2Andalusian Institute of Sexology and Psychology, Malaga, Spain
3Area of methodology, Department of Psychology, University of Cadiz, Cadiz, Spainn
Objectives: The specific objectives are: a) to analyse the level of knowledge about HIV and STIs and attitudes toward sexuality (erotophilia-erotophobia) of adolescents; b) measure the differences between the various academic courses; c) evaluate sources of information on sexuality which uses this population; d) correlating the level of knowledge about HIV and STIs with erotophilia level.
Method: The sample was composed of adolescents (n = 879) between 12 and 18 years, from five High School of the province of Malaga, obtained through non-probability sampling. EROS and ECI questionnaire were used and Spearman's bivariate correlation were run to analyse the relationship between two questionnaires.
Result: The Scale of knowledge about HIV and other STIs (ECI), it was observed that the items they scored lowest were those related to the mechanisms of HIV transmission, followed by the related to the knowledge about the effective contraceptive methods to prevent the transmission of STIs. A coefficient significant negative correlation was obtained in the test of Spearman's bivariate correlation. In addition, statistically significant difference was found in sexual attitudes among the students of the first course in front of the other.
Conclusion: The adolescents in this study presented a significant disinformation, with a percentage of success in around 50% on STIs and HIV. Those who show a more positive attitude toward sexuality have a lower knowledge on HIV and STIs. It is a matter of priority an action plan in this area carried out by the nurse in order to better understand what influences an effective sex education besides preventing the transmission of HIV and other STIs.
Keywords: HIV and STI knowledge; prevention HIV; Adolescent; Sexual education
Since the prevention and promotion nurse, several strategies to eradicate the virus are implemented. In the primary prevention of public health, need to search for first the target populations to act directly on them, of which is, among others, the adolescent population, due to its recent awakening to the sexually active and their perception of immunity before the risks [1,7]. It is the function of the community nurse ensures the prevention of the diseases that may affect the sexual health of adolescents in general, and especially of those with who works. Adolescents live an unstable stage influenced on one side by the body and hormones changes, which behaves like an adult body, and secondly by the psychological development, which is still between child thinking and adult thinking difficult responsible decision making. [8]. In Spain, as in other countries, adolescents, due to the sexual liberation that has occurred in the society, begin to have active sexuality increasingly younger ages, currently at about the age of 14 [9-11]. As evidenced by the recent studies, early initiation of sexual intercourse, as well as the use inconsistent condom, is a risk factor for the transmission of STIs [4,10]. Likewise, the sexual intercourse of the adolescents are influenced by the erroneous knowledge that have [12,13] and attitudes toward sexuality, both own as the social environment in which they live [14]. Erotophilia-erotophobia, is a bipolar concept defined by Fisher, Byrne, White and Kelley [15], as the arrangement learned the response to sexual stimulation along a continuum that extends from a negative pole (erotophobia) to a pole positive (erotophilia), based on an affective evaluation. This attitude influences the sexual behaviour of people. The people who are more erotofílicas tend to have sexual behaviour that involve less risk, such as the use of condoms, favourable attitudes toward the contraceptive methods and skills more effective for the prevention of STI [16].
Besides, has been proven in recent studies that, despite the existence of sex education programs instituted by nurses in the centres of education, adolescents consult health professionals less frequently to be informed about sexuality.Instead, they say they usually search that information on friends, parents and, increasingly growing on the Internet [10,17,18]. This fact is worrying, because best prepared people to provide sexual information are less taken into account, increasing the probability of receiving little and incomplete knowledge, moreover inaccurate and sometimes even up to contradictory only favour the adoption of risk behaviours and negative attitudes towards sexuality.
The knowledge of HIV and STIs is essential to lay the groundwork for the sex education programs carried out by the nurses, with the aim of building a healthy and positive sexuality [12]. From the investigation it is suggested the hypothesis that the students of 1st Compulsory Secondary Education (ESO) will have less knowledge than those of other courses. The specific objectives are: a) to analyse the level of knowledge about HIV and STIs and attitudes toward sexuality (erotophilia-erotophobia) of adolescents; b) evaluate sources of information on sexuality which uses this population; c) correlating the level of knowledge about HIV and STIs with erotophilia level; d) measure the differences between the various academic courses.
The distribution of the sample according to the school year, 53 (6.03%) was coursed 1st Compulsory Secondary Education (ESO), 136 (1547%) 2ndESO, 347 (39.48%) 3rd ESO and 343 (39.02%) 4th ESO.
