Forum; AIDS and the University

Thanks for watching! From the Longhorn Radio Network, the University of Texas at Austin, this is Forum. In terms of counseling, we do offer individual therapy for people who are dealing with the infection from the HIV virus. And this could also be partners, family members. It doesn't have to be the person who actually has the diagnosis. Psychologist David Kramer participated in a faculty staff panel that discussed the impact of the AIDS virus on the University student population. There are other services available through group programs, group therapy programs both on campus and off campus.

And many students would prefer to go off campus just to be sure about confidentiality and to try to remain as anonymous as possible, primarily because of a big fear of discrimination. Services in counseling centers are very confidential, but they're still a big fear of being discriminated against. This is Olive Graham. The subject today on forum is AIDS on the University campus. The guests, as to pursue this vital topic, are active in those aspects of the university community that treat the mental and physical health of the student population at the University of Texas at Austin, as well as provide the appropriate workplace information to faculty and staff. Participants from the UT Austin Student Health Center include the director, Dr. Robert Wyreg. Dr. Wyreg has served on the American College Health Association Task Force on AIDS since its inception in 1985. Dr. Wyreg.

It's clear that we're dealing with a population at risk. We can't be deceived just because we don't see a large number of full-blown cases of AIDS diagnosed in our student population. That's a community population that should be neglected. To the contrary, the college students are very sexually active. And in the healthcare facility serving that population, we don't see any abatement in the number of cases of chlamydia, herpes, gonorrhea, syphilis. They're still there, very much evident. There's a lot of sexual activity in this population. Sherry Bell is the manager of the Health Education Department at the Student Health Center at the University of Texas at Austin. Ms. Bell is responsible for the on-campus health programs that make AIDS information available to students. Institutions of higher education such as the University of Texas at Austin can play a very strong role in prevention of the disease. When you look at age distribution with statistics out of the Centers for Disease Control, we're seeing that about 21% of diagnosed cases of full-blown AIDS are in the age group 20 to 29.

And if we're looking at an average incubation period from time of infection to time of showing symptoms of full-blown AIDS of 7.8 years, we can see that probably a whole lot of people are being infected during the ages that people would be in college. Now, of course, these statistics aren't specific to college students. Dr. Scott Speer is a staff physician at the UT Austin Student Health Center. He was site coordinator of the American College Health Association and Centers for Disease Control, Human Immunodeficiency Virus, CERO Prevalence Study at UT Austin. Dr. Speer explains its significance. We think that the numbers coming out of the CERO Prevalence Survey, some of these are preliminary numbers, but they do include the numbers that our campus submitted, suggests that there may be three in a thousand students who are positive for antibodies to this virus, which means that they're infected with HIV. Many of those may have no symptoms.

So we're talking about somewhere between 150 and 200 people being infected with HIV on this campus. Now, a smaller percentage of those will have symptoms. Perhaps somewhere in the range of 25 to 50 may have some degree of symptoms, and a much greater, much smaller percentage would actually be able to be diagnosed as having full-blown AIDS, or what was formally known as ARC. Psychologist David Kramer is Director of the Group Therapy Program at the Counseling and Mental Health Center at the University of Texas at Austin. Educational centers are trained to do education. And education is the way to prevent this disease, the primary method we have for fighting it. So we're the people who are supposed to know how to do that. I think that provides more impetus for us to take that responsibility on. Group therapy does seem to be the primary mode for helping people deal with the stress, the major life issues they have to take on at a very early age, for feeling like they're not the only one out there who's suffering. The issues of prevention, counseling, education, and testing were the primary areas of concern for the panel. From his vantage point as a staff physician, Dr. Scott Spear discusses the relevance of the youth of this population to their confrontation with this disease. The age does not seem to be a key factor. There seem to be other elements involved, such as whether they happen to be IV drug users, that seems to have a rather poor prognosis in terms of how rapidly a person is going to develop full-blown AIDS and subsequently die.

