Children's Perceptions of AIDS

DAVID FASSLER , M.D . , KELLY McQUEEN, B.A., PAULA DUNCAN, M .D ., A N D

LUCIA COPELAND , R .N ., M.S .

A bstract , Knowledge and attitudes about A[DS were surve yed in 147 childre n between the agcs o f () and12. Awareness of and accurate information about AIDS increased stead ily through the early schoo l ycars. Fromthird grade on, ove r 90% of children had heard of A[DS, with the majority capab le of providing additional acc urateinforma tion. Significant misconcep tions we re also identified in all age gro ups. Tel evision was found to be the majorsource of information abo ut AIDS for most children. J . Alii. Acad . Child Ado lcsc, Psvchiatrv, I()l)0. 29,3 :459­462 . Key Wo rds : AIDS , know ledge , attitudes .

AIDS education is currently viewed as a major priori tyin our nation's sch ool sys tem . Alt hough several researcher shav e exp lored knowledge and att itudes about AIDS amongadolescent pop ulations (Price et al. , 1985; DiClemente etal . , 1986; Strunin and Hingson, 1987; Brown and Frit z ,1988), litt le is known about the ex isting ideas and beliefsheld by elementary school age children . This paper describesthe results of the first survey to explore general kno wledgeand attitudes abo ut A IDS among this popu lation.

Method

On e hundred forty- seven (14 7) children between the agesof 6 and 12 were surv eyed through a sub urba n Vermontpubli c school sys tem . The study populat ion incl uded 55chil dren in grades I to 3 and 92 chi ldr en in grades 4 to 6.Students had rece ived no for mal instru ction about AIDSprior to participating in the survey. Children in grades I to3 were interviewed individually using a semistructured , open­ended format. Childr en in grades 4 to 6 co mpleted a wr itte nquestionnaire . Both survey methods assessed bas ic knowl­edge in three are as: ( I) awareness of A IDS ; (2) und erstand­ing of terminology used to describe the disease ; and (3)knowledge abo ut the causes of A IDS . In addi tion to theinterviews and qu estionnaires, each child was asked to drawa picture of "a viru s" and "a perso n with AIDS . " Infor­mati on 0 11 sources of know ledg e as well as children ' s ques­tions , concerns , and att itudes abo ut AIDS were also col­lected . Afte r completing the survey, all children parti cipatedin an age appropriate A IDS education program .

Results

Results ind icated that awareness of and accurate infor­mation about AIDS increased steadi ly through the ea rlyschool years (Figure I). Although 62% of firs t graders sur­veyed indicated that they ha d heard of AIDS, only 15%could provide CVCll minimally acc urat e in formation a bo utthe disease . Fro m third grade on , over 90% of chil dren had

Accepted November 22 . 1989.The authors are ajjilia ted with the University of Yermont ,This study \l'as supported , in part , by f unding FOIII the Gannett

Foundation and the State of vcrmnnt, Department of Health .Reprint requests to Dr . Fass ler, % Dept. of Psychiatry . University

of Vermont College of Medicine . Burl ington, VT 05405 .0890-8567/9012903-0459$02.0010© 1990 by the American Academy

of Child and Ado lescen t Psychiatry .

459

heard of AIDS, with the majorit y cap ab le of providi ng ad­ditional acc urate information .

Children ' s understanding of the voca bulary used to dis ­cus s AIDS also increased steadily throughou t the schoolyears. For example , only 15% of first g raders cou ld co rrectlydefin e the term VIR US . By fourth g rade, over 70 % of thechildren were fam iliar with th is ter m (Figure 2) . Simi larpattern s we re iden tified for the terms " Disea se, Co ntag ious,Transmi ssion , Transfusion , and Cure" (Fig ures 2- 7) .

Although the majority of chi ldren in fo ur th through sixthgrade responded correctly to the survey q uestions , ce rta inmisconceptions we re evident. Fort y per cent o f fourth grad­ers believed that doctors could make people with A IDS"okay," while 18% of fifth grade rs and 26% of sixth grad­ers exp ressed this belief. Sixty-nine percent of fourth grad­ers, 24% of fifth graders , and 35 % of s ixth graders thou ghtthat A IDS co uld be acquired by donating blood . A majori tyof fourth grade rs (60%) felt that children with A IDS shouldnot be allowed to attend school with other ch ildren . Only9% of fifth and sixth graders ind icated suc h a bel ief. lt wasalso ev ide nt that children arc obtain ing much of their in­formation about A IDS from the media . The maj ority ofchildren sur veyed indicated that telev ision wa s their primarysource of info rmation about A IDS (Figure 8).

Fears , questions , and concerns were also frequentl y en­countered dur ing the interview and sur vey pro cess . Chil­dren ' s questions incl uded : "Wil l my mom and dad d ie ofAIDS?" " W ill everyone get AIDS so meday?" and " W he nwil l there be a cure for A IDS?" Man y or the child ren ingrades 4 to 6 asked qu est ions deal ing with the sexua l tran s­mission of A IDS .

