and education angle. Originally
a member of this Commission, Dr. Burton Lee had been scheduled
to join me, but unfortunately, inclement weather forced us to
postpone that visit. Nonetheless, I look forward to the time
when Dr. Lee will be able to join in. I think that he will find
that there is much to see and much with which to be impressed in
our State of Rhode Island.

7 385

 

 

 
 

. . ;

‘There is a multipronged battle being waged in our
state. We are attacking AIDS on the three most critical fronts:
research, health care and, also, education: Researchers,
scientists and physicians at Brown University and various |
hospitals are engaged in a wide range of research on the HIV |.
virus and other community health projects. The State Deaprtment
of Health is coordinating additional research, as well as
overseeing a public awareness and education program focused on
high-risk groups, all part of a $3 million initiative by Governor
DiPrete and the Governor’s AIDS Advisory Council.

There is, also, a volunteer group called Rhode Island
Project AIDS which has been established to help cope with all
aspects of the AIDS crisis in our state. _ The organization
provides counseling to AIDS patients. It runs a bilingual AIDS
hotline service which is just about to start up. It provides
information and educational materials on AIDS and AIDS-related
initiatives, and it puts on workshops and publishes an
information newsletter. They, also, have sponsored a workshop
on AIDS in the workplace for corporate and business leaders.

Some of our state’s best education efforts are
occurring in Rhode Island’s schools. If Pilgrim High School in
Warwick, Rhode Island, which I visited Monday, is any indication
of the effectiveness of AIDS education in our schools, and if
these students eventually turn their knowledge of the disease
into preventive actions, then I have very high hopes that we can
significantly thwart the spread of AIDS. But as you know, only
16 other states and the District of Columbia require AIDS
education in their schools.

 

Last summer Governor DiPrete called on his fellow
governors to follow Rhode Island’s lead and adopt similar AIDS
education efforts in their states. That proposal was
unanimously endorsed by the governors.

Mr. Chairman, I urge this Commission to do likewise,
to recommend that AIDS education become as basic in the
curricula of our schools as reading and writing, and based on my
experiences in Rhode Island, I would especially urge the
Commission to consider the following recommendations: The
Department of Education should work with US Public Health
Service of the Department of Health and Human Services to
develop AIDS education courses and corollary materials, both
print and visual, for use in the nation’s schools, beginning at
the primary or secondary school level. In order to teach one of
the statistically most susceptible groups, Hispanic Americans,
educational materials should, also, be produced in Spanish.
Thirdly, I believe a central clearinghouse should be established’
for states to share educational methods and materials, curriculum
development and teacher training information. Fourth, education
programs should be targeted to high-risk groups, especially

386

 

 

 
 

nO

minority communities and IV drug users and, also, education and
counseling programs should be developed for use in corporate
America. Sixth, in order to give our citizens an accurate
understanding of the extent of the disease, the government should
regularly publish statistics on the spread of the AIDS virus so
that we have the opportunity to measure progress as we proceed,
and in a like vein, the government should regularly poll or test,
if you will, citizens on the effectiveness of our AIDS education
efforts so that we know that we are spending our money wisely and
that the educational efforts are having an impact.

In order to keep the public informed of the progress
being made in research into a cure for AIDS, a central
Clearinghouse should be established for the sharing and
dissemination of the most up-to-date research on AIDS and, also,
any type of alternative cures. The United States should take an
active role in sharing our educational efforts with other nations
and international organizations, such as the World Health
Organization. Similarly the United States should seek to learn
what other countries and world groups are doing to educate their
public. I happen to serve on the Science and Technology
Committee, and we have had some hearings about information
sharing on AIDS and our role in the World Health Organization.

It seems to me that there is opportunity for improvement there in
terms of information generation and exchange.

I realize, Mr. Chairman and members of the Commission
that the powers of this Commission are very limited, just as the
extent of what we in the Congress can do directly is limited. In
that respect we share a mutual frustration. However, we look to
this distinguished body to direct our national strategy to combat
AIDS. With all the medical, the ethical and constitutional
ramifications attendant to the AIDS dilemma, your mission is not
an easy one, but your leadership is essential. We look toward
that leadership, and I, for one, offer to provide you with any
kind of assistance, congressional or personal, that I can
possibly lend you. Thank you very much.

 

CHAIRMAN WATKINS: Thank you very much, Congresswoman
Schneider.

Governor DiPrete?

GOVERNOR DI PRETE: Thank you very much, Mr. Chairman.
I would like to thank you members of this Commission for
allowing me the opportunity to testify today. As a sitting
governor, I wanted to speak today of the role that state chief
executives can play in meeting the challenges presented by the
AIDS epidemic, and before proceeding, I would, also, like to
take just a moment to introduce Rhode Island’s Director of
Health, Dr. Denman Scott. Also, Susan Barry from my Policy
Office is here.

387

 

 

 
 

 

State governors occupy, in my opinion, a unique
position in the American political system. Like others in
public office, we stand at the focal point of public scrutiny
but must at the same time be responsive to the needs of society
while being responsible to the statutory and constitutional
constraints of governing.

Whenever a real crisis occurs, the first person who
gets called is usually the governor, and in the case of an
ongoing crisis, such as the AIDS epidemic, it is the governor
who is responsible for articulating and promoting the best means
for protecting the people of his or her state. Fortunately,
governors also possess some very important tools to assist them
in carrying out their role. They command the enormous resources
of state government, both in terms of money and in terms of
personnel, and just as important, they can mold public opinion
through their access to the news media. In using the power of
personal authority, a governor can bring together the experts to
sort out the facts and move toward a reasoned consensus on the
proper course of action. These powers are particularly important
in meeting the challenges posed by the AIDS crisis. We are
talking about a highly complex issue, one of staggering
importance but which is often cloaked in fear and
sensationalism. It is an issue that has been further
complicated by unique legal and civil liberties issues, and it
is an issue that medical science itself is struggling to come to
grips with.

It is, also, an issue now on the desk of every
governor in every state in this nation. It is not something
that can be ducked. The steps that we take today can make all
the difference in containing this epidemic until a cure ora
vaccine can be developed. Governors must act, and they must act
quickly. We cannot afford to wait until all the facts are in,
and what is more, we have to speed up the process to get
appropriations through and get the programs on line. As the
chief public elected official of the state, a governor’s job is
to get the public and private sectors moving and moving together
quickly. In short, our goals are these; one, to stop the spread
of the disease; two, to assure medical and social services to
victims and to their families; three, to protect the health care
system from being overwhelmed by new demands on the capabilities;
four, to maintain the fiscal viability of care providers, health
insurance carriers and the state budget itself; five, to calm the
fears of the public; and six, ;to prevent unfair discrimination
against those who are stricken by the disease.

You have already heard testimony from Dr. Denman ~ .
Scott, as I mentioned, Director of Health. He was generous in
describing my role in our common effort to fight AIDS and was
too modest, in my opinion, in describing his own very important

388

 

 

 
 

OT

role in presenting his case to me, but he was correct about the
sense of urgency I feel especially about the need to safeguard
our young and my impatience with a "business as usual" approach
to fighting a lethal epidemic.

Rhode Island has the distinct advantage of being
behind some of the other states in the onset of the disease. We
are a state of modest size. We are about 1 million people, and
our initial number of cases of AIDS was correspondingly low.
This presented us with a strategic advantage of beginning the
fight against the disease at a relatively early stage and
provided us with the opportunity to learn the lessons of other
states and municipalities. I felt it was imperative to use this
advantage to the fullest.

There are four areas which a governor must command,
especially in time of crisis; one, policy formation; two,
administration of state agency programs; three, legislation; and
four, public leadership.

I want to say a word about how these apply to AIDS.
Setting policy means establishing goals and charting a course of
action. Where AIDS is concerned, setting policy is made
difficult by uncertainty about the disease, fear of
transmission, disagreement about what works best and concern, of
course, about civil liberties. We have to understand that good
people can disagree, but this disagreement was creating
confusion and was an impediment to action. Our decision,
therefore, in Rhode Island was to break through this confusion.
To do this I named 39 highly qualified people from different
walks of life to a Governor’s Advisory Council on AIDS. I told
them that I was increasing the AIDS appropriation in my new
budget proposal by nearly 700 percent to approximately $3
million, and I told them that they had 3 months in which to
develop practical recommendations for spending the money. We
didn’t have the time for ultimate answers. We needed. to take
the best information we had now and to act on that information.
You sometimes hear said that study commissions are established
to avoid decisions rather than to help make them, but this is
not the case. We had a real emergency, real lives at stake and
real money to spend. A governor, fortunately, and Claudine
Schneider alluded to this, commands the resources of multiple
state agencies, their staff, budgets and programs. It is
through this that he is able to work most directly. Even before
we had the AIDS Council Report, we knew there were things that we
could do right away through the instrumentality of state
agencies.

 

‘

_ The first thing we did early in 1987 was to beef up
the AIDS Control Unit in the Department of Health in order to
increase its disease surveillance capabilities, its testing and
counseling services and its AIDS education programs. Second, we

389

 

 

 
 

 

asked the Board of Regents for Elementary and Secondary
Education to mandate AIDS education in public junior and senior
high schools. There is nothing more important in my mind than
making sure our children know how to protect themselves and each
other from this terrible but preventable disease. Third,
because IV drug users are a major risk group for AIDS in Rhode
Island, we increased the number of Methadone maintenance slots
funded through the State Department of Mental Health,
Retardation and Hospitals.

Our legislators, incidentally, are very much aware of
AIDS, very concerned about it, a merit, in fact, to the general
public which it represents, but like the public, the legislature
has been divided in its perception of AIDS and how best to
confront it.

Last year the general assembly was flooded with a
variety of unrelated, sometimes contradictory bills as have been
the legislatures in all 50 states, the impulse to do something
constructive running ahead of any consensus as to what the best
approach might be. This year we hope to bring a greater measure
of coherence to our legislative deliberations by using the
recommendations of the AIDS Advisory Council as a basis for
action. :

In addition to program recommendations for allocating
the AIDS budget, we submitted an administration bill
incorporating council recommendations to establish a balance
between public health needs and civil liberties concerns. For
example, one, the bill establishes the principle that people may
not be tested for the AIDS virus against their will, but it does
establish certain narrowly defined exceptions, for example,
children, wards of the state, exposed workers and so forth to
protect the individual himself or to protect others with whom he
or she comes into contact.

Second, the bill establishes the principle that AIDS
test results may not be disclosed without the tested person’s
notification and permission, again, and I stress, with certain
exceptions, such as health care workers to whom victims have
been referred for care.

Third, the bill bars discrimination against people who
are infected with the AIDS virus in housing, employment or the
delivery of services and provides for administrative relief from
the state human rights commission.

Finally, the visibility of a governor ptovides an
opportunity to take moral leadership and an unparalleled
opportunity to speak directly to the people. The governor can
influence opinion, calm fears, generate community support for
positive action and if necessary, force reconsideration of

390 -

 

 

 
 

 

impulsive tendencies which may be well meaning but
counterproductive. The mere fact that the governor has a
personal interest, a commitment and involvement in the fight
against AIDS gives a certain amount of reassurance to the
public.

In addition, gubernatorial sponsorship for programs
helps make them work. Let me just give you two examples, if I
may. Some communities in our State of Rhode Island in the past
have been reluctant to make sex education a part of the school
curriculum. Inevitably AIDS education requires that we speak
frankly about sexual transmission at a level, of course,
commensurate with the age level of the student. I believe that
my public stand on this issue, both in Rhode Island and
nationally, facilitated public acceptance of what had previously
been a very controversial undertaking.

I might add that in broader forums, as well, governors
can use their power of persuasion to make a difference. Last
year I proposed to my fellow governors at the National Governors
Association a resolution recommending mandatory AIDS education in
our nation’s public schools. In making the case we were able to
convince each governor of the importance of this step, and
consequently the resolution was adopted unanimously by our
nation’s governors. Back at the state level a governor’s
opposition and, if necessary, a gubernatorial veto can force
reconsideration of an overly hasty measure.

Now, I don’t want to suggest that any governor can be
a one-person solution to the AIDS problem. It is just not going
to work that way, but governors are elected to provide
leadership in terms of policy, programs, legislation, and in
educating the public. Particularly in regard to the AIDS
crisis, these functions allow a governor to make a material
contribution to both the direction and substance of a battle
whose outcome is of the highest importance to the people of an
entire state.

Finally, I want to say a word about the ethical side
of the governor’s responsibility in the AIDS crisis. You
sometimes hear about AIDS being a disease that people bring upon
themselves because of their life style choices and that we
shouldn’t have to worry about violating the civil liberties of
people who endanger others. I don’t think it is the role of
government to make those kinds of decisions. Under our
Constitution, and we have all taken an oath, and we have sworn
to uphold the Constitution, every citizen is entitled to equal
protection of the laws. It is not just the right thing to do;
it is the law.

As governor, I intend to continue to be tough but
tough on the virus, not tough on people. Does mandatory testing
=. ~

- 391 - ~

al -

 

 

 
 

EE

make sense? In some cases, yes, it does, and we are providing
for that in law, but we do not enshrine mandatory testing as a
principle. On the contrary, it must be viewed as a necessary
exception at this time in certain limited cases.

Now, let me conclude by commending President Reagan
for his leadership and the members of this Commission for their
tireless efforts in examining strategies for dealing with this
lethal menace. We do a lot of things in government, but
protecting the lives of our citizens is the most important.

Again, Mr. Chairman, I thank you for allowing me the
opportunity to testify today, and certainly I and members of my
staff will be very happy to answer any questions.

CHAIRMAN WATKINS: Thank you very much, Governor
DiPrete. I know I speak for all the panel members to say how
proud we are that the State of Rhode Island would have sought
presence before this Commission in such numbers. Dr. Scott
testified for us 2 days ago on matters of his feeling about the
overview of the public health system and its relationship to the
epidemic. Congresswoman Schneider has asked us to accompany her
through a variety of sites in Rhode Island to see what you are
doing, and I think your personal leadership and the statement you
just made gives us courage that your leadership within the
National Governor’s Association will spark continuing interest
and attention and personal involvement by that leadership, and
that is what it is going to take, and so, I commend you and
Congresswoman Schneider and Dr. Scott for being so much in view
before the Commission. I think it is great for you state. It
shows tremendous personal involvement, and that is very important
to the Commission.

 

GOVERNOR DI PRETE: We appreciate those comments, Mr.
Chairman.

CHAIRMAN WATKINS: I know that you may have to be
pulled out, but just a minute, Congresswoman Schneider, and I
would like to ask one question before I pass it down the line to
the other Commissioners. Where do you think Rhode Island
business leadership is right now in their involvement in the
entire effort of partnership with community-based organizations,
with state and local authorities in dealing with this? Are they
becoming involved in it to the extent that there is greater
participation, a greater personal knowledge so that there is a
bridge between AIDS in the workplace, AIDS education in the
schools? Are there even some monetary contributions where the
demand is more than state funds will allow, but they could come
in and begin to help out in areas that clearly are both
underserved and underfunded right now?

392

 

 
 

 

CONGRESSWOMAN SCHNEIDER: Insofar as the awareness of
the business community in the State of Rhode Island, the
workshop that was held by Rhode Island Project AIDS generated
interest on the part of about 150 different companies, and the
way you often measure interest in a topic when you are holding a
workshop is to see who stays after lunch. As it turned out,
overwhelmingly the majority of attendees at this conference, at
this workshop stayed beyond and throughout the afternoon, and
there was a great deal of interest.

Now, insofar as their desire to have access to
information about how to educate their employees, how to provide
answers to questions of insurance or discrimination or whatever,
much of that information was provided to them. So, I think that
Rhode Island is in the forefront of tackling the questions of the
business community. Insofar as your question about the
willingness of the business community to put forward financial
resources to help grapple with the problem, that is something I
am not aware of, but you can be sure that when I go back to Rhode
Island on the weekends, I often have the opportunity to speak
with the Chamber of Commerce and many other business leaders, and
I will ask that question to see if they are willing to commit
some resources and certainly for the generation of information
about the disease I think that that would be a useful expenditure
on the part of the business community. So, I will take that
question and turn it into action and positive suggestion on your
part.

CHAIRMAN WATKINS: Governor DiPrete, do you have
anything to add to that?

GOVERNOR DI PRETE: The business community has been
very supportive of this. In fact, the immediate past president,
a gentleman who just stepped down as Chairman of the Providence
Chamber of Commerce was a member of the Council on AIDS, the
Advisory Council on AIDS. He was very active. in it, and every
single indication I have had from the business community that
they are very supportive, both from a humanitarian point of view,
and I think they feel that these are the things that improve the
quality of life, and that certainly affects business.

CHAIRMAN WATKINS: Thank you very much. I would like
now to, since Congressman Sander Levin, 17th District, State of
Michigan has arrived to allow him to give us his short
statement, and then we will continue with the questions.

Congressman Levin?

CONGRESSMAN LEVIN: Thank you very much, Mr. Chairman,
Admiral and your colleagues. You have heard a lot of testimony.
I thought it might be useful for me to give you a report from the
grassroots, so to speak. I represent a district that is in many

393

 

 
 

 

respects, typical in this country, urban-suburban. It has only
one farm in it. So, we don’t claim we are typical in that
respect. It is evenly divided blue collar-white collar,
socioeconomically diverse, and yet in one respect the district is
different than parts of America. It is perhaps somewhat
atypical. The district includes, as I mentioned Northwest
Detroit. Northwest Detroit has the second highest number of IV
heroin addicts in the country. There is, also, I might add
rather significant, much too much drug abuse within the suburban
areas. Any drug abuse is too much, and there is a considerable
problem within the suburban areas of Detroit.

We faced in our office this question, what should we
do? I was a member of Congress. AIDS was spreading. What were
our opportunities and our obligations? We had considerable
debate. This was a number of months ago. Within our office,
there was a wide diversity of opinion. There was hesitation to
engage in an education campaign for what seemed to be obvious
reasons. We framed the discussion, "should we distribute the
Surgeon General’s Report?" The decision ultimately was made by
the member. I decided that we should proceed to distribute the
Surgeon General’s Report, and we picked out three communities,
diversified communities, Northwest Detroit, which has a
substantial minority population lower income than Southfield.
Southfield was the second community which we picked out, which
has a higher percentage of white collar than blue collar
population. The third community was Dearborn Heights, a rather
traditional community, in the Detroit spectrum, blue collar,
white collar, and a considerable what might be called an ethnic
population.

We told the staff in our main office in Michigan after
we sent 100,000 leaflets, "Get ready for the deluge." We
thought we would receive primarily protests. Five years ago, I
don’t think any office would have thought of sending material
that discussed the subjects that are in the Surgeon General’s
Report. There was no AIDS epidemic then. As I indicated in my
testimony, instead of the phone ringing off the hook with
protests from 100,000 homes, we did not receive a single letter
of protest or a single telephone call. I was very surprised. We
had decided to hold a series of town meetings in conjunction with
the report, and as indicated in the testimony a number of
experts, Dr. Osborn, Dr. Thier, Dr. Fisher came to these meetings
and again, we had contemplated on a very large turnout beyond the
norm, and so, we selected halls that could accommodate what we
thought might be very volatile meetings.

In two of the three communities a smaller number of
people came than is usual. Those who did participate were
vitally interested in the subject, and we had a most informative
and at times controversial discussion but more informative than
controversial. '

394

 

 
 

 

I think there are lessons to be learned from this. I
don’t think our district is very different than the rest of the
country. I think people would wish to avoid the subject of
AIDS. They would wish it away, for obvious reasons. Also, the
incidence of AIDS has not reached a point in Michigan where most
people know somebody who has the disease. So, in that sense it
seems remote, but also, it is clear to me from our experience
that most people want this information. If that were not true,
we would have had a large number of phone calls like we are
receiving today, and we have received the last few days on AIDS,
and I was struck when I went to Europe on a trip with the Select
Committee on Narcotics how far behind this country is compared to
other countries. We went to Portugul, and I brought with me what
they are disseminating through the postal service in Portugul, a
country whom one might think by tradition would never send this
kind of material, but they did and long before we did, and so, as
I indicate in my testimony, it seems to me that several points
are clear. We have learned from the grassroots within the 17th
District the following: AIDS is a threatening subject. Most
people prefer to avoid discussion of it. Two, people know that
AIDS is a serious subject, so they will accept clear information
about it; and thirdly, even though most people wish to avoid and
at the same time learn about it, they don’t feel it is yet close
enough to home to leave their living rooms, attend meetings,
initiate discussions or otherwise become involved in the subject,
and that increases the obligation, it seems to me, upon those who
have responsibility for education in this country.

Finally, as I say, in my testimony, regarding
education I think the experience in the 17th shows the
following: First, the message must be clear, and if you would
like, I can spell that out. Secondly, the message must be
complete. The public needs no less and will accept candor.
Third, the message must be repeated. Fourthly, the message must
be carried by leaders in the community. We scheduled as a
follow-up to the town meetings a session with community leaders,
private and public, local leaders, municipals, church,
education. They came in large numbers. And lastly the message
cannot wait.

