Positive Prevention: HIV/STD Education for California Youth and Positive Prevention PLUS: Sexual Health Education for California Youth, Level A (2010)

Transcription

1 Positive Prevention: HIV/STD Education for California Youth and Positive Prevention PLUS: Sexual Health Purpose of the Evaluation The purpose of the evaluation is to assess the compliance of the curriculum with California laws regarding sexual health and HIV/AIDS prevention education. Curriculum Description Level A of Youth and Positive Prevention PLUS: Sexual Health Education for California Youth published by the American Red Cross 1 provide instruction about prevention of sexually transmitted diseases (including HIV/AIDS) as well as prevention of unplanned pregnancies for middle school students. Abstinence is emphasized as the most effective hod to prevent unintended pregnancy and sexually transmitted diseases (including HIV/AIDS). Skill development is included with a focus on decision making. Positive Prevention Level A consists of six lessons while Positive Prevention PLUS Level A consists of five lessons. The intention of the curriculum designers is that both curricula are implemented together, as the content is complementary and not redundant. Summary of Attributes Student objectives, content of lessons, teaching strategies, and activities are age appropriate for middle/junior high school students. The curricula provide guidelines, background information, and tips to assist the teacher to address the content in developmentally appropriate ways. Both curricula provide information and opportunities for students to practice skills to make responsible choices about behaviors that put them at risk for exposure to sexually transmitted infections and unintended pregnancy. Abstinence is consistently described as the safest and most reliable way to avoid pregnancy and sexually transmitted diseases. Medically accurate information is also provided for other prevention hods. Local testing information is included and teachers are prompted to prepare to give specifics about the local resources to students. Spanish-language versions of written materials for students and parents are provided. Hotlines recommended include Spanish and Filipino languages in addition to English. The California law regarding surrendering physical custody of a minor child is addressed in a clear and thorough fashion. By inviting a presentation by a speaker who is HIV positive and providing opportunities for students to process the experience, Positive Prevention Level A addresses stereotyping and engenders compassion for those infected and affected by HIV/AIDS. 1 Please contact the curriculum publisher, American Red Cross, at to access additional information about the curriculum, including updates and new editions. California Healthy Kids Resource Center, 2010 Page 1 of 27

2 In Positive Prevention Level A, adaptations for students with vision and hearing impairments and learning disabilities are included. It should be noted that a separate curriculum, Positive Prevention: HIV/STD Prevention Education for Special Populations (2009), for students in grades seven through twelve is published by the National American Red Cross. Summary of Concerns In general, the instructional content and language of the curricula did not reflect bias on the basis of sex, gender, or sexual orientation, with two notable exceptions: (1) incomplete and inequitable anatomical information for the female reproductive system, and (2) a lack of instructional content related to sexual orientation. Similarly, while sexual orientation is listed as part of a learning objective for the first lesson in Positive Prevention PLUS Level A, there are no references to sexual orientation in either the content or activities for the lesson, leaving the instructor without any guidance to facilitate learning or meaningful discussions about sexual orientation in that lesson or in the body of the curriculum. Content regarding sexual orientation is relegated to the appendices. The extent to which the curricula as presented are appropriate for a diverse population with language-specific needs and/or ethnic, cultural, and racial differences needs to be considered. Adding languages in the communities served by the schools for those who are recent immigrants from non-english speaking countries and those with language-specific needs in addition to Spanish may need to be considered. Hotlines listed ( SIDA and AIDS) currently have referrals to a new hotline number. While values of families, cultures, and religions are addressed, the working definition of culture did not seem to include the cultures of immigrant groups nor of groups within the community that are bonded by nation of origin and/or race. Places of worship and titles of religious leaders do not accommodate the diversity of religious affiliations in California. Overview of Requirements These requirements represent criteria 2 set forth by the California Education Code ( ) and the California Health and Safety Code ( ) listed below. The purpose of these requirements is to ensure that pupils are provided with the knowledge and skills necessary to protect their sexual and reproductive health from unintended pregnancy and sexually transmitted diseases, 3 and to encourage pupils to develop healthy attitudes concerning adolescent growth and development, body image, gender roles, sexual orientation, dating, marriage, and family. 2 Access the review criteria definitions at 3 In this document the term sexually transmitted disease (STD) is used to be consistent with the terms used in,, and. The term sexually transmitted infection (STI) is used in some of the evaluated curricula, and is interchangeable with the term STD. California Healthy Kids Resource Center, 2010 Page 2 of 27

