St.John's
A STUDY OF THE KNOWI.ED GE, EXPEIUE NCESANn ATT ITUDESOF SCHOOL COUNSELLO RSIN NEWFOUNDLAN nANDI.A8 RADOR AS"Hl':V
RELATE TOAIDS AN nAIDSEDUCATiON
by Cynthia LynnRO!i~BA B.EtI.(Conjoint)
A Thesis sub mittedin partialfulfilmentof therequir ements for thedegreeof
Mastersof Education
Departmentof EducationalPsycholugy Memorial University ofNewfoundland
August. 1995
Newfoundland
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{SBN 0·612·13942·5
Canada
A8S1RAcr
One hundre dandtwenty threeschoolcounsellorsemployedinthe public schoolsof Newfoundlan d and labradorcompleteda survey questionn aireto determine the ir knowledgelevel, attitudes,personaland professionalexper ience related to AIDSand AIDSeducation.Thesu...ey addressed theirbackground as counsellors,AIDSrela teded ucationalexperience,their knowledgeof AIDS, counsellingand personalexperie ncerelated to AIDS,andthe typesof AIDS educationalactivitiesbeingprovidedtothe stude ntsintheirschools.
Schoolcounsellors areunanimousintheir view that AIDS ed ucationmust be addressed inthepublic schoolforstudents,teachers andthemselves. Afullonethird of those surveyed hadnotreceivedanyformal inserviceeducationwhich specifically addressed AIDSandAI OS education. Although,as agroup,theirAIDSrelated knowledgelevelwasmoderateto high,thereweresome specific knowledgegapsin the area ofstatistics relatedtotransmissionandpreve ntion.Asignificant number of schoolcounsetlorssurveyed have beenprovidingtheirstudentswith professional services relatedtoAIDSincluding;addressingtheanxietyofstudents whofear becoming infected,sendingstudents for HIVtesting,anda small numberhave counselledstudentswho are HIVpositive. However,despite thisextensive involvement, 38%ofcounsellorshavenOIbeeninvolved inany of thesetypes of counsellingactivities.
Counsellorswere awareof theirethicalresponsibility andthe ethical guidelinesrelatingtothe"duty to warn"when working withclients who are HIV
positive.They also showeda sensitivityto andwncem over balancingthisobtigation with their commitme nt toensure confidentiality.Counsellorsreported:Ihigh level of comfortwithrespec t to personal contactwithpeIToOn.~who aremvpositive.They expressed theneed forreliab le and up-to-dateAIDS relatedinformationlind for education in dealingwithtoss,uncertaintyandconfusio nin preparationforwelrk with HIV clients.
Although counsello rsdididen tify variousAIOSeducation activitieswhichnrc on-going atthe schoo l level as part ofeduca ting stude ntsabout AIDS. their responses andre co rt-n end utions reflect the view thatimproveme nt of AIDS educa tion forschoolcounsello rsandstudentsinthepublic schools of Newfoundland sho uldbegivenincreasedpriority.
iii
TABLEOF CONTENTS
ABSTRACT .. . ...ii
ACKNOWLEDGEMENTS
"
LIST OFTABLES... viii
CHAPTER I•INT RODUCfIO N.
...
[... .. . . ... .... .... .. ...I .. .. . ..I , ••2 ..
... ..
; ..5 Purpos e,. .•. , ...ResearchQuestions ... ...•.
Rat ionale ....•... .. ... .. .. . DefinitionofTerms.. .•.
Limitations .
CHAPTER 2·REVIEW OF THELITERATURE . ..7
AIDS:The Epidemic ,.. ...7
AIDS, the Adolescentand theChild . . HI
AIDSEducatio n: The Roleof the Schools....•,.. . .. .. ..13 AIDSEducationand the Role ofthe SchoolCounsello r 17 AIDS:Knowledgeand Attitudes.. ...19
AIDS and EthicalIssues .. . ...2n
CHAPTER3• METHODOLOGY ...22
... 22 .... .. .. .. .. .. .. ...22 ... .. . .. 23 24 24 ... ... .24 SamplingProcedure.... .
Method ofData Collection Descriptionofthe Questionnaire Scoring and Analysisof theDatu.... . .•.. ...
Scoring•....,•.... . . ... .. Analysisof theData
CHAPTER 4·RESULTSAND DISCUSSiON... .. 26
Characteristicsof SchoolCounsellorsinthe Study.. ., ...26
Gende r and Geograp hy ... . .. .. .. . ...26
Age,Education.andCounsellingExperience..•. .. . ... .... . • . .26
Teachingand otherRelatedDuties....•. . . ..•. . ..• ...28
Professional and Persona lExperienceof Schoo lCou nsellors 28 Introduction•... ...• ... .. .. .,.... .•. 28
EducationalExperiences...•.. ... ..• 29
CounsellingExperience... .. .. .. ... . .• . . .•.. . . ... ,.. . ..31
AIDSRelatedCounsellingChallenges.. ... .... , .. ...•. 34
Provisio n of AIDSEducationalActivities forStudents ... . ...37
Perceived Level of Comfort ... . ... •.. .. .... •... .. .40
AwarenessofHlv -PosltiveIndividuals ..•... . ... ...41
Experiences Affecting their Beliefs about AIDS... . ..•...42
Changesin Beliefs 44 Knowledge Level Re lated to AIDS StatisticalKnowledge.... .. .... •.... ... GeneralKnowledge Related to AIDS•.... , Tra nsmission andPrevention.... .. . . . ...45
...46
.. ... .. ...46
. 47 ViewsandAttitudes...• ..., ..•...., 51
Perceptions of SelfKnowledge Relatedto AIDS.... , 51
Perceptionsof Student Knowledge Relatedto AIDS... .• .. .. . 52
AttitudesReflectingFear of HIVJAIDSInfection . 53 Attitudes Regardi ng AIDS RelatedPolicyIssues.. ... .. ..•.... . 55
GeneralAttitude s Regardingthe Issue of AIDS .. . . . .•. ... •. 58
AIDSPrevention Curriculum .•... .. ••. . .. . . ...•.59
GeneralCommentsand Recommendations. ... . ... ..,•...59
CHA PTE R .5·CONCLUSiONSANDRECOMMENDATIONS 61 References.• ..•.. ,... . . . .•.•... .,.•... ... ... •...72
..76 .. ... . . .89 AppendixA . Questionnaire
Appendix B -Letterto SchoolCounsellors.... AppendixC - OtherAIDSEducationalActivities .
Appendix D. AdditionalComments .
. 91
. 93
vii
LIST OF TA8LES TABLE
Percentageof Scho ol CounsellorsBy Age .. . 27 YearsofExperie nceAsA schoolCounsellor.. . .•.•.28 Percentageof SchoolCounsellorsReceivingAIDS Related
Education allnservices.... .. . .. • . ,.. .•. .•. .~O OtherAIDS RelatedEduca tional Experience , . 31 AIDS RelatedCounsellingExperienceBy Percentageand
Estimate of Numberof StudentsSeen....• ... . .33 Othercounselling ExperienceRelatedto AIDS..•.. . . ..34 AIDS RelatedCounsellingChallenge sof Counsellors
WhoHave CuunselledHlv-PostuveStudent s, . . . .. ....35 Perceptionof AIDS RelatedCounsellingChallenges ..37 Provisionof AIDS EducationalActivitiesForStudents. . ..31) 10 PerceivedLevelof ComfortIfIn Cont actwithan
HIVPositiveIndividual. .... .. ....,40 II Aware ness ofHrvPositiveIndividuals ... ....•. . 41 12 Experie nces Affect ingSchoolCounsellorsBeliefsAboutAIDS .. .43 13 Changes in Beliefs ..•..•• ... ... . , .•. 44 14 AIDS Rela tedKnowledge LevelofCounse llors By Percenta ge
of Correct Responses .... .••... . . ...•...•. ..., .45 15 AIDS RelatedKnowledge of SchoolCounsellorsBy
hem and Percentageof CounsellorsWho Answered
EachItemCorrectly....• .. . . . ... . , . .•... . .•. ...48
viii
16 PerceptionofSelfKnowledgeRelatedto AIDS...••.. .52 17 Perception of StudentKnowledgeRelatedtoAIDS ....•. .... . .. ..53 18 Attitudes ReflectingFearofHIV/AIDS Infection .... . . . •. . ... . . .54
19 AttitudesRegarding AIDS PolicyIssues 56
20 GeneralAttitudes Regarding theIssue of AIDS.. .. .. .. . 58 21 Counsellor'sPerceptionof Gradesinwhich AIDS
Prevention CurriculumShould Begin,.• . .. .. . .. .. ... .•. . . ...S9
ix
CHAPTE RONE INllWOUcn ON
Purpose
Thepurpose ofthis studywasto obtainadescriptio n of theknowle dge.
expe riences,andbeliefs of schoo lcounsellorsintheProvince ofNewfoundland and Labrador withrespect 10AcquiredImmune: Deficiency Synd rome (AIDS) andhnw AIDS Educationis addressed withinthepublic schoolsyste m.
ResearchQuest ions Thisstudy soughtto answerthefollowing question s:
Howknowledgeable:areschoo l counsellors abou t the issueufI\IDS and AIDS Education ?