I read the testimony of the Secretary, of Mr. Bennett
this morning, and I must say when you look at his testimony in
relationship to our experience in the 17th District, it strikes
me that it sets up an absolutely false dichotomy. It is not a
question of teaching responsibility or providing information.
There is nothing inherently contradictory. They must go
together. He says that we should not be afraid to talk about
the demands of decency, self-respect, personal responsibility in
the presence of the young, that is exactly what we are trying to
do within the 17th District. We, also, I think, should not be
afraid to talk about the nature of the illness and the nature of

395

 

 
 

 

avoiding it, in addition to the supreme obligation of youngsters
and others to meet the demands of decency, self-respect and
personal responsibility.

We have a student forum in our District. We meet
three times a year. We had one the previous year on drug abuse,
and I was astonished at the descriptions by the students of the
nature of drug abuse in the schools of this District across all
lines. I think it is misleading to talk about condom mania.
That isn’t what our effort was involved with at all. It isa
question of meeting our responsibility for education, and I close
with this. I want you to know what moved me more than anything
else. I said to myself, "Doesn’t every family deserve the kind
of information about AIDS that my family has?" My wife and I
have four children. They range in age from 19 to 29. Then it
was 18 to 28, and I had to ask myself the question, being
immersed in this issue, reviewing the materials, should not there
be within every household of this country the same information
for parents and children to use as we were able to utilize within
our house. And believe me, in our household, as old as the
children are, it is not a question of either/or. It seemed to me
I had just one answer, and that was I should not sit by and see
that my children and our family, when it comes to a fatal
illness, is advantaged over any other family.

You have taken important steps in other areas. I hope
you will do the same in the field of education.

CHAIRMAN WATKINS: Thank you, Mr. Levin. I would like
to open it to questions now on my left, Dr. Conway-Welch?

DR. CONWAY-WELCH: Governor DiPrete, I would like to
ask you a question on your testimony. On Page 9, No. 2, the
administration bill talks about the principle that AIDS test
results may not be disclosed without the tested person’s
notification and permission, with certain exceptions, such as
health care workers to whom victims have been referred for
health care.

Could you expand on some of the rationale behind that?
GOVERNOR DI PRETE: The rationale for the exception?
DR. CONWAY-WELCH: Yes.

GOVERNOR DI PRETE: Referring to health care workers -
the health care workers have a right to such information,
certainly to protect their own health. I think if there is a
substantial exposure that they should at least be aware of it so
that they can take the necessary precautions. We are not saying
that the health care personnel should not expect to treat AIDS
victims. I think they should, but I think that they should be

396

 

 
 

 

aware of the type illness that the person has so that they can be
properly protected.

DR. CONWAY-WELCH: Thank you.
CHAIRMAN WATKINS: Ms. Gebbie?

MS. GEBBIE: I appreciate the comments that each of
you made, and I am not really certain to whom this question is
addressed. We have heard considerable testimony that the kinds
of things many people believe are important to young people and
adults as well about HIV infection - how to protect themselves-
are intertwined with a whole range of issues about being a
healthy person and a healthy member of our society. A number of
witnesses have indicated that this should be a part of a more
comprehensive health education attack that gives people tools for
healthy living in all aspects of their life. There is an
impression, in at least some quarters, that elected officials are
more interested in small bites of things, that AIDS education is
more politically palatable than comprhensive health education
which sounds huge and unaccomplishable. Is it realistic that we
look at this more comprehensive approach and say, “Yes, AIDS is
important, but don’t take it out of context. Take it in a broad

sense?" Do you think that, in fact, elected officials can get
behind that broader viewpoint if it were put forward?

CONGRESSWOMAN SCHNEIDER: I certainly think that
insofar as curricula being developed in individual states that a
comprehensive approach is probably the best approach, but I am
particularly biased when it comes to health care and to
education because it seems to me that we need to educate the
American people about body systems and about the entire body,
the mind-body connection.

I think that even in the elementary schools, I have a
document from the Centers for Disease Control, and the question
has often been raised, where do you being teaching children, and
do you take, as you asked, a piece of the action or a broader
approach in terms of education? Even in dealing with early
elementary school, I think one of the most important things to
first get across is to eliminate the fear, to let children know
that one does not get AIDS easily and that one should not be
afraid of being near or touching someone and that scientists all
over the world are working toward a cure. I think integrating
information about AIDS of this type can come in small pieces, but
ought to be part of the whole educational health program.

CONGRESSMAN LEVIN: Let me just add that I think the
answer is yes, but again there has to be a rule of reason.
There is an urgency here. So, I don’t think you teach one piece
or another. Again, I think there is no conflict between

397

 

 
 

 

§

emphasis on moral values and information. There can be, but you
teach both, and you base it as broadly as you can. Otherwise it
will be misunderstood. But I think you would agree, you don’t
want to try to teach a PHD course to elementary or secondary
students, but it does need a context. Also, we have to remember
its urgency. I fear we are losing the sense of urgency about the
spread of this disease. I am glad for data that indicates the
threat may be less than some feared, but it is there, and for
those who may be attacked by the illness, it is totally there.

; GOVERNOR DI PRETE: I might add to that that prior to
February 1987, it was the official policy of the Board of ,
Regents for Elementary and Secondary Education in Rhode Island
not to mandate AIDS education in any form in the public schools,
and after talking to Dr. Scott and others on this issue, I felt
just the opposite. In fact, I wrote to the Board of Regents and
asked that they reverse their policy and mandate AIDS education,
as a part, as you say, of a comprehensive program of health and
family living. The health and family living curriculum obviously
was intended, and I stressed this in the letter, to be given ata
level commensurate with the age level of the student, to be
introduced no later than grade 7 and the Department of Education
working with the Department of Health did come up with pilot
programs, and they started going around the state several months
ago. I know at one particular school a number of parents
attended. This was advertised as a private program that would
likely be introduced into the school system to teach about AIDS,
and the parents went to the junior high school. Many of them
were quoted in the press as saying that they went there intending
to oppose it: "we don’t want it; you are intruding on our
rights" and so forth. Seeing the professional way that it was —
presented, directed at the age level of the students, part of an
overall program of health and family living, the parents there
unanimously supported it that night. I think this has been the:
key to it, that it is identified as part of the whole picture of
improving one’s knowledge of health.

MS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Dr. Lilly?

DR. LILLY: Governor DiPrete, I had intended to
approach a little bit the same question that Dr. Conway-Welch
approached earlier. In the three recommendations or the three
examples that you give, you do talk about certain exceptions to
the barring of mandatory testing or at least one exception to
the idea of confidentiality. You don’t speak of any exceptions
to the right to discriminate or the lack of a right to
discriminate against persons with AIDS. I have problems with
these exceptions. For example, if health care workers have a
right to know the HIV antibody status of their patients, is the |
opposite also, true? .Do patients have a right to know about the

398

 

 
 

 

HIV antibody status of their health care workers? Then
one --

GOVERNOR DI PRETE: I can answer that by saying that
all the institutions supplying health care delivery in the State
of Rhode Island obviously operate under the supervision of the
Department of Health. They are required to be certified. The
Department of Health periodically, on a regular basis, inspects
the premises, the operation, the supervision, the staffing. All
these things are overseen and monitored not on a daily but on a
regular basis by the Department of Health.

DR. LILLY: I am sorry, I am not entirely clear
exactly how that answers the question.

GOVERNOR DI PRETE: Maybe I am misunderstanding you,
but I think the generic question is probably on oversight on
both sides. I will leave this to Dr. Scott, if he wants to
amplify it. I don’t say that the Health Department goes in and
conducts a blood test on each of the people who are employed by
the hospital. Is that your question?

DR. LILLY: . Yes, partly. I mean that is one aspect of
it, yes. I think one has to take very seriously exceptions to
the idea of confidentiality simply because of your third point
here which is the great potential for discrimination.

GOVERNOR DI PRETE: Let me talk on that third point.
The bill bars discrimination against people who are infected
with AIDS virus in housing, employment, delivery of services. I
had some questions on this, and the rationale was, for example,
specifically in employment. If one infected with AIDS was in
some kind of an occupation and with competent medical testimony
it could be shown that there was with reasonable certitude a
danger to the health of other people who might come in contact
with the infected person for example if the AIDS person worked in
a restaurant or worked at delivery of services that conceivably
would be contagious to other individuals - competent medical
testimony would have to establish a legitimate reason for the
practice of discrimination. It would not be easily done.

DR. LILLY: I think I will pass.

CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: Governor DiPrete, I want to commend you on
your judgment in appointing Dr. Scott. He is one of the most
thoughtful witnesses we have had before us. He is a very
high-class professional and I hope you can keep him.

GOVERNOR DI PRETE: I concur.

399

 

 
 

EEE

DR. LEE: Congressman Levin, are you on Charlie
Rangel’s Subcommittee?

CONGRESSWOMAN SCHNEIDER: No.
DR. LEE: But you were with him?
CONGRESSWOMAN SCHNEIDER: Yes, I was with him.

DR. LEE: I have had a good bit to do with his
Subcommittee, and I have great respect for his dedication to
this drug abuse problem. My question to this group of panelists
is do you agree with us that drug abuse is the major problem?
Where do you put it? We feel in the medical profession that drug
abuse may be the major health problem in the United States of
America today. What is your position on that?

GOVERNOR DI PRETE: I don’t think there is any
question that drug abuse certainly is a major contributor to the
infection of AIDS, and the drug problem that we are all
addressing, both on a state level and on a national level. What
we are all saying is that it is not about to be solved
overnight. It is complex. We are working through it from an
educational point of view to reduce the demand on drugs. We are
working through it from a law enforcement point of view, but
there aren’t enough, as I have said before, there aren’t enough
state policemen and Coast Guard ships and everything else to stop
every illegal shipment of drugs into the United States. I think
the long-term solution is addressing the demand side through
education, and there is no question that drug abuse is a major
root cause of the AIDS infection problen.

 

CONGRESSWOMAN SCHNEIDER: There is no question in my
mind that as we in Congress attempt to grapple with the supply
end of things which is really limited insofar as our control,
that oftentimes we have a tendency to overlook the demand side,
and it is very clear to me that we are now in the era of
communications. In the olden days members of Congress could
come back to their districts with a bag of money and say, "We
are going to build a new bridge or we are going to build a new
justice building or this or that." Those times have changed.

The best thing that we can bring home now to our
constituents happens to be information, and I think that we need
to develop the types of information transfer to young people and
to working adults. I mean I have been informed that there are as
many people taking drugs on Wall Street that could cause the
collapse of our economy. So, it is an all-pervasive challenge
that we have, and I think that there is no question that we have
to focus on information about drug addiction and its relationship

~

400

 

 
 

 

to AIDS being one of the major challenges of the century.

CONGRESSMAN LEVIN: I very much agree. My trip I took
with Chairman Rangel and Mr. Gillman and others just underlined
the seriousness. Surely on the supply side we worked more than
on the demand side. But I mentioned my experience within the
District and our student forum. I don’t think I am surprised
too easily, but to sit there and listen to students from 20
public and private high schools cutting across, as I mentioned,
all kinds of lines, talk about drug problems in their schools, I
don’t know how we can do anything but marshal our resources and
approach it from all sides. Again, I think the dichotomy
approach is a serious mistake. It isn’t either/or. We have to
attack the demand side in terms of moral values for sure,
discipline for sure, education, information for sure, treatment.
What you said last week or was it this week, is so true. If you
just look at the statistics in Detroit, the 80,000 IV heroin
addicts, 10 percent infected with the virus, if we follow the
same pattern as New York, it would mean 40,000. That is beyond
one’s imagination. So, drug abuse is a serious issue without
regard to AIDS. When you combine the two, it is a set of issues
that demands our immediate attention. It won’t be done just with
one thing or another.

DR. LEE: Thank you.

CHAIRMAN WATKINS: Dr..Walsh? | ' | 4],

t fate tha

 

!

' DR. WALSH: I think I will address my comments to all
of you and ask for yours. We all, of course, are very much /
impressed with the emotional impact that AIDS has had, not only
on the country as a whole, but particularly on law makers
because it does attack a young, vibrant age group, both in the
minorities and in the gay community. That it is a sentence of
death gives it an urgency that you referred to, Congressionman
Levin. One of the things, however, that concerns me is that we !
have had the drug problem for a long time. In this era of
limited resources, budget problems and the like, even with its
association with AIDS, this budget has been reduced. We have
had teenage pregnancy. We have had sexually-transmitted disease
of all kinds for years. We have it on the rise now, despite many
years of education, and yet, we see a tendency to legislate funds
just for AIDS. You made a point, also, Congressman Levin, that
was significant. There comes a time in the attention span of the
American people - somehow they are even reading glimmerings now -,

there are erroneous reports that it is tapering off as a
concern. I am, also, concerned that in the rush for funding for |;
AIDS we are taking funding away rather than adding funding or tO
rather than providing new funding. We may be taking funding away |
from other things that are, also, in need, and I wondered whether
you, Governor, in your Conference of Governors feel from the
sense of your colleagues that the problems of

401

 
 

 

sexually-transmitted disease or long-term care which are involved
in.the AIDS epidemic are things that the governors are ready to
tackle. Both of you members of Congress, as you well know, have
been wrestling with long-term care problems for what, at leat the
last 8 years and probably longer than that. As we get down to
appropriating funding and urging funding, are we going to be
taking from Peter to pay Paul or is it in the mood and the spirit
of the Congress today to bite the bullet on the fact that AIDS is
a disease which will and should require long-term. care but the
long-term care problem itself in relation to other diseases

needs handling? In the field of. health education, as Kris

Gebbie spoke of earlier, are we prepared to urge our schools and
our PTA’s and whatever to go to a broader base of health
education and of respect for one another and our fellow man?

Are we concerned with the civil rights of the uninfected, as

well as the civil rights of the infected? How are you going to
handle that? I mean these are questions that I would love for
all of you to voice an opinion on.

. GOVERNOR DI PRETE: It is my job as a governor,

doctor, first of all to identify and recognize the problems and
services that are required of residents of my particular state.
It is my job in the formulation of my budget priorities to deal
with each of these based on the seriousness - and of course AIDS
is extremely serious. To show you the progression that we have
gone through in this particular area in just 3 years - 3 years
ago, for the first time we had recommended an appropriation in
the state budget to address AIDS. Like you mentioned, several
years ago, this just simply wasn’t on the agenda of most of us in
government. I recommended $120,000, a mere pittance, you might |
say. The General Assembly was not. ready, I, guess to deal with it
as a priority item and they reduced it to $60,000.

_,. The following year, 1987, the budget request was _
around $350,000 to $400,000, and this year we have upped it to
nearly $3 million. TI have not heard anybody.come forward yet in
the General Assembly and say that I am recommending too much
money. Is. it a new expense? Is it a new demand on our
resources? Yes, it is, and I don’t think it is a question of
either/or. It is important enough, certainly that it is a
responsibility I have as governor to tackle and include this in
the priority of services that we have to render. I think it is
important, the last point, to get the neighborhood groups and
parent groups’ support of a comprehensive program of health
education. I think they go hand in hand. If we are ever going
to get this. thing under control, and we are doing that - Rhode ..
Island was the first state in the country to mandate AIDS.
education - I look for more states to adopt that same philosophy
and same requirement. ; .

CONGRESSWOMAN SCHNEIDER: When I look at the challenge

402

 

 
 

 

that we have to face in terms of AIDS, I look, and perhaps you
do it in a more broad fashion, but I categorize it in education
research and then, also, in long-term care as you have
delineated, but it seems to me that it is necessary to set our
priorities when we have limited resources. So, I would like to
share with you where I see the priorities coming in each of
those areas. Are we taking money from Peter to pay Paul? In
the area of education I think that if we spend the money wisely,
which I surely trust that we will given the make-up of this
Commission, given the directives that have already been coming
from this Commission, it seems to me that any money spent on
education is money well spent because it is preventive in nature.
I think one of our major challenges right now is to focus as many
resources as we possibly can to prevent further spread and
greater understanding and to diminish the degree of fear that is
running rampant throughout the United States and the world right
now.

So, I think that that needs to be a high priority.
Forewarned is forearmed, and there are too many people who have
been acting out of ignorance, and now, I believe that ignorance
is beginning to subside based on the statistics that you are
currently looking at in different social groups.

The second area of research, where are we taking from
the research budget to put more into the AIDS? I serve on the
Science and Research Technology Committee. I have served there
for 8 years now.

Let me share with you that the Federal Government,
right now, spends 73 percent of our research dollar on defense.
We have stolen from Paul in the area of cancer research and AIDS
research. We have stolen from energy efficiency technology. We
could build national security for this country by increasing or,
excuse me, reducing our reliance on foreign oil. We have taken
monies away from materials research which has been detrimental to
our balance of trade. There are a number of different areas
where research has suffered as a result of our large investment
in that one sector of the defense economy. It seems to me that
research dollars are not the only way to address the problem, but
addressing the bureaucracy is. I think this is an area where
Congress can take some actions, where we can support legislation
that would speed up the grant review time that has taken from 12
months to perhaps 6 months and provide money so that we might
have more people available to review those grant applications to
see if there are alternatives to AZT or what type of inoculations
or preventive measures might be available.

So, I think that there are actions other than dollars
spent in the research area, but those are well placed,
considering where we are placing our priorities with the federal
research dollar. The private sector is investing a considerable

403

 

 
 

 

amount of money. Sandoz Corporation and a number of others are
investing in AIDS research, and that should get the moral support
of this Commission and, also, the President.

The third area you mentioned, long-term care, as a
representative of the people, it is my responsibility, I feel,
and the responsibility of governors throughout our country to
provide for long-term care. I think this is a civil rights and
a human rights issue, and certainly if we do first challenge
appropriately the educational challenge, then that long-term
care will not be that long term, and if we speed up our
research, perhaps it will not continue to be long-te care
either. So, if we act expeditiously on one and two, not always
throwing money at the problem, but speeding up the bureaucracy,
we will have a significant impact, and I think it is resources
well spent.

CONGRESSMAN LEVIN: Let me respond to your question,
Dr. Welch: drawing, if I might, upon the hearings we held when
I was on a government subcommittee, and we had testimony on the
issue of AIDS four years ago. First of all, budget priorities
won’t be set well, even discussed well, if there is ‘a vacuum of
leadership, and I think first we had a vacuum of léadership on
this issue. That was true in 1983-84, and our efforts won’t
work very well if there is divided leadership, and I am afraid
there is such in Washington.

I hope you can put this into perspective and provide a
clear message, not indicating that there are all easy answers
but some clear messages. Secondly, for a while, reflecting the
vacuum of leadership, funds were being shifted around. When the
Under Secretary of Health came before us almost 5 years ago,
there was a clear tendency to minimize the AIDS question and the
need for research, the need for education. In those days, I
remember the hearings so vividly, to minimize the need for
everyone to have access to AZT was unfathomable to me and others
of us on the committee. But in the last years, on a bibpartisan
basis within the Congress, monies were allocated, not taken from
cancer research and putting it into AIDS research. But it takes
leadership, if you are not going to rob Peter to pay Paul. Let
me also, if I might, comment briefly on the question of the civil
rights of the uninfected. I think everybody’s civil rights have
to be attended to here, and there are some thorny issues. I
wouldn’t deny it, but I think we must resist the temptation to
pit people against each other in this arena or to follow other
agendas or to have the issues relating to AIDS be thrown against
broader canvasses. Let us fight out those other issues some
other place than in relationship to a fatal disease, unless they
are directly relevant.

I just know from our experience in the 17th, 200,000

404

 

 

 
 

OT

leaflets being mailed to this diverse population and then town
meetings and then municipal officials and others gathering
together. The public really doesn’t mainly want the AIDS issue
to be an arena for debate of other issues. They want government
to lead, to educate, to research, to provide care and yes, to
tackle the thorny civil rights issues but to get on with it.

They are waiting for our leadership. They don’t want to argue
over the appropriate role of government because in an area like
this, if government doesn’t lead, who will? Not do it all, there
is a distinct role for the private sector, and we are going to be
debating some bills in the Congress in the next months and the
issue of civil rights will very much be there, but again, I hope
we resist the temptation or the tendency to move to a resolution
by dividing us. I think the nation really wants some unity on
this issue. They recognize what a threat it is.

CHAIRMAN WATKINS: Thank you very much.
DR. WALSH: That is why I asked the question.

CHAIRMAN WATKINS: We are fairly late and imposing on
your time. We don’t have assembled before us very often people
of your stature and position in decision making. We would like,
perhaps, if possible to take about another 10 minutes, but if you
must leave, we will understand, and you will not offend us. We
are imposing on you, and we recognize that, but we would like to
go on for a couple of more questions from the Commissioners.

