Almost 17 years have passed since the first mention of AIDS in the United States. As we approach the new millenium and the twentieth anniversary of AIDS presence in our country, higher education institutions cannot remit in their aggressive prevention efforts. Colleges and universities must continue to ask better questions and challenge students to think beyond personal infection to global concerns surrounding HIV and AIDS. This article explores the history of HIV and AIDS education and prevention efforts, discusses the implications for student affairs, and will convince readers that a curriculum change for HIV and AIDS prevention education is necessary.

Acquired Immunodeficiency Syndrome (AIDS) was first identified between 1902 and 1911 in seven Italian men. Between 1912 and 1966 twenty-two cases were reported throughout Europe and the Americas. In June of 1981, North America saw its first cases of AIDS with the reports that several homosexual men had developed rare strains of cancer and pneumonia (Vargo, 1992). In this early period of the virus, physicians were unable to predict the likelihood of occurrence, or vehicle of transmission, of this deadly disease. Dr. Michael Gottlieb, one of the first physicians to discover AIDS and AIDS Related Complex (ARC), recalled

At first, I naively thought that the patients would recover and that they would be healthy once again. I was wrong. All of them died. It was clear to me before too long that we were on the brink of a natural disaster as devastating as any on earth. (Vargo, p.11).

Indeed, “in under 35 years, the AIDS epidemic devastated humanity even more than the bubonic plague, which took almost 2,000 years to cause 50 million deaths worldwide” (Quirolgico, 1993, p.64).

Using the information they had acquired up to that point, doctors named this immune system disease, Gay-Related Immune Deficiency or GRID, which would later prove to be problematic in prevention education efforts. Health care workers and scientists would eventually learn that AIDS is caused by the Human Immunodeficiency Virus (HIV), which is transmitted through blood, semen, breast milk, vaginal, pre-seminal, and cerebral spinal fluids. Transmission occurs primarily though intimate sexual contact or contaminated syringes during intravenous drug use and can infect heterosexuals, bisexuals and homosexuals indiscriminately. Consequently, HIV and AIDS prevention education efforts since those early days have focused on making the general public more knowledgeable about the modes of transmission and the appropriate methods needed to prevent infection.

As of April 1998, 610,000 cases of AIDS have been reported in the United States while 380,000 people have already died (Corser, personal communication, April, 1998). In June of 1995, estimates of worldwide AIDS cases were 4.5 million while HIV infections were 19.5 million (Douglas & Pinsky, 1996). By the year 2000, as many as 110 million people worldwide may be infected with HIV (Corser). From these cases, research conducted has helped health care workers treat HIV infections and AIDS complicated diseases more effectively. Likewise, HIV/AIDS prevention educators have used the knowledge gained over the past ten years to aggressively alert this epidemic to the general public.

In the initial stages of this disease, college-aged adults were not the primary age group infected. As of 1986, there had only been a few documented cases of AIDS on college campuses (Keeling, 1986). However, the prolonged incubation period of HIV, and inadequate testing procedures at that time, combined to produce uncertain information regarding HIV’s prevalence on college campuses. Nevertheless, in 1985, the American College Health Association (ACHE) developed a special task force to examine the need for and methods of prevention education efforts. Based on the assumptions that students are experimental, exercise inconsistent judgment in selection of sexual partners, toy with recreational drugs, and do not confine their sexual practices to the campus community, the ACHA determined that no community population could be left un-targeted in these efforts (Keeling).

The general public did not heed the initial reports of HIV any more than did college students. Because nearly three-quarters of AIDS patients were homosexual or bisexual males and 17% were intravenous drug users (Keeling, 1986), people who did not identify with either group paid little attention to early educational attempts. Later, HIV and AIDS began to appear in the heterosexual community as well as among hemophiliacs and children. As a result, the general public became hungry for information and fearful of a health concern they did not understand. “That many Americans continue to believe that AIDS can be acquired from a drinking glass, toilet seat, or one’s casual companion undoubtedly reflects not just misinformation, but fear” (Keeling, p.125).

