Teaching young children about HIV and AIDS.

AIDS education initiatives need to begin early, within the elementary grades, to be effective. We should no longer underestimate the capacity of young children to understand and benefit from this instruction. In addition, we should not overestimate the impact of brief interventions, and should plan for continued AIDS prevention instruction throughout the school years, involving sequential, developmentally appropriate curricula that respond to the preadolescent's and adolescent's changing cognitive capabilities, social skills, and expanding exposure to sexual experiences. We should require that new approaches and methodologies for AIDS prevention education be developed and evaluated rigorously for efficacy with the same fervor required for the development and evaluation of new drugs to combat this illness on the biologic front. New modalities and approaches should be integrated with those that have already been shown to be effective, creating multimodal and comprehensive educational initiatives comparable to the multidrug treatment regimens. We should be skeptical of those who are satisfied with the implementation of one interesting and simplistic slogan for health promotion efforts for children (e.g., "Just say no"). Even if such efforts were effective in the short term, sole reliance on this approach is likely to result in the development of resistance. As the field of AIDS prevention looks for novel approaches and theoretic constructs, it should borrow ideas from other fields of study and foster interdisciplinary collaborations with professionals from complementary fields. In this manner, educational interventions can move beyond the individual context to begin to address the social influences on sexual behaviors. Sexual behavior is interpersonal and occurs in a social context. Programs must therefore address peer and social pressures to engage in sexual activity. Although attempts are being made to address the social network of children through such efforts as peer education, we cannot ignore the broader social context (e.g., poverty) within which these behaviors occur. For example, efforts to promote increased condom usage will be ineffective until we learn more about why significant numbers of adolescents practice unprotected sex. We are unlikely to affect behavioral change unless we understand fully the motivation for such behavior. We must also recognize that children are more than what they do and study outcomes other than behavior. There is a need for further research on the development of attitudes, fears, stigma, and coping in children, as well as means of promoting the development of healthy sexual relationships.