 

DR. SERVAAS: My questions will be addressed to the
governor, and I congratulate you on a very good presentation
and, also, for your support of the gentleman at your right.
Governor, we were told that prison guards and guards in jails
are themselves pushers of drugs and/or drug addicts. In Florida
we are told that illegal drugs are as easy to obtain in jail as
out of jail. If this were true in your state, how would you
handle it, and my second question is our hearing today is on AIDS
prevention. Does it bother you that an estimated 80 to 90
percent of those who are infected, probably in your state, as
well, don’t know that they are infected and therefore, won’t be
able to prevent the spread to their sexual partner? Do you have

any comments about that and how you think in the future it could
be handled?

GOVERNOR DI PRETE: On your first question of drug
activity in prisons or involving prison guards, I think to be
perfectly candid that it is a known problem to happen around the
country. To what degree prison guards might be involved around
the country, I am not so sure. I can only say that the operation
of prisons today is a more severe problem, the administration of
them is more severe than ever in our history. As you are aware,
we have a rapidly growing prison population around the country of

405

 

 
 

 

some 8 to 10 percent, putting drains on the resources of prisons,
and in my own state budget that I just.submitted to the General
Assembly, the largest growth in any department was in the
Department of Corrections. It was not that I wanted to put my
priority that way, but that was the right thing to do out of
necessity. I could only say that we closely monitor, as closely
aS possible, what activities the prison guards are involved in,
what they are doing. We would come down very severely, extremely
severely on prison guards who have been shown and convicted to
have introduced drugs into prison to sell them, exchange then,
whatever. It is a problem that we are dealing with, and I dare
say that it will never go away completely, but all we can do is
monitor and deal extremely severely with the highest penalties
possible.

And your second question, dealing with the exchange of
information --

DR. SERVAAS: My second question was do you have any
ideas or does it bother you or could you comment on the fact
that in your state probably 80 to 90 percent of teenagers and
all those who are now infected with the AIDS virus don’t know
that they are infected? Do you have any ideas about that, does
that | bother: you?

GOVERNOR DI PRETE: Of course it bothers me, but I am
not ready to start imposing mandatory testing on a carte blanche
basis. I have taken a public stand against it as fay as state
employees are concerned and in any other jurisdiction of the
governor. I believe where there is a reasonable possibility of
someone having the AIDS virus or there is a high-risk situation
that there is a special case, and by the way, it could involve
going back to your first question. It could involvé activities
around a prison. Then I might say that in those specific cases,
and only in those high-risk cases, would I be comfortable with
imposing mandatory testing. I would not be comfortable ina free
society as we live in to say that every person walking the street
or every person applying for a job be it the public industry or
private sector would be subject to a test. I would not agree
with that.

DR. SERVAAS: I don’t think any of us would, but what
I guess I am asking is do you have any ideas about encouraging
voluntary kinds of testing,’ since this is on prevention of the
spread of AIDS?

GOVERNOR DI PRETE: Again, on prevention and spread, I
think the greatest hope, and while this may answer your question
in an indirect manner, I think the greatest hope of prevention
lies in education - how AIDS is contracted; how it can be
prevented; and any and all means of prevention. Introducing this
in schools around the country is the key to the prevention of the

406

 

 

 
 

 

spread of AIDS. Other approaches might be Band-aid approaches,
so to speak, but the overwhelming effects will come from
widespread education on the contraction of HIV and how to prevent
it.

DR. SERVAAS: Thank you.
CHAIRMAN WATKINS: Dr. Crenshaw, one quick question?

DR. CRENSHAW: In the interest of time, I will defer
to you, Admiral.

CHAIRMAN WATKINS: We want to thank this panel very
much. You are very kind to take the time to come down from the
Hill at this important time, and you, Governor -~- I know you have
a plane to catch. We would like to keep our dialogue open with
you, all of you, as we have with other witnesses.

We are open until 24 June by our charter and would
like to keep that avenue of communication open with the very
much involved and interested leaders in the country. So, if
that is permissible with you, we will continue that dialogue.
Thank you very much.

Next is a special panel that deals with student
perspectives, and we have a very special witness in Mr. Ryan
Wayne White, a student at Hamilton Heights High School, Cicero,
Indiana. With him is Ms. Jill Stewart, Student Council
President, Hamilton Heights High School, Cicero, Indiana, and
we, also, invite Ryan’s mother, Ms. Jean White to sit at the
table, and perhaps she would even allow us to open questions up
to her. I know she is not going to make an initial statement.
We are particularly honored to have people like Ryan come before
us. We have had many others with HIV infection come to the
Commission. They have given us unique insights that no one else
can give. They have, also, given us the sense of urgency that I
think you will find within the Commission. They have, also,
inspired us. So, Ryan, if you will come up to the table, if you
are here?

I would like to welcome all three of you to the
Commission. Ryan, we would love to have you tell us anything
that you feel would be helpful to us as we deal with this
epidemic in the country.

MR. WHITE: Thank you. I am Ryan White, and I am 16
years old. I am here today to tell you of some of the hardships
and struggles of dealing with hemophilia and AIDS. When I was 3
days old, the doctors told my parents I was a severe hemophiliac,
meaning my blood does not clot. There was a product just
approved by the Food and Drug Administration called Factor 8
which contains the clotting agent found in blood. While I was

407

 

 

 
 

 

growing up, I had many bleeds or hemorrhages in my joints which
made it very painful. Twice a week, I would receive injections
of Factor 8 which clotted the blood and broke it down. A bleed
occurs from a broken blood vessel or vein. The blood then had
nowhere to go. So, it would swell up in the joint. You could
compare it to trying to pour a quart of milk into a pint-sized
container.

The first 5 to 6 years of my life were spent in and
out of the hospital. All in all, I led a pretty normal life.
Most recently, my battle has been against AIDS and the |,
discrimination surrounding it. On December 17, 1984, I’ had
surgery to remove 2 inches of my left lung due to pneumonia.
After 2 hours of surgery the doctors told my mother I had AIDS.
I contracted AIDS through my Factor 8. When I came out of
surgery, I was on a respirator and had a tube in my left lung.

I spent Christmas and the next 30 days in the hospital. A lot
of my time was spent searching, thinking and ‘planning my life.
~ /

I came face to face with death at 13. I was diagnosed
with AIDS, a killer. Doctors told me I was not contagious. I
was given 6 months to live, and being the fighter that I am, I
set high goals for myself. It was my decision to live a normal
life, go to school, be with friends and enjoy day-to-day
activities. It was not going to be easy. The school I was going
to said that they had no guidelines for a person with AIDS. The
school board, my teachers and my principal voted to keep me out
of the classroom even after the guidelines were set by the local
state board of health for fear of someone getting AIDS from me by
casual contact. Rumors of sneezing, kissing, tears, sweat and
saliva spreading AIDS caused people to panic.

We began a series of court battles for 9 months, while
I was attending classes by telephone. , Eventually I won the
right to attend school, but the prejudice was still there.
Listening to medical facts was not enough. People wanted
percent guarantees. There are no 100 percent guarantees in
life, but concessions were made by my mom and me to help ease
the fear. We decided to meet everyone half way. We agreed to
separate restrooms and drinking fountains, no gym, disposable
eating utensils and trays, even though we knew that AIDS was not
spread through casual contact. Nevertheless, parents of 20
students started their own school. | They were still not
convinced. Because of the lack of education on AIDS,
discrimination, fear, panic and lies surrounded me. I became
the target of Ryan White jokes; lies about me biting people;
spitting on vegetables and cookies in grocery stores and
urinating on bathroom walls. Some restaurants threw away my
dishes, and my locker was vandalized inside, and folders were
marked "fag" and other obscenities.

I was labeled a troublemaker, my mom an unfit mother,

408

 

 

 
 

 

and I was not welcome anywhere. People would get up and leave
so they would nnot have to sit anywhere near me. Even at church,
people would not shake my hand.

This brought on the news media, TV crews, interviews
and numerous public appearances. I became known as the AIDS
boy. I received thousands of letters of support from all around
the world, all because I wanted to go to school. Mayor Koch in
New York was the first public figure to give me support.
Entertainers, athletes and stars started giving me support, and I
met some of the greatest like Elton John, Greg Louganis, Max
Headroom, Ayssa Milano, my teen idol, Lyndon King of the Los
Angeles Raiders and Charlie Sheen. All of these people, plus
many more, became my friends. I had very few friends at school.
How could these people in the public eye not be afraid of me, but
my whole town was?

It was difficult at times to handle, but I tried to
ignore the injustice because I knew the people were wrong. My
family and I held no hatred for those people because we realized
they were victims of their own ignorance. We had great faith
that with patience, understanding and education that my family
and I could be helpful in changing their minds and attitudes
around.

Financial hardships were rough on us, even though my
mother had a good job. The more I was sick, the more work she
had to miss. Bills became impossible to pay. My sister Andrea
was a championship roller skater who had to sacrifice, too.
There was no money for her lessons and travel. AIDS can destroy
a family if you let it, but luckily for my sister and me, mom
taught us to keep going, not to give up and be proud of who you
are and never feel sorry for yourself.

After 2 years of declining health, two attacks of
pneumocystis, shingles and a rare form of whooping cough, I was
faced with fighting chills, fevers, coughing, tiredness and
vomiting. I was very ill and being tutored at home. The desire
to move into a bigger house to avoid living AIDS daily and a
dream to be accepted by community and school became possible and
a reality with a movie about my life, the Ryan White Story.

My life is better now. At the end of the school year
of 1986 and 1987, my family and I decided to move to Cicero,
Indiana. We did a lot of hoping and praying that the community
would welcome us, and they did. For the first time in 3 years,
we feel we have a home, a supportive school and lots of friends.
The communities of Cicero, Atlanta; Arcadia and Noblesville,
Indiana, are now what we call home. I am feeling great.

I am a normal happy teenager again. I have a
learner’s permit to drive. -I attend sports functions and
dances. My studies are important to me. I even made the honor

409

 

 

 
 

 

roll just recently with two A’s and two B’s. I am just one of
the kids, and all because the students at Hamilton Heights High
School listened to the facts, educated their parents and
themselves and believed in me.

I believe in myself as I look forward to graduating
from Hamilton Heights High School in 1991. Hamilton Heights
High School is proof that AIDS education works in schools.
Thank you.

CHAIRMAN WATKINS: ‘Thank you very much, Ryan.
Ms. Stewart, would you like to make a few comments?

_ MS. STEWART: Hi. My name is Jill Stewart and I am
the student body president at Hamilton Heights High School. The
school has approximately 600 students, and our /school has been
fortunate enough to have Ryan attend. As you know,/he is a
victim of AIDS. I am going to speak to you about what our
school accomplished through AIDS education. People are afraid
of the unknown, and the unknown becomes known, and then people
are unafraid.

In the spring of 1987, there were rumors that Ryan
might attend our school. At that time our school system was
already sending counselors and nurses to our county task force
that had a commission for AIDS.

Due to the possibility of Ryan coming to school, the
Indiana State Board of Health held inservices for both our
teaching and custodial staffs. These inservices were designed
to find out what we were facing, what the possibilities and
dangers were and what we knew about AIDS. The eighth grade
which last year would have been the class that Ryan was moving
into was given a special convocation by the State Board of
Health. In June 1987, it was confirmed that Ryan would begin
school at Hamilton Heights in the fall. Our school had two
jnitial strengths going. First of all, we had witnessed at
close range Ryan’s pain in his former. community, and second of
all, we had time to prepare and instruct through education about
AIDS. At this point the statute had been tested so the courts
would allow students with any communicable disease to attend
school, and so our school began with that premise. We knew that
the government had researched the disease, and they would not
purposefully endanger anyone’s lives or their possibility of
contracting the disease. We decided that this was going to
happen, and it must be dealt with. There was no reason for Ryan
to go through the pain again. The issue of AIDS needed to be
faced. So; we put our strength in our government and science.
It had not been too long since cancer patients had been alienated
for lack of unaerstanding of the disease.

mean >
4d

410% x

 

 
 

 

Then we began our AIDS education and instruction. In
the fall of 1987, Ms. White arranged with our principal a 2-week
preparation period for educational purposes. During this time
period education occurred in many forms. By this time the
teachers had a total understanding of the disease, and they had
an open mind.

The nursing and custodial staffs were fully trained on
cleaning and dealing with any accidents that might occur.

The State Board of Health Department sent experts on
AIDS to our school on AIDS, and they gave seminars to our school
in two sessions. These life script sessions were aimed on the
students knowing the situation, understanding the disease,
learning how and how not AIDS was transmitted and relieving fears
due to inaccurate rumors.

Next, our principal met with each class, the freshman,
the sophomore, the junior and the senior class, and they
discussed the questions and fears of the students in these
sessions. -

Then the students were given the opportunity to meet
one on one, both with counselors and with the principal to talk
about further questions they might have, and the student
government created what we call the "Louie the Locker," and we
put "Louie the Locker" in the main hall; we put a little face on
him, and we told students that if they had any questions, or if
they needed to arrange a meeting with the principal or guidance
counselors to just slip the note into the locker. We got a lot
of response through that, and from the anonymous requests we
used, we had a bulletin board to put the answers so that the
whole school could freely read. For students who wanted to meet
one on one with someone privately, we arranged a conference
through him. It must be noted that by the point in time that we
had the "Louie the Locker," and were ready for the one-on-one
communication that the students weren’t asking questions that
were dealing with fear or apprehension of accepting Ryan, but
were then asking how they could help out of compassion and what
they could do for him to make it easier. Next the freshman and
sophomore classes had what we call direct education, and this
occurred in the PE and health classes. They dropped what they
were doing, and this was still in the first 2 weeks of school
that we had done all this, and they took VCR tapes, materials,
films and had a cram education ceremony on the disease. Then the
juniors and seniors had brief education through science classes,
psychology classes and sociology classes, and teachers were
encouraged to hold discussion on AIDS at any time they wanted.
So, now, the administrators, the teachers and the students were
educated. So, the community was dealt with. Information was
given to the press, and the press told -basics on the disease and
where people could locate more information. We had VCR’s

411

 

 
 

 

available and films and materials, and our principal went to many
churches and other group meetings in the area to educate the
community further.

The local Kiwanis club had a speaker from San
Francisco who had dealt with AIDS patients before it even had
been diagnosed. So, that helped with the knowledge. Then the
State Board of Health had a speaker come to our school board
meeting, which was held open to the public for all the parents,
and they asked questions to make sure there was a complete
understanding. Then it was believed that Ryan was ready to come
to school, and we had a few parents call in and say, "If he is
going to come, I don’t know if I will allow my student to go."
And the day that he came, the students told their parents that
they understood their views, and they were going to go to
school. I think that this stresses how important it is to get
the education to especially the students. The parents need it,
too, but through educating the students you create conversations
at home that are based more on the education factor and not on
the panic factor. From then on Ryan came to school, -- the first
week was a little abnormal, but immediately they involved
students in interviews and discussions. The first day of school,
student government members helped get Ryan to his classes, and
football members had volunteered to help carry his books which
wasn’t necessary. The freshmen in his class had offered their
tutoring services, and people requested to sit by Ryan, and then
we put AIDS into part of our permanent curriculum. So, the key,
I think, has been explicit education and instruction according to
knowledge to make as smooth a transition as possible.

From the beginning, experts were straightforward in
answering all the questions we had which eliminated needless
fears and created an open attitude.

By working with the family to respect the wishes of
the patient, and working with the students to respect their
concerns, patients do not have to suffer.

I have one final remark, and that is that our school
has been commended on what we have done for Ryan; yet no one
realizes how much he has done for us. We have learned and grown
so much from knowing Ryan. He is a really warm and wonderful
human being, and he has been a source of strength through all
this. He puts life into perspective in many ways, and these
things we cannot measure, and we have forgiven the schools who
have not had-some of this time as we have due to lack of
understanding and time to prepare, but now, it is time for
education, for people to act compassionately to help those with
AIDS.

CHAIRMAN WATKINS: Thank you, very much, Ms. Stewart.

412

 

 

 
 

 

We would like, I think, to have about 10 or 15 minutes of |
questions from the Commissioners. I would like to start on my
right with Dr. Walsh.

DR. WALSH: I actually feel that to ask questions at
this point is almost moot. I watched Ryan last night, perhaps
as many of you did on the Ted Koppel Show. He was asked all the
questions I could think of and many, many more besides, but I
think that what has impressed me so about Ryan, is not only his
courage, his demeanor, and his behavior - everyone has to accept
his courage - but what impressed me so was what he said last
night and what he said, also, in his testimony today - that
despite the really horrible way in which he was treated as an
innocent victim of it which is different than some - he had a
compassion and an understanding of those who had fear. This is a
very mature judgment for a youngster of not 16. He was younger
than that then, and it must have been very difficult for you, Ms.
White, as well, to feel that same compassion. But he wouldn’t
have felt it, if you didn’t feel it. Despite the treatment you
received, you were, in effect, man enough to say, "It is not
their fault." I think the reward that you have received in going
to another location, to another school where you were treated as
a human being with equal compassion in kind is because of the
leadership that you provided in your student body. With the
leadership from your principal and your fellow students, you
three have probably contributed more to a public understanding of
what can be done with this problem that is before us and before
this Commission today, than anyone. Rather than question you, I
wanted to use my few moments to simply praise you to the sky for
what you have done, to thank you, all three of you, for what you
have done. I know, Ryan, that the Lord, in His wisdom, will give
you many good years yet, and I look forward to that.

CHAIRMAN WATKINS: Dr. SerVaas?

DR. SER VAAS: Since Dr. Walsh mentioned the Lord in ©
his wisdom, Ryan, I would just like you to tell the dudience and |
the panel, what is the last thing you do before you go to bed at
night? And then I would like you to tell them what kind of car
you are going to drive when you get your license and what you are
going to be? I know what you are going to be, but you tell us
all what you are going to be when you have your career unfolding?

MR. WHITE: I hope to be the best person I can be, and |
I would like to be an architect, not an architect but an
advertising.agent, and as to your other question, I hope to
drive a Chevy Cavalier because someone has generously donated,
and I don’t know, I just hope to have a good life.

DR. SER VAAS: Ryan, you are just like all the rest of
the teenagers. You have changed your career plans. At
Christmas you were going to be an advertising copy writer,

" 413

 

 

 
 

 

remember? — | ot

MR. WHITE: Yes, in advertising. I heard an architect
this morning on TV, and I just was -~

(Laughter. )
CHAIRMAN WATKINS: — Dr. Crenshaw? .

DR. CRENSHAW: I think that the three of you
demonstrate one of the few things coming out of this serious
disease, and that is that in its challenge to us, it is
improving and forcing qualities in human nature that we don’t
always have to draw upon so heavily in improving compassion,
understanding, tolerance, patience and learning. The gay
community has found this to be true. You have been just
incredible, and I think it is courageous, and the rest of the
world is going to find that they can develop these qualities,
too, to be mutually supportive in all of this. -

CHAIRMAN WATKINS: Dr. Conway-Welch?

DR.. CONWAY-WELCH: I am interested in the strategy
that you used to educate the children to educate the parents,
ana that seems to have been rather successful for you.

MS. STEWART: Okay, originally I don’t think the
administrators did have a plan, and they went into it. I don’t
think they, at the beginning had begun or had planned to say,
"Let us educate 'the students and then they will educate their
parents." That sort of happened, but the administrators went
into it with a positive attitude of let us do this as carefully
and phrase it without creating a panic. The students were the
logical place to start because that is what our school had
control over. The administrators knew that they could get it in
through our students. They went home, and they told their
parents, "This is what I learned in school today," and at the
time when it happened, AIDS was coming out in the press and the
media, and it was well publicized, but the facts were not
necessarily. We knew about the disease, and we knew what its
effects were, but we didn’t necessarily know how it was
transmitted or what we should be afraid of. So, then when the
students said, "The experts have told us that these are the four
ways that it is transmitted," they went and told their parents,
anda the kids were -- we had such a positive, strong feeling from
teachers to the students that the students took that home to the
parents, and there was never any panic created. I think that was
the key to that, to answer your question.

CHAIRMAN WATKINS: Ms. Gebbie?
MS. GEBBIE: I would like to follow up along the same

414

 

 
 

 

line. The issue of how to create a kind of positive experience
that you are now describing to us is an important one, and while
you, Ryan, have come through this with very positive feelings, I
think we would all hate it if every school district in the
country had to go through some of what you experienced in order
to get to a point where kids had the knowledge they need and the
system held together as you described it. Are you sharing some
of your experiences, Ms. Stewart, with other school districts in
your own state with student body presidents? Is there a system
so that what you learned is being shared in other places that you
know of?

MS. STEWART: Currently we don’t have any systems
intact, but we have had a lot of coverage; the press in Indiana
has helped us tremendously. They have been one of the main
sources of getting the information around and helping with the
positive aspects of what we are doing. There was a parent in
Noblesville which is the neighboring town to Cicero, and they
have a parent who has -- is it the Syndrome? I don’t know if
you have heard, but they have called our principal and dicussed
how we did it. So, we have not started reaching out to others,
but I guess right now the attitude is we are sort of letting
them come to us, since they know how we have dealt with it.