Admit to having had sexual intercourse 190 adolescents (22.35%), with a mean age of 14.53 years (SD = 1.19) in his first relationship. Heterosexual were declared the 95.69% (821) of the sample, the 1.86% (16) stated homosexual and 2.45% (21) stated bisexual.
Revised survey of Sexual Opinion (EROS) [19], is an adaptation of the Spanish version [20] of the original questionnaire Sexual Opinion Survey [15]. EROS is answered on a Likert scale of 1 to 7, where 1 means completely disagree, and 7 fully agree. Evaluates the sexual attitudes, in a bipolar continuous in which one end would be a negative attitude about sexuality, rejecting sexual stimuli (erotophobia), and at the other end would be people with positive attitudes toward sexuality. The Cronbach's alpha of the questionnaire EROS was 0.835. EROS includes 4 factors: erotophobia, erotophilia, homophobia and sex unconventional. The total scores will fluctuate between 0 (maximum erotofobia) and 120 (maximum erotofilia).
Scale of knowledge about HIV and other STIs (ECI), created by Espada, et al. [12] for adolescent population. ECI is a scale with three response options, true, false and does not answer. Assesses the knowledge that participants have on HIV and STIs. ECI consists of five factors: knowledge about HIV transmission, general knowledge of HIV, prevention of HIV, condom and other STIs. The Cronbach's alpha of the questionnaire ECI was 0.776. The questionnaire is corrected by adding up all the successes.
It is also performed tests of Kruskal-Wallis and Mann-Whitney U-test to compare the differences obtained in the mean scores in the questionnaires. Data analysis was carried out with the SPSS® v.19.
As one can see in the table above, adolescents in the sample have a tendency towards erotophilia, which increases with academic courses. On the contrary, they show a lower score on the questionnaire ECI as the school year progresses, although all courses have an average score.
In this study will analyse the items separately because it is considered more important the analysis of some items exclusively due to the erroneous knowledge specific more than an analysis of the factors. Were calculated the percentage of success for each of the items in the questionnaire ECI, the data are presented in Table 2.
As noted in the data, the lowest scores are those of items 1 (19.7%), 2 (33.5%), 3 (35.1), 4 (32.7%), 5 (22.6%) and 18 (15.6%); which do not exceed the 50% of success, which are related to the mechanism of transmission of HIV. There was also a low percentage of success in items 21 (55.2%), 22 (46.3%), 23 (34.1%) and 24 (30.1%), related to the knowledge about the effective contraceptive methods to prevent the transmission of STIs; in this line of knowledge, the highest percentage of success what gets the item 20 (74.4%), on the male condom. There is a high percentage of success also in the items that query on the other STIs, that are not HIV: item 6 (62.5%), 7 (72.7%), 8 (69.6%), 9 (24.4%), 10 (72.5%) and 11 (63.9%).
It must be pointed out that when they are consulted on where to obtain sexual information, as a first option point, they respond among others: friends 19.23%, internet 19.22%, High School 13.09%, father and mother 12.06%, sexual education 9.67%, doesn't answer 7.17%, television 3.75%, "on the street" 3.65%, family (in general) 2.95% and any information 2.05%.
