There is growing acknowledgment that many young adults regularly engage in sexual behaviors that place them, at risk for HIV infection. Nurse educators can create interventions that both educate college students about HIV primary prevention and provide unique learning opportunities for undergraduate nursing students. The purpose of this article is to describe such an educational innovation, the HIV Primary Prevention intervention, which has been offered since 1989 by nursing students at Hunter College of the City University of New York. Although Hunter College is in an urban setting with a very diverse student body (N=19,000) in Manhattan, this intervention could be replicated in any college that has an undergraduate nursing program and a commitment to preventing the transmission of HIV infection. According to the final report of the National Commission on AIDS (1993), HIV prevention efforts need to provide information, build skills to avoid risk, and provide easy access to the means to do so. In addition, they must be culturally sensitive, sustained over time, and complemented by broader efforts over the long haul, both to change behavioral norms within communities and to empower individuals to change (p. 7). The HIV Primary Prevention intervention at Hunter College incorporates these recommendations. This intervention consists of groups of nursing students who position themselves in a high visibility area on the main campus and use a variety of strategies to educate anyone stopping by the table about ways to prevent HIV transmission. Although the vast majority of people who stop at the table are Hunter students, faculty, staff; and visitors from the community also pause in their busy schedules to discuss how HIV is transmitted.
In order to attract passersby to the table, videotapes are shown. The Arsenio Hall and Magic Johnson video, Time Out, is being used currently and is very well-received. Despite the length of the videotape, groups of between 5 and 25 people pause for varying lengths of time to watch. Information about male and female condoms is duplicated and distributed. Students often ask about the availability of HIV antibody testing and so resources about free testing sites are available. In order to promote interaction between the nursing student and the Hunter student, two quizzes were developed. The purpose of the first quiz, the AIDS Information Quiz, was to prompt respondents to think about specific HTV-related information. This 15-item true/false questionnaire was adapted from an instrument developed by the National AIDS Demonstration Research Project of the National Institute on Drug Abuse ("^immunity Research Branch and was used between the years 1989 and 1991.
During those years, the author noticed that a number of Hunter students stated that they "knew about condoms," but were reluctant to discuss specific condom practices any further. Using the same format as the AIDS Information Quiz, the Knowledge about Condoms Quiz was developed to promote dialogue about the male condom. Based on responses from the preceding year, this quiz has been revised three times and over 2,000 Hunter students have completed at least one form of the Knowledge about Condoms Quiz. Currently, only the Condoms quiz is used since knowledge about HTV disease was very high and the students complained that the items on the AIDS Information Quiz were too basic.
The Hunter student completes the quiz in the immediate vicinity of the nursing students. Students are encouraged to take their own quiz and not to share responses, and there is some attempt to promote privacy in this very public setting. It usually takes less than 5 minutes to complete the quiz. The completed quiz is then corrected by a nursing student who stands next to the Hunter student and discusses the wrong answers, clarifies any confusion, and provides additional information as requested. Hunter students return the completed quiz, but are provided with blank copies and the correct answers if they are interested in using the quiz with other groups. In addition, the author's business address is on the bottom of each quiz with the following statement, "feel free to use this tool but send feedback to..."
Perhaps the most significant feature of this intervention is the opportunity to engage in discourse with a health care professional student. Hunter students expect the nursing students to be able to answer a variety of health-related questions and to provide for referrals. In recognition of this, the nursing students are provided with a handout describing a number of sexually transmitted diseases. The nursing students are advised to refer Hunter students who need more indepth information about HIV/AIDS to the author who is readily available onsite or by phone, The printed material, quizzes, and videotapes are definitely enhanced by this health counseling component of the intervention.
Building Skills and Providing Easy Access to the Means to Avoid HIV Infection
The nursing students suggested that a model of an erect penis would be helpful to them in demonstrating correct condom application and, in 1993, a model was purchased. During 1989 and 1990, condoms were made available free of charge from the New York City Department of Health. When that source of condoms was no longer available, the author approached the President of Hunter College and he was agreeable to supporting the purchase of condoms. The nursing students distribute between 800 and 1000 condoms during each HIV Primary Prevention Intervention Day. Since the Fall of 1993, female condoms have also been made available.
The diversity of the nursing students who have participated in the HTV Primary Prevention Intervention reflecte the diversity of the Hunter College students. The author has noted that Hunter students drop by the table in greater numbers when the nursing student's apparent ethnicity and gender reflect their own ethnicity and gender.
Sustained Over Time
In contrast to episodic health fairs, the HIV Primary Prevention activities have been offered over a relatively sustained period. Since the Spring of 1989, different nursing students have offered this primary prevention program once a month during the Fall and Spring semesters and, since 1991, the location has also been consistent. The best location is one that offers high visibility and privacy. There is a walkway between the three buildinge on the main campus of Hunter College that has proven to achieve both of these goals. Immediately outside of the cafeteria proved to be too noisy and offered little privacy but high visibility. The permanent location has less visibility but is relatively quiet, and hallways in the immediate vicinity can be used to promote some privacy. Initially, the author required the nursing students to wear their student uniform as a means of promoting nursings presence on the uptown campus. While this rationale is still meaningful, a much more important reason for wearing the nursing student uniform quickly emerged. Hunter students share very intimate information with these nursing students and the uniform helps promote a professional, rather than a peer, relationship. Hunter students know that HIV Primary Prevention tables offered by the nursing students offer consistent information and professional consultation with a health care provider. This is in contrast to some of the other primary preventions events offered by the other departments within the college which have more of a episodic nature.