CHAIRMAN WATKINS: Dr. Lilly?

DR. LILLY: Since I admire very much Ryan’s response
to the turmoil that he has been through, I would like to ask Ms.
White a little bit of her feelings about the turmoil that the
family went through.

MS. WHITE: My objective all along was, you know, to
be strong. Ryan, all growing up, I mean even when he was little
he was in and out of the hospital a lot. He had hemophilia which
is painful, but at least Ryan looked normal, and he was in the
hospital with a lot of kids who had severe burns, you know, that
were disfigured, and that were in a lot more pain than he was.
There is always somebody out there worse than you, and I always
stressed that to both my kids, you know, not to feel sorry for
yourself and keep thinking that everything is going to get
better, and it is up to you to try to make it better. You know,
you cannot just sit around and let everything come to you. You
have got to go out and reach for things in life.

DR. LILLY: Thank you.

CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: No questions. I just want to tell you two

415

 

 
 

<=

kids that you are super people. You have taught us a lot, just
as kids usually teach the grownups a lot, and we thank you for
it. I know Ms. White feels the same way.

CHAIRMAN WATKINS: I am closing out this important
part of the testimony we have heard. I would have to say that
at the end of 3 intense days of often pessimistic testimony on
the epidemic that you three have truly been bright lights in the
dark world of this disease, and I think every once in a while it
lis very, very ‘important that we have these symbols of hope that
you bring us, and the positive steps and the planning that Ms.
Stewart talked about ahead of time, so that Cicero can be proud
and a role model for the nation in Hamilton Heights High School
of how they prepared and how they did the job so beautifully.

So, we thank you for the lesson. We have heard from
many adult witnesses, but we need to hear it from you,
particularly you, Ms. Stewart that you set up and continued to
work so hard in such a program and have found a home in school
for Ryan. So, you are both great examples of what this nation
is all about, and we are proud to have had you here today.

Thank you, Ms. White for allowing us to have all three
of you before the Commission. I would like to give you all a
round of applause.

 

(Applause. )

CHAIRMAN WATKINS: I think we can just take 5 minutes.
Maybe you would allow us to meet you personally.

(Brief recess.)

CHAIRMAN WATKINS: The next panel is on AIDS and
education in the nation’s schools. I am very happy to have the
President of the National Education Association, Mary Futrell,
here and Dolores Hardison, President, National Association of
Elementary School Principals; Dr. Eric Voth, Board Member,
National Federation of Parents for a Drug Free Youth, Medical
Director, St. Francis Chemical Dependency Treatment Center,
Topeka, Kansas and Dr. Stephen Sroka, Cleveland Public Schools,
Cleveland, Ohio.

Thank you very much, all of you, for coming. We are
extremely pleased that you were able to take time, Ms. Futrell
to come as the president of the organization. We are honored to
have you. We would like to have you start with your testimony.

MS. FUTRELL: Thank you very much. Let me, first of
all, express my appreciation for the leadership which the
Commission is providing on this very, very crucial issue. The
members of the NEA are most appreciative of what you have done

416

 

 

 
 

 

and what you will do regarding this issue.

My name is Mary Hatwood Futrell and I am the president
of the 1.9 million member National Education Association. I
welcome this opportunity talk with you about AIDS education in
the schools. No group of Americans is more deeply interested in
this topic than the members of the NEA, the men and women who now
face the challenge of educating America’s young people about the
dangers of AIDS.

Education is, of course, the key to stopping the
spread of AIDS. More and more Americans are understanding that
there is no magic cure or vaccine for AIDS on the horizon. In
fact, there is no guarantee that medical science will ever find a
cure for AIDS.

That is why education is so crucial in the campaign
against AIDS. The more Americans understand how specific
behaviors can place them at risk for AIDS, the more likely we as
a nation will be able to reduce the incidence and severity of the
AIDS epidemic.

America’s schools must clearly take the lead in the
education effort that combatting AIDS demands. But we all need
to realize that simply telling students the facts about AIDS
isn’t enough. AIDS cannot be treated as just another topic in
the school curriculum. Teachers cannot just teach AIDS in the
same way they teach Shakespeare or geometry or American history.

Lessons about Shakespeare, after all, do not need to
motivate students to change their behavior in deeply personal
and sensitive areas. But lessons about AIDS, if they are going
to be effective, must do just that. Lessons about AIDS must
motivate students to avoid the personal behaviors that put them
at risk.

There are, fortunately, resources now available to
help schools and community people work together to develop
effective AIDS education programs; programs that can help change
student behavior. The U.S. Centers for Disease Control has
recently completed and published a most valuable booklet
entitled, "Guidelines for Effective School Health Education to
Prevent the Spread of AIDS." I am proud to say that the NEA was
one of the 15 national organizations closely involved with the
development of the curriculum guidelines in this CDC publication.
We in NEA are now distributing these guidelines to NEA affiliates
across the United States.

The new CDC guidelines recommend that AIDS should be
taught as part of a comprehensive health education program that
begins in the early grades and continues through high school.
For each grade level, the guidelines recommend the basic

417

 

 

 
 

 

 

messages about AIDS that need to be ‘taught. to students.

We applaud the cbc for preparing these much needed
guidelines, but we also recognize that they guidelines cannot
simply be incorporated into a school district’s curriculum by
administrative fiat.

AIDS prevention programs that are designed to make
student behavior safer raise sensitive moral as well as
educational questions. The decisions about what should be
taught about AIDS, and in what manner, need to be discussed in
each community. Home and community support for AIDS education
isn’t just desirable, it is absolutely imperative. :

Teachers, in other words, need to work side by side
with parents. We need to work with elected officials, clergy,
the members of the medical profession and other citizens to talk
through the design of AIDS educational programs. Such programs
just won’t work -- won’t help students adopt health-enhancing
behavior -- if schools are delivering one message about AIDS and
homes are delivering another message.

AIDS education programs also won’t work unless they
are taught at all grade levels. We cannot afford to postpone
AIDS education until the last few years of high school. Many
students have already had sexual experiences by the time they
become high school juniors and seniors some by the time they
enter junior high school.

Changing student behavior means convincing students to
abstain from sex, to use medically accepted protective devices,
and to avoid drugs. To get students to accept these ideas, we
need to build AIDS education into the overall school curriculum.

We also need to understand that'all teachers need
training about AIDS. All teachers need to be able to speak
intelligently about AIDS because, after all, students will bring
the questions they have about sensitive subjects, like AIDS, to
the teachers they trust the most. Those trusted teachers might
teach any subject. For example, I teach business education, and
many times my students would ask me questions that would have
absolutely nothing to do with that subject.

We in NEA are trying to do our part to help all
teachers understand the facts about AIDS. We have mailed almost
2 million copies of an AIDS fact book directly to our members.
We are in the process of reprinting that booklet and translating
it into Spanish because we recognize that there is a high
incidence of AIDS within the Spanish community.

We are also trying to help teachers involve their
communities in discussions about AIDS .education. In Minnesota,
New Jersey and Maryland, we are helping our local affiliates

' 418

 

 
 

 

test innovative approaches to getting a community dialogue about
AIDS underway.

Frankly, that’s not an easy thing to do. Most people
don’t want to face the AIDS issue. "We don’t have the problem
in our community," they say, "so why should we deal with the
issue of AIDS?"

We are under no illusions about the impact of our
work. No single educational organization, even an organization
as large as we are, has the resources to do what needs to be
done in AIDS education. And what needs to be done? Every
school district in this nation needs administrators and teachers
who are well-versed on the facts about AIDS and specially trained
to discuss these sensitive facts with students.

Every school district in this nation also needs the
support of its community for AIDS education. To gain that
support, educators will have to discuss sensitive AIDS-related
issues with local parents and residents.

Meeting these goals will not be easy. In fact,
meeting these goals won’t be possible without the help of the
Federal Government. Yet, so far, the resources the Federal
Government has placed into AIDS education have been pitifully
small.

Let me give you just one small example. The Federal
Government last year began encouraging national educational
organizations, such as the NEA, the school boards, and
administrators, to launch AIDS prevention projects. But the
Federal Government has yet to do its part. Federal funding of
these programs has been totally inadequate. So far, the only
program the Federal Government has created to help national
organizations promote AIDS education in the schools limits annual
grants to an average of $125,000.00.

Let’s take a moment to analyze this $125,000.00
figure. There are approximately 16,000 school districts in the
United States today. That means the Federal Government is
willing to spend a grand total of less than $8.00 per school
district per year to help all national education groups combat
AIDS. That is not a serious effort. That is shameful.

With support for AIDS education so low, national
educational organizations essentially have two choices. One,
they can send out a booklet or pamphlet on AIDS -- and hope it
makes a difference. Or they can choose a few school districts
and provide the kind of help that local educators really need to
develop programs that change student behavior.

Neither option is adequate. If we are to win the

419

 

 
 

 

education war against AIDS, then the behavior of the Federal
Government must change. AIDS education must become a serious
fiscal priority. This is a message that the White House and
Congress need to hear and this is a message that I hope this
Commission will decide to send. Thank you very much for allowing
me to appear before you this afternoon. I will be happy to
respond to questions whenever you are ready for me to do that.

CHAIRMAN WATKINS: Thank you very much, Ms. Futrell.
Ms. Hardison.

MS. HARDISON: Thank you. My name is Dolores Hardison.
I am serving this year as President of the National Association
of Elementary School Principals, an organization representing
over 25,000 elementary and middle school principals throughout
our nation. On their behalf, I want to thank you for the work
that you are doing. You are bringing light rather than heat to
this important issue.
I want to thank you, too, for granting us an opportunity to
testify.

I am from Florida, and you know the impact that the
Arcadia situation had -- not only on Florida schools, but on
every school and community across this country. We cannot
endlessly repeat that scenario. It is not fair to the children
and their families, nor to the school community. We need to
find a better way and I am hoping that through your
deliberations, the Commission will identify and widely
disseminate the most promising practices now being implemented
so that episodes of the Arcadia type will never occur again.

There are a number of examples of promising AIDS
programs that I am sure you have heard of or read about: the
Washington, D.C. public schools; Longmeadow, Massachusetts;
Wilmette, Illinois and Fairfax, Virginia. These school
districts have developed a process and a program that have
provided information rationally, communicated effectively and
emphasized fact -- not fear -- in their approach.

We need to know more about these programs. We know
they have succeeded, but we don’t have all the nuts-and-bolts
information, the "how to get started" basic procedures and
understandings that will build the strong foundation that school
districts want. Pamphlets and brochures, while containing
valuable information, are not enough. Elementary and middle
school principals call for more, and I would urge the following
five steps. -

First, begin early. Children are curious. They have
heard about AIDS and need to have the facts. We need programs
and materials to give them those facts. If we have time, I

420

 

 

 
 

 

would be happy to share some specific examples with the
Commission.

Second, provide training. Principals and teachers
need to hear and to be educated by health experts. We must work
to educate parents. We depend on their cooperation. Adults need
to develop an awareness and clear understanding about AIDS in
order to communicate effectively with our children and youth and
with one another.

Third, emphasize respect. The rights of AIDS victims
deserve the same respect as do the rights of those who come in
contact with them. It is the virus that is the enemy, not the
person victimized by it.

Fourth, involve the media. Schools cannot do the job
by themselves. In addition to public service messages on radio
and television, the inclusion of AIDS situations in prime time
television drama, sitcoms and soap operas could be very helpful.
With so many people getting their education and information from
television, we need greater cooperation from and involvement of
the networks.

Fifth, build coalitions. School personnel, school
boards, parents, health experts and community leaders working
together can make a real difference. All successful programs
have been built on this concept. Coalition building is a
necessary prime ingredient in assuring a well-accepted and
positive program in each school and community.

And people, expert people, talking with non-
specialists is essential. School building staff, principals,
teachers, support staff, in addition to the school comnunity,
must be educated about AIDS, what it is and what it is not.
Curricular materials appropriate to the developmental level of
elementary school children must be designed and produced. As I
said, elementary school is not too soon to begin to educate
children about AIDS.

The guidelines offered by the Centers for Disease
Control are a good beginning. The project started under the
direction of the Education Development Corporation looks very
promising. The fact that President Reagan has proposed
additional funding for AIDS information and research is
encouraging. Our association is strengthening its involvement
also. Surgeon General Koop, who addressed our state association
leaders’ conference last July, will be a general session speaker
at our annual convention in San Francisco next month. (April 16-
20, 1988). Program sessions on AIDS will also be featured.

Many of you have read the Newsweek, Phi Delta Ka

421 os

 

 

 
 

 

4

and Chicago Tribune Magazine articles that mentioned Paul
Nilsen, Central School Principal in Wilmette, Illinois. Paul
shared his very effective process with us at our National
Fellows Program last summer and he spoke last month at the
American Association of School Administrators meeting in Las
Vegas.’ He is also serving as a consultant to a number of school
districts. We need to find more Paul Nilsens and benefit from
their expertise.

In addition to providing training opportunities for
our member principals, we also want to help inform you on the
quality and availability of AIDS programs in school districts
and individual schools throughout the country. We have just
mailed a survey seeking a variety of information on such areas
as public awareness, school district and school programs and
principals’ preferences. A copy of the survey has been
furnishea to the Commission. As soon as we have compiled this
data and written a report, we will be sure to send copies to
you.

Right now, we do not have the answers to all the
issues relating to AIDS in our schools, but we think our survey
is asking the right questions. We are making every effort to
alert our members to the help that is available and what
processes seem to work most effectively.

We look forward to continuing to discover and
disseminate promising practices and to work with the Commission
in finding practical solutions for concerns related to AIDS in
our schools. Thank you for allowing me to testify.

CHAIRMAN WATKINS: Thank you very much, Ms. Hardison.

Dr. Voth, we welcome you and as a distinguished son of
a distinguished Admiral in the Navy, give my respects to your
father.

DR. VOTH: He sends his regards to you, too.
CHAIRMAN WATKINS: Dr. Voth.

DR. VOTH: I am very pleased to be here before the
Commission and in this capacity, I represent the National
Federation of Parents for a Drug Free Youth. My professional
involvement is with actually treatment in that I run a chemical
dependency treatment program, put in my involvement with the
National Federation of Parents, I am involved in drug abuse
prevention nationwide.

As I have outlined in my written testimony, which
somehow didn’t make it through the mail apparently, so I have
provided another copy today , the spread of the Human

422

 

 
 

 

Immunodeficiency Virus and its related syndrone, AIDS, presents
an enigma to the providers of health care in the United States
today.

The changes in human values and behavior which have
given rise to the spread of AIDS, have their roots in the
concurrent changes in the American family. Since World War II,
families have been increasingly disrupted because of pressures
which have driven parents from the home, given rise to an
increased divorce rate, and resulted in children being raised in
Single parent homes at an alarming rate.

The very fiber of the family and, therefore, our
society is being eroded. As these changes have taken place, the
basic mores of right and wrong, good, bad, masculinity and
femininity have become blurred. Slowly; parents have not only
relinquished their responsibilities in the home but they have to
some extent fled them. This has given rise to a generation of
hedonistic, egocentric individuals who do not have the basic
upbringing to uphold healthy values for society.

Instead of parents raising their children with the
appropriate nurturing and care, parents have succumbed to the
trend of non-parenting and have in some cases joined the trend
of deviant sexual and social behavior. As young generations
have moved into the sexual revolution, rampant sexual activity
has led to far more than sexual freedom and gratification. It
has led to uncontrolled birth rates, tremendous rates of
venereal disease and young people, who unfortunately could not
distinguish unbridled sex from loving and caring.

It should be no surprise that the Human
Immunodeficiency Virus became so widespread. AIDS did not
Simply appear out of thin air. It was carefully selected for.
In some cities widespread promiscuous, homosexual and
heterosexual activity resulted in hundreds of sexual contacts
each year. IV drug addicts routinely use dirty needs or shared
needs for multiple injections.

Any time that the natural balance is so seriously
disrupted, health consequences result. For example, smoking
cigarettes causes cancer. Overeating causes obesity, and a
whole wide range of other examples. The major question before
the Commission today is the educational process in the schools
that can turn this erosion around, and I will parenthetically add
that the educational process in the school should not supplant
effective education and upbringing at home.

To turn this around, two of the most difficult
behaviors to deal with must be dealt with; drug abuse and sexual
promiscuity. It is ludicrous to think that teaching safer sex
alone or passing out needles to junkies alone will make a dent in

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the problen.

Specifically, programs in the schools must take a hard
stance regarding sexual promiscuity and drug abuse together. We
should teach that it is okay to have fluctuations in mood. It is
okay to refuse to give in to peer pressure. It is okay to delay
sexual activity. Teaching young people today to delay sexual
activity rather than only be safe with it lets them defer that
sexual activity to a time when one is more physically and
psychologically able to deal with it.

While presenting a clear message, prevention programs
should help identify youth that are at high risk for drug abuse
and gender identity problems. Prevention programs should also
help to bolster self-worth and refusal skills. Traditionally,
prevention programs have either tried scare tactics on one hand
or have totally lacked guidance as to what constitutes right or
wrong on the other. What often appeared under the guise of
responsible decision-making was often the message that no single
decision was preferable or correct.

The parents’ movement supports clear messages which
uphold refusing these influences. No longer should prevention
programs only take a soft, middle-of-the-road approach. On
national and local levels the family must be revitalized. High
risk families should be provided with assistance when
identified. The national trend of self-gratification must be
changed with a strong, national leadership to encourage parents
to reinvest time, caring, attention and love in their families.

Finally, AIDS should be addressed as any other
infectious epidemic. It should not be handled with kidd gloves
simply because the high risk group includes a very visible and
vocal minority.

I agree with Dr. Walsh in the sense that we must not
rob Peter to pay Paul. The high risk group includes both IV
drug abuse and promiscuous homosexuals and heterosexuals. The
basic triad of prevention, intervention and treatment must be
followed with, of course, particular emphasis on these high risk
groups regarding AIDS, but we should not solely focus on these
groups in our prevention efforts.

Hopefully, the combined approach of education to the
dangers of high risk behaviors, working on communication and
refusal skills and intervening on high risk individuals and

families concurrently working to revitalize the American family
will be an effective approach.

CHAIRMAN WATKINS: Thank you.

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Dr. Sroka.

DR. SROKA: I would like to thank the Commission for
the opportunity to testify.

My name is Steve Sroka. I am an inner city eighth
grade health teacher in Cleveland. I am also an adjunct |
associate professor at Cleveland State University and I am an
AIDS and other STD education consultant. Since 1984, I have
trained over 8,000 teachers, who teach over two million kids and
the book that I have written, "Educators Guide to AIDS and other
STDs," is into its 24th edition now. I have assisted in programs
in small and large cities, as well as states. I have set up
programs for large Catholic, as well as Episcopal diocese.

Based on my experiences, I would like to bring you a
message from the trenches and talk about what I see is wrong
with AIDS education from a teacher’s point of view and from a
consultant’s point of view. There are nine problem areas. I
won’t read this, just try to highlight it.

First of all, AIDS education today is crisis-oriented.
It contributes to AFRAIDS (acute fear regarding AIDS). We don’t
need AIDS education in our schools today. When school officials
show me their AIDS education programs, I ask them where is your
herpes program from two years ago. We need a sound educational
framework to help desensitize this educational problem. We have
to allay the fears not only for our students, but for our
teachers.

We have to put AIDS education into a comprehensive K
through 12 curriculum. I suggest teaching it as communicable
diseases. One of the things the panel might find interesting is
that most of the schools and I have set up a lot of programs --
is that most schools in this country do not teach sex education.
So, you go in to talk about something in sex education, and most
school systems don’t have it. I suggest trying communicable
diseases to get your foot in the door.

In other words, what I am telling you today, with all
this time and money we are talking about putting into this
program, we should set up a program so that if there was a
miraculous cure for AIDS today, and there is not going to be,
our programs would still be viable tomorrow. Most of the
programs out there could not pass this test.

The second problem, materials don’t allow for local
determination of community needs. You have to put out a program
that respects the needs and values of that community. You have
to work with these people. You have to get them involved so they
get ownership and that is how you get a successful program. You
have got to work with that group there. You have to have that

425

 

 
 

 

respect for them.

The third problem I see is materials are not teacher
friendly. The programs that are out today are put together by
physicians, college professors, nurses, but they are not
Classroom teachers. We have people trying to tell us what to do
in the classroom when they have never been there. They don’t
understand the realities of classroom teaching today. The pains
of teaching six classes a day with 50 kids and they don’t want to
hear what you are talking about. There is not a sense of reality
to most of the programs here. You have to respect the teacher as
the person who best knows how and what to teach.

 

Maybe the panel would not be surprised, but the
average person in this country who teaches AIDS education today,
the health teacher, is not a trained health teacher. They are
gym teachers. Not only do they need information, they need
skills in order to -- teach this subject when, the door is shut.