3 1. California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act - Education Code 4 - Authorized Comprehensive Sexual Health Education 2. California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act - Education Code 5 - Required HIV/AIDS Prevention Education 3. Sexual Health Education Accountability Act - California Health and Safety Code Evaluation Detail The review criteria reflecting the legal requirements of,, and are organized into the following categories: I. Accuracy and Appropriateness II. Accessibility III. Objectivity IV. Content: Knowledge/Information - Sexual Health V. Content: Knowledge/Information - HIV/AIDS VI. Content: Attitudes VII. Content: Skills The Evaluation Detail on the following pages identifies the laws each criterion represents, whether the curriculum or did not meet the criterion, and the evidence supporting the ratings. 7 After the Evaluation Detail the report provides recommendations, based on the evaluation of its legal compliance, if the curriculum is to be used in California schools and community settings. 4 Required for school districts providing sexual health education. 5 Required HIV/AIDS prevention education for all grades Required for organizations providing sexual health and/or HIV/AIDS programs conducted, operated, or administered by any state agency that are funded directly or indirectly by the state, or receives any financial assistance from state funds or funds administered by a state agency, excluding any program offered by a school district, a county superintendent of schools, or a community college district. 7 Access the At-a-Glance Evaluation Chart at California Healthy Kids Resource Center, 2010 Page 3 of 27

4 I. Accuracy and Appropriateness Criterion 1. Instruction and materials are age-appropriate. Student objectives, content of lessons, teaching strategies, and activities are age-appropriate for middle/junior high school students. The content is consistent with the California Health Education Content Standards (CHS) for grades seven through eight. The curricula provide guidelines, background information, and tips to assist the teacher to address the content in developmentally appropriate ways. Positive Prevention (PP) Attributes: 1. (Introduction) p. xxi: The chart on page xxi indicates in which lessons the CHS standards are addressed. School districts are cautioned not to rely on the publisher s list of grade-level CHS by each lesson, but to conduct an independent assessment of standards alignment. 2. The learning objectives for each of six lessons clearly articulate age-appropriate student outcomes. Positive Prevention PLUS (PPPLUS) Attributes: 1. (Introduction) pp. xxiii-xxvi: The chart on pages xxiii-xxvi indicates the publisher s assessment of how the lessons are aligned with the CHS. School districts are cautioned not to rely on the publisher s list of grade-level CHS by each lesson, but to conduct an independent assessment of standards alignment. Criterion 2. Instruction is medically accurate and current. Factual information is medically accurate. 1. p. 27: Instructors are prompted to gather updated HIV infection and AIDS statistics/projections for the world, the United States, and their state or community and are provided with resources for gathering this information in Appendix A. 2. pp. 71 and 79: Human papillomavirus (HPV) vaccine to prevent genital warts is included. 3. pp : Hepatitis A and B are listed as sexually transmitted and the vaccines for A California Healthy Kids Resource Center, 2010 Page 4 of 27

5 and B are included. 4. p. 163: Effectiveness of hods to prevent both pregnancy and HIV/STDs are reported with citation and Web site of Planned Parenthood. 5. pp. 163 and 169: Spermicide is depicted on chart of effectiveness of hods to prevent HIV/STDs as not effective. 6. pp : Three studies about the success and failure rates of latex condoms in preventing HIV are reported. 7. (Appendix A) pp : Resources listed for teachers include reliable national resources such as CDC and AIDS and hepatitis hotlines as well as California resources such as Department of Health Services and the STD Control Branch. 1. p. 52: Spermicide is depicted on chart of effectiveness of hods to prevent HIV/STDs as not effective. 2. p. 52: Current success and failure rates of hods to prevent pregnancy and HIV/STD were depicted on a chart. 3. pp : Emergency contraception is included among hods of contraception. 4. pp and video clip: California s Safe Surrender Law is explained in written materials and in video clip. Positive Prevention PLUS Concerns: 1. pp. 6 and 96: Item 20 of the student pre-test and post-test is: A condom is only effective if it is used consistently and correctly. When used correctly and consistently, condoms are 98% effective in preventing pregnancy. The response options are agree, disagree, or not sure. As worded, this item could lead students to conclude that condoms are not at all effective unless used consistently and correctly, thus discouraging their use. Success rates of inconsistent users of condoms to prevent spread of HIV ranges from 86 to 90 percent in three studies reported on page 159 of Positive Prevention. A suggestion for better wording of the pre- and post-test question is: Condoms are most effective when used consistently and correctly. 2. Appendix D, pp. 9-11: The Female Reproductive Anatomy is incomplete, showing and describing only the internal components, omitting the external genitalia. 3. pp : The Male Reproductive Anatomy includes an overhead with drawings of erect and ejaculating penises without accompanying instructional objectives or content, leaving the teacher without guidance as to how and what information to present in relation to these drawings. 4. p. 9: The lesson extension on Female and Male Reproductive Anatomy starts abruptly with number 3, and appears to be missing sections (Content, Instructional Objectives, Materials Needed, and Related Vocabulary) and lesson plan steps numbers 1 and 2, making it difficult to teach the lesson accurately and appropriately. California Healthy Kids Resource Center, 2010 Page 5 of 27

