Prevention Methods Dramatized : AIDS Education Aimed at Mainstream America

Walt Disney Productions is aiming one of its newest releases for the teen-age audience. The cast is topped by Ally Sheedy, the fresh-faced everygirl star of the films “Short Circuit,” “The Breakfast Club” and “WarGames.” The music is by Stevie Wonder. The animation is by computer.

It could soon be playing in a classroom near you--provided, of course, your school board is willing.

This film, an educational documentary, is titled “AIDS.”

“It is important to follow safe sex practices if you are having sexual relations,” Sheedy, as host, cautions young viewers. “Always use condoms during sexual intercourse.” In sobering detail, the film goes on to discuss topics such as the risks of oral and anal sex.

Strong stuff, some might think, for grades 7 through 12. But many public health authorities consider it crucially important for students across the country to learn the nitty-gritty do’s and don’ts about acquired immune deficiency syndrome. Surgeon General C. Everett Koop in October urged that AIDS education start as early as the third grade “so that children can grow up knowing the behavior to avoid to protect themselves.”

As the Disney film illustrates, the lesson about AIDS prevention, once focused exclusively on the high-risk homosexual community, is aiming for mainstream America. With the virus increasingly creeping into the heterosexual population and a vaccine years away, if at all, AIDS prevention efforts are slowly finding their way into schools, colleges and the workplace.

AIDS Project Los Angeles, a community support group, has delivered lectures to churches and synagogues, college fraternities and sororities, and chapters of such groups as Parents Without Partners, Lions Club and Kiwanis.

At the same time, some health officials and activists are urging gay males to voluntarily take the confidential AIDS antibodies test to see if they have been exposed to the virus and modify their behavior accordingly.

But compared to the magnitude of the growing AIDS threat, even these educational efforts may not be enough, partly as a result of insufficient government funding, many authorities and activists say.

“All we’ve done so far is to apply a Band-Aid to an open wound,” said Bruce Decker, chairman of Gov. George Deukmejian’s California AIDS Advisory Committee. “There is a small but relatively visible AIDS prevention effort, but it has been hobbled by paralysis in the government from the beginning.”

Such efforts are all the more crucial, health officials say, because of the public’s misconceptions about AIDS and aversion to a subject matter that is shrouded in taboos concerning sex, homosexuality, drugs and death.

For instance, despite the consensus that the AIDS virus is not transmitted through casual social contact, 54% in a recent Gallup Poll said AIDS patients should be quarantined. A year earlier, a Los Angeles Times Poll in December, 1985, found 51% in favor of quarantine. A Louis Harris Poll in September, 1985, found that 30% to 53% of respondents believed AIDS could be contracted through such contacts as “working side by side with someone with AIDS” or “sitting in a classroom with an AIDS victim.”

Protection Against AIDS

Still, among society’s advantages, authorities say, is the fact that protection against the AIDS virus requires no technological advances. A sturdy condom will suffice. But because condoms sometimes break, some researchers also recommend the use of a nonoxynol 9 spermicide as an extra safeguard because it has been shown to kill the virus in laboratory tests. (Such measures also lessen the risk of contracting other sexually transmitted diseases. But health officials stress that spermicide alone may not prevent spread of the AIDS virus.)

Thus, in practice, AIDS prevention can be a fairly simple matter, doctors say. But changing the sexual habits of a nation is something else.

“Before the (birth control) pill, it seemed like every man in America went around with a shriveled up rubber in his wallet,” said Dr. Peter Heseltine, co-director of the AIDS program at the Los Angeles County-USC Medical Center. “Well, I think we should go back to that.”

As it is, authorities say, many people may avoid activities that are perfectly safe, such as dining in a gay-operated restaurant. Those same people, however, may indulge in other activities that are risky, such as unprotected sex.

The U.S. Public Health Service estimates that about 1.5 million people in the United States are infected by the AIDS virus. All of these people are thought to be capable of transmitting the disease, but many of them, perhaps most, do not even realize they are infected. About 25% to 30% of them can expect to develop the invariably fatal AID.

The large majority of the carriers are males, who contracted the disease through homosexual intercourse, followed by persons of both sexes who became infected by sharing intravenous drug needles, and, finally, by persons of both sexes who became infected via blood transfusions. (Because of extensive blood donation screening, the risk of receiving contaminated blood is considered slight.) Anyone who has sexual contact with any of these persons also potentially carries the infection.