Gay men, probably, white gay men, and hemophiliacs tend to do the best once they're infected in terms of long-term survival. It's not clear whether it's just the IV drug users are coming in later, and so when they actually do present they're much sicker, but there seem to be factors that have yet to be sorted out in terms of why some people can survive long periods of time with the infection without developing full-blown AIDS. Again, why other people succumb rather quickly, and some people, even with the diagnosis of full-blown AIDS, have lived a number of years. What about testing itself on campus? Dr. Warrer, could you address that? I think this really comes into a part of an administrative question, too, and willing to commit resources to support such a program. It certainly makes sense if in our only weapon against it is education, and we're communicating with the people we're trying to reach with the messages that if individuals perceive themselves to be at risk or feel that they have been exposed to the virus

through either sexual activity or IV drug abuse, they should make themselves available for voluntary, anonymous HIV antibody testing to find out what their HIV status is. So yes, I think HIV antibody testing is extremely important, and those services need to be provided in the communities. How frequently should one individual student who has an at-risk lifestyle come back for testing? Well, hopefully the message that they get from the testing, one of the important things about testing is that it offers another intervention point for education. And it can be, it's a very individual intervention because the counselor or the nurse who they're talking to about being tested helps them to discover what kind of behaviors in their lifestyle may be putting them at risk.

And hopefully once they've come in for this kind of counseling, they make changes so that they're no longer putting themselves at risk. We do know that once somebody has had a risky behavior, an exposure that may have put them at risk, that it may be as long as six months or in some very rare cases as long as a year before they do convert to being positive if they became infected with that risk behavior. But hopefully people will cease ongoing risky behaviors. I think that's another element where counseling is important. Any quality testing program will have pre-imposed counseling involved where someone sets down one to one with the person requesting the test to help them balance the pluses and minuses about getting tested and to discuss what the results will mean. And as Dr. Spears pointing out to really emphasize the importance of safer sex, other kinds of safer behavior, controlling, IV drug use, preventing the spread of the disease. I think that anyone getting a negative result can be rightfully relieved. But as Dr. Spears was saying, unless they had abstained from any unprotected intercourse, any unsafe sexual activity, unless they had not received any blood products or shared IV needles for at least six months prior to their test, they may be getting a false negative because it would take in some instances up to six months before antibodies to the virus would show up in a blood test even though they may be carrying the virus.

And what we need to make sure is that people walking away from a negative test don't attach any preventive significance to it. In other words, I've got a negative test, so my lifestyle is okay if they're engaging in any risk behavior whatsoever. The negative test won't prevent them from being exposed if that night, for example, they have unprotected intercourse with someone who's infected. We also have to try hard with negative tests to reassure the person that it doesn't mean that they're invincible, which is a problem with young people feeling that they're invincible. Some do walk away and say, well, you know, I've been having risky behavior and my test is negative, that must mean I can't get it. And then subsequently, I've had patients who are now infected, have told me that at previous tests, they came away with that sort of feeling. So we have to try hard in our education to combat that.

We feel fortunate, at least on our campus, to have had the great cooperation of the Texas Department of Health to enable us to and help support us to make such a service available. I think it's important in any such testing program that the people be well trained and certain people on staff be dedicated to providing that service. It's extremely important that there's consistency in the counseling, both pre and post test counseling that's made available. And it's critical that the information be kept highly confidential. Those kinds of characteristics or criteria will make for invaluable HIV antibody testing service programs. Are there any kinds of in place campus support groups? It's a big topic in the gay men's groups that we run at the counseling center. Certainly it's something that people do have to face and talk about.

