A Look at the AIDS Epidemic in Children and Possible Solutions

One of the most deadly social problems plaguing the nation and the world is the HIV/AIDS epidemic. More narrowly, a look at the statistics of children with HIV/AIDS and/or other sexually transmitted infections (STIs) will tell you that there is a very serious social problem happening here, and in this case, it's a matter of life and death. Understanding this social problem requires a look at the claims-making involved, a discussion of identity, and a discourse on solutions.

While the AIDS epidemic is often looked at from a global perspective, people in the United States often forget that it is a problem here too. A look at the sheer number of HIV/AIDS/STI cases in the U.S among the 13-24 year old population will tell you how it is a social problem. Analyzing the cause and nature of diseases; that they are nearly one hundred percent preventable, for example, will tell you why this is a social problem.

According to the 2003 census, there were 43,704 reported AIDS cases in 2003, up from 40, 307 in 2000 (U.S. Census). The number of STD/STI cases in 2003 was 1,246,906 in 2003 (U.S. Census). In 2005, the number of AIDS cases in youth/adolescents was 2437 (AIDS.gov). And the Center for Disease Control (CDC) "estimates that 19 million new infections occur each year, almost half of them among young people ages 15-24." These numbers are particularly alarming, and show that there is a social problem at work, and the trend is growing.

"AIDS is now the sixth leading cause of death among 15-24 year olds" (Kadivar, Garvie, Sinnock, Heston & Flynn 2006: 544) and this type of information is the kind that makes people think that HIV/AIDS and STIs are indeed a social problem. In defining what a social problem is, the term is used "to categorize conditions that we believe are troublesome, prevalent, can be changed, and should be changed" (Loseke 2003: 7 emphasis added). As mentioned before, this type of social problem is almost completely preventable, and is most often (but not always) the result of certain kinds of social behavior, such as unsafe sex and/or drug use. Because the AIDS epidemic is so grand and also avoidable, it qualifies as a social problem. The way in which this issue presents itself as a social problem is by the use of what Loseke calls "objective indicators," (Loseke 2003: 8) or statistics like the ones presented in the beginning of this paper.

The claims-making at work with this issue is focused on constructing victims. According to Joel Best in "Victimization and the Victim Industry," "attempts to draw attention to social problems often emphasize the large numbers of people affected and claims about victims routinely argue that victimization is widespread" (Best 1997: 10). Whenever claims-makers are at work to make audiences believe that childhood HIV/AIDS is a social problem, they appeal to audiences by presenting discussions or visuals of the victims. As Loseke notes, "we can feel sympathy when we think about social problems victims" (Loseke 2003: 76). Instead of simply saying that HIV/AIDS is a big social problem, claims-makers highlight the victims of the disease, in this case, the children that suffer. Because we as a Americans place particular emphasis on keeping children safe and healthy, claims-makers succeed in establishing this as a social problem when they frame it in terms of children as victims. For claims-makers as well as activists for solutions to the problem, highlighting the suffering of children with AIDS is key to creating change; "the more victims are constructed as suffering, the more effective claims tend to be in motivating audience members" (Loseke 2003: 80).

The dominant claims surrounding this social problem have to do with the causes of HIV/AIDS. Most claims-makers (myself included) argue that the disease is the result of specific behaviors, and is, therefore, totally preventable. In one study conducted via St. Jude's Children's Research Hospital, "among the adolescents currently served in the programme, approximately 15% were infected via perinatal transmission or transfusion with the remaining 85% infected via high-risk behaviours" (Kadivar et al. 2006: 545 [sic]). It is this instance of "high-risk" behaviors that is at the root of the HIV/AIDS and STI epidemic among children and adolescents in the United States. Another study conducted with women in prison cites sexual abuse in childhood as precursor to the type of risky behavior that causes HIV/AIDS. Janet Mullings, James Marquart and Deborah Hartley point out that "women who had been sexually abused were more likely to engage in behaviors placing them at risk for HIV/AIDS infection" (Mullings et al. 2003: 443). So even though the abuse may have been the reason that the women engaged in unsafe behaviors, it is those behaviors that cause the disease, and those behaviors that can be prevented, which is what many of the efforts to solve this problem seek to do.

In order to further understand how this social problem functions in our society, one has to examine its relationship to other social problems. In this case, race and poverty contribute to the HIV/AIDS epidemic in children. For example, one study on race and AIDS cited that "today, African American women are 23 times more likely to be diagnosed with AIDS that white women.... Similarly, among teenagers aged 13-19, African American girls account for 61 percent of new AIDS cases" (Jones-DeWeever 2005: 79). This kind of study is relatively new, considering the fact that at the beginning of the AIDS crisis in this country, the disease was thought to be only a gay, white, male problem. Likewise, race and poverty are often linked; for example D. Stanley Eitzen points out that "the likelihood of being poor is heightened for some categories: (1) racial minorities (24.3 percent of all African Americans, 22.5 percent of all Latinos)" (Eitzen 2007: 22), and thus, interplay of race and poverty definitely contribute to the instances of AIDS. Jones-DeWeever also points out that "the prevalence of poverty within the African American community creates an environment fertile for increased levels of vulnerability among Black women" (Jones-DeWeever 2005: 81). She is suggesting that an impoverished environment harbors high-risk behaviors, such as drug use and unsafe sex, and leads to the acquisition of diseases.

