If you turn 14 today, you were born in 1997.
A former employee, Monica, used to say, “I got 10 minutes of HIV education in 10th grade and it wasn’t enough.” Against all odds, Monica graduated from high school, moved herself away from the “wrong crowd” and found a healthy distance from her family. But when she got sick, she refused medication because she was already “too tired to fight.” Monica died of HIV-related causes at age 21.
Since the day Monica died, I’ve been committed to figuring out how to put Metro TeenAIDS (MTA) out of business. I’ve also spent much time trying to re-think this fight. How do we get to scale? How can we “interrupt” our local epidemic? What factors in the environment are preventing 30 years of messages from getting through? And with a skyrocketing STD epidemic and rising pregnancy rates, what other issues might we have to take on to get our HIV messages across?
You might be tempted to think that all the answers are on Facebook. The Internet is certainly a valuable tool to reach youth but I think that what’s needed is far more basic.
First on my list to fix is our education system. It is no secret that education in D.C. leaves much to be desired, but, I can tell you with 100 percent certainty, that many kids in D.C. schools do not get good health education. When kids are not getting the right information, we sentence them to make under-informed choices that have kept Washington, D.C. in the No. 1 spot for HIV, STD, teen pregnancy, obesity, diabetes and the like for many years.
While there has been some movement on this front at the school level, we are still missing three key components. First, it’s still true that not every young person in D.C. learns about HIV, which leaves many youth at risk. Second, there is no formal coordination between public health and health education. And third, we do not currently measure health education like we measure math, reading and science.
As an example of how the disconnect between public health and education hurts kids, in 2009 I watched a doctor from Children’s National Medical Center testify about the alarming increase in scaldings because small children pull “superheated” liquids from microwaves. The doctor went on to say that one solution would help to reduce these accidents: families should turn their microwaves sideways. Since that time no lessons were created and disseminated to schools. No mail was sent to parents of students telling them how to protect their kids. We sometimes seem content to just to let kids burn.
Which brings me to parents and teachers; they need more information and support. Talking to kids about sex is not easy. At MTA we often say that while we do sex education for a living, it’s still difficult for us. Yet only D.C. Public Schools currently has a clear and vibrant program to support health teachers in delivering sexual and reproductive health curriculum. And to make matters worse, the D.C. government does not certify health teachers. (Metro TeenAIDS has recently received funding from Venture Philanthropy Partners to expand our work in all D.C. Public Charter Schools.)
Let me be honest about this. Despite my chosen profession, my husband and I have a two-year-old and I’m already nervous about “the talk.” Parents get little support when it comes to talking to kids about sex. And, of course, most of us did not have great role models. You won’t be surprised to hear that things haven’t changed so much since you were a kid (no matter how old you are). But most parents want to do a better job. They want their kids to be safe. In a survey of D.C. parents we did in 2008, 90 percent of parents were concerned about the high rates of HIV and STDs and an equal 90 percent of parents said they were interested in getting training from professionals on how to talk to their kids.
The research shows that when given training, parents who start conversations with their kids between 4th and 6th grade said they felt they had increased “skills, comfort and confidence” to ensure open lines of communication with their children around sexual risk taking and that kids were more likely to wait longer before having sex.
But what about once kids reach middle school and begin to put more stock in their friends than their parents? Well, for one thing, it is important for parents to know that even when your middle schooler gives you “the look,” they are still listening. But peers become more and more important as tweens become teens.
Before he died, I had a chance to ask Dr. Martin Fishbein, one of the foremost researchers on behavior change, what he would do to end the HIV epidemic in D.C. He said the best return on investment would be to help change “peer norms.” But to do it effectively, we’d have to do it at scale – reaching into the social networks of youth and using marketing and messaging to “inoculate” youth against unhealthy peer norms. As an example, our own local data show that when youth start having sex they use condoms somewhat consistently but that over time, condom use decreases. And this trend continues into adulthood to the point that low condom use is one of the biggest drivers of our local epidemic. So what could we do to keep condom use high?
While we’re just at the beginning of the effort, we’ve launched a new effort with the Global Business Council on HIV, Tuberculosis and Malaria to bring the likes of Nike, Axe body spray, Dove Soap and Gatorade to D.C.’s table. We’re not talking to them about an old style public health campaign. They don’t sell product by talking about the benefits of body spray. They make kids feel like they need body spray to get what they really want. And this is most likely where we can really make the most of the Internet and social media.
I don’t know how many more years of this epidemic we’ll have. I do know that youth are getting infected early every day in our community. And I also know that unless we continue to push for change, ask for support and reach youth when and how they need us, we will continue to bury them. I miss Monica.
Adam Tenner is executive director of Metro TeenAIDS. Reach him via metroteenaids.org.