Since that is a population that probably knows or has seen somebody who has AIDS. The general student population probably hasn't yet. Scott was saying most of the people who are in this age group aren't thinking about death and dying. Maybe they've had a grandparent die, but they're usually 40 or 50 years older. And so they don't think it's going to happen to them and they haven't seen it happen to a classmate yet. So that's a little harder group to organize. This type of information is also being incorporated in terms of safer sex information and other types of educational programming such as the methods of contraception classes that are offered from the Student Health Center and outreach to residents halls and fraternities and sororities with information on both safer sex and contraceptive issues. There's been quite a bit of training done through classrooms, but it's very difficult when an educational program is voluntary to get the attention of a student who doesn't believe that they're engaged in behaviors that are placing them at risk, doesn't believe that this information will ever be pertinent to them. And consequently when you're competing with a busy social academic and work schedule, it's difficult to generate that enthusiasm and maintain it.

I think if one subscribes to the notion that this virus is an equal opportunity employer really doesn't discriminate on the basis of who you are or what you are. It's a matter of what you do and that makes it rather pervasive for the population at large to be concerned about. If one subscribes to that notion, therefore, then it's incumbent upon communities and a college or university as a community to be organized to the point to look at the educational interventions that may be necessary on this particular campus. We have an organization called the UT Austin AIDS Task Force that was recognized by the president of the institution, President Cuttingham a little over a year ago. That particular group has a membership of about 50 individuals who meet on every four to six weeks to exchange information. It's made up of faculty, staff, and students. We come together at convenient times and exchange the best information that's available.

Hopefully, these people will fan out into their respective departments or programs and further disseminate the information that's been provided. It's a kind of informal network for information exchange. It's kind of the ears and the eyes for the university community to occasionally bring to the table issues or concerns that our university community needs to address. We make a special point in our periodic meetings to invite members from the community at large, so we see it as an entire community interest in not just the university. I think we've also reached out to other universities around the state through the American College Health Association through a grant from the Centers for Disease Control. We had a symposium on how to do AIDS education, safe sex education on college campuses, which I think is a very needed resource. We realize that we're dealing with a very tough subject. We're trying to change behavior. These are behaviors that are very intrinsic to people's sense of who they are.

We realize that we have to appeal to positive aspects and people to try to get them to change behavior that fear tactics are not what we're about here. We want to help students to incorporate lifelong behavior changes that will help them to live more healthy lives and more enjoyable lives. We need to use different strategies I think that have been used in the past. I think the AIDS issue has brought us to addressing a number of areas of sexually transmitted infections that we've been struggling with for quite a long time. All the infections that Dr. Wyark was talking about as well as the human papilloma virus which we all recognize is a very serious infection on college campuses and can lead to cervical cancer and significant number of cases can also be prevented by the same kinds of measures that safe sex prevention for HIV infection would entail. I think since the term safer sex was sort of coined with the HIV epidemic that many students who are many people who feel they may not be at risk when they hear safer sex may turn that off rather than listening to the other types of infections that they're also susceptible to and that they can prevent by changing behaviors.

Are universities in a position of having to have treatment programs? I think that's a very good question. I think that that's still an ongoing issue. I think earlier in this epidemic there were resources available. We had less that we could actually do until people became very sick. The first patient we had we basically just sat and waited until he got sick with full blown AIDS. That's no longer the case. There are now a number of interventions that can and should occur much earlier and I think those are highly appropriate for primary care, primary medical care sites such as a student health center to be involved with. I think that each health center has to determine what their level of expertise is, what their level of skill and the resources and how far they can go in terms of care for people who are infected and may have full blown AIDS. I think it may vary from campus to campus but there has to be a referral network if the student becomes too sick to be cared for in the student health center setting then those health care providers need to have a referral base to get the student further care if that's needed.

It's raising questions related to management, case management, where college health physicians and other health care personnel are perceived to be members of a management team. If a student is intellectually and mentally capable of attending classes then he cannot or she cannot be discriminated against and must be permitted to attend those classes. At the same time that individual is on constant watch with any compromise in their state of health and it's likely that a member of the campus health service team would be a partner in helping manage that students health concerns related to AIDS. It may be a first stop on campus and then a referral to the more stable ongoing medical support services that that patient or student has has tied in with.