Teachers can’t be an after-thought for the program.
In most of them, there are. ,

Problem number four, facts are not enough. Knowing
about the T4 helper cells in the ninth grade is not going to
save our kids from AIDS or any other STDs. We need behavioral
strategies. We have heard this several times, the skills in
decision-making, stress management, assertive communication,
empowerment. Let’s teach our kids to take control of their
lives. These skills can be taught in kindergarten. That is how
AIDS education can start. It can start in kindergarten. Talk
about communicable diseases and skills to take control of your
life. The programs I see, have limited effect on kids’
behavior. We have to teach our kids that AIDS is a disease you
choose to put yourself at risk for.

 

Fifth problem, I find that kids do not feel themselves
at risk even when they are sexually active. The statistics are
well-known. I won’t go through them, but one out of every seven
teenagers in this country will have a sexually transmitted
disease this year. There are few people in the schools with AIDS
but we know with the incubation period, many of them could be
putting themselves at risk.

From the classroom I get messages like -- they tell
me, I can’t get AIDS; I am not gay. I have had kids tell me I
would rather die -- I would rather die than stop having sex.
And I am telling you, the middle class value that if you have
sex, you might die does not have any -- it doesn’t mean anything
to the typical adolescent today. As one minority student told me
if this so disproportionately affects the minority people, you
just tell me one, just one, famous black or Hispanic person who
ever died from AIDS. I said Willie Smith. They said who, you

426

 

 
 

 

don’t know what you are talking about, teacher.

We have got to teach that education is our only
weapon. We have to get it into the kids. We have got to get
relevant messages to then.

The sixth problem I see is that saying "no" is not
enough for many of our students. By 17 years old, 57 percent of
our kids are having sex. Perhaps we need a more realistic
message. What I have found worked well in many of the schools I
have worked with is the ABC’s of STD’s, where you stress "A" is
abstinence; "B" is be monogamous or as some of my kids say, be
monotonous, but monogamous, and "C" is condoms: but qualifying
the condom statement with a statement that they reduce but do not
eliminate the risk of infection.

 

I set up a program with a Catholic diocese and when I
sat down with the Secretary of Education, her message could be
worked out to work within the Catholic Church. First of all,
they don’t condone the use of condoms, but many of our kids are
not living by the Christian way of life. So, we have a moral
responsibility to teach these kids to reduce the risk of
infection in hopes of keeping them alive long enough to kick
some Christian ethics into their heads.

I think right now the "Say No" message is not relevant
and perhaps the panel might consider this "Say No" message right
here. Say know, not "N-O," but say know, "K-N-O-W."

Another problem, seven, materials are just too costly.
Suddenly -- education is, big money. Publishers want you to buy
bound books and how do you update these bound books, you buy a
new book. They want you to buy student manuals. It is an
extremely expensive progran.

 

One approach is a three-ring notebook, which is a
program that I developed and anybody could develop. It makes it
very easy to update. In one state, I serviced the entire state,
several thousand teachers, with materials for the cost of 7 cents
per student. The entire program cost the state $43,000.00.

To use a competitive program that had student manuals
would have cost 2 1/2 million dollars. We have to be creative
here. Classroom teachers in large urban areas often have -- no
budget for materials.

The eighth problem I see is everybody reinventing the
wheel. Education is our only weapon but nobody is talking to
one another. Nobody is sharing ideas. I hear people saying we
have got to find materials. Materials are out there. It seems
as if from my perspective everybody who gets a grant develops
their pamphlets, their curricula, their video. People don’t

427

 

 
 

 

realize this takes a lot of money and it takes a lot of time.
Time is money. I think we have to start sharing our materials
and our information with one another. We have to use existing
programs. The American Red Cross has fine material or, at
least, if you can work with these, at least modify them. Don’t
start fresh and do it by yourself.

I believe the government and agencies and foundations
should stop funding programs, which duplicate programs that are
already out there. We have to stop wasting all this time and
money .

The last point, the last problem is that different

interest groups have prevented students from receiving a
consistent message regarding AIDS prevention. One group wants
safer sex; another group wants teaching only abstinence.
Blacks, whites, Hispanics, every group is calling for its own
program but what I see is that some of these programs that go
out to try to address minority needs are not sensitive enough
and, in fact, they almost backfire and, in fact, they further
discriminate the group that they are trying to help.

I can tell you from doing programs since 1984, that
there is a strong homophobia that has never been out there
before. I sense a minority phobia that is growing out there.
We have to be very sensitive in our approaches to minority
groups.

My recommendation on this last point is that we can no
longer separate our AIDS education efforts from others because
of whatever differences may exist. Schools have to work with
health departments. Schools are part of the community. We have
to get the total community involved; the parents, the doctors,
the media. We have to work together. The three key words that
we have to do to be honest with our kids is we have to get them
messages that are consistent, sensitive and realistic and it

doesn’t matter if these kids are black or white, gay or straight,
young or old.

I can tell you how it is done it in some of the
communities, but I think our lives are just too valuable. I
think I am on to something because I have a letter of support
from Koop and also a recommendation from William Bennett, but I
really want to stress to you today that -- my last point, just
like in the class, sometimes you don’t say it, you have to show
it, is that I appeal to you that for many of our students we
need AIDS education today because for some of them tomorrow will
be too late. Thank you very much.

CHAIRMAN WATKINS: Thank you, Dr. Sroka.
I would like to open the questions now from the panel,

428

 

 
 

 

from the Commissioners, Dr. Conway-Welch.

DR. CONWAY-WELCH: Ms. Futrell, you mentioned on page 6
of your testimony that you are helping local affiliates pilot
test new and innovative approaches to creating an ongoing
teacher/community dialogue about AIDS. I wonder if you can give
us an example of that or perhaps help frame that in a
recommendation of the type of pilot program that should occur or
could occur?

MS. FUTRELL: We will be very happy to help you frame
it. We provided training to a team of teachers in each of the
three states I mentioned. We helped develop materials, develop
a training program, and learn to work with members of the
community.

In Burnsville, Minnesota, for example, when the team
went back, it sat down and developed a program for that
community. The goal was to involve teachers, administrators,
educational support personnel, representatives from the Chamber
of Commerce, the medical profession, parents, and others. The
team tried to get all the groups together to discuss AIDS and to
arrive at a consensus about how the community should address the
issues.

The first attempt was not very successful because, as
I indicated earlier, many people in the community said "we do
not have a problem, so why should we discuss AIDS? The team
tried again about three or four months later, with more success.
More people came to the meeting, and everyone discussed why AIDS
education is important and why guidelines are important.

DR. CONWAY-WELCH: So, you do have a model for --

MS. FUTRELL: Yes, we do have a model --

DR. CONWAY-WELCH: Is there an evaluation component in
that model?

MS. FUTRELL: We are in the process of evaluating
those programs now. One was in an urban area; one was ina
Suburban area, and one was in a more rural area.

DR. CONWAY-WELCH: If you could share that with us --

MS. FUTRELL: We will be very happy to do that.

CHAIRMAN WATKINS: Ms. Gebbie.

MS. GEBBIE: One of the things that I hear, talking to

429

 

 
 

 

people trying to put something like this in the schools, is the
difficulty sometimes of making the connections with a resource:
like the local health department and really making it a
collaborative effort. I hear people from the health side saying
they act like we are invading their territory when we come
offering to help. I hear people from schools saying why do they
want to use up our time with this extraneous stuff that isn’t
really education. What I have heard here is an interest in
getting the materials. Could you talk about your perception of
barriers to using that kind of resource at the local level,
where it might exist and where there are people genuinely
interested in being partners with school teachers or school

districts or school principles in the process?

MS. FUTRELL: Well, I will be happy to let the others
share their experiences, but the concern you have raised is a
very real one. We have had a conflict or had some tension when
the agency simply says it is going to come in and provide
training or provide information, and there is no attempt to
coordinate this activity.

Our suggestion is that the school community sit down
with members of the larger health community -- the health
agencies, the medical profession, nurses, and others -- and talk
about how we can work together to reach not only school
personnel and students, but also members of the community. We
should discuss what role the teachers, for example, would play
in that whole process. :

When we have worked in that manner, we have been very
successful. Where we have had problems is when teachers were
told, "This is what you are going to have to do." Often times .
they are not given time to do the work. And frequently they
have not been involved in developing the program. Where
teachers have been involved in the planning, those tensions have
not existed.

DR. VOTH: I would further expand on that, that there
have been several problems. One of the most frequent that we
have seen, particularly in the drug abuse area, is denial on the
part of the schools that there, in fact, is a problem. We have
documented severe problems in some schools where the
administrations are unwilling to allow drug abuse education to
take place, simply because of the fact that they have denied
that their school couldn’t be involved.

I think ‘another concern is that once the door is open
and they want to do something about it, the uniformity of the
message has been very difficult. Some schools have been badly
burned, thinking that they have gotten a quality program to come
in and it has turned out to backfire.

430

 

 
 

 

Third, I think that programs that have put additional
pressures on the teachers to be the ones teaching everything
have been a problem, too, because they have got their hands full
as it is. To expect them to fully reeducate about a very
difficult issue, such as drug abuse and AIDS prevention, may not
necessarily be the most fair or effective thing for the
teachers.

MS. HARDISON: I would like to comment also that I
feel we need a very strong health education program beginning at
the earliest time that children come to school. In some cases
they may be only three or four years old. We need to talk with
children things not only about drug education and sex education,
but also about problems such as child abuse. We have a
program called "Me-ology," where we work with self concepts with
our little children. AIDS should be a part of our total health
education program.

DR. SROKA: I would share my experience in the setting
of programs. The biggest road blocks I have experienced are
school boards. They are elected to serve the people. I have
been in school systems where you could not do anything because
there was a school board election. That is the biggest hurdle.

The second biggest hurdle is teachers. There is no
problem with kids. Kids want the information. I find parents
extremely receptive to programs. Teachers feel, as I think we
have had expressed here before, I already teach the world and
now I have to teach another subject and often times it is this
coach, you know. He is the guy who kicks you in the butt after
you drop a pass and now he is going to talk about sex and drugs
and dying. It is very difficult. And we have to put a lot of
time and effort into making these people feel comfortable.

My main mission when I set up programs is to make
those teachers feel comfortable and to make it as easy’ as
possible to teach.

CHAIRMAN WATKINS: Dr. Lilly. Ms. Pullen.

MS. PULLEN: Dr. Sroka, would you expand briefly on
the advantages in the tool of the loose leaf notebook type
curriculum for this purpose?

DR. SROKA: Thank you, Ms. Pullen. You should all
know here that several major publishers in this country told me I
was just foolish to put out a book like this because truly if you
put out a bound book and you need to update it, you have to buy a
second one. What I am trying to do is put out a -- what I have
found out is all teachers teach differently. I consider this a
resource.

431

 

 
 

 

. Teachers have their lessons plans. Sometimes they
plug into the ones that I have here. The layout I have of this
book, which is very unique, is that I have teacher keys with
student activity sheets. So, the teachers literally can run off
and they can decide in their own community what is appropriate.
Can they talk about anal intercourse? Can they talk about
homosexuality? Can they talk about condoms?

They decide. The information is there but the teacher
decides what is appropriate in their particular community. I
think that is very important. The fact that you don’t have to
buy a student manual puts the cost at mere pennies for students.
What I suggest that people do is put one of these books in a
school and xerox it as much as they would like. That doesn’t rub
well with many publishers, but I think when you have a format
like this, you can, adapt, you can grow, you can add, you can take
out.

When I set up the churches, the Catholic diocese and
the Episcopal diocese, they put their little insert in at the
beginning on the Catholic way of life. It is adaptable and I
think if we don’t respect the teacher as the person who best
knows how to teach it, the problem is going to be doomed to
failure. So, there is not just one way to do it. We have to be
flexible and we have to be adaptable and I think we have to be
creative and innovative. This is one approach that has worked
very well.

This is not my idea. This is 8,000 teachers talking
to me. I am not using my own ideas here.

CHAIRMAN WATKINS: Dr. Lee.

DR. LEE: I sure do agree with Dr. -- the son of
Admiral Watkin’s cohort -- when you said that parents seem to
have given up their responsibility at home. As a matter of
fact, they have fled their responsibilities and they have left
them to the schools. But you can’t feel sorry now. You have
got the problem, so let’s deal with it now.

I:am going to play the devil’s advocate on this. Why
should the Federal Government run around and give you money
because there is something new to teach your students?
Knowledge is your business. It is your business to teach your
students about anything or everything that comes into your head.
Why do you run to the Federal Government for money about AIDS?
Why not run to it for a million other things?

It seems to me, and I haven’t heard it here -- maybe
we will hear it from the college group that comes up -- why
isn’t AIDS in your biology course? Why isn’t simple human
reproduction in your biology course? Is that a thing of the

432

 

 

 
 

 

past? Don’t you teach biology? Shouldn’t everybody who goes to
high school or gets out of high school have had at least one year
of basic comparative biology? I mean -- respond.

MS. FUTRELL: I think that the Federal Government
should get involved because we are talking about a national
health crisis and a world health crisis. We know, for example,
that many young people will become infected. I understand that
hy the early 1990s that AIDS will be the leading cause of death
among 24 to 29 year olds. Many of those young people are in high
school or in college now. We know for a fact that within the
next two years some 3,000 young people will be born in this
country with AIDS. Many of them will be coming into the schools.

We also know, whether we want to accept the fact or
not, that our young people are much more sexually active than we
would like them to be. They could be infected right now. We
also know that many of them are using drugs. Some are in
school; some are out of school. What we’re talking about is a
national health crisis, and the Federal Government, I believe,
has to be involved. We need the federal government’s to help
stop the spread of AIDS by helpin people change their behaviors
so that they will not jeopardize themselves.

Why don’t we just teach it in biology? Because I
don’t think it is just a biology issue. It is not just a
science issue or a health education issue. It is an issue which
all teachers must help young people understand and help them to
address. As I said earlier, we cannot wait until the 9th or the
10th grade, which is the level where most young people would take
biology. We must begin to teach them and talk to them about AIDS
much earlier -- in the elementary schools, the middle schools,
junior high schools, all the way through.

At the elementary school, I think'the emphasis should
be on reducing the fear about AIDS. We should talk to students
about respecting people, as well as. talking to them about AIDS
itself.

At the junior high school level, we ought to talk to
them about the virus, about how people get it, and, especially
at the junior high and the secondary level about changing their
behavior.

;DR. LEE: What do you mean? What is new about this?
Of course, these behavioral changes are obvious, but I don’t
think the Federal Government can tell you or not run around and
be as promiscuous as you possibly can. I don’t know --

MS. FUTRELL: In the past we might have taught a topic
such as this one in a sex education class or in a health
education class. It would have been the responsibility of only
a few teachers. What is new is the urgency of the problem.

433

 

 

 
 

 

What is new is the fact that we all have a responsibility to -

help our young people know about this disease and understand how —

to avoid it.

I wish I could say to you that young people are not.
engaged in sex, that they are not using drugs, that they are not
doing all these things, but as a junior high school teacher, I
know better, I had too many kids coming into my classroom who
were involved. How did I know? Because they were pregnant; they
were on drugs; they were doing all kinds of things. So, it is my
responsibility -- as a business teacher, as a citizen -- to be
concerned about what happens to these young people. And I would.
think that our government would also be concerned.

When I was growing up, the disease was polio, and the |
government had to step in to find a cure for polio. I would put.
this disease in basically the same category. It is a very, very
dangerous disease and it will wipe out hundreds of thousands of
people. I don’t want hundreds of thousands of people in this —
country to die. I don’t want that to happen.

So, I have a responsibility to do everything I can to
stop it, but I need help as a teacher, as a citizen, and schools
need help too.

DR. LEE: Lorraine Hale -- do you know who I am
talking about? Lorraine Hale, who is the daughter of Mother
Hale, Ph.D., psychologist, et cetera, et cetera, stood up in
Congress the other day in Charlie Rangle’s subcommittee, and
said that the overwhelming majority of the teenage girls, who
come in to her, who are pregnant, think that God sent them the
child. "

Now, what went wrong? I mean, who isn’t teaching
them, I repeat, biology.

MS. FUTRELL: Mr. Lee, I am not here to second guess
what went wrong or who didn’t do his or her job. I simply know
that the problem exists and that I want to help. When I see
young kids coming in who can’t support themselves or who are
pregnant or who have all the opportunities in the world but are
on drugs, I can’t second guess what went wrong. I don’t know
what went wrong. But the problems are out there and I need your —
help to do something about then.

DR. VOTH: Dr. Lee, I will comment on that, if I might..

Two preliminary comments. First of all, I would hope |
that any AIDS efforts would be dovetailed with national drug
abuse efforts because, for instance, right now the White House
Conference on Drug Abuse is taking place just across town. So,
we don’t want to head down two separate directions here "

434

 

 
 

 

altogether.

But I will tell you exactly what went wrong. Very
close to the time of World War II and thereafter, families began
to deteriorate. Very clearly, before World War II, mores as to
what was acceptable, what was not acceptable, et cetera, were
defined in the family. Once the family began to deteriorate and
parents began to feel afraid of saying don’t use drugs, don’t go
out and get drunk, Johnny, don’t be sexually promiscuous, things
began to deteriorate.

And if you look at what has begun to shake down, not
only have families begun to deteriorate and those coming out of
families have not been brought up with the normal upbringing of
basic mores, but they also have not been given the appropriate
nurturing to have inner strengths to refuse these influences.

If you look at what has happened to spread AIDS, it is
very simple; rampant IV drug abuse and extremely promiscuous
homosexual and heterosexual behavior. The other areas have been
minor and have been off-shoots of these areas and, as
controversial as it may sound, you can trace those behaviors
back to what has happened with the breakdown of the family. The
reason the government should be involved is the only way to
revitalize the family is with strong national leadership that
starts from the White House and comes down from there saying we
are on a campaign to revitalize the family and the spinoffs from
that are obvious.

DR. LEE: I agree with you.

MS. HARDISON: I was going to comment on the same
things, and echo what Dr. Voth said about the family. The
schools are reflecting what is happening in society and when we
have children -- I had children in first grade, two little boys
last year, who had anal intercourse --

DR. LEE: In the first grade?

|

MS. HARDISON: Yes. And a third grade prostitute.
Society is changing and the children are coming in with
different problems than the children we saw in schools ten years
ago or fifteen years ago. I agree that we should not be
reinventing the wheel, but we need assistance from the
government for a year or two, I think, in sharing information
about what is working in certain school districts. Help us get
the message across and let’s not wait until two or three years
from now, because we have some serious problems right now.

DR. SROKA: There is just a tremendous frustration
with teachers in the classroom. Everybody is telling us that
education is our only weapon and everybody is giving us a

435

 

 
 

 

pamphlet, a video. We don’t want more materials. We can read
the papers. What we guys need is strategies. We need methods
to do the job.

I think it is coming out here as different people have
talked. There are good programs around. It is just that we
don't know about them. Wisconsin, for instance, has moved ahead
with initiatives. I mean, they are doing in-service for all
their teachers through the Department of Health and through the
Department of Education with no AIDS money. I mean, there are
people that have moved without money. They have taken
leadership positions and said this is a top priority and we are
moving with it. I see a lot of times people use the excuse, we
just need more money, when, in fact, although sometimes it is
economic, it comes down to politics and egos. Sometimes you
just have to say this is the problem and we are going to work
with it.

So many of the ideas, I keep saying, from being a
classroom teacher, my concern about drugs is not IV drug use.
My concern is alcohol. Alcohol is the drug of choice. You
know, our kids know the difference between a beautiful and an
ugly person, six kids. Let’s get drunk in school. It doesn’t
matter if I go inner city, little rural areas, that -- it isa
social -- oh, my God, my kid came home. I am so glad he wasn’t
doing drugs; he was only drunk. There is an acceptance of this
drug. This is the drug that sets up people to do other things

and yet it is acceptable.

I think sometimes it --
\
DR. LEE: It is not acceptable in your age group that
you are teaching. |

DR. VOTH: And I would agree with you o\ waar
percent --

DR. LEE: It is not acceptable.

DR. VOTH: And that has been the entire crux of the
national war on drugs because there is still a very definite
movement to try to teach young people to be responsible, quote,
unquote, with drug and alcohol use, which is a mutually
exclusive term.

What the parents’ movement has been trying to do is to
try to teach them refusing drugs and alcohol and building
healthy lifestyles. I mean we are very focused on AIDS and it
is a tremendous problem but, my, God, our number one problen,
our number one cause of death in adolescents is suicide and
accidents and those are alcohol and drug-related largely.

MS. FUTRELL: Let me just add that I don’t want us to

436

 

 
 

 

go away assuming that the only people who are going to get this
disease are those who are promiscuous in their sexual behavior
or who use drugs. The data I have seen indicates that about 80
percent of the children who are getting it get it from their
mothers, and it doesn’t necessarily mean that that mother has
been promiscuous. | ;

So, while we need to change the behavior, we also need
to understand -- and you understand it better than I do -- that
there are other ways to get this disease and other ways that
young people can get it. We just heard someone testify to that
effect. Ryan didn’t get AIDS because he was on drugs or he was
an alcoholic or he was out being promiscuous. He got it because
he had an operation.