2. What are theirprofessio nalandpersonalexperiencesrelated tothe issueorAIDS and AIDS Education?
3. What type(s) ofAIDSeducatio nal progra mming andcounselling related servicesare made availablein theirrespectiveSChfKJb? 4. What recommendationswouldthey offe r toimprovetheir present
levelof AIDSeducationand to enhance theirco mpe tencyto deal withAIDSrelat ed challenges in thepublicschoolsystem?
Rationale
A numberof factorscombine 10 make a study ofschool counsellors' experiences,knowledgeandbeliefsrelatedtoAIDS and AIDS Educationa worthwhileendeavor:
First,worldwide,AIDScontinues tospread among men,women,teens,and children. A~ofJanua ry 1994,theWorldHealthOrganization(WHO),estimated that 9 to 11 million individualsareinfectedwith the human immunodeficiency virus (HIV), which causesAIDS (WHO, 1994). Al the present time, thereare approximatc ly 156 known casesof HIVin Newfoundlandand Labrador.Forty-seven of these ca ses have AIDS of which34 havealready died. (Government of NewfoundlandandLabrador, Department ofHealth. 1994). Over 50%of these 156 Htv-posulve casesinvolved infectionof individualsless than 30 yearsof age (NewfoundlandAIDSCommittee,1994).
Asthe rate of infectioncontinuesto growinthe teenage and young ad ult population, with nocure in sight,prevention througheducat io nisthe strongest defenceagainstthe transmissionofHIVtonon-infected individua ls.Therefore.the publicschoolsare not immune10thisreality and are faced withthechallengeof actively inform ing stude ntsof therisksassociatedwithhigh-risk sexualbehavior, helping them to changeanysuchbehaviour,providingservices to studentswho re quire suppor tbecauseafam ilymemberorfriend is infected,and providing co unselling and supportto students who are themselves infected . In orde r tomeet
thischallengemost effectively,those Involved in the educationproce sscanprovide informatio naboutwhatprogramsandservicesarepresen tlyinpla ce.aswellas identify su pportsand resourcesneededbyeducatorsttlimprove the effective nesstlf AIDSrela tedprogramming inthe schoo ls. Schoolcounsellor slirennegruup in the educationsystem whocan.incollabo rationwijhtheir colleaguesined ucntion mul healt h,develop,promote,and delive r some of the resourcesandservicesnCCd Cl11t1 add ress the many issuesand conce rnsassociatedwithAIDSantiAIDScducatiou.
Second, schoolcou nsellors are in a unique posit iontogainvaluublc informatio n useful in thedevelopment, imple menta tiun, and improve men t elfAIDS ed ucat ionin theschoolsystems. Counsellors, in theirefforts to implement comprehensiveguidanceprograms,areexpected tua....sume a numhe rofrule sand respo nsibili ties.Theseroles includeclosecontactwithstudents thrn ughindividual andgroupcounselli ng,andgroupguidancein theareasof persona landS1.oal developme nt (Government of Newfoundlan d and Labrador. Dep art ment IIf Education,1988).Itisthroughthese varyingrolesthatthe school coumellnris able to gathera wealth ofinfor mation regardingstude nl needs. Itis this informa cion whic hcan be useful in thedevelopmentof AIDSprevent ion programswithin the schoolsystems. Many counsellorsmay eventakea more formalapproac hby ad ministe ringaneeds survey to stude nts, teachers andsometimes parents,us Uha~i~
for establishingtheir AIDSeducatio nal progra mming.
Third,schoolcounsellors, as part oftheir role intheschool.areexpected to offertheir expertiseindeveloping programswhichaddressthe personal and social needs of studentsin theirschools.Altho ughAIDS preventionmay be seen as a healthissue,it is dea rlyan educational challengeas well.The life threate ning nature of J-fIV.the concerns withchangingstudentsaltitudesandbehaviours.and the many anxietiesassocia ted withAIDS dearlyrequire schoolcounsellors tohe knnwlcdgeahlc andactivein AIDSeducation.Theflnt stepinprovidingeducational opportu nityIn schoolcounsellorsregarding AIDSis 10evaluatetheir curre ntlevel ofknowledge aboutAIDS. Therefore.anevaluationofthe school counsellors knowle dge.experiences.and beliefs couldprovidevaluableinformation usefulinthe devetopmenr ofpre-se rvice and in-serviceeducatio nneeds of school counse llors.
Finally.through lhe examinationofschool counsellors'experiences,both personalandpro fessional,two goals maybemet:(a)the personal experie nces of a sample
0 '
thegeneral population,like school counsellors,canbedeter mined and inferences maderegardin g theneedforfurther AIDSeduca tion;(b) anexamination of the AIDSrcl at etlprofessiunal andprogrammingexperiencesofschoolcounsellors will he lpform ahotJyofknowledge of howtheissu e of AIDS is beingaddressed in the Newfoundla ndlindLabrado rschoolsystem.HIV:
Definitio nof Terms The follo wingare thebasictermsutilized in this study:
AIDS: Acqui redimmune deficiency syndrom e isa life thrc:.ue ning disorderof the imm unesystemwhichtcnvcs the bully de fe ncelessagainstdisease. AIDS iscaused hy a virusknown as HIV.Although treatmentof thisdisorderCUllprolonglife, thereis noknown cure.
HumanImmunodeficien cyVirus isaviruswhichL~transmitted bydirecttransmissionof bodilyfluids from an infe cted individual. Most peo plewith lIIV havedevelop edSylll p W I11S or progress10 thestage considered10beAIDS.
Schoo!Counsello rs:Theprofessionals, ide ntified by the Department(IfEd ucutirm, asthepersonsrespon sible for thedevelopment and delive ryof guida nceand counselli ng services.
Forthisstudy,theterm s AIDSvirusand IIIV arcusedOISsynonymousand interchan geableterm s.
Limita tionsofthe Study
A~with mostresearch, some caution must hetake nwhen interpreting the resultsof thisstu dy, The followingpointshighlightthelimitat ionsof this study:
This study is limitedtoschool counsellorsin the ProvinceofNewfoundland nod Labrador.Therefore.any generalizationsto school counsellorsoutside thisProvincecould onlybe made with theutmost caution.
2. Itis oftendifficult toassessknowledge by mean sofaquestionnair eandself assessmentbecauseitrequiresahigh levelof openne ssandself aware ness in orderto increasethe reliabilityofthe findings.Participantsmay alsohave a tendency10give.whatthey believe10be.'socially desirab le'responses.
3. Sincethisisa preliminarydescriptive study,itdoesnotpermit an analysisof relationshipsamong variableswhichmightbeconsidered significant.
CHAPTERlWO REVIEWOFmE LITERATURE
This chapte r reviews the extentofthe AIDS epide micinNorthAmerica, as wellas, AIDS and the schoolagepopulation.Ieexaminesthespecial challengesand respon sibilities facingeducators and cou nsello rswho workwith, childrenand adolescents regar ding AIDSeducationand the provisionof counse llingservices10studentsand families whohave directexpe riencewiththe virus.
AIDS:The Epidemic
Acquire d Imm une Deficiency Syndrome (AIDS) and the Human Immunodeficie ncy Virus(HIV)werefirst ident ified inthe early19ROs.Sincethat time,thenumberof AIDScasesin NorthAmericahasrisendramat ically.A~uf December,1994,HealthCa nadahasreceived reportsof1O,6K9casestodalewhich meet thedefinitio n for AIDSandatotal of7,471 deaths have been re por tedin Canada(Governmen toiNewfoundlandand La brador,Dep ar tmen t of Health , 19(4 ).
The World Healt hOrganization (WHO )estimatesthat HIVwill haveinfected40 millionpeopleworldwidebythe turn of thecen tury. It furthe rsuggeststhaiitis unlikelythat the "globa lprevalenceofHIV willstabilize or le ve l off for atleast seve raldecades"(To nks,1993,poSO).
InNewfoundlandand Labrador ,the AIDSvirusconti nuestospread.A~of Dece mber,1994,124 males and 32female s have testedHIV positiveand at prese n t
47case !'> of clinicalAIDS have beendocumen ted in the Province .Of these47 cases, 35 have died fro mcomplica tionsduetoAIDS(Departmentof Health, 1994).These number s mayap pearlow untilone considers that there maybema nymore individu alswho are HIVinfected but have not requ estedHIV testi ng.The sprea d ofIIIV in Newfou ndland continue s to rise,especia llywithinthe fe malepop ulation.
Newfou ndland has thesecondhighestpe r capitafemale HIV infectionratein Canada.TheHIVinfect io nratefor pregna nt womenin Newfoundla ndis abo utfou r timeshigher than thenation al average(Governmen tof Newfo undla ndand Labrador, Depart me nt ofHe alth,1994). Casey (1995),incitingthese anduthe rhealthrelated statistics,pointsou t that"risktaking behaviorandits conseq uencesareoccurringin aprovin cethatisundergo ing substantialchanges in its economic,social,andcultural fabric...theneed for he a lth educat ion and commun ity invol vemen t hasneve r been greater" (p.7).
