High school health teachers are most likely to feel confident of their ability to teach about HIV prevention, and perceive the fewest barriers to doing so, if they have received appropriate formal training, according to a national survey of such educators.1 Three in five respondents did not perceive any barriers to teaching about HIV prevention; among those who did, lack of resources was the most commonly cited obstacle. The topics that respondents were least likely to teach, and least likely to feel confident about teaching, were how to obtain condoms and how to use them correctly.
Although more than three‐quarters of states require public schools to teach about HIV prevention, few mandate that teachers undergo specific training or obtain certification in the subject, and many instructors report that they do not feel sufficiently knowledgeable about HIV. To assess teachers’ perceptions and practices concerning HIV prevention education, researchers stratified public high schools according to whether they required such education and sent a 26‐item questionnaire to the lead health teacher at 400 randomly selected schools in each category; the analytic sample consisted of 362 participating teachers. The researchers tabulated responses and performed logistic regression analyses to identify correlates of teacher practices and perceptions.
Fifty‐five percent of respondents were female, and 90% were white. The vast majority (92%) were certified to teach health education; of those, about half had been teaching the subject for 10 or more years. Fifty‐eight percent were required to teach HIV prevention, and 63% had been trained to do so. Slightly more than half of those who had received training reported that more than two years had elapsed since their most recent training.
On average, respondents spent 3.7 hours teaching about HIV prevention in each of their courses; nonwhite teachers dedicated more time to the subject than did white instructors (4.8 vs. 3.6 hours). Of the 11 prevention‐related topics covered by the survey, three were taught by more than nine in 10 respondents: the influence of alcohol and other drugs on HIV risk behaviors, means of HIV transmission and prevention of transmission. Most of the remaining topics were taught by at least three‐fourths of the teachers; the exceptions were how to obtain condoms (54%) and how to use them (44%).
Nearly all of the instructors (98%) believed that teaching about HIV prevention is beneficial; the most frequently cited benefits were that it increases awareness of HIV (91%), improves students’ ability to avoid high‐risk behaviors (88%) and helps reduce the spread of the virus (80%). Teachers cited a greater number of benefits to HIV prevention education if they had been trained in it than if they had not been trained, or if they taught in a state that required HIV prevention education rather than in a state without such requirements.
Fifty‐eight percent of respondents did not perceive any barriers to teaching about HIV prevention. However, 23% reported that they lacked adequate materials or other resources, 12% said they had not been trained to teach the topic, 10% cited insufficient time and 8% noted a lack of parental support; smaller proportions cited several other barriers. Instructors listed a smaller number of barriers if they had been trained to teach HIV prevention, had a graduate degree or worked in a rural school than if they had not received such training, did not have a degree or worked in an urban school, respectively.
Teachers were asked to rate their confidence in their ability to teach 10 topics related to HIV prevention. For all 10, at least 60% of teachers said they were confident or very confident of their ability to teach the subject; for all but two, 94% or more expressed at least a little confidence. However, 14% were not at all confident of their ability to teach students how to use a condom correctly, and 10% were not confident that they could teach students how to obtain condoms. Ratings of self‐confidence were higher among educators who had been trained to teach HIV prevention than among other instructors.
Finally, attitudes toward teaching HIV prevention were highly positive. The vast majority of respondents agreed that the role of a health education instructor includes teaching students how HIV is transmitted (96%) and how to reduce transmission risk (96%), and that teaching HIV prevention does not encourage students to be sexually active (95%). Only 22% felt that abstinence‐only instruction is the best way to teach about HIV prevention. Attitudes toward teaching about HIV prevention were more positive among males than among females, and among teachers who had taught health education for at least 10 years than among less experienced educators.
Limitations of the study, according to the researchers, include a fairly low response rate; the closed format of the survey questions; and the exclusion from the sampling frame of alternative, vocational and other nonstandard high schools. Given the associations between respondents’ levels of training and experience and the study outcomes, the investigators recommend that health education instructors receive formal training in HIV prevention, as well as any resources they need to teach the subject.—P. Doskoch