College health educators inundated students with information about transmissibility, susceptibility, safe sex and abstinence. Similar to the apathy that existed previously in the general population, college students only partially listened to the information being given to them. Studies about perceived susceptibility to infection and the prevailing beliefs about HIV and AIDS among college students produced some startling results and indicated the need for better prevention education. A study conducted by Manning, et al. in 1989 revealed students’ opinions of their susceptibility to the disease. “There are no Haitians on campus; The AIDS problem is elsewhere; They trust their partners; AIDS is not prevalent among heterosexuals; They are young and rich; They only have one partner; They’re educated enough to use discretion (p.70).”

Another study conducted by Livingston in 1990 showed that many misconceptions about AIDS still existed among college students. Most of Livingston’s respondents (greater than 60%) felt confident that they could not contract HIV from shaking hands with another person who has AIDS, kissing on the cheek with someone who has AIDS, or attending school with someone who has AIDS. However, many of these same students were not quite as certain of their susceptibility of contracting HIV while working with someone who has AIDS, eating at a place where the cook has AIDS, sharing utensils with someone who has AIDS, or using public toilets. Twenty-three percent of the students believed they were somewhat likely to be infected by a mosquito carrying the virus and a 1986 survey found that “much of the general public and even some health professionals equate infectious agents with airborne transmission (Vargo, 1992, p.61).”

Education efforts were reaching their targeted audiences but not all the information was being received accurately. ACHA efforts emphasized that AIDS is not transmitted by any form of casual interpersonal contact, that the virus is extremely fragile and cannot survive in the air, that it cannot multiply on inanimate objects or environmental surfaces, nor can it swim across pools or fly through the air. They correctly asserted that HIV is transmitted solely through intimate sexual contact or by sharing needles. College health educators repeatedly stressed these facts to students and, by the late 1980’s and early 1990’s, the message was heard in its entirety. “College students had learned that the risk is not that of the classroom, or the residence hall, or the roommate: it is what is done in the residence hall, or with the roommate” (Keeling, 1986, p.125).

After the introduction of AIDS education to college-aged students, efforts were made to extend HIV infection prevention efforts to junior high and high school settings. This was in large part due to the rising cases of infection in children and adolescents (Vargo, 1992). Experts believed that the earlier this information was introduced the more effective it would be in preventing new cases of infection. Likewise, to stop the spread of this epidemic, prevention education was introduced to students before they engaged in intimate sexual behavior rather than afterward. Unfortunately, many junior high and high schools were reluctant to include information about condom use and safe sex in their curriculum. These schools were not entirely to blame for the relative lack of HIV education, however. Under Ronald Reagan, the government was accused of withholding funds for medical research and public health education for HIV and AIDS because these illnesses had historically affected only social, sexual and racial minorities. During this period, none of these groups were judged important enough to be included on the “A-list of the Republican Party” (Vargo).

In the late 1980’s and early 1990’s advances in education and technology helped disseminate information to more people across the United States. Secondary schools included HIV education as part of their mandatory curriculum. Although many groups and individuals ostracized and condemned those suffering from AIDS in the past, often blaming victims for contracting the illness (Vargo, 1992), humanitarian support and educational programs became more sensitive in the 1990’s. Institutions of higher education also joined in education and prevention efforts. They utilized a variety of strategies and resources, including small groups of students, faculty, and staff members as well as officially appointed task forces and committees on policy issues (Keeling, 1996). “HIV became strangely ‘routine’ on campus. A combination of workshops, conferences, consistent policy recommendations, technical assistance from professional organizations, enlightened leadership, and perhaps, the passage of time softened campus resistance to dealing effectively with HIV“ (Keeling, p.6).

The discussion of HIV, and the acknowledgement of its presence on college campuses, by the late 1980’s became easier. The portrayal of HIV as an egalitarian risk and a mainstream problem, not just a gay disease, helped further dialogue around the issues associated with AIDS. “On campus, education and services about HIV became more comfortable - indeed more possible - in direct proportion to the subtraction of homosexuality from HIV” (Keeling, 1996, p.6). AIDS awareness weeks, condom vending machines, World AIDS Day celebrations, AIDS fundraising events and memorials saturated the academy. Many of the students were already knowledgeable about HIV and AIDS by the time they entered college because of earlier educational efforts. Although there were signs that early education was working and that students were knowledgeable about the disease, infection rates continued to increase among adolescents. This increase in education and infection was most likely due to the paradox of prevention: “Knowledge alone does not alter behavior, even when the knowledge is of a serious, life threatening hazard and the changes required for prevention are within reach” (Keeling, p.1). This paradox is no stranger to the academy; college health educators have encountered it in their efforts to curb binge drinking and eating disorders as well.

