District of Columbia: Adolescent AIDS Prevention Program (Correspondence,
09/20/2000, GAO/HEHS-00-194R).

Pursuant to a congressional request, GAO reviewed the District of
Columbia's (D.C.) Adolescent Acquired Immunodeficiency Syndrome (AIDS)
Prevention Program, focusing on: (1) statistics on the specific schools
that are participating in this program; (2) how the schools were
selected to participate in the program; (3) the source and amount of
funding identified in the D.C. government budget; (4) statistics on
sexually transmitted diseases, human immunodeficiency virus (HIV)/AIDS,
and pregnancies among D.C. public school students; (5) the policies that
govern the distribution of all forms of contraception devices to
students in the D.C. Public Schools; and (6) information on policies
governing sex education in the D.C. Public Schools.

GAO noted that: (1) the Adolescent AIDS Prevention Program is
administered by school nurses in all 17 of the District's operating
public senior high schools, at the discretion of the Mayor, the D.C.
Public Schools Superintendent, and the D.C. Health and Hospitals Public
Benefit Corporation; (2) although the program is not a separate item in
the D.C. budget, a D.C. Department of Health official reported that the
condoms distributed by school nurses in the 1999-2000 school year cost
$2,625 and were purchased through a grant from the Centers for Disease
Control and Prevention; (3) information on the incidence of sexually
transmitted diseases and HIV/AIDS among D.C. public high school students
is not available; (4) however, there were 1,862 reported cases of
sexually transmitted diseases (about 55 per 1,000 teenagers) and fewer
than 5 newly reported AIDS cases among all D.C. teenagers in 1999; (5)
for the 1998-1999 school year, school nurses were aware of and
monitoring 249 student pregnancies among all D.C. public school
students; (6) the D.C. Health and Hospitals Public Benefit Corporation
sets the policies governing the program, which allows condoms to be
distributed only through school nurses and only after a student has
specifically requested them; (7) no other forms of contraception may be
distributed in the D.C. Public Schools; and (8) the D.C. City Council
established regulations that require the D.C. Public Schools to: (a)
teach age-appropriate sex education as part of the regular curriculum;
(b) submit a list of all textbooks to be used for sex education to the
D.C. Board of Education annually for approval; (c) notify parents or
guardians in writing before sex education is taught; and (d) make all
instructional materials available for inspection by parents or guardians
of students receiving sex education.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-194R
     TITLE:  District of Columbia: Adolescent AIDS Prevention Program
      DATE:  09/20/2000
   SUBJECT:  Sexually transmitted diseases
	     Public schools
	     School health services
	     Acquired immunodeficiency syndrome
	     Secondary school students
	     Pregnancy
	     Contraception
	     Statistical data
	     Teenagers
IDENTIFIER:  District of Columbia
	     District of Columbia Adolescent AIDS Prevention Program
	     AIDS

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GAO/HEHS-00-194R

GAO/ HEHS-00-194R D. C. Adolescent AIDS Prevention Program United States
General Accounting Office

Washington, DC 20548 Health, Education, and

Human Services Division

B- 286071 September 20, 2000 The Honorable Ernest J. Istook, Jr. Chairman,
Subcommittee on the District of Columbia Committee on Appropriations House
of Representatives

Subject: District of Columbia: Adolescent AIDS Prevention Program Dear Mr.
Chairman: In response to your request, we have reviewed the District of
Columbia's Adolescent AIDS Prevention Program, which makes condoms available
to students in the D. C. Public Schools. Specifically, you asked us to
obtain (1) statistics on the specific schools that are participating in this
program; (2) information about how the schools were selected to participate
in the program; (3) the source and amount of funding identified in the D. C.
government budget; (4) statistics on sexually transmitted diseases, human
immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/ AIDS), and
pregnancies among D. C. public school students; 1 (5) the policies that
govern the distribution of all forms of contraception devices to students in
the D. C. Public Schools; and (6) information on policies governing sex
education in the D. C. Public Schools.

In summary, the Adolescent AIDS Prevention Program is administered by school
nurses in all 17 of the District's currently operating public senior high
schools, at the discretion of the Mayor, the D. C. Public Schools
Superintendent, and the D. C. Health and Hospitals Public Benefit
Corporation. Although the program is not a separate item in the D. C.
budget, a D. C. Department of Health (DOH) official reported that the
condoms distributed by school nurses in the 1999- 2000 school year cost
$2,625 and were purchased through a grant from the Centers for Disease
Control and Prevention (CDC). Information on the incidence of sexually
transmitted diseases and HIV/ AIDS among D. C. public high school students
is not available. However, there were 1,862 reported cases of sexually
transmitted diseases (about 55 per 1,000 teenagers) and fewer than 5 newly
reported AIDS cases among all D. C. teenagers in 1999. For the 1998- 99
school year, school nurses were aware of and monitoring 249 student