Additionally, poverty is linked to inadequate education and healthcare, two things that are important for AIDS treatment and prevention. With the Bush Administration's implementation of the No Child Left Behind policy, schools are losing money and having to cut programs (Weaver 2007). With money running short, things deemed unessential to public education are cut; often this means health education, which is vital in preventing AIDS and sexually transmitted diseases. Similarly, with a healthcare system that favors the wealthy, poor children who already have the disease cannot get the care they need, and the mortality rate goes up. Not to mention, community and clinic-based programs for treatment and prevention are also often inaccessible to the poor. Thus, the singular social problems of racism, poverty and inadequate health care and education are all interconnected, and are also connected to the childhood HIV/AIDS/STI crisis. The claims-making strategies and solutions are all similar and require working both inside and outside of the system of government.

Merely claiming that HIV/AIDS in children, poverty, racism, etc. are social problems is not enough; the audience has to be convinced and in order to be convinced, audience members must identify with the problem. The subject of identity is important in discussions of social problems. Amartya Sen presents an in-depth discussion of identity in his book Identity and Violence and of understanding identity he writes: "A person has to make choices...about what relative importance to attach, in a particular context, to the divergent loyalties and priorities that may compete for precedence" (Sen 2006: 19). In other words, when examining identity, we have to determine what is important to their own identity and to others' identities. This can also be attributed to social problems; when listening to claims and determining whether we buy in or not, we have to examine them in terms of where our loyalties and priorities lie. Do we identify enough, in terms of our loyalties and priorities, to believe claims and be active audience members/come up with solutions?

Sen also talks about how identity is fluid but as a nation, we tend to lump groups of people (other countries, usually) together based on one singular, prominent facet of their identity. He calls this "civilzational partitioning" (Sen 2006: 42) and that because of the partitioning, violence is created (he argues it doesn't simply just exist). Similarly, Sen points out that as individuals we also tend to focus on singular facets of identity but, he notes, "the illusion of singularity draws on the presumption that a person not be seen as an individual with many affiliations...but just as a member of one particular collectivity" (Sen 2006: 45). We have to remove ourselves from this way of thinking if we can begin to really understand and create change/solutions for social problems. Only then, when we break away from singular notions of identity can we create social movements and social change, which is what Sen is trying to argue.

Social movements concerned with this issue focus on raising money for education reform and increasing awareness about the HIV/AIDS crisis--working outside of the system. For example, there are countless charities out there working proactively to help people prevent AIDS and other STIs. To highlight a few, AVERT, is an international AIDS charity based in the UK, working to AVERT HIV/AIDS worldwide (AVERT.org). The website includes statistics, educational resources, and ways people can help the fight against the epidemic. There are also many charities based in the United States, as well as well known charities in every state (with the exception of Maine, sadly) that are fighting the fight from within. For example, I found one charity from Chatham North Carolina called that Chatham Social Health Council that aimed to increase knowledge, teach risk reduction skills and stress adoption of safer sex skills (www.chathamcouncil.org).

In addition to smaller charities, there is World AIDS Day, (Dec 1 of each year) and an annual National HIV Prevention Conference, both of which seek to increase awareness and raise money to aid both charities and help people on an individual basis who are suffering from HIV/AIDS. The CDC listed many charities and resources including a program called TLC: Together Learning Choices. TLC is described as a "small, group-level intervention that helps young people living with HIV/AIDS maintain health, reduce transmission of HIV and other sexually transmitted diseases, and improve their quality of life" (CDC). Young people enrolled in the program (ages 13-24) attend a series of sessions and/or classes about making the right choices and how to stay healthy.

As is easy to see, a lot of what is being done about the social problem that is the HIV/AIDS epidemic is based in education. Educating children and adolescents about what AIDS is and how to prevent it is the single most effective way to eradicate the epidemic: "HIV/AIDS education is essential for all students" (Robenstine 1994: 229). I propose that we begin trying to solve the problem by using education. One of the things that is most important about using education as a model for a solution for this problem is the fact that children educated properly about disease prevention are less likely to become infected adults. There are a few different models and approaches to this solution with some being better than others.