6 II. Accessibility Criterion 1. Instruction and materials are appropriate for use with pupils of all races and ethnic and cultural backgrounds. Cultural and ethnic differences are considered and respected. Instruction is appropriate for a diverse population of students. 1. p. 9: The first lesson includes a note for teachers about cultural sensitivity. For the Family/Home assignment for this initial lesson, students are encouraged to discuss the beliefs of their families, cultures, and religions regarding sexuality and HIV/STDs. 2. p. 211: Family/Home assignment encourages students to discuss how their families rules about sexual behavior are influenced by their cultures and religions. 1. Introduction, p. xxxii: One of the guiding principles for sexual health educators is Sexuality and sexual behavior are defined and shaped by genetics, culture, tradition, race/ethnicity, and religion. Positive Prevention and Positive Prevention PLUS Concerns: 1. While values of families, cultures, and religions are addressed, the working definition of culture did not seem to include the cultures of immigrant groups nor of groups within the community that are bonded by nation of origin and/or race. Criterion 2. Instruction and materials are appropriate for use with pupils of all genders and sexual orientations. Gender is addressed equitably. Resources for creating an atmosphere that is safe for lesbian, gay, bisexual and transgendered students are provided in the appendix. Gender-neutral language is used when presenting most relationships. 1. pp. 1-3: Establishing ground rules for the class includes being respectful of others and no put downs. California Healthy Kids Resource Center, 2010 Page 6 of 27

7 1. pp : An extension lesson about bullying and harassment notes gender role or perceived sexual orientation as possible student responses to questions about types of bullying and why bullying happens. 2. (Appendix C) pp : Teachers are given resources to create safer school environments of students who are lesbian, gay, bisexual and transgendered. Positive Prevention PLUS Concerns: 1. pp : In the Facing an Unplanned Pregnancy lesson the point of view is exclusively female thus failing to address the needs of male students to understand their options when faced with a partner s pregnancy. Criterion 3. Instruction and materials are appropriate for use with pupils with disabilities. Adaptations are included for special populations. In addition, Positive Prevention: HIV/STD Education for Special Populations is a separate curriculum for grades seven through twelve published in Appendix C, pp. 1-15: Adaptations for students who are hard of hearing, visually impaired, and enrolled in Special Day Class (SDC) are suggested as well as national and statewide resources for information and materials. Criterion 4. Instruction is available to English learners. Student materials are available in Spanish. 1. Materials in Spanish for students are included on a CD that comes with the curriculum. Positive Prevention and Positive Prevention PLUS Concerns: 1. Materials are not provided for languages other than English and Spanish. 2. Numbers for national hotlines in English and Spanish published in the curricula now have a referral number to (800) CDC-INFO. California Healthy Kids Resource Center, 2010 Page 7 of 27

8 Criterion 5. Instruction is culturally and linguistically appropriate for its targeted population. Parent and student materials are available in Spanish on CD. 1. Appendix B, pp : Parent resources include Spanish- and English-language hotlines operated by American Social Health Association as well as information in a variety of languages. California AIDS hotline offers trilingual services in English, Spanish, and Filipino. 1. Parent resources are provided in English, Spanish, and Filipino. Positive Prevention Concerns: 1. Printed materials for students and parents are provided in English and Spanish only. 2. Numbers for national hotlines in English and Spanish published in the curricula now have a referral number to (800) CDC-INFO. Positive Prevention PLUS Concerns: 1. Student materials are provided in English only. 2. Printed materials for parents are provided in English and Spanish only. California Healthy Kids Resource Center, 2010 Page 8 of 27

