“Half of all new HIV infections in the United State occur among people under age 25. Every hour, two Americans aged 13-24 are infected with HIV,” states Advocates for Youth, an organization dedicated to advocating for a more positive and realistic approach to adolescent sexual health. Of greater concern, “Far too many HIV-positive youth are unaware of their HIV status because they have not been tested. Relatively few youth know where to go for HIV counseling and testing.”

Today’s school nurses face the prospect of being the first individual a concerned student will turn to when questions about HIV-AIDS surface. As educators with a broad array of health knowledge and skills and as advocates for healthy students and schools, school nurses are caring and responsive individuals who provide “safe havens” for students where students believe they will receive accurate and timely information in a confidential and respectful manner. A school nurse can be prepared to help students in need, and the following ideas may prove useful in helping the nurse serve as that vital link to comprehensive health care and related services that an HIV-positive youth will need.

Determine the basis for a student’s concerns about HIV-AIDS. Some youth may have critical concerns about their own health or HIV status. For school nurses, it is important to understand that far too many HIV positive youth have not been tested and are therefore, unaware of their health status. Their concerns may arise because they lack basic information about HIV, or because they are unsure of what to do, or where to go, to determine their health status. Many times, youth lack trust and fear disclosure about their concerns to others, and turn to the school nurse for help.

Share knowledge and information. The school nurse should share as much accurate factual information as possible about HIV with the student to allay any unfounded concerns and to continue to establish a relationship based on trust. The school nurse should ensure that the student understands the critical need for early diagnosis, and health care treatment, if necessary. Other information can be shared, such as the consequences of HIV infection on a pregnancy, the need to engage in safe sex behaviors, or potential impact on partners, based upon the student’s need for additional information.

Students should be informed that confidentiality requirements set at the local level must be followed in making any referral or recommendations. It is helpful for school nurses to know and be able to share with students that research recognizes components of programs that effectively serve HIV-positive youth, or youth that seek information about their health status, and that resources may be available locally.

Link the student to comprehensive health care and related services. Following are some of the considerations that result in programs that effectively serve at-risk or HIV-positive youth. Each school nurse should consider exploring services available in the greater school community.

Youth in general are often reluctant to access health care. Youth who are at risk for HIV-infection face many barriers to seeking health care. In many cases, mistrust of health care systems, lack of insurance, concern about disclosure, fear of changes in peer relations, and family concerns are only a few of the barriers to youth seeking help. Without appropriate testing and care, the disease can go undetected and untreated. Fear of the unknown can create anxiety and concern for any youth, whether or not testing proves to be positive or negative.

The school nurse should make every effort to refer the student to community-based health care and related services that are youth-friendly. These services often have many of the following characteristics: flexible hours, including evenings and weekends; walk-in appointments that require no waiting time; convenient locations; culturally appropriate services based on racial/ethnic culture, gender, or sexual orientation; active involvement of young people in the program; or other factors such as décor and atmosphere inviting to youth.

In many cases, HIV-positive youth face multiple problems in addition to the disease. The school nurse can be an important part of the student’s emotional and social support structure, helping ensure that the student is referred to appropriate resources to address related problems such as mental illness or substance abuse. The nurse can also play a key supportive role in the school setting, helping all staff better understand HIV.

Monitor and follow-up on the student’s needs and access to services. The school nurse is in a pivotal position to provide the ongoing support an HIV-positive student will need to continue her/his education. Working in collaboration with health care and related service providers, the school nurse can help the student deal with the multiple problems including discrimination from peers, adherence to medical regimes, and developing the skills needed for changing risk behaviors.

To meet the needs of the entire student population, a school nurse can facilitate HIV awareness by: (1) assuring that all youth have information available about risk factors, such as drug use or sexual behaviors, for HIV-infection and an understanding that engaging in risky behaviors can result in the potential for HIV-infection and other sexually transmitted diseases; (2) actively supporting and implementing youth-oriented prevention programs to encourage youth to engage in positive behaviors; (3) being available to youth on an individual basis to support them in making sound decisions about their own health; and (4) having information available about community resources for youth and their families.

Information excerpted from Advocates for Youth, written by Jennifer Augustine, November 2002. For more information and additional links regarding resources for HIV Positive Youth, visit the Advocates for Youth website at www.advocatesforyouth.org.