Educator s andothe r professionals arenowrealizing tha tchild re nand adolesce ntsare notimmunetothe spreadof thisvirus.Leland and Barth(1993) pointsnut that in November 1991,768ofthe 202,843tota l ide ntifie dIf.S.casesof AIDSwere diagnosed in adolesce nts (Cent refor Disease Control, 1991).However, becauseestimat esfor the incubatio n perio d for the AIDSvirusspan from2.5 to15 years (Ha rris,1987), theysuggestitisprobablethatthe time ofinfectionfor a suhstuntialnumb e rofthe 39,768 casesofAIDSdiagnosed in those ind ividua lsin the
20to 29 years ofage rangeactuallyoccurredwhen thesepeo ple were ndotcsccms and engagingin unsafesex (p.59).
Infa ntsandschoo lagechildren arealfcctedhy theAIDSepidemic,both directly andindire ctly. Be cause ofHIVtransmissfon inuteroFrom Htvpositive mothers,itisexpectedtha tby1997,HIV/AIDSwillhcco rnctheItltgcsl cause of me ntalretardation and braindamagein children (Gray and House,19X9).Thiswill have an impact onthe schoolsandeduca torswhowillheexpected\0mee tthe special ne edsof these stud ents.
Asthenumber ofHIV infectedindividuals increases,andronnyofthese infectedindividu als show symptomsofAIDS,mo reandmorepeople,especially schoolagechildre n,areaffe cted bythe virus.Whenschoolagechild renhavefamily me mberswho are dyingfr o m AIDS,schoo lswillhe forcedtoaddress theissueof AIDSandgriefcounselling for the irstudentswhoselivesmay beinupheavalbecause a loved oneis dying orhasdied. Many preado lescentschoolage childrenure indirectlyaffectedby AIDS.andtherearea small number ofchildre nwhohaveheel!
infectedbyHlv,mostly through birthand bloodtransfusio ns.Also, cont roversy continuestosurro und theissue of confidenti ality andschoo l attendan ce(IftheIIIV infected student. Fear andigno rance continuestoprevailinthe mains tream popu lation regardingtheissueofAIDS.
Theadolescentpopulation isonegroup which.given theinfection sta tistics.
sho uld begivenspecialco nsiderationin ter msof the risk of infectionandthe need
10 for education. Hou seand Walke r(1993)support th isviewwhentheycomm enton the characteristicsof the individuals in the adolescencestageofdevelopment .They suggest that:
"adolescence isatime oflifecharacterizedbyexperimentation, confusion, andchallenging authority. Teens see themselvesas immortalandinvulnerable. which can lead them10ta ke chancesand experimentwithriskysexualbehavior and druguse-(p.283).
AI DS,theAdolescent.and theChild
In19!18,Health andWelfareCanadafunded a projectentitled"Canada, Youth,andAIDS·study(Government of Newfoundla ndandLabrad or,Depa rtment ofHealth, 1989). This study, conducted by Queen'sUniversity,surveyed38,000 Canadianyouth, ages11to21,to determinetheirknowledge, attitudes,and behaviors withrespectto AIDSandother sexually transmitte d diseases(STDs).In general,thissurveyconcludedthat young Canadianscan accuratelydefineAIDSbut are not as well informed abouthowto preventHIVinfection.Italsofoundthat, althoughthereis a generalanxietyamongyoungpeopleaboutAIDS, it does not seem tohave motivated them tomodify theirat riskbehavior.According to the research,mostoftheyouthsurveyeddonot believetheir ownsexual behaviors could put them at riskof contractinga STDandthereforedo not consider abstinenceor usingprotectionwhenhavingsexualintercourse.Of the fiftyto seventy-fivepercent of16 to21 yearaidswho indicated theyare engaginginsexualintercourse,only
11 twenty-five percentprotectthemselves"most of thetime"by using a condom (P.133).
Roscoeand Kruger(1990)sugge s t thatthosewhit work with the middle und late adolescent must beawareof the warningofferedby prnfesskumls(Will the
medicalfield.He citesStafr(19 88) when he states:
"given thefacttha tasignificantportion of todayspersonswith AIDS (PWA)wereaffected as adolescentsdue to the time lug,it is imperative to realize that given timeand continuedoperation o(risk
•transmission vectors,AIDSwillspread.especially among the adolescent populationso proneto beginningnowhazard o us sexu al activityatthisdevelopmentalperiod"(p.6).
Research hasshownthatadolescentsengage inhighrisksexual hchavinr and are susceptible to Sills such asHIV infection(Feldman,19R9,O'Connor,11)1)2).
Dworkinand Pincu(199 3 ) discussed the importa nce(IfHIVtesting and huw critical testingisfor theteen. Given the advancesmade in thecarly treatmentufHlv infectedindividuals,this earlydetectionin a highriskpopula tion such asadolescence wouldseem even more important .
Themo de of transmissionof thevirusinthe adolescentpopulat io n is not restricted to sexual behavior.Some adolescents arc not engagingin highrisk sexual behavior buthave, neverthe less,cont ractedthevirus. Theseadolescents und children, such as those whoha ve hcmcphclla,shareneedles,and haveblood transfusions,maystillface alife thatincludesallthe challenges
or
being aHIVinfectedperson.
12 Inareview ofthe literatur e for theirstudyof adolescentswh oattempted to avuidHIV, LelandandBa rth (1993)citedthefollowing American statistics:More thanfiftyperce ntofU.S.adolescentshave engagedin sexua lintercoursebyage 17 (Harris&Associates,1986 ), forty-ninepercentoffem aleadolcscen\t ;4avcmultiple
~eJCpart ners(Hof enh&Hayes.1987;Zelnick,1983),2.5 millionacqu ireone or more sexually transmitteddisease annua lly(Centrefor DiseaseControl.1907). andmost do notusecondoms(Harris,1986;Kegele s,Adler&Irwin . 1988). Giventhese smnsucs,AIDSisclearly asignificant threattotheteenagepopulation.
For adolescentsinCanada, thelevel ofsexualactivity wascited inthe Canada. Youth. and AIDSstudy (1988). Theseresearchersfound that Canadian teenagers are as sexuallyactiveasAmericanteenagers withalmost fifty percentof adolescentsup toege17having engagedin sexualintercou rse.A review of the sexual behavior of theNewfoundland adolescents surveyedinthis1988 studyalso indicated similar results asthe Am ericanand Canadianstatist icswit hJ7 percentof 141015yearolds andSSpercentof16 to 17yearolds re portingthat theyhave engaged insexua l intercourse atle as!once.(p.25·26)
One importa nt questionthathas beenposed in there searchonthesexual behavior oftheadolescentis 'wh at makes some adolescentschoosetoeng agein high-risk sexual behaviorwhile oth e rsrefrain fromengagingin the same behavi ors?"
LelandandBarth(1993)foundsexuallyexperienced students whorep ortedthat they attemptedtoavoidexposuretoAIDSwe remorelikelytohave discussedavariety
of sexual topics with theirparentsincluding ways to protect themselves fmm STDs.
Therefore,they concluded that"on eto one'communication hctwee nudotcsccnts and trusted adults may have a positive effect onreducingthe high-riskbehaviors among youngpeople.
Thesefindings suggest theneed to developa parent-adolescentsexual communication component of AIDS preventioneducationas a means ofrc d uch.g high-risksexualbehavior.Other researcherssupportthese findings (Barth, !IJIN, Kirby,Barth, Leland andFetro, 1991). However,furtherresearchappearsIn he needed to determinewhat and how informationisdiscussed with parents (Lelandnnd Barth, 1993).
AIDSEducation: TheRole or the Schools
Inthe 199Os,the onlycureforAIDS is prevention.Douce(1993) emphasize the importance of school,college, and university counsellors,and udmlnistrutors embracing theeducational challenge.Also,
a.,
Ostrow (1989)points out:"if'educatio nis the curefor AIDS'is to he more than a cliche.
then we must continuallysee k ways to evaluateourcurrentefforts, and design educational prog ramswhichcan have a maximumimpact on the futureAIDS epidemic"(p.lSt).
He further suggests theimportance ofdeveloping aneducat iona lmessage that balances the threat of AIDSwith realistically achievable behavioralchange that encourages a sense of responsibility for and on the partof the adolescent.
I' Levine (1991)suggests that develop me ntally appropriateschool-basedAIDS ed ucationshouldbesupportedfro m kindergartenthrough higher ed ucatio n.She cited the Center forDiseaseControl(1988) guidelines for effectivehe a lth ed ucation whichenco uragesschool systems tomakeprogramsavailable thaiwillenableyoung people whohave net engaged insexual intercourseto abstainfromSCJluntil marriage.toencourage those whoare havingsexto stopuntilthe yarereadyto marry,an dforthoseyoungpeoplewhocont inueto putthemselves at risk,the CDC.
re comme ndsthat"schoolsystems, inconsultation withparentsandhealthofficials.
should provideAIDS educationchataddress preve ntivetypesofbehavior..• in cluding condom use"CPA).