1 HIV/ AIDS can be contracted through means other than sexual contact and is
counted separately from other sexually transmitted diseases. In addition to
sexual transmission, HIV may be contracted in a number of ways, including
contaminated needles, mother- to- child transmission through birth or
breastfeeding, or transfusions of infected blood.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 2 pregnancies
among all D. C. public school students. The D. C. Health and Hospitals

Public Benefit Corporation sets the policies governing the program, which
allows condoms to be distributed only through school nurses and only after a
student has specifically requested them. No other forms of contraception may
be distributed in the D. C. Public Schools. The D. C. City Council
established regulations that require the D. C. Public Schools to teach age-
appropriate sex education as part of the regular curriculum; submit a list
of all textbooks to be used for sex education to the D. C. Board of
Education annually for approval; notify parents or guardians in writing
before sex education is taught; and make all instructional materials
available for inspection by parents or guardians of students receiving sex
education.

To address your request, we collected data and policy documents from DOH,
the D. C. Health and Hospitals Public Benefit Corporation, the D. C. State
Center for Health Statistics, and the D. C. Public Schools. We also
interviewed officials from each of these agencies, and reviewed the D. C.
budget for fiscal year 2000 and the proposed budget for 2001. Although some
data are available by school, we are presenting aggregated data to protect
the confidentiality of students. We did not independently verify health
statistics or statistics on the number of condoms distributed to public
school students. In every other respect, our work was performed in
accordance with generally accepted government auditing standards.

BACKGROUND The Adolescent AIDS Prevention Program was implemented in all of
D. C. 's public senior high schools and in four junior high schools in
September 1992 under former Mayor Sharon Pratt Kelly. 2 The program was part
of Mayor Kelly's response to the rising incidence of HIV infection in the
District. The program's objective is to prevent the spread of HIV infection
among high school students in the D. C. Public Schools through a combination
of (1) prevention education, (2) individual counseling, and (3) condom
access.

As detailed in figure 1, the first component- prevention education- is
taught to all high school students and is administered by the school nurse
in cooperation with other relevant agencies and outside resources. The
second component- individual counseling- is given only at the request of a
student. School nurses and student peer educators 3 are available to assist
students who have concerns or questions about HIV/ AIDS that they would like
addressed privately.

2 In the 1992- 93 school year, there were 22 senior high schools in the
District of Columbia. Since then, several of these high schools have closed,
leaving a total of 17 public high schools, all of which continue to
participate in the Adolescent AIDS Prevention Program. One of the
participating junior high schools dropped out of the program in the 1993- 94
school year and the remaining three dropped out in the 1996- 97 school year.

3 Student peer educators, also known as Peer AIDS Prevention Educators, are
students who are trained to help their peers identify pressures that may
lead to sexual involvement, to provide skill building workshops that
encourage abstinence and safer sex, to network with other schools to promote
AIDS prevention education activities, and to conduct AIDS prevention
education activities within their schools.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 3 Figure 1:
Adolescent AIDS Prevention Program Components

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 4 Students do
not automatically receive condoms through the Adolescent AIDS

Prevention Program. Students must request condoms from a school nurse, who
provides information about abstinence as an alternative to engaging in
sexual activity in addition to providing instruction in how to use condoms
to reduce the risk of HIV infection.

STATISTICS AND POLICIES The Adolescent AIDS Prevention Program is
administered in all 17 of the District's currently operating public senior
high schools at the discretion of the Mayor, the D. C. Public Schools
Superintendent, and the D. C. Health and Hospitals Public Benefit
Corporation. Table 1 provides basic information about each of the
participating schools, and figure 2 shows where these schools are located.

Table 1: D. C. Public High Schools Participating in the Adolescent AIDS
Prevention Program