9 III. Objectivity Criterion 1. All factual information is objective. Information provided is objective. Learning activities support students to use factual information to make health-related decisions. 1. pp : Lesson about modes of HIV transmission includes clear and factual information and learning activities that reinforce factual information about how HIV is and is not transmitted. 2. p. 163: Information is provided regarding the effectiveness of contraceptives in preventing pregnancy and strategies to prevent HIV/STD. Criterion 2. Instruction and materials do not teach or promote religious doctrine. No religious doctrines were promoted but their existence and importance in making decisions about sexual behavior are acknowledged. 1. p. 9: When giving the first homework assignment, teachers are prompted not to hold one belief over all others. Have the students explore how their families beliefs support the prevention of HIV/STDs. Students are encouraged to discuss cultural and religious beliefs about sex, and HIV/AIDS at home with their families. 1. (Introduction) p. xxxvi: The Respect for Differences section provides background information from the California Department of Education to the teacher regarding the educational value of open discussion and respect for religious differences versus indoctrination. Positive Prevention and 1. (Introduction) p. xxxvi: Teachers are given guidelines for responding to student questions that reflect religious beliefs without supporting or denigrating their beliefs. California Healthy Kids Resource Center, 2010 Page 9 of 27

10 Criterion 3. Instruction and materials do not reflect or promote bias against any person on the basis of sex, gender, or sexual orientation. In general the content and language does not reflect bias on the basis of sex, gender, or sexual orientation, with two noteworthy exceptions: incomplete and inequitable anatomical detail for the female reproductive system (external genitalia missing), and lack of instructional content related to sexual orientation in the instructional components of the curriculum. 1. pp : Gender role determination and societal navigation is identified as a sexual concern of both males and females. Positive Prevention PLUS Concerns: 1. (Appendix D) pp. 9-19: The Reproductive Anatomy figures and description for the female includes only internal structures but no external genitalia; those for the male include internal structures and external genitalia and greater descriptive and figural detail. 2. (Introduction) p. xxxvi: Sexual orientation is listed as part of a learning objective for the Getting Started lesson: Distinguish between male, female, sexual orientation, masculinity, femininity, sexuality, sexual intercourse, HIV/AIDS and STDs, and sexual orientation is listed in the Related Vocabulary of the lesson (p. 1). However, sexual orientation is not addressed in the instructional content or activities for the lesson. Femininity/masculinity/gender role are listed as female and male sexual concerns, but sexual orientation is missing. Further, the pre-test (p. 5) includes the item, Everyone has the same sexual orientation and gender identity, but sexual orientation is not included in the instructional content of the lesson or curriculum. 3. (Appendix C) p. 18: Although advising schools to Introduce school curriculum that includes lesbian, gay, bisexual, and transgendered people and age-appropriate information about sexual orientation and gender identity, these topics are absent from the instructional components of the curriculum. 4. Although gender identity/sexual orientation is listed as student responses to teacherled class discussions (e.g., p. 20, p. 45), teachers are not guided to include this information if it is not supplied by students, nor are teachers provided with guidance for addressing sexual orientation in the instructional components of the curriculum. California Healthy Kids Resource Center, 2010 Page 10 of 27

11 Criterion 4. Instruction and materials do not reflect or promote bias against any person on the basis of ethnic group, race, national origin, color, or ancestry. Instruction and materials do not reflect or promote bias. 1. (Introduction) p. xxxii: One of the guiding principles for sexual health educators is Sexuality and sexual behavior are defined and shaped by genetics, culture, tradition, race/ethnicity, and religion. Criterion 5. Instruction and materials do not reflect or promote bias against any person on the basis of religion. Religious beliefs about sexual behavior are acknowledged but neither promoted nor denigrated. 1. (Introduction) p. xxxvi: Teachers are given guidelines for responding to student questions that reflect religious beliefs without supporting or denigrating their beliefs. 2. p. 9: When giving the first homework assignment, teachers are prompted not to hold one belief over all others. Have the students explore how their family s beliefs support the prevention of HIV/STDs. Positive Prevention PLUS Concerns: 1. Terminology for religious leaders and places of worship is not inclusive of the diverse religious affiliations in California. California Healthy Kids Resource Center, 2010 Page 11 of 27

12 Criterion 6. Instruction and materials do not reflect or promote bias against any person on the basis of mental or physical disability. Instruction and materials do not promote or reflect bias on the basis of mental or physical disability. Criterion 7. Instruction and materials do not reflect or promote bias against any person on the basis of actual or perceived association with any of the groups listed in numbers 1-6 above. See number 3 above. California Healthy Kids Resource Center, 2010 Page 12 of 27

