Effect of Adolescents’ Perception and Awareness of HIV/AIDs on Sexual Behaviour
CHAPTER ONE
Aim and Objectives
The aim of the study was to assess the knowledge of, and attitudes towards HIV and risky sexual behaviour among adolescent secondary school students in Lagos, Nigeria.
The objectives of the study were:
- To assess the knowledge and attitudes of school-going adolescents in this locality about HIV/AIDS transmission and
- To assess the students’ attitude concerning the sources of HIV/AIDS information available in the
- To describe the nature of risky sexual behaviour and practices of adolescent
- To investigate the factors influencing the students’ risk-taking
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter discusses information from the literature with respect to (a) HIV prevalence and adolescence; (b) adolescent risk behaviour; (c) sexual knowledge and risk taking behaviour; (d) deviant behaviour as a factor for sexual risk taking; (e) age at first intercourse as a risk factor for HIV; (f) peer influence and sexual risk taking; (g) HIV risk perception; and (h) drug and alcohol use as variables for HIV risk.
HIV prevalence and adolescence
With a national HIV prevalence rate of 4.6% in 2008, Nigeria remains the second most burdened country globally, after South Africa (WHO, 2008). In 2008 more than 350,000 new cases were diagnosed in the country, and there were over 280 AIDS-related deaths (NACA, 2009). Countrywide, the prevalence rate is higher in urban than rural areas, those in the 20-29 age bracket being the most affected. However, in the South-south zone and the South-east zones the prevalence is highest among the 15-19 age group (FMOH, 2005; WHO, 2008). This portends grave economic consequences for the region as incapacitation of the youth will arrest their educational advancement and hamper their participation in the economic workforce. This would propel the society into a vicious downward spiral of poverty as narrated by Etokidem and Udonwa (2004) in their case studies of the predicaments facing rural Nigerian people living with HIV/AIDS.
Only a few studies on the prevalence of HIV among adolescents in Africa have been conducted. Garcia-Calleja, Gouws and Ghys (2006) reported that only nineteen countries in Africa to date had conducted national population based surveys on HIV prevalence. Notably Nigeria was not among these countries and as a result, sentinel surveillance among pregnant women attending antenatal clinics have been widely used to monitor trends of HIV in the general population (Garcia-Calleja Gouws and Ghys, 2006). In a review article, Richens (1994) observed that the frequency of STIs (including HIV/AIDS) in younger age groups in developing countries is not well documented but can be gauged indirectly by reported experience of STIs in surveys of adolescents and young adults. However the validity of such studies is not well established and caution should be exercised in inferring HIV prevalence rates by extrapolation from data generated from such studies. Population based studies would provide more accurate data on adolescent HIV prevalence in Africa as they target a large number of subjects and are specifically designed to gather data on HIV.
CHAPTER THREE
METHODOLOGY
Research design
A quantitative descriptive cross-sectional survey was performed allowing objective collection of information. A qualitative approach would have been less appropriate because of the sensitive nature of the topic. The survey method had the advantage of economy of design and rapid turnaround of data collection. It allowed attributes of the larger population of adolescents to be inferred from the small random sample that was studied.
Target population
All twelve secondary schools in Lagos were included in the study which included schools located in remote areas with homogenous populations. The study population consisted of all male and female secondary school students aged 14-18 from these secondary schools. This age range was chosen because they are deemed capable of understanding sexual issues. More so, they are at the age where sexual experimentation occurs. The following were the exclusion criteria: current marriage or divorce, current or any previous pregnancy. Those in these categories are assumed to be sexually experienced whose pattern of behaviour may not mirror that of less experienced adolescents.
Sample size and sampling procedure
Of the total of 4,500 students, it was estimated that two thirds (3000) fell within the designated age group. The study aimed to obtain a sample of at least 432 students i.e. 36 from each school. This sample size was estimated assuming ±5% precision (Israel, 2003) and was derived from a table of statistical values (Fisher &Yates, 1974). Making allowance for non-responders, incomplete and defaced questionnaires, it was estimated at least 380 questionnaires would be available for analysis. Stratified random sampling strategy was used to recruit 36 students from each school. A list of all students’ names in each school was obtained. Those names within the required age range were selected and allotted according to gender. Eighteen learners were randomly selected from each gender group by pulling names out of the box. Students who opted not to participate in the study were replaced by picking extra names.