I think maybe there's always a quick and simple answer to your question. The universities yes are having to provide treatment programs. Fortunately the numbers are small and hopefully they'll stay small. They may not but hopefully they will. We also have to treat lots of non medical things that go along with AIDS and that's fear, discrimination, hysteria, hatred, violence and all of that acts out in college settings. People who are accused of being gay are receiving threatening phone calls at home because of fear related to AIDS and homophobia. It also has to be addressed and as part of the education. Where do parents come into all of this? Are you dealing with a minor population? I think we're at least from my perspective we're seeing a fairly interesting shift in parental attitudes.

We participate, a star student health service staff participate in orientation programs during the summer when parents come on campus with their son and daughter. And we have experienced in the last couple years increasing numbers of questions by parents. What are you doing about the AIDS issue on your campus? What programs do you have available for my son or daughter to participate in to prevent them from coming into contact with this virus? They are less reluctant to have somebody else talk about human sexuality issues than they were four or five years ago. They realize that there are some risks that young people have while they're attending school and they want to make sure that the campus is providing some resources from a prevention standpoint. So I'm seeing a fairly interesting shift from parental attitudes. We've anecdotally this summer we actually had a mother ask during one of the meetings if there was anything on campus that her son could be forced to attend in order to pick information about safer sex. And that was followed the next session by a parent who said that her daughter would never be sexually acted before marriage and really didn't need the information that we had provided to them. So there's still some differences out there.

It's actually been nice to see parents start to come around like this. I think parents are becoming very educated themselves. I remember a couple of years ago there was the feeling that when parents sent their sons and daughters here and they got their introductory packet to the residence hall and included AIDS pamphlets and rape prevention pamphlets and other sorts of pamphlets that there was a little bit of a shockwave or what's going to happen to my kid when they go to college. And they've since learned that going to college is not just an intellectual experience, but it's a life education. And I have felt at least through the counseling service that parents have been very eager to have their children educated about this issue. They want their kids to live. I also think we haven't educated parent population because I don't think we've seen a lot of fear of the kinds of issues that Dr. Warrick stated that the parents are raising are not how are you going to prevent my child from being in a dorm room, for instance. I think we know that that's not how the infection has passed and that we have parents who are sophisticated enough to know that as well. There have been campuses and dorm settings that have been very concerned. I don't know if it's actually coming to pass where the administrators have been concerned that parents would be very fearful and make sure that there were want rules preventing a child from being saying a dorm room or even in a whole dorm.

Or class with somebody who happened to be infected. I don't think we've seen that kind of fear that kind of unfounded fear. And I think that also speaks to the intelligence of the parent community at UT. Well, if you've got a population 2029 was a group that sharing mentioned earlier that is in a position to be bombarded even with all of the information and services that could possibly be available to the unit of that description. Are we behind the curve or ahead of the curve in terms of the greater population?

I think we've got to that's one of our greatest challenges because the population that we're challenged to work with does not see themselves at risk. We've experienced tremendous apathy among students, although at different times of the year we see kinds of peaks and valleys of interest and willingness to participate in programs. Our attitudes I think are changing in terms of the delivery of the information how we're trying to convey the messages. We're starting to move from the large group presentations to get the information out and the simple distribution of pamphlets and flyers and hoping people will read them to find other means of more direct contact with students, either on one-on-one or small group basis. And believe that this can be done in a number of ways through the many different student organizations, through the Greek system with fraternities and sororities, through academic classes, contact classes with cooperation of members of the faculty. So our strategies are starting to change. We're looking at more of the captive kinds of audiences. Typically in the past, if we would advertise a program that was going to talk about AIDS, it would be like talking to the choir.