13 IV. Content: Knowledge/Information Sexual Health 1. Criterion 1. Instruction and materials provide the information that abstinence is the only certain way to prevent unintended pregnancy and sexually transmitted disease (STD), and presents information about the value of abstinence, while also providing medically accurate information about other hods to prevent unintended pregnancy and sexually transmitted disease (STD). Abstinence is consistently described as the safest and most reliable way to avoid pregnancy and STDs. Medically accurate information is also provided for other prevention hods. 1. p.101: Student learning objective for lesson is, Identify abstinence from sexual intercourse as the only 100% safe hod for avoiding unplanned pregnancy and the sexual transmission of HIV and other STDs. 2. p. 161: Abstinence is called out as a behavior that removes the risk of HIV/STD transmission. 3. p. 163: Poster with levels of effectiveness in preventing pregnancy and HIV/STDs lists sexual abstinence first with effectiveness of 100 percent. 4. pp : Chart with levels of effectiveness for hods to prevent pregnancy and HIV/STD lists continuous abstinence (no insertive anal, oral or vaginal sex) first with 100% effectiveness with many advantages and few disadvantages. 1. p. 50: In discussing What is family planning? teachers are prompted to tell students that abstinence is the only certain way to prevent pregnancy and sexually transmitted infections. 2. p. 52: The Contraceptive Choices overhead with levels of effectiveness of hods to prevent pregnancy and HIV/STDs lists sexual abstinence first with an effectiveness level of 100 percent. 3. pp : The Contraceptive Choices chart with levels of effectiveness of 12 hods (11 plus emergency contraception) to prevent pregnancy and HIV/STD lists continuous abstinence (no insertive anal, oral or vaginal sex) first, with 100 percent effectiveness, many advantages, and few disadvantages. California Healthy Kids Resource Center, 2010 Page 13 of 27

14 4. p. 56: The class is divided in groups and the task is to list reasons why people should abstain from sex, then share and discuss the group lists. Criterion 2. Instruction provides information about STDs including how they are and are not transmitted. Transmission of STDs is clearly described including how they are not transmitted. 1. pp : Lesson provides information about how gonorrhea, syphilis, Chlamydia, Human papillomavirus, HIV, Hepatitis B, herpes, and pubic lice are transmitted. 2. pp : Lesson differentiates activities that transmit STDs from those that do not. Criterion 3. Instruction provides medically accurate information on hods of preventing pregnancy and STDs. Medically accurate information about preventing both pregnancy and STDs is provided. 1. p. 93: Ways to prevent HIV/STD infection are presented including sexual abstinence, reducing the number of sexual contacts, using condoms, asking partners about previous STDs, vaccinating against Hepatitis B, and abstaining from drugs and alcohol. 2. p. 163: Poster/slide includes levels of effectiveness of hods to prevent pregnancy and STDs with advantages and disadvantages of each. 1. p. 52: Poster/slide master includes levels of effectiveness of hods to prevent pregnancy and HIV/STDs. 2. p : Chart with levels of effectiveness of 12 hods (11 plus emergency contraception) to prevent pregnancy and HIV/STD and includes information about advantages and disadvantages (side effects). California Healthy Kids Resource Center, 2010 Page 14 of 27

15 Criterion 4. Instruction provides information on local resources for testing and medical care for STDs. Local sources for testing and medical care are included. 1. p. 93: Students discuss when someone should get tested for STDs. Prompted answers include after having unprotected sex, when symptoms arise, when they know they have been exposed to an STD, and when they are pregnant. 2. pp. 97 and 99: Student homework assignment (and optional STD worksheet activity) is to research the location of local clinics that provide STD testing and Hepatitis B vaccine. 3. pp : Entire lesson is focused on STD testing, the process, and locations of local resources 4. pp : A typical HIV/STD testing experience is described. 5. p. 220: Teachers are prompted to obtain information for students about local clinics that provide HIV and STD testing. The information is to include location, telephone number, hours, cost, and whether or not HIV antibody testing is confidential or anonymous and if both HIV and STD screening tests are administered at the location. 1. pp : Lesson 4 provides information about local testing sites for which the teacher is prompted to do research. The student learning objective is, Identify community resources for STD testing and treatment. California Healthy Kids Resource Center, 2010 Page 15 of 27