I think we also have to understand how much politics
is involved here. We need to be able to transcend the politics
and come up with policies, programs and curricula that will help
us address the problem.

DR. LEE: Thank you.
CHAIRMAN WATKINS: Dr. Walsh..

DR. WALSH: I feel like I keep coming around the same
bend all the time on this education thing. I recognize, as I
said before, that AIDS is a new and dramatic -- relatively new
and dramatic disease with which we are faced. I keep wondering
where were not only our parents but also our teachers when we
were worrying about teenage pregnancy, when we were worrying .
about drugs. Why is suddenly the thought of a new curriculum
for one disease so overwhelming that we need, as my friend, Burt
Lee says, an outpouring of federal funding to set up a
curriculum for a sexually transmitted disease?

Now, granted, I know that you are talking about the
innocent pediatric sufferers of AIDS and so on, but our
education is -- certainly at the school level - is directed at
protecting the next generation. It is really protecting the new
generation that is coming because a significant part of the
generation that has already gone through your hands has already
been infected or has been exposed.

So, what I can’t figure is why Ms. Futrell, have we
not in school been addressing, whether they be in general health
Classes or PTA meetings and so on, these things? I assume we
have been addressing family. problems. I assume we have been
addressing teenage pregnancy. I assume we have been addressing
the incidence of venereal disease and all of these things are
related to how you get AIDS.

Don’t we have some foundation into which this can be

437

 

 
 

 

added? To me, it is a cop out when you say if the government
just doesn’t give us more money we can’t handle this. I think
that is a cop out. I mean, I think you need more money. Don’t
misunderstand me. I am not-that far off, but to say that if we
don’t get money, we can’t handle it and if the next generation
disappears with this disease, it is someone else’s fault. I
keep, as I say, coming around the bend. AIDS is a horrible
disease. We will have 55,000 deaths in 1991, but we will have
close to half a million from heart disease and close to 400,000
from lung disease and 350,000 from cancer and so on.

So, all of these things are’ major problems for us and
I agree with you if you can use AIDS as a wedge, as a wedge to
get into curriculums what maybe parents and school boards have
objected to before -- I would find it very hard to support with
enthusiasm -- if the rest of the Commissioners want you to have
more funds, I will go along, but without enthusiasm if those
funds are even implicitly just for AIDS.

There is so much else you can do and I agree that
parents have not done their share and they have to do more, too,
but it just seems to me that you must have a structure on which
you can build in the schools and I think, as you pointed out, you
have to be sure whoever is doing the teaching knows what they are
talking about because that is what parents are also worried
about.

MS. FUTRELL: Well, let me try to respond to --

DR. WALSH: ‘I would like you to address that because
it really concerns me. I keep going around in the same circle.

MS. FUTRELL: Okay. I will try.

The concerns you have raised are very, very legitimate
and very real. We have an epidemic of teenage pregnancies in
this country.

DR. WALSH: Sure, unfortunately.

| ‘MS. FUTRELL: We have a million young women getting
pregnant every year; 500,000 decide to go full term. We have an
increasing number of teenagers having their second and third
ibabies before they are 16.

DR. WALSH: Right. Now, you are talking.

MS. FUTRELL: We also have, unfortunately, a large
number of young people who are becoming increasingly more and
more reliant on drugs. And I am not just talking about alcohol
because that is the number one problem, but I am talking about
heroin and crack and cocaine. When I was coming along, going out

438

 

 
 

 

and having a beer, that was a big deal.
DR. WALSH: Big deal.

MS. FUTRELL: And these problems back them look pale
in comparison to what we are experiencing today.

We have tried to get school districts to put in sex
education programs to say to young people, "You need to stay
away from sex," "you need to wait," "you need to abstain." We
have said, "If you do become involved, these are the
consequences: disease, unwanted pregnancies, et cetera." Many
school districts have adopted such programs and put them in
place. In many school districts, including mine, we have
programs dealing with family education. We talk about the
importance of having a strong family in place, to nurture a
child. But we also stress the family as a structure that is
very, very important to our society.

We have put in programs to try to deal with drugs. If
we can’t get students to stay away from drugs, then we tell them
about places they can go to get help. We tell them about the
dangers getting involved with alcohol or heroin or whatever.

So, those programs are in place. We’re working with
families; with the PTA, with groups like the Children’s Defense
Fund. NEA has set up a National Health Information Network
because we know that information and many services are not
available in the schools. We are working with pediatricians,
with general practitioners, with school nurses, to get more
information into the schools. In many instances the information
simply is not there.

We don’t diminish the importance of diseases like
heart conditions, diseases like tuberculosis, cancer and many of
the others. But what is different about AIDS is that it is
spreading so quickly and that so little is known about it.

While we don’t have a cure, we know that if we can get people to
change their behavior, we can save a lot of people -- especially
young people -- from contracting this disease. And one of the
best places to start is in the school.

We need up-to-date information and we need training.
We have discovered that there is very little training available.
Who provides the training, for example, when teachers are told to
go out and talk about AIDS? Whoever provides training must have
absolutely accurate information because we don’t want to go out
and create more of a problem than we already have.

The young people I talk to are absolutely paranoid
about this disease. These young people are bright and
intelligent yet they say things like, "If I sit in the same

439

 

 
 

 

chair as an AIDS-infected person, I am going to get this
disease," or "if ‘they’ are in the same classroom or school with
me, I am going to get this disease." "Why don’t we quarantine
them? Put all the teachers and all the students who have this
disease in one place and make them stay there." They say things
like that. And they are scared to death.

So, we need to make sure that the information we put
out is accurate, that it is medically researched. We work with
the medical profession to make sure the information is adaptable
to schools. We work with parents to make sure they understand
what we are doing. We tell parents we have the resources to
disseminate materials and other information, such as films and
cassettes.

This education effort should not to take away from
anything else. But we must try to change behaviors which are
detrimental to our young people. That is why I think the
urgency is there.

DR.. WALSH: That is the answer for the next generation
and we have to do it.

MS. FUTRELL: Right. And we are, for example,
providing training programs for our own members and for others
who have asked us to help because they don’t have the training
programs available.

DR. WALSH: But you do feel that you have something of
a structure in which to build this into, though, now, don’t you?

MS. FUTRELL: Yes.

DR. WALSH: I mean, you are not exactly starting from
zero?

MS. FUTRELL: No. We work very ¢losely with the
Centers for Disease Control, with Surgeon General Koop. We have
worked very closely with the medical profession, school nurses,
our own people, school boards, and different groups, to put this
information together.

Just to give you an example of how desperate the need
for training is -- we were asked by a branch of the military to
provide training for some of its personnel because it doesn’t
don’t have the training. So, we used our staff to go to Texas
to train some military people regarding -~-

DR. WALSH: But you use these same people to teach
other things than AIDS prevention --

440

 

 
 

 

MS. FUTRELL: Right. |

DR. WALSH: -- I would hope. I really think, Ms.
Futrell, if the educators, like yourself, and the educational
leaders, would promote the fact that you recognize there are
diseases and problems besides AIDS --

MS. FUTRELL: Well, we do.

DR. WALSH: -- that you would get a better hearing. I
am glad to see you point out something about self-esteem because
I was a little astonished -- one of the Congressmen, who is a

good friend of mine, sort of belittled the idea of the

individual responsibility because "we have an emergency." Well,
where in the devil has been the individual responsibility for the
last 25 years with drugs and everything else.

MS. FUTRELL: We are trying to teach young people that
they are responsible for themselves and they can say: "no,"
knowing we will provide them with the support to stick with that
"no" answer.

DR. WALSH: Right.

DR. VOTH: Dr. Walsh, I would just add that there is
already an excellent federal program there, too, through ADAMHA
and the Office of Substance Prevention, where a lot of federal
funds are coming down for drug abuse prevention efforts. The
guidelines, in fact, having reviewed many of those, are
identical to what is being proposed for AIDS. It woulda just be a
matter of tailoring additional broadening of some of those
programs to be substance abuse and AIDS and sexually transmitted
disease. That has been one of the criticisms that I have placed
to OSAP is the same thing. Why only focus on drug abuse? We
need to broaden that and focus on other issues as well, but there
is a federal framework for that and I think it would be a
terrible mistake to get off on a second tangent here, massive
federal funding to a whole separate AIDS approach, when there are
other networks that exist to address the problem.

CHAIRMAN WATKINS: Any other questions? Dr. Lee.

DR. LEE: It seems to me -- here is another thing that
might respond to it -- it seems to me that AIDS would make your
job easier and more difficult -- it is a terribly fascinating
subject that gets you into an assortment of subjects that you
teach. It gets you into biology. It gets you into psychology.
It gets you into anatomy. It gets you into family matters. It
gets you into sexual matters. It gets you into all the things

441

 

 
 

 

 

that you are interested in. teaching and it gives you an
instrument that brings it home to the kids. It seems to me that
it is a great tool to use in the primary and secondary school
system. Am I right?

DR. VOTH: Absolutely.

MS. FUTRELL: Yes. I was very curious -- I was
talking with some teachers the other day who were talking about
teaching this across discipline lines. I was trying to figure
out how do you teach this in math? How would you teach it in
history? Or how would you teach it in business education? In
history, you can relate AIDS to other plagues we have had
throughout history. And in business, the cost. And, so, all of
the sudden, I see there are ways to bring it up ana relate it to
what you are doing in your class.

DR. LEE: The ills of society are all intertwined in
such a dramatic fashion.

DR. VOTH: Dr. Lee, I would add, though, the real ky
is going to be very similar to what happened with drug abuse.
Instead of trying to teach people how to get away with it and
not catch it, it is how to prevent the behavior in the first
place because if they are thinking now, if I only stick my
needle in Clorox or if I only wear a condom, I am going to be
safe, that just is not going to address the problem. It is
phenomenal how many of my drug addicts come in wanting AIDS data.
It is phenomenal. It is an excellent way to open the door to the
whole overall problem that you have suggested, but I think we
have to be on the prevention end.

! ,
MS. HARDISON: I would like to make one final comment.
One of the problems we have seen in working with parents -- is
that they were a little leery when we started bringing sex
education into the elementary schools. They wanted to know who
is going to do this; what is the curriculum going to be like.
So, we did have permission from all'the parents before their
children participated in this. :

Some teachers are hesitant. They are uncomfortable to
talking about AIDS or sex education, and to combat their
reluctance we said that there would be a specified curriculun.
As a principal, I want to be sure that the curriculum -- what
teachers are going to say in that classroom to the children --
is accurate and that not just anybody is going to be talking
about it. ‘I think this is an assurance that we need to give our
parents -- that it is a very informative curriculum and' that it
will be good -- and then our parents will buy it and they will
let their children participate. But they need that assurance.
That is why I tend to support, having in a school several teachers

who will be almost specialists in health education, even in the

442

 

 
 

 

elementary school, who will follow set guidelines, a specified
curriculum, rather than just everybody in the school talking
about it.

Certainly, all teachers should be aware and be able to
answer questions, but there are differences in the abilities of
people to give that information. We want to be sure that it is
correct.

DR. LEE: I can only speculate about that terrible
thing you told me in the first grade.

MS. HARDISON: It happened. I had a little boy from
South America, who had been used by some older boys in South
America, and he came to this country and one day he went into
the bathroom and said want me to show what they did at my other
school.

Then I as the principal sat and had to tell the
parents of the other little first grade boy what had -- guess
what happened in school today.

The children do see - hear AIDS. They will hear
comments from this Commission on the evening news and they are
very aware of what happens. I have very strong feelings about
child abuse. I think we need to teach these children not to let
anyone touch their bodies in an offensive way.

DR. LEE: It is possible that you people need combat

pay.
CHAIRMAN WATKINS: Dr. Conway-Welch.

DR. CONWAY-WELCH: One of the previous panels today
when I asked the question -- mentioned that school nurses would
have to be certified to teach the students about AIDS, in fact,
if they were used to teach about AIDS. And it was pointed out
to me that as dean of the School of Nursing at Vanderbilt and I
teach a lot, that I could not teach about AIDS in the Public
Health School System in the school down the street in Nashville,
Tennessee. I wonder if you would comment about that. That seems
to be a significant barrier.

MS. FUTRELL: Well, we work very closely with the
school nurses, and we certainly have not said to them that in
order to work in the schools or to work with us, they must be
certified. The way to address that problem, perhaps, would be
for a certified teacher to invite a school nurse, a certified
teacher would be there, but you would still have to talk with
and teach my students about AIDS or perhaps another topic. The
certification issue does not have to be a barrier. It might be a
barrier in some states, but in most states, I would not think so.
In my school district it is not a barrier. I can invite the

443

 

 
 

<<

school nurse to come in and talk about different things. I have
to stay there in that classroom with the students, but I can
invite the nurse to come in and talk about any health-related
topic.

DR. CONWAY-WELCH: That doesn’t seem very cost
efficient, though, when we are looking at ways of delivering the
content to the student by telling experts that they have to be
monitored by a teacher.

MS. FUTRELL: But that is not unusual. When we invite
resource people to come in -- I would categorize a nurse as a
resource person still we are the ones responsible for the class.

In most school districts, there is not a full-time
nurse at the elementary level. There may be one at the
secondary school. So, you would have to share a nurse with
another school. I doubt school districts would be willing to
pay to bring in an outside expert to conduct the kinds of
discussions you are describing. So, if I want that discussion
to take place, and I feel that I cannot do it, I would use
someone from the profession.

DR. SROKA: The problem I have seen around the country
is that there are just enough school nurses and that in most
states, they are getting one nurse for three or four different
schools, but they are utilized very often because they are the
medical experts within the school.

 

I set up 24 different programs, including statewide
programs and large cities and small city programs and if you
would like to know some of the problems I have had in that -- I
find it very interesting that I have probably set up more
programs for more states and more cities in the country and
nobody wants to talk. They all want to do their own thing. I
find that very frustrating. It is very difficult right now. I
think there is something about this disease where everybody
wants to do their own thing. They want to get their grant.

They want to roll with it and I think that is very frustrating.
If people could just start talking and sharing and letting us see
what each other has been doing -- I am going to come to the
National Association of Elementary School Principals. I am doing
a workshop there and that is going to be my message. We have got
to start sharing information with one another and if people are
saying something you don’t like, you have to at least listen.

I can’t rule out somebody because I don’t like the way
they think. We have got to sit down and get our methods
together. I hear people saying, well, you are not saying what I
am saying, so I am not going to talk with you and our kids are
losing out.

444

 

 

 
 

 

CHAIRMAN WATKINS: Ms. Gebbie, another question.

MS. GEBBIE: Yes, a bit of a shift. We have really
been talking about the kids in the school during this period of
time and what has occurred to me a couple of times while you
were talking is what we heard from witnesses yesterday, who
pointed out that they were worrying about these kids who drop
out of school and what we should do about them. Their
experiences have been that is very easy for a kid to get out of
school but once out, it is almost impossible to get them back
in. Many barriers are erected for the return to school of a
child who has once dropped out.

That strikes me as rather odd because it ought be the
reverse of that. It ought to be very hard to somehow escape
from the clutches of schools and if you should do so, that it
ought to be easy to get you back in as a part of our solution.

Was that just a phrase that actually has no meaning in
fact? What is your experience about the schools and the people
who work in them being interested in having some share of
responsibility or involvement with these kids who have dropped
out, who are not a part of the system right now?

MS. FUTRELL: The National Educational Association has
launched a program to try to keep young people who’have been
identified as potential dropouts in school. Today some 30
percent of the children drop out every year. So, we are talking
about a million children dropping out before graduation.

So, we have tried programs that try to keep these |
young people in school, programs that give them skills to help
them get a job or go to college.

We have also tried to get dropouts to come back to
school through a regular program or a night program. Once they
drop out, the problem is not so much getting them to come back
as finding then. If you can find them and persuade them to
come back, all they have to do is go to the school with a
parent or guardian and indicate a desire to go back in. As long
as they are within the legal age there’s no problem. If they are
above the age, of course, they have to pay. But the real problem
is finding them, once they are out in the community, so you can
persuade them to come back. )

. Many of them do go back to night school to get their
GED. How do we get information to this group about AIDS? We
have to rely primarily on the media and on agencies in the °
community that work very closely these students.

We also have programs that try to keep students in
school, called Operation Rescue. We have been relatively

445

 

 
 

 

Voy ‘
i ‘

successful, but it is very difficult to keep students in school
because there are so many other competing factors.

+ DR. SROKA: Can I comment? Working in a lot of inner
cities, we have a disease of color out there, but the color is
not black or brown. The color is green. Poor kids don’t get
good educations. They don’t get good health care. In the
system I am in half of the students. drop out of school and I am
concerned because -- by the time they graduate from high school,
half the kids -- half my nirth grade students will not graduate
from high school. I am very concerned because when I am in class
teaching, the real kids that are at risk are at home putting
themselves at risk. They are not in the classroom.

So, my problem is then how do we try to access these
people. Sometimes we hook up through the health department.
When they go in for sexually transmitted diseases or other
health problems, sometimes that is a teachable moment. You
might try.to access them then. What I have done in several
cities now is hooked up with local media people that have appeal
-- for instance, in Cleveland we have an adolescent type show on
Friday night. We brought these people in. We brought in Michael
Stanley, who is a rock star, and we put together a program and we
showed it on a Saturday from 12:00 to 2:00 in the afternoon. We
are going to put that back on in prime time again.

Sometimes I have done other specials in other cities on
holidays when all kids would be home and we could access the
kids. Maybe while they are lying in bed putting themselves at
risk, they might be watching this program. I think we have to be
creative; we have to be innovative and we have to look at
different ways we could work with these people.

I have been surprised that often times school kids
take messages home to their brothers and sisters, who are not in
school: They educate their parents. So, I think a lot of
times, you know, we have to make everybody into AIDS educators
and we are going to have to be creative in trying to hit this
student that truly at risk because they often don’t live by our
values and the things that scare you and me don’t scare those
people. So, we are going to have to look at it in ways that
maybe we haven’t looked at it yet and use these people, if we
can, to get help us get the message to those people.

‘MS. HARDISON: I think it is wonderful that we have a
strong national movement now to do something about the kids who
are at risk, who are potential dropouts. We can identify those
children. We usually ‘have a profile as early as third or fourth
grade. We can tell you who is at risk and we are doing things
about it. So, that is one good note. I want to bring some good
news here.

446

 

 
 

 

DR. VOTH: One of the things that has been found,
particularly with the K through 12 type of prevention programs
is that when the prevention programs are in process, it is so
easy to see these kids that are shut down with their
communication. They come to school hungry, come to school
dirty, come to school very tired and -- but that is why it is so
important that we don’t just start in Junior high or high
school, that we really look at a K through 12 program, while the
kids are still locked in in their early grade school years, to
try to intervene early, rather than try to catch them when it is
too late.

\

CHAIRMAN WATKINS: Let me close out the panel with one
question. We have had testimony, rather significant testimony,
where we are hearing words like "comprehensive school health,"
“education health promotion plans" and so forth. We had one
witness this morning, who is a representative of the National
Association of State Boards of Education who talked rather
positively and optimistically about the strong health education
program in the State of Kansas in one sense, but she also said
she had put on "Health Education/AIDS" in order to really get
attention and get support in that area.

What I would like to ask Ms. Futrell and Ms. Hardison,
both, is if you had to grade the United States, A, B, C, Dor F,
on the degree to which we have now in the country, across the
nation, a solid health education, health promotion progran,
preschool through baccalaureate level, what grade would you give
the nation as a whole, recognizing that there are going to be
differences across the states? If you had to give a mark, Ms.
Futrell, what would you give us? Integrated as curricular, not
extracurricular, integrated with school, understanding our own
human biology, a baseline on which we can absorb a thing like
AIDS, STDs, teen pregnancy, all the stresses coming into the
ethnic exchanges, the 30 percent of the kids born into poverty,
all of the issues that HHS says are projecting us at a very rapid
rate towards a chaotic situation in health of our young people if
we don’t get on it? Isn’t it time to take a hard look at
ourselves? It is telling us something. It is a plea for
something much more fundamental in the way we treat education in
its relationship to good health practices and the like.

So, I would like you to give us a grade from your
point of view and you also, Ms. Hardison, not just for the
United States, but also for elementary schools, what grade would
you give us? How well do we do there on fundamentals at that
level of maturation?

MS. FUTRELL: If I understand the question you are
asking me, I believe I would give us a D.

447

 

 
 

<<

CHAIRMAN WATKINS: Good for you. I would give us --
it would either be a D or a D minus.

MS. FUTRELL: Yes, I was leaning towards a D minus.

CHAIRMAN WATKINS: Everywhere we turn, we uncover the
rocks of this epidemic. As we look through things, we see a
plea for some much more integrative approach. I asked the
Secretary of Education today what monies has he requested to
pull the Department of HHS and Education -- there have been
attempts made in the past and rejected. No funding by the
Congress. On the other hand, isn’t it time to review the
bidding -- when we threw out the baby with the bath water on
that one, to bring education and health back much more into
harmony in its fundamental sense so that we have a place to put
these various things instead of a lot of different band-aids on
the shelf because we don’t know when the next mutant is going to
come around the corner. We don’t know what the next event is.