Senior high school Ward Number

of students a

Black (%) a White

(%) a Hispanic (%) a

Asian/ Pacific Islander

(%) a Eligible

for free/ reduced price

lunch (%) b

Promotion rate (%) a

Attendance rate (%) c

Anacostia 6 778 99.9 0. 1 0.0 0. 0 98.0 70.0 85.2 Ballou 8 1,033 99.5 0. 5
0.0 0. 0 68.0 77.5 80.9 Banneker 1 432 92.8 0. 7 3.2 3. 2 27.0 98.1 96.4
Bell Multicultural 1 662 23.7 0. 5 64.4 11.5 96.0 91.2 Unavailable Cardozo 1
825 75.5 0. 4 20.7 3. 3 79.0 80.1 90.1 Coolidge 4 1, 064 96.5 0. 2 2.8 0. 5
22.0 94.9 85.3 Dunbar 5 697 99.0 0. 0 0.9 0. 1 77.0 86.9 84.2 Eastern 6
1,543 99.5 0. 1 0.4 0. 1 77.0 85.4 88.6 Ellington School of the Arts 2 489
86.9 8. 8 3.9 0. 4 36.0 87.7 87.4 Luke C. Moore Academy 5 196 96.4 0. 0 3.6
0. 0 34.0 53.2 45.0 Phelps Career Senior High School 5 435 99.8 0. 2 0.0 0.
0 88.0 74.2 94.3 Roosevelt 4 703 78.9 0. 0 20.1 0. 7 49.0 86.7 81.8 School
Without Walls 2 339 64.9 19.5 8. 0 7.4 11.0 95.4 Unavailable Joel Elias
Spingarn 5 580 99.0 0. 2 0.7 0. 2 62.0 79.0 78.7 M. M. Washington Career
Senior High School 5 383 97.4 0. 0 2.3 0. 3 42.0 94.1 86.4 Woodrow Wilson 3
1, 510 56.3 18.1 17.2 8. 4 31.0 89.0 94.4 H. D. Woodson 7 778 99.6 0. 0 0.4
0. 0 87.0 70.1 79.8

All senior high schools 12,447 85.4 3. 2 9.0 2. 3 57.9 d 83.1 d 83.9 d

a As of October 7, 1999. b For school year 1999- 2000. c For school year
1998- 99. d Column average.

Source: D. C. Public Schools.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 5 Figure 2:
Locations of D. C. Public High Schools, by Ward

Ward 3

! Woodrow Wilson

Ward 4

! Coolidge

! Roosevelt

Ward 8

! Ballou

Ward 6

! Anacostia

! Eastern

Ward 1

! Banneker

! Bell Multicultural

! Cardozo

Ward 2

! Ellington School of the Arts

! School Without Walls

Ward 5

! Dunbar

! Luke C. Moore Academy

! Phelps

! Spingarn

! M. M. Washington

Ward 7

! H. D. Woodson

Sources: Map obtained from the D. C. Board of Elections and Ethics. School
information obtained from the D. C. Public Schools.

The Adolescent AIDS Prevention Program is funded through the D. C. Health
and Hospitals Public Benefit Corporation, which pays the salaries of the
public school nurses who administer the program, and through DOH, which
purchases the condoms that nurses distribute to students. In fiscal year
1999, the Public Benefit Corporation's budget for school nursing services
was $4,797,000, but this total includes the services of school nurses who
did not administer the Adolescent AIDS Prevention Program, and it covers all
the services that school nurses perform. In the 1999- 2000 school year,
nurses at 17 high schools distributed 23,483 condoms to high school
students, at a cost of about 10 cents per condom. DOH purchases the condoms
that are made available to students with grant moneys received from CDC. The
total cost of the condoms purchased by DOH for the 1999- 2000 school year
was $2,625.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 6 Available
statistics show that the number of condoms distributed to D. C. public high

school students through the Adolescent AIDS Prevention Program has
fluctuated since the program began, although there has been an overall
increase in the number of condoms distributed. (See figs. 3 and 4.) The drop
in the number of condoms distributed between the 1993- 94 and 1994- 95
school years is due, in part, to the phasing out of the program in junior
high schools and the closure of a senior high school. Also, according to one
Public Benefit Corporation official, a number of school nurses retired
during this time period and were replaced with contract nurses, who were not
permitted to distribute condoms. This official also attributed the sudden
decline to waning interest in the program after its initial start- up.

Figure 3: Total Condoms Distributed in D. C. Public Schools, School Years
1992- 93 Through 1999- 2000

0 5,000

10,000 15,000

20,000 25,000

1999- 2000 1998- 99 1997- 98 1996- 97 1995- 96 1994- 95 1993- 94 1992- 93

Number of Condoms School Years

22,408 13,674 22,418

15,198 17,351

13,495 19,865

23,483

a

a Through May 2000. Source: D. C. Health and Hospitals Public Benefit
Corporation, Community and School Health Program.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 7 Figure 4:
Average Number of Condoms Distributed per Student, School Years

1992- 93 Through 1999- 2000

0.0 0.4

0.8 1.2

1.6 2.0

1999- 2000 1998- 99 1997- 98 1996- 97 1995- 96 1994- 95 1993- 94 1992- 93

Average per Student School Years

1.24 0.77 1.25

0.91 1.20

0.88 1.57

1.75

a

a Through May 2000. Source: D. C. Health and Hospitals Public Benefit
Corporation, Community and School Health Program. According to DOH, the
total number of reported cases of sexually transmitted diseases among D. C.
teenagers rose between 1996 and 1998. Much of the overall increase appears
to be attributable to an increase in diagnosed cases of chlamydia. Cases of
gonorrhea have declined since 1995, and syphilis cases have declined since
1996. However, it is not known how many public high school students in D. C.
have been infected, because the D. C. Public Schools do not monitor the
incidence of sexually transmitted diseases among students. The numbers
reported by DOH include diagnosed cases of sexually transmitted diseases
among all D. C. teenagers, including those who do not attend D. C. Public
Schools and who do not participate in the Adolescent AIDS Prevention
Program. The total number of cases decreased from 1998 to 1999. (See fig.
5.)

