Awareness among Community College Students 1992-1998
ASM Focus on Education, Spring 1999
AIDS first came to public attention in 1981 with reports that a few young homosexual men had died of Pneumocystis pneumonia. By 1998, the World Health Organization estimated that 30 million people worldwide were living with HIV/AIDS and that 10,000 new HIV infections occur each day (7). The majority of individuals with AIDS are in the sexually active age group and include both men and women. In 1993, HIV infection became the most common cause of death among persons aged 25 to 44 years. The long latency between infection with HIV and the development of AIDS suggests that many people are infected in adolescence. In the United States, in areas where both AIDS and HIV infection are monitored, 3% of people with AIDS and 14% of those with HIV infection reported between January 1994 and June 1997 were 13 to 24 years old (4). Therefore, decreasing high-risk sexual and drug-using behaviors among teenagers and young adults is a primary HIV prevention priority. Rich et al. believe that college students may be an important target population for prevention measures (9). Additionally, college students are in a position to influence the behavior of their high-school-age friends and relatives.
In 1988, Surgeon General C. Everett Koop advocated that AIDS education must begin in elementary school. He stated that "adolescents and preadolescents are those whose behavior we wish especially to influence because they are exploring their own sexuality (heterosexual and homosexual) and perhaps experimenting with drugs." In that year, the Centers for Disease Control and Prevention (CDC) published guidelines for AIDS education for elementary through high school (1). At the same time, the CDC published results of the Youth Risk Behavior Surveillance assessing their knowledge about AIDS prevention. Various proportions of high school students knew that blood donation, insect bites, use of public toilets, or blood tests (2) cannot transmit HIV. Most students knew that having sexual intercourse without using a condom can transmit HIV. The percentage of high school students who received HIV instruction in school increased from 54% in 1989 to 83% in 1991. From 1989 to 1991, significant declines occurred in the percentages of students who reported ever having had sexual intercourse and having two or more sex partners during their lifetime (3).
By the time students enter college, they have been exposed to AIDS risk intervention programs through (i) high school, (ii) mass media, and (iii) public health information on campus. According to Fisher and Fisher, most of these intervention programs are informal and based primarily on conceptualizations to improve AIDS knowledge (6). In 1992, Cline and Johnson reported that many college students still considered HIV/AIDS associated primarily with homosexuality (5).
Ideally, improved AIDS knowledge would allow young people to implement behavioral changes to reduce the risk of infection. However, a recent study of community college students showed that AIDS ranked third on a list of lifes worries, behind getting bad grades and the death of a family member. For black and Hispanic students, getting AIDS ranked first on a list of lifes worries. Students reporting high-risk behavior for getting HIV also ranked getting AIDS first on their list of lifes worries (9). This suggests that the students might not have the knowledge or that they are not assimilating their new knowledge to take control of their lives. The latter could have a variety of social and psychological reasons. Our study was designed to determine whether they had the knowledge.
Purpose and Procedures
The purpose of this ongoing
study is to assess the level of AIDS awareness in community college students.
Each semester a questionnaire is given to students at a community college
located five miles outside of San Francisco. The students are enrolled in
general biology classes designed for nonscience majors. Students are not asked
personal questions, and their responses are anonymous. Students enrolled in
the general biology classes reflect the gender and ethnic composition of the
college. The college is a minority institution, and over half of the students
are female (Table 1).
|Table 1. Selected Characteristics of Study Population|
|Median age||25 yr.|
The questionnaire is used to introduce immunology. It is also intended to pique students interest in the topic and provide the instructor with information about the students knowledge, not to assess whether they have learned or changed their behavior as a result of a specific program or course. We have been pleased with the interest generated among students. Students always comment that "this is interesting" and "this is important," and they talk with friends about the questions outside of class.
There are 20 questions on various aspects of immunology and emerging disease. Although questions may vary with the semester, 10 have remained constant over time (Figure 1). By comparing student responses to these questions, we have been able to monitor trends in student awareness levels.
As shown in Figure 1, students today are more aware of AIDS than they were 7 years ago (question #1) and they know that the presence of antibodies against HIV is used to indicate infection (question #2). Students also know that AIDS is not transmitted by casual contact (question #3). For those questions (#4 to 7) that most directly address risk of HIV/AIDS, the percentage of correct answers increased from 35% in 1992 to 43% in 1995. However, the percentage increase in correct answers was negligible between 1995 (43%) and 1998 (44%).
Fewer than half (41%) of the students know that heterosexual sex is the primary method of transmission; this is down from 61% in 1995. Slightly less than half (47%) of the students are aware of the susceptibility of women to AIDS. Students are not aware that the rate of HIV/AIDS in the Hispanic white population is significantly (three times) higher than in the non-Hispanic white population, although there was a higher percentage (50%) of correct answers in 1998 than in 1996 (35%), the first time this question was used. Students are unaware of the magnitude of the AIDS epidemic (questions 8 and 9).
Figure 1. Percentages
of students answering selected questions correctly: 1992, 1995, and 1998.
(1992, N = 265; 1995, N = 121; 1998, N = 228.)
Key to Questions. The
questions were presented in multiple-choice format. An * indicates the correct
1. In [current year],
the number of new cases of (a*) gonorrhea; (b) AIDS.
2. People with AIDS have no antibodies. True or False*
3. Which of the following is not true about HIV? (d*) It is transmitted by saliva and tears.
4. Worldwide, the primary method of transmission of AIDS is (d*) heterosexual sex.
5. Which is greater? The likelihood that a 24-year-old with AIDS contracted the disease as (b*) a teenager
6. Which is greater? During heterosexual intercourse between 24 and 44 years of age, the likelihood that the (a*) woman will get AIDS.
7. In the U.S., the ranking of AIDS as a cause of death among people of all races (ages 15 to 44 yr.) is (b*) #2 to 5
8. Which is greater? In the U.S., the number of new AIDS cases between: (a)1981-1992; (b)1992-1999; (c*) equal.
9. The incidence of AIDS is greater in (a*) New York
ß10. Which is greater: In [current year], in the U.S., the rate of new AIDS cases among (a*) Hispanic white This question was not asked in 1992. It was asked in Fall 1996 for the first time. Fall 1996 and Fall 1998 responses are compared in the graph.
Our results, as well as those from other studies (8), show that students knowledge/awareness about AIDS and how AIDS is and is not transmitted has improved since 1992. However, our results indicate little change in awareness/knowledge since 1995. Fewer than half of the students correctly answered questions that relate to their risk of infection.
It is impossible to know from these data why students knowledge/awareness has not increased. Two factors that could make AIDS information a low priority for young people are as follows. (i) New therapies such as protease inhibitors are prolonging the life of people with HIV/AIDS. Consequently, between 1995 and 1997, AIDS dropped from first to fifth as a cause of death in 25- to 44-year-olds. (ii) AIDS has not received much attention from the national news media since 1995. Unfortunately, the data we obtained may mean that college students are more complacent about their high-risk behaviors.
© 1999 ASM