It seems to me that the lesson learned here is that we
have learned that we have a terrible situation in the country
regarding this. I would like to know if you agree with that and
if you, Ms. Hardison, agree with a D?

MS. HARDISON: I was going to say a D, maybe a D minus
or -- we don’t give E’s, but in this case, I would give an E for
effort. We are giving a little bit of effort but not enough.

 

CHAIRMAN WATKINS: People like you always get an E for
effort but I am looking for the absolute mark for --

MS. HARDISON: The absolute mark that I would have to
put on the card would be a D because we do have below average
prograns.

CHAIRMAN WATKINS: Do you think that if the Commission
were to bring additional witnesses before the Commission, who
have in depth knowledge in this area and have been pushing --
there are foundations, there are many groups, the Committee on
Economic Development made up of academics and business people,
who are very concerned about it, people like Children’s Defense
Fund - if we could bring that kind of pressure to bear, isn’t
there an opportunity here, in addition to the AIDS-specific
education, health education and health promotion practices, to
open up that issue and make some recommendations that would
reinstate in our country a much more fundamental approach to our
own health and our knowledge? Wouldn’t we learn to respect
ourselves and our neighbors a little bit better?

MS. FUTRELL: I believe that we would and I believe
that the United States of America, the people of this country,

448

 

 

 
 

TT

would be absolutely shocked if they knew that millions and
millions of children in this country, the most affluent society
in the world, do not have good health care. They do not have
access to good nutrition. We are abusing generation after
generation of children in this country in terms of health care.

I don’t think people are conscious of what we are
doing to the young people. For many young people, the only
medical care they receive is through a school nurse. That is
it. And if there is no school nurse, they do not have access to
medical care.

For many, the only nutritional meal they will receive
is what they get in school. For many, there is no one who
really cares whether they are in good health. We are trying to
work with these children on a day-to-day basis but I see the
situation getting worse rather than better.

I am absolutely amazed at the number of families which
do not have insurance, and can’t take the child to get medical
treatment. So, the situation is very bad, much worse than
people believe.

CHAIRMAN WATKINS: There is a tendency, I think, for
everyone to think of education in this context of being somewhat
-- let’s say at the secondary school or something of that nature,
when, in fact, we are facing very fundamental issues that go back
even to prenatal. At the 2000 Conference here last year a lot
of people were saying to start health educaation at early
adolescence; other people were preschool, but the general thrust
is get going early -- get into it early and worry a lot about it.

 

MS. FUTRELL: Just look at the infant mortality rates
in this country, for example. The infant mortality rate in
Washington, D.C. or Detroit is worse than what we would find in
Third World countries. So, I think if you decide to bring some
people forward representing the Children’s Defense Fund, the
School Nurses Association or other groups, you will be
enlightened by what you will hear. You probably will also be
shocked.

CHAIRMAN WATKINS: Would you two be willing to write
me a personal letter in follow-up to this discussion on
fundamental health education and health promotion? Perhaps some
ideas of how and who you might recommend to bring together on a
rather urgent basis.

We on the Carnegie Council are looking at a middle
school package. David Hornbeck is running our task force to put
health education in a strong movement with lots of money behind
it - to move it out into those areas that really are ready for

449

 

 

 
 

 

 

it. So, I think it is very timely now and I would hate to miss
this opportunity to get on the fundamentals, as well as on the
specifics of this virus.

MS. HARDISON: There are some states that right now, I
think, are doing some very exciting things, like Colorado and
Missouri, that have parenting classes and they are working with
parents. They are working with the mothers before the babies
are born, prenatal programs. I think there are some really good
programs and I wish that all of our students would have that.
But we need to get those people together. You are right.

CHAIRMAN WATKINS: Thank you very much for coming
before the Commission today and we would like to maintain our
contacts with you from now until our Commission goes out of
business in June. Thank you very much.

MS. FUTRELL: Thank you.

CHAIRMAN WATKINS: I would like to call the next panel
up and then I am going to turn the chair over to Dr. Crenshaw for
a brief period. It is on college/university education. Our
panelists are Dr. Arthur Sandeen, Vice President for Student
Affairs, University of Florida at Gainesville. We have Dr.
Richard Keeling, Director, University of Virginia Department of
Student Health; President-elect, American College Health
Association; Chairman of the American College Health Association
AIDS Task Force; James A. Kellar, Student Counselor, University
of Virginia and Laura Jill, Flickinger, Student Counselor,
University of Virginia.

Welcome to the panel and I will turn over the chair
now temporarily to Dr. Crenshaw.

6

DR. CRENSHAW: Welcome.
Dr. Sandeen, would you begin, please.

DR. SANDEEN: Thank you very much, Dr. Crenshaw, and
Members of the Commission. I want to express my appreciation
for this opportunity to comment on a topic of great importance
to all of us. I can assure you that those of us in colleges and
universities view this problem as a high priority and now one of
our most critical responsibilities.

I would also like to acknowledge today the outstanding
work of my colleague to my immediate left, Dr. Richard Keeling,
Director of the Student Health Service at the University of
Virginia. With his help and leadership through the American
College Health Association, those of us on college campuses now
have excellent resources, policy advice. and educational programs
available to us and it is through his positive leadership that I

450

 

 

 
 

 

am here today and the programs -- at least on my campus at the
University of Florida -- are doing as well as they are.

My comments, and I will shorten these from the written
ones that I submitted to you, focus mainly on the kinds of
responsibilities that I consider as a student affairs
administrator on a large college campus of 35,000 students. It
is my assumption that every college and university has a
responsibility to its students to provide the most accurate
information currently available about AIDS and to raise the
level of awareness about this disease.

How does a process like this get underway on a college
campus? Well, at the University of Florida and at many other
institutions around the country the most effective way has been
to approach the president of the institution, primarily through
the auspices of the Director of the Student Health Service and
other key administrators on the campus.

Usually, this takes the form of a presidential
committee on AIDS and that is what we have done at the
University of Florida. Such committees ought to involve medical
personnel, faculty, legal staff, student affairs deans, campus
clergy, psychological counselors, public affairs officers,
student government leaders, residence hall staff, minority
students, representatives of gay and lesbian student groups and
physically disabled students. We have had such a committee on
our campus operating now for about three years.

What kinds of obstacles are frequently confronted by
such groups on college campuses? As I said before, it is very
important to have the support of the institution’s president so
it is clear that the work of the committee reflects the goals of
the institution. Certain groups, of course, may complain to the
university that the institution should not deal with this topic
because the subject matter may encourage behavior that they
consider inappropriate or immoral. Others may express other
fears and suggest that the university discontinue any support for
gay student organizations, for example. Parents may even demand
that the institution adopt various restrictive policies and some
members of the college community may insist on the free
distribution of condoms or the sale of them in college residence
halls.

Some institutional administrators, fearful that
sexually explicit language or pictures in AIDS educational
materials may not enhance the college’s image may attempt to
screen or even censor publications.

Finally, some students may not trust the institution

to keep its counseling and medical records confidential and,
thus, may be hesitant to use the campus services.

451

 

 
 

 

Now, these matters, of course, are very serious and
well-known to members of the Commission, but they pale in
comparison to the three major obstacles that we find on college
campuses that face us in our educational efforts: fear,
ignorance and apathy. Strenuous efforts will be needed to
combat these problems. Students, of course, often think their
youthful vigor that makes them invulnerable to any disease and
out of fear of its consequences may ignore educational efforts
directed at then.

Youthful apathy may actually be avoidance or denial
because confronting one’s sexuality may be too threatening,
especially for young people struggling to establish their own
sexual identities.

We have several components to our AIDS educational
programs and as the American College Health Association
recommends, any AIDS education program on a college campus
should have several aspects to it. We have effective
publications that have been made available through the ACHA that
we have distributed to students. We also have developed
specific publications of our own that we distribute to every
enrolled student at the university, together with a letter from
the president of the institution. We think it is that
important. Very key, of course, for an educational institution
is to educate the gatekeepers, as we call them; those
counselors, teachers, student affairs staff, medical staff and
the like, who will have contact with students on these issues.

Good video tapes have been made available and we are
making use of these in several areas of our campus. Perhaps the
most encouraging part of our educational program in terms of its
positive impact upon students -- and I think you will hear more
about that from the students here from the University of Virginia
-- is peer group facilitators. Making use of trained volunteer
students in residence halls, in fraternities and sororities, in
classroom settings and in a number of other areas, I believe, is
the most effective way to develop programs that have the
potential of really changing student behavior.

We are fortunate at our institution to have a very
active student health service, as well, and we have two full
time, professionally-trained health educators there. However,
most of our activity on our campus through this committee has
been out of class; that is, through the extracurricular program.
One of the things that we need to do more of in all of our
institutions around the country is to build AIDS education and
good health education programs into the classroom experiences of
all students. I will conclude my comments by mentioning various
messages that I think that we should be sending through our
university and college AIDS education programs to our students.

452 -

 

 

 
 

 

There is fundamental disagreement about the propriety
of educational messages to prevent AIDS, according to Harvey
Feinberg at the School of Public Health at Harvard. He urges us
to avoid ambivalence in our educational message. Too often the
messages people receive are either reassuring or alarming. So,
our obligation in our programs and our campuses, of course, is to
provide consistent, honest, factual, up-to-date information.

That is the first message I hope we will give.

Second, in our AIDS education programs on college
campuses, if they are to be effective, they must lead to changes
in behavior. Those of us involved in AIDS education must focus
on this important fact. Information is needed, of course, but we
must urge students to deal openly with a topic which our culture
still finds socially uncomfortable our sexual behavior.

Until we are able to get our students to talk frankly
and honestly with each other about their sexual practices, we
probably will not make a very important impact with our campus
AIDS education programs. The most encouraging part of our peer
facilitator participation is that they have been reasonably
successful in getting students to talk with each other.

The third message: Bigotry in any form cannot be
tolerated on our campuses. This is a very important message
that the campus AIDS education program must transmit. It will
serve no one’s purpose to ridicule, judge or exclude members of
some group because of their sexual preferences or their
needle-sharing practices. A successful AIDS education program
requires a genuine, caring, non-judgmental concern for people.
If this tolerant, accepting attitude is not present, it will be
quickly sensed by those who need it most and the educational
program will be for naught.

Perhaps most importantly, the campus AIDS education
program must convey a sense of compassion. This must be
reflected in all of the activities and attitudes of the people
involved, from student peer facilitators, residence hall staff
and counselors to student affairs administrators, health
professionals and the campus president. The stakes in this
battle are much more serious than any other that we have faced
and the educational effort of our colleges and universities on
the AIDS problem should bring out the very best of us as human
beings. Thank you.

DR. CRENSHAW: Dr. Keeling.

DR. KEELING: Dr. Crenshaw, Members of the Commission,
I am troubled by the fairly dismal assessment of our young
people that we have been hearing today. As someone working on a
college campus, I would present an alternative view. I actually

453

 

 

 
 

 

have considerable confidence in the future of our young people.
I have a great deal of respect for the energy and commitment of
people like the two sitting on my left and I have a lot of hope
for the future that is in their hands. I would like to distill
the comments I made to you in my written testimony into ten
recommendations concerning AIDS education on college campuses.

First, I hope you will recommend and promote the
development of those educational programs. Dr. Watkins asked
that I comment in my testimony about reasons for our concern
about the spread of HIV among college students and I will do so
briefly.

The first of those concerns can be summarized as a
series of developmental issues. I don’t really see college
students as the hedonistic, uncaring, self-absorbed people
portrayed earlier today. Rather, I see them simply as people
going through the same developmental processes that you and I
did when we were their age.

I think that cognitive and moral development in
college students occur in settings of struggles to achieve
autonomy and responsibility; in settings that allow and
encourage experimental behavior. The same rejection of risk
which encourages drunk driving, use of alcohol and drugs, and
staying up all night the night before the final exams will
encourage unsafe sexual contacts.

In campus environments, the development of autonomy
and identity occur in contexts that stretch all boundaries of
thought and action. People are often away from home for the
first time. We often see them, therefore, put in situations of
relatively great vulnerability to HIV infection.

Many students have difficulty acknowledging or
planning for sexual activity, especially when parental or
societal standards forbid it. Many don’t know what they want
out of sex, don’t know where sex fits into their priorities, and
have not systematically separated their values from those of
others. It may be so difficult for them to acknowledge sexual
behavior that experimental sexual encounters will be furtive and
unacknowledged and, therefore, very often unprotected.

In addition, students will often use alcohol or
recreational drugs as a cover, which allows them to avoid
responsibility for sexual activity or as a way to promote sexual
activity in someone else. Acquaintance
rape is a serious problem on college campuses. In the situation
of acquaintance rape, precautions are seldom, if ever, taken.

Many students have not developed the self-esteen,
self-confidence, or assertiveness to make good decisions, to

454

 

 

 
 

postpone sexual activity, to demand safer sexual behaviors, or
to insist on the use of condoms, if they are having sexual
intercourse.

Complicating all of this is the fact that many of our
students arrive in college with a relatively fragile sense of
values. What indirect and inconsistent messages they may receive
from parents or others are often diluted by the strong influence
of peer pressure, what they see in the public media, what they
read in advertising. The relativity of values which is inherent
in a series of revelations about the personal behavior of
television evangelists or presidential candidates contributes to
a cynicism about morality in general and to a distrust of
restrictions suggested by people in authority.

Beyond these developmental considerations about sexual
behavior are similar issues related to experimental use of
drugs, which on college campuses is more often occasional and
experimental than it is addictive and consistent.

Reinforcing these developmental concerns is the
experience of college health centers, which tells us repeatedly
that students are commonly sexually active and that they are
rarely predictable or consistent in their use of measures to
prevent pregnancy or sexually transmitted disease. We know that
as much as 25 percent of the clinical case load in many student
health services is made up directly of problems related to sexual
behavior or unprotected sexual contacts.

For all of these reasons then, we have both
theoretical and experiential concern about the possibility of
transmission of HIV among college students. Therefore, our
first recommendation is to promote the development of effective
eduation programs.

Our second recommendation: we hope that you will
encourage and endorse those education/prevention programs on all
college campuses. Dr. Watkins asked that I address barriers to
effective AIDS education. One is the obstacle of opposition from
other people looking at these programs and concerned about the
terminology, the concepts, the vocabulary, or the imagery.

Sometimes people deny that AIDS can happen "here."
They think it is "somebody else’s problem." The endorsement of a
prestigious national panel would lend relevance and credibility
to the implementation of these programs in institutions, which
have thus far been reluctant. It will be helpful to work through
national organizations to set guidelines and standards for these
programs.

A third recommendation is that you assist colleges and
universities in organizing and implementing these programs

455

 

 
 

EE

through training educators and counselors. Another barrier to
providing AIDS education is not just reluctance, but inadequacy
of numbers of educators or counselors or amounts of funds to
train and prepare them for the work they have to do.

Training grants, regional workshops, institutes
sponsored through the American College Health Association, (as
is now done through our cooperative agreement with the Centers
for Disease Control,) will help. More of those initiatives are
needed to build skill and expertise in specific issues of
college and university AIDS prevention.

Let me emphasize in response to a question asked in.
the previous panel that these training programs have been
carried on for more than three years without federal assistance
prior to the development of the cooperative agreements, through
volunteer work, through the contribution of people in national
organizations and higher education and the support of individual
schools.

Our fourth recommendation is that you encourage the
development of explicit and effective sexuality and sexually
transmitted disease education programs in higher education prior
to college. The fact is that many of our students arrive on our
college campuses imperfectly prepared to deal with the issues
that face them when they get there. Parents and, sometimes,
school systems have been unable or unwilling to provide accurate,
sensible and comprehensive information. Often the programs have
been quite watered down. Sometimes people fear that explicit
language will convert good kids into bad ones and the result for
us is that many of our students arrive in our residence halls
with incomplete and sometimes distorted knowledge about
sexuality, contraception and sexually transmitted disease.

 

Our fifth recommendation is that we hope you will
provide resources for research into effective educational
strategies by funding demonstration projects and teaching models
that address the specific vulnerabilities of college and
university students. These good educational programs, we think,
will work with and through the developmental conflicts we have
addressed. They will emphasize skills building, negotiation, and
good decision-making. They will work to develop community
consensus of safer behavior and safer decisions. They will
emphasize the development of self-esteem.

We believe in the American College Health Association
and on college campuses that the most important weapon our
students have in protecting themselves against infection with
HIV is self-respect and self-esteem. The message we deliver
must be one of valuation and we must find ways to encourage
self-esteem if we are going to hope to prevent HIV infection.

456

 

 
 

 

 

Messages of self esteem should be for male and female
students, gay and straight students, white and minority
students. The fact is that if we continue to tell our students
that they are hedonistic and self-absorbed, or if we tell our
black students that they are second rate, or if we tell our gay
students that all they do or are is wrong, we have no hope of
their regarding themselves with enough value to take the
precautions that will protect them from HIV infection.

Our sixth recommendation is that you support basic
behavioral, social, and psychological research into educational
approaches which overcome the resistance inherent in the sense
of invulnerability and invincibility among students in this
group. We believe many of those projects will center in the
development of self-esteem.

Seventh, we hope you will assist colleges and
universities in the development of resources and materials which
are explicit and helpful. The common admonition of AIDS
education for young people, "don’t share body fluids," is
confusing. What fluids are we talking about? What exactly does
"Share" mean? A society that launders and sanitizes words,
replaces unpleasant images with euphemisms, and romanticizes them
with substitutes will promote the same mythological thinking that
has allowed some students to believe you cannot conceive
pregnancy if intercourse occurs with both parties standing up.

Eighth, we hope you support the development and
implementation of education programs which specifically address
the different and important issues of a rich diversity of
students on our campuses. Programs which work for inner city
schools will be different than those that work on residential
campuses. Programs which work for Latino students in some areas
may not work for Latinos in others.

We need to address the needs of black students when
they are in the majority and when they are in the minority on
the college campus. Materials for gay students must be cautious
that our teaching about male to male sexuality does not
stigmatize gay men nor blame them for this epidemic.

Ninth, I hope you will support the development of a
variety of education models are integrated into a diversity of
other campus activities. These AIDS education programs, if they
function as part of the ordinary process of life in an
institution, will provide more success and less risk. They can
be provided through campus ministers, through counselors,
through the local Red Cross blood centers, through resident
advisors in residence halls, through athletic trainers, through
international student centers and advisers and through the peer
education programs that you will hear about in just a moment.
Organizations representing and working with those individuals

457

 

 
 

 

may be involved in AIDS education through the model of the
cooperative agreements that we have seen. Multiplying of .
resources will allow us to reach a large number of students with
the expenditure of relatively small numbers of funds.

Finally, our tenth recommendation: we hope you will
support carefully-designed and sensitively-conducted
seroprevalence studies to estimate the incidence of HIV
infection among college students and to monitor trends in
infection over time such that we will have baseline data on
which to base educational strategies and on which to target our
interventions.

Those are our recommendations. Thank you very much.
DR. CRENSHAW: Thank you.

Mr. Kellar.

MR. KELLER: Thank you.

I am a third year architecture student at the
University of Virginia and have been a peer sexuality educator
for two years now and I wanted to describe to you who we are as
peer sexuality educators and what we do at the university.

First of all, we are not medically-trained experts.
Rather, we are specially-trained students. We are trained in
the area of contraception, sexually transmitted diseases, sexual
lifestyle issues and pelvic exam procedure.

Our activities include dorm talks where we go to the
first year dorms at the university and discuss with the first
year students contraception. We bring a bag of a condon,
diaphragm, spermacide, to show first year students. We discuss
sexually transmitted diseases and then we generally go into a
discussion about sexual lifestyle issues.

Very often we talk about date rape and we talk about
AIDS. Those are the two big areas where we get all the
questions.

. We hand out our safer sex packet, which we have put
together, which include a condom and information on sexually
transmitted diseases and contraception. We publish a booklet
called "Ounce of Prevention," which has extensive information on
contraception, sexually transmitted diseases, is edited by,
among others, Dr. Keeling, and that is also handed’ out at the
dorm talks.

Each peer sexuality educator has office hours at
Student Health, where we see students who come in. They either

458

 

 
 

 

make an appointment or they call us. Usually we have a lot of
females coming in for their first pelvic exam and we tell then,
first of all, what they should expect. We also get a lot of
students coming in wanting to know about birth control.

Usually, if someone comes in thinking they have a
sexually transmitted disease, we refer them to a medical expert.

We co-sponsor an annual condom awareness day at the
university. We co-sponsor it with the Lesbian and Gay Student
Union. This has achieved somewhat legendary status at the
university. A lot of people look forward to it with
anticipation, ourselves included. At this event, we hand out
condoms and information on birth control and sexually
transmitted diseases.