Developinganedu cational program thataddressestheAIDS prev ention ne edsofstudentsin our school systemshasnotbeenanea.~ytask. Bayer(1989) discussedthebehavioralgoalsofed ucationandsugges tsthatonedearand simple goal inAIDS education is"thesewho are uninfeetedwinhavetoinsis tthatcondoms beusedinsexualintercoursewithpartners whoseHIVstatusis uncertain,Somewill choosenottohave intercourse,un de r any circumstanceswiththeinfected- (p.95).
CarolLevine(1991)Execu tive DirectoroftheCitizenComm issiononAIDS for NewYor kCitynod NorthernNewJersey, discussedtheconclusions reachedby thiscommissionregardingAIDSeducation and preventioninthepublic school systems.Levineconcluded thateducatio na leffortsagainst thespre adofHIVmust containsever alkeyelements.Twoof the suggestion spresent edwerethene edfor;
15 (1) educationalmessages10be developedandcommunicate d by l)Crsonswhu me know ledgea b leandcredible tothe audience, and (2) approachesIIIinclu depositive alte rnatives to risky behavior.Shesuggeststhat socialucce ptabilhy und humo rarc oftenmoreeffectivethanfear arousingmessages.
TheDepartm ent ofEducation , Govern mentof Newfoundlandan d Labrad or, has developedcomponentsofthe healt hcurriculumthataddressestheissueofAIDS education.Thejunio r high school He alth/Ad olescence programs doin cludeunits onhu manse xuality whichdoesaddresstheissuesofresp onsiblebehaviorrelatin g III the transmission of sexually transmitteddiseases.HIV.AIDS.and safer sex,The Avalo nConsolidatedSchoolBoard (1993),isjustoneschool boar d which has distri bu teda special resource to beusedbythe irHeal th/Adtll"~"encete a ch ers.'111is resource,titled 'SkillsforHe althyRela tionships"(1993),wasdevelope dby Queens Universityaspart of an experimenta lGrade nineAIDS/ STD / SexeutuyProgra m, Althoughdevelopedfor the gradenineprogram,itisbeing recommended fllr uscin the gradeseven andeighthe alt h programs.
Someschool boardshave form edcomm itteeswhosema ndateit is10devel op policies andprocedu ressurrounding the issueot sexua tlytransmitteddiseases and AID Swithintheir respective schoolsystems, Onesuchcommitteewasformed hy the Avalo nConsolidated School Board in June.1992. This"CommitteeonSexua lly TransmittedDisease andAIDS·,throughtheprocess ofgatheringinformationfrum
16 oth erschoo l jurisdict ionsandtheirownstude nts, teachers,andparents,developed amissionstatementstating:
"The AvalonConsolida tedSchoolBoardwillstrive to provideour youthwiththe knowledgeeducationandskills they must acquirein orderto pre ventor atleastminimizedinfection withSTDs/AIDS, andto developschoolandindividua l measure swhich helpyouth developvalu esand lifestylesthatmaintainor enhanceth e irsta t e of wellbeing(p.?).
The developmentofthistypeof mis.sio nstatement Isgroundedon thefundamental belief"thatschools, in partnershipwithparents and communitymustplaya pivo tal role in the educationofyouth aboutsexuality"(p.7).Thistypeof lnlrattvebylocal boardssuch astheAvalonConsolidatedSchoolBoard.indicatesthated u c ators have reco gnized a need wit hinthe irschoolsand aretaking actionto meetthese needs.
In1992,the Departmentof Education, in conjunctionwith Memorial Univer sityof NewfoundlandSchoolof Social Work, embarked on afollo w upst udy tothe19SB "CanadaYouthand AIDS Study". This study, "Sexuality,AIDS,and DecisionMaking:A StudyofNewfoundlandYouth"(1992),concludedthatGrade Elevenstud e n ts arebetter informed tha ntheywerein the1988stu dyon some of the Issuespertain ing10AIDSandSTDs, andsomeof their altitudes havebecomemo re openandle ssjudgemental.The researchersconcludedthai the introductionof the gradenine Adolescence course appears10 bere lated tothisimp rovementand this finding 'place sscho o ls in a roleof even greater responsibilityfor providing educa tion thatwill notonly inform.butwillalsostimulatestud ents ' ability to
17 translatethis knowledgeinto day-til-day situations nnd10apply it thoughtfullyand withcircumspection' (Avalon Consolidated School Board,Policylind Procedur es.
p.1S).
AIDS Educatio nand the Rol e of theSchoolCounsello r During the 1990's,school counsellors,whoseroleand responsibilitiesarc defined bythe needsof the studentsthey serve,will he expectedIn usc their expertise tomeetsome ofthe challenges posedhythis life-threateningI\JI)S epidem ic.Such responsibilities include de veloping aguida nce progrum thata~~ist students in gaini ngaccura te AIDS related information,promoting thedeve lopme nt of skills usefulin responsible decision making.and providing counsell ingrelated servicestotho se studentswhoselife hasbeen directlyor Indirectlyaffected hy the NDS virus(Guidelines for GuidanceServices, Departmentof Education, IWill).
Most of the research in thearea of AIDS and counsell ing te nds to fo cus1111 theneed s and dilemmasof individualswho need counsellinglind relatedsupport be cause theyeitherhave AIDS/HIVor someone close to them bus AIDS/lilY (Croteau,Nero,Johnson-Prosser, 1993;DworkinandPincu,llJ())).Thefearofn life threatening disease suchas AIDSwill sometimes createa group which Dworkinand Pincu (1993)have identifiedas the"worried well",This group may includethose ind ividua ls whomay ormaynot be engaging in highrisk behaviors hutwhoselive s have been negativelyaffectedby their fearof becominginfected withIll Y (p,27lJ).
18 Although the counsellingneeds ofthis group maydifferfro m thosewhoare HIV infected. these individua lsmayreq uire counsellingservicesto cope with thesefears.
AIDS relate dse rvices inthepublic school system canbedivided into two categories:programswithcomponentsthat addressAIDS/HIV prevention andthose withcomponen tsthai prov ideservices toadd resstheneeds of those who arc infecte d or whosefam ilymembe rsare infected. Roscoe and Kruger (1990)suggest that successfulAIDSeducati onwill needto be integrat edintotherealltyofnormal sexua l experimentatio n.Th eycited Keeling's(1988) recommenda tionsofhow counsellors and educators'needto provide expliciteducation" and theimportance'for educato rs10bedirectandopen discussingsafersex; theyneed to communicateon alevel III whichthe ir audiencecanrelat e." More specific 10 thecoc nselto rsrole.
Kee lingfu rthersuggeststhai-devel opm e ntal counselling nee ds10beoffe red.You ng peopleneed tobelaugh t empowerme nt.assertive ness.and negouaticnskills-(p.46).
Characte risticsof an effectivecounsellorofadolesce ntswe re alsoaddressedby Kee ling whopromoted t heeffectiveuse ofthe counsellor/student rel a tio nshipSlating
"adolesce nts nee d u coun..sellor who is sensitive, yet direct andexpli cit •a pmfc:<o...iona lwho willtalk 10them inthe ir own la ngu ageandliste n wit hout bias·
(p.2S).
'9
AIDS: Knowledgeand A.ttltude s
Previo usrese ar ch has shown thatAID S elicitsnegative rcn cuous fromthe ge nera lpublicandcertain health care professionals (Douglas, Kalman.&.Kalma n, 1985:Kelly,St.Lawr e nce.Hoo d, Smith,&Co ok,1988; Kat z,Hass.Parisi, Asrcu c, McEv:J.ddy,&Lucido,1987). In a1990 study of practi sin gpsycho logists and thei r attit udestoward pa tie nt withAID S.St. Lawren ce,Kelly,Owe n.Hogan,ami Wibu l1 (1990),conclud edthat responde ntsevalua tedanAIDS patien t more nega tivelyand re port ed less willingness10intera ct wit h him inaprofesslonulroleOTin casu al socia l situati o ns.
Further research relatingto attitudesand knowledge was completed hy Carney, Werth, and Emanuel so n.(1994 )whofoundthatfor unde rg radu a te stude nts, themo re know ledgea stude nt has abo ut HIVdise a se,the morewilling heorsheis to as sociate withan HIV infect edindividual andthe lesshomop hobicheorsheis likely to be.Theyalso foundthatthe levelof AIDS rel at edknowledg e ofstude nts in co un sellor educa tio n prog ram swas averagewit hcorrect respon sesrangingfrum 53 to 90percen t. Theyconcluded that counse llors intraining who re portedpositive at titudestowardperso nswhoaregayand personswho haveAIDS alsotended10 de mons trate higherlevels of HIVand AIDSknowled ge . Sim ila rcon clus ionwere als o suppo rt e d byearli erresearch(Fe nnel ,1990;Goe rtze l&Blucbo nd-Lungcr, 199 1).Furthermor e,Scollay, Doucett , Perry,&wtnterbonom, (1992)fou nd tha t perso na lassociatio nwithaperson whois gayoraper son with theHIVdise ase
20 increases tolera ncetowardmembers of these groups. Although it isnolonger appropriateto view AIDS asa gay disease,many of these studieshave examined homophobic attitudesas wellbecauseattitudesrela tedto AIDS areoftenconnected with attitudestoward persons who are gay.
