College Students as a Demographic Risk Population

College students need to be aware of the risk of HIV infection. In 1989, the American College Health Association (ACHA) tested students across the country and found that one in every five hundred college students tested positive for the Human Immunodeficiency Virus (HIV). This statistic is currently valid (Rathus, Nevid and Fichner-Rathus 1993). HIV is the only virus known to cause the Acquired Immunodeficiency Syndrome (AIDS). There is no cure for this disease. HIV is found in blood and blood-products, semen, vaginal fluids and breast milk. According to statistics, in a college population of approximately four thousand students, there will be approximately eight HIV-infected individuals. As this disease continuously spreads into every sector of the population, no one who engages in risky behavior is safe. Many college students who are away from home for the first time push boundaries and experiment with sex, alcohol, and other drugs. These drugs impair judgment and may cause a student to engage in risky behaviors. Risky behaviors include unprotected sex with one or more partners whose HIV status cannot be guaranteed. Given that the average number of sex partners a graduating high school senior has had is four and that the second highest incidence rate of AIDS in the United States is found in people 20-30 years old, students may appear on campus already infected (Tufel and Brooks 1993; Levy et al. 1993).

Injecting drugs with needles, such as heroin and steroids, is risky. Sharing razors or needles for body piercing and tattooing are also potential mediums of infection. Anyone practicing these behaviors is potentially at risk for contracting HIV. Unfortunately, these forms of risk-taking behaviors accompany many students as they travel home, to other colleges, and to their yearly retreats known as 'spring break.'

The History of HIV Education at SUNY Potsdam

SUNY Potsdam is primarily a four-year, liberal arts undergraduate unit of the State University of New York. It is located in a rural, economically depressed and sociopolitically conservative region in Northern New York, twenty miles from the Canadian border. There are approximately 4,000 undergraduates enrolled, largely drawn from Western New York, the New York City Metropolitan area and Northern New York. Prior to 1987, there were few formal HIV educational efforts on the campus.

In 1987 the college sponsored a day-long community-based symposium on HIV infection with an interdisciplinary panel on various aspects of the topic. An interdisciplinary group was also formed that year which discussed issues related to HIV transmission. One of the founding members of SUNYPAEG was also granted a semester's sabbatical (Spring 1988) to study HIV educational programs in San Francisco, CA. Research conducted during a second year long sabbatical in 1994-1995 focused on women's risk for HIV infection from their sexual behavior. In 1988 a campus AIDS Policy went into effect. This policy stated that discrimination against any individual with HIV or AIDS would be prohibited (see Appendix). From these activities, the SUNY Potsdam AIDS Education Group (SUNYPAEG) was formed as a volunteer group of faculty, staff, administrators and students in the fall of 1988. Peer Educator Training Programs began in the spring of 1989 and have continued to the present, with more than 400 educators trained as of Spring 2000.

Since the spring semester of 1990, safer sex kits have been distributed to the student population at Student Health Services. They consist of informational brochures and those modes of protection which, if used consistently and properly, can reduce the risk for infection. In 1992, Student Health Services began testing and counseling for HIV.

SUNYPAEG and the Peer AIDS Educators are involved in HIV education on other campuses in this area of St. Lawrence County. These efforts include peer educator presentations to the residence life staff at St. Lawrence University, exchange of guest professors, and co-sponsorship with other groups to help bring guest speakers to the area. Guest speakers have included the past president of the American College Health Association (ACHA), Richard Keeling, Ms. Gloria Lockett, an internationally known speaker who works with Afro-American populations in Oakland, CA, HIV-infected individuals, and health care workers.

Students of SUNY Potsdam were also urged to volunteer at and to attend the showing of the Names Project AIDS Memorial Quilt, and to attend Arthur Ashe's guest lecture in 1992, sponsored by the Education for Life Group and SUNY Potsdam's Student Affairs Division. Several peer educators went to Washington D.C. in October 1996, to view and participate in the display of the Names Project AIDS Memorial Quilt.

The goals of SUNYPAEG are to raise awareness, provide information from a variety of perspectives, and to reduce risks relative to contracting HIV. The purpose of SUNYPAEG is to prevent HIV infection and to provide support for people who may already be infected.

SUNYPAEG members have been involved in many ongoing educational projects. They participate in National Condom Week and International AIDS Day. They distribute educational brochures, posters which discuss transmission myths, safer sex kits and an AIDS Resource List which identifies people in the region available to address various aspects of HIV infection and AIDS. In 1989 SUNYPAEG planned and organized the Peer AIDS Educators training programs. In 1993, the first 'Women and AIDS' programs were presented; based on their success, the programs are offered periodically. A 'Men and AIDS' program was held in the Fall of 1993. SUNYPAEG has been proactive in AIDS awareness and education, implementing programs and policies prior to State-mandated guidelines.

Budget

Initially SUNYPAEG was funded from the general Student Affairs budget. Since 1991, funding has come from the Student Health budget at $2,000 per academic year. This money purchases safer sex kits, trains peer educators, purchases two journals and videos, supports guest speakers, and partially funds conference attendance for the Campus AIDS Coordinator.