As part of the Bush administration, an approach has surfaced; that of abstinence-only education. On this type of education, teachers tell students that the sure-fire way to prevent these diseases is to abstain from sex (which is true) but that is where they leave it, and they leave a lot to be desired as far as prevention goes. The United States House of Representatives released a document from its Committee on Government Reform-Special Investigations Division that basically debunks the federally funded program. In the report, they cited that "abstinence only curricula contain false information about the effectiveness of contraceptives" (US House of Representatives 2004: i). In addition the investigations found that abstinence only programs tend to "blur religion and science" and "treat stereotypes about girls and boys as scientific fact" (US House of Representative 2004: ii) as well as other inaccuracies:

The report finds numerous examples of these errors. Serious and pervasive problems with the accuracy of abstinence-only curricula may help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to have informed choices about precautions when they do have sex (US House of Representatives 2004: ii).

Education is the best means of prevention, but clearly, it has to be set up and implemented in an accurate and effective way. Abstinence-only, I argue, isn't the answer.

If abstinence only education doesn't work, other models must be developed. One study was conducted using biology as a way of educating children about HIV/AIDS and other STIs. Researchers noted that "a present day challenge for educators is finding ways to teach adolescents about the transmission of multiple STDs without overwhelming or confusing students" (Zamora, Romo and Au 2006: 109). They noted that when students are bombarded with precautions they tend to lose interest and "develop little understanding about why certain behaviors are safe or unsafe" (Zamora et al. 2006: 110). They took a biological approach, teaching the students what AIDS is in terms of how one contracts it, what happens to it in the body and how it manifests itself. They figured that by learning the ins and outs of AIDS and STDs, the students would know more and protect themselves more.

I argue that if the health education programs were implemented in schools, (i.e. if funding for the programs were made available) the programs would have to emphasize safe-sex practices. The reality is that people are going to have sex (especially if you tell them not to) so they have to be taught to do it safely. The sex-education unit of a typical health class would discuss correct condom usage in addition to abstinence, since its obvious that abstinence is the most effective way to prevent HIV/AIDS/STIs. Sex education would also include an in-depth study of what those diseases are (similar to the biological approach discussed above) and the difficulty in treating them. Health classes would also continue to educate against drug usage, as that contributes to disease transmission as well. Teachers, as well as students, would have to be educated; teachers have to know all the facts in order to be able to teach correctly.

Also important to this issue of education is when it starts. Currently in this state, there is a big debate about condoms and birth control being made available in middle schools. In Maine, schools are not required by law to provide any sex education (Teen-Aid Inc.). However, in one school district, a new health program was implemented that made condoms and birth control available to those middle school students. Many parents were in uproar, saying that providing contraceptives was promoting sexual behavior. I do not think that is the case, and was relieved to see that condoms and birth control pills were made available in middle schools. I think beginning sex-education in middle school (as young as sixth grade, even) is the best way to prevent disease, and my theory is, if kids are going to have sex (which, sadly, in middle school, they do) at least give them a safe way to do it, so they don't become another one of my AIDS/STD statistics.

In order to provide these educational programs, which, as I have cited before, is the best solution to this social problem, the programs actually have to exist, and that takes money. This is where working inside the system comes in. Though, for right now, No Child Left Behind gets in the way of a lot of funding, I think people need to appeal to their state representatives to lobby for more money for education so that these types of programs can be made available in all schools. Solutions exist, but it takes a little action.

References

AIDS.gov. "Facts, statistics, and myths." Retrieved October 20, 2007 (http://www.aids.gov).

Centers for Disease Control and Prevention. 2007. "TLC: Together Learning Choices: A small group-level intervention with young people living with HIV/AIDS." Retrieved October 30, 2007 (http://www.cdc.gov/hiv/topics/prev_prog/rep/packages/TLC.htm).

Jones-DeWeever, Avis. 2005. "Saving Ourselves: African American Women and the HIV/AIDS Crisis." Harvard Journal of African American Public Policy 11: 79-83.

Kadivar, H.; Garvie, P.; Sinnock,C.; Heston, D. and Flynn, P. 2006. "Psychosocial profile of HIV-infected adolescents in a southern US urban cohort." AIDS Care 18(6): 544-49.

Mullings, J.; Marquart, J. and Hartley, D. 2003. "Exploring the effects of childhood sexual abuse and its impact on HIV/AIDS risk-taking behavior among women prisoners." The Prison Journal 83: 442-63.

Robenstine, Clark. 1994. "HIV/AIDS education for adolescents: School policy and practice." Clearing House 67(4): 229-33.

Unites States Census. "State Public Health, Children Immunized, and STDs and AIDS." Retrieved October 20, 2007. (http://www.census.gov).

United States House of Representatives. "The Content of Federally Funded Abstinence Only Education Programs." Retrieved November 5, 2007. (http://www.democrats.reform.house.gov).

www.avert.org

www.cdc.gov

www.census.gov

www.chathamcouncil.org

www.teen-aid.org

Zamore, A.; Romo, L. and Au, T. 2006. "Using biology to teach adolescents about STD transmission and self-protective behaviors." Applied Developmental Psychology 27: 109-24