In the area of knowledge and changeinbehavior, Scoll ay et a1 (1992) found thatalthough knowled ge scoresincreased significantly,similar increasesin behavioral inte nt had notsimilarlybeenaffected.Howevertheyfurther concludedthat HIV positivespeaker canhaveasignificantinfluenceon AIDS/HIV preventionprograms aimedat alteringbehavior.
The relationshipbetweenattitudes toward AIDS andknowledgeof AIDS has alsobeenstud iedbyRoyse,Dhoop er,and Hatch (1987). Theyfoundtha t. for under graduate and graduat e students, greater knowledgewas associated withgrea ter empathy.They furt hersuggested theimportanceof knowledgefor reducin g fea r of AIDSand improvingempathyfor victimsofAIDS.
AIDSand EthicalIssues
TheAIDSep idemic presentsCanadia nswiththechallenge ofbalancing the rights of the individua lwiththerightsof the communitytobeprotectedfromhealth relatedthreats. Theright to privacy and confidentiali ty of medicalandsexual information. the rightto freedom ofassociation.freedom of movement. and the right
21 to protectionfromwrongful discrimination are allconsideredthe liberties:urisk:IS theAIDSepidemicgains momentum.
Schoolcounsellors areeduca ted to havestrongcom mitmenttothe principles ofprivacy and confide ntiality. Throughtheir professio nal experience.sehoul counse llo rs are often priry10confidential information. This may placethem in situationswhich require ethicaldecisions thatconflictwithliteconrldentinl counselling relationship. lIarding, Gray,andNeal (1993),in theirreview of the issues surrounding the confidentialitydilemma, withrespecttoHIV,concludedthat the emergingethicaltheme in thehelping professional literatureis:
"Counsellors, psychologists, psychiatrists, social workers. and physicianshave anobtilgauon toconside r the healthand welfareof society at large whenAIDSdiems are unwillingtoinformsexual partner(s )with whomthey are exchanging booilynuids-(p.3O.1).
Inthecaseoftheschoolcounsellor,whowouldpos.~iblyheinvolved in01
counselling relat ionship withanadolescent,theethical judgement wouldrequire not only considerati o n ofthe threat ofinfection 10thestude nts'pannc rts)bUIal~othe facttha t ayoungpersonwho isHIV-positive willneed theguidance andliuppm t of a caring adulttoassist intellingotherssuch<ISparent s.Co unsellors arechalle nged to maintain confidentiaJlity sothatstudents areencouraged10approa ch theirschool counsellor ifthey suspect theyareHtv-positive.whileassistingthemInlocale appropriate reso urcesand 10make necessarydecisionsrequire a high level of professiona lcompete ncy.
CHAPTER nlREE METHODOLOGY
Sampling Procedure
Thesamp le forthlsstudyco nslsred of all individualsemployedunde rthetitle 'School Counsellor"inNewfoundland and Labrador.Alislofallschoolcounsellors employed hy theschoolboardswithin theProvincewasobta ined from the Departmentof Education .Oftheone hundred and ninety schoolcounsellor s.one hundred andtwent ythre e(65%)returnedcompleted qnestto nnelres.
MethodofDat a Collectio n
Acopy of therese archques tionna ire(Appen dix A) wasmailedto allschool counsellorsidentified ina directoryobtainedfrom theDepartment ofEducatio n.All responden ts inthestudyremainsanonymous.Aletteroutli ning thepurpose ofthe st udyandtheavailabilityofcashprizesto thosecounsellorswho returned their complete dquestionnairewithina giventime framewasalso anached(AppenduB).
Two weeksfollow ingthe first mailing.theresearch ersentanotherletter and/ormadephon e calls to those whose questionnairehad not beenreceived.The purposeofthissecond comactwa.. toremindthosecou nsellorswhomayhave furgonentoretu rn theirquestion naireand/orto obtain feed backonproblemsor co.cems relatedto theircompletingit. Allquestionnaireswere returned tothe researcherbythe endofMay.
2-'
Descriptionof the Queslionnaire
The questionnairewas developedforIhis study. Initially, an exte nsiveseurch of theliterature was conductedwith particular attentio n to suchareas as:research onthe attit udes,and theknowledge of variousprofessional andlay groups,AIDS informat ionwithinthe public domain uspresentedinthe me d ia andthepublic informationlite rature,thesalient messagesand factua linformation withinvarious school-based AJDS educationprograms,and thepotentialethica l Issuesrelated10 the conduct of counsellorsand othereducatorsonmailers relatedtoAIDS.
Followingthe genera tionof a list of questionsbasedonthissearc h,the questionnaire was refined andfurtherchanged.This draft questionnairewas critically evaluated by a number ofindividuals andgroups. Thedraftquestionnairewasreviewed by the AIDSCommitteeof Newfound landand Labrado r. Itwas furthe rexaminedby severalcounselloreducatorsandby anumber of graduate studentsin counselling.
They wereaskedtocomment on the appropriatenessofits conte n ts.theclar ity of the instruct ionsand questions,andto makeanysuggestio ns which mightimprove both thepresen tationandthe substanceof the questionnaire.Thefinal versionof thc questionna ire,followingthisco nsultationprocess,wasthc n printed in a booklet form inte ndedtoenhance itslayou tand appea lto potentia lrespondents.
The following were the main areasof interestas theyrelate to theresearch questionsidentified:
24 Demog raphi cs of the counsello rsinvolved.
The generalattitudesofcoun sellorstoward variousaspects of AIDS.
The general knowledgelevel of counsellorswithrespectto theAIDS issue.
Training,backgrou nd. andexperie ncesofthecounsellorrelated to HIV/AID S.
Pe rceptions ofthe counsellorswith respecttoimproving educational programming inthe areaof AIDS preventio n.
The AIDSrelatedprogram mingandservices presentl yin placeat the public school leve l.
Themajorityof thequestionsincludedon thequestionnaire requiredthe respo nde nts to selecturespon sefroma numher of differentresponsefor mats. A numberof open ended questions alsoinvited therespondents toprovide briefcomments.
Scoring and Analysis of Data
The scoringfor the questionnaireinvolved assigning numeric valuesto each purl of uquestion in orde r 10 codethe data for computeranalysis. Itwasthen tran sferredto codingsheets andentered into a computer file for processi ng.
Analysisof theDal a
The datuwereanalyzed usingthe Statis tica lPackageforthe SocialSciences (Norusls. 1993).
2.' Thestatistical analyseswereof a descriptivenature.Frequencydistributions weregeneratedforthe majorityof questionsanti crosstabulatio ns were calculated acrossage, gender.urban/ruratlocarlonof the school(s) se rved. andleachingduties assignedto theschoolcounsellors.
CHAPTERFOUR
RESULTS AND DiSC USSION
This chapter presentsa comprehensive analysisof theda ta gatheredto investigate thefour researchquestion soutlinedin ChapterOne.Inordertoenhance readabilityandto focus on predominantpatternsobservedthroughout the data analysis.theresults willbepresented infivesections dealingwith the following:CA) Characteristicsof school counsellors inthe study;(B)Pro fession al and personal experiences; (C) Schoolcounsellorsknowledgelevel;(D )Viewsandatt itudesof schoolcounsellors and:(E)Recommendationsby school counsellors relatedtothe issueofAIDSeducatio n.
CharacterlsllcsorSchoolCounsellorsInthe Study
Gruder aud(dompby
Of the123school counsellorswho returned the quest ionnaire,53.7%were female and46.3%were male.In termsofloca tion withintheprovince ,59.5%of the M:hool counsellorsservedarural area while40.5%served an urba narea. Forthe purpose ofthisstudy,communitieswith a populationofSOOOand over aredefined aurban, and those with a population underSOOOaredefinedasrural(Government ofNewfound landami Labrador,Depar tment ofEducatio n,1994).
AgeEd ucall ouand CoynseJllngExperience
The ageof the schoolcounsellorsranged between 25and54.Thehighest per centageofcoun sellors were inthe40to44age category and 71.5% were over the ageof 35.(SeeTable I).
27 Table1
Percentageof SchoolCounsellor'sbyAge
Age 25-29
30-34 35-39
40-44 4549 50-54 Missingdata Total
(N=123) 0/0ofSchoolCounsellors 10.6 12.2 21.1 2.', 6 21.1 5.7 5.7 100%
Schoolcounsellorswere askedto indicate the highestdegreetheyhal! completed.
Their responseswereassigned to one of threecategories:bachelorsdegree,masters
degree , and other, whichincluded thosewho had obtaineda graduate diploma.The majority,84.4%.hadcompleted their mastersdegree.
The number ofyearstherespondents have beenemployed as a school counsellorissummarizedin Table 2. Itisnotedthatalthough must ofthe counsellorswere 35 years ofage and older,46.3%had lessthan 6 yearsexperience as a school counsellor. This mostlikelyreflectsthecareer pathfor schlll,1
28 cou nse llorsinNewfoundland.They typicalJyentertheprofessio n followinga number of yearsa.s a teacherand the subsequentcompletionof a mastersdegree in counselling.