Together, these factors mean that anybody who has had sexual relations in the past eight years outside a mutually monogamous relationship has had at least a minute chance of exposure to the virus, experts say. The more sex partners, the greater the chance.

Educational Problems

The educational problems are also practical--how to deal with the diverse socioeconomic levels, ethnic groups, languages and moral attitudes of American society. Dilemmas are inevitable. Just last week, AIDS service groups, noting that the disease has disproportionately struck the Latino community, introduced a new Spanish-language instructional program. Also, the Roman Catholic Archdiocese of Los Angeles at first endorsed a new Spanish-language AIDS education program, but then rescinded its support because “this . . . would be seen as a sanction for using condoms.” Catholic doctrine forbids sex outside of marriage and prohibits the use of condoms.

Perhaps the most difficult group to educate is also one of the most important: The users of intravenous drugs, who spread the virus among themselves by sharing needles. They are considered an important link in spreading the virus to the heterosexual mainstream. These people who chronically abuse their own health pose a threat to their sexual partners, and thus their partner’s partners, and so on.

“How do you reach them?” Walter Dowdle, CDC’s AIDS director and director of its center for infectious diseases, said of drug users. “What is the message? How do you package it? That’s the key.”

In New York and New Jersey, where intravenous drug abusers make up as much as 50% of AIDS cases, drug rehabilitation counselors have given AIDS lectures to junkies who come in for treatment. Some workers have gone into the rough neighborhoods where drug use is common to distribute AIDS prevention brochures. Posters adorn walls and telephone poles advising people not to share needles.

Authorities in New Jersey have sent reformed addicts with AIDS warnings into the so-called “shooting galleries.” Officials say an unexpected ally joined the fight against AIDS. Some junkies have told drug counselors that they had already heard the AIDS warnings and read the brochures. Their dealers, it turned out, were handing them out.

The pushers “have an economic incentive,” said Annette Johnson, a health education specialist in the New York state Health Department. “They don’t want that population to die. They wouldn’t have anybody to supply.”

Lower Rate in California

In California, reports of AIDS among intravenous drug abusers have been on the rise, but they are still nowhere near the proportions of the New York area. One study in San Francisco found the AIDS virus among 18% of intravenous drug users. In Los Angeles, county health authorities estimate the prevalence at 3%.

So far, California authorities have largely relied on drug counselors to provide AIDS education.

But when it comes to reaching teen-agers and young adults, different problems arise.

Several universities, including the University of California and the California State University systems, have developed AIDS educational programs for their students. Just last month, a discussion titled “Heterosexual College Students and AIDS: Behavior and Prevention” was featured during AIDS Awareness Week at Cal State Long Beach.

But the level of interest in such programs is still low. “The general impression I get is that the heterosexual students feel it still isn’t really something to concern them,” said Roland Kerr, director of student affairs at the Long Beach campus who helped develop the education program. “Some are just embarrassed to go up and find out more.”

In the secondary schools, AIDS education becomes a matter of controversy.

“Many of us have tried to emphasize the need to get information about this disease into middle schools to kids just thinking about playing around with sex or drugs--and this makes parents hyperventilate real fast,” said Kristine Gebbie, chairwoman of the AIDS task force of the Assn. of State and Territorial Health Officers.

“It means talking some about gay sex. It means asking questions like, ‘Should we provide condoms to all teen-age boys?’ These are all things thrown around in discussion,” Gebbie said. “Some school districts are thinking about curriculum material. Others are holding way off.”

Ironically, health authorities say some school districts have played a regressive role in AIDS education by barring from school students who have AIDS or test positive for AIDS antibodies, thus reinforcing the incorrect view that AIDS can be spread in casual contact.

While many school districts around the country continue to shy away from AIDS education, a striking exception is the Los Angeles Unified School District.

Part of Health Curriculum

In a decision widely praised by health officials, the Los Angeles school board in October, 1985, became one of the nation’s first to require AIDS as part of its health curriculum, starting at grade 7.

The curriculum in the Los Angeles school system, like the state’s proposed teaching guide for AIDS curriculum, cites abstention as the best method of avoiding AIDS as well as other sexually transmitted diseases and unwanted pregnancies. The curriculum also recommends using condoms, limiting the number of partners and avoiding risky sexual practices such as anal intercourse.