CHAPTER FOUR
Results
Socio-demographic and economic background
The frequency distributions of the socio-demographic backgrounds of the students are presented in Table 4.1. Three hundred and eighty one students participated in the survey, of which approximately half were male (48.8%) and half (51.2%) were female. Their ages ranged from 11 to 18. Most (76.6%) were 16 or over whilst 23.1% were 14 or 15. Their years of schooling ranged from 2 to 14 years. (Although the value of 2 years was reported by a respondent it is unlikely to be correct). Over half (53.5%) had ten years of schooling, whilst 13.5% had less than 10 years and 33% had over ten years at school. Over half of the students (51.1%) were living with their parents, whilst about one fifth (20.7%) lived with their mother alone, about one fifth (21.6%) lived with siblings, aunts, uncles, neighbours or other persons, and 6.6% lived with their grandparents.
The frequency distribution of the demographic background of the students is provided in Table 4.1. 91.4% (i.e. 59.1% + 23.9 %+ 8.4%) reported that only their father and/or mother paid the school fees. 4.5% paid entirely for themselves. Two students (0.5%) reported their only financial support was from a Government Scholarship. About a third (31.0%) never missed school even though they did not have enough money. About a half (49.6%) sometimes or often missed school because they did not have enough money, whilst 13.9% very often missed school for this reason. Less than a half (43.3%) of the students worked to earn money themselves.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Conclusion
The design of effective educational programs to promote responsible sexual behaviour and reduce the epidemic of HIV and other STI infections in Nigeria requires better understanding of the risky sexual activities of adolescents and the factors influencing these activities. Previous research has shown to vary geographically from one region to another, with respect to numerous background, social, and environmental factors including education, socio-economic status, and religion. Small studies in a restricted geographical area, such as this one are therefore essential to explore local issues and needs. This study is the first of its kind in Lagos to provide a local insight into adolescents’ risky behaviour and knowledge of STIs, specifically HIV infection. The findings confirmed the presence of relatively high levels of risky sexual activity amongst school going adolescents in Lagos, consistent with the rest of Nigeria. However, the of initiation of sex is relatively low in Lagos compared to elsewhere. The results also indicate that a high proportion of the adolescents in Lagos engage in risky sexual behaviour by not using a condom to protect themselves from infection with STIs and prevent unwanted pregnancy. Their level of knowledge about HIV transmission and prevention was however better than that found in other surveys. It is possible that the relatively higher levels of knowledge were linked to the implementation of educational programs in the last decade.
Most students in this study were found to obtain information about sexual health from the mass media or their parents; however the high level of risky sexual behaviour reported by the students indicated that access to such information is insufficient to change their behaviour. Interventions should ideally place less emphasis on the risk and danger of sexual behaviour and highlight the more positive aspects of the healthy development of young people in a safe and encouraging environment (Michaud, 2006). More emphasis should be placed on promoting the factors that prevent risk adolescent behaviour (Jessor, 1991) rather than emphasizing the deleterious outcomes of the risk factors.
There appears to be a relatively low incidence of other risky activities, such as coerced sex and rape, and substance and alcohol abuse among school going adolescents in Lagos, relative to other parts of Nigeria, but this is not a reason for complacency. This may be explained by the presence of communal moral codes and institutions like the age grades which exert considerable modulating effect on social behaviour. A statistical association between sexual activity and the use of alcohol and drugs was identified. Therefore, reducing drinking and drug abuse amongst the adolescents in Lagos may be an appropriate strategy to reduce their levels of risky sexual behaviour.
Recommendations
The following recommendations are made based on the findings of this study.
- In view of the statistical association between increasing age and experience of sexual intercourse and other risky behaviour including alcohol and drug use, interventions to stop the spread of HIV should ideally start before the age of 15 (the median age of sexual initiation in Lagos).
- The education authority should integrate HIV/AIDS education in the school
- Prevention of HIV/STIs should constitute a major part of the health education curriculum currently being taught in secondary schools.
- Health education teachers should be trained and encouraged to constantly update their skills on how to sensitively deliver sex education messages to adolescents. Regular in- service workshops should be organised for teachers and appropriate incentives offered to encourage
- Information, education and communication (IEC) materials on HIV/STIs prevention should be provided to all schools in the local government area. These materials may be displayed in the school libraries and students should be encouraged to use
- The subject of HIV/AIDS control should be made a permanent agenda for discussion during PTA meetings. This would allow free exchange of information between parents and teachers on how to approach the sensitive issue of sex/HIV/AIDS
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