AIDS education became routine and the predicted “epidemiological fireworks in the ‘general population’ failed to materialize” (Keeling, 1986, p.7). Also, during the time period that AIDS education became commonplace, new drugs to treat AIDS patients were developed. Early pharmaceutical research produced AZT and other drugs that reduced the speed at which the virus reproduced in the body. Increasing amounts of funds were allocated to AIDS research, and technology allowed scientists to work at a greater speed and with more accuracy than before. By December, 1995, a new treatment therapy was being released: protease inhibitors. These medications, the first of which was Saquinavir, created a newfound hope for people suffering with AIDS. Protease inhibitors block an enzyme critical for the replication of HIV, may lower viral loads of HIV in patients’ blood to undetectable levels, and increase healthy white blood cell counts called T-cells (Gallagher, 1996). Many people close to death due to AIDS experienced dramatic increases in immune system defenses after treatment with protease inhibitors. In September of 1997, the nation’s top AIDS researchers called for plans to test an HIV vaccine in 50 healthy Chicago volunteers (Pointcast Network, 1997). The National Institute of Allergy and Infectious Diseases and the National Institute of Health declared that this vaccine trial was premature and could lead to infection of new individuals (Pointcast Network). This risk was too great and the trial was aborted.

The Center for Disease Control (CDC) released figures in October 1998, indicating that AIDS deaths had fallen 47% between 1996 to 1997 (Shenitz, 1999). The same report showed that AIDS was no longer the leading cause of death among persons between 25 and 44 years of age; it is now the fifth, down from the leading cause in 1995. And, on August 13 San Francisco’s Bay Area Reporter ran the headline “NO OBITS” in bright red letters, announcing that they had not received any AIDS-related death notices for an entire week - the first such nonoccurrence in 17 years (Shenitz, 1999). These reports, along with developments in treatment, led to a decline in safe sexual behaviors across American campus communities. Today, there is a prevailing attitude among college students that HIV infections are no longer a major concern. “The general perception is that we have a ‘cure’...” (Radigan, 1998, p.1). “More and more, AIDS is seen as a chronic, not fatal disease” (Shenitz, p.56). Once again, students are not convinced they need to use a condom. Elisa Luna, Director of Education and Outreach at the National Association of People With AIDS asserted, “In light of a so called ‘cure’ we are seeing a return to multiple partners, more unprotected sex among people regardless of sexual orientation, more sharing of needles by drug users and in general, less attention to personal risk” (Radigan, p1). According to Richard Elovich, Director of HIV prevention at the New York City-based Gay Men’s Health Crisis Center, young gay men are becoming infected at a rate of up to 4% a year, far above rates from the late 1980’s (Gallagher, 1998). In February 1997, columnist Dan Savage wrote, “even if AIDS ain’t over, the AIDS crisis is” (Shenitz) and Andrew Sullivan, in his most recent book entitled Love Undectable, argues that the plague has ended. He writes, “something profound in the history of AIDS has occurred these last two years. It no longer signifies death. It merely signifies illness” (Sullivan, 1998, p.8). A more relaxed attitude and resultant unsafe behaviors are apparently prevalent in the general population as well as in the academy. In light of this dangerous trend, what are we, as higher education administrators, to do?

HIV and AIDS education has evolved significantly since the first discussions about viruses, testing, and transmission. The dialogue has become too easy. People have become bored and complacent. Whereas lack of information used to be our barrier to effective education, now apathy has become the catalyst new infections. Members of the academy and health educators must take a serious look at this epidemic, once again, and re-focus their efforts.