But some critics, including many religious conservatives, say schools should advocate chastity and nothing else. “Schools should tell kids that sex is wonderful and sex is beautiful, but only in marriage,” said Gloria Gillogley, chairwoman of the Women’s Committee for Responsible Government, an anti-abortion group that has sued the state over its sex education materials.

“If you waste it when you’re a kid, you’re not only jeopardizing your future happiness, but you can get AIDS. . . . Tell them the best thing to do is to wait. . . . That’s a good sex education program,” Gillogley said.

Erika Scarano of Hollywood, leader of an anti-abortion group working to close health clinics on Los Angeles high school campuses, agreed: “Condoms and other so-called precautions can give students a false sense of security. . . . I think it’s dangerous.”

On the other hand, the National Parents Teachers Assn. has advocated more extensive preventive education. Katy Keene, chairwoman of the national PTA’s health and welfare commission, said it is difficult to assess whether AIDS will have a dramatic impact on curriculum nationwide.

“It really does vary so much from community to community,” Keene said. “I hope it has an impact. I don’t know that it will.”

In her hometown schools of Hillsborough County, Fla., for example, Keene considers health and sex education to be inadequate. After the surgeon general’s report on AIDS, one Hillsborough board member said, “Koop had no right to say what we should be teaching in school,” Keene recalled.

“Anytime we have approached our school board in Hillsborough County,” she said, “the opponents rally around very quickly, and they’re very loud and very vocal.”

Early response to the Disney film indicates that there is a considerable interest in expanding AIDS education in the schools, said Laury Leibowitz, marketing supervisor at the Disney division that handles educational media. Several other AIDS educational films are being distributed by other studios, various government agencies and nonprofit organizations such as the American Red Cross.

‘A Lot of Response’

It is too early to tell whether “AIDS,” the movie, will be a hit in the educational marketplace. “I know we’ve had a lot of response,” Leibowitz said. “A lot of people do want to look at it at least” to review the film. Hospitals and community agencies are another market for the film, Leibowitz said.

What viewers would see is a combination of biology, the basics of AIDS prevention and a dash of social commentary.

For example, upon learning that small traces of the AIDS virus have been found in saliva, one teen-age girl in the film asks, “Can you catch AIDS from, like, real heavy kissing?”

Dr. Donald P. Francis, a Centers for Disease Control epidemiologist, then explains that kissing is safe so long as there are no sores present in the mouth through which the virus could enter the bloodstream. (In an interview, Francis went further, saying that traces of the virus in saliva are so minute that such transmission is extremely unlikely. The presence of the virus in saliva “is a laboratory artifact,” he said. “It doesn’t go anywhere.”)

Another doctor in the film carries the dialogue a another step.

“The mouth normally has the same kind of protective layer as the skin, and therefore it’s probably a much poorer environment in which to transmit the virus than would be the rectum or even possibly the vagina,” the doctor explains.

“Nevertheless, it is probable that if there were open sores in the mouth and infected semen were introduced, that might be an effective way to introduce the virus,” he said.

In the film’s conclusion, Sheedy tells her audience, “AIDS has forced everyone of us to think seriously about what it means to be with someone sexually and to realize it is an expression of love and caring that brings with it certain responsibilities.”

In addition to advocating the use of condoms, Sheedy further warns viewers to “avoid anal intercourse, because the blood vessels in the anal cavity break easily, allowing blood and semen to mix.”

‘Impair Your Judgment’

Sheedy also instructs viewers to “never take drugs using needles.” She elaborates: “Alcohol and drugs are physically harmful and should be avoided, but particularly now, with the chance of exposure to (the AIDS virus). They should be avoided because they can impair your judgment to make safe sex decisions.”

The film also stresses that AIDS sufferers deserve compassion, not scorn, and that the disease “is caused by a virus, not a life style.”

Meanwhile, many of the nation’s employers also have begun providing on-the-job education about AIDS.

The San Francisco AIDS Foundation--with funding from Chevron, Pacific Bell, BankAmerica, Wells Fargo, Levi-Strauss, AT&T; and Mervyns--has developed an educational package for the workplace that includes a documentary film titled an “An Epidemic of Fear.”

“The reason I’m not worried about contracting AIDS in the workplace,” a smartly dressed businesswoman tells viewers, “is I’m not having sex in the workplace or shooting up in the workplace.” The package, sold for $398 to raise money for the foundation, also includes a teaching manual and policy development guide.