Ta ble 2
Yearsof Experience as aSchoolCounsellor
Years 1·5 6· 10 11+
Missingdata
TOTAL
(N-I23) (%)of School Counsellors 46.3 29.3 23.6 .8
100%
Teach jngan dOtherRelatedDuties
Fifty-twopercent oftheschoolcounsellorssurveyed indicatedtheywere assignedsome teachingduties.Of thosewith teachingresponsibilities, 76.6% were assignedguidancerelated tea chingduties(CareerEducation,Peer Counselling, Adolescenceand Health).Theremaining 23.4%ofthese counsellorswereassigned non-guidance relatedsubjects to teach.
Professional and Persona! Exper iences of School CQIIDseJlors Schoolcounsellorswereasked toreflect on theirprofessionaland personal experiences related to theissue of AIDS. Questions were related totheir
2.
educationaland counselling experie nces. perceptionsof AIDS relatedcounselling challenges.and the provision of AIDS educationalactivities in the ir respective schools. An overviewof theirrespo nsestothese questionsisprovidedin the fo llowingsection.
Ed uca tio na lExperie nces
Of the schoolcounsellors surveyed. 48.8%reportedreceiving someinscrvice onAIDSeducation31theirschool and/orschool districtlevel.On theotherhand.
47.2%had notreceived anysuch continuingeducationat their schoolor school district level with 4.1%notrespond ing to thisitem.Evenfewerscho olcounsellors (33.3%)hadreceived AIDSeducation from othersources such as professiunal conferences(SCAN,COCA). (See Table3fOTa briefsummary).The responsesto thisquestionalso indicate that38.2%of the counsellorssurveyedhadre ceived neither lnservlce educationattheirschool/dis trictlevel or professional conferences.
30 Table3
Ptrttnlage orSchoolCounsellorsReceiving AIDSRelated EducalionalIn~nict5
(N=l23)
Typeoflnserv ice (%)Yes (%)No (%)Missing
School andjor 48.8 472 4.0
SchoolDistrict
Professional 33.3 63.4 3.3
Conferences
Note:38.2%of respondents indicated theyhadreceivedneitheroftheabovetypes ofinserviceeducation
Addition al10 inservireeducationaleventsat theirschool andprofessional conferencing level. schoolcounsellors indicatedtheyhad experienced other educatio nalopportunitieswithrespectto AIDSeducation.
or
the54responses given.42.6%ofthese involved selCeducationthroughreading. viewing documentaries relatedto AIDS.Otherexperiences includedexposure 10AIDSrelatedinformation throughgraduate courses (14.8%),presentationsbyother professiona l(Doctors.Nurses)to siaff/siudems(22.2%).Knowledgewas alsogainedthrough contactwith anHIV positiveindividual (20.4%). However.themajorityofthecounsellors, (64.2%)did not identifyanyAIDS relatededucationexperience beyond thatreceived atschool orconferences.
31 Table4
OtherAIDS RelatedEducational Experience (fotalRespons es=54)
Experience SelfEducation (Re ad ing, Videos) GraduateCourses Contac tWith HIV PositiveIndividuals
(N·54) (%)
42.6
14.8 20.4
ProfessionalPrese ntations 22.2 (Doctors , Nurses) at Staff
Meetings.~~~~~ ~
Note:Respondents could give uptotworesponses.
Cou nse lling Experience
Schoo lcou nsellors didindicatemany of them arcproviding AIDS related counse llingto stude ntsintheir schools.Of thecounsellorssurveyed. 34. 1%reported theyhave counselledstudents whowere worriedabout being111V positive,37.4%
hadprovidedinforma tion10individ ual studentson how 10he tested for lIIV.and 56.1%haveprovided specific informationregardingthe use of condomsus a wayto preven tthe sp readofHIV.Only 3.3%of the counse llorssurveyedhave provided counsellingto students whohave beentestedandfoundInbeHlv -poshlvc. AlmOM 18% indicatedhaving referre d studentsforHIVtesting. NotedinTabl e 5, 3:U%
32 nfthe counsellors surveyed indicatedthey had notprovidedany of the above five types(Ifcounsellingservices10 theirstude nts.Table5alsoprovidesa summaryof thenumberof students10 whom counsellors have estimatedtheyprovided these counsellingservices.
Other cou nselling experiences werecitedby13%oftherespondents.A brief
!'Iummary is providedin Table 6.Although themajo rity of thecounsello rsdid not ide ntifyany counsellingexperiencerelat ed toAIDSbeyondthoselistedinTableS.
tbnse whodid,weremainlyinvolvedinAIDSrelatedindividual counselling with stude nts who hada familymemberwhowasHlVpositiveorhad died ofAIDS (3.2%),stu dents who neededindividualcounselling on AIDSrelatedissues suchas birthcontrol(3-'%~andgroup counsellingof students10 provide general infor ma tion linAIDS (3.3% ).Pare nts andteachers werealsoprovidedcouns elling
!\eMUSrelated 10 AIDS (2.4%)
33
Table5
AIDSRelated Counse llingExperiencesbyPercenta ge andESli ma teor Numberor Students Seen
Counselling (%)Yes (%)Nn Mis.."iing Estimated Number of Studen ts Providedspecificinformation 56.\ 41.5 2.4 I-50 regardingcondomuse
Providedspecificinfor mat ionon 37.4 61,(1 1.6 1-23 how tobetested for HIV
Counselle dstudentsworried 34.1 65.• 1-5
about beingHIV+
Referredstudents forHIV 17.• 82.1 1-5
testing
Counselle dstudents whohave 3.3 95.9 .8 testedIIIV+
Note:382%ofthe counsellors provided neitheroftheabove counsel lingservices to theirstudents.
34 Table 6
Other Coun sellingExperienceRelatedto AIDS
CounsellingExperience (N:123) (%)
Counsellingstudents whose family 3,2 memberha s HIVIAIDSand/or
has dled.
Individualcounsellingre: related issues.
Group counselling for stude ntsto providegeneralinformation onAIDS.
Individual counsellingrc: AIDSwith concernedparentsandteachers.
Counsellingof studentswho hay: now diedof AIDS.
No such experienceidentified
AlP S Related CounseJllng Cballenges
3.3
3.3
2.4
.8
87.0
The counsellingchalleng es notedbyschool counsellorswhohave counse lled studentswhoare HIV positive(3.3%)aresummarizedin Table 7. They indicated thaI the mostchalle ngingaspect ofthesecounsellin g relationshipswas having updatedinfor matio nrelatedto AIDS/HIV(28.6%), he lpingstudents dealwiththe anxie tyand fear relate d to bei ngsickandpossibly dyin g (28.6%),helpingstude nts
35 dealwith feelingsofisolation(14.3%),helping studentsaccepttheir diagnosis (I4.3%),and having limitedtime availab leto assist HIVpo sitive students(14.3%).
Although these may notbe unexpectedchallenges,it doesunderscore the magnitude andmultiface tednature of counsellingstudentswho arc HIVpositive.
Information andits accu racyandpotencyfor the personseekingandhearing:ittakes on an increasedsignifican ce.Italsorequires thaico unsellor shave thecompete ncies andsufficientcomfortlevelto engage ingriefcou nsellingandhelpi ng the ir clients deal with issues of fear, uncertainty. andisolation.
Table 7
AIDSRelated Co unselli ngCha llenges ofCounsellors Who HaveCounselledHIV PositiveStudents
CounsellingChallenge Having updatedinformation
(TotalResponses=7) (%) 2M.6 Helping students dealwith anxiety
andfear relatedto sicknessand death Helpingstudentsdeal with feelingsofisolation
Helping students accepttheirdiagnosis Limited time available
Note: Respondents couldgive up totwo responses.
28.6
14.3
14.3 14.3
36 The majorilyof schoolcounsellors who responded tothesurveyhad not
counselled astude nt whowasHIV positive .Howe vertheywereasked about their percept ionsofthe counsellingchallengestheybelieved theywouldhave to meetif theywere to counsel a studentwhowasHIV positive. The ir responsesweresimilar 10those schoolcounsellorswhohad counselledHIVpositivestudentsinthat helping studentscope withanxie ty, fearand fe e lings of isolation related to being HIV positiveweretwo aspectsofsuch counsellingwhichtheybelievedwouldprese nt them with somechallenge. Ta ble8providesa summa ryof theseperceptions. One noticeabledifferencebetweenthose schoolcounsellorswhohavecounselled aHIV positivestudentandthosewho havenot was thefac tthatthe cou nsellorswho had already faced thisco~nsellingchallenge wereconcerned about having updated informa tionon AIDStha twouldbehelpful inthe counsellingsitu a tio n.This need wasnot mentionedby theinexperienced group.
37 TableS
Perception of AIDS RelatedCounselling Challenges
Perceived Challenges (TotalResponses =137) (%)of Response Helping stude ntscopewithanxiety 32.8 andfear related to being sick anddying
HelpingHIVpositivestude ntscreate 21.3 a senseof purposein life
Helpingstudentscope with feelings of 19.7 isolation
Issuesrelatedto furtherspreading 8.2 Feeling co mfortablewithsomeoneHIV 6.8 positivein a counsellingsituation
Copingwitha newcounsellin g expe rience 7.3 Finding a supportgroup/services 3.9 Having timeavailable toprovide counselling ,7 Note: Respondentscouldgiveupto tworesponses.