|
|
EROS |
ECI |
||
Academic Year |
n |
M |
SD |
M |
SD |
1st ESO |
53 |
52.77 |
18,94 |
12,93 |
2.57 |
2nd ESO |
136 |
62,04 |
21.51 |
12.61 |
2.56 |
3rd ESO |
347 |
64,80 |
19.38 |
12.41 |
2.33 |
4th ESO |
343 |
65,89 |
18.39 |
12.43 |
2.28 |
Total |
879 |
64,08 |
19.54 |
12.48 |
2.36 |
|
n |
% |
|
172 |
19.7 |
|
294 |
33.5 |
3. Wash the clothes of a HIV positive or AIDS patient involves risk of contracting the disease |
307 |
35.1 |
4. Give a wet kiss to a person with HIV is a risk for the transmission of HIV |
287 |
32.7 |
5. Embrace and kiss on the cheek to an HIV-positive person carries the risk of HIV transmission |
198 |
22.6 |
6. When a boy/girl has gonorrhoea or gonorrhoea is not necessary to treat the couple |
549 |
62.5 |
7. The gonorrhoea cure themselves in most cases |
635 |
72.7 |
8. Syphilis is a disease practically disappeared |
608 |
69.6 |
9. The syphilis can leave permanent damage if not treated early |
214 |
24.4 |
10. The contagion of syphilis is currently very difficult |
634 |
72.5 |
11. The hepatitis B never leaves sequelae |
604 |
69.3 |
12. AIDS is caused by a virus called "HIV" |
638 |
73.4 |
13. The main route of HIV transmission in Spain is through sexual intercourse |
730 |
83.1 |
14. A pregnant woman with HIV can transmit HIV to your baby |
467 |
53.5 |
15. HIV is transmitted through vaginal secretions and semen, and blood |
615 |
70.5 |
16. There is a risk of contracting HIV by sharing contaminated needles |
632 |
72.1 |
17. HIV affects the immune system |
486 |
55.5 |
18. The window period is the time it takes the body to produce antibodies after the transmission of HIV |
136 |
15.6 |
19. The HIV test is usually done using a blood analysis |
604 |
69.2 |
20. The condom is an effective method to prevent the transmission of HIV |
651 |
74.4 |
21. The female condom is as effective as the male condom to prevent the transmission of the AIDS virus |
481 |
55.2 |
22. The vaginal ring or the IUD are effective methods to prevent AIDS |
404 |
46.3 |
23. Birth control pills are effective in preventing the transmission of HIV in sexual relations |
298 |
34.1 |
24. Practice the intercourse by making the "pull out method" is a sure way of having sex without risk of infection by HIV |
264 |
30.1 |
The test was conducted of the bivariate correlation of Spearman between the scores obtained in the two questionnaires, resulting in a significant correlation (0.05) being the correlation coefficient negative (-.091), which indicates that adolescents who have less knowledge about HIV and STIs are those that present a higher score in the questionnaire of sexual attitudes (1st, EROS = 52.77, ECI = 12.93), i.e., those who are more likely to engage in sexual intercourse.
The Kruskal-Wallis test was realized to contrast the differences found between the different academic years in each of the questionnaires. Test indicates that there are significant differences in response to the variable academic year in the mean score in the questionnaire EROS, not in the questionnaire ECI. Because of the characteristics of this test, it is unknown between what academic years is the difference therefore is performed The Mann-Whitney U test with the courses taken two by two. The differences are between the first and second courses (Z = -2.769; p = 0.006), first and third (Z = -4.092; p = 0.000), and first and fourth (Z = -4.354; p = 0.000). In the other courses difference we were found statistically significant.
As can be seen in the correlations between the two questionnaires, there is a negative correlation between the mean scores of the Questionnaires EROS and ECI, which opens another issue of concern to the adolescent sexuality. These data show that those teenagers who have less knowledge about transmission of STIs are those that have a higher predisposition to have sexual relations. The fact of having a greater lack of knowledge of STIs and more positive attitudes toward sexual intercourse, relate with the possibility to perform risk practices. Since both not have a high level of knowledge about HIV and have a positive attitude towards sexuality are considered risk factors for carrying out risk behaviours [4]. Between the practices of risk observed in this study highlights, first have an early beginning of the coital activity, being the average age 14.53, data that are consistent with the recent research [10,11]. The knowledge and attitudes of risk, together with the risk practices are factors that put at risk the sexual health of adolescents.
As has been observed in the results, one confirms that influences the academic year in attitudes toward sexuality, but not in the knowledge about HIV and STIs. These data are considered very important because knowledge of STIs themselves is taught in sex education received by adolescents, imparted by the community nurses, in the study in the last two academic years. However, they not always are formed in an affective-sexual education, which is where attitudes toward sexuality is taught, and this itself is influenced by the academic year. Moreover, we must bear in mind that today's teens are considered in gave the most prepared and most likely to access information generation. But, nevertheless, they continue to have high misinformation in what refers to sexual health.
One can say, it is the duty of the nursing profession and the institutions responsible for sexual education in adolescence analyse what is bad for teens are not well informed on sexual health. That is why we have to emphasize the prevention strategies to follow to prevent STIs, among them would do campaigns for early detection of STIs, and of training courses in knowledge of the unhealthy behaviours and the risks that concern. Another main work of nursing is the promotion of health and within it of healthy and positive sexuality. On the basis of this principle should be give personal tools to adolescents so that they can discard the risk behaviours that involve a possible disease. Finally, it seems necessary that an issue as important as is the sexual education is carried out by nurses specialized in sexology and with a dynamic and active methodology that involve the adolescent of their own learning and responsible for their sexual health, promoting a positive attitude to sexuality, and always healthy.
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