These are the people that really don't need to be reached. And you see the same faces from one program to another. They're educated to death about it. It's the rest of the population that we're more acutely concerned about and feel that there are better ways of reaching them. And that's something that I think a lot of people on college campuses are trying to address currently more effective strategies to get the information to the people who need it and can profit from it. And when we look at what is it that we need to be working with, there are an awful lot of students on this campus who can talk to you about AIDS and how it's transmitted in the disease process. And do very well in a multiple choice or a true false test. But are those students then taking that information and translating it into behavior change? If you can be incredibly knowledgeable about the disease, but if you don't have the communication skills to communicate with a partner about what it is that you want and need and expect in a relationship, if you have not yet learned to deal with peer pressure to the point that you can make a decision independent of what friends may be reinforcing. If your self-esteem isn't at the point where you can feel comfortable with decisions that you make, this is a very, very touchy area to be working with and we're dealing with sexual activity.

And so there are so many types of life skills training, decision-making skills, et cetera, that cannot only impact sexual behaviors but substance using behaviors and other types of health related issues. That's what we need to be approaching and attacking and that needs to start not when someone is 19 years old and is a sophomore in college but that needs to be something that's addressed way before someone gets into an institution of higher education. So those are just some of the things we're looking at and we're dealing with AIDS prevention. The focus is starting to change from one of, let's provide information about AIDS to one of, let's provide a broader base of information of which AIDS information is a part. Issues concerning interpersonal relationships, concerns about self-esteem, how I feel about myself and other people. Decision-making, tough decisions, peer pressure and how I manage that, how I handle that.

All that relates to behavior concerns, some of which gets people in trouble as it relates to AIDS, alcohol abuse and other drugs of abuse. Perhaps Dr. Kramer can speak to that better than any of us because he's in the firing line with all those issues. I think there's a lot of truth to that, this age group is going through what would developmentally be a normal time to be experimenting with self-growth including sexuality but also including empowering the self and becoming more comfortable with who one is and being able to set limits on what one does based upon their own desires. And there still continues to be a lot of peer pressure into the college years, it doesn't stop at high school, it's very strong in this age group. And there's a lot of emphasis based in our culture on bodily image and how you look and how you sell yourself. And all of that gets tied up and how one feels about him or herself and has a lot to do with whether or not for example a woman can say no to a boy who's coming onto or too strong on a date. Or can has enough sophistication with alcohol so that that doesn't become a factor in whether they decide to be sexually active or not.

Sure he has a, I think a real classic program in that it's titled Sex Drugs in the Honor Roll and it's offered during orientation programs. These what a way to deal with all those kinds of issues, the fact that people aren't going to stay in school very long, let alone make the Honor Roll if they don't watch what they do and how they do it. If their health is compromised, they're not going to be able to fulfill their their college expectations. And to have a program offering sex drugs in the Honor Roll that enables somebody to tie all those issues and concerns together, I think is a real creative way of addressing the AIDS issue. But it's a program that not just gives and doesn't just give information, but helps to develop strategies, helps the individual to develop strategies for making behavior changes. And we realize that that's very key in this whole issue. The topic on forum has been AIDS in the University.

The guests have been Dr. Robert Wyrag, Dr. Scott Speer, and Ms. Sherry Bell of the Student Health Center and Dr. David Kramer of the Counseling and Mental Health Center all at the University of Texas at Austin. The views expressed on this program do not express the views of the University of Texas at Austin or this station. Technical producer for forum Walter Morgan, Production Assistant's Christine Drawer, Byron E. Belt, and Elliot George Garcia. I'm your producer and host, Olive Graham. Cassette copies of this program are available and may be purchased by writing forum cassettes, longhorn radio network, communication building B, UT Austin, Austin, Texas 78712. From the Center for Telecommunication Services, the University of Texas at Austin, this is the Longhorn Radio Network. In terms of counseling, we do offer individual therapy for people who are dealing with the infection from the HIV virus.

And this could also be partners, family members. It doesn't have to be the person who actually has the diagnosis. This week on forum, AIDS in the University campus.