We have an outreach program where we go out -- number
one, to train a group called Madison Health Hotline. They man a
hotline at the university, which anyone can call. It is a kind of
general, all-purpose, depression, trouble, problem hotline and we
train them in our area of expertise.

Once in awhile we will get a request from a social
organization, such as a fraternity or a sorority, for us to
discuss with them -- usually they want to know about sexually
transmitted diseases, specifically AIDS, and other sexual
lifestyle issues.

Finally, all of our literature is kept, as well as at
Student Health, at a place -- at our main student activity
building, called the Wellness Center, a type of self-diagnostic
treatment center, where all the literature, all of our
materials, are easy to reach by the students.

DR. CRENSHAW: Thank you very much, Mr. Keller.
Ms. Flickinger.

MS. FLICKINGER: I am Laura Flickinger. I am a fourth
year English major and the chairperson of peer sexuality
education at the University of Virginia. I got involved with
the program in my first year because I was interested in getting
some counseling experience and also because I saw a need at UVA
for peer education.

I think college students find it a lot easier to talk
about sensitive issues, like sexuality, with a trained peer,
rather than having to talk with a doctor, nurse or some other
type of authority figure.

Being a peer sexually educator has been extremely
rewarding for me. For example, many women come into the office
for their first peliv exams extremely nervous and upset. I just

459

 

 
 

 

sit down with them and go over the procedure and talk out their
fears a bit. It is really, rewarding to see them leave the room
looking very much relieved. In addition, I have friends who call
GYN and ‘ask to talk to me in particular. I find that very
satisfying as well.

Also, I gave a talk in my sorority a couple of months
ago, which went really well. We generated a lot of discussion.
In fact, we discussed the talk for weeks afterwards. It
appeared that everyone came away well-informed and that the
material made them think. It was very successful.

One thing I want to talk about today is our training.
I don’t want you to think that we go and impart all this
information to students without having been adequately prepared.
The training is extensive. It is 30 hours long and it requires
that we read and attend lectures about anatomy and physiology,
birth control, sexually transmitted disease, group facilitation,
communication skills and the emotional, identity and
developmental issues of sexuality. Thus, we are very well
prepared.

In addition, all new PSEs must complete a mock session
before they can be allowed to counsel. It is just a role play in
which one potential PSE will play the client and the other will
be the PSE and they will go through a session in front of an old
PSE. The PSE will give the role players feedback and let them
know if they are prepared well enough to actually be counseling
other students.

Another good thing about the program, besides the fact
that we are well-trained, is that the group itself is very
diverse. Of the 25 members, we have students from all walks of
life, with males and females, blacks, whites, homosexuals, RAs,
people from all the different schools at UVA. Also, the
personalities of the people who are in the group are fantastic.
Everyone is very open and they enjoy their jobs. They really
care about the students to whom they are talking.

Student reception to the program has been
enthusiastic. We give evaluations to all the students who come
into the office and 95 percent of those come back rating the
PSEs as excellent. That is also reflected in the dorm talks,
which Mr. Keller talked about before, where two or three PSEs
will go into the first year dorms and discuss issues like birth
control, sexually transmitted disease and values. Those
students are very enthusiastic and a lot of good discussion gets
going.

One thing we find from the evaluations from the dorm
talks is that these students really do need the information.
They say that they have had ‘sex education in high school, but

460

 

 
 

 

also that they learned something new at the talks, which
reflects that either we are going into more depth or covering
different issues than they learned in high school. So, they are
getting information that they truly need.

In conclusion, I would like to say that I think the
program benefits everyone involved, both the people who are in
the program as PSEs and also the students who are receiving the
education. And I would be extremely happy if, as a Commission,
you would support peer education on college campuses. Thank you.

DR. CRENSHAW: Thank you.
Let’s begin the questions with Dr. Walsh.
DR. WALSH: Thank you, Dr. Crenshaw.

We are always into the essence of the success of
education as behavioral modification. We have heard varied
opinions about if you don’t get them in kindergarten, you don’t
get them at all on up through, different age groups, each
feeling strongly about what they believe.

One question is by the time a young man or woman gets
to college in this generation, is behavioral modification still
on fertile soil? I mean, is there something that you are able
to do in bringing about behavioral modification, whether it be
in substance abuse, alcohol, sex habits? Is your counseling and
your support primarily supportive by that time rather than able
to achieve any behavioral modification? All or any of you.

DR. SANDEEN: I suspect you are going to hear
responses from a biased group. I have spent my career with
college students, so I believe that the college years represent
an important stage where developmental education takes place. I
am speaking now primarily with the 18 to 22 year old group of
college students. Of course, there are many much older than
that, as well. But there is a good deal of research to indicate
that students, in fact, do change during those years in-terms of
their attitudes, their values, and the ways they choose to spend
their lives. And much of the education that we are involved in
with students is directed at those issues. So my response very
clearly is "yes," we do believe that students during these years
can change. That is one of our important responsibilities, to
assist them in that process.

DR. KEELING: I would agree with Art Sandeen. I think
that the whole process of what we talk about in student affairs
in a college setting we call of student development and the use
of that term, I think, implies very correctly that these young
people are still not just fertile but wonderfully fertile for
development and advancement and change.

461

 

 
 

 

I think that sometimes our perception that we fail to |
do that is based more on the failure of our methods than it is
on the fertility of the soil. _*

MR. KELLER: There is a lot of pressure in college by
the freshman year to have a basic knowledge of birth control, of
sexually transmitted diseases so that -- at least in the company
of their peers, when we walk into a dorm, we run the risk of
being redundant and we don’t get a lot of response from
discussing birth control. We get some response from sexually
transmitted diseases and we get a lot of response from AIDS and
other issues, such as date rape.

We do find, however, that there are a lot of basic
facts about sexuality that slip through the cracks and we find
that when we talk to people in the office hours. People come to
us and it is really rewarding to tell someone something that is
second nature to you, that they have just never really
understood or never even knew. So, I think there is a lot of
room for expansion in college.

MS. FLICKINGER: I would definitely agree. I think
that sometimes students don’t listen to information. It kind of
goes in one ear and out the other until they really get
themselves into a situation where the information is going to do
them some good. It is when students have need of information
that it is nice that we are available because they can come and
ask us. There is definitely room for change because students are
changing constantly.

DR. WALSH: I think you implied as much, Mr. Keller,
as a counselor and a college student, or close to that level,
you have been surprised, perhaps, at the lack of sophistication
of some of your classmates by the time they get to college or do
you find them fairly knowledgeable, despite what apparently isa
lack of health education, in secondary schools or lower?

MR. KELLER: No. I find them, on a whole, very --
DR. WALSH: Very sophisticated.

MR. KELLER: -- sophisticated, very well-versed in
sexuality. What I was trying to get across is that that kind of
breeds an atmosphere where if you don’t know certain basic
facts, it is difficult to ask in some settings. So, when they
do come to us, it is about some -- generally, it is a small
thing, well, to us, but to them it can mean a world of
difference.

DR. WALSH: Now, my last question is we have seen a
great deal about behavioral modification and heard a great deal
about behavioral modification among the gay community. I think

462

 

 
 

 

that has been primarily among the so-called mature gay

community, in the major cities, where they have done a very fine
job of education. Do you notice any difference or any trend or
any change in the behavior of homosexuals at the college age. Do
you see that many homosexuals at college age that are not having
behavioral modification in their sexual habits?

MR. KELLER: We do see a lot of homosexuals. We are
-- I personally have not talked to that many. It is hard from
my perspective to grasp the change. What I see in the gay
community is a lot of change toward having fewer sexual
partners, a definite awareness of ways to prevent catching a
sexually transmitted disease, a definite awareness that they are
in a high risk group.

DR. WALSH: No, it is good because I was curious as to
whether the education that has been offered by the gay men’s
groups has reached down to that level. We know it has reached
the more adult group. Have you had experience with that?

DR. KEELING: Let me just comment from the point of
view of a health service. By the evidence we see in either
patterns of immunization to Hepatitis B, which is strongly
recommended for our gay students or by rates of sexually
transmitted diseases in our gay population, we see
extraordinary evidence of responsibility.

The rates of sexually transmitted diseases among our
gay students are now much lower than rates of sexually
transmitted disease among students in general.

DR. WALSH: Both homosexual and bisexual students?
DR. KEELING: Right.
DR. WALSH: Good.

DR. KEELING: And what we find, I think, would
validate everything that Andy said and that what we see
medically verifies the social observations he makes.

DR. SANDEEN: If I can make a brief comment on that,
it has only been in about the last 15 years, at least in my
experience in the Midwest and in Florida, that some of our gay
student organizations on college campuses have, in effect, come
out as student organizations and have participated in campus
life openly, in student government activities and the like.

Since the AIDS problem has been with us, many of us on
college campuses have seen these gay student organizations
become much less visible. So, those of us engaged in AIDS

463

 

 
 

 

education efforts, in order to reach those students, have had to
make special efforts to assist them to feel more comfortable on
the campus, not only as individuals but as organizations. We
feel that is an important component of the efforts that we are
engaged in now.

DR. WALSH: Thank you.
DR. CRENSHAW: Ms. Welch.

DR. CONWAY-WELCH: Dr. Sandeen, a brief question. Do
you see the interest on college campuses now in terms of
education about sexuality in general and HIV in particular coming
out of a groundswell of student interest to which administrators
respond or is it administrative interest which is sort of imposed
on -- not imposed, but comes down from above down to the students
in the sense that they should be interested in it?

DR. SANDEEN: I think there is probably some of both,
but as you know, as a health professional, there is great
interest in health, fitness, wellness throughout our society and
perhaps among our college age youth, in particular.

On the other hand, specifically on the AIDS issue, at
least on our campus at the University of Florida, the
initiative, began with us as administrators, but we quickly
found, as we find with all other activities, where we are trying
to have some impact upon our students, we must involve student
organizations throughout the campus, and faculty. So, it quickly
became a joint effort and now our students are very active
supporters.

DR. CONWAY-WELCH: Thank you.

DR. KEELING: Dr. Welch, if I could add, in the
process of my work in the past three years, I have, as of
yesterday, been to 186 college campuses, doing AIDS education
work. About 20 percent of the time I actually am brought in by
student groups themselves, as opposed to by the campus
administration. There is a pleasing diversity of those groups,
sometimes from sororities to lesbian/gay student groups to peer
sexuality education groups to sometimes just coalitions of black
students or others, who want to learn.

I think that some of the most impressive AIDS
education programs we have had on our college campuses have
actually developed at grass roots level by students themselves
and have required and eventually sought assistance from us in
student affairs to work with them.

|

DR. CONWAY-WELCH: Thank you.

464

 

 
 

 

DR. CRENSHAW: Thank you --

MS. FLICKINGER: I wanted to add that I talked to a
friend the other day, who is a chairperson of peer sexuality
education at the University of Pennsylvania, and she said that
~- they are having a big problem getting it started because
there is a lack of interest from the administration.

DR. CRENSHAW: Thank you. Thank you, Dr. Welch.
Ms. Gebbie.

MS. GEBBIE: I have some sense that we may have been
hearing described today sort of the cream of the program; that
is, a rather comprehensive and well-structured one and we have
heard something about the level of interest in other colleges,
but if you -- sort of like the question that was asked of the
previous panel, if you had to rate in general colleges across
the country, are more than half of them well up into the kind of
program we have been hearing described this afternoon or 5 or 10
percent or are some of them still absolutely terrified of this
kind of open acknowledgment of the sexuality of their students?

DR. KEELING: We have some anecdotal information about
that and some survey information. The American Council on
Education this past May surveyed institutions to seek whether
they had AIDS policies or AIDS education programs. They found
an overall rate of only 19 percent of American colleges and
universities then operating such programs or having such
policies.

Within that 19 percent, however, were some
distinctions which are important. Institutions which had
baccalaureate programs had lower rates than those with master’s
or doctorate programs and as you reached universities with more
comprehensive educational programs, the likelihood of having an
AIDS education program or policy did surpass 50 percent.

I think what we have seen in the past six or eight
months is some improvement in those numbers, but the cooperative
agreement between our association and the CDC was expressly
developed to try to raise those numbers and improve the numbers
of schools providing AIDS education programs. I would estimate
now maybe 30 percent or a third of all institutions providing
them. Many of the ones which are do are smaller, commuter,
community colleges or two year schools, which have fewer
resources and fewer people, less access to a "captive population"
for an educational programs.

, DR. CRENSHAW: Thank you. Dr. Lilly.
DR. LILLY: Just a quick question. --

465

 

 
 

 

DR. CRENSHAW: Hold it. Do you have --
MS. GEBBIE: I have another question.

One of the things that has been suggested to me by a
faculty member of a university is that in addition to this kind.
of very specific service and the student health-related things
on AIDS and the biology-oriented approach to AIDS, that colleges
and universities could contribute to our total social
understanding of this epidemic through an academic exploration
of the epidemic from a broader base in interdisciplinary
courses, in which ethicists, sociologists, historians might join
with biologists to look at what is going on and interpret some of
what we are experiencing here ‘to aid the society.

po ' Is that something that has been talked about that you “
are familiar with in any way or what kind of comment would you .
have on that?

DR. KEELING: It has and there have been some
experimental programs developed. Interestingly, several of
them, which have been most creative, have been developed in
schools or colleges of nursing as parts of universities, in
which nursing professionals have brought together the skills of
people from the medical school, other academic areas, sociology,
anthropology, biology, psychology, to put together comprehensive
courses on AIDS.

‘The one through our nursing school at the University
of Virginia, for example, is simply called "AIDS: Beyond the
Medical Issues." There is attention to the medical issue for
the first couple of weeks, but the remaining 16 weeks of the
course deal with everything from ethics and philosophy to public
policy to law, et cetera. That is mirrored in other attempts to
integrate information about AIDS into class curricula through
courses. Some of the most important and helpful experiences
that many of us doing campus AIDS education have are those of
going into a lecture class, doing a couple of. guest lectures
about AIDS and then participating in the discussions that
follow.

_DR. CRENSHAW: Dr. Lilly. |

_ ;DR. LILLY: Just a ‘quick question out of curiosity. "
Mr. Keller, you used twice the phrase "lifestyle." What did you
‘mean by that phrase? - yo, 4 .

MR. KELLER: We use that phrase to encompass the types

of issues that we.discuss. . Like I said, date rape is a large
issue and -- " . So |

466

 

 
 

 

DR. LILLY: As a lifestyle?

MR. KELLER: No, but it is something to acknowledge
during your lifetime. We also -- that refers to people coming
in to our office hours discussing sexual dysfunction,
homosexuality -- |

DR. LILLY: I just wondered. Thank you.

DR. CRENSHAW: Dr. Lee

DR. LEE: When we are talking to this group, we are.
talking to the cream of the crop and there is a problem that we
have in the AIDS game, that most of the people that are getting
AIDS are not college graduates. They don’t have educated
parents. They don’t have intact families. That is what sort of
brought AIDS to -~ well, excuse me -- it happens, but it is
tremendously in disproportion with the people in the
disadvantaged homes, et cetera.

They drop out of college; they drop out of high
school; they drop out of grade school. You people on the right
are very valued in helping your peers. I know at Yale, my alma
mater, there is an awful lot of activity in the community, New
Haven. Do you try to interact with your local communities and
in the cities where you operate because that is where a
tremendous percentage of the problem lies?

DR. SANDEEN: I appreciate that question because, as
Dr. Keeling said earlier, he is very high about college students
and the positive things that characterize their lives these days.
I share that view and there is a move now on many campuses
throughout the country back to volunteerism by students in the
very best sense of that word. An organization called Campus
Compact, through the Education Commission of the States, now is
on well over a hundred campuses, specifically recruiting students
to engage in community service activities.

We now have a volunteer center on our campus and while
we are not located in a large, urban area -- we only have a
hundred thousand people in our city -- there are obvious needs
there that perhaps our students can contribute to related to this
problem.

| I think that opens up an important area of
responsibility that we can help teach our students while they
are, in college because it is one of the responsibilities that
they have as college educated people.

‘DR. KEELING: Let me add that I think in teaching and
working with the very gifted people whom we have the real
privilege to deal with in our work, that we are dealing with
people from whom will come leadership in the future; leadership

467

if’

 

 
 

EE

in programs and policy, leadership in society and ethics and I
think that what we do with our college students will be almost
endlessly multiplied in what they will do after they leave us.
The investment we make in them, even to the extent that some of
them would not have allowed themselves to be at risk anyway, c
will be greatly rewarded in what they will do for others who
might be more at risk.

I would also say that as a physician, who does care
for patients with AIDS, that at least 80 percent of the people
with AIDS I have cared for and buried have had college degrees.
I think that we wouldn’t want to create the impression that
people who did have college degrees were any less at risk than -:
people who didn’t. 7

MR. KELLER: I would like to say that we have our
hands full at the University of Virginia in the things that we
do and if we were to go out into the community, it would take an
expansion of our organization.

1

DR. KEELING: I might just mention one other little
piece of that, though. We have at one level beyond college, in:
the professional school level, we have medical students at the
University of Virginia, who are performing AIDS education
service in the high school systems in the communities in which
they live. They take what is basically the limited off-time
that they have to go work with high school students towards’
better AIDS education. Similar programs among graduate and

é
‘

 

undergraduate nursing students from our institution ~-- and Art
is nodding his head, I suspect from others that he knows of as —
well.

DR. LEE: One of the main reasons I am trying to put
this to you, though, is if I talk to a 14 or a 16 year old and
he is a person who is not my child, they would think of me at
the present time as ancient history. They are going to look. at
this gentleman as history and they are going to look at him as,
okay, maybe we have to listen. For them, you two people are
gods. You are in your early twenties. You know all the answers
and you are simply gods to a 14 or 15 year old kid.

In the local communities, as has been stressed here,
self-esteem and self-worth, when you are a young person, is the
whole of the game and you can spot instantly the person in the
group that knows what he is doing, knows where he is going. The
other students just gravitate to him. That is why a gentleman —
like this, I know, would be very successful. They are going to‘
go right for him. He has a feel for it. You people have a
terrific role to play with these kids. An awful lot of the
people going into drugs have no self-esteem whatsoever. I ‘mean;
that has been the testimony that comes out endlessly on this and
the peers in your age group are everything. So, I am trying to

468

 

 

 
 

 

téll you what power you have and I hope that you will be
encouraged to use it." 7 °° By

‘DR. CRENSHAW: Dr. Keeling, you ‘mentioned the quest
for some baseline surveillance data that could be followed over
time in the college students. Do you think there is a role for
testing among ‘college students,’ voluntary testing, and, if so,
are the facilities readily ‘available to the students?

- BR. KEELING: I think’ we have a-couple of different -—
possibilities here. I think what we need ‘first is an absolutely
blinded series of studies to try to answer the very basic
question of prevalence of infection. Once we ‘know that data, it
may ‘be appropriate to subdivide and refine the study to'try to

define’ risk: factors or define areas of infection or try to focus

our educationdl programs”on''the basis of that data. ~_

When you get to those levels of study that may require
voluntary consent,’ as opposed to a blinded study. In addition,
I would add that many college health services now provide
counseling and testing services for HIV antibody. There are a
number of college health services, which provide truly anonymous
testing. The majority of good college health centers which have
laboratory capability provide either their own drawing of blood
for antibody testing service or referral to an immediately
accessible community clinic for it.

In all of these situations, I think the health services
accept their responsibility to provide the pre-test counseling
and the post-counseling and support, which are inherent in any
good testing programs. So, I think there is room for both
research level testing to help us define our needs better and for
voluntary available testing for students, who want to assess
their own risk of infection or to answer the questions they need
to know.

DR. CRENSHAW: Thank you.
Dr. SerVaas, did you have any questions? No. Okay.

I want to thank you so much. It is really a pleasure
at the end of the day to hear an encouraging and uplifting
message because I happen to believe in our kids, too, and I
think that they are capable of teaching us a few things. So,
thank you for your thoughtfulness and for your encouraging words
and at this point I would like to turn the meeting back over to
the Admiral.

CHAIRMAN WATKINS: Thank you very much, panel members.
I apologize for not having been here for a majority of your
discussions. I did hear Dr. Sandeen talk about the Campus
Compact, which I think is one of the bright hopes. We have to
begin the movement of community service among youth in the

| 469

 

 
 

 

ie

nation. We need them desperately to help other youth. We need
them in many other ways. And the work you are doing at Brown
University and other universities is really heartening. It will
probably be the embreyo of a movement in this nation to move much
more aggressively. |

We are going to need that baccalaureate level
experience and push to get help in the nation. We all know the
numbers. We need 3 1/2 million young people helping us right
now. So, we can use that movement and it is an inspiration to
hear that you are enthusiastic about it. —

a ‘Thank you very much. We are going to adjourn the
formal hearings on education at this point and we are going to
reconvene the Commission in Executive Session at this point. I
call all the Members of the Commission up now for Executive
Session. : :

7 (Whereupon, at 5:33 p.m., the open session of the

hearing was adjourned.) Z