Significant miscon ceptions about A IDS were also iden ­tified in all agc groups . Inaccurate info rmatio n focused onmodes of transmission of the virus . Children thought A IDScould be spread in a variety of ways including: mosq uitobites , dr inking fount ains , toil ets , touc hing any need les ,touch ing a perso n with A IDS, or by do na ting blood . Ge n­erali zed fear and confusion OVL:r ma nifestations o f the dis­ease were also evident. For example , a 7-year -o ld boy ex­pla ined , " AIDS ca n make you act like yo u' re drunk . So ifyou see some body acting strange, kee p away from him . Hemight not be drunk . He might have A IDS . "

Th e children's drawings demonstr ated several s ignificantthem es (Figure 9) . Viru ses were depi cted in man y forms,inc luding anthropom orphized version s . Ma ny children ap -

FASS LER ET AI..

CHILDREN 'S AWARENESS OF AIDSVIRUS

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F IG. 2. Children 's understanding of terminology used to explain AIDS .

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460

TRANSFUSION

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l.Am.Acad. Child Adolesc. Psychiatry ,29:3, May 1990

CIllLDREN'S PERCEPTIONS OF AJI)S

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FIG. 9. Upper left: "A virus" drawn by a 7-year old. Upper right:"A person with AIDS" drawn by a IO-year old. Center: "People withAIDS look just like everybody else" drawn by an l l-year old. Bottom:"A person with AIDS" drawn by 7-year old.

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pear to associate AIDS with chicken pox, the viral diseasewith which they arc most familiar. Several children pro­duced drawings of "regular people" explaining that, "Peo­ple with AIDS look just like everybody else." Images ofdeath were also prevalent in the drawings.

Discussion

The results of this study indicate that children arc awareof AIDS at a very young age. However, they have manyfears, fantasies, and misconceptions about the disease. Theseresults arc quite consistent with previously reported surveysof knowledge and attitudes among adolescent populations(Price et al., 1985; DiClemente et al., 1986; Strunin andHingson, 1987; Brown and Fritz, 1988). Although thesestudies have demonstrated that adolescents are increasinglyknowledgeable about AIDS, they have also documented thepersistence of significant misconceptions. The findings ofthe present study suggest that many of these misconceptionsare, in fact, already present at a very early agc.

Brown and Fritz (1988) emphasize the importance of earlyAIDS education, noting that "Even 12-year-olds alreadyknow something about AIDS and view the epidemic asrelevant to their lives." The results of the present surveysuggest that the majority of 6- and 7-year-olds are aware ofAIDS; strongly supporting the need for developmentallyappropriate AIDS education at all grade levels.

The results of this study also indicate that television isthe primary source of information about AIDS for manyyoung children. This finding is also consistent with previoussurveys of adolescents, with Brown and Fritz (1988) re­porting that a majority of 7th and 10th graders identi Iicdtelevision as the source of most of their information aboutAIDS. Although school and family based educational effortsare currently receiving increased attention, it is likely thattelevision will continue to playa significant role in providinginformation about AIDS to both children and adults. Moreresearch is clearly needed to explore how this powerfulmedium can be most effectively utilized as a tool for en-

FIG. 8. Source of children's information about AIDS.

/"A' .;..

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FIG. 7.

J. Am. Acad. Child Adolesc. Psychiatry, 29:3, May 1990 461

FASSLER ET AL.

hancing public awareness and understanding about AIDS.lt is important to acknowledge that this study was con­

ducted in a suburban community located in a state with arelatively low incidence of AIDS. However, despite theirlimited contact with patients and families affected by AIDS,the children surveyed displayed considerable knowledgeabout the disease. Results of the study suggest that infor­mation about AIDS was derived largely from mass mediasources. However, it is quite possible that the knowledgeand attitudes of young children in an urban setting with ahigh incidence of AIDS would differ significantly from thoseof the population described in the present study, and a rep­lication of this survey in such a setting would appear war­ranted.

lt is evident from the above findings that many of theterms usually used to explain AIDS are not accurately under­stood by young chldren. These results underscore the need

462

for simplified educational programs appropriate for use withthese age groups. By encouraging the development of suchprograms and supporting educational efforts in the earlyschool years, we can hope to have a significant impact onchildren's knowledge about AIDS, and ultimately on theirattitudes and behavior patterns.

ReferencesBrown, L. & Fritz, G. (1988), Children's knowledge and attitudes

about AIDS. J. Am. Acad. Child Adolesc. Psychiatry, 27:504-508.DiClemente, R., Zorn, J. & Temoshok, L. (1986), Adolescents and

AIDS: a survey of knowledge, attitudes, and beliefs about AIDS inSan Francisco. Am. J. Public Health, 76:1443-1445.

Price, J., Desmond, S. & Kukolla, G. (1985), High school students'perceptions and misperceptions of AIDS. J. Sch. Health, 55:107­109.

Strunin, L. & Hingson, R. (1987), Acquired immunodeficiency syn­drome and adolescents: knowledge, beliefs, attitudes, and behav­iors. Pediatrics, 79:825-828.

J. Am. Acad. Child Adolesc. Psychiatry, 29:3, May 1990