HIV Primary Prevention is offered as a one credit independent study course for both undergraduate and RN students who are seeking their baccalaureate degree in nursing. Forty-three nursing students have participated in this independent study and all except five have been either undergraduate juniors or seniors. Students must complete at least 15 hours in direct interaction with Hunter students and have an additional administrative responsibility such as bringing the printed materials, setting up the videotapes, or coordinating staffing for the intervention. There is always a minimum of two students in the area at any one time and the group usually varies between 3 and 6 nursing students during each semester.
The author coordinates the HTV Primary Prevention intervention as part of her teaching assignment. The author meets with each student group for a 2hour orientation and ie available to nursing students and Hunter students for consultation during the intervention. Hours are scheduled that are mutually convenient for the students, the author, and the greatest number of Hunter students, Occasionally, nursing students will join with other departments in the College such as the Center for the Prevention of AIDS, Drug Abuse and Community Health during special events like World AIDS Day (December 1). Expenses related to the project, such as copying and videotapes, are absorbed by the existing departments within the College.
A very important measure of a program's effectiveness is the number of condoms distributed during a specified period of time (Kirby, 1993). During each semester, approximately 3,000 to 4,000 condoms are distributed and while it is acknowledged that having a condom does not ensure that the condom is used, the fact that Hunter students have consistently sought out the HIV Primary Prevention table area to access condoms indicates that large numbers of students have condoms. Research is needed to determine whether the condoms are actually being used during sexual activity. Approximately 1,000 Knowledge about Condoms Quizzee are also completed and discussed with the respondents each year. The number and type of pamphlets distributed is not recorded.
The nursing students are required to submit a one- to two-page evaluation of their perception of what they have learned by completing the independent study. They are advised that their grade will be submitted once this evaluation is received. The content analysis approach described by Waltz, Strickland, and Lenz (1991) was used to analyze these evaluations (iV=43) and two categories emerged from the students' responses: enhanced professional growth and enhanced personal growth.
The nursing students identified that this independent study enhanced their professional growth in a variety of ways. Each of the nine sub-themes in the enhancing professional growth category is illustrated by a representative quote. The nursing students reported that their professional growth was facilitated by: 1) increasing their knowledge about HIWAIDS (my knowledge of HTV transmission was supplemented); 2) enhancing their experience in talking with people about sensitive issues (as a nursing student, it was gratifying to know I could discuss sexual matters with strangers); 3) finding out how uninformed the general public was about HIV/AIDS (I thought more college students knew more about HIV\AIDS); 4) gaining experience in working in groups of nursing students (our team members were really understanding of each other); 5) expanding their experience in primary care settings (it brought prevention teaching to a reality by trying to educate people about the importance of safer sex); 6) fostering leadership skills (the experience helped me to develop my leadership skills as a health professional); 7) improving communication skills (I had the opportunity to reinforce my teaching and communication skills); 8) effecting change and recognizing the difficulty of promoting changes in attitude (a few of the misinformed were skeptical; they found it difficult to abandon their misconceptions); and 9) enhancing professional identity (I was glad that we wore the nursing students' uniform because it clearly identified our role and purpose as professionals).
The second category to emerge from the student evaluations of the experience was enhanced personal growth. Four subthemes in this category were also identified and are illustrated by a representative quote. These sub-themes are: 1) increasing self-confidence (I felt very knowledgeable and respected by my peers. I was honored that these people took me into their confidence and shared some very personal experiences with me); 2) an increase in self-awareness (I felt I connected with almost all the students I talked to, both on a professional and personal level. And I think we all were richer for the experience); 3) change in personal attitude (before I took the ATDS interdisciplinary course and worked in the hospital and did this independent study, my attitude toward AIDS was one of fear, hatred, and disgust; but now, my heart goes out to all the victims of this dreaded disease); and 4) deciding to become personally involved in some aspect, not necessarily professional (after graduation, I hope to become involved with a community-based program to help educate people in my neighborhood).
In addition to the two categories that emerged from the evaluation data, the nursing students identified that the independent study experience generated a number of feelings. These feelings included sadness, anger, shock and fright, surprise, challenge, fulfillment, and pride. The overall feeling of uncertainty, which was expressed by a number of nursing students, can be summarized by the following quote:
At the beginning of this course, I had no idea what to expect. I was uncertain about whether or not students would be willing to complete questionnaires that tested their knowledge of condom application. I didn't know if people wanted to talk about HTV and AIDS. But meet of all, I was uncertain if I would be able to speak freely on a subject that involved one of the most intimate areas of an individual's life.
One of the recommendations of the final report of the National Commission on ATDS (1993) was that HTV prevention efforts need to be complemented by broader efforts over the long haul in order to change behavioral norms within communities and to empower individuals to change. Young adults who attend college are in a unique position to act as leaders within their community of origin because they are better educated than many of their peers. Nurses assert that they are willing to take a leadership role in meeting the prevention needs of the public. Nursing students are in a unique role to communicate HTV primary prevention methods to the other students on their campuses. By establishing a sustained primary prevention program, nursing students have the opportunity to contribute to both the health of their student peers and learn how to implement primary prevention interventions.
- Kirby, D. (1993). Research and evaluation in Condoms in the schools. In S. Samuels & M. Smith (Eds), The Kaiser Forums (pp. 89-109). Menlo Park, CA; Harvey J. Kaiser Foundation.
- National Commission on AIDS. (1993). AIDS: Art expanding tragedy. The final report of the National Commission on AIDS. Rockville, MD: CDC National AIDS Clearinghouse.
- Waltz, C., Strickland, O., & Lenz, E. (1991). Measurement in nursing research. Philadelphia, PA FA Davis.