The first outside fund-raiser was an AIDS Ball in February 1994 where donations were accepted and deposited in SUNYPAEG's account. We also received an anonymous donation for HIV education in 1994. This donation was used to bring in a guest speaker.

Peer AIDS Educators

Peer AIDS Educators are a group of students across the gender, age, ethnic and orientation spectrum who volunteer to participate in one or more training sessions and then apply their knowledge to both formal and informal HIV educational situations. These situations range from informing friends and family about casual contact myths, to staffing HIV education tables at Wellness Fairs and National Condom Week observances, to regular presentations in residence halls on this and neighboring campuses, to becoming a New York State trained HIV pre-and post-test counselor. The Peer Education Program began in February 1989. As of February 2000, more than 400 educators have been trained.

Training sessions are held every semester. Announcements of the training sessions are found in the campus newspapers and are made in the classes which the campus AIDS coordinator teaches. They are also spread by word of mouth. Session size is limited to twenty people for Level One and ten for Level Two. Admission is open for Level One and by application which is reviewed by SUNYPAEG for Level Two. The sessions are held on campus on Sunday afternoons with refreshments served.

The form, structure and content of these training sessions were adapted from two other models. One was the eight-day, ten-hour per day training certification program in which the campus AIDS coordinator participated. The other was a two-day training program for health care providers and non-governmental organization (NGOs) officials in the Dominican Republic. These programs were condensed and adapted to meet the needs of our participating students.

Level One training covers basic HIV information, values clarification and awareness exercises concerning sexuality and sexual orientation, videos and a demonstration and explanation of the contents of the safer sex kits. Confidentiality is agreed upon at the beginning of the session.

Level Two was requested by trained Level One Peer Educators who wanted to expand and update their knowledge and skills. A format similar to Level One is used. Topics included in Level Two include an update of statistics and treatment modalities, the HIV antibody test procedures, confidentiality issues, care of persons with AIDS (PWAs) as infected persons, the role of a care giver, and death and dying issues. Videos depicting people with full-blown AIDS and one about women and AIDS are shown. Due to the issues covered in Level Two and their intense psychosocial impact on everyone in the session, the size of this group is limited.

Safer Sex Kits

Safer Sex Kits were introduced on campus during the 1990-1991 academic year. Their rationale, contents and distribution were developed based on focus groups of students, alumni, administrators, faculty, staff and parents. The Safer Sex Kits are another educational mechanism to promote responsible decision-making and behavior relative to the risk for HIV infection.

The contents of the kits are based on what is considered to reduce the risk for HIV infection in sexually active adults. These guidelines were culled from the Gay Men's Health Crisis (GMHC), the San Francisco AIDS Foundation (SFAF), the American College Health Association (ACHA), and the Centers for Disease Control and Prevention (CDC). The kits include:

a) A brochure which defines terms relevant to HIV infection, discusses modes of transmission, provides incidence rates of AIDS in the United States and New York State. The statistics are updated yearly. There is also a list of AIDS hotlines in New York State.

b) A brochure which graphically describes sexual behaviors along the risky sex continuum from low risk to high risk. Definitions of the behaviors, e.g., fellatio, are provided. Illustrated instructions for proper use of latex condoms and vaginal dams are included.

The brochures are written in language appropriate for college students. They clearly state that abstinence is a choice and that education does not promote sexual behavior.

c) A lubricated, latex condom and an unlubricated, latex condom

d) Spermicidal lubricant

e) Cut up, unlubricated, flavored condom to be used for cunnilingus and perianal oral sex (rimming)

f) Finger cot

g) Latex glove

The kits are distributed free of charge in brown stapled paper bags primarily through the Student Health Center. They are also used for educational and demonstration purposes in residence hall talks on HIV, in speech classes and in the lower division Human Sexuality course. Since 1991, free condoms also have been available from the Student Health Center. Given the contents of the kits and their explicitness, their distribution is carefully monitored so that only college students, for whom they are intended, can obtain them. SUNY Potsdam students have been remarkably conscientious overall in disposing of them responsibly.

Careful distribution of the kits has helped to reduce the real fears that some administrators had concerning children or the general public having access to them. As an 'open campus' which had a campus school (K-6) on the premises, this is a legitimate concern. We have had no problem with the kits since we began their distribution (see Appendix).

Programming

In addition to the peer educator training sessions, SUNY-PAEG offers programming financed from our budget. Programming occurs on the SUNY Potsdam campus and campuses in the area, and is occasionally arranged with community AIDS groups (e.g., with AIDS Outreach to bring two HIV-infected women to speak on campus in the fall of 1993). In addition to bringing HIV-positive speakers to campus on a variety of issues, we commemorate National AIDS month (October), International AIDS Day (December 1), and National Condom Week (February 14-21), and participate in campus health and wellness fairs. These latter kinds of events usually include tables staffed by Peer Educators who distribute pamphlets, show videos and answer questions. Residence hall talks by trained educators are an ongoing event. Inter-campus educational programs are conducted by peer educators as well as by the Campus AIDS Coordinator.