Proyis loDof AIDS EducatlonalAcUvillesrorStudenls
School counsellorswereaskedto indicatewhetherOfnotthe irschoolhas pro vid ed spe cifictypes,of AIDSrelate deduca tionalactivities10theirstu dents within thepast two years.As can be seen fromTable 9 themostcommo nactivitycitedwas the distribu tionof AIDS awarenessprintmaterial tostudents (74.0%) and AIDS
38 being taugh taspart ofthecurriculum(70.7% ).Presentat ionson AIDS togroupsof stu d entseit he rbyind ividualsinthemedical profession (51.2%)and/orbytheschool counsello rs in theclassroomsetting (4 8%) werealsofairly com mon in the schools.
Althoughto alesser degree, otheractivitie s include dguest speaker s whohave AIDS/HIV(36.6%)and AID SAware nessDay s(26.8%) . Asmallperce ntage(1.6%) have provid e dsuppo rtgroups for studentswhose family membershad AlDSjHIV.
Ot h e ractiv ities not listedinTable 9but expressed inthe comm e ntsof the co u nsellorsC:1nbe fo undin Append ixC.
Table9
Provision or AIDS EducationalActivitiesforoStudents
Activity (%)Yes (%)No
AIDSAwarenessPrint 74.0 26.0
MaterialDistributed to Students
AIDS EducationTaught 70.7 29.3 as Partof Curriculum
AIDS Pr esentatio nsBy 51.2 4K.8
MedicalProfession
Counsellor Prepared 48.0 52.0
ClassroomSessionon AIDS
GuestSpeakerWhoHa s 36.6 63.4
AlDS/HIV.
AIDSAwarene; sDays 26.8 73.2
•Other 13.8 86.2
Support GroupWhose 1.6 9K4
FamilyMemberHasAIDS/
HIV Note:(N=I 23)
3'
40 Pe ml"ed1m!ofComfort
Schoolcounsellorswereask edto reflecton theirper ceivedlevelofcomfort
infivesit uatensinvolving varyingdegrees ofcontactwithHIVpositiveindiv iduals, Ta ble10provides a summaryoftheirperceived levels of co m fort. Theresponses
ind icate thatmost rounsellorssee themselvesas feeling atlea st somewhat co mfortab leinthesesituations.
Table10
PercdvedLevelofComfort &rlnContadwithmvPositiveIndividua ls
Situation (%) Comfo rtable Unsure Uncomfortabl e Missi ng
Beinginthepresenceof 7M 13.0 9.8 0.8
astrangerwho isHIV positive
Beinginthepresenceof 86.1 33 9.8 0.8
someoneyouknowwho isHIYpositive
Shakinghands with 8O.l 73 11.4 0.8
so meoneHIVpositive
Playingba sketballwith 616 IS.4 21.1 08
someoneHIVpositive
Ernhraci ng someone 73.9 7.3 17.1 1.6
whoisHIV posit ive
41 Awareness ofHIY PosltlyeIndividuals
School counse llors wer e aske diftheyknew of anyindividuals in the ir communities .orscho o ls who were HIVpositive andifso,wha t theybelieved10he thenumbersof theseHIVpositive individual s. They were alsoquest ion edahuul whether ornot they havehadpersonalconta ctwith a person who the y knewWlIS HIVpositive.Table11provides abrief summaryofthe responses totlrese questions.
Altho ughalmosthalfof therespondents(43.1%)stated they wereaware
o r
ntlcusroneHIVpositi ve ind ividual intheir communityandslight lymorethan half(~2.5(l/t»
havehadperso nalcontact wit h apersonwhomtheybelievedwer eHIV positive.or those whoha ve had this perso nalcon tact, 4.1% indica teditwas a fa m ilymem ber, 11.4% withanHIV positivefriend.22.8%an acquaintan ce.anti 1:l.H% with orbcr.
Table11
Awarenessof HIV Positive Ind ividual
45.1 2.4
Individualsin (%)Yc, the:
Community 43.1
School 1.6
Person al 52.5
Co n ta ct
(% )N o
54.4
%.8
(%)Missing EMimatctl Numbers 2.4 1-150
.. Re spondents we reaskedtoindica teifthe person s whom theyhad person al contact wasfam ily,friend, acq uaintance , orother.
42 Experienc esAlTec;tiP!! (heir Beliers aboutAIDS
Ta ble 12summarizesthesc hool counsellors' responses to the question regarding the experienceswhichthe yfeltmostaffectedtheirbe lief aboutAIDS.The mostcommonexperiencecited washavingdirectcontact with an HIV positive ind ividual ora personwhosefamilymembe rhaddied of AIDS(24. 6%). Other experiencesinclude d exposuretothe massmed ia(18.5% ),the attentiongivento the highrateofHIV infectionin the Newfoundlandregionof ConceptionBay North (15.4%),and exposuretospeakers withHIV(15.4%).
Table 12
Experiences AfTedingSchoolCounsellorsBeliefsAboutAIDS
43
Expe rience (Tot a lResponsese 130) Direct contactwithindividuals whoareHIV+,hasAIDS,orIami'y memberhasdiedofAIDS Exposuretothe massmedia Local ConceptionBay Northsituation ExposuretospeakerswithHIV Statisticsrelating exte nt ofHIV infection in NFLD
Exposuretovideo'sdepletingaccounts ofHIV+pe rsonal experiences Discussionswithotherprofessional re:AJOS
Announcements of being
mv
+by celebritiesand/or sport;figures Statisticsrelated tohighlevels of sexua l activityofyouth Noone specificexperience(%)of Responses
24.6
18.5 15.4 15.4 10.6
3.1
3.1
3.1
3.1
3.1 Note: Respondentscould give uptotwo responses.
44
Changesin HeHers
Responde ntswere aske d to refle c ton anyof thei rbeliefsabout AIDSor peoplewhohave AI D Swhichtheymayhave revised orcha n ged. Table13 summa rizestheresponsespresent edbytho s ecoun sellors~hoansweredthe question.
Furtypercentofthe27response sindicated a cha nge inth ebeliefth atAID S is a gay disease,and 25.9%cha n get! their belief that AID S canhecontract edthroughcasual contact.
Table13 Changesin Heliers
Changed Belief (TotalResponsese;,7) AIDS is a gay disease AIDScan be contracted throughcasualconruct AIDS is uncommon Every HIV+person develo psAID S Onlycertainpeoplehav e 10 wo r ryabou t AIDS Pcoplewith AIDSloo ksick AIDSvictimshaveno rights lint!do not deservesu p port
(%)ofResponses
40.7 25.9
11.2 7.4
7.4
3.7 3.7
4S KnowledgeLevelRela tedto AIDS
A21item knowledge sectionwas designedto measurethe AIDSrelat ed knowledge levelofschoolcounsellors.E3Chcounsellor received a percentagecorrect score. Table 14providesa summaryofthescoresobtainedbythe counsellors.Fjfty- threepercentof thecounsellorshad from 50%to69%ofthe responses correct.
For ty-two percent of there spondents scoredinthehigh runge of 71%correct or higher.Sinc ethemajority of the counsellorshad lessthan 71%of theitemscorrect, it seemsfairtoconcludethattherearesome gapsin theirAIDSrelated knowledge.
Table14
AIDS Relat e d KnowledgeLevelof Counsellor sbyPercentageofCorrectResponses
Category Range of (%) (%)of Counsellors
Lev el Correct
Low <50 4.9
Mediu m 50-69 53.1
High 70-100 42.0
Note: Meanpercentageswith correctresponsese67%
Table15presents howknowled geable counsellors wer e on eachindividual item of theknowledgesectionofthe questionnaire.Each itemwas assigned 10 one ofthree categories: StatisticalKnowledge;GeneralKnowledge;andTransmission andPrevention.
46 Stat isticAl Knowle dge
The AIDS related statistical knowledge of schoolcounsellorsasOJgroup is reflectedin the percentage ofcounsellors who correctly answered thethree items in Ihis category.Sixty-eight perce nt of the counsellors knew that AIDS was northe leading cause of death amongCanadians under the age of 25.A little morethan 50%ofthe counsellors knew thatthe percentage of individuals whohave diedof AIDS were notteenagers. The one statistical item whichmorethan80%of r, ..msellnrs answeredincorrectlywas the over estimationof HIV infection in Canada that waspresented initem 13. The majority of counsellors incorrectly believedthat
I%ofthe Canadian populationisinfected withthe AIDSvirus whenactual statistics indicatethe number to be closerto.01%. This misunders tand ingmay not be surprisinggiventhe highlevel of publicity and mediaattention given to AIDS.
However.these results re flect that counsellorsdo haveso me gaps in statistical knowledge as it relatestoAIDS.
GeneralKnowledge:Rela ted toAIDS
The AIDS rel ated generalknowledge of counsellorswas measured by determining the ir correctresponses to sevenitems.Fiveofthese seven items were answered correc tlyby the counsellors.in ara nge of74% to 97% acrossthe items.