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 8 Figure 5:
Reported Cases of Sexually Transmitted Diseases Among D. C. Teenagers

Aged 13 Through 19, 1995- 2000

0 500

1000 1500

2000 2500

2000 1999 1998 1997 1996 1995

Diagnosed Cases Calendar Years

1,771 2,317

1,668 2,324

1,862 698

Other Chlamydia Syphilis Gonorrhea

a

Note: Data for 1992 through 1994 are not consistent with those for 1995
through 2000 because of DOH reporting changes and are therefore excluded.

a Through June 2000. Source: DOH Bureau of Sexually Transmitted Disease
Control. The incidence of HIV infection among high school students in the D.
C. Public Schools is not available for analysis because, in order to protect
students' right to privacy, the D. C. Public Schools do not gather this
information from students. DOH, however, reported that there were fewer than
5 new cases of AIDS reported for D. C. teenagers aged 13 through 19 in 1999
and that there have been fewer than 10 newly reported cases for D. C.
teenagers in any given year since 1992.

The number of pregnancies among D. C. public school students has declined
since the 1992- 93 school year, which is in keeping with the national trend.
4 However, these data account for all student pregnancies, not solely those
identified among high school students. Also, these data may not reflect the
total number of student pregnancies because they include only those
pregnancies identified and monitored by the school nurses. (See fig. 6.)

4 Nationally, the birth rate for adolescents dropped by more than one- fifth
between 1991 and 1998. See Federal Interagency Forum on Child and Family
Statistics, America's Children: Key National Indicators of Well- Being, 2000
(Washington, D. C.: U. S. Government Printing Office, July 2000).

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 9 Figure 6:
Newly Reported Student Pregnancies Tracked by D. C. School Nurses,

School Years 1992- 93 Through 1999- 2000

0 50

100 150

200 250

300 350

400 450

500 1999- 2000 1998- 99 1997- 98 1996- 97 1995- 96 1994- 95 1993- 94 1992-
93

Pregnancies Tracked School Years

441 260 347 320 351

247 249 147

a

a Through May 2000. Source: D. C. Health and Hospitals Public Benefit
Corporation, Community and School Health Program. The Adolescent AIDS
Prevention Program, which is administered solely in public high schools,
supplements the D. C. Public Schools sex education curriculum, which
operates under regulations established by the D. C. City Council. 5 The D.
C. Public Schools Superintendent oversees the implementation of these
regulations and establishes additional guidelines for schools. 6 Currently,
sex education is introduced in the 5 th grade and is part of the overall
health and physical education curriculum. This curriculum includes 11
content areas ranging from human sexuality to nutrition and first aid.
Students receive age- appropriate instruction on human sexuality and
reproduction, including information on human anatomy, pregnancy and
childbirth, sexually transmitted diseases, contraception, abortion,
homosexuality, awareness and prevention of rape and other sex offenses, and
discussion of the process of making personal decisions in matters involving
sexuality. At the high school level, students are required to complete three
semesters of health and physical education before they graduate, of which
about one semester may be spent on sex education.

5 Regulations that govern the teaching of human sexuality and reproduction
in the D. C. Public Schools are included in the D. C. Municipal Regulations
at D. C. Mun. Regs. tit. 5, 2305. 6 The D. C. Public Schools Office of
Academic Services currently is revising sex education guidelines for the D.
C. Public Schools.

B- 286071

GAO/ HEHS- 00- 194R D. C. Adolescent AIDS Prevention Program 10 AGENCY
COMMENTS

Officials from the Health and Hospitals Public Benefit Corporation reviewed
this correspondence and had no comments.

---- We are sending copies of this letter to Dr. Robin Newton, Interim Chief
Executive Officer of the D. C. Health and Hospitals Public Benefit
Corporation; Dr. Paul Vance, D. C. Public Schools' Superintendent; and Dr.
Ivan Walks, Director, D. C. Department of Health. We will also provide
copies to others on request.

Major contributors to this letter were David D. Bellis, Regina Santucci, and
Sharon Price. Please contact me at (202) 512- 7215 if you or your staff have
any questions.

Sincerely yours, Marnie S. Shaul Associate Director, Education, Workforce,

and Income Security Issues (102005)
*** End of document. ***