What to Tell Your Children About AIDS.

Hint: It's not just facts and figures about the epidemic that count. You have to share some of yourself, too.

The acquired immunodeficiency syndrome (AIDS) continues to pose a significant threat to humanity. The World Health Organization (WHO) estimates that 11.7 million people have already died from AIDS since the beginning of the epidemic, and 30.6 million more are infected with the human immunodeficiency virus (HIV), the agent known to cause AIDS. In the United States as of June 1997, a total of 612,078 cases of AIDS had been reported to the Centers for Disease Control and Prevention (CDC).

The WHO recently reported that the number of persons who are infected with HIV is far higher than previously thought. As many as one in every 100 sexually active people worldwide are HIV infected, and if current transmission rates hold steady, by the year 2000 the number of people living with HIV/AIDS will soar to 40 million. Each day approximately 16,000 individuals become infected with the AIDS virus. In most parts of the world the majority of new HIV infections are in individuals between the ages of 15 and 24 years.

The actual disease called AIDS represents only the end-stage manifestation of a prolonged infection with HIV. The CDC reported that 22 3 percent of diagnosed cases of AIDS in women and 17 percent in men were in the age group of 20-29 years. Since the latency period from the time of infection with HIV until the development of the AIDS complex is generally regarded as between eight and 10 years, it's highly likely that adolescents are becoming infected with HIV and are diagnosed with AIDS when they are no longer adolescents.

Sexual activity among adolescents poses several health consequences to those in this young age group. The cervix of the developing adolescent female is covered by a very thin layer of cells. This layer is still developing and has not yet matured into a thicker layer of cells that will better protect her from organisms that are known to cause sexually transmitted diseases, including the virus that causes AIDS.

Adolescence is also a time of profound physical, psychological, and social changes, when the process of family separation begins, independent thought and action develop, and the identity as a sexual self emerges. This is for many adolescents a time for exploring and experimenting with various behaviors. Many young adolescents who engage in sexual activity have not reached a level of cognitive development that allows them to be future-oriented or understanding of long-term consequences of their actions.

Adolescents often engage in impulsive behaviors and are at developmental stages characterized by taking risks--the consequences of which must be dealt with later in life. Although most adolescents are aware of various dangers around them, they frequently feel that they are immune, invulnerable, immortal, and will never die of anything. This may result in adolescents thinking AIDS cannot happen to them.

For some youth, there is a perception that risky behavior helps them gain admission to peer groups and enhance self-esteem. Some youth believe that taking risks helps them take control of their lives and express opposition to adult authority or society.

Teenagers who experiment with sex and drugs are vulnerable to HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy. Yet they are likely to be a difficult age group to influence toward HIV/AIDS prevention because of their susceptibility to negative peer pressure, propensity to take risks (including sex and drug experimentation), and difficulty grasping the long-term adverse consequences of their potentially dangerous behaviors.

Research designed to measure AIDS risk among youth started to emerge in the professional literature around 1985. These studies reported that youth had very low levels of knowledge regarding AIDS. Often they thought that one could contract HIV by holding hands or just by casual touching. Efforts were initiated by educators to correct this deficiency in understanding, and by 1990 subsequent research demonstrated that youth generally understood the modes of transmission of the AIDS virus quite accurately.

However, as their level of accurate knowledge regarding AIDS/HIV increased, the rates of their AIDS-risk behaviors, including sexual intercourse, did not decrease. High levels of accurate information were thus not effective in protecting them from practicing AIDS-risk behaviors.

One study done among students attending Christian schools in North America asked 1,748 students 13 questions regarding AIDS, such as "Can you get AIDS from a toilet seat or from a mosquito?" etc. The total student population in that study did quite well, answering around 90 percent of the questions correctly. When further analysis of the data was performed, it was found that those who were not sexually experienced scored 91 percent, and those who were sexually experienced scored 89 percent; both excellent scores. But clearly, accurate knowledge did not translate into refraining from sexual intercourse.

Recent research conducted by the University of Minnesota and the University of North Carolina investigated what features of a young person's environment (home, school, and individual) would emerge as protective for such things as drug use and sexual behaviors known to be associated with increased risk for contracting or transmitting the AIDS virus. They found that when teens feel connected to their families and when parents are involved in the children's lives, teens are relatively protected from many risky behaviors. Even in circumstances in which teenagers don't have a sense of family connectedness, they will be relatively protected from risky behaviors by a similar sense of connectedness to another significant adult in their lives, such as a mentor or a teacher.

An abundance of past research has reported that youth from single-parent homes, from families who are poor, and from racial or ethnic minorities are at great risk for participating in behaviors that increase risk for contracting the AIDS virus. The research above strikingly and importantly contradicts these long-held beliefs. Regardless of the number of parents in the household, whether families were rich or poor, race and ethnicity, children who reported feeling connected to a parent were protected against many different kinds of risks, including emotional distress; suicidal thoughts and attempts; cigarette, alcohol, and marijuana use; violent behavior; and early sexual activity. They also found that parents who give clear messages about delaying sex have children who are less likely to have early intercourse--an AIDS-risk behavior.

What to Tell Your Kids About AIDS

Tell your kids about the consequences of participating in sexual intercourse at a young age and of the value of waiting until marriage to participate in this God-created behavior. Talk with them about the risks of early pregnancy, the possibility of sexually transmitted diseases, and the particular risk young people face for contracting the virus that causes AIDS--including through heterosexual contact. Remember, most young people are not impressed with a message of fear. Stick to the facts, keep it simple, and repeat it at intervals.

But also remember, according to current research, as valuable as this information may be, it is not as important as clearly stating your own beliefs to your children regarding sexual intercourse before marriage. Furthermore, even beyond the information and the message of your own beliefs is the very real challenge of developing a meaningful relationship with your kids and creating a sense of connectedness within your family. Any intuition from our Christian backgrounds about this is correct: science now informs us that this sense of belonging and a feeling of being connected to adults will go further and do more to protect your kids from AIDS and other at-risk behaviors than the best intentions of a simple message.

Gary Hopkins, M.D., Dr. P.H., is director of the Institute for Prevention of Addictions, Andrews University, Berrien Springs, Michigan. William A. Wittlake, M.D., F.A.C.E.P., is chief of service at the Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, California. They were assisted in preparing this article by: Bruce Heischober, M.D., chief of public health emergency medicine at Loma Linda University Medical Center, Loma Linda, California; and John V. Stevens, Jr., J.D., attorney at law in Riverside, California.