16 Criterion 5. Instruction provides information about the effectiveness and safety of ALL contraceptive hods in preventing pregnancy, including emergency contraception approved by the federal Food and Drug Administration (FDA). In Positive Prevention, the lesson about birth control hods is optional and does not include emergency contraception and all other FDA-approved hods. In Positive Prevention PLUS, all FDA-approved contraceptive hods are included and accompanied by information about effectiveness and safety. Emergency contraception is also included in Positive Prevention PLUS. 1. p. 163: Poster/slide with levels of effectiveness of 12 hods of contraception with the first two being abstinence and outercourse. 2. pp : Chart with levels of effectiveness for hods to prevent pregnancy and HIV/STD with advantages and disadvantages of each. 1. p. 52: The Contraceptive Choices overhead provides levels of effectiveness of hods to prevent pregnancy and HIV/STDs. 2. p. 53: Information about emergency contraception is presented. 3. p : The Contraceptive Choices chart with levels of effectiveness of 12 hods (11 plus emergency contraception) to prevent pregnancy and HIV/STD includes information about advantages and disadvantages (side effects). California Healthy Kids Resource Center, 2010 Page 16 of 27

17 Criterion 6. Instruction provides information about the effectiveness and safety of AT LEAST ONE OR MORE drug or device approved by the FDA for preventing pregnancy. See number 5 above. Criterion 7. Instruction provides information about the effectiveness and safety of ALL FDA-approved hods of reducing risk of contracting STDs. Information is provided about effectiveness and safety of hods to reduce risk of exposure to STDs. 1. pp : The success and failure rates of condoms to prevent STD/HIV are presented. 2. p. 163: Poster/slide lists levels of effectiveness of FDA-approved hods to prevent STD/HIV. 3. pp : Chart includes levels of effectiveness for both male and female condoms to prevent HIV/STD with advantages and disadvantages of each. 1. p. 52: The Contraceptive Choices overhead has levels of effectiveness of male and female condoms to prevent HIV/STD. 2. pp : Effectiveness and safety (advantages/disadvantages) of hods to prevent HIV/STD includes both male and female condoms. California Healthy Kids Resource Center, 2010 Page 17 of 27

18 Criterion 8. Instruction provides information about the effectiveness and safety of AT LEAST ONE OR MORE drug or device approved by the FDA for reducing the risk of contracting STDs. See number 7 above. Criterion 9. Instruction provides information on the law on surrendering physical custody of a minor child 72 hours or younger. The California law regarding surrendering physical custody of a minor child is addressed in Positive Prevention PLUS. 1. pp : Lesson 3 is devoted to informing students about California s Safe Surrender law and how to make important decisions if faced with an unplanned pregnancy. Positive Prevention PLUS Concerns: 1. pp. 66 and 69: Step Four in the decision-making model regarding an unplanned pregnancy is to identify resources. Missing from the list of potential resources on both pages 66 and 69 is the other biological parent. California Healthy Kids Resource Center, 2010 Page 18 of 27

19 V. Content: Knowledge/Information HIV/AIDS Criterion 1. Instruction includes information on the nature of HIV/AIDS and its effects on the human body. HIV/AIDS effects on the body are described. 1. pp : An overview of the HIV/AIDS effect on the immune system is provided along with information about progression from HIV to AIDS (i.e., what is happening in the body). Criterion 2. Instruction includes information on the manner in which HIV is and is not transmitted, including information on activities that present the highest risk of HIV infection. Comparison of risk of activities that may transmit HIV is included. 1. pp : Information about HIV/AIDS transmission is presented by a brief review of the four body fluids that transmit HIV from one person to another (blood, semen, vaginal fluids, and breast milk). This is followed by an activity in which students are asked to examine the likelihood of HIV transmission involving different body fluids (e.g., blood, semen, tears, urine, etc.) and different body parts (e.g., mouth, penis, ear, navel, etc.). 2. pp : Answers to frequently asked questions about transmission clarify how HIV is and is not transmitted. 3. p. 74: In the context of other STDs, a clear explanation of how HIV is transmitted is provided. 4. pp : Red, yellow, and green lights are assigned to activities ranging from going to a movie to sharing needles to inject drugs. This game is designed to help students identify activities with highest risk of exposure to HIV. California Healthy Kids Resource Center, 2010 Page 19 of 27