Only two generalknowledge item were answered incorrect lyby morethan 50% of the counsellors(item 2 and 12).These items dealt with the average number of years
47 anAIDS victimsurvives afterthesymptomsfirstappea randthe type IIf cellswhich aredestroyedby the AIDSvirus. Although mostcounsello rs appeartohave accurate genera l knowledgeabo ut AIDS.thereappearstohesomeroum forimprovement.
transmissionand I)reventlon
The scoresobtainedonthe transmissionand prevention itemsofthe knowledgesectionwere inconsistent. Seventy-five per centof theenuusullu rs correctly answered mo re than 50% ofthe 11items inthis sectio n. However, there were three items whichwerescoredincorrectly by more than5ll% orthe counsellors.
These items (10, HI. 22) dea l withtransmissionof rheAIDSvirus. thisresult therefore reflects a gap intheknowledge of 51%to 67% of the counsellorssurveyed.
48 Tabl eIS
AidsRelated KnowledgeofSchool Counsello rs ByItem and Percentage of Counsellors whoAnsweredEach Item Correctly
Item# (N=l23)
StatisticalKnowledge (%)Correct
6. AIDSistheleading cause ofdeath among 68.3 Canadiansunder age 25.(False)
II. Half of the individuals who havediedof 51.2 theAIDS virusare teenagers.(False)
13. Approximately1%oftheCanadianpopulation 19.5 isinfected withthe AIDSvirus.(False)
GeneralKnowl edgeRelated to AIDS TheAIDS virusis nowcalled the human immunodeficiencyvirus.(H1V)(True)
(%) Correct 87.8
2.
4.
5.
The AIDSvirus weakens the immunesystem byde stroying red bloo dcells.(False) ApersoncanhavetheAIDS virus forseven or more yearswithout having symptoms of illness. (True)
Therearebloodtests to showif a person hasbe eninfect edby theAIDSvirus. (True)
42.3
92.7
97.6
Table IS (continued)
(% ) Cnr reCl 7. Apersoncan be infected foruptosix months 74.1'
befor ethe AIDSviruscanbedetected.(True) 12. Onaverage anAIDS victimdies abouttwo 3J.3
yearsafter the symptomsfirst appear. (True) 20. The earlydetection andtrea tment of AIDS 71UI
can prolong the lifespanof theinfected person,(True)
4'1
Transmission and Preventi on (%)Cor rcci
3. Menand women arcequa lly likelytohave se rious problemsif they co ntract the AIDS virus.(True)
91.1)
8. The AIDSvirusca n be sprea dfromafemale to 91J.2 her unborn child duringpregnancy. (True) 9. Condoms used with aspermicidal foam give 7H.0
effectiveprotectionfrom AIDS. (True)
10. Females and malesare eq ua lly atrisk of Ul.3 catchin gthe AIDS.(False)
14. An individual who hashada recentblood H7.11 transfusion standsa moderatechanceof
catchingAIDS.(False)
15. Hhasbeendocumented thatAIDScanbe 73.2 transmittedvia frenchkissing.(False)
TableIS(Contin ued)
(%)Correct 16. AIDScanbe transmittedvia oralintercourse. 813
(True)
17. The use oflambskin condomsasopposedto 63.4 latex condomsdecreases the chance of
infection with AlDS.(False)
18. Infectedmotherscan passthe AIDSvirusto 48.8 theirbabieswhilebreastfeeding.(True)
19. The AIDSviruscanbespreadbycoughs 87.2 andsneezes. (False)
21. All types of intercourseplacesan individual 33.3 equallyat riskof contractingthe AIDS virus.
(False)
50
51 Views lind Altitudes
The views and attitudes of school counsellors werere flected in their responsesto28statements.Foreach statement,counsellorswereaskedtoIndicate their level of agreementwitheach item. Items were divided into five categories:
perceptions of self knowledgelevel related to AIDS;perception ofstudents' knowledgelevelrelated toAIDS;altitude sregarding AIDS relatedpolicyissues:
attitudesreflecting fearof HIV/AIDSinfection: and general attitudes regardingthe issue ofAIDS.Theco unsellorsresponsesare addressedin the followingsections.
Pen:epti ons ofSelfKno wledgeRe latedto AIDS
Nearlyall (87%)of the counsellorsagreedthat they needed toleummore aboutAIDS and more than one halfof them wereeithe runsureubout theirskill levelorbelievedthattheydid not havethe skills and knowledgeto coordinateAIDS prevention education ,See Table 16.
52 Table 16
PerceptionofSelf KnowledgeRelatedto AIDS
Attitude (%) Agree Notsure Disagree Missing I need tolearn more 87.0
aboutAIDS
I haveskills and 43.9 knowledgeto coordinate AIDSprevention education
5.7
26.0 5.7
28.5 1.6
1.6
Pen:e ptio nsof Si udeni Knowledg e Related10 AIDS
Two of thetwentyeightitemsweredesignedto determinethecounsellors' perceptionof their students'AIDS related knowledge level.Table 11providesa summary of these views. Slightly more than50%of the counsellorsdid believe thai theirstudents do not view AIDS asa homosexualdisease.22.8%were unsureand
24.4%werein agreementwiththis statement.Similar responseswere providedto thestatement about whetheror notthey viewedtheirstude nts as having received sufficientinstructionand informationon AIDS. Forty-five percentviewed their studentsasreceiving insufficient instructionandinformation, 20.4%indicated they were unsure,and32.5% agreedwith this statement.
53 Ta ble 17
Pereepuo norStude m KnowledgeRelated to AIDS
Attitude (%) Agree Notsure Disagree
Students view AIDS as 24.4 22.8 51.2 ahomosexualdisease
Studentsreceive 32.5 20.3 45.5
sufficientinstructio n andinfor mationon AIDS
Missing
AtlltudesReflectingFt::P[or "IVIAIDSInrection
Of theschoolcounsellors surveyed, 935 %agree that AIDS isa serious problem.However,81.3%are notworried aboutcatchingtheAIDSvirus.AsIor the restrictionsthey believe shouldorshould not heplaced(10
mv
infected individuals,83.7%agree that peoplewithAIDSshould be allowedtoteachin public schools. Fewer counsellors.56.9%,agreewith thesamestatem e nt whenit isapplied to a differentsettingsuch asallowing pe ople withthe AIDSvirus til work in hospitals.Thissellingappea rsto create ca ution in more of thecounsellors.(Sec Table18)54 Table18
Attitudes Renecrlng Fear
or
HlV/ AIDS InfectionAttitude (%) AgreeNot sure DisagreeMissing Peoplewith AIDSshould 5.7 8.9 83.7 1.6 notbeallowedtoteach
in publicschools
AIDS isnotas seriousa 1.6 3.3 93.5 1.6 Problemasthe media
suggests
Iam worried about 5.7 10.6 81.3 2.4 catchingtheAIDS virus
Peoplewhohavethe 11.4 30.1 56.9 1.6 AIDSvirusshouldnot
be allowedtoworkin hospitals
Somepeoplewillbe 22.8 11.4 64.2 1.6 infectedbythe AIDS
virusnomatterhow they try(0avoidit
People who havethe 21.1 35.0 42.3 1.6 AIDSvirusshouldnotbe
allowedtoimmigrateto Canada
People who havethe 11,4 18.7 68.3 1.6 AIDSvirusshould not
be allowed toSCIVC the public
55 AttitudesRegardingAlPS Rel at edPolicy Ju un
The views of school counsellors onitemsrelated to the issues surroundi ng HIV infectionand confide ntiality, HIVinfectedstudents andteachers'rights, andthe responsibilityofschoolboards astheyaddressthe issueofAIDS inthe public schools aresummarizedin Tab le19.Therespo nses giventothese itemsind icat e IhaI 92.7%
ofcounsellorsbelieveschoolboards areresponsibleforprovidingan educational programfor those stude ntsinfectedwith the AIDS virusand 91.9%agreed thut boards should takeappropriatestepstoeducate students,parentsandschoo l employees regarding AlDSanditstransmission.
Regardin g the issue ofHIV testing andconfidentiality,most oftheschoo l counse llors(94.4%)did not believe that teachers shouldberequir ed10he testedfor HIV andthemajority of counsellors (77.2%)agreedthat teachers shouldnot tell othe rstudentsabout a classmatesHlv-positlve status. This may suggest that school counsellors, whi lebeingconcernedabout AIDS,are not50frightened as 10 abandon the irlo ng standing commitmentto theprincipleof confidentiali ty.
56 Table19
Attitudes Regarding AIDS PolicyIssues
Attitude ('Yo) Agree Notsure Disagree Missing
Peoplewhohave the 22.0 33.3 43.1 1.6
AIDSvirusshould be required 10let other peopleknow theyhave
;1
Studentswho have the .8 4.9 92.7 1.6
AIDSvirusshould not be allowedto attend regularschoolclasses
Teachersshouldtell 5.7 15.4 77.2 1.6
otherstudentsifa classmatehasthe AIDS virus
Teachersshouldteach 94.3 2.4 1.6 1.6 their studentsabout
AIDS
Allteachersshouldbe .8 3.3 94.3 1.6
requiredto betested fortheAIDSvirus