“For the general populace a work setting is probably the best place to educate people,” said psychologist Alan Emery, a consultant to the San Francisco AIDS Foundation. “People like to feel in alignment with the organization, and when the organization takes a stand on AIDS, it reassures people.”

More than 500 organizations have purchased the film and instructional guide, Emery said. “Responsible companies are communicating to their employees about AIDS now. . . . Of course, the people who have a negative stand are not going to request the materials.”

Indeed, many health officials and activists say society’s anxiety, fear and prejudice toward homosexuals all have played a role in the spread of AIDS. They note, for example, that Los Angeles County supervisors last year refused to release county-funded safe-sex guides for homosexuals because they thought the guides’ explicitness would offend public tastes. Several critics said that decision, ironically, might have furthered the spread of the virus--thus increasing the threat to the very public that the supervisors were worried about offending.

The one group that appears to have gotten the message are the gays. Surveys have shown that AIDS has radically altered sexual practices in some gay communities. In a span of three years, a San Francisco poll of homosexuals found, the average number of sexual partners has dropped from about five a month to two. A public health screening program in the city also has found a sharp decline in the incidence of rectal gonorrhea, suggesting that safe sex is being practiced.

‘It Works’

“San Francisco is an example that when we do an education program, it works,” said Decker of the California AIDS Advisory Committee. “But don’t think what has happened in San Francisco has necessarily happened in L.A. or San Diego. God knows it hasn’t happened in Orange County or Sacramento or Bakersfield or anyplace else.”

Decker is among the many gay activists who are urging others to take the antibodies test to learn if they have been exposed to the virus.

“If you’re negative, it’s a powerful motivator. You are not going to let anybody do anything to you that will make you positive,” he said. “And if you’re positive . . . you try not to become part of that 30%,” referring to those testing positive who are likely to develop AIDS.

But regardless of the test results, Decker said, ignorance can prove deadly.

He speaks from experience:

“I took the test, and I’m positive. It gave me pause for about two weeks. But it’s something we have to live with. And knowing is better than not knowing because I can do something about it.”

Many doctors believe that the presence of the AIDS virus--as shown by a positive antibodies test--may not by itself lead to the disease. They theorize that some other factors may bring on the illness.

“The bottom line is, if you’re antibody positive, you better stay healthy,” Decker said. Under doctor’s orders, Decker said he tries to rest, eat a nutritious diet, exercise, avoid alcohol and drugs, and avoid further exposure to the virus, which could further compromise the immune system. He has a physical examination every six months, along with a battery of blood tests. A reduction in the blood’s protective T-cells is thought to signal a period of hazard.

Decker and many other activists and health authorities have criticized President Reagan and his Administration for failing to take an aggressive leadership role in the AIDS crisis.

Federal Expenditures

After an initial expenditure of $5.5 million in fiscal 1982, the AIDS Action Council, a Washington-based lobbying group, reports that federal spending for all AIDS programs has climbed in succeeding fiscal years to $28.7 million, then $61.4 million, then $108.6 million, then $233.7 million, and finally to $410.7 million for fiscal 1987. The National Academy of Sciences recently recommended a crash program with at least $1 billion a year being spent on AIDS programs.

The current budget was “arrived at after several permutations,” said Gary McDonald, executive director of the AIDS Action Council. “The Reagan Administration initially requested $336 million, but they were pressed by us, by a number of other people and by Congress.

“Historically, in general, the (Reagan) Administration has always requested less than its own agencies were telling it was necessary, and Congress has consistently made up the difference. . . . I foresee that happening again.”

In isolated instances, enlightenment has come quickly.

When Michael Gibney, a former volunteer with AIDS Project Los Angeles, gave a talk on AIDS at a luncheon of the Glendale Kiwanis Club, giggles rippled through the audience as he took the podium.

“You might think this is funny,” he told the group of 30 men. “But let me tell you, the incidence for heterosexual transmission is rising. The incidence for AIDS in women is rising. . . . I bet a lot of you have teen-age children, and you don’t know what they’re doing with sex or drugs . . .

“My assumption is that a lot of you are married men, and you might go on your business trips and there might be some fooling around. . . . If you’re fooling around, you could bring it home and give it to your wife. And if your children are experimenting, they can bring it home too.”

“When I said that, there was complete silence,” Gibney recalled recently. “Then there was a barrage of questions.”

Several months after that December, 1985, talk, Gibney developed AIDS. He died last month.