20 Criterion 3. Instruction includes discussion of hods to reduce the risk of HIV infection, emphasizing: a. sexual abstinence b. monogamy c. avoidance of multiple sexual partners d. abstinence from intravenous (IV) drug use Instruction also teaches: e. statistics based on the latest medical information citing the successes and failure rates of condoms and other contraceptives in preventing sexually transmitted HIV infection f. information on other hods that may reduce the risk of HIV transmission from IV drug use a. Abstinence: Yes (PP) p. 93: Sexual abstinence is presented first on list of ways to prevent STD/HIV infection. (PP) p.101: The related student learning objective is, Identify abstinence from sexual intercourse as the only 100% safe hod for avoiding unplanned pregnancy and the sexual transmission of HIV and other STDs. b. Monogamy: Yes (PP) p. 64: Having sex with only one uninfected partner is described as a highly effective way to avoid HIV infection. (PP) pp. 101, 143, and 152: Sexual monogamy (one lifetime partner) is advanced as a way to reduce exposure to HIV. c. Avoidance of multiple sexual partners: Yes (PP) p. 93: Ways to prevent HIV/STD infection are presented including reducing the number of sexual contacts. (PP) pp. 101: Reducing the number of sexual partners is presented as a way to reduce risk of STDs and HIV. d. Abstinence from IV drug use: Yes (PP) p. 93: Ways to prevent HIV/STD infection are presented including abstaining from drugs and alcohol. California Healthy Kids Resource Center, 2010 Page 20 of 27

21 (PP) pp. 101 and 152: Sharing needles to use IV drugs is identified as a high risk activity. e. Success and failure rates: Yes (PP) pp. 159: Studies about condom effectiveness to prevent HIV are reported. (PPPLUS) p. 52: Overhead master includes levels of effectiveness of hods to prevent HIV/STDs. (PPPLUS) p : Chart includes levels of effectiveness of 12 hods (11 plus emergency contraception) to prevent pregnancy and HIV/STD and information about advantages and disadvantages (side effects). f. Other hods to reduce risk: Yes (PP) p. 153: Cleaning objects contaminated with another person s blood with bleach and water is explained as part of Universal Precautions. Criterion 4. Instruction includes discussion on the public health issues associated with HIV/AIDS. The role of public health in surveillance, education to reduce transmission, testing, and treatment is included. 1. pp : The world wide pandemic and the spread of HIV in the United States and in California are explained including the role of public health in tracking and reporting. 2. pp : The role of public health in testing and counseling and notification of sexual partners is covered. 1. pp. 76 and 78: Lesson 4 includes information about the availability of public health clinics for HIV/STD testing and treatment. California Healthy Kids Resource Center, 2010 Page 21 of 27

22 Criterion 5. Instruction includes information on local resources for HIV testing and medical care. Local testing information is included and teachers are prompted to prepare to give specifics about the local resources to students. 1. pp : Local resources for testing, treatment, and counseling when at risk for HIV exposure are provided. 2. pp : A typical HIV/STD testing experience is outlined and illustrated. Instructors are prompted to research and provide information about local resources for testing. 1. pp : Lesson 4 provides information about local testing sites for which the teacher is prompted to do research. The student learning objective is, Identify community resources for STD and HIV/AIDS testing and treatment. Criterion 6. Instruction includes discussion about societal views on HIV/AIDS, including stereotypes and myths regarding persons with HIV/AIDS. Myths and stereotypes are addressed as related to persons with HIV/AIDS. 1. pp : After a presentation by a speaker who is HIV positive, there are activities designed to help students process their reactions and do self-examination about stereotyping and lack of compassion. 2. p. 229: Teachers are prompted to encourage students to have discussions with parent(s) or supervising adult(s) about the spread of HIV, sexual abstinence, and what to do when they hear stereotyped and prejudiced remarks about people with HIV/AIDS. California Healthy Kids Resource Center, 2010 Page 22 of 27

23 VI. Content: Attitudes Criterion 1. Instruction and materials teach respect for marriage and committed relationships. Marriage and committed relationships are presented with respect. 1. p. 64: Having sex with only one uninfected partner is described as a highly effective way to avoid HIV infection. 2. pp. 101, 143, and 152: Sexual monogamy (one lifetime partner) is advanced as a way to reduce exposure to HIV. 1. p. 32: Students are asked to identify the characteristics of a high quality friendship. The instructor then highlights that the qualities that make up a high quality friendship are the same qualities needed in a committed relationship or marriage. Criterion 2. Instruction emphasizes compassion for persons living with HIV/AIDS. Compassion for persons with HIV/AIDS is encouraged with information, a guest speaker, and follow-up activities. 1. pp : Inviting persons who are HIV positive as classroom speakers followed by activities so that students can process their reactions elicits self-examination about stereotyping and compassion. 2. pp : The Loss Activity prompts students to examine the feelings that they would have if they were to lose valuable components of their lives (favorite traits, special skills, a special person, and future plans). California Healthy Kids Resource Center, 2010 Page 23 of 27