One of the factors influencing public opinion about the danger of contracting HIV is protease inhibitors. The efforts must include a more critical analysis of treatments and supposed “cures.” Indeed, protease inhibitors have given life, health and hope to some; however, they also cause significant problems such as: red blood cell breakdown, liver problems, kidney failure, increased bleeding in hemophiliacs, diabetes, bloating, cramps, and hair loss (Merck & Co., Inc., 1998; Radigan, 1998). Additionally, there are over 450 possible combinations of protease inhibitors, requiring the use of 30-60 pills daily and costing nearly $30,000 yearly. Drug companies have marketed the effectiveness of protease inhibitors by showing attractive people climbing mountains, riding bicycles and having fun (the same marketing strategy used by cigarette companies for years) (Radigan).

It should also be emphasized that protease inhibitors do not work for everyone. Also, effective HIV vaccines are also not currently available and still need approval from the Federal Drug Administration (FDA), a process that may require many years. At this time there is no cure for HIV infections and health educators must reiterate this fact. There needs to be a curriculum change for HIV and AIDS education. It is essential, if this is to be effective, that all members of the academy work together to implement this prevention education.

I envision a more comprehensive curriculum of prevention education. HIV and AIDS educators should talk as much about condom use and HIV-antibody testing programs as they do about social responsibility and the societal implications of this epidemic. For example, Richard Keeling, M.D. (1996) proposes a similar model that progresses beyond self-defense education (“Use a condom because you’re sleeping with everyone your partner slept with”) to caring and accountability (“What do we owe each other in an intimate relationship?”). Instead of focusing on individual health, we should be discussing the societal need to ensure a decrease in global infections. “These are the issues of citizenship as much as health, relating to the basic work of democracy, and they raise essential questions about humanity” (Keeling, 1996, p.8).

Prevention education which focuses on the mere acquisition and transmission of knowledge is a necessary step to stopping infections; it will not be sufficient, however, to end this epidemic or to stimulate student activism. We must challenge students to think beyond their own bodies and those of their partners, to consider AIDS a global concern. We must find a balance between talking about new treatments and discussing the inherent or potential failures and side effects of these treatments. We must continue to give hope to those already infected while using a global approach to prevent new infections.

The challenge for prevention education educators is to highlight the amazing impact these drugs have had for some, in both prolonging the lives of people living with AIDS and preventing the onset of AIDS in people with HIV, while we emphasize the very real hazards of HIV infection and the therapies designed to treat it (Radigan, 1998, p.2).

This new curriculum mandates using the same information and dialogue for those coping with the disease, those fighting for new and affordable treatment options, those (presumably) uninfected, and those opposing any funding for HIV or AIDS-related causes. HIV is an indiscriminate virus; it always has been. It is as likely to infect a person now as it was in the late 1980’s. The only thing that has changed is attitude. Now education prevention needs to follow closely behind.

Almost seventeen years have passed since the first mention of AIDS in the United States. Education efforts started out slowly and received much opposition and stigma. We have come a long way since those first attempts and now understand HIV and AIDS as well as we understand cancer, if not better. Higher education has attacked this virus with immediate defense strategies and strength. That commitment must not wane. As we approach the new millennium and the twentieth anniversary of the presence of AIDS, our educational efforts must become more advanced, ask better questions, and challenge us to be humanitarian and realistic. Scare tactics will not work. Pessimism will only destroy our previous efforts. What is left now for us to do, as health educators and students affairs professionals, is to purposefully develop a proactive approach to the following unanswered questions: 1) How can we encourage students to separate the hype from the hope of HIV and AIDS treatments? 2) What support services can we provide to infected students who are involved in or forgotton by in our prevention efforts? 3) How can we involve students in a conversation about barriers to safe sex practices? 4) How can we collaborate with students to perpetuate the momentum in this epidemiological fight?

As HIV itself is a surprisingly complex, unpredictable and mutating virus, student affairs professionals must stand ready to redefine any of the above questions, or develop new ones, when the need arises. At the very least, we must be willing to admit that HIV and AIDS education efforts in the academy are ineffective and the need for a curriculum change is now.

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Paul J. McLoughlin, II received his bachelor's degree in 1997 from Miami University where he majored in Zoology/pre-medicine and minored in Neuroscience. He is currently a second-year student in the HESA program and serves as the Graduate Assistant for the Center for Health and Wellbeing, Health Promotion Services.