24 VII. Content: Skills Criterion 1. Instruction and materials encourage students to communicate with his or her parents or guardians about human sexuality. Lessons encourage students to discuss course topics with parents. Ideas for family homework are provided to encourage parent/guardian communication. 1. p. 9: e to teachers to encourage discussions at home related to HIV/AIDS when assigning students to keep a journal that includes outcomes of discussions at home. 2. p. 211: Students are encouraged to set up a rescue plan with their parents or supervising adult regarding how to escape an awkward or risky situation. 3. p. 229: Teachers are prompted to encourage students to discuss spread of HIV, sexual abstinence, and what to do when they hear stereotyped and prejudiced remarks about people with HIV/AIDS with parent(s) or supervising adult(s). 1. (Appendix B) pp.1-10: Materials for parents and suggested agenda for a parent meeting to encourage communication with their children about sex are provided in English and Spanish. Positive Prevention and Positive Prevention PLUS Concerns: 1. The Family/Homework Assignments are simply activity suggestions (e.g., p. 57, recommend that students interview parent(s) about their greatest current health concern for their child(ren) or youth) without providing the guidance necessary to (a) ensure students do the family homework activity, (b) foster a successful experience for students and their families, or (c) support teachers to meaningfully incorporate the activities into instruction. California Healthy Kids Resource Center, 2010 Page 24 of 27

25 Criterion 2. Instruction provides skills for making and implementing responsible decisions about sexuality. Decision-making skill development is included in both curricula. 1. pp : Lesson 4 provides information and opportunities to practice the skills to recognize risk situations. 2. pp : Students are encouraged to make a personal contract that articulates their reasons for avoiding HIV/AIDS and to enlist the support of another person such as a parent to make the associated decisions. 1. pp : Lesson 3 addresses decision making when faced with unplanned pregnancy. The lesson provides a step-by-step model demonstrated by the teacher for the problem What can a girl do if she has an unintended pregnancy? Students then use the model to practice the decision-making steps on a personal decision they are currently making (e.g., Should I be alone at home with my boyfriend or girlfriend? ). 2. pp : Lesson 1 provides information supporting responsible decisions about bullying and harassment. Criterion 3. Instruction includes development of refusal skills for overcoming peer pressure and using effective decision-making skills to avoid high risk activities. Decision-making and refusal skills are taught and practiced. 1. pp : Clear and assertive communication skills are introduced and practiced by students using sample pressure lines and responses. 2. pp : Refusal skills are introduced and practiced by students using sample case study situations where students fill in the blanks as to how to effectively refuse an offer. California Healthy Kids Resource Center, 2010 Page 25 of 27

26 1. pp. 56: In a lesson on sexual abstinence, students are asked to brainstorm non-verbal communication strategies to show someone they are not interested in having sexual intercourse. California Healthy Kids Resource Center, 2010 Page 26 of 27

27 Implementation in California Schools and Community Settings When both curricula (Positive Prevention Level A and Positive Prevention PLUS Level A) for middle or junior high school students are implemented together, they comply with 41 of 45 (91 percent) of the requirements of the state Education Code and 11 of 13 (85 percent) of the requirements of the state Health and Safety Code. The two curricula are not designed to be used as separate learning modules and if used separately, neither is in full compliance with legal requirements in California. If used in California, the following enhancements are recommended to address gaps in compliance with legal requirements: (Roman numerals below refer to sections of the Evaluation Detail.) I. Accuracy and Appropriateness: Clarify content and test questions related to effectiveness of condoms (see concern number 1 in Section I, subsection 2). Address Positive Prevention PLUS concerns 2, 3 and 4 in Section I, subsection 2 about female anatomy omitting external genitalia, male visual of erect and ejaculating penis lacking teacher guidance about how it is to be used for instruction, and lesson extension that begins with #3. II. Accessibility: Provide parent and student materials in languages that are relevant to the student population. In many communities in California, family homework (and possibly some student handouts) would have to be translated into more languages than Spanish and done by persons from the specific groups to be sure the translations are culturally appropriate. When republished, update national hotline numbers. III. Objectivity: Use more inclusive terminology for titles of leaders in religious communities and names of the places where worship and prayer occur to reflect the diversity of religions in California. Add information and opportunities for students to be actively engaged in learning about sexual orientation in the body of the curricula, not relegating that topic to the appendices as is done in Positive Prevention PLUS. IV. Content: Knowledge/Information Sexual Health Address the omission of the other biological parent as a potential resource for the pregnant woman. California Healthy Kids Resource Center, 2010 Page 27 of 27